Ethical Complexities in Advanced Nursing Practice: A Taxonomic Framework for Decision-Making and Support
DOI:
https://doi.org/10.61978/curatio.v2i2.1397Keywords:
Advanced Practice Nursing, Ethical Dilemmas, Moral Distress, Taxonomy, Healthcare Ethics, Patient Autonomy, Clinical Decision-MakingAbstract
This study addresses the growing ethical challenges faced by Advanced Practice Nurses (APNs) as their clinical responsibilities expand within modern healthcare systems. These dilemmas — spanning patient autonomy versus safety, informed consent, end-of-life care, resource limitations, dual loyalty, interprofessional conflict, prescribing issues, coercive care, privacy concerns, and systemic constraints — frequently generate significant moral distress among APNs. Employing a qualitative content analysis of secondary data drawn from empirical reviews, ethical codes, and clinical case examples, the study developed a comprehensive ten-category taxonomy of ethical dilemmas. Core ethical principles — autonomy, beneficence, non-maleficence, and justice — were found to underpin most of these challenges. Findings reveal that ethical dilemmas are deeply interconnected and often intensified by institutional factors such as inadequate staffing and rigid organizational policies, which prevent APNs from acting on their ethical judgments and thereby increase moral distress. The study further identifies that structured ethics education, supportive institutional policies, and accessible ethics committees are key to strengthening ethical competence and alleviating moral distress. The resulting taxonomy serves as a practical tool for clinical training, ethics consultation, and policy development. This study presents a validated, actionable framework for understanding and navigating ethical challenges in APN practice, emphasizing that systemic support and ethics education are essential to sustaining the resilience and ethical integrity of APNs in complex healthcare environments.
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