Ethical concerns among outpatients nurses, physiotherapists and physicians: a scoping review

BACKGROUND: Nursing, physiotherapy and medicine are inherently morally loaded practices. If this fact has been acknowledged since ever in the medicine profession, it is only in the last few decades that awareness for moral challenges among healthcare professionals has caught the attentions of researchers. One explanation for this awareness could be found in the planetary shortage of qualified healthcare professionals and its related need for improving their wellbeing and in turn the length of their permanence in the profession. Researches have demonstrated that moral issues which are not addressed properly can lead to moral distress which has been defined as the set of negative feeling resulting from those situations where the moral agent believes to know the right thing to do in a given situation, but internal or external constraints make it nearly impossible to pursue the right course of actions. Understanding these situations and if there are any commonalities can offer a broader insight into the phenomena and possibly offer some recommendations on an interdisciplinary level. Ethical concerns are strictly related to the professional setting; therefore, we focus on ethical issues experienced by healthcare professionals working with outpatients. RESEARCH QUESTION According to the literature, which are the ethical concerns mostly experienced among nurses, physicians and physiotherapists working with outpatients? Are there commonalities among ethical concerns experienced by nurses, physicians and physiotherapists working with outpatients? METHOD AND MATERIAL We considered for this scoping review 65 articles retrieved from Pubmed, CINHAL, EMBASE, google Scholar published between 1984 to 2017. These articles were organized according to the profession (nursing, medicine and physiotherapy) and which the specific profession according to the source of the moral issues. RESULTS Not surprisingly the categories emerged are similar among the professions. Indeed, the literature suggests that all three professions experience moral issues related to: a) patients and their families; b) collaborations with colleagues and other healthcare professionals; c) economics, insurances and stakeholders. A few categories are unique to the professions, these categories are for nurses: a) issues related to the management; b) personal limits. For physiotherapists end-of-life issues represent an important category. Finally, some literature suggests as a moral issue among physicians a lack in ethics education. DISCUSSION Bringing to light the commonalities between moral issues experienced by the three healthcare professionals can be seen as a mean for reducing the distance between them. The way these issues are experiences is deeply shaped by the different perspective each profession has on the same issue. These issues are experienced with different intensity among the professions. CONCLUSION This scoping review opens new insights into commonalities and differences among ethical concerns experienced by physiotherapists, physicians and nurses. Given the alarming situation of qualified healthcare professionals, and given the fact that unaddressed moral issues can influence the wish of abandoning the profession, it could be suggested that efforts should focus on finding measures, which aim at addressing these issues possibly on an interdisciplinary level.