Nursing Ethics最新文献

Disgust is an inescapable yet underexplored emotion in nursing. While it serves a protective function in avoiding biological contaminants, its extension to social and moral domains raises ethical challenges in patient care. This paper examines disgust through theoretical analysis and moral philosophy, with particular focus on how it influences nurses' professional practice and capacity for compassion. Drawing on personal vignettes and interdisciplinary scholarship, the paper identifies two dominant themes in nursing responses to disgust: institutional suppression of emotional expression and contamination fears that extend beyond actual infection risks. Suppression of disgust can create dissonance between nurses' inner experiences and their outward professionalism, contributing to fatigue and turnover. Contamination fears manifest as protective behaviors and reinforce symbolic boundaries between "clean" professional bodies and "polluted" patient bodies. Disgust thus functions as a crude detection system for threats, but one that easily expands into social and moral domains, risking dehumanization of vulnerable patients. Eliminating disgust from nursing is neither possible nor desirable. Instead, cultivating compassion offers a counterbalance that preserves professional boundaries while affirming shared humanity. The paper argues for integrating moral education into nursing curricula to foster compassion, enabling nurses to navigate the ethical tensions posed by disgust without compromising patient dignity.

BackgroundIn the last 40 years, moral distress among nurses and other healthcare professionals (HCPs) has gained considerable attention. Some scholars, including Morley et al., have proposed expanding the definition of moral distress to include distress from moral constraint, conflict, uncertainty, dilemma, and tension; yet debates about this conceptualization persist.Aim of the studyThis study examines whether Morley's moral distress categories effectively capture moral distress experiences among HCPs, with a specific focus on the Italian context.Research designA convenience sample of 20 HCPs from a hospital in Northern Italy participated in semi-structured interviews describing morally distressing situations. Data were analyzed using deductive content analysis based on Morley's framework. As some situations did not fit existing categories, an inductive analysis was also conducted to identify additional moral distress causes.Ethical considerationsThis study was approved by the Ethics Committee of the University of Milan (approval no. #48/22) on 30 May 2022.ResultsWe identified 64 morally distressing situations, 41 aligning with Morley's framework (26 constraints, 14 conflict, 1 uncertainty, and 0 dilemmas). Six situations involved multiple causes, while 17 stemmed from a new cause, namely, misconduct. We also found that all identified causes led to moral distress because they implied a perceived violation of professional values and norms. This violation emerged as a necessary condition for moral distress, leading us to develop a multi-layered model positioning violation of professional values and norms as the deep cause of moral distress, with constraint, conflict, uncertainty, and misconduct as surface causes.ConclusionsOur findings suggest that Morley's framework does not fully capture moral distress's complexity. Additional sources of moral distress, such as misconduct, suggest that other triggers may be identified depending on the context. Defining moral distress solely by its surface causes risks fragmenting the concept and overlooking its deeper cause: The perceived violation of professional values and norms that leads to distress.

BackgroundPreserving dignity is a core element of nursing care. Older adults admitted to intensive care units (ICUs) are particularly vulnerable to dignity loss due to critical illness, invasive interventions, and limited communication.ObjectiveThis study examined the status and influencing factors of dignified care practices among ICU nurses in caring for older patients, with the aim of informing quality-improvement strategies.DesignAn explanatory sequential mixed-methods design was employed.Participants and SettingA questionnaire survey was completed by 487 ICU nurses from 5 tertiary hospitals in Hunan Province, China. Semi-structured interviews were then conducted with 18 ICU nurses. Qualitative data were analyzed using a descriptive phenomenological approach.Ethical ConsiderationsThe study was approved by the institutional ethics committee, and informed consent was obtained from all participants.FindingsNurses reported moderately high dignified care (79.12 ± 10.40). Scores were higher in absolute dignity (87.05 ± 11.43) than in relative dignity (70.19 ± 12.86). Regression analysis identified six predictors-gender, education, ethics training, work environment, moral sensitivity, and psychological capital-explaining 38.4% of the variance. Qualitative findings revealed four themes: difficulty balancing technical demands with dignity preservation; patient-related barriers such as severe illness and poor adherence; cultural conflicts between traditional respect for older adults and family decision-making; and organizational constraints, including heavy workloads and implicit workplace norms.ConclusionICU nurses generally demonstrate competence in dignity preservation; however, limitations remain in addressing individualized dignity needs. Dignified care is influenced by the interplay of individual, environmental, and cultural factors. Improvement requires optimizing the clinical environment, strengthening ethics education and psychological support, applying dignity-centered standards, and promoting patient-centered cultural transformation through leadership. Coordinated efforts by healthcare administrators are essential to achieve sustainable quality improvement.

BackgroundThe COVID-19 pandemic has posed unprecedented challenges for nurses, including resource shortages, heavier workloads, and ethical decision-making pressures, putting them at high risk for moral injury. This threatens their physical and mental health, job stability, and the quality of care.AimThe aim was to systematically assess the level of moral injury among nurses during the COVID-19 pandemic.MethodsA comprehensive search was conducted on 12 databases (PubMed, Web of Science, MEDLINE, ProQuest, Embase, CINAHL, Scopus, PsycINFO, CBM, CNKI, VIP, WanFang Data) for cross-sectional studies published up to 20 July 2025, that reported the level of moral injury among nurses using the Moral Injury Symptoms Scale-Health Professionals Version. A systematic review and meta-analysis were conducted. Two researchers independently screened the literature, extracted data, and assessed methodological quality. The pooled mean score was calculated using random-effects or fixed-effects models, with subgroup analysis to explore heterogeneity.Ethical considerationsEthical approval was not required as the review synthesized publicly available data.ResultsThis study included 16 articles, involving 5824 participants. The meta-analysis showed that the pooled mean total MISS-HP score for nurses was 42.12 (95% CI: 40.70-43.53). Among the dimensions, the pooled mean score for Loss of religion/spiritual faith was the highest at 5.68 (95% CI: 4.61-6.74), while the pooled mean score for religious struggles was the lowest at 2.26 (95% CI: 1.13-3.40). Subgroup analysis results indicated significant differences in moral injury levels among nurses based on Survey year and department (p < .001).ConclusionsUnder the context of the COVID-19 pandemic, nurses experienced moderate to high levels of moral injury, particularly during the early stages of the pandemic in 2020, with emergency department nurses being most affected. To support nurses' well-being and mental health, healthcare institutions should strengthen ethical support systems, improve management, and consider the role of religion/spiritual faith in alleviating moral injury.

BackgroundHemodialysis nurses face complex ethical challenges in their practice. However, a few studies have comprehensively integrated relevant factors to investigate the ethical issues.AimTo develop a systematic framework to categorize and analyze the ethical challenges encountered by hemodialysis nurses.Research designThis study follows a qualitative descriptive study.Participants and research contextThe sample comprised 31 hemodialysis nurses from seven hospitals (six Traditional Chinese Medicine hospitals and one general hospital) across six cities in Shandong Province, China. Data were collected through focus group discussions and in-depth individual interviews, and analyzed using inductive thematic analysis. An ethical framework was constructed based on the social-ecological theory.Ethical considerationsThe proposal was approved by the Ethics Committee of the local university. Participation in this study was voluntary. Written or electronic informed consent was obtained, and confidentiality was ensured.ResultsEthical dilemmas experienced by hemodialysis nurses were grouped into three themes with eight subthemes and 21 subcategories, and a multi-systemic ethical dilemma model was developed, encompassing macro-level dilemmas involving policy and organizational dimensions; meso-level interactions among healthcare providers and patients; and micro-level individual struggles.ConclusionThis study introduces a multi-systemic model that elucidates the permeation of ethical stress across societal, interpersonal, and individual levels in hemodialysis nursing. By demonstrating how ethical dilemmas are systemically produced and sustained, this framework fundamentally shifts the discourse from mere description to theoretical explanation. The findings underscore that synergistic, multi-level interventions-integrating organizational and policy changes with individual support-are imperative. We therefore advocate for the adoption of this integrated perspective across research, policy, and clinical management to develop sustainable solutions that bolster hemodialysis nursing practice and fortify the entire care ecosystem.

Assisted death, which encompasses euthanasia and assisted suicide, remains a contentious ethical and legal issue across Europe. As frontline healthcare professionals, nurses are uniquely positioned to interpret and respond to patients' suffering as well as their complex requests for assisted death. This scoping review explores European nurses' attitudes towards assisted death, examining the factors that shape their views. A systematic literature search was conducted in six databases, which was complemented by manual searches yielding 20 studies from various European countries. Thematic groups identified in the review include: (1) Legal and organisational conditions, (2) ethical tensions and moral reasoning, (3) nurses' roles and responsibilities and (4) individual and professional characteristics. The findings highlight significant variations in attitudes towards assisted death, which are influenced by legal, ethical, cultural and organisational conditions. In those European countries where assisted death has been legalised, nurses have expressed a strong desire to be more involved in decision-making processes, reflecting their proximity to patients and their critical role in interdisciplinary teams. Conversely, in countries without legal frameworks for assisted dying, nurses often reported uncertainty and ethical quandaries when navigating patients' requests for assisted death. Key factors that shaped these attitudes include demographic characteristics, religion, education, professional experience and work environment. Ethical tensions were identified between caring perspectives and principle-based concerns, and between respecting patient autonomy and adhering to the principle of non-maleficence. Additionally, differences in attitudes towards euthanasia and assisted suicide were linked to ethical distinctions between actively causing death and allowing death to occur. This scoping review underscores the need for enhanced training in communication and ethical competence, as well as the greater involvement of nurses in policy discussions and decision-making processes. The nursing profession can enhance its capacity to manage the ethical complexities of assisted death, ensuring that decisions are both ethically sound and patient-centred.

BackgroundSocial media has revolutionized healthcare communication, giving nurses unprecedented visibility and influence in shaping public perceptions of health and professionalism. Among these emerging figures are "nurse digital content creators"-nurses who use social platforms to communicate health information, advocate for the profession, and engage with large online audiences. Yet, their online presence challenges traditional ethical frameworks and professional boundaries.AimThis study explores how Italian nurse digital content creators perceive and negotiate ethical and professional boundaries in digital environments, focusing on their motivations, challenges, and the implications for nursing ethics and public health.Research designA qualitative reflexive thematic analysis was used to capture the lived experiences of four Italian nurse digital content creators.Participants and research contextParticipants were purposively selected based on defined criteria and interviewed through semi-structured video calls. Data were transcribed verbatim and analyzed using Braun and Clarke's six-step thematic analysis. Rigor was achieved through member checking, peer debriefing, and transparent coding.Ethical considerationsEthical approval was obtained. Participants provided informed consent electronically. All data were anonymized during the analysis.ResultsFive interrelated themes emerged: (1) Professional Purpose and Digital Advocacy; (2) Ethical Boundaries and Institutional Silence; (3) Privacy, Confidentiality, and Self-Protection; (4) Emotional Labour and Public Exposure; and (5) Health Misinformation and Moral Duty. Participants viewed digital communication as an ethical extension of care but struggled with ambiguous institutional guidance, fear of reputational risk, and the emotional toll of constant visibility.ConclusionNurse digital content creators play a crucial role in improving health literacy and reshaping the image of nursing in society. However, their engagement raises ethical questions that demand updated professional guidelines and institutional recognition. Integrating digital ethics and social media communication into nursing curricula and institutional policies is essential to safeguard professional integrity and enhance the educational potential of online engagement.

'Moral resilience' is a concept whereby individuals sustain and restore their integrity in the face of moral distress. While the key aspect of this concept is the individual's integrity, some indicate that personal and professional integrity differ. In clinical practice, a phenomenon is observed where nurses demonstrate resilience and behave ethically in accordance with their professional values. However, this phenomenon cannot be fully explained by moral resilience. This study proposes the concept of ethical resilience, a phenomenon in which resilience and ethical behaviour are demonstrated towards ethical issues, by undertaking concept synthesis. Articles that mention ethical resilience were selected from among those released on PubMed and CINAHL and Web of Science and Eric (up to 20 January 2024). Walker and Avant's method was used for the concept synthesis. Four attributes were extracted for ethical resilience: (1) grasping ethical issues, (2) integrity as a nurse, (3) flexible and tenacious approach, and (4) collaboration to resolve ethical issues. Based on the results of concept synthesis, nurses' ethical resilience was defined as the ability to sustain or restore professional competence when facing ethical issues while assessing the situation and collaborating with others. This concept describes a positive approach to ethical issues oriented towards professional ethical behaviour. The concept of ethical resilience was derived from previous studies accumulated to this date. Research on resilience to ethical issues and moral distress is still in its infancy, and thus it must be examined further. It is expected that discussion on these matters will advance further along with the concept of ethical resilience.

BackgroundAssisting patients with oral eating and drinking is a fundamental aspect of nursing activity, yet its ethical dimensions remain underexplored. This study addressed two key questions: (1) How do nursing students perceive the task of assisting patients with oral eating and drinking? (2) What ethical concerns do they encounter in this care?.Research designA qualitative descriptive approach using thematic analysis.Participants and contextForty-nine undergraduate nursing students with clinical experience from a single university in Brunei participated through online individual text-based interviews.Ethical considerationsThe study was approved by the University Research Ethics Committee. Participants provided digital informed consent.FindingsStudents highlighted the importance of preserving patient dignity through respectful and person-centred care, prioritising both verbal and non-verbal consent, and advocating for patients' needs. They expressed that advocating effectively for patients requires moral courage and professional responsibility. Three themes emerged: (1) carrying out respectful care, (2) making consent a priority, and (3) learning to speak up for patients.ConclusionsNursing students recognised that assisting patients with eating and drinking is an ethically significant practice requiring respectful care, attention to consent, and advocacy. Nursing education should strengthen ethical sensitivity and advocacy skills to prepare students for these responsibilities.

Background: Nurses and social workers play central roles in palliative care. While moral agency and professional identity have been widely studied, they are rarely examined together, leaving their intersection in palliative care insufficiently understood. Aim: The aim of this integrative review was to identify and analyze the key enablers and barriers influencing the construction of professional identity and the enactment of moral agency among nurses and social workers in the context of palliative care.Methods: The synthesis followed Whittemore and Knafl's integrative review methodology. 12 databases were queried between February 2022 and November 2023, and a manual search was conducted to identify additional publications. Qualitative analysis was performed using the three concurrent analytic activities proposed by Miles, Huberman, and Saldaña.Results: Of the initial 1448 articles retrieved, 34 were selected through screening, and 4 additional articles were included through manual search, for a total of 38 articles reviewed. For moral agency, the enablers were supportive cultures, relationships with patients and their relatives, and moral capacities and inner dispositions. The barriers identified were restrictive cultures, insufficient resources and workload, and interpersonal value conflicts and moral dissonance. For professional identity, the enablers included making a difference for patients, advocating for patient choices, and patient gratitude as a recursive loop. The main barriers were biomedical dominance and professional devaluation, and value tensions and emotional norms. This review revealed that both concepts are predominantly explored within the nursing literature, are deeply interconnected, and tend to reinforce each other. They also share common enablers and barriers in palliative care settings.Conclusion: The findings suggest the importance of incorporating both concepts into nursing education to support ethical competence in palliative care and to help mitigate the moral distress often experienced by nurses.Hoping this resolves the issue.