Ethics of Care in Nursing: Protocol for a Qualitative Systematic Review and Best-Fit Framework Synthesis

Ethics of care lies at the heart of the nursing profession. Grounded in the work of Gilligan and Tronto, it emphasizes relationships and responsiveness to the needs of those receiving care. Although Tronto's framework specifies 5 elements of care, no systematic synthesis has yet examined how each element is expressed through observable behavioral indicators in the nursing context.

This review aims to identify, appraise, and synthesize the components and indicators of the ethics of care in the nursing profession, drawing on the frameworks of Gilligan and Tronto. It addresses 4 research questions concerning the components of the ethics of care, the indicators or behaviors that reflect each component, any indicators or aspects not yet captured by the existing frameworks, and how the components and indicators vary across contexts.

This qualitative systematic review will use best-fit framework synthesis. Five electronic databases (CINAHL Complete, PubMed or MEDLINE, ScienceDirect, SpringerLink, and JSTOR) were searched, supplemented by backward citation searching of the reference lists of included studies, without date restriction and limited to English-language publications. The methodological quality of included studies will be appraised using the JBI tools to inform interpretation rather than as an exclusion criterion, and data will be synthesized in NVivo. The review will be reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension) guidelines.

This study received no external funding. The searches across the 5 databases were conducted in May 2026 and yielded 30,134 records; after the removal of 4855 duplicates, 25,279 records remained for screening. At the time of submission of this revised manuscript (May 2026), screening and data extraction were underway, and the review was anticipated to be completed by December 2026, with results expected to be published in 2027.

The synthesized definitions and indicators will provide a foundation for developing assessment instruments and practice guidelines for the ethics of care in the nursing profession, as well as for advancing nursing education.

PROSPERO CRD420251032024; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251032024.

DERR1-10.2196/85172.