The fourth question is why we found such an unexpectedly low number of previous primary studies on professional ethics in nursing, as we only identified 14 studies? Although it is well-established concept, research on the context of professional ethics is missing (Kasher 2005). Understandably, the most frequently used methodological approach has been theoretical examination. There is an obvious need for increased and advanced knowledge of professional ethics, in the field of ethics and empirical knowledge is needed. However, the current requirement for producing evidence-based knowledge about effectiveness is often inappropriate. More conceptual and philosophical research is needed to update professional ethics and gain and deeper understanding of the patient (Dobrowolska et al. 2007, Kangasniemi et al. 2010, Brecher 2014). In addition, awareness of professional ethics is reported to be inadequate in practice (Schank et al. 1996, Liaschenko & Peter 2004, Gonzalez-de Paz et al. 2012), implying that there is a need for improved empirical research and education. In future, literature reviews that cover the basic values of nursing and other healthcare professions, and
M. Kangasniemi et al.
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inter-professional ethics, are needed to deepen our understanding of the nature of professional ethics. More discussion is needed about how to use and combine data published over a long period of time and how to evaluate quality in articles from different decades. It is particularly noteworthy that the methodological rigour and evaluation of theoretical studies in the field of moral research is insufficient or challenge to assess.