Ethical Problems and Application of ethical decision-making models in Nursing Practice: A Scoping Review

Ethical decision-making is the process which make choices based on ethical principles and values. Several decision-making frameworks have been developed utilizing ethical principles and guidelines for nurses to assist in ethical decision-making. Each framework directs ethical considerations from a distinct point of view.  In this light, this study aimed to identify the ethical problems and describe the application of decision-making models in nursing practice. A literature search, ranging from 2000 to 2022, was conducted using the keywords “ethical decision-making models”, “clinical practice”, and “nursing” on electronic databases, Google Scholar, PubMed, Science Direct and CINAHL. Twenty-four (24) articles were selected for analysis. Three categories of ethical issues were identified, namely healthcare team member-related issues, patient-related issues, and caring behavior-related issues such as ethical conflicts. Four main factors (external factors, individual factors, environmental factors and facilitating strategies) which affect ethical decision-making were identified. The literature chosen for the study highlights four decision-making models: the clinical nursing accountability cycle model, the integrated ethical decision-making model, the integrated ethically driven environmental model, and the MORAL model. Nurses encounter numerous ethical challenges with patients and colleagues, underscoring the importance of sound ethical decision-making. Individual, environmental, and external factors, as well as facilitating strategies, influence their ethical decisions. Nurses frequently utilize ethical decision-making models to support their practice, emphasizing the need for updated models to improve their capabilities and address ethical dilemmas effectively.