Nursing Ethics最新文献

BackgroundNurses' innovative behaviors play an irreplaceable role in advancing nursing practice, improving healthcare service quality, and driving transformation in the nursing profession. However, existing studies on the factors influencing nurses' innovative behaviors and their underlying mechanisms remain limited, necessitating further investigation.ObjectiveThis study investigated the impact of ethical leadership on nurses' innovative behaviors, examining the mediating roles of innovative climate and self-efficacy.Research designThis is a multicenter longitudinal study with three-wave data collection (February-August 2024) following STROBE guidelines. Structural equation modeling was employed to examine mediation effects.Participants and research contextA total of 1,522 nurses from 16 tertiary hospitals in China completed baseline assessments (T1), with 1,409 (T2) and 1,298 (T3) completing follow-ups. Participants were registered nurses with ≥1 year of experience, sampled through stratified cluster sampling across clinical departments.Ethical considerationsapproved by the Henan University Biomedical Research Ethics Committee (HUSOM2023-478). Participants provided informed consent, data were collected anonymously, and confidentiality was maintained throughout.ResultsEthical leadership significantly predicted innovative behavior (β = 0.334, 95% CI [0.284,0.386]). Both innovative climate (β = 0.059 [0.046, 0.072]) and self-efficacy (β = 0.017 [0.011, 0.023]) served as partial mediators, with a significant chain mediation effect (β = 0.021 [0.015, 0.027]) accounting for 4.87% of total effect.ConclusionEthical leadership not only directly promotes nurses' innovative behaviors but also strengthens this effect indirectly through the chain-mediated roles of innovative climate and self-efficacy. Enhancing ethical leadership can optimize the innovative climate in nursing departments and improve nurses' self-efficacy, thereby effectively fostering their innovative behaviors.

Although principles-based approaches have long been a cornerstone of bioethics and remain well-suited to many aspects of medical ethics, their reliance on deductive reasoning and emphasis on individualistic interpretations of autonomy often fall short in addressing the nuanced complexities of end-of-life (EOL) issues. The Ethics of Care (EoC) provides a comprehensive anthropological and ethical framework that is well-suited for EOL decision-making, including treatment limitations. This article explores the application of EoC to EOL care, proposing that decisions should prioritize care, compassion, relational networks, and context-sensitive judgements rather than the deduction of abstract principles. The inherent tension between EoC as a theoretical framework and its strong orientation toward concrete, relational practice is also discussed. While EoC cannot provide prescriptive steps, it offers valuable insights to complement traditional approaches to ethics. Following it, we propose eight practical guides for improving EOL decision-making. They represent an interpretation of EoC's core elements, interpreted for the specific challenges of treatment limitation. The practical guides are as follows: (1) building a trusting relationship with the patient, (2) identification of the patient's needs and values, (3) respect for the patient's relational part of autonomy, (4) identifying good treatment for the patient, (5) recognition of HCP's own inclinations and interests, (6) weighing different responsibilities, (7) shared decision-making towards best care, and (8) ensuring continuity of care and openness to change. Integrating the EoC perspective into clinical practice can enhance healthcare professionals' ability to navigate the ethical challenges at the EOL.

The integration of artificial intelligence (AI) into healthcare marks a paradigmatic shift, raising not only technical and organizational challenges but also profound ethical questions. This theoretical-reflective paper explores the ethical dimensions of AI from a nursing perspective, focusing on the role of nurse leaders as ethical agents in the digital transformation of care. Drawing on philosophical and ethical frameworks, such as Heidegger's notion of humans as "sensors of machines" and the concept of algorethics, the article argues that AI should not replace the relational, interpretive, and moral dimensions of care, but rather support them, provided its implementation is guided by ethical vigilance. The World Health Organization's principles-autonomy, beneficence, transparency, accountability, justice, and sustainability-serve as the ethical foundation for AI in healthcare, highlighting the need to preserve human dignity and prevent discrimination. Yet algorithmic opacity, automation bias, and data-driven inequities demand renewed attention to responsibility, explainability, and the preservation of human agency. Nurse leaders are called to act along three ethical pillars: fostering transparency in algorithmic processes, ensuring shared responsibility for AI-supported decisions, and sustaining human relationships as the core of care. By reclaiming relational time (kairos) and resisting the delegation of moral judgment to machines, nurses safeguard the human face of care. In doing so, they embody a leadership rooted in presence, justice, and ethical discernment. Ultimately, this paper calls for a proactive governance of AI that anticipates its impacts and ensures its alignment with the telos of nursing: to care for persons with competence, conscience, and compassion.

BackgroundThe promotion of human dignity lies at the core of ethical patient-centered healthcare and encompasses the inherent worth, value, and respect that patients deserve. Little is known about how this concept applies to the distinct needs and challenges faced by young adults (young adults) seeking mental healthcare.ObjectiveThis study hopes to provide deeper insights into young adults perspectives about the factors that contribute to and hinder their sense of human dignity within the mental healthcare system.Research designA descriptive qualitative approach was used to explore participant perspectives through semi-structured interviews. Thematic analysis was performed on the interview transcripts by three coders.Participants and research contextThirteen young adults patients attending an ambulatory mental health clinic for mood and anxiety disorders in London, Ontario participated in this study.Ethical considerationsThis study was conducted in accordance with the Declaration of Helsinki. It was approved by the Health Sciences Research Ethics Board at the University of Western Ontario.Findings/resultsYound adults interviewed emphasize equality and equity as crucial aspects of dignity, value agency and involvement in healthcare decision-making as well as opportunities to engage with peers, and recognize system wide constraints as a barrier to feeling as though they have dignity within the healthcare system.ConclusionsWhile the young adults interviewed acknowledged that dignity is inherent to all people, they emphasized that all people are not treated as though they have dignity either in mental healthcare or in broader society based on their social location. To provide dignity affirming mental healthcare for young adults, clinicians should: approach their relationship with clients from a lens of cultural humility to provide individualized care, directly involve clients in their treatment plans, encourage client connection with their peers and communities, and actively consider and address systemic challenges that impact client wellbeing and sense of dignity at the societal level.

BackgroundLecturers who are working in empowering environments and are treated with respect by students and managers, feel dignified and capable of being positive role models to their students. The opposite happens when they are not treated with respect and experience challenging working environments.AimThe aim of the study was to explore and describe how nursing lecturers of a designated education institution in South Africa experienced factors that influenced their perceived professional dignity.Research designA descriptive phenomenological research design with a constructivist paradigm applied. Individual interviews were conducted with lecturers to obtain answers to the question 'How do you experience factors at the institution that influence your dignity as a professional person?' Probes were used encouraging the participants to comprehensively describe their experiences. The data were analysed according to the steps designed by Giorgi in which the natural dimension of the phenomenon as narrated by the participants was transformed into the phenomenological dimension of the phenomenon.Participants and research contextThe study was undertaken in South Africa at a nursing education institution and 18 voluntary purposively selected lecturers were involved.Ethical considerationsThe Faculty of Health Sciences Research Ethics Committee at the University of Pretoria approved the proposal and the applicable authorities gave written permission for the research to be conducted. Informed voluntary consent was obtained from the participants before the research commenced.FindingsThe essence of the participants' experiences refer to 'longing for professional dignity.' The supporting constituents are: 'acknowledging lecturers as specialists', 'enhancing their self-determination', 'acknowledging their capabilities', 'promoting collegiality', 'creating conducive teaching environments', 'being respected by students', and 'perceiving lecturers as possessing integrity'.ConclusionThe participants' perceived dignity was influenced by the way they had been treated by students and managers at the designated institution. Their working environment also impacted on their perceived professional dignity.

The integration of artificial intelligence technologies is transforming healthcare and nursing education, offering significant benefits for patient care and professional development. However, as their use grows, it is crucial to address the ethical implications to ensure that fundamental principles like justice and integrity are maintained in both clinical and educational settings. The aim of this integrative review is to explore the ethical challenges, risks, and future perspectives of integrating artificial intelligence into nursing education. It examines how these tools influence ethical decision-making processes, identifies critical barriers, and proposes strategies for ethical implementation. Following an integrative review methodology, 184 articles were identified, with 124 remaining after duplicate removal. Fifteen peer-reviewed studies analyzed. The methodological quality of the included studies was assessed using appropriate Joanna Briggs Institute Critical Appraisal Checklists based on study design. Searches were conducted in the PubMed, Cochrane Library, MEDLINE (Ovid), Scopus, Web of Science, CINAHL, and ScienceDirect databases from 2014 to September 2024. Data was analysed using constant comparative analysis. The review is registered in the PROSPERO database (CRD42024609440). Guided by Rest's Four-Component Model of Moral Behavior, the synthesis was organized under four components. Moral Sensitivity included themes such as ethical and psychosocial effects, data privacy, equity in access, and cultural sensitivity. Moral Judgment covered ethical reasoning skills, AI accuracy, bias, and academic integrity. Moral Motivation addressed over-reliance on AI and the need for ethical frameworks. Moral Character highlighted educator roles and research priorities for ethical AI use. Artificial intelligence offers transformative opportunities for nursing education, but also presents significant ethical challenges. To ensure its responsible integration, nursing curricula must adopt clear ethical frameworks, equip educators with the skills to guide students and address disparities in access.

BackgroundNurses' innovative behavior serves as a crucial driver for organizational improvement and technological advancement. However, the demanding nature of the nursing work environment (characterized by high intensity, risk, and pressure) hinders the sustained development and quality of such innovation. Investigating the factors influencing nurses' innovative behavior is therefore essential for enhancing overall nursing quality and patient recovery outcomes, yet research on these factors and their underlying mechanisms remains limited.AimTo examine the effect of ethical leadership on nurses' innovative behavior and explore the longitudinal mediating role of moral sensitivity.DesignA longitudinal mediated follow-up study with three waves (January-July 2024).Participants: and research Context397 nurses from three Chinese hospitals via multicenter stratified cluster sampling. Inclusion criteria: registered nurses with ≥1 year of experience.Ethical considerationsApproved by the relevant Ethics Subcommittee. Anonymous surveys with informed consent; voluntary participation.FindingsSignificant positive correlations existed between innovative behavior and both ethical leadership and moral sensitivity at each time point (T1, T2, T3). Longitudinal path analysis demonstrated that T1 ethical leadership significantly predicted T2 moral sensitivity (β = 0.26, p < .001), T2 moral sensitivity significantly predicted T3 innovative behavior (β = 0.24, p < .001), and T1 ethical leadership significantly predicted T3 innovative behavior (β = 0.14, p < .001). Moral sensitivity significantly mediated the relationship between ethical leadership and innovative behavior, accounting for 30.24% of the total effect.DiscussionEthical leadership fosters innovation both directly (through psychological safety) and indirectly by strengthening moral sensitivity, which empowers nurses to identify ethical dilemmas and develop novel solutions.ConclusionsHealthcare institutions should cultivate ethical leadership in nurse managers and implement moral sensitivity training (e.g., ethics case discussions) to sustainably promote nurses' innovative behavior and care quality.

BackgroundThe entitlements and rights related to eating for patients with terminal cancer have long been challenged, particularly as deteriorating health conditions may compromise their autonomy in food choices and dietary preparation. Their vulnerable situation remains poorly understood, and limited research has explored the ethical dimensions of their eating-related experiences in the context of home-based hospice care.Research aimThe aim of this study was to gain an in-depth understanding of eating-related experiences in terminally ill cancer patients from an ethical perspective.Research design and participantsThe descriptive qualitative method was conducted to explore the eating-related experience of 11 patients with terminal cancer who receiving home-based hospice care services.Ethical considerationsApproval was obtained from the Biomedical Research Ethics Committee of the corresponding author's University.FindingsThe following three interconnected main themes were identified in patients with terminal cancer: eating not for pleasure but as a form of torture, erosion of existential meaning in dietary restrictions, and social isolation in shared spaces.Conclusion and final considerationsPatients with terminal cancer may face a dilemma as they navigate the balance between their right to enjoy food, cherish their remaining days, and sustain a desire for longevity. It is essential to consider significant ethical concerns surrounding nutrition and emphasize the patients' needs to maintain eating autonomy, dignity, and meaningful communication until their final moments. Future research is needed to explore the ways to foster an environment where both patients and caregivers can engage in effective and equitable dialogue, thereby bridging the gap in perceptions related to eating habits and the deeper existential meanings attached to nourishment.

BackgroundNurses caring for hospitalised children can be told not to disclose information to the patient. Such non-disclosure directives in adult care pose recognised ethical problems, as they impinge on a patient's autonomy and right to their own information, and have been discussed widely in the literature, from a physician's perspective. Despite the ethical implications, there is less discussion of the ethics of withholding information from children. Nurses are well positioned to advocate for the rights of a child while considering their best interests; hence, nurses' thinking about the ethics of non-disclosure directives is valuable.AimThe aim of this study was to explore the experiences and attitudes of nurses with truth-telling to seriously ill children, specifically how nurses frame and think about the ethical challenges when given a directive not to tell the truth to a child.DesignAn interpretive phenomenological approach was employed for this research, with data collected by semi-structured interviews.Participant PopulationTwenty-six nurses in Australia who had cared for children hospitalised with a serious illness in the previous 5 years.Ethical ConsiderationsEthics approval was granted by the University of Melbourne's Human Research Ethics Committee (37283A). Informed consent was acquired from all participants.FindingsFour themes encompass the views nurse-participants expressed about the ethics of a non-disclosure directive: (i) Lying is wrong, (ii) Children should know, (iii) It's hard for us when the child doesn't know, but (iv) It's not our place to tell. Nurse-participants described how a non-disclosure directive affected how they cared for their patients.ConclusionsNurse-participants believed they should be honest and articulated ethical reasons why children should be told the truth about their medical condition, but did not feel they were able to initiate this. It is recommended that nurses are supported in these ethically challenging situations and included in decision-making about how to respond when parents direct that information be withheld from their child.

BackgroundMoral suffering is a growing concern in healthcare, especially in the nursing profession. It encompasses various forms, such as moral distress and moral injury, both of which impact nurses' professional integrity and mental and physical health. Despite extensive research, there is still no consensus on their definitions, distinctions, or causes, which impedes effective interventions. However, given their overlapping characteristics and consequences, joint consideration could offer critical insights to refine existing concepts.AimTo explore how nurses in clinical practice perceive moral suffering and analyze the essence of their experience of moral suffering.Research designData were collected through qualitative, semi-structured online interviews. The interview transcripts were analyzed using qualitative content analysis.Participants and research contextA total of 47 registered nurses from different clinical settings in German hospitals participated in the study.Ethical considerationsThe study protocol was approved by the Institutional Review Board at University Medicine Greifswald. All participants provided written informed consent.FindingsThe essence of moral suffering was determined in five main categories with corresponding subcategories: A trigger situation (1) in which a person in a specific moral disposition is present (2), whereupon they assess the situation as morally meaningful (3) and, accordingly, moral suffering is experienced in its three specific dimensions: (4) the characteristics (dynamic, context-dependence, temporality, fuzziness), dimensions of experience (rational and emotional integrity-related manifestation), and dimensions of action (handling, coping, prevention). This experience of moral suffering has consequences (5).ConclusionsThis study illuminates the complex nature of moral suffering among nurses, revealing its multidimensional essence and the interplay between personal and professional factors. The results underscore the need for a systemic approach to address moral suffering in nursing, emphasizing the importance of ethical leadership and workplace health promotion, and fostering shared values within healthcare teams.