Nursing Ethics最新文献

{"title":"Moral sensitivity and academic ethical awareness of nursing and medical students: A cross-sectional survey.","authors":"Yuet Kiu Ko, Cordelia Cho, Sihan Sun, Olivia My Ngan, Helen Yl Chan","doi":"10.1177/09697330241226604","DOIUrl":"10.1177/09697330241226604","url":null,"abstract":"<p><strong>Background: </strong>Moral sensitivity and academic integrity discernment hold paramount importance for healthcare professionals. Owing to distinct undergraduate educational backgrounds, nurses and physicians may exhibit divergent moral perspectives, academic integrity cognisance, and moral sensitivity within clinical environments. A limited number of studies have investigated the disparities and congruencies pertaining to moral sensitivity and academic ethical awareness among nursing and medical students.</p><p><strong>Objective: </strong>The study compares moral sensitivity and academic ethical awareness of undergraduate nursing and medical students with and without clinical exposure.</p><p><strong>Research design: </strong>A self-administered cross-sectional survey conducted from January to February 2022 was used to collect data from a medical school in Hong Kong.</p><p><strong>Participants and research context: </strong>A total of 545 respondents, including 137 nursing students and 408 medical students, completed the questionnaire.</p><p><strong>Ethical consideration: </strong>Ethics approval of the study was obtained. Written consent was waived to maintain anonymity because completing the questionnaire was considered implied consent.</p><p><strong>Findings: </strong>Both groups of undergraduates demonstrated a high level of bioethics knowledge. In terms of academic integrity, medical students were found to have a less concerned attitude towards punctuality, attendance, and skipping classes. Regarding moral sensitivity, senior medical students with clinical experience put less emphasis on decision-making involving patient participation, while senior nursing students were more hesitant in withholding treatment for incompetent patients who refused treatment. Both nursing and medical students showed decreased moral sensitivity in the 'conflicts' domain with increased clinical exposure.</p><p><strong>Conclusion: </strong>Study findings contribute to the discussion comparing the ethical attitudes of nursing and medical students. More effort should be made in nursing and medical education to promote practices in line with high academic integrity and to develop the ability to be morally sensitive in professional settings.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1499-1512"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693336","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":"Multi-professional perspectives to reduce moral distress: A qualitative investigation.","authors":"Sophia Fantus, Rebecca Cole, Timothy J Usset, Lataya E Hawkins","doi":"10.1177/09697330241230519","DOIUrl":"10.1177/09697330241230519","url":null,"abstract":"<p><strong>Background: </strong>Encounters of moral distress have long-term consequences on healthcare workers' physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited.</p><p><strong>Research objective: </strong>The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic medical center.</p><p><strong>Participants & research context: </strong>Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim.</p><p><strong>Research design: </strong>Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine's National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings.</p><p><strong>Ethical considerations: </strong>Ethics approval was obtained from the university and medical center institutional review boards.</p><p><strong>Findings: </strong>Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities.</p><p><strong>Conclusion: </strong>Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1513-1523"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the moral courage of nurses: A modified Delphi study.","authors":"Mingtao Huang, Yitao Wei, Qianqian Zhao, Wenhong Dong, Nan Mo","doi":"10.1177/09697330231221218","DOIUrl":"10.1177/09697330231221218","url":null,"abstract":"<p><strong>Background: </strong>The urgency of ensuring adequate moral courage in clinical nursing practice is evident. However, currently, there are few formal intervention plans targeted at enhancing the moral courage of nurses.</p><p><strong>Aim: </strong>To develop a training program for improving the moral courage of nurses using the modified Delphi method.</p><p><strong>Research design: </strong>A modified Delphi study.</p><p><strong>Participants and research context: </strong>From November to December 2022, a literature review and expert group discussion were conducted to develop a preliminary training plan framework. From January to March 2023, a two-round Delphi survey was performed, and a consensus was reached regarding the plan through online questionnaires. Descriptive statistics were used to analyze the data.</p><p><strong>Ethical considerations: </strong>This study was approved by the institutional ethics committee (No. 138, 30 August 2021). All participants provided written informed consent.</p><p><strong>Results: </strong>Consensus was reached on eight themes and 33 items to strengthen the moral courage training program for nurses.</p><p><strong>Conclusions: </strong>Guided by a unified goal of moral education, a multi-level and acceptable intervention plan was designed to enhance the moral courage of nurses.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1441-1456"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900754","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":"Ethical issues in research with second victims: A scoping review.","authors":"Lucía Catalán, María Kappes, Gabriela Morgado, Déborah Oliveira","doi":"10.1177/09697330241238345","DOIUrl":"10.1177/09697330241238345","url":null,"abstract":"<p><strong>Background: </strong>Second victim is the name given to the healthcare personnel-most often a nursing professional-involved with the error that led to the adverse event to a patient and who, as a result, have experienced negative psychological effects. Research with second victims has increased over the years, however concerns exist with regards to the ethical risks imposed upon these individuals.</p><p><strong>Aim: </strong>To explore the extent to which research with second victims of adverse events in healthcare settings adhere to ethical requirements.</p><p><strong>Methods: </strong>A scoping review was conducted following Arksey and O'Malley's methodological framework and using the following databases: PUBMED, Web of Science, and SCOPUS. Original research of any study design focused on second victims and published in English, Spanish, or Portuguese in 2014-2023 were included. A critical narrative approach was used to discuss the findings.</p><p><strong>Ethical considerations: </strong>The review followed ethical guidelines emphasizing accurate authorship attribution and truthful data reporting.</p><p><strong>Results: </strong>Fifteen studies using qualitative (<i>n</i> = 2), quantitative (<i>n</i> = 10), and mixed-method (<i>n</i> = 3) designs were included. Over half were not assessed by a research ethics committee, with questionable reasons given by the authors. One-third did not refer to having used an informed consent. In two studies, participants were recruited by their workplace superiors, which could potentially right to autonomy and voluntary participation.</p><p><strong>Conclusion: </strong>Over half of the included studies with second victims did not comply with fundamental ethical aspects, with risk to inflict respect for individual autonomy, confidentiality, and of not causing any harm to participants.</p><p><strong>Implications for nursing research: </strong>Healthcare personnel involved in adverse events are most often nursing professionals; therefore, any breach of ethics in research with this population is likely to directly affect their rights as research participants. We provide recommendations to promote better research practices with second victims towards safeguarding their rights as research participants.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1413-1427"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111974","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":"Work engagement among nurses in the context of the COVID-19 pandemic: A systematic review.","authors":"Ana Luiza Ferreira Aydogdu","doi":"10.1177/09697330241257570","DOIUrl":"10.1177/09697330241257570","url":null,"abstract":"<p><strong>Background: </strong>Despite nurses receiving education on how to respond during crises, the stress and demands arising from unprecedented situations, such as the COVID-19 pandemic, may affect their work engagement.</p><p><strong>Aim: </strong>To appraise and synthesize studies examining work engagement among nurses in the context of the COVID-19 pandemic.</p><p><strong>Methods: </strong>It is a systematic review in which three databases were searched. Critical appraisal tools and PRISMA guidelines were used. Content analysis was performed.</p><p><strong>Ethical considerations: </strong>Ethical approval was not required for this systematic review.</p><p><strong>Findings: </strong>A total of 21 studies were included. The results were classified into three categories: (1) levels and meanings of work engagement, (2) the relationship of work engagement with various factors, and (3) measures to enhance work engagement.</p><p><strong>Conclusion: </strong>The review revealed that nurses' work engagement varied from moderate to high. Factors such as education level and work schedule flexibility influenced their engagement. Positive associations were found between work engagement and job satisfaction, intention to stay, and organizational support, while stress and workload showed negative relationships. The crucial role of health policymakers, hospital administrators, and nurse managers in acting ethically, creating favorable working conditions and fostering nurses' work engagement was emphasized.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1688-1708"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248773","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":"Ethical challenges during critical phases of the COVID-19 pandemic: An interpretive synthesis.","authors":"Ignacio Macpherson, María V Roqué, Luis Echarte, Ignacio Segarra","doi":"10.1177/09697330241230684","DOIUrl":"10.1177/09697330241230684","url":null,"abstract":"<p><strong>Background: </strong>During the most critical phases of COVID-19 pandemic, dramatic situations were experienced in hospitals and care centers that nurses could hardly verbalize. Especially relevant were deep challenges related to terminal illness, situations of extreme sacrifice, as well as reflections on protective measures mixed with beliefs. We intend to analyze which problems had the greatest impact on professionals.</p><p><strong>Aim: </strong>The aim is to explore the ultimate basis for action when making decisions and the orientation of their behavior in the face of moral conflicts.</p><p><strong>Method: </strong>The methodological strategy is an interpretive synthesis. Narrative review of academic articles that analyzed ethical dilemmas during the pandemic was carried out by searching five databases (Pubmed, Scopus, Psycinfo, CINHAL, and WOS) between January 2020 and December 2022. Finally, 43 articles were selected.</p><p><strong>Ethical considerations: </strong>Ethical requirements were respected in all study phases.</p><p><strong>Results: </strong>The reading and review of the 43 articles initiated the first phase of inductive coding which resulted in 14 initial sub-themes. Based on this structure, a second phase of coding was carried out, giving rise to six categories or emerging themes. To facilitate the process of identifying the central category, the authors agreed to carry out a phase of synthesis, grouping the six themes into three meta-themes: the identification and acceptance of human vulnerability; the discovery of positive paradigms in traumatic situations in society; the prevalence of the common good over the particular interest, as the core structure of any society.</p><p><strong>Conclusion: </strong>The study has shown the need to consider healthcare benevolence as a new dimension of health care upon global vulnerability. Responsibility is required to ensure the well-being of a global society, prioritizing the common good over particular interests and building solutions on solid moral structures. A new ethical landscape is essential, starting with a humanistic curricular training of all healthcare professionals.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1646-1660"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730835","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":"Impacts of ethical climate and ethical sensitivity on caring efficacy.","authors":"Fiona Wing Ki Tang, Marques Shek Nam Ng, Kai Chow Choi, Gigi Cheuk Chi Ling, Winnie Kwok Wei So, Sek Ying Chair","doi":"10.1177/09697330231222595","DOIUrl":"10.1177/09697330231222595","url":null,"abstract":"<p><strong>Background: </strong>Caring practice begins with awareness of the suffering of patients in a given context. Understanding the interrelationship between the perceived ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses is crucial for strengthening the caring competency of nurses.</p><p><strong>Research aim: </strong>This study aimed to examine the associations between the ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses and to investigate the mediating effect of ethical sensitivity on the association between ethical climate and caring efficacy.</p><p><strong>Research design: </strong>This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey that measured the ethical climate, ethical sensitivity and caring efficacy using the Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire-Revised and Caring Efficacy Scale, respectively.</p><p><strong>Participants and research context: </strong>The study recruited 293 nurses from two general hospitals that provided acute in-patient and extended care in Hong Kong.</p><p><strong>Ethical considerations: </strong>Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants.</p><p><strong>Results: </strong>Ethical climate was associated with caring efficacy (<i>β</i> = 0.340, <i>p</i> < .001) and ethical sensitivity (<i>β</i> = 0.197, <i>p</i> < .001). After adjusting for ethical climate, ethical sensitivity was associated with caring efficacy (<i>β</i> = 0.860, <i>p</i> < .001). Ethical sensitivity showed a significant mediating effect on the association between ethical climate and caring efficacy (indirect effect = 0.169, 95% confidence interval: 0.097 to 0.261), which accounted for 50% of the total effect.</p><p><strong>Conclusions: </strong>The study reveals the complex and interwoven relationship between contextual and personal factors that affect nurses' caring efficacy from an ethical perspective. It provides insights into the significant roles of ethical climate and ethical sensitivity in strengthening caring efficacy. The results suggest theoretical and clinical implications for professionalisation.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1428-1440"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139058928","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":"Organizational trust breaches among nurses and aides: A qualitative study.","authors":"Katherine C Brewer, Andrew M Dierkes, Allison A Norful","doi":"10.1177/09697330241230520","DOIUrl":"10.1177/09697330241230520","url":null,"abstract":"<p><strong>Background: </strong>Healthcare worker retention and burnout are confounding issues. Trust among workers and their employer, that is, organization, is an important yet underexplored concept in research.</p><p><strong>Research aim: </strong>The aim of this qualitative study is to explore organizational actions and systems that promote or denigrate trust among registered nurses and patient care aides (aides).</p><p><strong>Research design: </strong>The study uses the Model of Psychological Contract as a theoretical framework. Focus groups were conducted to explore the concept of organizational trust and the consequences of broken trust.</p><p><strong>Participants: </strong>Registered nurses (RNs) (n=6) and aides (n=6) participated in the study. Six focus groups (three RN and three aide) were conducted, with two participants per group. Focus groups were conducted online.</p><p><strong>Ethical considerations: </strong>The study's methods were reviewed by the University of Pittsburgh Institutional Review Board.</p><p><strong>Findings: </strong>Among RNs and aides, a sense of trust and feeling valued were important to their sense of relationship with their employers. Trust was breached when resources were scarce, employees did not feel validated and listened to, and problems were not addressed. RNs and aides described feeling devalued when compensation practices were unjust or inequitable, they had limited autonomy, and the employer created an organizational climate where business needs superceded human caring. Consequences of trust breach included burnout, dejection, and feelings of non-belonging.</p><p><strong>Discussion: </strong>Tangible organizational resources (compensation and staffing) and intangible resources (value, respect, autonomy) are important to RNs and aides alike. Inability to provide these resources diminishes trust and even causes a sense of betrayal.</p><p><strong>Conclusion: </strong>Future research can explore the concepts of organizational justice and interventions to restore lost trust and improve healthcare worker well-being. This is one of only a few identified studies to explore organizational factors and well-being among aides and more research among this healthcare worker population is warranted.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1524-1536"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use and impact of the ANA Code: a scoping review.","authors":"Olivia Numminen, Hanna Kallio, Helena Leino-Kilpi, Liz Stokes, Martha Turner, Mari Kangasniemi","doi":"10.1177/09697330241230522","DOIUrl":"10.1177/09697330241230522","url":null,"abstract":"<p><p>Adherence to professional ethics in nursing is fundamental for high-quality ethical care. However, analysis of the use and impact of nurses' codes of ethics as a part of professional ethics is limited. To fill this gap in knowledge, the aim of our review was to describe the use and impact of the Code of Ethics for Nurses with Interpretive Statements published by the American Nurses Association as an example of one of the earliest and most extensive codes of ethics for nurses with their interpretative statements and constituting a strong basis for the International Council of Nurses' Code of Ethics for Nurses. We based our review on previous literature using a scoping review method. We included both non-scientific and scientific publications to provide an analysis of codes of ethics which can be utilized in development and revision of other nurses' codes of ethics. In the searches, we used CINAHL and PubMed databases limiting publications to texts with a connection to the Code of Ethics for Nurses published from January 2001 to November 2022 and written in English. Searches yielded 1739 references, from which 785 non-scientific and 71 scientific publications were included for analysis of the data. Although non-scientific and scientific publications addressed different number of categories, the results indicated that in the both groups the use and impact focused on professional ethics, nursing practice, and work environment and less on education, research, or social health issues. Nurses' ethical standards were not addressed in non-scientific publications, and clinical issues and leadership were not in focus in scientific publications. To increase evidence-based knowledge of the impact of codes of ethics additional research is needed. Good scientific conduct was followed.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1389-1412"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical internship environment and caring behaviours among nursing students: A moderated mediation model.","authors":"Zhuo-Er Huang, Xing Qiu, Ya-Qian Fu, Ai-di Zhang, Hui Huang, Jia Liu, Jin Yan, Qi-Feng Yi","doi":"10.1177/09697330231225393","DOIUrl":"10.1177/09697330231225393","url":null,"abstract":"<p><strong>Background: </strong>Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students' caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy.</p><p><strong>Research objective: </strong>This study aimed to examine the mediating effect of moral sensitivity and the moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours.</p><p><strong>Research design: </strong>A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro.</p><p><strong>Participants and research context: </strong>This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China.</p><p><strong>Ethical considerations: </strong>This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students.</p><p><strong>Results: </strong>The clinical internship environment (<i>B</i> = 0.450, 95% <i>CI</i> = [0.371, 0.530]) and moral sensitivity (<i>B</i> = 1.352, 95% <i>CI</i> = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students' caring behaviours via moral sensitivity (<i>B</i> = 0.161, 95% <i>CI</i> = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours (<i>B</i> = 0.019, 95% <i>CI</i> = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity (<i>B</i> = 0.006, 95% <i>CI</i> = [0.003, 0.010]).</p><p><strong>Conclusion: </strong>Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1481-1498"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984363","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}