Nursing EthicsPub Date : 2026-10-19DOI: 10.1177/09697330261489571
Gisela Vogel, Fredric Sjöberg, Cecilia Naurèn, Martin Salzmann-Erikson, Anna Schandl
{"title":"Emotional experiences of workplace violence in the intensive care unit.","authors":"Gisela Vogel, Fredric Sjöberg, Cecilia Naurèn, Martin Salzmann-Erikson, Anna Schandl","doi":"10.1177/09697330261489571","DOIUrl":"https://doi.org/10.1177/09697330261489571","url":null,"abstract":"<p><p>BackgroundWorkplace violence is common in intensive care units and is often regarded as an inevitable aspect of the job. This normalisation may obscure the emotional impact of violence on healthcare professionals and the ethical tensions that arise when altruistic caregiving values conflict with personal safety. Therefore, this study was conducted to explore healthcare professionals' emotional experiences of workplace violence within the context of intensive care.Research designThis study constitutes a secondary, inductive analysis of data originally collected in 37 semi-structured interviews. The interviews were conducted between November 2024 and March 2025 in intensive care units across five hospitals in Sweden. Data were interpreted using Reflexive thematic analysis.Ethical considerationsEthical aspects were carefully considered throughout the study in line with established ethical principles. Participation was voluntary, and informed consent was obtained from all individuals before the interview. Data confidentiality was ensured, and all direct quotes were anonymised.FindingsParticipants' descriptions of their emotional experiences generated three themes. A conflict between professional obligation and human vulnerability captured how participants experienced a tension between the expectation to remain composed in their professional roles and their human vulnerability. Balancing core values of caregiving with safety illustrated the professional and moral dilemmas that emerged when violence or escalating aggression forced healthcare professionals to reconcile their commitment to compassionate care. Organisational conditions influencing emotional responses reflected the conditions that either support or undermine ICU healthcare professionals' emotional resilience when they encounter violence.ConclusionsWorkplace violence in intensive care was experienced as more than a threat to personal safety; participants described how it challenged their professional identity and caring values. Organisational conditions influenced how healthcare professionals experienced and managed these challenges.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261489571"},"PeriodicalIF":3.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nursing EthicsPub Date : 2026-10-17DOI: 10.1177/09697330261493468
Christina Lamb, Dimitra V Pouliopoulou
{"title":"Child-specific bioethics: Review of pediatric palliative care ethics guidelines.","authors":"Christina Lamb, Dimitra V Pouliopoulou","doi":"10.1177/09697330261493468","DOIUrl":"https://doi.org/10.1177/09697330261493468","url":null,"abstract":"<p><p>Pediatric palliative care is increasingly recognized as an established practice yet less than ten percent of children who need it access it worldwide. Contributing to this gap is an absence of pediatric-specific bioethics frameworks to guide the care of dying children. Because philosophies influence cohesive care provision, the purpose of this review was to critically examine the international, scholarly literature on the ethical content of pediatric end-of-life care guidelines to ascertain what pediatric ethics approaches are used to guide the care of dying children. A Rapid Review of the international, scholarly literature was undertaken from September 2024 to April 2025. Of the 12,215 reviewed documents, 19 were retained for inclusion. Documents were mapped for the presence of pediatric-specific bioethics frameworks, care guidelines, ethical approaches, principles and values. Records were identified according to country, population, holistic care, child-centricity and pediatric, family, and ethicist involvement in ethical decision-making. Nineteen documents were included. Findings were synthesized through tabulation and narrative analysis. No pediatric-specific bioethics framework explicitly originating in pediatric theory and research was identified. Although most ethical approaches focused on children, they relied on prevailing adapted adult frameworks or adultist iterations of principlism, care and relational ethics and single or matrix-based principal accounts. Care for dying children needs to be consistently grounded in child philosophies. Recommendation: Expanding access to pediatric palliative care requires ethics education research toward pediatric-specific pedagogies and bioethics frameworks to support consistent, ethically robust, holistic, and child-centered care to improve access across clinical, international and interdisciplinary settings.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261493468"},"PeriodicalIF":3.8,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nursing EthicsPub Date : 2026-10-15DOI: 10.1177/09697330261489782
Fanny Ahokas, Marit Silén, Anna T Höglund, Jessica Hemberg
{"title":"Moral distress, shame, and professional identity in older adult care.","authors":"Fanny Ahokas, Marit Silén, Anna T Höglund, Jessica Hemberg","doi":"10.1177/09697330261489782","DOIUrl":"https://doi.org/10.1177/09697330261489782","url":null,"abstract":"<p><p>BackgroundMoral distress is an increasingly recognized ethical concern in healthcare, particularly in older adult care, where it is associated with negative consequences for nurses, patients, and healthcare organizations. Although widely studied, its emotional dimensions, particularly the role of shame, remain insufficiently understood.AimTo explore nurses' experiences of moral distress, shame, and professional identity in older adult care, as well as their perspectives on support and development opportunities that can alleviate moral distress and its consequences.Research designQualitative exploratory design. In-depth semi-structured interviews.Participants and research contextFifteen nurses in an older adult care context. Years of professional experience ranged from 4 to 46. Ethical considerationsEthical approval was obtained from the Committee on Research Ethics at Åbo Akademi University, Finland, and permission was granted by the participating Wellbeing Services County. Written and oral informed consent was obtained from all participants. The study adhered to the Finnish National Board on Research Integrity (TENK, 2023) guidelines on good scientific practice.FindingsThree main themes were identified: Moral distress as a pervasive threat to professional identity, Shame and moral conflict in the experience of moral distress, and Organizational conditions and strategies for managing moral distress. DiscussionMoral distress was perceived as closely linked to shame and professional identity. The findings underscore the need to address emotional and organizational dimensions of moral distress in care for older adults.ConclusionsMoral distress in older adult care is a pervasive, multidimensional, and sustained phenomenon shaped by individual factors and organizational conditions. Efforts to reduce moral distress should move beyond individual coping strategies and include structural and cultural changes that support nurses' professional and ethical values and encourage open dialogue. Addressing moral distress is important not only for supporting nurses but also for safeguarding the quality and sustainability of care in older adult settings.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261489782"},"PeriodicalIF":3.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nursing EthicsPub Date : 2026-10-15DOI: 10.1177/09697330261493466
Ros-Marie Taponen, Jessica Hemberg
{"title":"Moral distress and healthcare resource cutbacks: Leaders' and professionals' experiences.","authors":"Ros-Marie Taponen, Jessica Hemberg","doi":"10.1177/09697330261493466","DOIUrl":"https://doi.org/10.1177/09697330261493466","url":null,"abstract":"<p><p>BackgroundHealthcare resource cutbacks create organizational conditions that may constrain moral agency and contribute to moral distress, yet little is known about how leaders and healthcare professionals experience these ethical challenges.AimThe aim of this study was to explore how leaders and healthcare professionals experience moral distress associated with healthcare resource cutbacks. The research question was: How do leaders and healthcare professionals experience moral distress associated with healthcare resource cutbacks?Research designQualitative exploratory design. In-depth semi-structured interviews. Participants and research contextTwelve participants, six leaders and six health professionals. Among leaders, leadership experience ranged from 1 to 30 years. Among healthcare professionals, healthcare experience ranged from 7 to 41 years.Ethical considerationsThe study adhered to the Finnish National Board on Research Integrity (TENK) guidelines on good scientific practice. Ethical approval was obtained from an ethics committee at a university in Finland (verdict 11/2024) and research permissions were granted by the two healthcare organizations included in the study. Participants received written information about the study and provided informed consent before interviews.FindingsFive themes were generated: Organizational transformation as a source of moral constraint; Structural limitations create conflicts between professional values and organizational realities; Moral distress as emotional suffering and erosion of professional identity and well-being; Relational and organizational support as protection against moral distress; Professional commitment as both a source of resilience and vulnerability. ConclusionsMoral distress associated with healthcare resource cutbacks is an ethical and organizational phenomenon arising from tension between caring responsibility and restricted possibilities for ethical action experienced by both leaders and healthcare professionals. Ethically sustainable healthcare requires individual commitment and organizational structures that enable caring responsibility. Addressing moral distress requires attention to resource allocation, decision-making, leadership, and organizational conditions that strengthen moral agency and support care grounded in human dignity.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261493466"},"PeriodicalIF":3.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nursing EthicsPub Date : 2026-10-15DOI: 10.1177/09697330261490842
Gaelyn Grant, Aimee Milliken
{"title":"Moral distress & moral community: A narrative review of the literature.","authors":"Gaelyn Grant, Aimee Milliken","doi":"10.1177/09697330261490842","DOIUrl":"https://doi.org/10.1177/09697330261490842","url":null,"abstract":"<p><p>Moral distress is recognized as a major contributor to burnout and attrition among nurses. While the sequelae of moral distress are profound, the antecedents of moral distress are multi-factorial and therefore the phenomenon is challenging to address. Many interventions target individual-level factors such as moral resilience; however, moral distress is a system-level problem. As such, there is a growing focus on developing upstream, system-level interventions to mitigate or prevent moral distress in the healthcare setting. Moral community is a system-level dynamic that reflects ethical climate and perceived organizational support, metrics that are often associated with moral distress. However, the connection between moral distress and moral community in nursing remains under-examined. Therefore, the purpose of this narrative review was to explore the relationship between moral distress and the concept of moral community in the context of nursing practice. Three categories emerged from this analysis: organizational constraints that instigate moral distress, moral community as a concept, and the role of moral community in an organization. Based on these categories, a revised definition of moral community was developed and used to synthesize a novel theoretical framework relating moral community to moral distress. Further research may apply the proposed definition of moral community and theoretical framework to (1) evaluate existing organizational ethical frameworks and (2) formulate novel interventions to address moral distress.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261490842"},"PeriodicalIF":3.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nursing EthicsPub Date : 2026-10-13DOI: 10.1177/09697330261491023
Angga Wilandika, Salami Salami, Wike Widia Nengsih, Muhammad Insan Jawwad Haifa, Ristina Putri Rahmayanti
{"title":"Patient safety as ethical practice: A qualitative study of the Protection of Life principle in nursing care.","authors":"Angga Wilandika, Salami Salami, Wike Widia Nengsih, Muhammad Insan Jawwad Haifa, Ristina Putri Rahmayanti","doi":"10.1177/09697330261491023","DOIUrl":"https://doi.org/10.1177/09697330261491023","url":null,"abstract":"<p><p>BackgroundPatient safety is commonly conceptualized through ethical reductionism, risk management, and technical performance indicators. However, such approaches may insufficiently address the ethical, relational, spiritual, and culturally embedded dimensions of nursing care. Within Islamic ethical thought, the principle of <i>Hifz al-Nafs</i> (protection of life) offers a holistic moral framework for understanding patient protection beyond biomedical risk prevention.AimThis study aimed to explore Indonesian nurses' ethical understandings and lived experiences of patient safety and caring and to examine how <i>Hifz al-Nafs</i> can serve as a culturally grounded ethical lens for interpreting these experiences.Research designA qualitative descriptive design was employed using semi-structured face-to-face interviews and thematic analysis following Braun and Clarke's six-step framework.Participants and research contextTwelve registered nurses from two tertiary hospitals in Indonesia participated in the study. Participants were purposively recruited to ensure variation in clinical experience and practice settings.Ethical considerationsThis study was approved by the relevant institutional ethics committees. A written informed consent was obtained from all participants, and participation was voluntary and de-identified.ResultsThree interrelated thematic clusters were identified: Institutional Gaps, Binary Framings, and Community Solidarity. Participants described patient safety as an ethically grounded practice integrating technical competence, relational ethical care, spiritual sensitivity, and communal responsibility. Hifz al-Nafs was used retrospectively as an interpretive ethical lens; participants did not explicitly use the term during the interviews.ConclusionsThe findings reconceptualize patient safety as an ethical and culturally situated nursing practice rather than solely a technical process. The study contributes a culturally grounded Caring-Safety synthesis that links procedural safety, relational care, and moral responsibility without claiming a universally transferable model.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261491023"},"PeriodicalIF":3.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nurses' support for medical assistance in dying: A systematic review and meta-analysis.","authors":"Zhengjun Zhu, Changying Liu, Meifang Jiang, Yuyu Liu, Li Li, Chuntao Luo, Yanli Zeng","doi":"10.1177/09697330261493442","DOIUrl":"https://doi.org/10.1177/09697330261493442","url":null,"abstract":"<p><p>BackgroundMedical assistance in dying (MAID) raises complex ethical and professional questions for nurses, whose attitudes may vary across legal, sociocultural, and clinical contexts. Although nurses' experiences and attitudes toward assisted dying have been extensively examined, the prevalence and contextual variation of nurses' support for MAID across the international evidence remain unclear.Research aimTo estimate the prevalence of nurses' support for MAID and examine whether support varies across geographic, legal, clinical, and country-income contexts.Research designA systematic review and meta-analysis of studies reporting quantitative data on nurses' support for MAID or related assisted-dying practices.Search and quality appraisal10 electronic databases were searched from inception to 10 May 2025. Methodological quality was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Random-effects models were used to pool prevalence estimates, with subgroup analyses and univariable meta-regression used to examine contextual variation.Results26 studies involving 12,529 nurses from 19 countries were included. The pooled prevalence of support for MAID was 42.5% (95% confidence interval 34.6%-50.4%), with very high between-study heterogeneity (<i>I</i><sup>2</sup> = 99.6%). Support varied by geographic region (<i>p</i> = .004), with pooled estimates of 51.0% in Europe, North America, and Oceania, 30.1% in Asia, and 23.1% in Africa. Support was also higher where an eligible form of assisted dying was legally authorized than where it was not (58.4% vs 37.6%; <i>p</i> = .038). Neither clinical setting nor country income level was significantly associated with support.ConclusionsNurses' support for MAID varies substantially across the available international evidence and should not be interpreted as a uniform global professional position. Geographic region and legal status were associated with this variation, supporting the need for context-sensitive ethical preparedness, role clarity, and organizational support rather than assumptions of professional consensus.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261493442"},"PeriodicalIF":3.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nursing EthicsPub Date : 2026-10-11DOI: 10.1177/09697330261493452
Gamze Saatçi, Sevda Korkut, Muhammed Köstekçi, Ezgi Yıldız
{"title":"The effect of Ahi-based education on the professional values of nursing students.","authors":"Gamze Saatçi, Sevda Korkut, Muhammed Köstekçi, Ezgi Yıldız","doi":"10.1177/09697330261493452","DOIUrl":"https://doi.org/10.1177/09697330261493452","url":null,"abstract":"<p><p>BackgroundProfessional values guide nurses' ethical judgments, care relationships, and professional responsibilities. However, evidence on culturally grounded educational approaches that connect local moral traditions with nursing professional values remains limited.Research question and aimThis study aimed to compare the professional values of nursing students who received Ahi-based education with those who did not.Research designA non-randomized pretest-posttest quasi-experimental design with intervention and control groups was used.Participants and research contextThe study included 168 second-year nursing students from two state universities in Central Anatolia, Turkey. The intervention group (<i>n</i> = 84) received the face-to-face \"Ahi Culture and Professional Ethics\" course for two class hours weekly over 14 weeks in addition to routine nursing education, whereas the control group (<i>n</i> = 84) continued the routine curriculum.Ethical considerationsEthical approval and institutional permissions were obtained. Online informed consent was obtained, participation was voluntary, and no directly identifying information was collected. Students were informed that participation would not affect their grades or academic evaluation.FindingsAfter adjustment for the baseline NPVS-R total score, the intervention group had higher post-test NPVS-R total scores than the control group (adjusted mean difference = 6.05, 95% CI [1.02, 11.09], <i>p</i> = .019). Secondary exploratory analyses showed higher Caring and Trust factor scores in the intervention group, whereas the between-group difference in Professionalism was not statistically significant.ConclusionsStudents who received Ahi-based education had significantly higher overall professional values scores and higher scores on the Caring and Trust factors than those in the control group, whereas no significant between-group difference was observed in the Professionalism factor.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261493452"},"PeriodicalIF":3.8,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nursing EthicsPub Date : 2026-10-11DOI: 10.1177/09697330261490920
Haiyan Zhang, Lei Huang, Huijuan Qin, Meichan Chong, Zhiru Fan, Cui Liu, Junjun Sun, Xingyi Shao, Jin Li, Jinjin Gu, Peng Wang
{"title":"Constrained endurance in long-term family caregiving: Rethinking resilience through nursing ethics.","authors":"Haiyan Zhang, Lei Huang, Huijuan Qin, Meichan Chong, Zhiru Fan, Cui Liu, Junjun Sun, Xingyi Shao, Jin Li, Jinjin Gu, Peng Wang","doi":"10.1177/09697330261490920","DOIUrl":"https://doi.org/10.1177/09697330261490920","url":null,"abstract":"<p><p>Resilience is an established concept in family-caregiver research, where it is used to describe how caregivers maintain functioning and adapt to sustained adversity. In long-term family care for older adults with disabilities, however, resilience is ethically ambiguous. Continued care may reflect adaptive capacity, relational commitment and caregiving competence, but it may also be shaped by dependency, moral obligation, cultural expectations and limited alternatives. This article critically examines the ethical implications of caregiver resilience and develops the concept of constrained endurance to rethink resilience in long-term family caregiving. The article advances an ethical critique of resilience discourse by showing how resilience, when uncritically celebrated, may psychologise caregiver distress, individualise structural problems and attach moral value to endurance. Fatigue, ambivalence, complaint and the wish for relief may then be interpreted as signs of inadequate coping, insufficient responsibility or failure of care, rather than as signals that care arrangements have exceeded what can be sustainably borne. Rethinking resilience through the concept of constrained endurance shifts the ethical focus from asking how caregivers can endure more to examining the conditions under which continued caregiving becomes necessary, costly or unsustainable. For nursing ethics, resilience should function not as a moral standard but as an ethical signal: a prompt to recognise caregivers' limits, acknowledge ambivalence, make hidden costs visible and develop forms of support that make care sustainable rather than merely endurable.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261490920"},"PeriodicalIF":3.8,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Moral courage in nursing students before internship: A network analysis.","authors":"Binbin Yang, Changzai Li, Wei Zhao, Rui Yuan, Yawen Wu, Mingxu Wang, Yaning Zhao, Pan Zhang","doi":"10.1177/09697330261493444","DOIUrl":"https://doi.org/10.1177/09697330261493444","url":null,"abstract":"<p><p>BackgroundMoral courage helps nursing students respond to ethically difficult situations, yet little is known about how its dimensions relate to ethical sensitivity, professional identity, and emotional intelligence at the dimension level.Research objectiveThis study examined the dimension-level network structure of moral courage, ethical sensitivity, professional identity, and emotional intelligence among undergraduate nursing students.Research designA cross-sectional online survey was conducted. Dimension scores were standardized and analyzed with an EBICglasso Gaussian graphical model. Strength and bridge centrality were estimated, and network accuracy and stability were assessed using bootstrap procedures.Participants and research contextParticipants were 494 full-time third-year undergraduate nursing students from one university who were approaching a mandatory clinical internship.Ethical considerationsThis study was approved by the ethics committee of North China University of Science and Technology(approval no. 2024185). Informed consent was obtained from all participants.ResultsThe network included 16 nodes and 51 non-zero edges. Within moral courage, moral integrity showed two of the largest conditional associations, with compassion and true presence with the patient (0.383) and moral responsibility (0.369). Cross-community associations were generally smaller. Compassion and true presence with the patient had the highest bridge expected influence point estimate (0.180), whereas social comparison and self-reflection had the highest bridge strength (0.207). The leading bridge expected influence estimates were close. Correlation stability coefficients were 0.749 for strength, 0.516 for bridge expected influence, and 0.439 for bridge strength, warranting cautious interpretation.ConclusionAmong nursing students approaching clinical internship, moral courage showed relatively strong within-community associations and smaller cross-community associations with related constructs. Different bridge rankings indicated that cross-community connectivity was not concentrated in a single consistently highest-ranked dimension. These findings support longitudinal and educational research during the transition to clinical practice.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261493444"},"PeriodicalIF":3.8,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}