Nursing Ethics最新文献

{"title":"Healthcare professionals' conceptualisation of care violations as deviance: a qualitative study.","authors":"Natana de Morais Ramos, Matheus Tavares França da Silva, Maria Beatriz Nunes de Carvalho, Adriana Catarina de Souza Oliveira, Rhanna Emanuela Fontenele Lima de Carvalho","doi":"10.1177/09697330261474059","DOIUrl":"https://doi.org/10.1177/09697330261474059","url":null,"abstract":"<p><p>BackgroundViolations in healthcare practice represent significant ethical and clinical challenges. Although often categorized as technical failures, they are strongly influenced by organizational culture and professional decision-making. Understanding how frontline practitioners conceptualize these deviations is essential for strengthening patient safety and ethical practice.ObjectiveTo explore the meanings attributed by healthcare professionals to violations in clinical practice.MethodsThis qualitative study employed online focus groups with 26 healthcare professionals from different disciplines, predominantly from the nursing workforce (73%). Data were collected using a structured discussion script, transcribed verbatim and analysed through Bardin's thematic content analysis. The study followed the COREQ guidelines to ensure methodological rigor. Ethical approval was obtained (Protocol 5.871.911).Ethical considerationsThe study was approved by the relevant Research Ethics Committee (Protocol No. 5.871.911). All participants received information about the study and provided informed consent before data collection. Participation was voluntary, and confidentiality and anonymity were protected throughout data collection, analysis and reporting.ResultsParticipants described violations as conscious deviations from safe practice and acknowledged their potential consequences for patient safety. The findings reveal a process of normalization of deviance driven by precarious working conditions, institutional traditions, and resource constraints. Although participants' perceptions converged with theoretical definitions regarding the operational characteristics of violations, their formal conceptual understanding remained limited. A tension also emerged between learning-oriented strategies and persistent punitive approaches focused on individual culpability.ConclusionHealthcare professionals recognize key elements of violations and emphasize the role of continuing education in addressing them. However, conceptual gaps and punitive cultures hinder the full appropriation of the construct in clinical practice. These findings contribute to nursing ethics by highlighting how organizational conditions shape the ethical management of deviations from safe practice.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261474059"},"PeriodicalIF":3.8,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800407","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":"Faith-informed professionalism and gender interaction in nursing.","authors":"Mohamad Firdaus Mohamad Ismail, Ferry Efendi, Siti Zuhaidah Shahadan, Mohd Rosdi Mohd Bukhari","doi":"10.1177/09697330261476264","DOIUrl":"https://doi.org/10.1177/09697330261476264","url":null,"abstract":"<p><p>Contemporary nursing practice increasingly takes place within culturally, religiously, and ethically plural healthcare environments. Although professional standards provide a shared ethical foundation, limited conceptual attention has been given to how nurses' religious moral identities influence ethical reasoning during cross-gender care. Existing discussions of professionalism remain largely grounded in secular ethical perspectives, leaving insufficient exploration of how faith-based moral traditions may contribute to professional identity and moral agency. This paper examines gender interaction in nursing through Islamic ethical perspectives and proposes a conceptual framework of faith-informed professionalism to contribute to broader discussions of ethical pluralism in nursing ethics. A conceptual normative analysis was undertaken through critical engagement with literature on nursing professionalism, moral agency, ethical pluralism, and Islamic ethics. Relevant concepts were identified, interpreted, and synthesised to develop a conceptual framework integrating professional standards with Islamic ethical principles relevant to gender interaction in nursing practice. The analysis argues that gender interaction should be understood not only as a matter of professional conduct but also as an ethically significant encounter in which Muslim nurses negotiate professional responsibilities alongside religiously informed moral commitments. Drawing on the concepts of <i>haya'</i>, <i>adab</i>, <i>niyyah</i>, <i>ikhtilat</i>, <i>darurah</i>, and <i>maqasid al-shariah</i>, the paper develops faith-informed professionalism as a conceptual framework that explains how faith-based moral commitments may coexist with professional standards while maintaining patient welfare, professional accountability, and equitable care as overriding priorities. A clinical illustration demonstrates the framework's application as a guide for ethical reflection rather than a prescriptive model for practice. Faith-informed professionalism extends contemporary discussions of moral agency, professional identity, and ethical pluralism by recognising that religious moral traditions may complement, rather than compete with, established professional standards. The proposed framework offers a theoretical contribution to nursing ethics and provides a foundation for future empirical research and educational development within multicultural healthcare environments.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261476264"},"PeriodicalIF":3.8,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800361","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":"Care episodes and the ethics of continuity: Nursing practice under the European health data space.","authors":"Jinshuo Liu, Yonghui Ma","doi":"10.1177/09697330261476262","DOIUrl":"https://doi.org/10.1177/09697330261476262","url":null,"abstract":"<p><p>The European Health Data Space (EHDS) reconfigures continuity of care by framing healthcare delivery around 'specific episodes of care' and supporting cross-border interoperability of electronic health data. Rather than relying primarily on sustained interpersonal relationships between patients and healthcare professionals, the EHDS seeks to secure continuity through institutionalised informational infrastructures that enable timely access to standardised electronic records across settings and jurisdictions.This paper examines the ethical implications of this shift for nursing practice. Based on the conceptual distinctions between relational continuity, informational continuity, and managerial continuity, we argue that while the EHDS strengthens informational continuity, it does not secure the ethical goods traditionally sustained through relational continuity, including trust, meaningful informed consent, and clearly allocated accountability. Nurses occupy a pivotal position at the intersection of documentation, interpretation, and patient communication, and thus bear newly intensified ethical and legal burdens within episodic, data-driven care environments.We analyse three emerging areas of concern: trust-building under conditions of mediated data access, the growing demand for supporting patient autonomy in cross-border data governance, and the diffusion of accountability across fragmented care episodes. The paper concludes by proposing institutional safeguards, including structured training, standard operating procedures, participatory system design, and clearer responsibility allocation, to ensure that informational continuity can coexist with ethically defensible nursing practice. In doing so, we offer an interpretative account of how data infrastructures reshape the moral landscape of care without reducing nursing ethics to data governance alone.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261476262"},"PeriodicalIF":3.8,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799955","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":"Domestic violence and mental health: Legal issues in clinical practice.","authors":"Shannon Dhollande, Craig Morris, Jayde Shepheard, Catherine Hungerford","doi":"10.1177/09697330261476258","DOIUrl":"https://doi.org/10.1177/09697330261476258","url":null,"abstract":"<p><p>BackgroundHealthcare is a heavily regulated environment in which nurses must navigate the delivery of therapeutic care while also managing their legal responsibilities. Appropriate care may appear ambiguous when the person who has experienced domestic or family violence is also experiencing mental health issues.AimThis study aims to present a case study, with learning objectives aligned to core legal, ethical, and clinical decision-making considerations and then demonstrate how students can be guided to analyse the case study, identify legal concerns, and address the arising issues to provide appropriate mental healthcare.Research DesignA simulated, constructed teaching case was analysed against relevant Australian legislation, professional standards, and organizational policy to identify key legal and practice issues at the intersection of domestic and family violence and mental healthcare.Ethical ConsiderationsSimulated case studies include realistic details that mirror practice environments. This case, designed for educational purposes, does not reproduce or disclose any real patient information, thereby avoiding confidentiality and ethical concerns.ResultsRecommendations surrounding lawful information sharing and the use of least-restrictive practices have been made. There is a need to support nurses with relevant education aligned with clear policies that reflect legislation.ConclusionsThis article highlights how legislation underpins and influences the provision of safe trauma-informed healthcare. Where domestic and family violence intersect with mental deterioration nursing staff need to navigate between their legal and ethical role and responsibilities. Using a simulated case study this article provides recommendations for care for these often-complex presentations.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261476258"},"PeriodicalIF":3.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762486","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":"Establishing a clinical protocol to reduce patients' sexual dignity discomfort.","authors":"Min Jung Kang, Soo Yeon Lim, Sihyun Park","doi":"10.1177/09697330261476263","DOIUrl":"https://doi.org/10.1177/09697330261476263","url":null,"abstract":"<p><p>BackgroundIn healthcare, patients are inherently required to undress, expose their bodies, and entrust themselves to others at their most vulnerable states. However, the potential sexual dignity discomfort (SDD) during these moments remains an underexplored dimension of patient dignity in healthcare settings. Unaddressed SDD can erode patients' trust in providers, prompt avoidance of necessary care, and ultimately compromise health outcomes.Research aimThis study aimed to develop and validate a culturally grounded clinical protocol to prevent patients' SDD in South Korean healthcare settings.Research designA multistep protocol-development design was employed, comprising protocol development, Delphi validation, and interview-informed refinement.Participants and research contextA total of 26 healthcare professionals from diverse clinical settings in South Korea participated in the Delphi surveys, and nine experts participated in in-depth interviews.Ethical considerationsThis study was approved by the Institutional Review Board of Chung-Ang University, and all participants provided informed consent.FindingsThe initial Delphi survey demonstrated high perceived necessity and importance of the protocol items but relatively lower feasibility and practice, revealing a gap between ethical awareness and practical implementation. Qualitative interviews identified several barriers to implementation, including sociocultural norms, defensive clinical attitudes, structural constraints, and hierarchical power dynamics. Based on these findings, the protocol was refined and finalized with 7 domains and 24 items.ConclusionsThe protocol developed in this study offers an evidence-based and culturally feasible framework not only as a practical guide for healthcare providers but also as an affirmation that every patient who exposes their body in clinical care deserves to have their dignity recognized, respected, and actively protected.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261476263"},"PeriodicalIF":3.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765998","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":"Negotiating authority and hierarchy amongst UK and Australian nurses.","authors":"Ryan Essex, Lydia Mainey, Ada Hui","doi":"10.1177/09697330261476268","DOIUrl":"https://doi.org/10.1177/09697330261476268","url":null,"abstract":"<p><p>BackgroundAuthority and hierarchy shape nursing practice, influencing professional relationships, decision-making, advocacy and patient care. Although these concepts are widely present in healthcare, they are often examined indirectly through issues such as communication, bullying, professional status or organisational culture, rather than as phenomena in their own right.Research question/aim/objectivesThe aim of this study was to explore how nurses and midwives in the United Kingdom and Australia experience authority and navigate hierarchy in their work, and the consequences of these dynamics for ethical practice.Research designA qualitative study was conducted using online semi-structured interviews. Data were analysed inductively using reflexive thematic analysis, following COREQ reporting guidance.Participants and research context10 registered nurses and midwives from the United Kingdom and Australia participated. Participants worked across clinical, educational and academic contexts, with some still in full-time clinical practice and others having moved into non-clinical roles.Ethical considerationsEthical approval was granted by an institutional ethics committee. Participants provided informed consent. Given the sensitivity of the topic and the small sample, detailed demographic information was not collected or reported to protect confidentiality.Findings/resultsFive interconnected forms of authority were identified: professional, regulatory, theoretical, institutional and political. Authority was experienced as dynamic, relational and context-dependent, shifting across roles, relationships and settings. Participants described nursing as often positioned as subordinate within healthcare hierarchies, while also exercising authority through advocacy, expertise, influence and everyday resistance. Regulatory and institutional structures were experienced as both enabling and constraining, legitimising professional action while also limiting what could be said or done.ConclusionsAuthority in nursing is not fixed or determined solely by role or position, but it is continually negotiated in everyday practice. Nurses both reproduce and resist hierarchical structures while managing tensions between advocacy, compliance, professional risk and patient care, with authority and hierarchy shaping a range of ethical features of practice, including autonomy, communication and moral distress. Greater recognition of these dynamics may support safer, more ethical and more responsive healthcare systems.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261476268"},"PeriodicalIF":3.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765890","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":"Postgraduate nursing students' experiences of expressing concerns in supervisory relationships.","authors":"Yue Xiang, Haoning Shi, Keke Ren, Xilin Yang, Lin Li, Qinghua Zhao, Huanhuan Huang","doi":"10.1177/09697330261476265","DOIUrl":"https://doi.org/10.1177/09697330261476265","url":null,"abstract":"<p><p>BackgroundPower imbalances between supervisors and students can hinder graduate students from expressing concerns, potentially affecting academic progress and well-being. This issue may be more pronounced in nursing education due to the hierarchical culture.AimDrawing on boundary work theory, this study explores postgraduate nursing students' experiences of expressing concerns in power-imbalanced supervisory relationships, and examines whether informal peer support serves as an alternative channel when formal supervisory communication is constrained.DesignA descriptive qualitative design was employed. Data were collected through semi-structured interviews and analyzed using thematic analysis.Participants and research contextBetween November 2025 and January 2026, 18 postgraduate nursing students were recruited from four universities in Sichuan and Chongqing, China.Ethical considerationsEthical approval for this study was obtained from the Institutional Review Board of the First Affiliated Hospital of Chongqing Medical University (Approval Number: 2026-0423-01).ResultsThree main themes were identified: (1) Attempting formal feedback: exploring and defining supervisor-student boundaries; (2) Encountering obstacles in formal feedback: the narrowing and reinforcement of supervisor-student boundaries; (3) Shifting to informal peer support: alternative expressions within constrained boundaries.ConclusionPostgraduate nursing students commonly experience dissatisfaction in supervisory relationships. Within power-imbalanced contexts, their expression of concerns is often constrained and redirected toward informal peer support. The interviews indicate that peer support can provide emotional support and advice, but it does not fully address the underlying issues. Therefore, it is necessary to foster a more open and egalitarian communication climate among supervisors and to improve institutional feedback and communication mechanisms at the school level.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261476265"},"PeriodicalIF":3.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763368","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 distress risk profiling in ICU nurses: A cross-sectional study.","authors":"Wei Hu, Xia Li","doi":"10.1177/09697330261474090","DOIUrl":"https://doi.org/10.1177/09697330261474090","url":null,"abstract":"<p><p>BackgroundMoral distress is common among ICU nurses and has been linked to burnout, diminished care quality, and turnover. Which factors matter most - and how they combine to shape individual risk - remains poorly characterised.Research objectiveTo identify factors associated with moral distress in ICU nurses and develop a parsimonious, exploratory risk-profiling model.Research designMulticentre cross-sectional survey with machine learning analysis.Participants and research contextA total of 318 registered nurses were recruited from ICUs of multiple tertiary hospitals across China between January and June 2025. Participants completed the Chinese-validated Moral Distress Assessment in Professional Practice Scale, the Connor-Davidson Resilience Scale, and the Pittsburgh Sleep Quality Index. High moral distress was present in 28.6% of participants. Data were split into training (<i>n</i> = 223) and test (<i>n</i> = 95) sets. LASSO regression selected 12 predictors from 29 variables, and 11 machine learning algorithms were compared. SHapley Additive exPlanations (SHAP) analysis guided feature reduction.Ethical considerationsApproved by the Ethics Committee of Jinzhou Medical University (No. JZMULL2025136). All participants gave written informed consent.FindingsGradient boosting machine (GBM) achieved the best balanced performance among all models (F1 = 0.767). SHAP-guided reduction to six features preserved full discriminative accuracy (AUC = 0.907, 95% CI: 0.834-0.980; DeLong <i>p</i> = 0.969 vs the 12-feature model). The six predictors, in order of importance, were monthly night shifts, financial responsibility role, psychological resilience, sleep quality, nurse-to-patient ratio, and weekly working hours. The model was well-calibrated (Hosmer-Lemeshow <i>p</i> = 0.220; Brier score = 0.097) and demonstrated net clinical benefit in decision curve analysis. Night shift frequency exhibited a nonlinear relationship with moral distress risk.ConclusionsSix modifiable or assessable factors accounted for most of the predictive signal. These exploratory findings suggest directions for future research and potential intervention - night-shift arrangements, financial strain, and resilience- and sleep-focused support - but the model requires external validation before any clinical application.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261474090"},"PeriodicalIF":3.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763420","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":"Influence of Generation Z's values on healthcare career choices: A scoping review.","authors":"Martina Barbieri, Talita Sallai, Lara Delbene, Oluwakemi Rachael Adeboye, Zuzana Turiakova, Daniela Javornická, Helena Kisvetrova, Alison Steven, Annamaria Bagnasco","doi":"10.1177/09697330261476260","DOIUrl":"https://doi.org/10.1177/09697330261476260","url":null,"abstract":"<p><p>BackgroundGeneration Z is entering healthcare education and the early career during a period of workforce strain and rapid digital transformation. Ethical values may shape how this cohort engages with training, work environments, and professional roles, yet ethical perspectives are often addressed indirectly in existing studies.MethodsA scoping review following JBI guidance and PRISMA-ScR was conducted. MEDLINE (PubMed), CINAHL, PsycINFO, Embase, and ProQuest Dissertations & Theses were searched, with no date limits and inclusion of English, Italian, Spanish, and Portuguese sources. Screening and extraction followed a structured approach. Study characteristics were summarized descriptively, and ethics-related findings were synthesized using a thematic narrative approach.ResultsTwenty-eight were included, focused mainly on medicine and nursing area. The evidence base was heterogeneous and dominated by cross-sectional surveys, qualitative descriptive studies, and discursive papers, with few theory-driven designs and no consistent use of formal ethical frameworks. Ethical values were rarely the primary focus and more often appeared as embedded orientations within broader discussions. Recurring ethical themes encompassing education, career decisions, professional practice, and health-related behaviours included well-being and boundaries; meaningful work and purpose; empathy, teamwork, and supportive supervision; equity and fairness; autonomy and flexibility; and digital/technological ethics, including privacy, trust, diagnostic reliability, and human connection.ConclusionsEthics-related orientations among Generation Z in healthcare are consistently present but commonly implicit. Greater attention to value-context alignment in learning environments, leadership practices, and digital implementation may help inform strategies to support strengthen engagement and retention. Further research should strengthen conceptual clarity and broaden the contexts and professions studied.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261476260"},"PeriodicalIF":3.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714297","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":"Citations for the Human Rights and Nursing Awards 2026.","authors":"","doi":"10.1177/09697330261475401","DOIUrl":"https://doi.org/10.1177/09697330261475401","url":null,"abstract":"","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261475401"},"PeriodicalIF":3.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664970","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}