Nursing Ethics最新文献

{"title":"Baby-Friendly Hospital Initiative: A critical analysis within the nursing workforce.","authors":"Adrianna Lorraine Watson, Debra Jackson, Carmel Bond","doi":"10.1177/09697330261449454","DOIUrl":"10.1177/09697330261449454","url":null,"abstract":"<p><p>Healthcare systems routinely frame breastfeeding as an ethical and clinical priority requiring institutional protection, particularly in maternity and newborn services. The Baby-Friendly Hospital Initiative represents a global effort to embed these commitments through policy, practice, and environmental support. While these protections are well established for patient-mothers, far less attention has been given to how they are applied to the nursing workforce responsible for enacting them.The authors critically appraise an ethical contradiction experienced by lactating nurse-mothers. Breastfeeding is institutionally supported for patients but structurally constrained within nurses' own workplaces. Using relational ethics as the primary interpretive lens, supported by clinical and organizational ethics frameworks, the analysis positions nurse-mothers as embodied ethical agents whose experiences reveal systemic moral incoherence within maternal-centered institutions.Evidence suggests that nurse-mothers frequently encounter delayed or denied pumping breaks, inadequate lactation facilities, stigmatization, and career penalties despite strong breastfeeding knowledge and commitment. These conditions generate ethical tension, moral distress, and professional disengagement. Achieving ethical integrity in Baby-Friendly Hospitals therefore requires enforceable structural protections that recognize maternal embodiment and caregiving as legitimate dimensions of ethically sustainable professional life.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1952-1963"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037173","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 leadership and nurses' voice behavior: A longitudinal study.","authors":"Zhengyi Ma, Dongrun Liu, Yongkang Fu, Chunmei Shao, Huanhuan Zhang, Jie Liu, Chaoran Chen","doi":"10.1177/09697330261451371","DOIUrl":"10.1177/09697330261451371","url":null,"abstract":"<p><p>BackgroundEthical leadership is recognized as a key factor influencing proactive employee behaviors in healthcare. However, limited longitudinal evidence exists on its relationship with nurses' voice behavior over time.ObjectivesThis study examines the longitudinal relationship between ethical leadership and nurses' voice behavior and investigates the mediating role of sense of professional mission.Research designA multicenter longitudinal survey was conducted with data collected at three time points over 6 months; validated scales measured all variables. Data were analyzed using Pearson correlation and structural equation modeling.Participants and research contextThe study included 537 registered nurses from four hospitals in China, recruited through stratified cluster sampling.Ethical considerationsThe Biomedical Research Ethics Subcommittee of Henan University approved the study. Written informed consent was obtained, and anonymity was ensured.ResultsEthical leadership at T1 was positively associated with sense of professional mission at T2 (β = 0.18, <i>p</i> < 0.001), which predicted voice behavior at T3 (β = 0.20, <i>p</i> < 0.001). A direct path from T1 ethical leadership to T3 voice behavior was also found (β = 0.18, <i>p</i> < 0.001). Sense of professional mission mediated 16.98% of the total effect. The model demonstrated good fit (χ²/df = 2.374, RMSEA = 0.051, CFI = 0.986).ConclusionsEthical leadership influences nurses' voice behavior both directly and indirectly through enhancing sense of professional mission. Strengthening ethical leadership and fostering professional mission may promote voice behavior in clinical settings.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1854-1870"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984117","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":"Structural moral distress among nurse middle managers in crisis.","authors":"Tatiana Talya Fleishman, Daniel Sperling, Anat Drach-Zahavy, Nadya Golfenshtein, Orly Toren, Miriam Hirschfeld, Nurith Wagner, Julie Benbenishty, Einav Srulovici","doi":"10.1177/09697330261449300","DOIUrl":"10.1177/09697330261449300","url":null,"abstract":"<p><p>BackgroundAt a time marked by ongoing global instability and health emergencies, the ethical and operational burdens on healthcare systems derived from the COVID-19 crisis, remain urgently relevant. Positioned between frontline staff and senior management, nurse middle managers (NMMs) were tasked during the pandemic with implementing institutional policies while simultaneously supporting teams facing rapid clinical and emotional challenges. Despite the pivotal role of NMMs, there exists a significant gap in understanding the ethical challenges and the strategies they employed during time of crisis.Research design and populationThis qualitative study used Interpretative Phenomenological Analysis approach to examine the lived ethical experiences and coping strategies of 16 Israeli NMMs from diverse healthcare sectors during COVID-19, and their implications for future crises.Ethical considerationsThe study received ethical approval from the University Research Ethics Committee. All participants gave informed verbal consent after a detailed briefing.FindingsMoral distress emerged as an ongoing, cumulative condition shaped by structural exclusion, constrained moral agency, and institutional inequities Three main themes emerged (1) the dual role of NMMs and its ethical ramifications, (2) ethical tensions and frustration in the relationship with senior leadership, and (3) confronting ethical dilemmas emerging from the unique challenges of the pandemic. Participants reported distress when required to implement policies conflicting with professional values, while being excluded from decision-making yet expected to justify top-down directives. Many served as emotional anchors for their teams without reciprocal support.ConclusionsThe study illuminates the distinctive moral position of NMMs in time of crisis, revealing sustained ethical conflicts rooted in systemic constraints. By reframing moral distress as structurally embedded, it underscores the need for organizational reforms to strengthen ethical preparedness, support NMMs, and enhance healthcare system resilience in future crises.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1832-1853"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950091","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 and human formation in certified nursing assistant education: A qualitative study.","authors":"Camila Lucchini-Raies, Francisca Marquez-Doren, Esteban Chiu López","doi":"10.1177/09697330261451352","DOIUrl":"10.1177/09697330261451352","url":null,"abstract":"<p><p>Human and ethical values are foundational to nursing education and practice. However, limited empirical evidence exists on how ethical formation is enacted and sustained in Certified Nursing Assistant (CNA) education, particularly in vocational and non-university settings, despite CNAs' central role in patient care. To explore perceived strengths and challenges in the human and ethical formation of CNA students across different stages of training and early professional practice. Qualitative descriptive study using thematic analysis. The study was conducted within a five-semester CNA education program. Data were generated through 29 semi-structured interviews and two focus groups involving 44 participants, including students, graduates, teachers, teaching managers, clinical preceptors, and employers. Perspectives were explored across four stages: prior to program entry, during the curriculum, the internship period, and early employment. Ethical approval was granted by the institutional Scientific Ethics Committee (ID 211014002). Participation was voluntary, written informed consent was obtained, and confidentiality and anonymity were ensured. Participants identified a distinctive institutional hallmark characterized by humanized care and ethical commitment. Ethical formation was supported by students' value-based motivations, educator engagement, and reinforcement during clinical learning. However, participants also described tensions, including reliance on hidden curricula, insufficient educator preparation, misalignment between ethical instruction and clinical realities, limited support during internship, and lack of structured opportunities for continuing ethical development after graduation.  Ethical formation in CNA education was shaped not only by formal curriculum, but also by institutional culture, clinical environments, and transition into practice.  Although the program promotes strong humanistic and ethical values, the findings highlight the need for a more explicit and sustained institutional approach to ethics education. Strengthening ethical formation through curriculum, clinical accompaniment, interprofessional collaboration, and continuing support is essential to foster moral agency and person-centered care.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1817-1831"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976616","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":"Emergency nurses' ethical challenges with psychiatric patients: A qualitative study.","authors":"Liying Zhang, Yubin Chen, Hong Su","doi":"10.1177/09697330261441778","DOIUrl":"10.1177/09697330261441778","url":null,"abstract":"<p><p>BackgroundEmergency departments increasingly serve as access points for patients experiencing psychiatric crises, creating ethical challenges for nurses. These environments remain designed for biomedical acute care, fundamentally incongruent with the needs of individuals experiencing severe mental disorders. This phenomenon has rarely been explored through nurses' lived experiences.AimTo explore the structurally produced ethical conflicts and the care climate experienced by emergency nurses when caring for patients with severe mental disorders in general hospitals.Research designA qualitative study using interpretative phenomenological analysis underpinned by critical theoretical framework. Participants were purposively sampled. Data were collected through semi-structured interviews and analyzed following the six-step IPA procedure.Participants and research contextEmergency nurses (<i>n</i> = 15) from three tertiary general hospitals in Northeast China with experience treating patients with severe mental disorders. Data were collected through interviews lasting 29-54 min.Ethical considerationsEthical principles were observed throughout the research process, including informed consent and participant anonymity.FindingsNurses experienced a pervasive climate of structural violence manifesting through institutional oppression (structural violence reproduction in EDs), technological usurpation (digital ethical collapse in decision-making), and subjective disintegration (traumatic reconstruction of nursing relationships). These conditions were systematically produced through institutional structures, technological mediations, and identity fragmentations rather than individual moral failings. Emergency nurses navigated paradoxical spaces where institutional structures and a violent care climate rendered ethical nursing care structurally impossible rather than merely difficult.ConclusionEmergency nurses face fundamental crises in practice that cannot be addressed through conventional ethics consultations or resilience strategies. Findings indicate needs for specialized psychiatric emergency services within general EDs, revised nursing curricula, and policy reforms addressing staffing requirements to create environments where ethical care for patients with severe mental disorders becomes possible rather than exceptional.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1646-1664"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787412","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 ethical weight of monitoring-as-witnessing: ICU nurses' vicarious trauma.","authors":"Yuanyuana Wang, Hongyu Chen, Xu Guo, Yi Zheng, Yueqin Gu","doi":"10.1177/09697330261449459","DOIUrl":"10.1177/09697330261449459","url":null,"abstract":"<p><p>BackgroundIntensive care nurses repeatedly witness suffering, dying, grief, and conflict. In contemporary intensive care, protocols and monitoring routines can compress nursing work into execution and vigilance, limiting opportunities to exercise moral agency and creating ethically fraught \"witnessing\" positions.Research objectivesTo explore how intensive care nurses experience vicarious trauma, and how moral agency, ethical tensions, and organizational conditions shape its accumulation and repair.Research designA qualitative study using face-to-face semi-structured interviews and reflexive thematic analysis.Participants and research contextFifteen registered nurses from a general intensive care unit in eastern China, purposively sampled for maximum variation in gender, professional title, experience, and recent high-impact exposures.Ethical considerationsEthical approval was obtained from the Ethics Committee of The First Affiliated Hospital of Zhejiang Chinese Medical University (approval number: 2025-KLS-184-02). Written informed consent was obtained; confidentiality and a distress protocol were applied.FindingsFour themes were generated: (1) occupational boundary permeation and resonance, including identity mirroring, emotional absorption, and moral tension; (2) a spectrum of adaptation, where defensive distancing functioned as a strategy of moral survival under repeated exposure; (3) fractures in professional meaning and points of rupture, including constrained voice and experiences of powerless witnessing; and (4) meaning reconstruction in the cracks, reflecting moral repair through process-oriented care, renewed boundaries, and re-grounding in dignity-preserving practice.ConclusionsVicarious trauma in intensive care nursing is not only an individual psychological burden but an ethical and organizational phenomenon shaped by constrained moral agency and ethically contested trajectories of care. Interventions should move beyond individualized resilience and strengthen ethical infrastructures that legitimize nursing voice, support reflective processing, and enable ethically defensible practice in high-acuity settings.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1719-1734"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845210","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":"Sense of coherence, resilience, and end-of-life attitudes in critical care.","authors":"Akiko Kondo, Tomomi Oki, Keri Draganic, Ann Eckhardt","doi":"10.1177/09697330261437291","DOIUrl":"10.1177/09697330261437291","url":null,"abstract":"<p><p>BackgroundCritical care nurses frequently encounter end-of-life care situations without adequate preparation, which can intensify emotional burden. Psychological resources such as sense of coherence and resilience may shape coping and attitudes toward dying patients, while cultural background may also play a role.AimTo examine associations among sense of coherence, resilience, and end-of-life care attitudes in critical care nurses, and to explore cultural factors related to these attitudes.Research designCross-sectional, correlational design.Participants and research contextBetween June 2022 and September 2023, data were collected via the American Association of Critical Care Nurses website and seven intensive care units in a U.S. academic medical center. Participants (N = 131) completed demographic data, Connor-Davidson Resilience Scale, Frommelt Attitude Toward Care of Dying Scale Form B, and Orientation to Life Questionnaire (sense of coherence). Structural equation modeling was used to examine associations among variables.Ethical ConsiderationsThis study was approved by the ethics committees of the University (#2022-0555) and the Medical Center (STU-2022-0419) in accordance with the Declaration of Helsinki. All participants provided informed consent for the anonymous survey.ResultsSense of coherence was positively associated with resilience (<i>β</i> = 0.424, <i>p</i> < .001), which in turn predicted more positive attitudes toward caring for dying patients (<i>β</i> = 0.251, <i>p</i> < .001). Asian-identifying nurses reported significantly lower scores on end-of-life care attitudes than other ethnic groups (<i>β</i> = -0.246, <i>p</i> = .001). Religious affiliation was not significantly associated with attitudes. Positive attitudes were linked to peer support and greater experience with patient death. Higher sense of coherence correlated with workplace satisfaction and graduate-level education.ConclusionAttitudes toward end-of-life care reflect interactions among sense of coherence, resilience, racial identification, and workplace context. Strengthening sense of coherence and resilience through education, peer support, and culturally informed training may enhance nurses' preparedness for end-of-life care.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1701-1718"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822893","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' awareness of ethical issues relating to medical and caregiving robots.","authors":"Chiharu Ito, Yoshinori Tamenaga, Yoshie Hara, Emiko Shinozaki, Harumi Ejiri","doi":"10.1177/09697330261449299","DOIUrl":"10.1177/09697330261449299","url":null,"abstract":"<p><p>BackgroundJapan has been promoting the use of medical and long-term care robots to reduce the workload of healthcare professionals. In home-visit nursing, where the number of older adults and patients with dementia is increasing, robots may provide benefits, such as supporting infection control and physically demanding care. However, implementing these technologies may also generate new ethical challenges.ObjectiveTo clarify home-visiting nurses' perceptions and the ethical issues regarding the introduction of medical and caregiving robots into home-visiting nursing field in Japan.MethodsA mixed-methods design was employed. A questionnaire survey was distributed to one nurse from each of 1012 home-visit nursing stations in Prefecture A. Descriptive statistics were used for quantitative analysis. To gain deeper insights, interviews were conducted with eight nurses who consented to participate.Ethical considerationsThis study was approved by the institutional review board (Approval No.: 2022N-026). Participation was voluntary, and informed consent was obtained. Data were anonymized to ensure confidentiality.Results and discussionThe questionnaire response rate was 17%. Simple tabulation showed that visiting nurses had positive expectations regarding the introduction of medical care robots but lacked confidence in their specific usefulness and safety. Only \"disinfection of equipment\" was identified as a task that could be fully shifted to robots. Twenty-six tasks, including \"rehabilitation,\" \"massage,\" \"bathing and shower care,\" and \"relaxation,\" were considered shareable between nurses and robots. Fifteen tasks-such as \"suctioning,\" \"enema and fecal disimpaction,\" \"postmortem care,\" and \"explanations and communication with family\"-were regarded as nurse-exclusive. Interview findings suggest that medical and nursing care robots may help reduce workload and supplement care for individuals living alone or requiring intensive support. However, key challenges include device safety and reliability, user and family acceptance, privacy protection, and implementation costs. Ethical consideration and clinical effectiveness must be carefully evaluated after clarifying target users, purpose, and scope of intervention.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1939-1951"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044591","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' Experiences Following Disaster: Moral Distress and Relational Loss.","authors":"Yasuko Sato, Kiyoka Nozue","doi":"10.1177/09697330261449464","DOIUrl":"10.1177/09697330261449464","url":null,"abstract":"<p><p>BackgroundNurses working in areas affected by the Great East Japan Earthquake and the subsequent radiation disaster faced prolonged and complex stressors.AimThis study aimed to describe nurses' subjective experiences and conflicts, and interpret them from the perspective of moral distress and relational loss.Research designThis is a qualitative descriptive study based on open-ended responses. Previous quantitative analyses suggested persistent posttraumatic negative cognitions among affected nurses. To deepen understanding of the experiences underlying these findings, this study qualitatively analysed open-ended responses from repeated questionnaire surveys conducted during the first two years following the disaster among nurses from two healthcare facilities. In each of the three survey waves, the participants were asked to describe the stress they experienced during the disaster. Data were analysed using qualitative content analysis and responses were segmented into meaning units, coded, grouped into subcategories, and synthesised into themes through iterative discussions within the research team.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.FindingsSix themes were identified. Nurses' narratives depicted the layered impact of disrupted living foundations and ongoing threats, exhaustion from sustained emotional labour, and unavoidable choices under severe constraints. These experiences were interpreted as reflecting moral distress and, in some accounts, features suggestive of moral injury. Participants also described relational loss, including the erosion of trust, fragmentation within teams, and reduced mutual support in the workplace.ConclusionsNurses' experiences in a compound disaster setting were characterised by intertwined moral suffering and relational loss. Organisational approaches that validate nurses' responses as understandable in context provide psychologically safe spaces to reframe disaster-time actions, and intentionally support the repair of fractured relationships may help protect nurses' well-being during and after disasters. Preserving professional integrity through sympathetic presence may be particularly important in extreme conditions wherein action is constrained.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1779-1795"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845173","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":"On the frontlines of healthcare: Experiences, challenges, and ethical dilemmas during war.","authors":"Lior Naamati-Schneider, Hagar Binoun-Chaki, Shir Daphna-Tekoah","doi":"10.1177/09697330261449307","DOIUrl":"10.1177/09697330261449307","url":null,"abstract":"<p><p>BackgroundHealthcare professionals in Israel work within a system shaped by chronic strain, recurring security threats, and continuous organizational pressures. The Iron Swords War of October 2023 (the Israel-Gaza war, referred to in Israel as \"Iron Swords\") intensified these conditions, heightening workloads, emotional vulnerability, and complex ethical dilemmas. The country's multicultural workforce, including Jewish, Arab, and Druze professionals, added another layer of tension but also revealed moments of solidarity and shared commitment during extreme conditions.Research question and aimThe study examines how healthcare professionals experienced their work during the war, focusing on operational strain, ethical tensions, emotional burdens, and team dynamics in diverse clinical settings.Research designA qualitative abductive design was used to explore emergent themes alongside existing theoretical insights on crisis management, ethics, and healthcare work in conflict zones.Participants and research contextThirty four healthcare professionals from public hospitals across Israel participated. All interviews explored experiences during 2023-2024 in clinical environments directly affected by wartime demands.FindingsThe findings reveal five key themes: (1) Structural and Operational Strain Exposed; (2) Professional Commitment versus Ethical Strain; (3) Emotional Burden and Identity Blurring; (4) Team Dynamics: Solidarity, Fragmentation, and Adaptation; and (5) Reaffirming the Moral Identity of the Healthcare System. The study highlights the psychological toll on professionals, including moral distress and moral injury, as they balanced patient care, personal safety, and professional ethics within this diverse workforce.ConclusionsThe findings underscore the urgent need for structural reforms and institutional support mechanisms that address both operational strain and the emotional and moral burdens faced by healthcare professionals in crisis-prone environments. While rooted in the Israeli context, the study offers broader insights for healthcare systems operating under conditions of chronic strain, political tension, or conflict.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1755-1778"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845240","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}