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Ethical Dilemmas I01:17

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A social-ecological framework: A model for addressing ethical practice in nursing.

Patricia Davidson1,2, Cynda Hylton Rushton1,3, Melissa Kurtz1

  • 1Johns Hopkins School of Nursing, Baltimore, MD, USA.

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Nurses face daily ethical dilemmas. A social-ecological framework helps address these by examining individual, relational, organizational, and societal factors for better ethical practice and workplace support.

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Area of Science:

  • Nursing Ethics
  • Healthcare Management
  • Social Determinants of Health

Background:

  • Rapidly evolving healthcare landscapes present complex ethical dilemmas for nurses.
  • System pressures, cost reduction, and an aging population exacerbate ethical challenges.
  • Ethical issues are often treated abstractly, hindering practical application in nursing.

Purpose of the Study:

  • To develop a framework for discussing and addressing ethical issues in nursing practice.
  • To create a structured approach for formulating interventions to improve ethical care.
  • To provide a foundation for enhancing ethical practice and supportive work environments.

Main Methods:

  • Conceptual framework development.
  • Comprehensive literature review utilizing the social-ecological framework as an organizing construct.

Main Results:

  • The framework identifies eight interactive levels influencing ethical practice: individual (patient/nurse), professional relationships, patient-nurse relationships, organizational context, professional regulation, community, and socio-political-economic factors.
  • Ethical practice is viewed as an outcome of interactions across these multiple levels.
  • The framework highlights the interconnectedness of various influences on nursing ethics.

Conclusions:

  • The social-ecological framework offers a practical tool for developing targeted interventions to promote ethical nursing practice.
  • This framework is valuable for policy, practice, education, and research in nursing.
  • Applying this framework can assist nurses in developing strategies to navigate daily ethical challenges effectively.