TY  - JOUR
T1  - Ethical Issues in Palliative Care for Patients with Chronic Diseases: A Systematic Review of Nursing Perspectives
A1  - Aisha Bello
A1  - Zainab Musa
JF  - Journal of Integrative Nursing and Palliative Care
JO  - J Integr Nurs Palliat Care
SN  - 3006-5550
Y1  - 2026
VL  - 7
IS  - 1
DO  - 10.51847/jbe1AvOMQ3
SP  - 38
EP  - 50
N2  - The global rise in chronic conditions requiring prolonged management underscores the urgent need for optimized palliative care. Although nursing professionals are central to delivering this care, they routinely face ethical dilemmas, complex clinical decisions, and occupational burnout. This systematic review synthesizes and groups international data regarding nurses’ ethical viewpoints, dilemmas, and systemic interventions within both institutional hospital units and home-care environments. The analysis explicitly addresses three inquiries: (1) How do nurses ethically perceive the delivery of palliative services? (2) What specific moral dilemmas and decision-making barriers do they experience? (3) Which practical frameworks and protocols effectively promote ethically resilient care? Operating under the PRISMA 2020 methodological framework, a comprehensive literature search was executed across five databases (PubMed, Scopus, Web of Science, SID, and Magiran), along with gray literature from Google Scholar for investigations published from 2015 through 2025 in English or Persian. Peer-reviewed qualitative, quantitative, mixed-methods, and review papers tracking nursing-focused ethical conflicts in palliative environments were selected. Qualitative insights were extracted using inductive content analysis, quantitative data were gathered via descriptive synthesis, and mixed-methods profiles were integrated to harmonize conclusions across disparate research structures. Generated codes were systematically grouped into themes, organized into categories, and mapped into final overarching domains. 34 publications satisfied the established criteria, revealing four core areas of ethical friction: (1) Clinical decision-making and patient autonomy—focusing on disputes over life-prolonging measures, pharmacological and hydration protocols, palliative sedation, and friction between patient intent and familial or cultural paradigms; (2) Justice and resource allocation—highlighting deficient ethics training, severe workloads, minimal organizational backing, fractured interdisciplinary communication, and asset scarcity; (3) Beneficence and patient-centered care—comprising issues involving modern clinical technologies, informed consent, data protection, and structural stressors like ICU or emergency department conditions; (4) Non-maleficence and moral distress prevention—tracking moral distress, professional exhaustion, compromised moral fortitude, and legal vulnerabilities that alter clinical trajectories. Nursing personnel confront deep-seated moral obstacles when providing palliative services to individuals with chronic pathologies. Alleviating these burdens demands robust ethics coursework, formalized institutional policies, interprofessional alignment, and adaptive, setting-specific approaches that protect human dignity and mitigate moral distress. These conclusions offer empirical guidance for policy architects, clinical educators, and healthcare directors designing actionable frameworks across varied care delivery models.
UR  - https://journalinpc.com/article/ethical-issues-in-palliative-care-for-patients-with-chronic-diseases-a-systematic-review-of-nursing-jmsbla8tlvipr9f
ER  -