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Ethical dilemmas in nursing: An integrative review

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  • Jennifer Rainer
  • Joanne Kraenzle Schneider
  • Rebecca A. Lorenz

Abstract

Aims To identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision‐making among clinical nurses faced with ethical dilemmas. Background The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them. Design This study is an integrative review of published research from 2000 to 2017. Methods The keywords ethics, ethical dilemmas and nurs* were searched in CINAHL, PubMed, OVID and SCOPUS. Exclusion criteria were sources not available in English, not in acute care, and without an available abstract. Seventy‐two studies were screened; 35 were retained. Garrard's matrix was utilised to analyse and synthesise the studies. Results Ethical dilemmas arose from end‐of‐life issues, conflict with physicians or families, patient privacy concerns and organisational constraints. Differences were found in study location, and yet international research confirms that ethical dilemmas are universally prevalent and must be addressed globally to protect patients and nurses. Conclusions This review offers an analysis of the available evidence regarding ethical dilemmas in acute care, identifying themes, limitations and gaps in the literature. The gaps in quantitative intervention work, US paucity of research, and lack of comparisons across practice settings/nursing roles must be addressed. Further exploration is warranted in the relationship between ethical dilemmas and moral distress, the significance patient physical appearance plays on nurse determination of futility, and strategies for pain management and honesty. Relevance to Nursing Practice Understanding and addressing gaps in research is essential to develop strategies to help nurses resolve ethical dilemmas and to avoid moral distress and burnout.

Suggested Citation

  • Jennifer Rainer & Joanne Kraenzle Schneider & Rebecca A. Lorenz, 2018. "Ethical dilemmas in nursing: An integrative review," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(19-20), pages 3446-3461, October.
    • Handle: RePEc:wly:jocnur:v:27:y:2018:i:19-20:p:3446-3461
    DOI: 10.1111/jocn.14542
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    References listed on IDEAS

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    1. Melia, Kath M., 2001. "Ethical issues and the importance of consensus for the intensive care team," Social Science & Medicine, Elsevier, vol. 53(6), pages 707-719, September.
    2. Kari Langeland & Venke Sørlie, 2011. "Ethical challenges in nursing emergency practice," Journal of Clinical Nursing, John Wiley & Sons, vol. 20(13‐14), pages 2064-2070, July.
    3. Kälvemark, Sofia & Höglund, Anna T. & Hansson, Mats G. & Westerholm, Peter & Arnetz, Bengt, 2004. "Living with conflicts-ethical dilemmas and moral distress in the health care system," Social Science & Medicine, Elsevier, vol. 58(6), pages 1075-1084, March.
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    2. Biyun Ye & Esther Luo & Jie Zhang & Xuelei Chen & Jingping Zhang, 2022. "Moral Sensitivity and Emotional Intelligence in Intensive Care Unit Nurses," IJERPH, MDPI, vol. 19(9), pages 1-11, April.
    3. Moonok Kim & Younjae Oh & Byunghye Kong, 2020. "Ethical Conflicts Experienced by Nurses in Geriatric Hospitals in South Korea: “If You Can’t Stand the Heat, Get Out of the Kitchen”," IJERPH, MDPI, vol. 17(12), pages 1-13, June.
    4. Won Lee & Sungkyoung Choi & Sujeong Kim & Ari Min, 2020. "A Case-Centered Approach to Nursing Ethics Education: A Qualitative Study," IJERPH, MDPI, vol. 17(21), pages 1-10, October.
    5. Kashif Muhammad & Petrovskaya Irina & Samad Sarminah & Wijenayake Shanika, 2021. "Leaving in Mascot of Silence: Organizational Determinants of Employee Turnover Intentions in Mediating and Moderating Roles of Quiescent Silence and Coworker Support in a Russian Context," Journal of Management and Business Administration. Central Europe, Sciendo, vol. 29(2), pages 121-146, June.
    6. Risto Nikunlaakso & Kirsikka Selander & Elina Weiste & Eveliina Korkiakangas & Maria Paavolainen & Tiina Koivisto & Jaana Laitinen, 2022. "Understanding Moral Distress among Eldercare Workers: A Scoping Review," IJERPH, MDPI, vol. 19(15), pages 1-14, July.

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