Nursing Ethics

Lee, Sujeong; Cho, Hyeonmi

doi: 10.1177/09697330261437309pmid: 41863252

BackgroundHospital nurses frequently encounter ethical conflicts in daily practice. Moral courage is essential for acting according to ethical principles. Leadership and a supportive unit climate may enable nurses to enact moral courage, yet empirical evidence on the mechanism linking authentic leadership to moral courage remains limited.AimTo examine relationships among nurses’ perceptions of unit managers’ authentic leadership, psychological safety, and nurses’ moral courage and to evaluate whether psychological safety mediates the association between authentic leadership and moral courage.DesignA cross-sectional descriptive correlational design with mediation analysis.Participants and research contextA total of 211 hospital nurses in South Korea completed an online survey. Moral courage, authentic leadership, and psychological safety were measured using validated Korean versions of the Nurses’ Moral Courage Scale, the Authentic Leadership Questionnaire, and the team psychological safety scale. Data were analyzed using Pearson’s correlations, multiple linear regression, and PROCESS model 4 with 5000 bootstrap resamples.Ethical considerationThis study was approved by the Institutional Review Board of the authors’ affiliated university. Before accessing the questionnaire, participants reviewed an online information sheet describing the study purpose and procedures, potential risks and benefits, assurances of anonymity, and the voluntary nature of participation, including the right to withdraw at any time. Only those who provided electronic consent by selecting “I agree” proceeded to the survey.FindingsHigher psychological safety and authentic leadership were associated with higher moral courage. Moral courage was also higher among nurses working in intensive care units, operating rooms, or emergency departments, charge nurses, and nurses who had received ethics education during the past year. Psychological safety partially mediated the association between authentic leadership and moral courage.ConclusionInterventions that develop authentic leadership and strengthen psychologically safe unit climates, alongside meaningful ethics education, may support nurses’ ethical action in clinical practice.

Sarmadi, Sogand; Zare-Kaseb, Akbar; Sanaie, Neda; Borhani, Fariba

doi: 10.1177/09697330261428625pmid: 41797692

BackgroundUse of physical restraints in intensive care units (ICUs) creates ethical challenges for nurses and often causes moral distress as they balance patient safety with autonomy and dignity.Research aimTo explore Iranian ICU nurses’ experiences of moral distress related to decisions about PR use.Research designAn exploratory qualitative approach was used.Participants and research contextTwenty Persian-speaking ICU nurses with at least two years’ clinical experience were purposively recruited from hospitals affiliated with Shahid Beheshti University of Medical Sciences between September 10 and November 14, 2025. In-depth semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed using Elo and Kyngäs’s three-phase content analysis. Trustworthiness was ensured via Lincoln and Guba’s criteria of credibility, dependability, confirmability, and transferability.Ethical considerationsApproved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences (IR.SBMU.RETECH.REC.1404.397). Written informed consent and reconfirmed verbal consent were obtained.ResultsAnalysis generated 323 initial codes; 201 remained after refinement. Two principal categories emerged: (1) Moral suffering in clinical decision-making—ethical conflicts, negative emotions, consequences for the patient, and for nurses; and (2) Adaptation and efforts to reduce moral distress—contextual factors, coping strategies, and suggestions for reducing moral distress. Participants described emotional exhaustion, guilt, reduced motivation, and compromised quality of care. Key contributing factors included staff shortages, workload pressure, and unilateral physician orders. Coping strategies comprised peer support, temporary distancing from the situation, and spiritual or self-soothing practices. Suggestions for reducing moral distress emphasized education on restraint alternatives, clear clinical guidelines, and strengthened interprofessional decision-making.ConclusionMoral distress related to PR use among ICU nurses stems from tensions between patient safety and dignity and is shaped by organizational and contextual factors. While nurses described individual strategies to cope, organizational support, clearer guidance, and collaborative decision-making may reduce ethical burden. Further research should examine applicability in other clinical and cultural contexts.

Stuart, Peter

doi: 10.1177/09697330261424352pmid: 41811112

BackgroundHistorically love in nursing has been expressed as tender loving care but a move to technological thinking in nursing and the integration of healthcare systems may have changed this to one where love may be distant or avoided from the arena of care. It may now uncertain if love in nursing is an essential part of care, or supererogatory and additional to a paid duty of care.Research aimA study was conducted to investigate hospital nurses’ experiences of providing end-of-life care. A core theme from the study was the nurse’s expression of love. This article reports on this outcome and aims to provide clarity regarding the current nature of love in nurses’ care.Research designInterpretative phenomenology was used to explore hospital nurses’ experiences of providing end-of-life care.Participants and research context6 UK registered nurses with experience of hospital end-of-life care took part.Ethical considerationsEthical approval was gained before commencing the study. All participants consented to take part.FindingsThe nurses’ end-of-life care actions were done willingly with goodness, selflessness, sometime courage, placing others before themselves and going beyond their duty of care. As a consequence, their love is universal and not bound by a professional care ethic but given freely of themselves as a gift.DiscussionThe nurses’ action described love as both agape and eros suggesting a universal love. This was suggested a love not bound by a professional care ethic but one given freely of themselves as a gift.ConclusionsA contemporary view of love in nursing care is presented; when caring for dying vulnerable people in hospital, the value of love for another person is prevalent in the nursing care provided. It is not bound by a duty to care but is an addition to the process of care and is given freely of self.

Lyytikäinen, Satu; Kangasniemi, Mari; Moilanen, Tanja

doi: 10.1177/09697330261441782pmid: 41960974

BackgroundNurses’ unprofessional behavior endangers quality of care and patient safety as well as nurses’ careers and work communities. Existing knowledge concerning nurses’ unprofessional behavior and its effects on patient care should therefore be considered to facilitate early identification and the development of preventive strategies.AimThe aim of this scoping review is to systematically map and summarize existing knowledge about unprofessional behavior among nurses in order to support the development of strategies for its early detection and prevention.MethodA scoping review was performed based on electronic searches of the CINAHL, PubMed, Scopus, Web of Science, and ERIC databases together with manual searches of the reference lists of all publications retrieved in the initial searches. The database searches spanned the period from database creation to October 2024. Only peer-reviewed empirical research papers published in English were considered for inclusion. Publications were selected using predefined inclusion and exclusion criteria, and altogether 40 studies were included. Data was analyzed using descriptive methods.FindingsThe terms used in relation to unprofessional behavior are related to neglect and abuse, unethical behavior, and misbehavior. Types of unprofessional nursing behavior during patient care include neglecting nursing tasks, betraying professional confidence, and violating patient integrity. These behaviors may create risks to patient safety and cause patient dissatisfaction. Reasons for unprofessional behavior included nurses’ personal life histories, lack of professional competencies, and factors relating to the work environment and community.ConclusionsOur findings indicate that unprofessional behavior by nurses is an umbrella term, covering various forms of inadequate and unethical behavior. In future, more attention must be paid to nurses’ working conditions and ethical skills to protect patients’ safety and strengthen the nursing profession.

Tanaka, Maki

doi: 10.1177/09697330261451367pmid: 42190131

BackgroundContemporary nursing practice involves increasing complexity, time pressure, and organisational demands that require rapid judgement. Nurses are also expected to address the vulnerability of patients and families while maintaining dignity. Ethical tensions often occur when institutional expectations, professional responsibilities, and personal conscience do not fully align. Although conscience is recognised as an important ethical resource in nursing, little is known about how it is experienced in everyday clinical practice.AimThis study aimed to examine conscientious pauses experienced by nurses in Japanese nursing practice and to analyse how harmony is experienced and reconfigured during these ethical moments.Research designA thematic narrative analysis explored nurses’ ethical experiences in everyday practice.Participants and research contextTwelve nurses working in healthcare institutions in Japan participated in the study.Ethical considerationsEthical approval was obtained from the relevant ethics committee, and all participants provided informed consent.FindingsConscientious pauses occurred in several ways: as deliberate hesitation to avoid premature judgement, as relationally sensitive actions to maintain harmony, as engagement with organisational and institutional tensions, and as ongoing processes of meaning-making over time. These pauses were not limited to specific clinical domains and often appeared as sensitivity to unspoken vulnerability rather than explicit ethical claims. Harmony was experienced not as a fixed value but as a relational condition negotiated and reconfigured through practice.ConclusionsConscientious pauses are relational and temporal ethical practices that enable nurses to address vulnerability in daily care. By viewing ethics as lived experience rather than solely as decision outcomes, this study emphasises the need to recognise and support conscientious pauses as shared ethical moments in nursing practice.

Kvande, Monica Evelyn; Angel, Sanne; Højager Nielsen, Anne

doi: 10.1177/09697330261435046pmid: 41894817

Using Scandinavian literature reporting patient experiences of intensive care as a case, the aim of this qualitative systematic review was to explore if humanising was addressed in the descriptions of patient experiences and, if so, what words and theoretical perspectives were used to underpin the results. A comprehensive search of qualitative studies published between 1 January 2016 and 12 December 2024 was conducted in Embase, CINAHL, MEDLINE, Scopus, and Web of Science. Twenty-nine studies reporting patient ICU experiences were included and analysed using thematic synthesis following Thomas and Harden. The review adhered to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist. The terms humanisation and de-humanisation were not explicitly used, but the studies engaged with these concepts by corroborating the three themes that defined humanising ICU in this study: (1) feeling recognised as a human being when experiencing connectedness with healthcare professionals, (2) feeling connected with themselves and the situation when experiencing safety and well-being, and (3) feeling connected with significant persons and life outside the ICU. In addition, our analysis identified a further theme: (4) experiencing capacity to influence the situation when able to express themselves. Humanising intensive care involves ethical and caring engagement with the patient, helping them feel connected, experience well-being, and influence their situation. Although Scandinavian literature has not directly studied humanisation, it has focused on understanding patients’ experiences and addressing the ontology of critical illness. As such, humanising ICU aligns well with Scandinavian nursing traditions.Implications for clinical practiceICU staff should actively listen to patients and encourage them to express needs and preferences, create a safe and calm environment that supports well-being, and maintain communication with patients and families to promote a humanising approach to intensive care.

Tarakcioglu Celik, Gul Hatice; Ariburnu, Ozlem; Dinc, Leyla

doi: 10.1177/09697330261441781pmid: 41958060

BackgroundPatient privacy is a fundamental value and core ethical principle in healthcare. In Turkey, privacy is protected by legal regulations while also shaped by cultural and religious norms, which together influence how it is perceived and practiced in clinical settings.AimThis study explores how adult hospitalized patients perceive and experience patient privacy.Research DesignA descriptive qualitative approach guided by COREQ checklist was employed.Participants and Research ContextPurposive sampling was used to ensure variation, and thirty-three adult inpatients from general medical and surgical wards in five hospitals across Ankara participated in the study between the period of October and November 2024. Data collection involved face-to-face semi-structured interviews, and data saturation was reached when no additional findings, codes, or themes emerged. Braun and Clarke’s six-phase thematic analysis was applied to analyze the data. Some of the patient statements were included to illustrate key points.Ethical ConsiderationsApproval was granted by the Hacettepe University Health Sciences Research Ethics Committee (ID: 2023/08-24). All participants provided written and verbal informed consent.ResultsFour main themes emerged: (1) “The concept of privacy”—patients viewing privacy as a moral and human right connected to bodily integrity; (2) “Perception of patient privacy”—including bodily, informational, and emotional aspects; (3) “Protection of patient privacy”—practices that promote feelings of safety, well-being, and respect; (4) “Violation of patient privacy”—experiences that evoke fear, regret, and avoidance of healthcare. Cultural and religious norms—especially modesty and confidentiality—strongly shape perceptions.ConclusionsPatient privacy in Turkey is shaped by ethical, legal, and cultural values. Culturally sensitive patient care that respects patients’ physical, informational, and emotional boundaries is essential. To promote trust-based, ethical practice, we recommend improving environmental arrangements, enhancing data security measures, and providing ongoing ethics education for healthcare professionals.

Abdullahzadeh, Mehrdad

doi: 10.1177/09697330261424356pmid: 42033333

Male infertility—defined by the World Health Organization as the inability to achieve pregnancy after 12 months of unprotected intercourse due to male-factor reproductive impairment—contributes to nearly half of infertility cases worldwide. Yet within nursing scholarship, men’s reproductive experiences remain only partially visible, reflecting longstanding gendered assumptions that equate reproduction with femininity. This epistemic underdevelopment has ethical consequences: it sustains stigma, delays help-seeking, and limits nursing’s capacity to provide equitable, relationally attuned care. Drawing on a conceptual synthesis that integrates masculinity theory, cultural humility, and relational care models, this paper advances an epistemology of inclusion for nursing ethics. The analysis interrogates how psychosocial, cultural, and relational mechanisms shape men’s experiences of infertility and how their limited representation in nursing knowledge constitutes a form of hermeneutical and testimonial disadvantage. The Integrative Couple-Centered Nursing Framework (ICCNF) is introduced as an ethical praxis that operationalizes inclusivity through assessment, education, counseling, and advocacy. By reframing male infertility as a justice issue and a site of epistemic responsibility, the paper argues that nursing must reconfigure its epistemological boundaries to meaningfully advance equity in reproductive health.

Reato, Francesca; Bonaccorso, Alessia; Lommi, Marzia; Ivziku, Dhurata; Picozzi, Mario

doi: 10.1177/09697330261449458pmid: 42213603

BackgroundThe healthcare system is characterized by increasing complexity. As moral challenges in healthcare become increasingly frequent, healthcare professionals, patients, and families turn to Clinical Ethics Consultants (CECs) for support. This evolving scenario highlights the importance of establishing clear professional standards and competencies for consultants to ensure qualified, transparent, and ethically rigorous support.Research aimTo define a repertoire of technical-professional and transversal competencies for CECs.Research designA qualitative descriptive approach, employing the “Interview to the Double” and Hierarchical Task Analysis (HTA) techniques.Participants and contextTwenty-four Italian CECs, with interdisciplinary professional backgrounds were asked to imagine a ‘Double’ taking their place, to whom they would provide detailed instructions on activities, decisions, and daily interactions during consultations. Subsequently, HTA was used to map elements hierarchically into competencies. The interviews continued until data saturation was reached.Ethical considerationsThe study was conducted in accordance with international ethical guidelines and approved by the local Ethics Committee.FindingsOverall, 10 technical-professional and 12 transversal competencies were identified, encompassing 87 and 110 tasks, respectively, organized into 9 main areas of activity and 22 learning outcomes.Discussion and conclusionsThe national repertoire provides an operational tool that combines standardization and flexibility, makes the practice of CECs visible, supports the certification of CECs’ competencies, the development of transparent and evidence-based training pathways, and ensures that ethics consultations are conducted with responsibility, methodological rigor, and ethical grounding. In continuity with international experiences, it contributes to conceptual enrichment, strengthens scientific legitimacy, and supports the professionalization process and the public recognition of the CEC’s qualification as an expert profession.

Arazi, Tajmohammad; Mohammadi, Sepideh; Moeini, Vahid; Sarchahi, Zohreh; Rohaninasab, Mehrdad

doi: 10.1177/09697330261424354pmid: 41878938

BackgroundNurses caring for criminal inmates in hospitals face complex challenges that can compromise holistic and ethical care. In Iran, where incarceration rates are high, this issue is pressing, yet insufficiently explored.Research aimThis study aimed to explore the challenges Iranian nurses encounter when caring for criminal inmates transferred from prison to public hospitals.Research designA descriptive qualitative study using content analysis.Participants and research contextA qualitative study was conducted using purposive sampling with maximum variation to recruit 32 clinical nurses from five major departments (Emergency Medicine, Medical-Surgical, Orthopedics, General Surgery, and Operating Room) of general hospitals affiliated with Neyshabur University of Medical Sciences. Data were collected between October 2024 and January 2025 via in-depth, semi-structured interviews, continuing until theoretical saturation was reached. Data analysis was performed concurrently with data collection using the Granheim & Lundman content analysis method.Ethical considerationsEthical approval was granted by the Research Committee of the xxxx (Ethical code: xxx).ResultsThe central theme emerging from the data was “Failure to provide dignified care.” It included three categories: “Barriers to creating a therapeutic relationship,” “Discrimination in care,” and “Lack of training and Inadequate qualification.”ConclusionsThe findings of the present study revealed ethical, behavioral, communicative, and competency-related challenges faced by nurses. To address these challenges, a comprehensive approach involving structural, educational, organizational, and cultural interventions is essential. It is imperative that nurses provide non-judgmental and unbiased care, with a fundamental emphasis on respecting patients’ humanity.