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This phenomenological study examined the moral and ethical responsibilities of nurses in geriatric healthcare
decision-making in selected healthcare facilities in Davao, Philippines. Guided by Colaizzi’s descriptive method,
in-depth interviews were conducted with eleven staff nurses who had at least one year of experience in caring
for older adults. The study aimed to uncover how nurses navigate ethical dilemmas, interpret their professional
responsibilities, and reconcile institutional policies with personal values and cultural beliefs. Participants were
predominantly female (64%) and aged 35–44 years (73%), with most having 5–10 years of clinical experience.
Analysis of the qualitative data generated seven key themes: (1) Ethical Principles in Geriatric Healthcare, (2)
Ethical Dilemmas in Geriatric Practice, (3) Moral Responsibility and Ethical Reasoning in Nursing, (4)
Institutional Support and Ethics Education, (5) Moral Distress and Emotional Labor in Geriatric Care, (6)
Cultural and Contextual Factors in Ethical Decision-Making, and (7) Balancing Patient Needs with Personal
Beliefs. Findings revealed that while nurses consistently applied ethical principles such as autonomy,
beneficence, and justice, they frequently experienced tension when institutional policies conflicted with patient
needs or family expectations. Moral distress was common, especially in end-of-life care, with nurses highlighting
the emotional burden of ethically complex decisions. Cultural norms, personal beliefs, and religious values
strongly shaped ethical reasoning, underscoring the need for culturally sensitive ethics education. The study
concludes that ethical decision-making in geriatric nursing is a dynamic, reflective, and deeply personal process
requiring sustained institutional support, targeted ethics education, and emotional resilience. Recommendations
include integrating case-based ethics training, fostering reflective practice, establishing mentorship programs,
and developing emotional support systems to mitigate moral distress among geriatric nurses.
Keywords: geriatric nursing, ethical decision-making, moral responsibility, moral distress, nursing ethics,
cultural competence, phenomenology
INTRODUCTION AND BACKGROUND OF THE STUDY
Moral and ethical responsibilities in geriatric healthcare decision-making are grounded in the principles of
autonomy, beneficence, non-maleficence, and justice, which collectively safeguard the dignity, safety, and well-
being of older adults (Beauchamp & Childress, 2019). These principles are particularly critical in geriatric care,
where patients often face cognitive decline, chronic illnesses, and increased dependency on healthcare providers.
In the Philippines, the complexity of ethical decision-making in such contexts is heightened by systemic
constraints, resource limitations, and cultural dynamics that influence both professional practice and patient
expectations (Corpuz, 2022). Nurses, as front-line caregivers, often navigate ethical dilemmas involving consent,
end-of-life care, and conflicts between patient autonomy and family wishes, frequently making decisions under
emotionally charged and time-sensitive conditions (World Health Organization, 2020). The ability to apply
ethical principles consistently is influenced not only by individual competence but also by institutional support,
policy clarity, and access to ethics education (Silva & Andrade, 2021).
The philosophical foundation of this study is rooted in moral philosophy, specifically Beauchamp and
Childress’s Four Principles of Biomedical Ethics—autonomy, beneficence, non-maleficence, and justice—and
Andrew Jameton’s Theory of Moral Distress. The former offers a universal framework for clinical ethical
decision-making, while the latter emphasizes the psychological strain experienced by healthcare professionals
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when systemic or institutional barriers prevent them from acting on what they believe is ethically right (Jameton,
1984; Epstein & Hamric, 2009). In the Philippine healthcare context, where disparities in resources and ethics
infrastructure persist, these frameworks provide a dual lens for understanding how nurses interpret and enact
their ethical obligations. This study is also anchored in phenomenology as articulated by Moustakas (1994),
focusing on the lived experiences of nurses as they confront ethically challenging situations in geriatric care.
The purpose of this research is to explore and describe the lived experiences of nurses in fulfilling their moral
and ethical responsibilities in geriatric healthcare settings in Davao, Philippines. It seeks to uncover how nurses
respond to ethical dilemmas, the personal and institutional factors influencing their decisions, and how they
reconcile professional obligations with personal values and cultural norms. The scope of the study is limited to
nurses with at least one year of direct experience in geriatric care, including intensive care, emergency, medical,
and surgical settings. Eleven participants from selected healthcare facilities were engaged through in-depth
interviews, ensuring that findings reflect diverse yet context-specific experiences. While the study is limited by
its qualitative design and reliance on self-reported narratives, its phenomenological approach allows for a
nuanced and in-depth understanding of ethical decision-making in geriatric nursing.
The significance of this study spans nursing service, education, and research. For nursing service, the findings
can inform policy development, ethics guidelines, and institutional support systems aimed at reducing moral
distress and improving quality of care for older adults. In nursing education, the study offers insights that can be
integrated into curricula through case-based learning, reflective practice modules, and ethics simulations, thereby
enhancing the ethical competence of future nurses. From a research perspective, the study enriches the body of
qualitative nursing literature on ethics in geriatric care and lays the groundwork for developing culturally
sensitive frameworks for ethical decision-making in resource-constrained healthcare environments. By
amplifying the voices of nurses navigating these ethical landscapes, the study contributes to advancing patient-
centered, culturally competent, and ethically grounded geriatric care in the Philippines.
METHODOLOGY
This study employed Colaizzi’s descriptive phenomenological method to explore the lived experiences of nurses
in fulfilling their moral and ethical responsibilities in geriatric care. The phenomenological approach was chosen
to capture the essence of participants’ experiences, free from researcher bias, through the process of bracketing
as described by Husserl (as cited in Moustakas, 1994). Colaizzi’s (1978) seven-step process was followed,
beginning with reading all participants’ descriptions to obtain an overall understanding, extracting significant
statements, formulating meanings, clustering themes, developing an exhaustive description, identifying the
fundamental structure, and returning the findings to participants for validation. This approach aligned with the
Consolidated Criteria for Reporting Qualitative Research (COREQ) standards for qualitative rigor (Tong et al.,
2007).
The study population consisted of registered nurses currently employed in healthcare facilities in Davao City
who were actively engaged in geriatric care. Purposive sampling was applied to select participants with rich
experiential knowledge relevant to the phenomenon under investigation (Creswell & Poth, 2018). Inclusion
criteria required that participants (1) had at least three years of nursing experience, (2) were assigned in critical
areas such as emergency or intensive care units for a minimum of three years, and (3) were willing to participate
in the study. To capture a diverse range of perspectives, maximum variation sampling, a subtype of purposive
sampling, was also employed (Patton, 2015). Eleven nurses were recruited through personal visits, phone calls,
and online invitations. Both in-person and virtual interviews were conducted to accommodate participants’
availability.
The study was conducted in selected public and private healthcare facilities in Davao City that provide geriatric
services. Davao City, a major urban center in Mindanao, was considered an ideal setting because of its growing
elderly population and its mix of cultural diversity and family-oriented values, which influence healthcare
decision-making. The selected facilities included hospitals, specialized geriatric clinics, and long-term care
institutions chosen for their direct involvement in geriatric healthcare and decision-making processes.
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Data were collected using a researcher-developed semi-structured interview guide designed to elicit rich
narratives about moral and ethical decision-making in geriatric nursing. The instrument was informed by relevant
literature on nursing ethics and geriatric care and consisted of open-ended questions grouped into thematic areas
such as moral and ethical decisions, ethical responsibilities, ethical challenges, influencing factors, and coping
strategies. The interview guide began with demographic questions, followed by prompts to encourage
participants to share specific experiences, reflections, and perceived consequences of their decisions.
In qualitative research, validity was addressed through credibility, transferability, dependability, and
confirmability (Lincoln & Guba, 1985). Credibility was enhanced through prolonged engagement, triangulation
of data sources (face-to-face, online, and written interviews), and member checking, wherein transcripts were
returned to participants for verification. The interview guide underwent expert review by two qualitative
researchers and a healthcare ethics educator, and a pilot interview was conducted with one nurse not included in
the main study. Transferability was supported by providing thick descriptions of the study setting, participant
demographics, and procedures. Dependability was ensured through the maintenance of an audit trail
documenting all methodological decisions. Confirmability was achieved by reflexive journaling and peer
debriefing to minimize researcher bias.
Ethical approval was obtained from the Institutional Review Board of the University of Perpetual Help System
Dalta before data collection commenced. All participants provided informed consent after receiving a detailed
explanation of the study’s purpose, procedures, potential risks, and benefits. Participation was voluntary, and
participants could withdraw at any time without penalty. Confidentiality was safeguarded by removing
identifying information from transcripts and storing all data on password-protected devices. Physical documents,
such as signed consent forms, were kept in a locked cabinet accessible only to the researcher. Data will be
retained for five years and then securely destroyed. The researcher declared no conflicts of interest.
RESULTS AND DISCUSSION
The analysis of in-depth interviews revealed interrelated themes that reflected the complex ethical landscape of
geriatric nursing. Nurses described ethical dilemmas, moral responsibilities, systemic influences, and personal
belief systems as key factors shaping their decision-making. To capture these dynamics holistically, the findings
are represented through the metaphor of an Ethical Compass, which symbolizes how nurses orient themselves
when navigating morally complex terrain. At its center lies the guiding principle of patient-centered care,
representing the “true north” of their ethical practice. Each compass point reflects a dimension of their lived
experiences, illustrating the directions nurses must turn to when making difficult ethical decisions.
One recurring challenge, positioned at the north point of the compass, involved ethical dilemmas in end-of-life
care, particularly surrounding Do Not Resuscitate (DNR) orders. Nurses struggled with tensions between
honoring patient autonomy and responding to family requests, echoing Van Bogaert et al.’s (2012) findings that
aggressive, non-beneficial treatments contribute significantly to moral distress in geriatric settings. The south
point of the compass reflects the emotional burden of these situations, aligning with Corley et al.’s (2001)
definition of moral distress, where nurses experience psychological discomfort from being unable to act
according to their ethical judgment. Feelings of guilt, anxiety, and helplessness were common, particularly
among less experienced nurses, whose vulnerability to compassion fatigue has been well-documented (Beck et
al., 2016; Hiroko & Elsom, 2020; Poulsen et al., 2022).
The east and west points of the compass symbolize balance through support systems and shared accountability.
Participants emphasized the importance of collaborative team environments, noting that solidarity from
colleagues alleviated emotional strain and promoted ethical clarity. As one nurse reflected, “It helps when the
team backs your decision. You feel less alone in making ethical calls.” This supports Rafferty et al. (2003) and
Pawar et al. (2019), who identified positive ethical climates as protective against moral distress. In this way, the
compass metaphor illustrates how nurses recalibrate their orientation when supported by ethical dialogue and
team solidarity. Beyond these cardinal points, the compass is further informed by the principles that guide its
direction—autonomy, beneficence, and justice—which participants described as the foundation of ethical
responsibility. This is consistent with Lindahl (1998) and Caren-Gutiérrez and Rodríguez (2020), who
emphasized moral courage and patient advocacy as essential to nursing ethics. Nurses also highlighted moral
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sensitivity as their “decision-making compass,” enabling them to recognize and respond to dilemmas (Kim et
al., 2021). Yet, hierarchical constraints often pulled them off course, excluding them from key decisions and
fostering feelings of moral exclusion (Pinto & O’Brien, 2019). Systemic factors also influenced the compass’s
direction. Resource shortages, policy conflicts, and institutional priorities sometimes forced nurses to act against
their ethical instincts, reinforcing Nathaniel’s (2006) theory of moral reckoning and the persistence of moral
residue. While formal ethical policies provided a framework, their effectiveness depended on interpretive
judgment and situational adaptability (Feinsod & Wagner, 2005). Nurses also drew upon deeply held personal
and cultural values to steady their ethical compass. Many cited spirituality and Filipino traditions such as
paggalang sa matatanda as moral anchors. While these values served as sources of strength, they sometimes
conflicted with institutional directives, requiring negotiation and ethical mindfulness (Beagleh, 2024; Schlüter
et al., 2008). The compass was further sharpened by ethics education and reflective practice, which participants
described as essential in refining their moral reasoning. Simulation-based training and structured reflection
provided tools to navigate dilemmas with confidence (Hickman & Wocial, 2013; Qu et al., 2024). Together,
these strategies helped nurses recalibrate their orientation, ensuring their decisions aligned with both professional
standards and patient-centered principles.
Overall, the findings indicate that ethical practice in geriatric nursing is shaped by a dynamic interplay between
personal values, institutional structures, and patient-centered principles. The Ethical Compass metaphor
underscores that nurses do not follow a linear path but instead continuously reorient themselves in response to
moral challenges. Addressing moral distress requires not only robust policies and training but also a supportive
ethical climate that empowers nurses’ voices in decision-making.
This study concluded that ethical decision-making in geriatric nursing is a multidimensional process influenced
by clinical guidelines, personal beliefs, cultural values, and the ethical climate of healthcare institutions. While
nurses demonstrated strong moral responsibility and advocacy for patient dignity, their capacity to act ethically
was sometimes constrained by hierarchical decision-making, systemic limitations, and conflicting stakeholder
interests. Supportive team relationships, ethics education, and reflective practice emerged as critical in enabling
ethical resilience.
The findings of this study point to the need for a multi-pronged approach to strengthen ethical decision-making
in geriatric nursing. First, integrating scenario-based ethics simulations into continuing professional education
would allow nurses to practice responding to complex dilemmas, particularly in end-of-life care and consent-
related situations, thereby enhancing their moral reasoning and confidence in real-world settings. Equally
important is the implementation of structured ethics reflection programs, such as regular debriefing sessions or
guided journaling, which can help nurses process emotionally taxing experiences, reduce moral distress, and
foster a culture of openness. Institutions should also ensure that clear, accessible, and context-specific ethical
guidelines are in place, supported by functional ethics committees or designated ethics consultants to provide
timely advice when dilemmas arise. Given the influence of cultural and religious values on decision-making, it
is essential to embed cultural sensitivity into ethics training and policy formulation so that these beliefs can be
respected while still aligning with professional standards. Moreover, providing mental health support and peer
counseling can help mitigate the risk of compassion fatigue, which was identified as a recurring challenge.
Establishing mentorship programs that pair novice nurses with experienced practitioners can further enhance
ethical competence by facilitating the transfer of practical wisdom and critical thinking skills. Finally, integrating
ethics-related performance indicators into institutional quality assurance systems would ensure that ethical
practice is monitored, reinforced, and valued as a key component of geriatric care quality. Together, these
recommendations aim to create an ethically supportive environment that empowers nurses to deliver dignified,
patient-centered care while maintaining their own professional integrity.
This study was limited to a purposive sample of eleven nurses from selected healthcare facilities in Davao City,
which may restrict the transferability of findings to other contexts. The qualitative design, while offering rich
insights, does not permit statistical generalization. Additionally, participants’ responses may have been
influenced by recall bias or reluctance to discuss sensitive ethical conflicts openly. Future studies could expand
to multiple regions, include a larger sample, and employ mixed-method approaches to deepen and validate
findings.
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Figure 1: The Ethical Compass Metaphor for Ethical Decision-Making in Geriatric Nursing
This figure illustrates the Ethical Compass metaphor, representing how healthcare professionals navigate moral
and ethical decision-making in geriatric care. At the center of the compass lies the guiding principle of patient-
centered care, symbolizing the “true north” of ethical nursing practice. The north point represents ethical
dilemmas in end-of-life care, highlighting conflicts between respecting patient autonomy and responding to
family demands. The south point depicts emotional labor and moral distress, emphasizing the psychological
burden of ethical decisions. The east and west points signify support systems and shared accountability,
underscoring the role of teamwork, dialogue, and peer solidarity in buffering moral strain. Together, the compass
symbolizes the dynamic process by which nurses continuously reorient themselves amidst personal values,
institutional constraints, and cultural influences to deliver ethically sound and compassionate care.
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