title: A mixed-method systematic review: support for ethical competence of nurses.
abstract: OBJECTIVE
  The aim was to appraise and synthesize evidence of empirical studies of how nurses' ethical competence can be supported.
  
  
  BACKGROUND
  Ethical competence is an essential element of nursing practice. Nurses increasingly need support in competence when carrying out their responsibilities towards their patients.
  
  
  METHODS
  A mixed-method systematic review of quantitative and qualitative studies was undertaken according to the University of York's Centre for Reviews and Dissemination guidelines.
  
  
  METHODS
  Searches of MEDLINE, Nursing Database and British Nursing Index databases were conducted, yielding 512 citations between 1985-2012.
  
  
  METHODS
  After a two-stage application of inclusion and exclusion criteria, 34 articles were included. The quality of the studies was assessed using STROBE or COREQ criteria. Data were analysed by content analysis.
  
  
  RESULTS
  Nurses' ethical competence has been studied from different viewpoints: ethical decision-making, ethical sensitivity, ethical knowledge and ethical reflection. There was little empirical evidence of provided support, but studies offered recommendations on how to support ethical competence. The most common strategies to support ethical competence were ethics education, ethics rounds, ethics committee and consultation. Nurse leaders and colleagues have a key role in providing opportunities for nurses to gain ethical competence.
  
  
  CONCLUSIONS
  There is a need to develop evidence-based support at the organizational and individual level to support nurses' ethical competence. Barriers for multiprofessional cooperation in ethical issues should be recognized and addressed as part of the development of organizational ethical practices. Research should pay more attention to the conceptual, theoretical and practical perspectives of ethical competence.
authors.affiliation: Department of Nursing Science, University of Turku, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Poikkeus
authors.forename: Olivia
authors.initials: O
authors.lastname: Numminen
authors.forename: Riitta
authors.initials: R
authors.lastname: Suhonen
authors.forename: Helena
authors.initials: H
authors.lastname: Leino-Kilpi
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003657:Decision Making / Q000941:ethics; D004993:Ethics, Nursing; D009726:Nurses; D009729:Nursing / Q000592:standards*; D012944:Social Support
keywords: ethical competence; ethics; literature review; mixed-method systematic review; nurse; support