Nursing Ethics最新文献

Screening for dementia and mild cognitive impairment (MCI) in community-based settings helps connect vulnerable older adults to medical and social support services promoting well-being. Referencing a universal screening program for unhoused older adults seeking emergency shelter services as a case example, this paper calls attention to alignment of programmatic features with the four principles of biomedical ethics, beneficence, nonmaleficence, autonomy, and justice. Regarding beneficence, homeless services workers gain insight into clients' needs and can facilitate engagement with resources to aid in their successful exiting of homelessness. Using assessment findings to promote safety in shelter environments incorporates nonmaleficence. Concerning autonomy, by choosing to share screening results with healthcare providers and other human service stakeholders such as public safety officials and social service professionals, older adults are empowered to take charge of their care. Justice is embodied by the ability to influence policy changes related to homelessness prevention and equitable distribution of health resources.

BackgroundMoral distress occurs when ethically appropriate actions cannot be implemented, resulting in cognitive and emotional strain linked to outcomes like burnout and staff turnover. Despite extensive cross-cultural validation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP), no Italian adaptation currently exists, limiting research in Italian contexts.AimTo culturally adapt and validate the Italian version of the Measure of Moral Distress for Healthcare Professionals (MMD-HP-ITA) within two major Italian healthcare settings.MethodsAn observational multicenter cross-sectional study was conducted from December 2022 to September 2023. The original questionnaire underwent forward-backward translation. Confirmatory and exploratory factor analyses evaluated structural validity, and Cronbach's alpha assessed internal consistency. Construct validity was tested by correlating scores with the Ethical Leadership Scale.ParticipantsA sample of 567 healthcare professionals (median age 43 years; 74% female; 74% nurses) was recruited and completed the Italian version of the questionnaire online.Ethical considerationThe study was approved by the Ethics Committees of the two healthcare institutions involved. Informed consent was obtained from all participants.ResultsThe Italian version demonstrated strong internal consistency (Cronbach's α = 0.96). Exploratory factor analysis supported a three-factor model explaining 58.6% of the variance, with dimensions reflecting: (1) System-level constraints, (2) Team-level dynamics, and (3) Patient/family-level conflicts. Convergent validity was confirmed via significant associations with related constructs: moral distress scores were higher among nurses, younger professionals, and those considering job departure, and negatively correlated with ethical leadership ratings (r = -0.375, p < 0.001).ConclusionThe Italian version of the Measure of Moral Distress for Healthcare Professionals is a reliable and valid instrument for assessing moral distress among Italian healthcare professionals, effectively capturing the multidimensionality of the construct in a culturally relevant way.

BackgroundDying with dignity in intensive care units (ICUs) presents ethical and practical challenges, particularly within high-tech environments that often prioritize life-saving interventions over holistic end-of-life care. Respecting patient dignity requires attention to physical, emotional, and spiritual needs, as well as to privacy and family involvement.AimThis study aimed to explore the experiences of intensive care nurses in providing a dignified death to their patients, with a focus on understanding the factors that influence this process, the challenges encountered, and the care approaches employed.Research designA descriptive qualitative design was employed. Data were collected through in-depth semi-structured interviews and analyzed using Braun and Clarke's thematic analysis framework.Participants and research contextTwenty ICU nurses from eight different hospitals participated in the study. Participants were selected through purposive and snowball sampling techniques.Ethical considerationsEthical approval was obtained from the institutional review board. All participants gave informed consent, and the study followed COREQ guidelines.FindingsTwo main themes and eight sub-themes were identified. The first theme, Practices that support death with dignity, included peace of body, ensuring privacy, space for family farewells, fulfilling last wishes, and meeting spiritual needs. The second theme, Obstacles to death with dignity, included lack of staff, desensitization to death, and lack of knowledge.ConclusionsICU nurses play a vital role in promoting dignified death by addressing patients' physical, emotional, and spiritual needs. However, systemic barriers such as limited staffing, emotional burnout, and insufficient training hinder the consistent delivery of such care. Institutional reforms focusing on workforce support, education, and culturally sensitive protocols are essential to improve the quality of end-of-life care in ICUs.

BackgroundComplex health care environments present moral dilemmas for clinical nurses and nursing students that challenge their professional development as well as their physical and mental health. Ethical sensitivity (ES) is seen as a prerequisite that enables clinical nurses to make appropriate ethical decisions when facing a dilemma; therefore, ES should be a development focus for nursing students.PurposeThe aim of this study is to conduct a systematic evaluation of existing instruments to assess moral sensitivity (MS) or ES in nursing students. We subsequently provide recommendations of the proper research tools that can be used in future studies based on our study results.MethodsA systematic literature search across nine databases from their inception to November 17, 2024 was first conducted. Two researchers then independently screened these studies, which were published in English or Chinese. The studies evaluated were designed to develop or validate a scale used to measure ES or MS among nursing students. The COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) guidelines were followed to evaluate both the methodological quality and the quality of the psychometric properties of the identified tools. Finally, data synthesis was performed.ResultsWe ultimately included 13 assessment tools used for the assessment of ES or MS among nursing students. Only one tool was rated A, and four tools were rated C and not recommended for use. The remaining tools were rated B, and they have potential for assessing MS and ES among nursing students.ConclusionA majority of the tools included in this study still require further revision to enhance their quality prior to their effective use in MS and ES assessments. The COSMIN guidelines indicated that future studies should describe the development and validation of measurement tools in detail and improve their current data analysis methods.

BackgroundMoral injury, first identified in military settings, is increasingly recognised in healthcare, yet little is known about its impact on psychiatric nurses, particularly in Japan. Japanese psychiatric care remains heavily institutionalised, with widespread use of involuntary treatment and mechanical restraint, raising ethical concerns.AimThis study explores the experiences and causes of moral injury among psychiatric nurses in Japan who resigned due to moral or ethical distress.Research designA qualitative descriptive design was adopted.Participants and research contextSemi-structured interviews were conducted with 12 former psychiatric nurses between May 2024 and February 2025. Participants were nurses who had worked in psychiatric settings and quit due to ethical problems. They were recruited through purposive and snowball sampling. Data were analysed thematically.Ethical considerationThe study was conducted after the research ethics committees had approved, written informed consent was obtained from the participants, and their privacy was carefully considered.ResultsIn this study, two of six main themes are reported: (1) causes of moral injury and (2) experiences of moral injury. Nurses reported morally injurious practices such as unjustified mechanical restraints, neglect of patients, long-term institutionalisation for profit, physical abuse, and coercive treatments. These actions often conflicted with their personal and professional values, leading to negative feelings including guilt, shame, anger, and isolation. Many attempted to resist or improve care but faced institutional backlash or apathy from colleagues. Cultural norms valuing conformity and professional hierarchies further hindered ethical action and reinforced silence.ConclusionMoral injury among psychiatric nurses in Japan is deeply tied to systemic and cultural factors that normalise unethical practices and discourage dissent. The findings underscore the need for structural reform in psychiatric care, greater ethical support for nurses, and recognition of resistance not as insubordination but as a vital expression of professional integrity.

Background: Moral sensitivity, moral injury, and compassion fatigue are critical factors affecting the mental health and professional development of nursing interns, which have been studied in recent years. Moral development and mental health of nursing interns directly impact the quality of nursing care and patient safety.Aim: To explore the relationship among moral sensitivity, compassion fatigue, and moral injury among nursing interns and to analyze the role of moral injury in the relationship between moral sensitivity and compassion fatigue among nursing interns.Design: A correlational study design was employed. From October 2024 to January 2025, 206 eligible full-time nursing interns were recruited from Xi'an Medical University, Shaanxi Province. Data collection involved demographic questionnaires, Moral Sensitivity Questionnaire, Moral Injury Symptom Scale-Healthcare Professionals version, and the Compassion Fatigue-Short Scale. The relationships between moral sensitivity, moral injury, and compassion fatigue were examined using Pearson's correlation coefficient. Statistical significance was determined by a p-value of 0.05 or below. The mediation effect analysis was performed using the bootstrap method with 5000 bootstrap values. Data analysis was conducted using SPSS 27.0 and STATA 18.0.Ethical Considerations: This study was approved by Xi'an Medical University (XYLS2025001). The researchers ensured that participants were fully informed about the study's purpose and guaranteed that non-participation or withdrawal would not adversely affect their academic or internship outcomes. Informed consent was obtained from all participants.Results: There was a positive correlation between moral sensitivity and moral injury (r = 0.783, p < .001), and a positive correlation between moral sensitivity and compassion fatigue (r = 0.869, p < .001). The findings indicated a positive correlation between moral injury and compassion fatigue (r = 0.644, p < .001). The relationship between moral sensitivity and compassion fatigue was fully mediated by moral injury (β = 1.707, 95% CI: 1.252-2.162).Conclusion: Future studies could explore strategies to mitigate the adverse impact of moral sensitivity and moral injury on compassion fatigue among nursing interns.

BackgroundGlobally, ethics is recognized as a critical component for ensuring equitable and sustainable genomic healthcare. However, prior research has largely overlooked the ethical aspects when assessing nurses' genomic competence.Research aimThis study aimed to assess the genomic competence of nurses in Finland, with a specific focus on their perspectives regarding ethics in genomics.Research designThis was a cross-sectional study conducted among registered nurses in Finland.Participants and research contextThe data were collected via an online survey between October 30 and December 31, 2023, using the Canadian Adaptation of the Genetics Genomics Nursing Practice Survey (GGNPS-CA), which evaluates attitudes, receptivity, confidence, competency, knowledge, social systems, and the decision adoption process in genomics with ethical dimensions. A total of 234 registered nurses participated.Ethical considerationsThe study was ethically approved by the Ethics Committee of the Tampere Region, statement number 46/2023.ResultsWhile 76.8% of nurses rated their self-assessed understanding of genomics as poor, their actual Knowledge Score was relatively good (mean 9.12/12, SD 1.44). In addition, nurses reported limited understanding of the ethical issues associated with genomics, particularly concerning equity. The majority (59.4%) believed it was very important for nurses to become more educated on ethical issues, while 28.6% considered it somewhat important.ConclusionsThe findings suggest a strong perceived need among nurses for further education in both genomics and its ethical implications. The discrepancy between self-assessed and actual knowledge may reflect low confidence, which was additionally reported in the ethical issues. Low confidence is possibly influenced by the early stage of genomics integration into nursing practice.

BackgroundThe application of care technology is complex, and has an impact on all stakeholders. A specific issue with surveillance technologies is the resulting ethical dilemmas. These dilemmas often touch on people's values, which arise from their perspectives and determine their attitudes and behaviour. One of the prerequisites for successful stakeholder involvement is knowing and acknowledging their values. Schwartz's theory of human values has been empirically tested and facilitates the prediction of attitudes and behaviours in different contexts.Research aimTo develop, test and validate a conversation instrument suitable for use in interviews to explore stakeholders' values regarding the application of surveillance technologies. The instrument was based on Schwartz's ten values model and adapted to fit the stakeholders' (professional) backgrounds, education and language levels.Research designWe integrated and adapted Schwartz's ten and nineteen values model, the Personal Value Dictionary, the Portrait Values Questionnaire and Schwartz's Value Survey to value cards tailored to the stakeholders' education and language levels. The adaption was an iterative process involving expert consultation. The value cards were validated in 34 interviews with stakeholders involved in the application of surveillance technologies for people with dementia in nursing homes.Ethical considerationsThis study was approved by the Ethical Research Board of Tilburg University (ID TSB_RP771).FindingsThe iterative process resulted in a concept version of the value cards, with expert feedback and 'member checks' guiding final revisions. The value cards helped participants articulate their values and were seen as useful tools for reflecting on key considerations related to surveillance technologies.Discussion and conclusionValue cards assisted stakeholders in sharing their most important principles regarding the application of surveillance technologies and may help explore their values related to complex technological innovations in the context of psychogeriatrics.

Artificial Intelligence is revolutionizing the field of healthcare. In this context, a new medical paradigm is emerging and becoming consolidated, known as 5P Medicine, which refers to five key areas of development: Predictive, Preventive, Personalized, Participatory, and Precision Medicine. The field of nursing is not immune to this revolution. The increasingly prominent presence of AI, and especially robotics, calls for a thoughtful reflection on its impact on the profession. The Ethics of Care is a genuine framework for nursing ethics whose conceptual framework is characterized by recognizing care as the essence of nursing. This approach allows for reflection on the issue from the perspective of praxis: the nursing professional is a moral agent who uses technology to achieve a goal, namely, good care. The paradigm of the Ethics of Care enables reflection on how technology can assist, enhance, or distort the caregiving relationship.