Guilt as a Structural Symptom: Ethical Challenges in Contemporary Nursing Care.

Abstract

Guilt in nursing is not just an individual emotion but an ethical experience rooted in the tension between care values and the conditions that constrain their practice. This systematic literature review analyzes guilt as a multidimensional phenomenon shaped by institutional, relational, and subjective factors. Eight key categories emerged: moral distress, institutional constraints, emotional and physical effects, end-of-life care, ethical conflicts with families, spirituality, informed consent, and coping strategies. The review reveals that guilt often stems not from personal error but from ethical dissonance between nurses' values and clinical realities. Hierarchies, rigid protocols, bureaucratic procedures, and lack of resources undermine nurses' moral agency and reinforce a logic of ethical isolation. This individualization of guilt obscures systemic responsibility and frames moral distress as personal failure. The findings call for a political reconceptualization of care, moving beyond resilience to foster shared ethical responsibility within teams. Recognizing guilt as a systemic indicator of ethical dysfunction is vital to rehumanize nursing, strengthen ethical subjectivity, and create more just and transformative care environments. Addressing guilt in this way empowers nurses not only to resist moral suffering but to reshape the structural conditions that perpetuate it.