Nursing Ethics最新文献

{"title":"How generative AI shapes the last meal at life's end.","authors":"Masahiro Shirotsuki, Satoshi Otsuki, Shoko Oiwa, Junko Sugama","doi":"10.1177/09697330261483891","DOIUrl":"https://doi.org/10.1177/09697330261483891","url":null,"abstract":"<p><p>BackgroundThe selection of an end-of-life meal for a person nearing death is often framed as a deeply personal and meaningful act. Distinct from the well-documented practice of last-meal requests before execution, food and meal choices during the terminal phase of illness are shaped by medical constraints, family dynamics, cultural expectations, and ethical judgements. Palliative-care nursing literature increasingly recognises food and mealtimes as sources of both meaning and distress for patients and families. As generative artificial intelligence (AI) systems are increasingly introduced into healthcare contexts, they may also generate recommendations in ethically sensitive areas such as end-of-life care. Such recommendations are not neutral; they may reflect normative assumptions about safety, comfort, and what constitutes a \"good death.\"Research aimThis study examines how generative AI constructs and justifies end-of-life meal suggestions, and how these outputs reflect, reinforce, or silence particular ethical and cultural imaginaries of dying.Research designA qualitative, interpretive research design grounded in science and technology studies (STS) and critical AI-ethics perspectives on non-human actors as normative agents (see Theoretical framework, Section 4.1) was adopted, treating AI-generated outputs as cultural texts rather than clinical guidance. The analysis focused on both proposed meals and the justificatory language accompanying them.Participants and research contextNo human participants were involved. The dataset consisted of 75 AI-generated meal proposals produced by a single large language model. Fifteen systematically varied prompts were generated five times each, manipulating age, cultural background, religious orientation, family presence, swallowing difficulty, and preference deviation.Ethical considerationsThe authors' institutional research ethics committee confirmed that the study was exempt from full ethical review because it involved no human participants, patient data, or identifiable personal information (determination no. 001, dated 4 August 2026). The relevant institutional office also confirmed that no separate approval was required for the use and analysis of LLM-generated outputs. The analysis was conducted in accordance with the applicable terms of use of the LLM provider.FindingsSafety-oriented language dominated across outputs (93.3%), alongside emotional comfort and nostalgia. By contrast, explicit conflict, ritual specificity, and strong desire prioritisation were consistently absent. Even when preference deviation was prompted, AI outputs tended to neutralise tension and redirect choices towards harmonised, risk-averse narratives.ConclusionsAcross the outputs analysed, generative AI reproduced a narroaw moral script of dying that privileged safety and emotional tranquillity while marginalising conflict, ritual, and embodied desire. We do not claim that clinicians currently rely on generic AI tools to ","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261483891"},"PeriodicalIF":3.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041775","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":"Beyond cost-effectiveness: Reframing the value of essential nursing care in healthcare priority-setting.","authors":"Daniel Joseph E Berdida","doi":"10.1177/09697330261489620","DOIUrl":"https://doi.org/10.1177/09697330261489620","url":null,"abstract":"<p><p>Cost-effectiveness analysis (CEA) has become a dominant framework for healthcare priority-setting, offering policymakers a standardized way to compare costs with expected health gains under conditions of scarcity. Yet its dominance raises ethical and conceptual problems when applied to forms of care that are relational, continuous, preventive, and foundational to human wellbeing. Essential nursing care is often difficult to represent through the outcome metrics that CEA privileges, particularly in critical care, chronic illness management, palliative care, gerontological care, and end-of-life care. Drawing on feminist political economy, care ethics, health justice, and the capabilities approach, this discursive paper argues that essential nursing care should not be treated primarily as a discretionary investment whose legitimacy depends on economic efficiency. Rather, it should be understood as a human rights-based ethical commitment necessary for safe, dignified, equitable, and humane healthcare. The paper shows how prevailing evaluative frameworks may systematically undervalue nursing work by privileging what is most easily measured over what is morally and clinically indispensable. It then considers rights-based, capabilities-based, and deliberative approaches to priority-setting as more ethically adequate ways of recognizing the value of essential nursing care. The paper contributes to nursing ethics by arguing that essential nursing care should be recognized not only as a contributor to measurable outcomes, but also as a moral condition of dignity, safety, non-abandonment, and justice within healthcare systems.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261489620"},"PeriodicalIF":3.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041830","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":"Substituted judgment in health care decision-making: An evolutionary concept analysis.","authors":"Claire McGowan","doi":"10.1177/09697330261487675","DOIUrl":"10.1177/09697330261487675","url":null,"abstract":"<p><p>BackgroundSubstituted judgment guides health care decisions for patients who lack decision-making capacity, yet its meaning remains unsettled across legal, clinical, philosophical, and technological literatures. In practice, it is often conflated with best interests, family preference, and clinician judgment, while artificial intelligence preference predictors have renewed debate about what the standard is meant to preserve.AimTo clarify the concept of substituted judgment in health care decision-making using Rodgers' evolutionary method of concept analysis.Research designAn evolutionary concept analysis was conducted to examine the attributes, antecedents, consequences, surrogate and related terms, and disciplinary evolution of substituted judgment.Participants and research contextA multidisciplinary search across five databases with citation searching yielded 162 sources for analysis. Sixty-seven core analytic sources were extracted in full into a structured matrix with an audit trail.Ethical considerationsThe study analyzed published literature and did not involve human participants; institutional ethics approval was not required.FindingsThe concept evolved through four eras: legal origins in equity (1816 to 1969), migration into medicine and the courts (1969 to 1990), codification in bioethics and professional ethics (1990 to 2005), and critique and reinterpretation (2006 to present). Eight defining attributes were identified, including decisional incapacity, the moral relevance of prior personhood, distinction from best interests, surrogate interpretive responsibility, and practical and epistemic uncertainty. Consequences included value-concordant care and preserved patient authority, as well as false certainty, surrogate burden, and overreliance on prediction.ConclusionsSubstituted judgment is a morally constrained interpretive standard that seeks the decision most faithful to an incapacitated patient's prior values, commitments, and evaluative outlook under acknowledged uncertainty. Conceptual clarity can help nurses and other clinicians distinguish patient-centered reasoning from adjacent standards and influences.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261487675"},"PeriodicalIF":3.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041800","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":"Just deserts: Do students deserve a safe learning environment?","authors":"Mark Philip Wareing, Vasiliki Parlama","doi":"10.1177/09697330261487676","DOIUrl":"https://doi.org/10.1177/09697330261487676","url":null,"abstract":"<p><p>This conceptual paper critically analyses the notion of safe learning environments in the context of the introduction of a safe learning environment charter within the National Health Service in England. The experience of nursing students within complex ecologies of practice learning is considered including the triggers and drivers for the charter including patient safety incidents, calls for positive learning cultures and the lived experiences of learners and trainees. The utility of clinical learning environments is explored through distributive justice to question the extent to which a safe learning environment can be regarded as a just desert. The authors conclude that professional identity formation is dependent on experiences that may be deemed unsafe and that the translation of a policy ideal into some clinical settings makes the elements of the charter difficult to standardise or implement, particularly when learners are regarded as having a shared responsibility for the charter.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261487676"},"PeriodicalIF":3.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031744","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 Women's health: A systematic review of case reports.","authors":"Kaan Kurnaz, Zekiye Turan","doi":"10.1177/09697330261487677","DOIUrl":"https://doi.org/10.1177/09697330261487677","url":null,"abstract":"<p><p>AimThe aim of this systematic review is to identify ethical issues addressed in case reports published between 2016 and 2026 in the field of women's health and to analyze the types and characteristics of these ethical problems.MethodsIn this systematic review, predefined inclusion and exclusion criteria were applied. The inclusion criteria were (i) relevance to women's health (obstetrics, gynecology, and pregnancy), (ii) presence of an ethical dilemma or ethical issue, (iii) being a case report or case series, and (iv) publication between 2016 and 2026. Exclusion criteria were review articles and studies without ethical discussion. The studies were systematically searched in the following databases: PubMed, MEDLINE, Scopus, ScienceDirect, and Google Scholar, with the final search date set as 01.05.2026. The methodological quality of the included case reports was assessed based on CARE Guidelines. Findings were presented thematically.ResultsA total of 17 studies were included. The findings indicate that the conflict between autonomy and beneficence/non-maleficence constitutes the central ethical tension. The most frequently encountered ethical issues were categorized under five main themes: (1) maternal autonomy and fetal beneficence conflict, (2) fertility preservation and urgent medical indications, (3) maternal life-threatening conditions and pregnancy, (4) surrogacy and legal-biological parenthood ambiguity, and (5) vulnerability and end-of-life ethical decision-making. The results show that various ethical frameworks were used, including the four principles of bioethics, the four-box method, prima facie principles, the minus malum principle, the principle of double effect, the Islamic bioethics framework, and shared decision-making approaches.DiscussionThe most fundamental debate concerns the balance between fetal status as a silent patient and maternal autonomy. Cultural and legal frameworks significantly influence decision-making. Multidisciplinary approaches and structured ethical principles are essential.ConclusionEthical dilemmas arise in reproductive autonomy, critical maternal conditions, surrogacy, and vulnerable populations, influenced by cultural and religious contexts.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261487677"},"PeriodicalIF":3.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031701","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 Injury, Glass ceiling, and Nurses' Mental Well-Being.","authors":"Mohamed Ahmed Aly, Hossam Ali Ismail, Alshaimaa Yehia Mohammed Yehia, Mohamed Hussein Ramadan Atta","doi":"10.1177/09697330261486975","DOIUrl":"https://doi.org/10.1177/09697330261486975","url":null,"abstract":"<p><p>BackgroundNurses' mental well-being is shaped by organizational justice, professional growth opportunities, and ethically supportive work cultures. Perceived glass ceiling barriers may restrict professional advancement and create value conflicts that contribute to moral injury. However, the mechanisms linking structural career constraints to nurses' mental well-being remain insufficiently explored. This study integrates organizational ethics and psychological perspectives to provide insight into how moral injury may explain this relationship.Research Question/Aim/ObjectivesThis study examined the associations among glass ceiling syndrome, moral injury, and nurses' mental well-being, and investigated the mediating role of moral injury in the association between glass ceiling syndrome and mental well-being.Research DesignA descriptive correlational cross-sectional design was used. Data were analyzed using descriptive statistics, Pearson correlations, multivariable regression, and structural equation modeling.Participants and Research ContextThe study included 318 nurses from six public, university, and private hospitals in Cairo. Data were collected using a structured self-administered questionnaire, the Glass Ceiling Questionnaire, the Moral Injury Symptom Scale-Healthcare Professionals Version, and the Warwick-Edinburgh Mental Well-being Scale.Ethical ConsiderationsEthical approval was obtained from the relevant ethics committee. Written informed consent was obtained from all participants. Participation was voluntary, anonymous, and confidential.Findings/ResultsGlass ceiling syndrome was positively associated with moral injury and negatively associated with nurses' mental well-being. Moral injury was also negatively associated with mental well-being. In multivariable regression, moral injury showed the strongest negative association with mental well-being (β = -0.32, p < .001), followed by glass ceiling syndrome (β = -0.19, p < .001). The mediation model showed acceptable to good fit. Moral injury demonstrated a significant mediating effect in the association between glass ceiling syndrome and mental well-being (β = -0.24, 95% CI [-0.34, -0.14], p = .001). The mediating effect accounted for 53.3% of the total association estimated within the proposed model.ConclusionsGlass ceiling barriers and moral injury were associated with poorer nurses' mental well-being. The findings highlight the importance of equitable career advancement, ethical leadership, transparent promotion systems, and structured moral support in fostering healthier nursing work environments. This study provides new insights into the ethical and psychological pathways through which organizational barriers may influence nurses' well-being and offers evidence to inform future leadership strategies, educational initiatives, and intervention research.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261486975"},"PeriodicalIF":3.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026512","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":"The mediating role of compassionate love in the relationship between professional values and moral sensitivity.","authors":"Gülcan Eyüboğlu, Şenay Gül, Nigar Ünlüsoy Dinçer, Zehra Göçmen Baykara","doi":"10.1177/09697330261483592","DOIUrl":"https://doi.org/10.1177/09697330261483592","url":null,"abstract":"<p><p>BackgroundCompassionate love is an altruistic orientation encompassing care, compassion, empathy, and a desire to help others, making it deeply intertwined with the nature of nursing care. Although there is a substantial body of literature on nursing students' professional values and moral sensitivity, the role of compassionate love within the relationship between these two constructs remains unexplored.AimThis study was conducted to investigate the relationship among professional values, compassionate love, and moral sensitivity among nursing students and to analyze the mediating role of compassionate love in this relationship.Research designA cross-sectional and correlational study.Participants and research contextData were collected between January and May 2025 via an online survey administered to 309 undergraduate nursing students across two public universities located in the central region of Türkiye. Data analysis included descriptive statistics, Pearson correlations, and mediation modeling using the PROCESS macro.Ethical considerationsThe study was approved by the university's ethics committee (Date: 31.12.2024, Approval No: E-77082166-604.01-1130110). Electronic informed consent was obtained from all participants before data collection.FindingsStudents demonstrated moderate levels of compassionate love and moral sensitivity. A significant positive relationship was found between professional values and moral sensitivity. Regression-based mediation analysis indicated that professional values were significantly associated with compassionate love, which in turn had a positive indirect association with moral sensitivity. Furthermore, compassionate love significantly mediated the relationship between professional values and moral sensitivity.ConclusionsIn nursing education, it is crucial to recognize that compassionate love acts as a necessary catalyst, transforming professional values into actual moral sensitivity. Therefore, nursing curricula should actively integrate compassionate love alongside professional values to effectively foster students' moral sensitivity.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261483592"},"PeriodicalIF":3.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018478","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 and demoralization experienced by nurses in emergency departments: A systematic review and meta-synthesis.","authors":"Jiaqi Wang, Xiao Zhao","doi":"10.1177/09697330261483198","DOIUrl":"https://doi.org/10.1177/09697330261483198","url":null,"abstract":"<p><p>ObjectiveTo explore moral distress and demoralization experienced by nurses in emergency departments.MethodsFollowing PRISMA guidelines, nine databases (PubMed, Scopus, Embase, Web of Science, MEDLINE, ScienceDirect, CINAHL, PsycINFO, and ProQuest) were searched up to September 2025. Eligible studies were primary qualitative or mixed-methods research focusing on moral distress and/or demoralization among ED nurses. Data were extracted, appraised using the CASP Qualitative Checklist, and synthesized through thematic and interpretive meta-synthesis.ResultsSix high-quality qualitative studies (CASP scores: 8-9/10) conducted in Spain, the United States, and Türkiye were included. Five meta-themes and sixteen subthemes emerged: (1) Structural and organizational drivers-including power imbalances, resource scarcity, and policy-imposed ethical barriers; (2) Ethical conflict at the bedside-such as futile care, dehumanization, and unrelieved suffering; (3) Emotional consequences and moral residue-manifesting as guilt, shame, and identity erosion; (4) Coping responses-ranging from emotional numbing to peer solidarity and moral advocacy; and (5) Moral resilience and ethical sustenance-fostered by experience, supportive leadership, and value alignment. Moral distress was conceptualized not as an individual weakness but as a systemic moral injury shaped by institutional constraints.ConclusionsAddressing moral distress requires organizational accountability, structured ethical reflection, and policies that protect nurses' moral agency.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261483198"},"PeriodicalIF":3.8,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013232","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 emotional and ethical tensions in hospital-based end-of-life cancer care.","authors":"Mirko Prosen, Sabina Ličen","doi":"10.1177/09697330261486764","DOIUrl":"https://doi.org/10.1177/09697330261486764","url":null,"abstract":"&lt;p&gt;&lt;p&gt;BackgroundEnd-of-life cancer care is characterised by persistent tensions between curative and palliative approaches, creating emotional and ethical challenges for healthcare professionals.Research aimThis study aimed to explore how healthcare professionals experience and negotiate emotional and ethical tensions in end-of-life cancer care within hospital-based settings, and how these tensions are shaped by clinical, professional, and organisational contexts.Research designA qualitative study using an interpretative design and reflexive thematic analysis was conducted.Participants and research contextSemi-structured interviews were conducted with 25 healthcare professionals, including 15 nurses and 10 physicians, recruited from internal medicine, surgery, and intensive care departments across multiple hospitals in Slovenia. Participants had regular experience caring for patients with advanced cancer at the end-of-life.Ethical considerationsEthical approval was obtained from the Commission of the University of Primorska for Ethics in Human Subjects Research (Approval No: 4264-16-3/2022). Participation was voluntary, written informed consent was obtained from all participants, and confidentiality and anonymity were ensured throughout the study.Findings/resultsFour themes were generated: (1) negotiating the boundaries between life-prolongation and end-of-life care; (2) managing moral responsibility within team and hierarchical structures; (3) regulating emotional engagement to sustain professional functioning; and (4) working within structural constraints shaping care. While physicians primarily framed tensions through clinical decision-making and responsibility, nurses emphasised relational proximity to suffering and constrained professional agency. Emotional and ethical tensions were experienced as continuously produced through the interaction of uncertainty, hierarchy, emotional labour, and organisational conditions.OriginalityThis study provides an integrated interpretative account of how clinical uncertainty, professional hierarchy, emotional labour, and organisational constraints interact in shaping emotional and ethical tensions in hospital-based end-of-life cancer care. It further highlights how these tensions are experienced differently according to professional positioning, particularly the differing relationships between responsibility, relational proximity, and decision-making authority among nurses and physicians.ImpactThe findings indicate that emotional and ethical tensions in end-of-life cancer care cannot be addressed solely at the level of individual healthcare professionals. They highlight the need for stronger interdisciplinary collaboration, more inclusive involvement of nurses in decision-making, greater organisational support for emotional labour, and earlier integration of palliative care within acute hospital settings.ConclusionsEmotional and ethical tensions in end-of-life cancer care are embedded within broader instit","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261486764"},"PeriodicalIF":3.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992083","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":"mHealth use intensity and nurses' moral distress: The mediating role of perceived technical barriers to caring.","authors":"Peijun Wu, Maria Elizabeth Coronel Baua","doi":"10.1177/09697330261480340","DOIUrl":"https://doi.org/10.1177/09697330261480340","url":null,"abstract":"<p><p>BackgroundMobile health (mHealth) technologies have become increasingly integrated into nurses' workflows, enhancing efficiency while potentially disrupting the relational aspects of care. However, empirical evidence remains limited regarding how high-intensity mHealth use is associated with ethical strain among nurses.ObjectivesThis study examined the association between mHealth use intensity and nurses' moral distress and whether Perceived Technical Barriers to Caring (PTBC) statistically mediated this association.Research designA cross-sectional correlational design was used. An anonymous electronic questionnaire assessed mHealth use intensity, PTBC, and moral distress. Structural equation modeling with 5000 bootstrap resamples tested the hypothesized model.Participants and research contextA total of 331 registered nurses were recruited from three public general hospitals with established mHealth systems in Guizhou Province, Southwest China, between May and October 2025.Ethical considerationsThis study was undertaken during the author's doctoral studies in Nursing at St. Paul University Philippines. In accordance with the university's research ethics requirements, the study protocol was reviewed and approved by the Research Ethics Committee of St. Paul University Philippines. The study was conducted among registered nurses in public hospitals in Guizhou Province, China, and institutional permission was obtained from the participating hospitals before data collection.ResultsThe structural model demonstrated good fit (χ² = 195.02, df = 148, χ²/df = 1.32, CFI = 0.975, TLI = 0.972, RMSEA = 0.031, SRMR = 0.051). mHealth use intensity was significantly associated with PTBC (B = 0.31, β = 0.33, <i>p</i> < .001), and PTBC was significantly associated with moral distress (B = 1.58, β = 0.48, <i>p</i> < .001). The direct path from mHealth use intensity to moral distress was not significant (B = 0.57, β = 0.18, <i>p</i> = .157). A significant indirect association was observed through PTBC (unstandardized B = 0.49, bias-corrected 95% CI [0.22, 0.93]; standardized β = 0.16, 95% CI [0.06, 0.25]).ConclusionsmHealth use intensity was indirectly associated with moral distress through PTBC, but no significant direct association was observed. Care-sensitive digital implementation may help reduce technology-related ethical strain.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330261480340"},"PeriodicalIF":3.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931683","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}