Ethical challenges in acute and long-term care of the elderly: a scoping review.

Introduction: The discontinuity between the high ideals of nursing education and real-world practice is a major cause of frustration, moral distress and burnout among the youngest, and pushes up to half nurses to change career within two years. These conditions are accentuated in the care of elderly patients with multiple chronic needs.

Methods: A multidisciplinary team of nurses and philosophers investigated the chronic determinants of ethical issues in aged care nursing, building on insightful experiences from different institu-tional settings, in order to provide evidence for contextualized and patient-oriented professio-nal support. A scoping review protocol was employed at this purpose.

Results: Most of the environmental and organizational deteminants of chronical ethical issues are out-side the control of nurses, and most of the relational ones follow as a result in both settings. Many of the them have been confirmed and further aggravated by the COVID-19 pandemic.

Discussion: Although there are not universal solutions to the issues described, still it is possible to distin-guish which determinants fall within the control of nurses, to help them prevent or manage their occurrence; and what are beyond, to help them avoid self-blame and transfer constructive information to those who can intervene.

Conclusions: Education can help exercise critical thinking and communicate properly. However, once maximized team cooperation, orga-nizational efficiency and individual soft skills, diminishing room for improvement will be available at increasing human and financial costs. Improving the condition of nurses is an urgent political responsibility and requires a broader socio-cultural change.