Ethical dilemmas in nursing: An integrative review

Rainer, Jennifer; Schneider, Joanne Kraenzle; Lorenz, Rebecca

doi:10.1111/jocn.14542

Cited by 118 publications

(127 citation statements)

References 49 publications

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Section: Discussionsupporting

confidence: 89%

“…In terms of situations of conflict established with patients and/or family members, disrespect toward patients, ineffective communication, and exposure of patients configure ethical issues. These findings corroborate with a literature review ( 15 ) addressing ethical dilemmas in the nursing field, which highlighted that the main problems include disrespect, ineffective communication, and difficulty ensuring the privacy of patients. Therefore, nurses’ moral sensitivity is a resource that enables them to recognize ethical issues in clinical settings and promote actions based on the clarification of doubts, reassuring patients and minimizing their anguish, ensuring their rights and privacy, and minimizing conflicts arising from such conflicts ( 3 , 16 ) .…”

Section: Discussionsupporting

confidence: 87%

See 1 more Smart Citation

The ethical dimension of problems faced in general medicine: relationship with moral sensitivity

Yasin

Barlem

Tomaschewski-Barlem

et al. 2020

Rev. Latino-Am. Enfermagem

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Objective: to identify the main ethical problems and how these relate to the moral sensitivity of nurses working in a general medicine ward. Method: this qualitative, exploratory, and descriptive study was conducted in a university hospital located in the south of Brazil. A total of 18 nurses working in a general medicine ward were interviewed. A semi-structured interview script was used, and data were analyzed using discursive textual analysis. Results: nurses considered the main ethical problems to include conflicts at the institutional level, situations involving conflicts with patients and/or family members, and conflicts within the staff. The perception of nurses and how they deal with these problems relate to moral sensitivity. Two categories emerged: experiencing ethical problems, and relationship with moral sensitivity. Conclusion: because of the multidimensional nature of moral sensitivity, it trains and enables nurses to recognize and deal with ethical problems faced in clinical practice so that nurses become able to make fair and prudent decisions, improving the quality of nursing care.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 87%

The ethical dimension of problems faced in general medicine: relationship with moral sensitivity

Yasin

Barlem

Tomaschewski-Barlem

et al. 2020

Rev. Latino-Am. Enfermagem

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“…Ethical dilemmas encountered by nurses were experienced mainly through feelings towards terminally ill patients (Rainer, Kraenzle Schneider, & Lorenz, ). These dilemmas were related to, but not limited to, the over‐treatment of seriously ill patients or the difficulty in speaking overtly about their major disease or breaking bad news about transition to dying (Etkind, Bristowe, Bailey, Selman, & Murtagh, ; Griffiths, Ewing, Wilson, Connolly, & Grande, ; Hillman & Cardona‐Morrell, ).…”

Section: Discussionmentioning

confidence: 99%

Nursing’s professional dignity in palliative care: Exploration of an Italian context

Stıevano¹,

Sabatino²,

Affonso³

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To determine the relevance of nursing's professional dignity in palliative care. Background Dignity is a valued concept in the ethical discourse of health disciplines. Nursing's professional dignity, a concept related to professional identity, is not clearly defined nor have its characteristics been delineated for its clinical relevance in palliative care. Design A qualitative methodological approach. Methods Focus groups elicited dialogues of nursing's professional dignity among 69 nurses working in hospices and home‐care in Italy. Data were content‐analysed via an inductive process. The COREQ checklist for qualitative studies was used for reporting this research. Results A central theme related to (a) “Intrinsic dignity of persons” was embedded in the essence of palliative care. Several corollary themes underscored this central theme: (b) Professional (intra‐ and inter) relationships and teamwork; (c) Nursing professionalism; (d) Ethical dilemmas; and (e) Relationships with patients and their significant persons. Conclusions Nurses valued the essence of respect as persons and the essence of respect for their work as coherent with intrinsic dignity and work dignity in palliative care. Nurses perceived their psycho‐social relationships with patients and their families as rewarding incentives amidst disputatious interactions with peers and/or other healthcare professionals. They experienced ethical dilemmas, which they perceived as inherent in palliative care. Relevance to clinical practice Study findings corroborate the literature regarding the concept of nursing's professional dignity which is intrinsic in respect of the human person. The intrinsic dignity in palliative care manifests as nurses are working in juxtaposition of a demanding yet rewarding care ambience.

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“…1 – 4 Moral distress occurs when a clinician is unable to act in accordance with their ethical beliefs due to external constraints, particularly those related to hierarchy or institutional culture. 5 Historically, the topic has been explored primarily among nurses, 1 , 6 – 8 while few studies have been conducted among physicians. 2 Physician trainees are particularly vulnerable to moral distress as they are front-line clinicians less empowered than attending physicians to make difficult clinical decisions, they carry out potentially distressing resuscitation and procedures, and they typically spend more time with patients and families than attendings.…”

Section: Introductionmentioning

confidence: 99%

Understanding Experiences of Moral Distress in End-of-Life Care Among US and UK Physician Trainees: a Comparative Qualitative Study

et al. 2020

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Background Moral distress is a state in which a clinician cannot act in accordance with their ethical beliefs because of external constraints. Physician trainees, who work within rigid hierarchies and who lack clinical experience, are particularly vulnerable to moral distress. We examined the dynamics of physician trainee moral distress in end-of-life care by comparing experiences in two different national cultures and healthcare systems. Objective We investigated cultural factors in the US and the UK that may produce moral distress within their respective healthcare systems, as well as how these factors shape experiences of moral distress among physician trainees. Design Semi-structured in-depth qualitative interviews about experiences of end-of-life care and moral distress. Participants Sixteen internal medicine residents in the US and fourteen junior doctors in the UK. Approach The work was analyzed using thematic analysis. Key Results Some drivers of moral distress were similar among US and UK trainees, including delivery of potentially inappropriate treatments, a poorly defined care trajectory, and involvement of multiple teams creating different care expectations. For UK trainees, healthcare team hierarchy was common, whereas for US trainees, pressure from families, a lack of guidelines for withholding inappropriate treatments, and distress around physically harming patients were frequently cited. US trainees described how patient autonomy and a fear of lawsuits contributed to moral distress, whereas UK trainees described how societal expectations around resource allocation mitigated it. Conclusion This research highlights how the differing experiences of moral distress among US and UK physician trainees are influenced by their countries’ healthcare cultures. This research illustrates how experiences of moral distress reflect the broader culture in which it occurs and suggests how trainees may be particularly vulnerable to it. Clinicians and healthcare leaders in both countries can learn from each other about policies and practices that might decrease the moral distress trainees experience.

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Ethical dilemmas in nursing: An integrative review

Abstract: Understanding and addressing gaps in research is essential to develop strategies to help nurses resolve ethical dilemmas and to avoid moral distress and burnout.

Cited by 118 publications

References 49 publications

The ethical dimension of problems faced in general medicine: relationship with moral sensitivity

The ethical dimension of problems faced in general medicine: relationship with moral sensitivity

Nursing’s professional dignity in palliative care: Exploration of an Italian context

Understanding Experiences of Moral Distress in End-of-Life Care Among US and UK Physician Trainees: a Comparative Qualitative Study

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