Bridging the Ethical Divide: Enhancing Patient Autonomy through Shared Decision-Making and Advance Care Planning in Advanced Nursing Practice

Abstract

This study explores the barriers and ethical challenges faced by Advanced Practice Nurses (APNs) in implementing Shared Decision-Making (SDM) and Advance Care Planning (ACP). Although these practices are foundational to patient autonomy and endorsed by professional nursing codes, their application in clinical settings remains limited. This research examines the structural, cultural, and ethical factors that hinder or support SDM and ACP. A qualitative content analysis was conducted on structured datasets detailing clinical autonomy challenges and ethical responsibilities in nursing, using ethical codes from the American Nurses Association (ANA) and the International Council of Nurses (ICN) as guiding frameworks. The analysis identified three major areas of concern: institutional and cultural barriers, ethical conflicts (e.g., autonomy vs. beneficence, coercion), and operational deficiencies in documentation and workflow integration. Organizational constraints such as time pressure, lack of ACP documentation tools, and hierarchical cultures inhibit engagement, while cultural norms prioritizing family over individual autonomy and professional biases further restrict patient involvement. Ethical dilemmas commonly arise in high-acuity settings, and training deficits limit APN confidence in facilitating ethical conversations. The study concludes that effective SDM and ACP implementation requires systemic reforms, including embedded ethical frameworks, ethics education, and standardized documentation tools to promote patient-centered care.