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J Adv Nurs. 2008 Sep;63(6):540-9. doi: 10.1111/j.1365-2648.2008.04702.x.

Nurses' responses to ethical dilemmas in nursing practice: meta-analysis.

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



This paper is a report of a study to explore nurses' responses to ethical dilemmas in daily nursing practice.


Concern about nurses' ethical competence is growing. Most nurses perceived that there were barriers in their work environment to ethical practice, compromising their ability to perform ethically. Since most research focuses on contextual barriers to nurses' ethical practice, little is known about how nurses involve themselves in ethical decision-making and action in daily care.


A meta-analysis of nurses' ethical behaviour was conducted using data from nine studies in four countries (n = 1592 registered nurses). In all studies, the Ethical Behaviour Test was used to measure nurses' ethical responses, based on an adapted version of Kohlberg's theory of moral development. Data were analysed using random-intercept regression analysis.


All groups, except the expert group, displayed a uniform pattern of conventional ethical reasoning and practice. When nurses were faced with ethical dilemmas, they tended to use conventions as their predominant decision-guiding criteria rather than patients' personal needs and well-being.


Conformist practice (following conventions rather than pursuing good for the patient) constitutes a major barrier for nurses to take the appropriate ethical actions, as creativity and critical reflection are absent. There is an urgent need to find ways to promote nurses' ethical development from conventional to postconventional ethical practice. More research is needed to strengthen existing empirical evidence.

[Indexed for MEDLINE]

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