AIMS:
The purpose of this integrative review was to identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision-making among clinical nurses faced with ethical dilemmas.

BACKGROUND:
The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them.

DESIGN:
This paper is an integrative review of published research from 2000 to 2017.

METHODS:
The keywords ethics, ethical dilemmas and nurs* were searched in CINAHL, PubMed, OVID, and SCOPUS. Exclusion criteria were sources not available in English, not in acute care, and without an available abstract. Seventy-two studies were screened; 35 were retained. Garrard's matrix was utilized to analyze and synthesize the studies.

RESULTS:
Ethical dilemmas arose from end-of-life issues, conflict with physicians or families, patient privacy concerns, and organizational constraints. Differences were found in study location, and yet international research confirms that ethical dilemmas are universally prevalent and must be addressed globally to protect patients and nurses.

CONCLUSIONS:
This review offers an analysis of the available evidence regarding ethical dilemmas in acute care, identifying themes, limitations, and gaps in the literature. The gaps in quantitative intervention work, U.S. paucity of research, and lack of comparisons across practice settings/nursing roles must be addressed. Further exploration is warranted in the relationship between ethical dilemmas and moral distress, the significance patient physical appearance plays on nurse determination of futility, and strategies for pain management and honesty. This article is protected by copyright. All rights reserved.