SAP Health and Policy
SAP Health and Policy
Review Article 2025 Vol. 4 shp2025338

Ethical conflicts in nursing care: dilemmas, professional burnout and coping strategies

Grigsson Santiago Barragán Valdiviezo1 , Jorge Leodan Cabrera Olvera1
1Pontificia Universidad Católica del Ecuador Sede Santo Domingo, Escuela de Enfermería; Santo Domingo, Ecuador.

https://doi.org/10.56294/shp2025338

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Abstract

Introduction: nursing professionals are the main direct care health personnel in the different care services, focused on human care; however, work overload affects the emotional-physical health of the professional. Therefore, it was proposed to analyze the ethical questions that occur in nursing staff during care that causes professional burnout, as well as the coping strategies implemented to overcome them. Methods: a bibliographic review of original scientific articles in Spanish, English and Portuguese was carried out; 30 studies were selected by convenience sampling from indexed sources such as SCOPUS, Scielo, and Dialnet; these were organized in an Excel matrix for their analysis by applying the CASPe critical reading rubric. Results: professionals face several challenges in their work activities, which makes it necessary to implement stress management techniques, such as meditation or breathing exercises, which help them to remain calm in high-pressure situations. Conclusions: the nursing professional currently faces highly complex and demanding situations in health care services. Psychosocial factors such as work overload, lack of organizational support, and low autonomy at work are key determinants in the development of this syndrome. The implementation of programs that address both ethical dilemmas and coping strategies is essential to preserve the mental health of professionals and ensure quality patient care.

Keywords

Keyword: Professional burnout, Ethical dilemmas, Job stress, Coping skills

INTRODUCTION

Nursing professionals are the main direct healthcare personnel in different care services, working within a framework of principles and values centered on human care. However, the high demand for their work, excessive workloads, and lack of recognition negatively impact their well-being. It should be noted that, according to the World Health Organization (WHO), 12 million people lose their jobs due to depression and anxiety, which cause a global economic downturn, representing losses of millions of dollars. All of this is caused by a failure to meet the needs of workers, especially healthcare workers, which affects the performance of healthcare systems and services.(1)

Furthermore, healthcare personnel are affected by a lack of recognition of their functions and role in multi- and interdisciplinary teams, which causes professional burnout on a personal, physical, and emotional level, considered a chronic and worrying illness, centered on the chronic stress suffered by nursing staff.(2)

Furthermore, as this involves dealing with people in highly complex and demanding situations, such as critical services, short-, medium-, and long-term burnout can occur, with lasting effects, due to excessive workloads, consecutive shifts, mistreatment by users or leaders, and the surrounding environment.(3)

Similarly, professionals are surrounded by and exposed to various issues that can affect their health, associated with the multiple demands imposed by a boss or area leader, causing work-related stress and leading to professional burnout, which limits their ability to carry out their activities independently.(4)

The pandemic also had a significant impact on the health of many professionals. The most prominent illness was considered to be emotional well-being, centered on family disconnection, work overload, saturation of health systems, exposure to disease, discriminatory stereotypes due to the risk of infection, as well as the lack of policies on the importance of healthcare personnel in the care and treatment of the population.(5,6)

Furthermore, the lack of new methods and tactics in occupational health has created knowledge gaps that are highly relevant to emerging situations, making it challenging to address issues related to both work and personal concerns. However, technological advances are promoting learning, monitoring, and digital health tools.(7)

On the other hand, there is a work overload that affects the emotional health of professionals, resulting in a significant impact that is reflected in their daily performance, promoting concerns and discomfort throughout their workday, and contributing to fatigue, stress, and anxiety.(8,9)

For this reason, the various conflicts faced by healthcare workers will always be reflected in their attitude and behavior towards others, which can affect their work performance and ultimately lead to a considerable deterioration in their health and well-being.(10,11)

The above highlights the inherent need to explore this issue in greater depth. Therefore, the objective of this study is to analyze the ethical questions that arise among nursing staff during patient care, which can lead to professional burnout, as well as the coping strategies implemented to overcome it.

METHODS

This is a qualitative approach that seeks to understand the different contexts through an examination of other issues related to the dilemmas of work-related burnout in nursing professionals.(12)

Similarly, it uses a descriptive design as a methodological strategy that facilitated the contextualization of current information on the subject of study. This enables us to focus on the importance of synthesizing the diverse results of previous studies to obtain a comprehensive answer based on an exhaustive search for information. In addition, it is a bibliographic review that interprets the current state of the problem, focusing on examining and synthesizing the particularities of the selected articles in a general way.(12)

In this context, the population refers to the set of articles that exhibit typical characteristics in accordance with the research questions posed. In this case, it consisted of 83 scientific articles from indexed sources, from which a sample of 30 articles was selected, obtained from a convenience sample based on accessibility and selection criteria.(13)

Inclusion dilemmas

Original scientific articles

Published within the last 5 years

Research on work-related fatigue in healthcare personnel

Exclusion dilemmas

Studies from institutional repositories.

Essays.

Review articles

The information was obtained from indexed data sources such as SCOPUS, SCIELO, CINALH, PUBMED, and REDALYC, using keywords in English (burnout, dilemma, conflicts, strategies), Spanish (agotamiento, ilemma, conflictos, estratégias), and Portuguese (exaustão, ilemma, conflitos, estratégias), as well as Boolean operators (AND and OR). The information was validated by another researcher, who was responsible for verifying compliance with the selection criteria.

In addition, the information was stored in an Excel matrix with different items such as: (authors, year of publication, title, abstract, methods, findings, and conclusions). This matrix facilitated the organization of the information according to the problem posed.

The CASPe method was used to perform the analysis, which details the information collected based on a set of studies aimed at determining the quality and validity of the different results obtained, as well as compliance with a checklist. It should be noted that another person validated these.

DEVELOPMENT

Dilemmas presented in nursing care that increase work overload

Health and social security in the workplace are closely linked to various conditions that affect each person. These conditions influence the quality of the work environment, as well as performance in activities.(14) It should be noted that work overload among healthcare professionals, with an emphasis on nursing staff, has been recognized as a critical factor affecting the health, safety, and performance of staff in their actions related to the provision of care; consequently, this leads to patient vulnerability.(15)

Similarly, these conditions exacerbate work fatigue, particularly due to long hours and the resulting inequality in nursing care for patients.(16) In turn, high-demand and complex environments put pressure on professional capabilities, as well as the presence of superiority among colleagues due to seniority, which can cause high levels of stress during working hours and lead to risks of adverse events during the performance of care activities.(17)

Therefore, work-related stress is a harmful condition that affects people’s psychological well-being, as it generates emotional, cognitive, physiological, and behavioral reactions to high-demand situations that exceed available personal, work, and hy resources. This is both a social and economic problem, associated with psychosocial risk factors and specific triggers in the work environment.(18)

Furthermore, a high level of overload directly and indirectly affects the performance of everyday activities, marked by exhausting working hours that cross the barrier between work, social, and family life.(19) Consequently, this implies a series of emotional, physical, mental, and spiritual demands and obligations. It should be noted that in the healthcare sector, there is a high demand for professionals who suffer from work overload during specific shifts, mainly night shifts, as these are hours when the body requires prior rest.(20)

In this context, stress affects relationships within the work team, marked by negative emotions, as well as inequalities in the assignment and distribution of activities.(21) It should be emphasized that this problem, marked by a shortage of personnel and trained human talent, affects both the private and public sectors, thereby violating people’s right to access quality health care.(22)

Similarly, stressors in work environments during the COVID-19 health emergency increased, centered on restrictive biosafety regulations. As a result, the quality of care was affected, considering the high demand for hospital stays in a scenario of scarcity of medical resources and human talent, which led to deficiencies in the care provided, marked by dehumanization on the part of healthcare personnel.(23)

As a result, nursing staff face various dilemmas in their daily work that increase their workload. One of the most common issues is the assignment of an excessive number of patients to each nurse, which compromises the quality of care. Added to this are staff shortages, a lack of medical supplies and adequate equipment, and long working hours that exhaust professionals both physically and mentally. They also face ethical dilemmas when prioritizing care in high-demand situations. These conditions create a stressful work environment, impact the mental health of staff, and decrease efficiency in patient care.

Factors that cause professional burnout in nursing staff

Nursing plays a crucial role in people’s lives, significantly influencing their daily routine. It can be a source of personal satisfaction and success; however, it also generates stress and anxiety, which can lead to emotional and work-related problems. The quality of the work environment, interpersonal relationships, and workload are determining factors in the psychological well-being of employees.(24)

Similarly, professional burnout, also known as burnout syndrome, is a condition that arises after prolonged exposure to chronic stress. This phenomenon is particularly prevalent among healthcare professionals, especially nurses, and can have significant consequences for their physical and mental well-being, as well as their job performance.(25)

It should be noted that this increased during the health emergency caused by the COVID-19 pandemic, due to a lack of resources, stigmatization of healthcare personnel due to the risk of infection, and work overload due to the saturation of services, which affected the dynamics of professionals in both their work and personal lives, causing emotional exhaustion, depersonalization, and a feeling of low personal fulfillment.(26,27)

In this sense, professional exhaustion is a psychological condition that arises in response to chronic stress in the workplace, particularly when the demands of the job exceed the person’s ability to cope with them, with critical service areas being those that involve high demand and work complexity.(28)

Additionally, this condition is characterized by a lack of energy and disinterest in daily tasks, resulting in a decline in professional commitment. This can hinder interpersonal relationships in the workplace and increase the risk of adverse events related to work overload.(29,30)

On the other hand, depersonalization is the second dimension of burnout syndrome, manifesting as the development of negative, distant, and cold attitudes and responses toward others, particularly toward clients, patients, or users. This is due to a lack of recognition, workload, and treatment by service leaders.(31)

Furthermore, one of the causes that affects the occupational health of nursing professionals is work overload, especially when working hours are excessive. This factor not only jeopardizes the physical and emotional well-being of staff but can also deteriorate the quality of care provided and reduce service productivity.(32,33)

That is why several interrelated factors can contribute to professional burnout among nursing staff; therefore, a lack of emotional support and isolation in some work environments can lead to mental fatigue. Emotional stress also plays a crucial role, as nurses are in constant contact with suffering and death, which can result in exhaustion. The lack of adequate resources and infrastructure further exacerbates this situation, and the limited opportunities for professional development also impact the well-being of workers.

Coping strategies implemented by nursing professionals to deal with professional burnout

Work-related stress has become one of the most significant problems facing workers, considered the second most common illness in the professional sphere. This phenomenon not only affects the physical and mental health of employees, but also has a considerable impact on work productivity, with an estimated 50 % to 60 % decrease in the performance of affected workers. Consequently, the implementation of talks, activities, and emotional support videos made it possible to improve the work environment, thus creating a calmer atmosphere during shifts.(34)

Similarly, support from leaders and occupational health services has enabled the development of recreational and relaxation activities to help employees cope with work-related stress. In turn, anonymous reporting to human resources facilitates the detection of cases of workplace harassment and bullying, enabling the establishment of awareness, protection, and safety campaigns.(35)

It should be noted that burnout syndrome is a psychological disorder characterized by three key dimensions: emotional exhaustion, depersonalization, and low personal fulfillment. Therefore, recognition of achievements, continuous training, and awareness talks made it possible to reduce and mitigate the effects of these, while monitoring and timely treatment improved the well-being of the workforce.(36)

Furthermore, the psychology department’s monitoring of affected staff encourages timely treatment to counteract the effects of work-related stress at personal, professional, and family levels.(37) That is why the use of internal strategies within a work environment, such as the implementation of active breaks and team-building meetings, makes it possible to release stress accumulated during the workday.(38)

In this sense, the implementation of round tables facilitates dialogue and the sharing of experiences, enabling occupational health departments to manage emotions related to work and interpersonal relationships within the framework of promoting more resilient work environments.(39,40)

Similarly, training staff, particularly in high-demand and complex services, enables the reallocation and equitable distribution of care and administrative activities, thereby achieving equity in job functions. It should be noted that this is mainly linked to the hiring and training of new staff, as well as other services.(41,42)

Likewise, job uncertainty refers to the inability of workers to interpret events and situations that occur in their work environment, which prevents them from predicting the future of their employment due to a lack of information and clarity. Therefore, effective and open communication enables individuals to seek support and guidance when facing problems, as well as to adapt to stressors.(43)

For this reason, professionals face various challenges in their work activities, making it necessary to implement stress management techniques, such as meditation or breathing exercises, which help them remain calm in high-pressure situations. This focus on self-care plays a crucial role, including getting adequate rest, eating a healthy diet, and engaging in recreational activities outside the workplace, as well as organizational support that promotes a collaborative work environment and access to wellness programs, which are essential for reducing the effects of burnout.

CONCLUSIONS

Nursing professionals currently face highly complex and demanding situations in healthcare services, as well as work overload, lack of organizational and professional support, and limited autonomy at work. This leads to burnout, which affects their vocation and sense of duty toward others. Considering that it impacts the art of humanized care, centered on the ontological dignity of human beings, it thus affects the quality of care they provide.

For this reason, implementing programs that address coping strategies is essential to preserve the mental health of staff, focusing on the well-being, productivity, and integrity of each individual.

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Declarations

Funding

None.

Conflict of interest

None.

Authorship contributions

Conceptualization: Grigsson Santiago Barragán Valdiviezo; Jorge Leodan Cabrera Olvera.

Data curation: Grigsson Santiago Barragán Valdiviezo; Jorge Leodan Cabrera Olvera.

Formal analysis: Grigsson Santiago Barragán Valdiviezo; Jorge Leodan Cabrera Olvera.

Research: Grigsson Santiago Barragán Valdiviezo; Jorge Leodan Cabrera Olvera.

Methodology: Grigsson Santiago Barragán Valdiviezo; Jorge Leodan Cabrera Olvera.

Project management: Grigsson Santiago Barragán Valdiviezo; Jorge Leodan Cabrera Olvera.

Supervision: Grigsson Santiago Barragán Valdiviezo; Jorge Leodan Cabrera Olvera.

Validation: Grigsson Santiago Barragán Valdiviezo; Jorge Leodan Cabrera Olvera.

Visualization: Grigsson Santiago Barragán Valdiviezo; Jorge Leodan Cabrera Olvera.

Writing – original draft: Grigsson Santiago Barragán Valdiviezo; Jorge Leodan Cabrera Olvera.

Writing – review and editing: Grigsson Santiago Barragán Valdiviezo; Jorge Leodan Cabrera Olvera.

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