Nurses experiences of ethical dilemmas: A review

Abstract

Background: Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today’s hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual’s dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses’ options to act on the basis of ethical and moral grounds in the individual care situation. Aim: The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today. Method: The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas. Ethical consideration: We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. Results: The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse–patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses. Conclusion: Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses’ professional decision-making and forcing them to compromise basic nursing values.

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

“…Regarding institutional conflicts, the participants report ethical problems to include: lack of institutional support and an insufficient number of workers. A literature review ( 6 ) corroborates these findings concerning ethical dilemmas experienced by nurses during clinical practice. Problems such as lack of organizational support and lack of human and material resources lead nurses to experience ethical issues that require competence in terms of ethics.…”

“…A literature review (6) corroborates these findings and do demand such conditions, they are using their moral sensitivity (12) .…”

“…International studies (4,(6)(7) report that ethical problems may accrue from everyday situations that are experienced in daily practice and involve: questionable care and therapeutic practices, not asking patients an informed consent before performing procedures, insufficient human or material resources, and unequal treatments. Thus, nurses need to be prepared and sensitized morally to recognize the situation causing a given problem and face it with prudence, considering consequences that may affect all those involved.…”

Important situations that capture moral distress in paediatric oncology

“…This is not surprising because, in Sweden painful procedures, on children that are not sedated, are primarily performed by RNs. In the literature, procedures performed against patient's wishes are most often discussed together with unnecessary treatment [38,39]. In the original MDS-R, there are items about unnecessary treatment, but there was no item capturing disregard for patient wishes [14] which has been identified as a clinical situation causing moral distress [13].…”

Expert Nurses’ Coping Experiences in Ethically Challenging Situations: a Qualitative Study

“…Ethical insensitivity or numbness is considered to be a loss of moral sensitivity [22], and believed to be one of the main ethical issues that nurses face [23]. Nurses may become ethically insensitive when they are too busy with work in clinical settings [21,23]. However, the participants in this study engaged in constant self-re ection to avoid ethical insensitivity.…”