Nursing Ethics

Moral distress is a pervasive challenge in nursing practice, adversely impacting nurses’ well-being, career development, patient safety, and organizational performance. Ethical climate, as a modifiable organizational factor, plays a pivotal role in mitigating moral distress. Understanding the association between nurses' moral distress and ethical climate is critical for clinical practice, management, and policymaking.

The aim was to systematically assess the association between nurses’ moral distress and ethical climate.

A systematic review and meta-analysis was conducted based on a comprehensive search of ten databases (PubMed, Cochrane Library, Embase, Web of Science, CINAHL, PsycINFO, Scopus, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANFANG) from inception to December 27, 2024. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Correlation coefficients were synthesized using random or fixed-effects models. Subgroup analyses and meta-regression were performed to explore sources of heterogeneity.

Ethical approval was not required as the review synthesized publicly available data.

Thirty-one studies involving 7635 nurses were included. Meta-analysis identified a moderate negative association between overall moral distress and ethical climate (r = −0.49, 95% CI: −0.59 to −0.38), and between moral distress frequency and ethical climate (r = −0.37, 95% CI: −0.45 to −0.28). Moderator analyses indicated that participant characteristics (gender composition, age, and work experience), study characteristics (sampling methods and ethical climate measurement tools), and working settings contributed to heterogeneity.

This systematic review and meta-analysis demonstrated a moderate negative association between nurses’ moral distress and ethical climate. Variations in participant demographics, study methodologies, and working settings partially accounted for the observed heterogeneity. Future research should employ larger, more diverse samples and longitudinal designs. Strengthening the ethical climate is essential for alleviating nurses’ moral distress and enhancing organizational effectiveness.

Most patients in need of palliative care remain in their homes, thus great focus should be placed on the creation of functional palliative homecare. Suffering through an often multifaceted illness and contemplating one’s death can contribute to the loss of one’s sense of dignity, and the preservation of patient dignity is a major challenge for health professionals worldwide.

The aim of the study was to explore and describe nurses’ experiences of caring qualities alleviating suffering and preserving the dignity of patients in need of palliative homecare.

A qualitative exploratory study. In-depth semi-structured interviews as data collection method, and the qualitative content analysis of Graneheim and Lundman for data analysis. The theoretical perspective was based on Eriksson’s caritative caring theory.

A total of nine nurses with extensive work experience from a palliative homecare context participated in the study.

The study was conducted in accordance with the criteria set forth by the Finnish National Board on Research Integrity TENK. Research permission was granted and participants gave their written informed consent to participate in the study.

One main theme and three subthemes were found. The main theme was: Being there for the other alleviates suffering while shaping and reshaping dignity preservation in a process. The three subthemes were: (1) Being a sensitive and compassionate witness who becomes responsible, (2) Having compliance, courage, and perception in a deep presence, (3) Being calm and patient while having time for conducting skilled practical knowledge.

Certain caring qualities are important in the dignity-preserving care of people in need of palliative homecare, and person-centeredness plays a central role in alleviating suffering. Deep and trusting caring relationships and nurses’ ability to customize the care being provided are significant in alleviating patient suffering and preserving dignity.

Spain’s Euthanasia Law came into force in 2021. Nurses are involved throughout the entire process and yet the law only recognizes their role in the final administration of the drug.

To understand the practice and experience of nurses involved in the euthanasia process.

Qualitative study with a phenomenological approach. An interpretative phenomenological analysis was conducted using ATLAS-ti.

This study is part of a larger project for which the study population comprised professionals who have participated in the euthanasia process in Catalonia since the law came into force. This study is based on data collected from nurses through 6 in-depth interviews and 3 focus groups.

This study was approved by the Ethics Committee (22/094-P). All participants granted their informed consent. Interviews and focus groups were anonymized.

The results revolve around two themes: (1) Plasticity of nursing care in the face of regulatory gaps and (2) managing emotions while providing assisted dying. Nurses respond to patients and families by adapting to the demands of the process and self-managing any emotions that arise from participating in this practice. Nurses use rationalization to manage the range of emotions they experience resulting from the tension between respecting a person’s autonomous decision to request euthanasia and upholding their professional duty to prevent harm. The team stands out as a crucial element in managing these emotions.

Spanish nurses are involved throughout the entire euthanasia process, demonstrating great plasticity of care. Euthanasia care is complex and the relational context between professionals and the patient/family and between team members is key. The law should define and envisage the role of nurses, as it does for other professions.

This discussion paper provides a reflection on ethical aspects of participant recruitment experiences during one research (PhD) project in the Republic of Ireland (ROI). Using Gibbs' framework for reflection, this paper examines these experiences. The research (PhD) project that informed this reflection aimed to understand the experiences of family caregivers when caring for family members at the end of their life, through recorded interviews in the home, within the context of palliative care provision. Ethical approval had been granted for the main study; however, this paper does not draw on empirical data from the study.

This discussion paper aims to provide a reflection on some challenges faced when recruiting family caregivers at end of life during the research (PhD) project.

Gibbs’ framework for reflection was used to reflect on experiences of recruitment of 10 family caregivers, whose relatives were receiving palliative care, and who were interviewed in their home environments.

Our reflections revealed that the recruitment process was protracted and challenging. When attempting to recruit family caregivers for the study, recruitment extended over a longer period than originally planned. Our reflections suggest that while gatekeeper workload was an influencing factor, a concern arose that they may have applied their own additional and personal ethical measures to determine participant suitability.

More education and supportive collaboration with gatekeepers may be required to ensure that they develop a more comprehensive understanding of the gatekeeper role and are assured and informed of the ethical benchmarks that preceded their involvement. Enhanced understanding may highlight the benefits of families taking part in healthcare research.

Nurses in long-term care often experience moral distress. While moral distress has been reported to negatively impact nursing competence and patient outcomes, some studies suggest that it may contribute positively to nursing competence. Thus, knowledge regarding the impact of moral distress on nursing competence remains limited and inconsistent.

This study aimed to identify the mediating effects of moral sensitivity and ethical climate on the relationship between moral distress and nursing competence.

This was a quantitative study with a cross-sectional descriptive correlational design.

A survey was conducted with 175 registered nurses working in long-term care hospitals in Korea. Data were collected in September and October 2023. The survey measured moral distress, moral sensitivity, ethical climate, and nursing competence using the Moral Distress Scale, the Moral Sensitivity Questionnaire, the Hospital Ethical Climate Survey, and an instrument for measuring nursing competence in long-term care hospitals, respectively. The collected data were analyzed using SPSS Statistics version 27.0 and the PROCESS macro program.

This study was approved by the Institutional Review Board. Informed consent was obtained from participants prior to data collection.

Moral distress did not have a significant direct effect on nursing competence; however, it had a positive impact on nursing competence through the mediation of moral sensitivity and ethical climate. Moral sensitivity and ethical climate demonstrated a dual mediating effect in the relationship between moral distress and nursing competence.

The findings of this study provide insights into how moral distress can positively contribute to nursing competence. Ensuring that nurses have high moral sensitivity and that organizations foster a positive ethical climate may help moral distress enhance nursing competence.

Ethical decision-making ability is critical for senior nursing interns in addressing complex clinical dilemmas. However, the mediating role of hospital ethical climate in the relationship between moral sensitivity and ethical decision-making remains unexamined. This gap limits evidence-based strategies for enhancing interns’ ethical decision-making and the delivery of high-quality care.

To examine the mediating role of hospital ethical climate in the relationship between moral sensitivity and ethical decision-making among senior nursing interns, and to determine the relationship among these three variables.

The study is a cross-sectional correlational design.

Between August 2023 and January 2024, 1096 senior nursing interns from 44 universities across seven Chinese regions participated. The general information questionnaire, Judgement About Nursing Decision scale, Chinese Moral Sensitivity Questionnaire-Revised Version, and Hospital Ethical Climate Survey were distributed online. SPSS 27.0 was used for descriptive statistics and Pearson correlation analysis, while PROCESS macro handled mediation analysis.

This study was approved by the Ethical Review Board of Xiangya School of Nursing, Central South University (No. E2023125).

A total of 935 valid questionnaires were collected, with a response rate of 85.3%. Participants demonstrated moderate levels in ethical decision-making ability (276.41 ± 18.51), moral sensitivity (42.01 ± 7.61), and perceived hospital ethical climate (102.17 ± 14.63). There were significant positive correlations between each pair of these three variables (r = 0.248–0.474, p < 0.05). Moral sensitivity was associated with hospital ethical climate and ethical decision-making; hospital ethical climate mediated the relationship between moral sensitivity and ethical decision-making (β = 0.252–0.580, p < 0.05).

Comparing our findings with international research, this study highlights the influence of hospital ethical climate and moral sensitivity on ethical decision-making, emphasizing the mediating role of ethical climate and its implications.

Hospital ethical climate played a mediating role between moral sensitivity and ethical decision-making among senior nursing interns. Interventions targeting both are recommended to enhance ethical decision-making ability. Future research should explore specific measures for this population.

Ethical competence in nursing is essential. However, a theoretical definition of ethical competence in nursing and the critical components of ethical competence appear to be absent, resulting in a lack of convergence on the core content to be taught on ethical competence in nursing education.

This study aimed to answer the following questions: What are the essential components of ethical competence in nursing? What is their definition in terms of nursing? What is the theoretical definition of ethical competence in nursing?

Walker and Avant’s concept synthesis.

Ethical competence in nursing consists of 12 essential components, defined and grouped into three main themes: (1) Ethical knowledge and understanding; having knowledge and understanding of the main theories of theoretical and practical ethics and the principal codes of ethics in nursing; (2) Personal ethical qualities; having ethical awareness and ethical self-awareness, ethical sensitivity, ethical perception, and ethical judgement. (3) Ethical ability and courage to perform; capable of moral reasoning, ethical reflection, and ethical decision-making, having moral courage and demonstrating ethical action and behaviour. The theoretical definition is thus: Nurses considered ethically competent have knowledge and understanding of the main ethical principles in nursing and possess personal ethical qualities, that is, ethical self-awareness, ethical awareness, ethical sensitivity, ethical perception, and ethical judgment as well as having the ethical ability and the courage to perform ethically, that is, capable of moral reasoning, ethical reflection, ethical decision-making, having moral courage, they demonstrate ethical action, and ethically responsible conduct.

This study is essential to nursing as a discipline and profession. The findings provide a theoretical definition of ethical competence in nursing and the qualities characterising ethically competent nurses, which can be of great value in clinical practice, nursing education, leadership, and nursing research and theory development.

The compassionate presentation of caregiving skills, which constitute the building block of nursing care, directly affects the quality of health services. It is extremely important for the future of the nursing profession to develop compassion competence and satisfaction in students who are candidates for the nursing profession and to reveal their level of commitment to the profession.

This study examined the correlation between compassion competence, compassion satisfaction, and professional commitment levels of nursing students.

The study was conducted as a descriptive-correlational research.

The study was conducted between 01.05.2023 and 01.10.2024 with nursing students continuing their education in the Nursing Department of state universities in Gaziantep. The research sample consisted of 280 nursing students. A convenience sampling method was used in this study. Nursing students who met the inclusion criteria and voluntarily agreed to participate were included in the sample. Personal Information Form, Compassion Competence Scale, Compassion Satisfaction Scale, and Nursing Professional Commitment Scale were used as data collection tools. SPSS package program, t-test, ANOVA, and Pearson correlation analyses were used to analyze the data.

Ethical approval for the study was received from the Non-Interventional Clinical Research Ethics Committee. The study was conducted following the Declaration of Helsinki.

Nursing students’ total score on the Compassion Competence Scale was 3.86 ± 0.04. The mean total score of the Compassion Satisfaction Scale was 50.37 ± 0.58. It was determined that the mean total score of the Nursing Professional Commitment Scale was 72.98 ± 0.77. A weak, positive, statistically significant relationship was found between compassion competence and professional commitment (r: 0.288, p < .05). A moderate, positive, statistically significant relationship was found between compassion satisfaction and professional commitment (r: 0.403, p < .05).

A positive correlation was found between compassion competence, compassion satisfaction, and professional commitment among nursing students. It is recommended to increase studies on developing empathy, compassion, and emotional resilience skills in nursing education programs. In addition, these findings emphasize that a compassion-oriented approach should be adopted to improve quality in the nursing profession.

An ethical foundation for caring involves doing good, alleviating suffering, and treating human beings with dignity and respect. While virtual reality (VR) has primarily been used to develop clinical skills, there is limited research on its use for educating healthcare personnel in ethical competence and the use of VR grounded by ethical concepts and theories. This gap has prompted us to develop a theoretical basis grounded in enhancing the ethical competence of health professionals using VR.

The study aimed to develop a caring-perception model for enhancing ethical competence in VR environments for educating healthcare personnel.

The development of the caring-perception model was fundamentally anchored in theoretical frameworks established by the three caring theorists Eriksson, Martinsen, and Koskinen. Hermeneutic reading was used to interpret selected texts, extracting meaningful fragments to form interpretive patterns, leading to the creation of basic elements for a theoretical model. The caring-perception model was then interpreted in the context of developing ethical competence in a VR environment.

The caring-perception model consists of six fundamental elements: “I am here,” “I see and listen,” “I’m affected,” “I realize,” “I’m responsible,” and a synthesis in “ethical bearing and acting.” The theory model serves as a robust framework aimed at enhancing healthcare personnel’s ethical competence within VR environments.

VR grounded on a theoretical basis and educational model has the potential to offer unique opportunities to enhance healthcare personnel’s ethical competence and to practice ethical decision-making in simulated scenarios, fostering presence, attentiveness, and ethical reflection. Despite challenges such as technical barriers and the need for substantial investment, the potential benefits of using VR for ethical training can promise improved patient outcomes and a more ethically aware healthcare workforce.

Storytelling is a frequent practice within nursing education. Stories are thought to be helpful for student learning, engagement, professional role development, and transmission of ethical values. Despite its common use, little is known about the stories told by nurse educators and the implicit ethical values within those stories.

To describe the reasons nurse educators tell stories to undergraduate students and examine implicit ethical values within these stories.

A qualitative descriptive study with Rubin and Rubin’s responsive interviewing method. Interview transcripts and written stories were analyzed thematically with constant comparison.

Participants included 15 nurse educators, primarily from the northeastern United States.

Institutional Review Board (IRB) approval for protection of human subjects was received prior to conducting the study. Informed consent was obtained from all participants.

Nurse educators use storytelling to help students understand what it means to be a nurse, to improve student learning, because we are all human, and because the art and science of nursing requires storytelling. Ethical values from these stories were organized into the following themes: advocacy, nurse attributes, importance of the nurse-patient relationship, and reflection.

Findings suggest that that storytelling in nursing education is used for role development and communicating ethical values. Additional studies are needed to determine the effectiveness of storytelling and how it can be used to improve nursing practice.

Nursing students’ professional dignity development during work-integrated learning is dependent on support from professional nurses. If they are left unsupported, such development is jeopardised.

The aim of the study was to explore and describe the support that nursing students need from professional nurses, including their lecturers, during work-integrated learning to develop professional dignity.

A qualitative, exploratory-descriptive research design applied. Through volunteer sampling, participants were invited for face-to-face in-depth individual interviews to discuss the question: ‘What support did you need from others during work-integrated learning to feel dignified as nursing students?’ Saturation of data determined the number of participants. Recording of the interviews and the writing of field notes were carried out with the permission of the participants. Manual coding in a thematic analysis was done to analyse the intricate data content with intuition and insight.

The study was undertaken in South Africa at a designated nursing education institution and the hospital where the students performed the bulk of work-integrated learning. Fourteen third-year students were interviewed. They had sufficient experience with work-integrated learning and could provide rich data concerning support needed to develop professional dignity.

The Faculty of Health Sciences Research Ethics Committee at the University of Pretoria approved the proposal (Reference number 73/2023) and the applicable authorities gave written permission for the research to be conducted. Since the participants were students, the researchers made sure that they did not feel obliged to participate.

Four categories were identified, namely, (a) improving work-integrated learning experience, (b) value students’ professional development, (c) cooperate to benefit students’ professional growth and (d) manage resources optimally.

Students needed to be respected and their input to quality nursing care acknowledged. Positive role models and learning conducive clinical environments contributed to their development.

Many patients in medical wards lack decision-making capacity and cannot provide valid consent. As a result, nurses and other healthcare professionals often face a dilemma: whether to neglect the medical needs of such patients, or provide healthcare interventions without obtaining valid consent. Previous studies have indicated that many interventions are provided without consent; however, there is insufficient knowledge about how staff in this context reason about the ethical dilemmas they encounter.

To explore the ethical reasons provided by nurses and other healthcare professionals in medical wards for and against providing healthcare interventions without patients’ consent.

The study employed a qualitative explorative design. Eight focus group interviews were held with 37 staff across five different professions, mainly nurses, at two Swedish hospitals. The material was subjected to qualitative analysis, following a Reflective Thematic Analysis framework.

Ethical approval for this study was obtained from the Swedish Ethical Review Authority. All participants were informed orally and in writing about the study’s aims and its voluntary nature. No sensitive personal information was registered. Participants provided their oral consent to participate before the interviews took place.

Thematic analysis resulted in four main themes: Coercion is a bad word; Reasons to accept coercion; Coercion is part of ward culture, and Unacceptable coercion.

Participants overwhelmingly supported the current use of ‘consentless measures’ at the investigated wards. Most situations described either needed no justification, according to participants, or could be easily justified by reference to the benefit of the patient, the patient’s poor decision-making capacity, or the benefit of others. A range of implicit, contextual, and institutional justifications were also given. Suboptimal ward culture was considered a prime driver of consentless measures and a force that compromises nurses’ agency in the patient encounter.

Healthcare organizations are driven by mission-driven values, yet these values can be compromised in employee-organization relationships. Hospitals present psychologically challenging environments for their nurses, potentially causing breaches of psychological contracts. Despite extensive research on ethical climates, their impact on mitigating interpersonal deviance in healthcare remains understudied. This warrants investigation into how ethical workplace climates and breaches of psychological contracts affect interpersonal deviance in nurses.

This study investigates how psychological contract breaches mediate the relationship between ethical climates and interpersonal deviance.

The study employs a cross-sectional design, collecting data from 230 nurses across five hospitals in India. Standard scales are used to measure the constructs in the study, with established reliability and validity. Structural equation modeling (SEM) was utilized to examine the hypotheses outlined in the study. We also tested the moderating effect of work experience in the moderated mediation model.

This study received ethical approval (#ERB-ASBC-2024-027) from the University Ethical Review Board, constituted at Amrita School of Business, Coimbatore.

Permission to conduct the study was obtained from the hospital administration. Nursing staff participated voluntarily. They were informed about the survey’s purpose and their right to withdraw at any time. Consent was obtained on the survey form before recording their responses, and no personal identifiers were collected.

An ethical workplace climate reduces nurses’ interpersonal deviance, mediated by psychological contract breach. This mediation is moderated by work experience, with a stronger effect on less-experienced nurses.

The study suggests that regular assessments of ethical workplace climate can aid in planning effective reinforcements at individual, leadership, or organizational level to reduce interpersonal deviance and perceptions of psychological contract breach.

Medical gaslighting refers to the mistreatment that patients experience following interactions with clinicians when their medical complaints and suffering are discounted, doubted, questioned, second-guessed, or denied, resulting in self-doubts of patients and psychological ramifications. This research focuses on the ethical aspects of medical gaslighting among hospitalized patients by nurses.

What are the nursing care and nursing ethics perspectives concerning medical gaslighting?

A narrative review.

Interpretation of two narrative interviews with each participant through the lenses of nursing ethics.

14 hospitalized patients, males and females, ages 30–81, from the majority group in the population.

Lengthy hospitalizations.

Ethical approval was granted; all participants signed an informed consent form for participation and publication.

Patient experiences demonstrate medical gaslighting by nurses, violating relational autonomy and resulting in delayed care.

Medical gaslighting contradicts ethics of care, the professional values of nursing, and patient-centered care constituting obstacles to respectful patient–nurse relationships and to relational autonomy.

Medical gaslighting is a profoundly concerning ethical phenomenon that adversely affects patient well-being and trust in nursing as a significant profession in a just society.

Addressing drug use among pregnant and postpartum women is complicated by the social, ethical, and legal interplay between maternal and child needs. The moral experiences of providers as they care for this population are poorly understood. The purpose of this review is to synthesize the qualitative literature on the moral experiences of prescribing maternity providers managing the care of pregnant and postpartum women who use drugs (PPWUD), specifically focused on drug testing and child welfare reporting decisions.

The Hunt and Carnevale (2011) bioethics framework was used to define moral experience as “a person’s sense that values that he or she deem important are being realized or thwarted in everyday life.” A systematic search of PubMed, PsycINFO, and CINAHL resulted in 31 eligible articles. Study quality was assessed using the Critical Appraisal Checklist for Qualitative Research from the Joanna Briggs Institute (2015). Thematic narrative analysis was used to synthesize results and identify themes.

Overall, maternity providers’ experiences were characterized by ethical conflicts influenced by provider-level and policy-level factors. Even when endorsing patient autonomy and parental rights, no maternity providers endorsed continued maternal substance use that placed the fetus or child at significant risk. Structural constraints within healthcare systems and punitive laws were cited as significant barriers to providing optimal care to PPWUD. Biased drug testing protocols and some child welfare reporting policies created ethical conflict by placing maternity providers’ relationship with their patients in opposition to their legal and ethical responsibility to report child maltreatment.

More rigorous characterization of these moral experiences is needed to support the development of provider-level interventions and policy-level changes as maternity providers care for both mothers and children impacted by drug use.

Patients with intellectual developmental disabilities (IDDs), as members of a vulnerable population, require specialized care that many ICU nurses feel inadequately prepared to provide. The complexity of caring for IDD patients often leads to feelings of moral distress, self-doubt, and a struggle to maintain resilience among ICU nurses.

This study aims to explore ICU nurses’ lived experiences caring for patients with IDD.

A descriptive, phenomenological qualitative approach was used along with inductive analysis to explore the meanings ICU nurses attribute to experiences caring for IDD patients.

ICU nurses (N = 20) who met inclusion criteria were purposively sampled.

The study received ethical approval from an institutional review board. Informed consent was obtained from all participants.

Three main themes emerged from the analysis. First, in main theme 1, If Only I Had Known More, nurses reported insufficient training specific to IDD care, expressing shame about their knowledge gaps. Second, in main theme 2, They Deserve Better, nurses highlighted the lack of resources and institutional support, complicating efforts to deliver appropriate care. Finally, in main theme 3, It Weighs on My Soul, nurses reflected on the emotional toll of caring for IDD patients, discussing subthemes such as self-doubt, emotional detachment, coping efforts, witnessing isolation, and moral distress.

These findings highlight personal, educational, and systemic gaps shaping ICU nurses’ experiences with IDD patients. Limited training and insufficient resources intensified moral distress. There is an urgent need for IDD-oriented education, institutional support, and policies that promote compassionate, tailored care.

Findings suggest there is a strong alignment with the ethics of care framework. Such a connection emphasizes the need for systemic changes to empower ICU nurses to deliver compassionate, individualized care to IDD patients and enhance professional resilience and patient outcomes.

Australia faces a critical shortage of nurses, yet international nursing graduates (INGs) encounter significant barriers to securing employment after graduation. Current policies often prioritize domestic graduates, creating systemic disadvantages for INGs, particularly those on temporary visas. This inequity raises ethical concerns and undermines Australia’s ability to fully utilize its nursing workforce, potentially compromising the quality of healthcare services.

This study explores the lived experiences of INGs regarding employment challenges in Australia, critically examining the ethical and equity implications of existing practices.

A qualitative study employing a combined phenomenological and exploratory approach was conducted. Data were analyzed using a thematic analysis framework.

Twelve international nursing students in their final semester of the Bachelor of Nursing program at two metropolitan universities in Australia participated in semi-structured interviews.

Ethical approval was obtained from the Monash University Human Research Ethics Committee (MUHREC-44400) and the University of Technology Sydney (ETH24-10028). Informed consent was obtained from all participants, who were assured of their right to confidentiality and to withdraw from the study at any time.

Five overarching themes emerged: (1) Economic Disparity and Ethical Considerations, (2) Systemic Discrimination and Inequality, (3) Mental Health and Well-being, (4) Policy and Regulatory Barriers, and (5) Lack of Cultural Inclusion and a Sense of (Un)Belongingness.

The findings highlight urgent ethical concerns and equity challenges that demand comprehensive reforms to create a more inclusive and ethically sound environment for INGs in Australia. These reforms necessitate policy changes to address discriminatory practices and visa restrictions, enhanced institutional support to facilitate INGs’ transition into the workforce, and a commitment to cultural competence and inclusion at all levels of the healthcare system. Addressing these systemic barriers is not only a matter of fairness and justice but is also crucial for ensuring a robust and ethically sustainable healthcare workforce in Australia.

Moralization, or the application of moral value onto individuals’ actions or identities, has broad impact in the context of health and healthcare. In particular, moralization may result in interpersonal and institutional consequences for certain groups of individuals such as people who use substances during pregnancy or while feeding human milk. Reflexive moralization is an underexplored phenomenon that represents the reflex-like nature of some instances of moralization. Objectives: The purpose of this study was to explore and explain how reflexive moralization impacts the perinatal care of substance-exposed dyads.

In this targeted sub-analysis, dimensional analysis was used in the mode of emergent fit to analyze qualitative interviews conducted for a parent study investigating the circumstances under which clinicians bring moral considerations into the care of substance-exposed dyads.

Interviews with fifteen perinatal health clinician providing health or social care to substance-exposed dyads were included in this analysis.

The X IRB determined this study exempt. All participants provided informed consent prior to enrolling in the study.

Findings revealed novel dimensions of reflexive moralization, including the process of sympathization, which occurs when clinicians demoralize and transform their reflexive moralization into a tool for care. In order for the transformative process of sympathization to occur, clinician moral well-being must be assessed as sufficient, meaning clinicians must feel they have the capacity and competence to provide adequate care to patients. Discussion: Future research should further investigate the nature of clinician moral well-being in order to measure and develop interventions to support it.

Clinician moral well-being plays a pivotal role in clinical care delivery for substance-exposed dyads, in the context of reflexive moralization.

Media narratives about healthcare scandals can profoundly influence public trust in medical institutions and professionals. In neonatal care, where trust in healthcare providers is crucial for parental decision-making, negative media portrayals may create ethical challenges by fostering fear and skepticism. The erosion of trust in neonatal nurses and healthcare institutions may seriously affect maternal decision-making and neonatal health outcomes.

To explore the ethical implications of media narratives on maternal trust in neonatal care. Specifically, it investigates how media portrayals of neonatal care scandals impact expectant mothers’ perceptions of neonatal professionals, their emotional responses, and their healthcare choices.

A qualitative research design was employed using semi-structured interviews. Thematic analysis, following Braun and Clarke’s framework, was used to analyze the data.

The study included 22 expectant mothers in their third trimester who had been exposed to media coverage of neonatal care scandals in Turkey.

Ethical approval was obtained from the University Research Ethics Committee. Participants provided written informed consent, ensuring voluntary participation and anonymity.

Four major themes emerged: (1) erosion of trust in neonatal nurses and institutions, leading to skepticism and emotional distress; (2) the emotional impact of media narratives, including fear, anxiety, and defensive decision-making regarding neonatal care choices; (3) perceived quality of care, highlighting concerns over the differences between public and private NICUs and resource allocation; and (4) the need for ethical reforms, including transparency, independent oversight, and media accountability to restore trust.

Media narratives significantly shape maternal perceptions of neonatal care, raising critical ethical concerns about trust and accountability. The findings highlight the need for systemic reforms to ensure ethical transparency, responsible media reporting, and enhanced communication between healthcare providers and the public. Addressing these ethical challenges is essential for fostering trust in neonatal nursing and ensuring equitable, high-quality care for newborns.

Ethically challenging situations often arise in interactions between healthcare professionals (HCPs) and families. Although the Calgary models offer guidance for practical work and are beneficial in various challenging situations, explicit awareness and recognition of the ethical concepts and theories underlying Family Systems Care (FSC) is generally lacking.

This study examined the basis of FSC in virtue ethics, deontology, and teleology.

Utilizing a qualitative design, an expert consensus was conducted through two focus group interviews, a Delphi group, and an expert panel.

The expert consensus consisted of 23 professionals in FSC from various specialities, including nurses (n = 18), midwives (n = 4), and a general practitioner, who explored ethical considerations in clinical practice.

The research project was conducted in accordance with the ethical principles of participants’ informed consent and the Declaration of Helsinki.

Participants recognized the significance of classical virtues such as faith, fortitude, hope, and caritas in FSC. They emphasized that these virtues not only guide HCPs in their practice but also empower families to rediscover their strengths amid suffering. Additionally, the integration of deontological principles and teleological perspectives highlighted the importance of balancing individual and collective well-being, and fostering compassionate relationships while navigating ethical complexities in therapeutic conversations.

This study highlights the importance of virtue ethics, deontology, and teleology in guiding HCPs’ moral reasoning within FSC. Participants emphasized respect and appreciation as essential values for maintaining trust with families during ethical challenges. By integrating ethical theories into practice, HCPs can navigate complex situations effectively, fostering compassionate and dignified care.

Intensive care is essential for critically ill patients who experience loss of personal identity and restricted physical and emotional expression. However, patient privacy in Intensive Care Units (ICUs) remains inadequately protected, with both patients and healthcare professionals (HCPs) reporting breaches. Cultural backgrounds and individual perspectives of patients and HCPs significantly shape their views on privacy. In China, discourse on ICU patient privacy is still in its early stages.

This study aims to explore the experiences of HCPs and patients regarding the patient privacy in ICU under the Chinese background.

A qualitative study was conducted using purposive sampling methods for semi-structured, face-to-face, in-depth interviews, followed by thematic analysis to identify key themes.

Six focus-group interviews (with a total of 33 nurses) were conducted, while seven doctors and 10 patients were interviewed individually from March to July 2024 at a tertiary hospital in China.

This study was approved by the hospital’s Ethics Committee (reference number: 2024-L-158). Informed consent was obtained from all participants, and data confidentiality was ensured through anonymization and encrypted storage.

Four themes were identified: (1) the coexistence of consensus and disagreement regarding privacy scope; (2) the paradoxical perception of privacy protection; (3) conflicting responses to privacy violation and (4) much has been done, but more is needed.

Minimizing exposure of ICU patients’ private areas and protecting their information are essential to safeguarding privacy. Education and training in bioethics can enhance HCPs’ sensitivity to ethical issues and improve practices regarding privacy protection. Teaching resilience and stress management can help mitigate psychological distress associated with privacy violations in ICU patients. Additionally, promoting HCPs’ privacy awareness, limiting visits by opposite-sex family members, and enhancing HCPs’ empathy are key strategies in this context.

This 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.

The study aims to assess acceptance levels, concerns, and expectations regarding humanoid nurse robots among Generations X, Y, and Z.

A mixed-method design combining quantitative survey analysis and qualitative interviews was employed.

The 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.

The 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.

Quantitative 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.

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.

Disclosure of information that identifies deceased organ donors and/or organ transplant recipients is prohibited in many countries, including Australia. Anecdotal evidence suggests that some donor family members and transplant recipients desire and independently establish contact using strategies such as social media.

To describe and synthesise the views of Australian donor family members, transplant recipients, and healthcare professionals regarding the disclosure of identifying information between donor family members and transplant recipients.

An exploratory descriptive qualitative study design was used.

Semi-structured interviews were conducted with 23 donor family members, 25 transplant recipients, and 16 healthcare professionals. Interviews were audio recorded and transcribed verbatim. Data were extracted and synthesised using thematic analysis.

This study was approved by the Human Research Ethics Committee of Griffith University, Queensland. Participation was voluntary, and informed consent was obtained from all participants.

Three themes were revealed: (i) a desire for choice, (ii) perceptions of benefits, and (iii) perceptions of risks and risk mitigation. Some donor family members and transplant recipients would like the choice to pursue identifiable contact, and for this to be facilitated by donation agencies and transplant units. Many healthcare professionals also support the notion of choice.

Current Australian laws prohibit the disclosure of information identifying deceased organ donors and transplant recipients to each other. Any desire to amend existing laws would necessitate a thorough consultation process and the establishment of suitable systems and processes to support identity disclosure. Further research is needed to ascertain options for identifiable contact and to identify strategies to maximise benefit and minimise harm for donor family members and recipients.

Ensuring that mothers and newborns receive respectful care is crucial to providing high-quality care. Our research aimed to describe the care received by neonates and identify risk variables for Disrespect and Abuse (D&A) in neonates.

We carried out a comprehensive analysis of published, quantitative research on D&A on newborns. The databases of SCOPUS, Web of Science, PubMed, Embase, ProQuest, and Cochrane Library were thoroughly searched for articles. The quality of the research was assessed using the STROBE measures. Studies meeting certain requirements were eligible for inclusion: they had to evaluate the prevalence and risk factors associated with the mistreatment of newborns after childbirth; finally, 525 potentially relevant articles were carefully reviewed, and only 10 were ultimately selected.

Six prospective cohort studies, one retrospective cohort study, two cross-sectional studies, and one mixed-method research comprised the 10 papers that made up this review. In included studies infants had experienced at least one D&A episode. We have divided them into two categories: indicators of disrespect and factors affecting disrespect. Indicators of disrespect were the major contributing factor to D&A. According to this review, some maternal and newborn factors contributed to the D&A of newborns: preterm births, female deliveries assisted by an instrument, rural births, mothers living in rural areas, births with parity greater than 2, and unmarried birth mothers.

Health systems must be confident that no neonate is denied medical care due to family socio-economic and cultural factors. This study can inform future research around interventions for improving policy and practice.