30 Years of Nursing Ethics: Reflections on progress in the field

Background: The field of formal nursing ethics is not new, with literature primarily from North America, dating back to the 1880s. The establishment of the international journal Nursing Ethics in 1994 served to stimulate, curate and disseminate research and scholarship in this evolving field. Three decades on, it is timely to review progress and to make recommendations for the future focus of the field. Purpose: This article reviews 182 issues of Nursing Ethics over 30 years, focusing on: regions of origin of published articles; methodologies; and topic themes. Research design: The process involved documentary analysis, by hand, summarising: (1) regions of origin; (2) most common methodologies - qualitative; quantitative; mixed methods; argument-based; and reviews; and (3) themes relating to topic areas. Ethical considerations: The manuscript was reviewed by members of the Nursing Ethics Editorial Board and revised in accord with reviewers' feedback. The research did not involve human participants nor require consent from individuals. Findings: There has been an escalation of scholarship in nursing ethics with significant shifts over 3 decades, as evidenced in the journal Nursing Ethics. This paper focuses on trends relating to: (1) Regions of origin of published papers - initially manuscripts were primarily from Europe and North America and there is now more geographical diversity; (2) Methodologies - there is strong evidence of the 'empirical turn' from an initial focus on philosophical perspectives to empirical research, particularly quantitative research; and (3) Topic areas - whilst there is rich diversity, there has been increasing focus on areas such as moral distress, ethical climate and ethics education. Conclusion: This review is intended to stimulate reflection on progress made and approaches to future directions. This includes more critical focus on: the meaning and purpose of nursing ethics; impact on practice, education and research; and potential to respond to care challenges.