Clinical nurse adherence to professional ethics: A grounded theory

Abstract

Background

Professional ethics is the regulation and discipline of nurses’ daily nursing work. Nurses often encounter various ethical challenges and problems in their clinical work, but there are few studies on nurses' adherence to professional ethics.

Research Aim

An analysis of nursing adherence to nursing ethics from the perspective of clinical nurses in the Chinese public health system.

Research Design

This study adopts the grounded theory approach proposed by Strauss and Corbin.

Participants and research context

Between July 2021 and January 2022, Clinical nurses were recruited for online video interviews using purposive and theoretical sampling methods in seven hospitals in Beijing, Tianjin, Shanxi, Henan, Guangdong, and Fujian, China. Data analysis was conducted using Strauss and Corbin’s coding approach.

Ethical considerations

This study was approved by the Ethics Committee of Sanming First Hospital (MingYiLun 71/2021)

Findings

A total of 27 participants were included. A theoretical model of nursing staff adherence to professional ethics was constructed. The main core was adherence to professional ethics and the other cores were (1) causal conditions: professional ethics code, individual conscience; (2) intervening conditions: personal growth, social support system, matching career compensation, prediction of adverse consequences; (3) action strategies: sticking to professional values, self-regulation, flexible response, post-event improvement; and (4) outcomes: self-harmony, reduced medical disputes.

Conclusions

This study provides an interpretive understanding of why clinical nurses adhere to professional ethics in China and describes the challenges and issues posed by nurses’ use of strategies to cope with ethical adversity. The findings can be used to develop future complex studies.

Keywords

Nurses professional ethics China grounded theory

Introduction

Nursing, as a moral profession, is a moral practice to safeguard the interests of patients.¹ Professional ethics for nurses is a standard of practical behavior for every member of the nursing profession, guiding the practical decisions of nurses’ actions that can improve the care provided by nursing staff,^2,3 including the values, rights, duties, and responsibilities of nurses.⁴ Nurses have a responsibility to themselves, their profession, and their patients to uphold the highest ethical standards.⁵

Professional ethics for nurses are set out in national legislation and international agreements, and are detailed in professional codes. For instance, ICN Code of Ethics for Nurses,⁶ ANA Code of Ethics for Nurses,² and Code of Professional Ethics for Chinese Nurses.⁷ Although established within the nursing profession, the professional ethics for nurses are subject to constant change due to internal and external considerations,⁴ and therefore the principles of professional ethics by themselves do not clearly guide nurses in all settings to make reasonable and ethical service decisions.⁸

As nurses have the most contact with patients of all healthcare professionals,⁹ there is a high frequency and moderate degree of ethical challenges in nursing practice, creating professional burnout, reduced ethical sensitivity, and reduced job satisfaction, to name but a few.¹⁰ This results in a relatively uneven adherence to professional ethics by nursing staff, which over time can put at risk not only the quality of care but also the physical and mental health of nurses and other healthcare professionals.^11,12

Background

Exploring the reasons that can help nurses comply with professional ethics is undoubtedly important. Previous studies research has mentioned ethical resilience,^13,14 the ability of individuals to maintain or restore their integrity in response to moral complexity, confusion, distress, or frustration, and communication within the organization,¹⁵ and support from nurse leaders,¹⁶ as important factors in helping nurses maintain ethical principles in the face of moral adversity. Rushton et al.,¹³ suggest developing moral resilience can help individuals to maintain or restore their integrity in the face of moral complexity, confusion, or frustration and to move smoothly through moral dilemmas. Jia and Chen et al.,¹⁷ put forward that by providing nurses with social support when needed, nurses will feel respected, increase their sense of professional identity and become more passionate about nursing, thus increasing their initiative to comply with professional ethical codes that might otherwise cause problems in professionalism.

Although adherence to ethical principles is an important part of the nursing profession, few studies have focused on adherence to nursing ethics.^18,19 Further research is now needed on the ethical adherence of nursing staff, for example, ethical resilience is a developing concept that has not been accurately applied to nursing in previous studies; other relevant studies have focused in depth on ethical professional compliance and have only been briefly addressed in texts; and the applicability to China is questionable.

This study used a grounded theory approach to construct a concept model to explain the reasons why Chinese nursing staff adhere to nursing ethics.

Methods

Design

This study is guided by Strauss and Corbin’s procedural grounded theory.²⁰ It is a qualitative methodology aimed at constructing a data-based theory, emphasizing the systematic collection and analysis of empirical facts, abstracting theories from empirical facts to grasp underlying social psychological processes, and developing substantive theories with repeatable research procedures and traceability of research results, overcoming problems such as the weak persuasiveness of previous qualitative research results. Accordingly, grounded theory is regarded as the most scientific method in qualitative research.²¹

Participants

This study first used purposive sampling, and as the analysis progressed, nurses were theoretically sampled to collect data from places, people, and events that will maximize concept development, reveal change, and identify relationships between concepts.²⁰ After saturation was reached, the researcher stopped theoretical sampling.

Inclusion criteria: (1) relevant experience in dealing with ethical events; (2) 1 year of clinical work experience; (3) ability to fully express their inner feelings and thoughts; and (4) understanding of the purpose of this study and voluntary participation. Exclusion criteria: (1) not enough time and energy to participate in this study and (2) avoid discussing ethical issues at work. Twenty seven front-line nursing staff from different departments of seven hospitals in six provinces, namely Beijing, Tianjin, Shanxi, Henan, Guangdong, and Fujian were finally recruited as study participants.

Data gathering

Twenty seven in-depth semi-structured online video interviews were conducted between July 2021 and January 2022, with each interview lasting approximately 30–60 min. The researcher spent about 5 min before the start of the interview appropriately exchanging pleasantries and creating a relaxed atmosphere by making the person feel that we are listening carefully through appropriate glances, gestures, or other body language, and after the patient relaxed and completed the general information questionnaire, the interview officially started. The interview outline was determined through literature review, expert consultation, and pre-interviews with a modified sample of 2 clinical nurses.

Data analysis

After the interviews, the audio recordings were transcribed verbatim from the text by two researchers, and information about the interviewees' tone of voice and pauses was also used to assist in the analysis. This study analyzed the data using MAXQDA 12.0 software, which is a powerful tool for qualitative data evaluation and can be used to analyze all unstructured data, including interviews, essays, tweets, and others. It has the benefit of being simple in design and easy to use. Following Strauss and Corbin’s²⁰ approach, by repeatedly listening to the recordings and reading the transcribed text, using three coding stages for textual analysis: performing open coding to conceptualize and scope the data, principal axis coding to establish links between different categories and strengthen the associations between categories, selective coding to clarify the relationships between the principal categories and The constant ratio method was used throughout the analysis to continuously improve the results.

Rigor

The principle of triangulation test was followed to ensure the validity of the study.²² On the one hand, on the basis of theoretical sampling, interviewees from different regions, departments and levels were selected as much as possible to ensure the relevance and comprehensiveness of the information obtained. On the other hand, multiple sources and forms of data were actively collected for cross-validation during the study to determine the authenticity of the events and the accuracy of the data. Finally, after the data coding was completed, it was sent to each participant to ask whether the code truly expressed their original intention.

Ethical consisderation

Ethical approval for this study was obtained from the Institutional Ethics Review Board (approval number MingYiLun 71/2021). The purpose, methods and significance of the study, the anonymity of the participants and the right to withdraw at any time were explained to the participants. All material generated during the study will be kept under the principle of confidentiality.

Findings

This study was conducted among 27 nurses from several hospitals in China. The main participants are female, married, with a bachelor’s degree and an income of more than 5000 RMB per month (Table 1). The data were analyzed to form categories and subcategories of reasons for nursing staff adherence to nursing theory (Table 2). Interviewees are listed in order of interview, using the serial numbers Clinical Nurse1-Clinical Nurse 27.

Table 1.

Demographic characteristics of the participants.

Variables	Dimensions	N	Variables	Dimensions	N
Gender	Male	2	Education	Junior college	1
Gender	Female	25		College	7
Age	20–30	12		Undergraduate	18
	30–40	12		Graduate	1
	> 40	3	Salary income (RMB/per month)	2001–4999	1
Marital status	In marriage	14		5000–7999	15
Marital status	Not in marriage	13		≥8000	11
Job title	Junior and below	14	Working experience (year)	< 5	12
	Intermediate	12		5–10	7
	Senior	1		> 10	8

Table 2.

Categories and Subcategories obtained from interview data.

A model structure to nursing staff to comply with nursing ethics	Category	Subcategory
Causal conditions	Code of professional ethics	Complying with hospital regulations and nursing professional codes, recognition of professional values, clear goals and objectives of nursing care, positive professional attitude, take professional responsibility
Causal conditions	Individual conscience	Personal principles, individual bottom line, self-imposed requirements, know your own personality traits, know what role you play
Intervening conditions	Personal growth	Experience, education, age, working years
	Social support system	Support from clients, support from leaders and colleagues, support from family support
	Matching career compensation	Salary, appropriate workload, sufficient rest time
	Prediction of adverse consequences	Generate a sense of guilt, possible harm to patients, personal interests compromised
Action strategies	Sticking to professional values	Judgment of people and events, rejecting the negative influence of others, dare to speak up, self-restraint in private
	Self-regulation	Talking to others, console oneself, try to adapt, diverting attention
	Flexible response	Put yourself in each other’s shoes, tolerance toward others, take actions within one’s competence
	Post-event improvement	Compensating customers in other ways, reflecting, using mistakes to remind themselves, actively learning
Outcomes	Self-harmony	Meeting the demand, carry out nursing work smoothly, no desire to leave
Outcomes	Reduced medical disputes	Understand the root causes of medical disputes, providing the right medical care to patients, establishing harmonious patient–nurse relationship

Causal conditions

Causal conditions are events that lead to the creation or development of a phenomenon.²⁰ The causal conditions of this study included professional codes of ethics and individual conscience.

Code of professional ethics

This category covers five subcategories of compliance with hospital regulations and the professional code of nursing, recognition of professional values, clear goals and objectives of nursing care, positive professional attitudes and assumption of professional responsibility:

The hospital regime and professional code of conduct are compulsory and we are obliged to comply with them to prevent us from doing anything that might affect our work, such as not being allowed to carry a mobile phone at work or to take a nap during the night shift. (Clinical Nurse 3)

I believe that nursing is more than just a job, it is professional and noble and I feel valued in this profession. (Clinical Nurse 24)

In your working life, you are numb if you go to work every day without your own way forward. I have my own nursing goals … I want to make a career in nursing. (Clinical Nurse 4)

Most people and things are good, and running into something bad doesn’t affect my real attitude to work, meaning that I’m going to do what I need to do and still do it. (Clinical Nurse 5)

I have to take responsibility for my patients and behave in a manner consistent with my profession. (Clinical Nurse 8)

In the healthcare system, the hospital system and the professional code of nursing are important for clinical nurses, not only to regulate what nursing staff say and do in their daily work but also to prevent nursing staff from making mistakes. The professional purpose of nursing staff is primarily to earn a living and achieve aspirations, which makes nursing staff willing to give and keep working for it, and to maintain a positive work attitude and remain calm in front of bad people and events. Nursing staff repeatedly emphasize professional responsibility, which in their eyes even means everything about the job.

Personal conscience

The subcategories of personal conscience are about personal principles, personal bottom line, self-imposed requirements, understanding one’s own personality traits and knowing the role one plays.

You can’t act against your conscience, and what you can do is certainly still in accordance with your principles. (Clinical Nurse 5)

I think one must have a bottom line and not be an immoral person in the future. If the issue breaks my bottom line, then I have to try to avoid it. (Clinical Nurse 27)

People have self-imposed requirements, I want this thing I’m doing to be up to my standards, and I definitely don’t want to do a wrong thing. (Clinical Nurse 6)

I have this personality trait of being more down-to-earth and reliable, so I don’t do anything too out of the ordinary. (Clinical Nurse 24)

I’m in a more senior teaching position, so how can I lead others if I’m going off the rails. It’s a role that I’m in myself and should have limits on myself. (Clinical Nurse 2)

Personal principles guide the actions of clinical nursing staff. Nursing staff’s awareness of their own character traits and the role they play in their working lives makes them set certain standards and limits on themselves, to the extent that it is difficult for nursing staff to do things that break their own ethical boundaries.

Intervening conditions

Intervening conditions are those broad yet general conditions that make a difference to the action/interaction strategy to be adopted by the actor.²⁰ In this study, intervening conditions are personal growth, social support systems, matching career pay, and threat of adverse consequences.

Personal growth

Personal growth incorporates experience, education, age, and years of work.

Each experience is different because there are things that happen to you that just happen to you that are definitely changing for that person. (Clinical Nurse 2)

I’ve been brought up with the kind of education that makes me feel bad about doing these things that are against my morals. (Clinical Nurse 9)

As we get older, people mature slowly. In my twenties, I might see that there are things that I don’t understand and get angry about, and now in my forties I find that it doesn’t really matter, I still do what I have to do and do it. (Clinical Nurse 5)

After I’ve been working for 3–5 years, I’ve got my own judgement, I’ve got my own direction, I’m going with my heart and I think it’s hard to change. (Clinical Nurse 2)

With more age, more education, more years of service and more social experience, nursing staff are growing up and gradually seeing people and things for what they are, and will be more accepting of things and will no longer let things affect them on a moral level.

Social support system

The social support system category consists of support from customers, support from leaders and colleagues, and support from family.

The patients’ support for my work, their monthly comments on my job satisfaction, let me know what it means to stick to my ethics. (Clinical Nurse 1)

We are a team and can seek help from leaders and colleagues. (Clinical Nurse 15)

At the very least, I can ask my family for help. (Clinical Nurse 24)

Therefore, support from service users, leaders and colleagues, as well as family members, helps clinical nurses to act in accordance with professional ethics.

Matching career pay

Wages, appropriate workload, adequate rest time are subcategory of matching occupational remuneration.

If I had enough money to support me, I wouldn’t do things that go against my heart because of the pressure I’m under to survive. (Clinical Nurse 27)

There are things that you are not supposed to do, but the system requires you to do them, and sometimes I am too busy to take care of them, so I feel guilty when I look at such patients sometimes. (Clinical Nurse 6)

After all, the physiological state of man is to sleep at night, but our sleep is interrupted, so some of us are in a bad mood at night, and sometimes we put off work for each other. (Clinical Nurse 16)

If the pay is low, the workload is high and the sleeping hours are long, this will create a poor working experience for nursing staff and will not be conducive to the extent to which nurses obey professional ethics.

Prediction of adverse consequences

The category of prediction of adverse consequences includes the development of feelings of guilt, possible harm to the patient and damage to personal interests.

If the patient is really sick and something happens because of my negligence, I will be deeply condemned in the future. (Clinical Nurse 2)

Even though I was tired, I couldn’t let up when I thought that my negligence could cause irreparable harm to my patients. (Clinical Nurse 15)

If there is a serious adverse event, all kinds of merit and salary will be affected, so this is taken very seriously. (Clinical Nurse 7)

The potential negative consequences of nursing staff breaching nursing ethics and reminding nursing staff to be conscious of nursing ethics.

Action strategies

Action/interaction strategies are the intentional, explicit actions, and internal mental states employed in dealing with the phenomenon.²⁰ The behavioral strategies for nurses to adhere to ethical nursing involve staying true to professional values, self-regulation, response flexibility, and post-event improvement.

Sticking to professional values

This category has four subcategories as follows: judgement of people and events, rejection of negative influences from others, speaking up, and being self-restraint.

I will make my own judgement where it is contrary to my own moral code. (Clinical Nurse 18)

Firstly I wouldn’t do bad things like others, and secondly I would probably keep him at a distance as much as possible, because if he had something bad going on and I worked with him, it might have a bad effect on me. (Clinical Nurse 12)

There are times when I feel that others are wrong and I will argue my case, but it’s up to others to take it or leave it, so I’ll put my own ideas out there. (Clinical Nurse 15)

With or without supervision, I do what is expected of me and what is best for the patient. (Clinical Nurse 4)

Clinical nurses have their own judgment and perceptions of people and events, and do not accept bad influences from others, preferring to act consciously according to their own heart.

Self-regulation

Self-regulation by nursing staff can be achieved by talking to others, self-soothing, trying to adapt, and distraction.

If I get emotional and resist, I just talk to some friends and let the matter go. (Clinical Nurse 13)

My own way of dealing with it is to reassure myself that it's okay. (Clinical Nurse 25)

When I can’t go and change others, I can only adapt and change my mind. (Clinical Nurse 16)

I’m not happy at work, then I go off work for fun and don’t think about work anymore. (Clinical Nurse 11)

Clinical nurses do not store up bad feelings and tend to find outlets for them, which facilitates their compliance with professional ethical requirements in the long term.

Flexible responses

Putting yourself in the other person’s shoes, being tolerant of others, and acting within your means are subcategories of flexible handling.

We nurses need to put ourselves in the patient’s shoes and consider different issues and understand these poor, difficult and unreasonable patients on different levels so that we can think straight, otherwise we feel aggravated every day. (Clinical Nurse 1)

Patients experience a lot of pain that we medical staff do not know, so try to be tolerant in the face of their incomprehensible behavior and harsh words. (Clinical Nurse 3)

I will do what I can, what I can’t do I won’t. (Clinical Nurse 4)

By putting themselves in the shoes of others, nursing staff tend to be able to remain tolerant of others. Constrained by certain realities, caregivers will weigh up the pros and cons and stick to what they can do.

Post-event improvement

Improving afterward means compensating the customer in other ways, reflecting, reminding oneself with mistakes, and proactive learning.

Within my ability, I will make amends for the patient, encourage him, support him and give some other help. (Clinical Nurse 12)

I just like to reflect on how I would handle what I would do if I came across something like that in the future. I don’t think one can keep going on like that all the time without thinking about it and potentially doing the wrong things. (Clinical Nurse 3)

Study more, go around and see more of the world, develop the ability to distinguish between right and wrong, and strengthen your own cultivation. (Clinical Nurse 9)

I might just write it down and then secretly admonish myself that. (Clinical Nurse 12)

If an incident is beyond the nurse’s competence, the nurse will try to improve it afterward, which is a good aid to professional ethics.

Outcomes

Outcomes are the direct result of an action/interaction strategy employed to process, control, or handle the phenomenon.²⁰ This category has two subcategories, namely self-harmony and medical dispute reduction.

Self-harmony

The main outcome of adherence to the ethics of care is that the needs of the nursing staff are met and the nursing work is carried out smoothly, with no desire to leave.

This job allows me to make ends meet, or gives me some professional value and gives me some kind of satisfaction, and I am not supposed to do something that goes against the ethics of nursing. (Clinical Nurse 7)

In all aspects, we will also put ourselves more in his shoes and understand him better, which in turn will help us in our work. (Clinical Nurse 12)

I will be more committed to my ethics and will not leave my job easily. (Clinical Nurse 24)

When nurses do things that are in line with their own perceptions of professional ethics, they believe that they are doing the right thing, and they themselves stop obsessing and reach a state of harmony.

Reduced medical disputes

This category includes three subcategories as follows: understanding the underlying causes of medical errors, providing the right medical care to patients, and building a harmonious nurse–patient relationship.

I cannot understand some of the doctor-patient disputes if, without considering professional ethics, I only see nursing as a means of earning a living. (Clinical Nurse 12)

I should be able to provide the right medical care for my patients, or at least what seems to be a right medical care for now. (Clinical Nurse 6)

All things are mutual, if I think of others, they will not overdo it. (Clinical Nurse 5)

In the process of complying with nursing ethics, nursing staff gradually understand the causes and consequences of disputes and the importance of providing the right medical care to patients and establishing a harmonious nurse–patient relationship, which helps to reduce the incidence of medical disputes.

Discussion

This study constructs a model for the reasons why Chinese nursing staff adhere to nursing ethics. The main reason for nursing staff to maintain nursing ethics is the professional code of ethics and personal moral discipline. A code of professional ethics guides nurses to act and think in a professional and ethical manner. To make sound judgment and decisions in the complex clinical workplace, nurses must follow a code of professional ethics that is socially accepted and adopted.^15,23,24 Personal ethics are formed quietly during development and nurses have their own standards of what is right and wrong.²⁵ When faced with complex and changing ethical situations in the clinical setting, and confusion arises because the professional codes of nursing cannot be fully applied,²⁶ nursing staff tend to follow their own rules.

Our research and similar studies have shown that in some cases nurses have difficulty providing ethical care,²⁷ and this is where mediating conditions play an extremely important intervention role. One of the conditions of intervention that supports nursing staff to maintain ethical conduct is personal growth. Younger, shorter-serving caregivers (with less experience) are often more susceptible to adverse ethical incidents when they first enter the profession.^28–30 Participants reported that, based on the education they received, the frequency of ethical incidents experienced and the professional experience they gained as they get older, the ethics of the nursing profession are gradually integrated and solidified into a personal set of rules for caregivers and actively followed.³¹

A healthy social support system is an important intervention condition that facilitates nurses to express their negative emotions, feel the value of their profession, not feel alone in their efforts, feel more confident in dealing with their discomfort and stress, and recover more easily afterward. Conversely, a lack of social support, denies nurses the opportunity to enhance their moral identity and professional satisfaction, increases the risk of nurses breaching their professional ethics.^32,33 It is worth noting that, unlike other studies,¹⁵ the participants in this study felt that there was a lack of government, institutional support in upholding ethics, and some even felt that they were instead responsible for the higher ethical risk.

This is similar to earlier studies in which the intervention condition of ‘matched professional compensation’ was controversial in supporting nursing staff to uphold nursing ethics.^22,28 The results of this study showed that some nursing staff displayed negative attitudes toward maintaining nursing ethics in the face of overload, low pay and sleep deprivation, while some nurses reported that these factors did not change their commitment to nursing ethics. This may be related to inter-individual differences in the nursing population. What is beyond doubt, however, is that matching professional remuneration is conducive to an ethical nursing workforce.

The last but not least mediating condition was the prediction of adverse outcomes. Almost all participants reported that the current healthcare environment in China is not promising, with increasing disputes between patients and healthcare professionals and providers, and that they face higher risks in their work than before.^34,35 Adhering to nursing ethics is a way to protect themselves and others and avoid unnecessary hazards, so they choose to comply with certain institutional requirements even if they are less than reasonable.

A virtuous circle in which action strategies to defend ethics reinforce adherence to ethics. Commitment to professional values is a key strategy for nursing staff to uphold nursing ethics so that nurses can successfully overcome ethical dilemmas and strive to provide the best possible care to their patients.³⁶ Nurses’ professional values govern their ethical actions,³⁷ so rather than looking at professional values from an abstract perspective such as responsibility, compassion, and humanistic care,^15,38 this study examines how nurses uphold their professional ethics through the lens of the specific behaviors they adopt to stick to their values.

Self-regulation and flexible coping are action strategies for regulating nurses’ own adverse emotions and dealing with conflicts outside themselves, respectively, and are necessary for immediate relief from adverse effects and for achieving long-term adherence to nursing ethics.³⁹ From the interviews, it is clear that clinical nurses do not tend to accumulate stress and fatigue in order to work efficiently on a daily basis; they look for ways to release it, such as confiding in others, self-soothing, and distraction.⁴⁰ As for the on-the-spot coping styles of being more considerate of each other, living within one’s means, and being tolerant of others, the possibility of violating professional ethics is eliminated at the root.

Another strategy is post-incident improvement. In common with some studies, the results of this study show that nurses can improve ethical compliance through self-improvement, reflection and warning themselves with past mistakes.⁴¹ Interestingly, participants indicated that if the patient’s interests were compromised due to themselves or others in the healthcare team, they would not act strictly in accordance with professional ethics in order to protect themselves and their team, but they would try to compensate in other ways, such as offering to comfort the patient, being more tolerant of the patient and providing more discreet professional services. In this way, they gain a psychological balance and do not develop a negative attitude toward observing professional ethics in the future.

One of the results of nurses’ adherence to professional ethics is that they achieve inner harmony. Professional ethics enhances nurses’ professionalism and produces positive psychological changes, including satisfaction, a greater sense of competence, and commitment to their work.^42,43 When needs are met, they do not leave the profession. Moreover, when nurses achieve a desired level of observance of ethical principles, nurses are able to apply ethical knowledge to their practice and successfully carry out their nursing work.⁴⁴

The reduction in medical disputes is another positive result of nurses’ adherence to the ethics of nursing. Nurses who observe professional ethics in their professional practice can increase patient satisfaction with nursing services, repair the nurse–patient relationship, regain patient trust, and even reduce hospital stays and hospital costs.^18,45 Furthermore, Professional ethics play a role in guiding their understanding of the causes of medical disputes and their efforts to avoid them. Without ethics, they may be confused about ethical issues and may not know what is the right service to give to patients.⁴⁶

The COVID-19 pandemic presents challenges and opportunities for nurses’ professional and ethical compliance. On the one hand, the nursing team is affected by increased patient numbers, clinical complexity, sudden and unpredictable staff reductions, and lack of family member or caregiver support. Professional ethical compliance is inevitably put to the test. On the other hand, the experience of a health emergency may also have a significant impact on the development of professional and personal skills, strengthening the professional identity, and values of caregivers and enriching the way the nursing profession is ethically observed.^47,48

Conclusion

To our knowledge, this study is one of the few to explore the reasons for clinical nurses’ observance of professional ethics in China. For intrinsic or extrinsic reasons, adherence to professional ethics has become a way for clinical nurses to cope with moral adversity, safeguard the quality of patient care, and balance the nurses themselves and alleviate the conflicts in the social healthcare system. This study may also provide a reference for studies related to the revision of healthcare service policies and professional norms, and the allocation of nurses’ performance. In addition, future research involving nursing students or clinical nursing staff in adhering to ethical norms and improving the quality of care may be further expanded.

Strengths and limitations

This study uses a grounded theory methodology to explore clinical nurses’ adherence to professional ethics in China. It is informative for future revisions of nursing ethics codes and interventions to help nursing staff adhere to nursing ethics. However, this study used a purposive sampling method, which lacks the randomness of a random sampling method. The sample size was not very adequate and the nurses were drawn from various departments, which may lack the specificity of a particular department.

Footnotes

Acknowledgements

The authors would like to thank all the participants in this study, as well as the individuals and institutions that contributed to this study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by a grant from the Social Science Foundation of Fujian Province project “Exploring the realization path of trust and harmonious nurse–patient relationship based on the dual perspectives of nurses and patients.” (Grant No. F2021B064).

ORCID iD

Qingqing Yang

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