Table 3 Details of studies that contained an explicit definition of ‘ethical challenges’
From: Defining ethical challenge(s) in healthcare research: a rapid review
Study | Study title | Study design | Study field, location | Definition | Concepts | Study participants | Conflict and uncertainty | Emotional or moral distress |
|---|---|---|---|---|---|---|---|---|
Draper and Jenkins [48] | Ethical challenges experienced by UK military medical personnel deployed to Sierra Leone (operation GRITROCK) during the 2014–2015 Ebola outbreak: a qualitative study | Semi-structured interviews | Sierra Leone/UK | ‘A shared understanding of what was meant by an ethical challenge was established either during the interview or immediately before it commenced. We took as our working definition that adopted by Schwartz et al.: ‘situations where either the HCPs [health care professionals] knew what they felt was the right thing to do but were somehow prevented from enacting it, or where “doing the right thing” also caused harm’.’ | ✓ | ✓ | ||
Forbes and Phillips [50] | Ethical Challenges Encountered by Clinical Trials Nurses: A Grounded Theory Study | Online real-time typing interviews | Oncology clinical trial nurses USA | Study authors allowed participants to define ethical challenge. 'What does the term 'ethically challenging' mean to you' Results are described using participants’ descriptions | ✓ | |||
Heggestad et al. [13] | Ethical challenges in home-based care: A systematic literature review | Systematic Review | Home based care n/a review | ‘Here, we have chosen to define an ethical challenge as “when there is doubt or disagreement about what is right or wrong.”’ This quotation references a definition used in Lillemoen L, Pedersen R. Ethical challenges and how to develop ethics support in primary health care. Nursing Ethics. 2013;20(1):96–108 [15] | ✓ | |||
Hem et al. [14] | Ethical challenges when using coercion in mental healthcare: A systematic literature review | Systematic Review | Mental Healthcare n/a review | ‘An ethical challenge occurs when one does not know how to behave and act in the best way, when one feels doubt or discomfort or when one is uncertain with respect to how one should interact in or react to the situation.’ | ✓ | ✓ | ||
Jakobsen and Sorlie [56] | Ethical challenges: Trust and leadership in dementia care | Semi-structured interviews | Dementia care nursing home Norway | ‘The single question invites the informants to express themselves openly through their narratives. Hence, it is up to them to define the situations that are ethically difficult.’ | ✓ | |||
Jia et al. [57] | Nurses' ethical challenges caring for people with COVID-19: A qualitative study | Semi-structured interviews | COVID-19 Units China | ‘The expression “ethical challenges” mainly refers to ethical dilemmas and ethical conflicts as well as other scenarios where difficult choices have to be made. Ethical dilemmas are described as situations that cannot be solved; decisions made between two options may be morally plausible but are equally problematic due to the circumstances. Ethical conflicts, on the contrary, arise when one is aware of the necessity of proper actions but he or she may have trouble exercising these actions because of certain internal or external factors.’ | ✓ | ✓ | ||
Larkin et al. [66] | Ethical challenges experienced by clinical research nurses: A qualitative study | Semi-structured interviews | Clinical research nurse practice USA | ‘For this study, “ethical challenges” were defined broadly to encompass ethical dilemmas, ethical conflicts, and other ethical issues potentially leading to moral distress and moral residue.’ | ✓ | ✓ | ||
Mlughu et al. [69] | Voluntary HIV Counseling [sic] and Testing Among Commercial Motorcyclist Youths: An Exploration of Ethical Challenges and Coping Mechanisms in Dar es Salaam | Interviews & focus groups | Commercial motorcyclist youths Tanzania | ‘In this context, ethical challenge refers to the situation whereby every alternative is morally wrong and still one has to make a choice’ | ✓ | |||
Saghafi et al. [98] | Examining the ethical challenges in managing elder abuse: a systematic review | Systematic Review | Elder abuse n/a review | ‘ethical conflicts and challenges emerge when two or several ethical values relevant to a particular situation necessitate conflicting measures’ | ✓ | |||
Schofield et al. [101] | Real-world ethics in palliative care: protocol for a systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice | Systematic review protocol | Palliative care n/a review | ‘The definition of ‘ethical challenges’ will be intentionally kept broad to capture the maximum number of examples. It includes but is not limited to terms such as ethical issues, moral challenges, moral dilemmas, values, good/bad, right/wrong. Ethical challenges can be labelled as such either by authors or participants.’ | ✓ | ✓ | ||
Schofield et al. [12] | Real-world ethics in palliative care: A systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice | Systematic review | Palliative care n/a review | ‘The definition of ‘ethical challenges’ will be intentionally kept broad to capture the maximum number of examples. It includes but is not limited to terms such as ethical issues, moral challenges, moral dilemmas, values, good/bad, right/wrong. Ethical challenges can be labelled as such either by authors or participants.’ | ✓ | ✓ | ||
Storaker et al. [81] | From painful busyness to emotional immunization: Nurses' experiences of ethical challenges | Interview study | Hospital nurses Norway | ‘In this article, ethical challenges refer to values that entail emotional and moral stress in healthcare personnel.’ | ✓ |