Legal and ethical conflicts in hospital settings: thematic synthesis of qualitative studies focused on nursing...

The conflict between legal requirements and the principles of care ethics is one of the fundamental challenges in healthcare settings. Such conflicts can lead to moral distress, emotional exhaustion, and a crisis of professional identity among healthcare staff. This study aimed to identify and explain the dimensions and consequences of these conflicts in a hospital nursing care.

This research employed thematic synthesis of qualitative studies. A systematic search was conducted in reputable national and international databases for studies published between 2010 and 2025. Of the retrieved literature, 15 qualitative studies were included that examined legal-ethical conflicts in hospital settings. Data were synthesized through open coding, axial categorization, and the development of analytical themes.

Four overarching themes and twelve subthemes emerged: (1) Patient autonomy versus legal protection, (2) Organizational directives and resource allocation versus moral duty of care, (3) Defensive documentation versus ethical transparency, and (4) Hierarchy, inequality, and professional silence versus justice and integrity. These tensions frequently led to moral distress, erosion of professional identity, and emotional strain among healthcare professionals.

Legal-ethical conflicts deeply affect both caregivers and institutional cultures. Mitigating their impact requires coordinated reforms: integrating ethics education and decision-making training into nursing curricula, revising legal frameworks to allow greater contextual flexibility, and establishing psychosocial and ethical support systems for staff exposed to recurring moral tensions. Such multi-level strategies can bridge the gap between law and moral care, fostering ethical coherence, professional sustainability, and trust within healthcare systems.