Risking vulnerability: Enacting moral agency in the is/ought gap in mental health care

Aim To explore how healthcare providers in acute care mental health settings navigate ethically challenging situations, enact moral agency, practice congruence with ethical standards and mitigate distress (MD). Design Grounded theory, a qualitative methodology. Methods Over 18 months between 2015 2017, we reviewed documents, conducted observations interviewed multidisciplinary participants (N = 27) from inpatient emergency departments. Participants either provided direct 14) or were leadership positions 13). Data analysed iteratively using constant comparison, coding, memoing theorizing, which continued until saturation was reached July 2016. Findings The basic social process of professionals enacted Risking Vulnerability, occurred the context Systemic Inhumanity, source MD. Risked balancing professional obligations, clinical expertise organizational processes their own vulnerability system as they strove to ethically. Vulnerability composed Pushing Back, Working Through Team Relationships Struggling Inhumanity. Conclusion Healthcare professionals’ agency at nexus structure (organizational constraints) (persons). Given this, interventions for MD should be directed all levels support promote improve care. Impact Sociopolitical elements such austerity measures undermined level Enactment is dynamic, influencing experiences MD: supported by colleagues noted that not stuck Interventions supporting throughout are necessary enhance our understanding role action experience