Abstract
Background: Since 1997, nursing ethics research has focused on solving ethical dilemmas, enhancing decision-making strategies, and introducing professional education. Few studies describe the triggers of ethical dilemmas among primary care nurses. The aim of this study was to explore the moral distress and ethical dilemmas among primary care nurses. Methods: A scoping review was performed following Arskey and O’Malley’s framework. PubMed, CINAHL, PsycINFO, Embase, and Scopus were searched systematically to retrieve relevant titles and abstracts. A temporal filter was applied to focus on the most recent literature (years of 2010–2020). The research was completed on 17 November 2020. Results: Of 184 articles retrieved, 15 were included in the review. Some (n = 7) studies had a qualitative design, and the most productive country was Brazil (n = 7). The total number of nurses involved in quantitative studies was 1137 (range: 36–433); the total number of nurses involved in qualitative studies was 144 (range: 7–73). Three main focus areas were identified: (a) frequent ethical conflicts and moral distress episodes among nurses working in primary care settings; (b) frequent moral distress measures here employed; (c) coping strategies here adopted to prevent or manage moral distress. Conclusion: Further research is needed to examine the differences between moral distress triggers and sources of ethical dilemmas among the different care environments, such as primary care and acute care settings.
Highlights
Many studies have been conducted about the ethical dilemmas faced by nurses in healthcare settings
We aimed to describe the main ethical dilemmas and moral distress triggers in primary care settings
Our findings highlight the need to understand moral distress triggers among primary care nurses more in depth as moral distress is a serious problem in nursing, caused mainly by ethical dilemmas
Summary
Many studies have been conducted about the ethical dilemmas faced by nurses in healthcare settings. Norlyk, Martinsen, and Dreyer [3], “nurses have to take care of needs of patients and their families, [but] they face multiple demands from medical teams and hospital management in their everyday work”. During their daily practice, nurses make moral decisions based on their individual awareness and on their own ideas of “good” [4] to understand the best course of action in the interest of the patient [3]. “the right thing to do” is sometimes not immediately clear: in many clinical contingencies, the principles of biomedical ethics (autonomy, beneficence, nonmaleficence, and justice) are conflicting, both mutually and against the individual perception of nurses [5]
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