International Journal of Nursing Studies
Volume 47, Issue 5 , Pages 635-650 , May 2010

Nurses’ ethical reasoning and behaviour: A literature review

  • Sabine Goethals

      Affiliations

    • Catholic University College Ghent, Department of Nursing, Hospitaalstraat 23, 9100 Sint-Niklaas, Belgium
    • Corresponding Author InformationCorresponding author. Tel.: +32 37808905; fax: +32 37663462.
    • ,
  • Chris Gastmans

      Affiliations

    • Centre for Biomedical Ethics and Law, Faculty of Medicine, Catholic University Leuven, Belgium
    • ,
  • Bernadette Dierckx de Casterlé

      Affiliations

    • Centre of Health Services and Nursing Research, Catholic University Leuven, Belgium

Received 16 July 2009 ,Revised 4 November 2009 ,Accepted 18 December 2009.

References 

  1. Aiken L, Clarke SP, Sloane DM, Sochalski JA, Busse R, Clarke H, et al. Nurses’ reports on hospital care in five countries. Health Affaires. 2001;20(3):43–53
  2. Aström G, Jansson L, Norberg A, Hallberg IR. Experienced nurses’ narratives of their being in ethically difficult care situations. Cancer Nursing. 1993;16(3):179–187
  3. Aström G, Furaker C, Norberg A. Nurses’ skills in managing ethically difficult care situations: interpretation of nurses’ narratives. Journal of Advanced Nursing. 1995;21:1073–1080
  4. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. New York: Oxford University Press; 1979;
  5. Bishop AH, Scudder JR. The Practical, Moral and Personal Sense of Nursing A Phenomenological Philosophy of Practice. New York: State University of New York Press; 1990;
  6. Bolmsjö IA, Sandman L, Andersson E. Everyday ethics in the care of elderly people. Nursing Ethics. 2006;13(3):249–263
  7. Carpenter MA. The process of ethical decision making in psychiatric nursing practice. Issues in Mental Health Nursing. 1991;12:179–191
  8. Centre for Reviews and Dissemination, 2001. Undertaking systematic reviews of research on effectiveness—CRD guidelines for those carrying out or commissioning reviews. CRD Report Number 42nd ed. NHS CRD, York.
  9. Chally PS. Nursing research: moral decision making by nurses in intensive care. Plastic Surgical Nursing. 1995;15(2):120–124
  10. Corbin J, Strauss A. Grounded theory method: procedures, canons, and evaluative procedures. Qualitative Sociology. 1990;13(1):3–21
  11. Corley MC, Selig P. Prevalence of principled thinking by critical care nurses. Dimensions of Critical Care Nursing. 1994;13(2):96–103
  12. Crisham P. Measuring moral judgment in nursing dilemmas. Nursing Research. 1981;30(2):104–110
  13. Davidson B, Vander Laan R, Hirschfeld M, Norberg A, Pitman E, Ying LJ, et al. Ethical reasoning associated with the feeding of terminally ill elderly cancer patients: an international perspective. Cancer Nursing. 1990;13(5):286–292
  14. Dean B. Reflections on technology: increasing the science but diminishing the art of nursing?. Accident and Emergency Nursing. 1998;6:200–206
  15. De Geest S, Claessens P, Longerich H, Schubert M. Transformational leadership: worthwhile the investment!. European Journal of Cardiovascular Nursing. 2003;2:3–5
  16. Dierckx de Casterlé, B. 1993. [Dissertation] The impact of education on ethical behaviour of nursing students. An Empirical Study (Dutch). University of Leuven, Leuven.
  17. Dierckx de Casterlé B, Grypdonck M, Vuylsteke-Wauters M, Janssen PJ. Nursing students’ responses to ethical dilemmas in nursing practice. Nursing Ethics. 1997;4(1):12–28
  18. Dierckx de Casterlé B, Izumi S, Godfrey NS, Denhaerynck K. Nurses’ responses to ethical dilemmas in nursing practice: meta-analysis. Journal of Advanced Nursing. 2008;63(6):540–549
  19. Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J, et al. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology. 2006;6:35
  20. Doane G, Pauly B, Brown H, McPherson G. Exploring the heart of ethical practice: implications for ethics education. Nursing Ethics. 2004;11:240–253
  21. Dodd SJ, Jansson BS, Brown-Saltzman K, Shirk M, Wunch K. Expanding nurses’ participation in ethics: an empirical examination of ethical activism and ethical assertiveness. Nursing Ethics. 2004;11(1):15–27
  22. Elder R, Price J, Williams G. Differences in ethical attitudes between registered nurses and medical students. Nursing Ethics. 2003;10(2):149–164
  23. Erlen JA, Frost B. Nurses’ perceptions of powerlessness in influencing ethical decisions. Western Journal of Nursing Research. 1991;13(3):397–407
  24. Erlen JA, Sereika SM. Critical care nurses, ethical decision-making and stress. Journal of Advanced Nursing. 1997;26:953–961
  25. Finfgeld-Connett D. Meta-synthesis of caring in nursing. Journal of Clinical Nursing. 2007;17:196–204
  26. Garritson SH. Ethical decision making patterns. Journal of Psychosocial and Nursing Mental Health Services. 1988;26(4):22–29
  27. Gastmans C, Dierckx de Casterlé B, Schotsmans P. Nursing considered as moral practice: a philosophical–ethical interpretation of nursing. Kennedy Institute of Ethics Journal. 1998;8(1):43–69
  28. Gastmans C, Milisen K. Use of physical restraint in nursing homes: clinical–ethical considerations. Journal of Medical Ethics. 2006;32:148–152
  29. Gilligan C. In A Different Voice. Cambridge, MA: Harvard University Press; 1982;
  30. Giorgi A, Fisher C, Murray E. Duquesne Studies in Phenomenological Psychology. Pittsburgh: Duquesne University Press; 1975;
  31. Glaser B, Strauss A. The Discovery of Grounded Theory. Chicago: Aldine; 1967;
  32. Grady C, Danis M, Soeken KL, O’Donnell P, Taylor C, Farra A, et al. Does ethics education influence the moral action of practicing nurses and social workers?. The American Journal of Bioethics. 2008;8(4):4–23
  33. Grundstein-Amado R. Differences in ethical decision-making processes among nurses and doctors. Journal of Advanced Nursing. 1992;17:129–137
  34. Gutteriez KM. Critical care nurses’ perceptions of and responses to moral distress. Dimensions of Critical Care Nursing. 2005;24(5):229–241
  35. Ham K. Principled thinking: a comparison of nursing students and experienced nurses. The Journal of Continuing Education in Nursing. 2004;35(2):66–73
  36. Hawker S, Payne S, Kerr C, Hardy M, Powell J. Appraising the evidence: reviewing disparate data systematically. Qualitative Health Research. 2002;12(9):1284–1299
  37. Holm S, Gjersoe P, Grode G, Hartling O, Ibsen KE, Marcussen H. Ethical reasoning in mixed nurse–physician groups. Journal of Medical Ethics. 1996;22:168–173
  38. Jameton A. Nursing Practice: The Ethical Issues. Englewood Cliffs, NJ: Prentice-Hall; 1984;
  39. Jansson L, Norberg A. Ethical reasoning concerning the feeding of terminally ill cancer patients. Interviews with registered nurses experienced in the care of cancer patients. Cancer Nursing. 1989;12(6):352–358
  40. Jansson L, Norberg A. Ethical reasoning among registered nurses experienced in dementia care interviews concerning the feeding of severely demented patients. Scandinavian Journal of Caring Sciences. 1992;6(4):219–227
  41. Kälvemark S, Höglund AT, Hansson MT, Westerholm P, Arnetz B. Living with conflicts-ethical dilemmas and moral distress in the health care system. Social Science and Medicine. 2004;58:1075–1084
  42. Ketefian S. Critical thinking, educational preparation, and development of moral judgment in selected groups of practicing nurses. Nursing Research. 1981;30:98–103
  43. Ketefian S. Moral reasoning and ethical practice. Annual Review of Nursing Research. 1989;173–195
  44. Kim, Y.S., 1999. Effect of ethics education on nurses’ moral judgement [Dissertation]. University of Yonsei (in Korean).
  45. Kim YS, Park JH, Han SS. Differences in moral judgment between nursing students and qualified nurses. Nursing Ethics. 2007;14(3):309–319
  46. Kohlberg L. The Philosophy of Moral Development. San Francisco, CA: Harper & Row Publishers; 1981;
  47. Kuhse H, Singer P, Rickard M, Cannold L, van Dyck J. Partial and impartial ethical reasoning in health care professionals. Journal of Medical Ethics. 1997;23:226–232
  48. Kyriacos V. Developing nurses’ moral reasoning skills. Curationis. 1995;18(4):38–42
  49. Larson E. The impact of physician–nurse interaction on patient care. Holistic Nursing Practice. 1999;13(2):38–46
  50. Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage; 1985;
  51. Lützen K, Nordin C. Structuring moral meaning in psychiatric nursing practice. Scandinavian Journal of Caring Sciences. 1993;7:175–180
  52. Lützen K, Nordin C. Benevolence, a central moral concept derived from a grounded theory of nursing decision making in psychiatric setting. Journal of Advanced Nursing. 1993;18:1106–1111
  53. Lützen K, Nordin C. Modifying autonomy—a concept grounded in nurses’ experiences of moral decision-making in psychiatric practice. Journal of Medical Ethics. 1994;20:101–107
  54. Martin DA. Nurses’ involvement in ethical decision-making with severely ill newborns. Issues in Comprehensive Pediatric Nursing. 1989;12:463–473
  55. Mattiasson AC, Andersson L. Moral reasoning among professional caregivers in nursing homes. Western Journal of Nursing Research. 1995;17(3):277–291
  56. Mattiasson AC, Hemberg M. Intimacy—meeting needs and respecting privacy in the care of elderly people: what is a good moral attitude on the part of the nurse/carer?. Nursing Ethics. 1998;5(6):527–534
  57. Milisen K, Abraham I, Siebens K, Darras E, Dierckx de Casterlé B. Work environment and workforce problems: a cross-sectional questionnaire survey of hospital nurses in Belgium. International Journal of Nursing Studies. 2006;43:745–754
  58. Monterosso L, Kristjanson L, Sly PD, Mulcahy M, Holland BG, Grimwood S, et al. The role of the neonatal intensive care nurse in decision-making: advocacy, involvement in ethical decisions and communication. International Journal of Nursing Practice. 2005;11:108–117
  59. Norberg A, Hirschfeld M, Davidson B, Davis A, Lauri S, Lin JY, et al. Ethical reasoning concerning the feeding of severely demented patients: an international perspective. Nursing Ethics. 1994;1(1):3–13
  60. Norberg A, Uden G. Gender differences in moral reasoning among physicians, registered nurses and enrolled nurses engaged in geriatric and surgical care. Nursing Ethics. 1995;2(3):233–242
  61. Nordam A, Torjuul K, Sorlie V. Ethical challenges in the care of older people and risk of being burned out among male nurses. Journal of Clinical Nursing. 2005;14:1248–1256
  62. Oberle K, Hughes D. Doctors’ and nurses’ perceptions of ethical problems in end-of-life decisions. Journal of Advanced Nursing. 2001;33(6):707–715
  63. Omery A. Values, moral reasoning, and ethics. Nursing Clinics of North America. 1989;24(2):499–508
  64. Pauly B, Varcoe C, Storch J, Newton L. Registered nurses’ perceptions of moral distress and ethical climate. Nursing Ethics. 2009;16(5):561–573
  65. Pendry PS. Moral distress: recognizing it to retain nurses. Nursing Economics. 2007;25(4):217–221
  66. Penticuff JH, Walden M. Influence of practice environment and nurse characteristics on perinatal nurses’ responses to ethical dilemmas. Nursing Research. 2000;49(2):64–72
  67. Peter EH, Macfarlane AV, O’Brien-Pallas LL. Analysis of the moral habitability of the nursing work environment. Journal of Advanced Nursing. 2004;47(4):356–367
  68. Polit DF, Beck CT. Nursing research. Generating and Assessing Evidence for Nursing Practice. 8th ed.. Philadelphia, PA: Lippincot; 2008;
  69. Raines ML. Ethical decision making in nurses. relationships among moral reasoning, coping style, and ethics stress. JONA's Healthcare Law, Ethics and Regulation. 2000;2(1):29–41
  70. Rest JR. New approaches in assessing moral judgement. In:  Lickona T editors. Moral Development and Behaviour: Theory, Research and Social Issues. New York: Holt, Rinehart & Winston; 1976;p. 198–218
  71. Rodney P, Varcoe C, Storch JL, McPherson G, Mahoney K, Brown H, et al. Navigating towards a moral horizon: a multisite qualitative study of ethical practice in nursing. Canadian Journal of Nursing Research. 2002;34(3):75–102
  72. Schluter J, Winch S, Holzhauser K, Henderson A. Nurses’ moral sensitivity and hospital ethical climate: a literature review. Nursing Ethics. 2008;15(3):304–321
  73. Sherblom S, Shipps TB, Sherblom JC. Justice, care and integrated concerns in the ethical decision making of nurses. Qualitative Health Research. 1993;3(4):442–464
  74. Siebens K, Dierckx de Casterlé B, Abraham I, Dierckx K, Braes T, Darras E, et al. The professional self-image of nurses in Belgian Hospitals: a cross-sectional questionnaire survey. International Journal of Nursing Studies. 2006;43:71–82
  75. Sorlie V, Jansson L, Norberg A. The meaning of being in ethically difficult care situations in paediatric care as narrated by female Registered Nurses. Scandinavian Journal of Caring Sciences. 2003;17:285–292
  76. Spitzer A. Nursing in the health care system of the postmodern world: crossroads, paradoxes and complexity. Journal of Advanced Nursing. 1998;28(1):164–171
  77. Torjuul K, Sorlie V. Nursing is different than medicine: ethical difficulties in the process of care in surgical units. Journal of Advanced Nursing. 2006;56(4):404–413
  78. Tsaloglidou A, Rammos K, Kiriklidis K, Zourladani A, Matziari C. Nurses’ ethical decision-making role in artificial nutritional support. British Journal of Nursing. 2007;16(16):996–1001
  79. Uden G, Norberg A, Lindseth A, Marhaug V. Ethical reasoning in nurses’ and physicians’ stories about care episodes. Journal of Advanced Nursing. 1992;17:1028–1034
  80. Vanlaere L, Gastmans C. Ethics in nursing education: learning to reflect on care practices. Nursing Ethics. 2007;14(6):758–766
  81. Varcoe C, Doane G, Pauly B, Rodney P, Storch JL, Mahoney K, et al. Ethical practice in nursing: working the in-betweens. Journal of Advanced Nursing. 2004;45(3):316–325
  82. Viens D. The moral reasoning of nurse practitioners. Journal of the American Academy of Nurse Practitioners. 1995;7(6):277–285
  83. Vogel Smith K. Ethical decision-making by staff nurses. Nursing Ethics. 1996;3(1):17–25
  84. Woods M. Nursing ethics education: are we really delivering the good(s)?. Nursing Ethics. 2005;12(1):5–18

PII: S0020-7489(09)00402-7

doi: 10.1016/j.ijnurstu.2009.12.010

International Journal of Nursing Studies
Volume 47, Issue 5 , Pages 635-650 , May 2010

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