Developing quality vignettes for exploring ethical decision-making in the care of people with dementia: A methodological approach

BackgroundNurses caring for people with dementia in acute settings frequently encounter ethical challenges involving autonomy, safety, dignity, and organisational constraints. Supporting nurses to navigate these challenges is important for person-centred care and reducing moral distress. Although vignettes are widely used to explore ethical decision-making and support ethics education, limited methodological guidance exists for developing clinically realistic vignettes reflecting ethical challenges in practice.Research aimTo develop and refine theory-informed, clinically realistic vignettes for exploring ethical decision-making among nurses caring for people with dementia.Research designThis methodological study employed a four-phase, theory-informed vignette development process comprising: (1) development of initial vignettes; (2) expert consultation and refinement through focus group discussions; (3) structured expert evaluation using Vignette Development and Evaluation Criteria informed by findings from a scoping review, clinical expertise, James Rest's Four-Component Model of Ethical Decision-Making, and vignette methodology literature; and (4) multidisciplinary review and final vignette selection.Participants and research contextThe study was conducted in an acute setting in Ireland. An expert panel of five nurses with 15+ years' experience in caring for people with dementia participated in the process.Ethical considerationsEthical approval was granted by the Dublin City University Research Ethics Committee (DCUREC/2025/145).FindingsExpert consultation resulted in substantial refinement of the initial vignette set. Participants identified additional ethical issues, informed revisions to existing scenarios, and supported the exclusion of unrealistic or clinically irrelevant scenarios. Seven refined vignettes underwent structured evaluation using the Vignette Development and Evaluation Criteria. Following multidisciplinary review, four vignettes were selected that demonstrated strong clinical realism, ethical complexity, thematic diversity, and capacity to elicit ethical reasoning.ConclusionThis study describes a transparent, theory-informed approach to developing vignettes for exploring ethical decision-making in the care of people with dementia. The methodology may inform future vignette development for research, ethics education and professional reflection.