Nursing students' ethical dilemmas regarding patient care: An integrative review

Abstract

BACKGROUND The ethical and moral complexities are inherent to nursing practice. Ethical dilemmas of professional nurses and nursing students' ethical concerns with their preceptors are well-documented. No reviews have synthesized students' ethical dilemmas regarding patient care. OBJECTIVES This review aimed to develop a comprehensive understanding of nursing students' ethical dilemmas regarding patient care in clinical settings. DESIGN An integrative review based on Whittemore and Knafl's methodology. DATA SOURCES Literature was searched within PubMed, CINAHL, Google Scholar, Scopus, and Science Direct databases and 13 articles including eight qualitative, three quantitative, one mixed methods and one secondary data analysis were reviewed. The articles were published from January 2000-March 2019. REVIEW METHODS The Mixed Methods Critical Appraisal Tool was used for quality assessment. Two reviewers independently reviewed the articles and the third reviewer validated the extracted and synthesized findings. Literature summary tables were developed for data extraction and thematic synthesis techniques and narratives were used for data synthesis. For synthesis, findings from strongly and moderately rated studies were given more weight and those from the low-quality studies were used to support the synthesized themes. RESULTS Three themes emerged: a) applying learned ethical values vs. accepting unethical practices, b) desiring to provide ethical care but lacking autonomous decision making, and c) Silence vs. whistleblowing patient care neglects. CONCLUSIONS Nursing students feel torn between the conflicts of whether to provide ethical care or accept unethical practices, stay silent about patient care neglect or confront and report it, provide ethical and quality care or adapt to the culture due to lack of autonomous decision making. Such conflicts can be detrimental to students' professional learning and mental health. Therefore, educators and nursing institutions should develop programs to support students and help them develop ethical competence and courage to confront such dilemmas.