International Journal For Multidisciplinary Research

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Ethical Governance, Medico-Legal Accountability, and Clinical Decision-Making in Nursing Practice: A Systematic Review of Awareness, Ethical Challenges, and Institutional Determinants

Author(s) Mr. Anand Kumar, Dr. Abhishek Dhar Dwivedi, Dr. Ranjana Verma, Mr. Akhil Tomy, Dr. Kawal Krishna Pandita, Prof. Dr. Lakshmi Prasad
Country India
Abstract Background: Nurses constitute the largest segment of the healthcare workforce and remain central to patient care delivery across clinical settings. Increasing complexity in healthcare systems, expansion of patient rights frameworks, technological transformation, and rising medico-legal scrutiny have substantially intensified the ethical and legal responsibilities of nursing professionals. Ethical conflicts related to autonomy, end-of-life decision-making, informed consent, confidentiality, and professional accountability continue to challenge nursing practice globally.
Objective: This systematic review was conducted to synthesize contemporary evidence regarding awareness, practices, ethical dilemmas, medico-legal responsibilities, and institutional challenges encountered by nurses in clinical healthcare settings.

Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic databases including PubMed/MEDLINE, Scopus, and Web of Science were systematically searched for studies published between January 2010 and December 2025. Eligible studies included quantitative, qualitative, mixed-method, and review studies examining ethical or medico-legal issues among nurses in hospital or critical care settings. Data extraction and methodological quality assessment were conducted using standardized appraisal frameworks, including the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Critical Appraisal Skills Programme (CASP) tool. A narrative thematic synthesis approach was adopted because of methodological heterogeneity across studies.

Results: Thirty studies met the eligibility criteria and were included in the final synthesis. The findings demonstrated considerable variability in nurses’ awareness of medico-legal responsibilities, particularly concerning legal accountability, negligence, documentation standards, and informed consent processes. Ethical dilemmas were most frequently reported in intensive care units and end-of-life care settings, where conflicts involving withdrawal of life support, futile care, patient autonomy, and family-centered decision-making contributed substantially to moral distress. Although awareness regarding confidentiality principles was generally high, implementation gaps persisted in relation to electronic health records, data protection, and informal clinical communication practices. Institutional determinants including ethics education, organizational support systems, policy availability, and leadership culture emerged as major factors influencing ethical competence and medico-legal preparedness.

Conclusion: Ethical and medico-legal challenges represent a critical dimension of contemporary nursing practice and significantly influence patient safety, professional integrity, and healthcare quality. The review highlights the urgent need for structured ethics education, strengthened institutional governance frameworks, role clarification in informed consent practices, and organizational mechanisms to mitigate moral distress among nurses. Developing ethically resilient and legally competent nursing systems is essential for advancing patient-centered, accountable, and high-quality healthcare delivery.
Keywords Nursing Ethics, Medico-Legal Issues, Ethical Decision-Making, Intensive Care Unit Ethics, Nursing Administration, Professional Accountability
Published In Volume 8, Issue 3, May-June 2026
Published On 2026-05-14
DOI https://doi.org/10.36948/ijfmr.2026.v08i03.78424
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