Factors influencing ethical decision-making in nursing: A mixed-methods systematic review

Background Ethical decision-making in nursing significantly impacts population health, yet systematic analyses of factors influencing this process remain scarce. Aim The aim is to systematically evaluate factors influencing ethical decision-making in clinical care and provide a reference for follow-up nursing ethics education, medical institution management, and policy research in this field. Research Design This study was conducted using a mixed-methods systematic review design. In December 2024, we searched PubMed, Web of Science, Wanfang Data, VIP Database, and China National Knowledge Infrastructure for studies on factors influencing nursing ethical decision-making. The search covered records from each database’s inception to 1 December 2024. After literature screening and quality assessment, quantitative and qualitative data were extracted following the Joanna Briggs Institute Mixed-Methods Review guidelines. Core influencing factors were identified through thematic synthesis. Ethical Considerations Ethical review was not required for this study. Results Seventeen studies were included (13 quantitative and 4 qualitative). Thematic integration revealed four categories of influencing factors: nurse-related factors (e.g., professional identity perception), patient-related factors (e.g., clinical condition changes), team dynamics (e.g., collaboration among healthcare providers), and decision-making context (e.g., workload intensity), totaling 17 specific factors. Conclusion Nursing ethical decision-making is influenced by personal, patient-related, team-related, and contextual factors. Strategies to enhance this process include improving nurses’ ethical competence, fostering teamwork, optimizing decision-making environments, and integrating findings into clinical practice.