Nursing Ethics最新文献

BackgroundThe use of assisted reproductive technology (ART) in individuals with intellectual disabilities raises significant ethical tensions between reproductive autonomy and the welfare of future offspring. Global guidelines addressing this dilemma remain absent. In China, nurses frequently encounter these dual responsibilities without clear operational frameworks.AimTo explore how nursing interventions can support ethical decision-making and reproductive safety for an intellectually disabled patient undergoing ART.DesignA qualitative, exploratory single-case study.MethodsThe study followed a 27-year-old woman with mild intellectual disability through an in vitro fertilization (IVF) pathway. A nurse-led dual-intervention strategy was implemented: (1) cognitively adaptive decision-making tools (pictogram-based IVF guides, emoji risk charts, visual medication calendars); and (2) government-integrated perinatal care services, including prenatal registration, structured follow-up, and postpartum home visits.Ethical ConsiderationsEthical approval was obtained, and the study adhered to strict ethical standards, including a tailored informed consent process and robust guarantees of confidentiality.FindingsThe intervention ensured informed consent completion, medication adherence without errors, and comprehensive prenatal tracking via the national maternal health system. The patient delivered a healthy infant (Apgar score = 10). These outcomes demonstrate that nurse-designed cognitive adaptations, combined with systemic safeguards, enhance patient autonomy and reproductive safety.ConclusionThis study illustrates an ethical and practical paradigm for reconciling reproductive justice and cognitive equity in ART. Nurse-led innovations, supported by institutional governance, may inform global frameworks for ethically complex fertility care.

BackgroundMoral resilience enables nurses to navigate ethical challenges and mitigate moral distress, supporting well-being and high-quality care.AimTo synthesize evidence on the level of moral resilience among nurses and identify potential moderating factors.MethodsA systematic review and meta-analysis were conducted across nine electronic databases from inception to December 2024, updated in August 2025. Observational studies reporting quantitative data using the Rushton Moral Resilience Scale (RMRS) were included. Two reviewers independently performed study selection, data extraction, and quality assessment. Random-effects meta-analysis, subgroup analyses, and meta-regression were used to pool data and explore heterogeneity.Ethical considerationsEthical approval was not required as the review synthesized publicly available data.ResultsTwenty-four cross-sectional studies comprising 9510 nurses from seven countries were included. The pooled mean moral resilience score was 2.88 (95% CI: 2.78-2.99), indicating a moderate level. Subscale means were: response to moral adversity 2.66 (95% CI: 2.45-2.87), relational integrity 2.79 (95% CI: 2.62-2.96), personal integrity 2.95 (95% CI: 2.80-3.11), and moral efficacy 3.19 (95% CI: 3.06-3.32). Clinical department and employment type significantly moderated moral resilience.ConclusionsNurses globally demonstrate moderate moral resilience, with the lowest capacity in responding to moral adversity. Targeted training and systemic support are needed, particularly for high-stress departments and non-permanent staff, to enhance ethical practice and safeguard nurse well-being.

BackgroundDignity is a fundamental value and right of every human being and a central concept in nursing care. Due to radical life changes caused by neurodegenerative diseases, there is an increased risk of experiencing impaired dignity.Research aimThe aim was to gain an understanding of how people suffering from selected neurodegenerative diseases make sense of their dignity.Research design and participantsA qualitative, multiperspective interpretative phenomenological design was used, collecting data through semi-structured, face-to-face interviews with 9 participants with multiple sclerosis and 5 participants with Parkinson's disease.Ethical considerationsThe study was approved by the faculty Ethical Committee (No. EK 49/2021).FindingsTwo overlapping themes were identified: Embodiment and new identity affecting self-worth, and Desire to be accepted. The dignity of the participants was shaped by reframing values, active determination to fight for the highest possible quality of life, and receiving support from the community and relationships. Conversely, bodily limitations with unpredictable symptoms, stigmatization, expressions of pity, and loss of independence negatively impacted their sense of identity. In the context of dignified healthcare, participants emphasized the importance of a partnership approach, the need to be heard, and the ability to rely on healthcare professionals. The inhumane approach, disinterest, and paternalism were seen as aspects that increased vulnerability and diminished dignity.ConclusionsIndividual narratives provide valuable insights into the dynamic and relational nature of dignity. Identifying unique lived experiences of dignity shaped by illness and understanding the needs of a particular person is an integral part of dignified life and person-centered care.

This conceptual paper explores the ethical challenges faced by pediatric oncology nurses in healthcare settings where diversity, equity, and inclusion (DEI) frameworks are withdrawn, diminished, or absent. The removal of equity-focused policies heightens moral conflict for pediatric nurses, forcing them to navigate ethical dilemmas without clear institutional support. Drawing on Kohlberg's theory of moral development, alongside complementary perspectives from Perry, Gilligan, Tronto, and Selman, this paper demonstrates how nurses must increasingly depend on postconventional reasoning to protect justice, fairness, and patient-centered equity in culturally complex care. To bridge theory and practice, the discussion integrates real-world vignettes from pediatric oncology contexts, illustrating how institutional vulnerabilities, patient needs, and the moral distress of nurses can intersect in ways that jeopardize health, safety, and overall well-being. These scenarios reveal the ethical tensions that arise when organizational constraints conflict with professional commitments to advocacy, cultural humility, and inclusive care. Framed as a conceptual construction, we have argued for a dual approach to addressing these challenges: a top-down strategy in which healthcare institutions develop alternative ethical frameworks and supportive policies to preserve equity in the absence of formal DEI structures, and a bottom-up approach in which future research explores how individual nurses' moral development can be strengthened through ethics education, reflective practice, and cultural competence training. Ultimately, sustaining equitable pediatric oncology care in the current sociopolitical climate requires more than individual moral courage, it demands institutional accountability, policy innovation, and a reinvigorated commitment to justice in healthcare. This work offers recommendations for nursing educators, clinical practice, and policy to safeguard the dignity, safety, and well-being of every child and family they serve.

BackgroundNursing turnover rates are among the highest measured in recent years, contributing to financial and staffing challenges in the healthcare industry. Citing ethical challenges and subsequent moral distress, nurses have increasingly turned to travel nurse positions. Current literature regarding moral distress and ethical challenges has largely focused on staff nurses, and it is unknown how travel nurses experience ethical challenges and any associated moral distress.AimTo explore travel nurses' experiences with ethical challenges, inclusive of how they respond and feel or mitigate moral distress related to these challenges. Sources of support will be identified, with a focus on personal and organizational resources.Research designA qualitative descriptive study conducted through individual interviews. Participants were recruited with a purposive sampling strategy through flyers and social media. The data was analyzed using inductive and deductive content analysis. Participants and research context: Nurses (n = 15) working as travel nurses in the United States of America. Data was collected between August 2024 and February 2025.Ethical considerationsThis study received approval by the Institutional Review Board at the UMass Chan Medical School and Baystate Medical Center.FindingsThree themes described the participants' experience of ethical challenges. Strategies that travel nurses use to address and cope with ethical challenges include reflective thought, formation of a support network, and contemplation of action strategies.DiscussionTravel nurses' experience with ethical challenges has some unique qualities, and coping strategies have some distinctions from recommended strategies to avoid and mitigate moral distress.ConclusionThis study will inform practice models of travel nursing and strategies to support all nurses encountering ethical challenges in their practice. Nursing leaders should foster strategies for feedback from travel nurses, including ways to improve the ethical environment.

BackgroundSelecting and applying the most effective educational strategies for teaching ethics to undergraduate nursing students is challenging for educators.Research aimThe aim of this study was to compare the effects of three different educational methods in the Nursing Philosophy and Ethics course on students' ethical decision-making levels and to evaluate the perceived effectiveness of the ethics education provided.Research designA quasi-experimental design was used.Participants and research contextThis study conducted on 121 nursing students that divided into simulation with standardized patients, role play, and case analysis groups. Data were collected using the Nursing Ethical Dilemma Test and Nursing Effectiveness of Ethics Education Scale and analyzed using SPSS version 21.0.Ethical considerationsThe study received ethical approval from the University Social Research Ethics Board (Protocol No: 2023/18-01; Date: 1 November 2023). Verbal consent was given by students who voluntarily agreed after being informed about the study.ResultsThe results indicated that there was no statistically significant difference between the groups in terms of mean scores on the Nursing Ethical Dilemma Test, though the case analysis group had slightly higher averages. Among the groups, the simulation group obtained the highest scores on the Nursing Effectiveness of Ethics Education Scale and reported the highest level of student satisfaction.ConclusionsEthics education incorporating active learning strategies, such as simulation, appears to enhance students' perceived effectiveness and satisfaction with ethics education. Nonetheless, considering the absence of statistically significant differences among the three instructional methods, case analysis being more cost-effective and readily implementable remains a viable and practical primary approach in nursing ethics education.

BackgroundLarge-scale disasters, such as the February 6, 2023, Kahramanmaraş-centred earthquakes, significantly affect healthcare systems and frontline professionals, including nurses. Understanding the ethical experiences of nurses' in such contexts is crucial for disaster preparedness and nursing ethics.AimThis study aimed to explore the ethical challenges and moral distress experienced by nurses providing care after the 2023 earthquakes, as well as their coping strategies. The focus was on their lived experiences and professional responsibilities, and the influence of cultural and systemic factors.Research designA qualitative phenomenological approach was adopted to gain an in-depth understanding of the experiences of nurses.Participants and research contextSeventeen nurses were interviewed. The interviews were conducted between June and August 2024. They used a semi-structured guide. All coding and theme development were conducted manually to ensure close engagement with the data.Ethical considerationsEthical approval was obtained from Adiyaman University Social and Human Sciences Ethics Committee (Decision No: 69, 05.06.2024), and all participants provided informed consent, and anonymity was maintained throughout the study.FindingsThe main theme of 'Staying in Limbo' reflects nurses' feelings about being in a state between their personal needs and their professional duties. Three subthemes were identified: (1) Professional Responsibility, which encompasses moral distress, motivation, and ethical values; (2) Managerial Problems, which highlight resource scarcity, organisational deficiencies, and training gaps; and (3) Lessons Learned and Recommendations, which emphasise teamwork, collective ethical decision-making, and systemic preparedness. As they navigated ethical dilemmas within personal, cultural, and institutional frameworks, nurses experienced moral ambiguity, temporal disorientation, and identity fragmentation.ConclusionFactors such as culture, structure, and institutions affect nurses' ethical decision-making in disasters. The findings show the importance of disaster preparedness and response strategies that support nurses in making ethical decisions and provide them with the necessary support.

Ethics education has emphasized abstract principles and the centrality of prospective reasoning without adequately addressing the embodied, emotional dimensions of moral decision-making or moral psychology's changing understanding of how moral decisions are made. These limitations may leave nurses less prepared for the ethical complexity and moral pain involved in clinical practice. This article describes a "Moral Phenomenology" assignment meant to address these inadequacies by integrating insights from Merleau-Pontian phenomenology in ethics education. The assignment guides students through offering a deep description of an ethical dilemma they have faced, applying phenomenological concepts to deepen their understanding of moral perception, and finally, analyzing the dilemma using classical ethical tools and Lisa Tessman's concept of moral failure. By engaging in sustained phenomenological and ethical reflection on personal dilemmas, students undergo ethical formation rather than mere information acquisition, developing into practitioners whose moral intuitions, perceptual sensitivities, and reflective capacities enable them to navigate moral distress with courage and perceive ethical dimensions of care that might otherwise remain invisible.

Moral distress among nurses has been well examined within the literature since the concept's introduction in 1984. Moral distress occurs when constraints result in an individual being unable to act or compelled to act against their professional moral obligations, resulting in a sense of complicity and wrongdoing. Extensive research has explored the experience and consequences of moral distress, particularly among bedside nurses. Despite an abundance of articles regarding moral distress in nursing, few examine the concept among nurse leaders. Leadership roles within nursing can be at the patient care, unit, middle, and executive levels. Existing evidence suggests that nurse leaders experience moral distress similarly to other nursing populations; however, their leadership roles introduce unique challenges and experiences. The purpose of this paper is to present a framework for understanding moral distress among nurse leaders grounded in existing theory and evidence. The Moral Distress Theory, Crescendo Effect, and Ecological Systems Theory served as theoretical frameworks. The conceptual framework was developed from 2022 to 2024 following literature review, empirical (qualitative) validation, and content expert review and validation (n = 5). The Conceptual Framework of Moral Distress Among Nurse Leaders consists of four primary elements: (1) nurse leaders as moral agents within a moral ecology, (2) antecedents of moral distress among nurse leaders, (3) physiological, psychological, and emotional effects of moral distress among nurse leaders, and (4) responsive action(s) versus inaction. This proposed conceptual framework may serve as a foundational understanding of moral distress experienced by nurse leaders and a guide for future moral distress research among nurse leaders.

BackgroundThis study explores intergenerational perspectives on the use of humanoid nurse robots in healthcare settings, recognizing the increasing relevance of robotic technologies and associated ethical, emotional, and privacy concerns.Research aimThe study aims to assess acceptance levels, concerns, and expectations regarding humanoid nurse robots among Generations X, Y, and Z.Research designA mixed-method design combining quantitative survey analysis and qualitative interviews was employed.Participants and research contextThe study was conducted in Türkiye with 45 participants: 15 from Generation X (1965-1980), 15 from Generation Y (1981-1996), and 15 from Generation Z (1997-2012). Visual scenarios depicting robotic nurse applications were used during data collection.Ethical considerationsThe research obtained ethical approval from the Maltepe University Ethics Committee with the decision number 2024/23-02, issued during the meeting held on December 12, 2024 (Meeting No: 2024/23). Informed consent was obtained from all participants, and confidentiality and voluntary participation were ensured.FindingsQuantitative findings showed that Generations Y and Z were more accepting of robots in technical tasks, whereas Generation X expressed skepticism, especially in emergency care roles. Privacy concerns were high across all groups (mean = 4.2). Qualitative interviews revealed that 75% of participants were skeptical about robots' lack of empathy and strongly opposed their use in birth and neonatal care, emphasizing that these emotionally sensitive areas require the compassionate presence and emotional intelligence of human nurses.Conclusions: Cultural and generational characteristics significantly affect the acceptance of humanoid nurse robots. Targeted education, stronger data privacy frameworks, and emotionally intelligent human-robot interaction strategies are essential for successful integration into healthcare. The study confirms the Robot Anxiety Scale's validity and reliability in the Turkish context.