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A qualitative, exploratory, descriptive and contextual study using an 'interpretive descriptive approach' was undertaken in order to develop a practice-level model for the facilitation of mental health of patients diagnosed as having Borderline Personality Disorder by the community psychiatric nurse. The context of the study was the in the Psychiatric Community Services in the greater Johannesburg region, South Africa. Individual and focus group interviews were conducted with patients and mental health clinicians representing the multidisciplinary team with experience in managing the condition, either in a personal capacity or as professional mental health practitioners. Themes extrapolated from the transcribed interviews were further explored and a practice-based theory was constructed. This article reports on the first theme 'Trust', the concept identified by both patients and clinicians as crucial for the establishment and maintenance of the therapeutic relationship that forms the vehicle for care of patients with this disorder in psychiatric mental health care.

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Background. Moral distress is experienced when nurses experience conflict while making an ethical decision. This is magnified when the decisions are about withholding or withdrawing life-sustaining treatment. Objective. To explore and describe nurses' experiences of situations that involve end-of-life care and evoke moral distress in the intensive care units (ICUs) of two public tertiary-level hospitals in South Africa (SA), the personal consequences of these situations and the means employed to manage their distress. Methods. An exploratory, descriptive design was used. A short survey/interview guide was administered to registered and enrolled nurses (N=100) employed in the ICUs from two academic-affiliated, specialist public hospitals. Results. A total of 65 completed surveys were collected. Of these, 32 responses were judged not to be describing moral distress while 33 clearly described moral distress and were included and analysed by means of initial content analysis. The findings were presented in five major categories: (i) collegial incompetence or inexperience; (ii) resource constraints; (iii) end-of-life issues; (iv) lack of consultation, communication and negotiation; and (v) support. Conclusion. The study found that nurses experienced considerable moral distress. This is compounded in an environment where gender, professional and social status inhibit the nurses' assertiveness, 'voice' and influence in the healthcare system. Parallels can be drawn between the microcosm of the ICU and the macrocosm of the SA social and ethical character.