Nursing Ethics最新文献

{"title":"Nurses' perspectives on compassion fatigue, burnout and moral injury in war zone hospitals.","authors":"Guido Veronese, Fayez Mahamid, Bilal Hamamra","doi":"10.1177/09697330261437306","DOIUrl":"10.1177/09697330261437306","url":null,"abstract":"<p><p>BackgroundThe ongoing genocide (as declared on September 16, 2025 by the UN Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel) and militarized siege in Gaza has led to the systematic collapse of the health system, with hospitals overwhelmed by targeted bombings, mass casualties, infrastructural annihilation, and profound psychological suffering. Nurses have been subjected not only to extreme occupational stress but to deliberate conditions of deprivation and moral violation.Research aimTo explore the lived experiences of nurses in Gaza's hospitals, documenting compassion fatigue, burnout, and moral injury within a genocidal context of healthcare destruction.Research designA qualitative design was employed using thematic analysis of in-depth testimonies.Participants and Research ContextTestimonies were collected from nurses working in Gaza's remaining hospitals between late 2023 and mid2025. Participants served as frontline caregivers while enduring forced displacement, starvation, and personal bereavement.Ethical considerationsEthical approval was obtained from local review boards. Informed consent, confidentiality, and emotional safety were ensured under exceptionally high-risk conditions.FindingsSix themes were identified: (1) collapse of hospital care; (2) nurses' bodies and minds under siege; (3) maternal starvation and neonatal death; (4) burden of infection and decay; (5) solitary mourning and improvised funerary practices; and (6) the struggle to endure and find meaning. Nurses reported compassion fatigue, moral injury, somaticexhaustion, and cognitive impairment, all intensified by the genocide's material and emotional toll.DiscussionCaregiving persisted despite repeated targeting of medical personnel and infrastructure. Findings extend conventional models ofburnout and secondary trauma by situating experiences within the concept of 'medicide,' defined as the systematic destruction of health systems.ConclusionsThis study provides an empirically grounded account of nursing labor under conditions described by international bodies as genocidal. Insights have urgent implications for nursing ethics, international humanitarian law, and interventions to support health workers in colonized and militarized settings.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1684-1700"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822863","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 moral dilemma of ICU nurses in end-of-life care: A meta-synthesis.","authors":"Ziru Leng, Chunmei Huang, Lihan Ying, Hongji Yv, Qingyun He, Xinling Zhou, Deyan Gao","doi":"10.1177/09697330261437266","DOIUrl":"10.1177/09697330261437266","url":null,"abstract":"<p><p>Despite advancements in critical care medicine, moral challenges in end-of-life care persist. Approximately 80% of ICU deaths occur after decisions are made to limit or withdraw life-sustaining treatments. ICU nurses frequently experience moral dilemma when their professional judgment conflicts with clinical realities or institutional constraints. This meta-synthesis systematically integrated qualitative evidence to explore ICU nurses' experiences, alongside the sources and impacts of this dilemma. We conducted a comprehensive search of PubMed, Web of Science, Embase, CINAHL, CNKI, and Wanfang databases from inception to May 2025, ultimately including six qualitative studies from six countries. The analysis identified three core themes: (1) Sources of moral dilemmas; (2) Impacts of moral dilemmas on nurses; (3) Coping with moral dilemmas. The sources of moral dilemmas comprise five sub-themes: (1)Conflict between futile treatment and dignity preservation; (2) Infringement of patients' right to informed consent and autonomy; (3) Lack of nursing voice in clinical decision-making; (4) Insufficient family involvement in end-of-life care; and (5) Inadequate organizational support. The impact of moral dilemmas includes two sub-themes: (1) Distress experience and emotional exhaustion and (2) Professional burnout. These findings highlight the critical importance of recognizing that ICU nurses operate within a complex moral environment shaped by interwoven institutional structures, cultural norms, and relational dynamics. Therefore, providing effective support requires the implementation of systematic interventions, which should encompass comprehensive moral training, strong interdisciplinary collaboration, and the formulation of organizational policies that clearly prioritize nurses' autonomy and the maintenance of patients' dignity. This review highlights the urgent need to foster supportive moral environments globally to alleviate moral dilemma and improve the quality of end-of-life care in ICUs.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1665-1683"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787358","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":"Epistemic humility: addressing ageism toward older patients.","authors":"Brenda Bogaert","doi":"10.1177/09697330261449298","DOIUrl":"10.1177/09697330261449298","url":null,"abstract":"<p><p>The rise of ageist beliefs and practices negatively affects the delivery of quality care for older persons. When ageism is practiced by healthcare providers and institutions, it not only limits patient participation but also decreases healthcare outcomes and further isolates an already isolated population. In this contribution, we consider how the development and practice of epistemic humility may improve care for this group. By epistemic humility, we refer to the virtue of developing both an inward perspective (an awareness of the limits of one's epistemic capacities) and an outward perspective (a disposition to seek alternative resources to overcome one's shortcomings). We consider what kind of resources and opportunities future and current healthcare providers may need to develop and practice epistemic humility toward their older patients. Among proposals to be discussed include: (1) at the level of training, teaching students to value humility and develop critical thinking skills on intergenerational perspectives; (2) integrating older patient advocates in care and training to enable healthcare professionals to understand a greater diversity of patient perspectives; (3) developing patient empowerment programs adapted to the desires and capabilities of older patients, in particular through phenomenological methods.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1964-1973"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044563","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":"Educational programmes improving nurses' ethical competence: A scoping review.","authors":"Farzaneh Mohamadnezhad, Mahin Gheibizadeh, Neda Sayadi, Alireza Irajpour, Ehsan Shamsi Gooshki, Morteza Nasiri","doi":"10.1177/09697330251403137","DOIUrl":"10.1177/09697330251403137","url":null,"abstract":"<p><p>Enhancing ethical competence in nursing has become a crucial educational focus due to growing ethical challenges in clinical settings. However, systematic knowledge about the design and impact of relevant educational programs remains limited. This scoping review seeks to address that gap by examining the scope, variety, and characteristics of such programs, highlighting their educational strategies and content, and proposing directions for future research to inform more effective ethical competence development in nursing. The review was conducted using the Arksey and O'Malley framework and reported in accordance with PRISMA-ScR guidelines. A systematic search was performed across five international databases including PubMed, Scopus, Web of Science, EMBASE, and Google Scholar between 2000 and 2024. Of 25,868 initial sources, 35 studies were selected for final analysis. The findings revealed four main educational approaches utilized: e-learning, simulation and role-playing, group discussions, and traditional lectures. Ethical content focused on fundamental ethical principles, professional codes, ethical reasoning, and ethical challenges. Although most studies reported improvements in ethical sensitivity or ethical decision-making, significant gaps persist in the design, implementation, and evaluation of the effectiveness of these programs. While ethics education can facilitate ethical development in nurses, the absence of standardized evaluations and evidence-based frameworks limits the generalizability of findings. This review outlines the current state of ethics education in nursing, highlighting the crucial need for future research to develop robust, culturally appropriate, and evidence-based programs that truly enhance nurses' ethical competence. All stages of this review adhered to valid scientific research principles.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1796-1816"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876352","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":"Structures and practices of whistleblowing in healthcare: An integrative review.","authors":"Outi Järvinen, Riitta Suhonen, Johanna Wiisak","doi":"10.1177/09697330261449295","DOIUrl":"10.1177/09697330261449295","url":null,"abstract":"<p><p>Wrongdoings occur in healthcare, and effective whistleblowing structures and practices are essential for ethically addressing these issues in organisations. However, research on whistleblowing in healthcare from an organisational perspective remains limited. The aim of this integrative literature review was to synthesise the empirical evidence about the structures and practices of whistleblowing in healthcare organisations. Whittemore and Knafl's methodology was followed, and the study selection process was documented using the Preferred Reporting Items for Systematic Reviews and Meta-analyses flow diagram. A systematic literature search was performed in February 2024 and updated in January 2026 across Cumulative Index to Nursing and Allied Health Literature, MEDLINE (PubMed), Scopus, SocINDEX, and Web of Science Core Collection. This search was complemented by a manual search. Peer-reviewed empirical studies published in English were selected. Data were analysed using inductive content analysis. Fourteen included studies were published between 2007 and 2023. Most studies were qualitative and conducted in the United Kingdom; the overall methodological quality was high. Five categories describing the structures and practices of whistleblowing in healthcare organisations were identified: (1) inconsistent, inadequate and insufficient structures and practices of whistleblowing, (2) the absence of standardised practices or their implementation in an inconsistent manner, (3) the influence of organisational culture and leadership on whistleblowing structures and practices, (4) the need for substantial development in whistleblowing structures and practices, and (5) the need to reframe attitudes towards whistleblowing as both an opportunity and a tool for organisational improvement. The results show the fragmented and inconsistent nature of structures and practices of whistleblowing in healthcare organisations; they also underscore the influence of organisational culture, leadership, and power dynamics on their effectiveness. The findings illuminate how internal whistleblowing develops and highlight the need for future studies that employ designs capable of more robustly evaluating whistleblowing mechanisms.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1871-1891"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984108","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":"Nurse practitioner ethicist reconsidered: A nominally flawed proposition?","authors":"Pamela J Grace, Aimee B Milliken, Christopher M Charles, Marsha D Fowler","doi":"10.1177/09697330261437326","DOIUrl":"10.1177/09697330261437326","url":null,"abstract":"<p><p>In this paper we respectfully present a counter argument to Jesse Michael Kay's thesis, as we understand it, in his article titled, \"The Nurse Practitioner Ethicist: Distinct from a Nurse Ethicist?\" Foundational to our analysis is that we take the distinction between nursing as a discipline and a practice profession, and clinical ethics as an emerging discipline seriously. The distinctions between them are well described in the literature. The two have different reasons for existence. While we agree that one's professional background can inform a secondary endeavor such as clinical ethics the goals are incommensurable. Moreover, we present an expanded definition of nursing ethics to explain the historical development of nursing goals and perspectives and its codes of ethics or conduct. Importantly, we provide support for the assertion that nurse practitioners are nurses in expanded roles but still accountable to nursing codes of ethics. Additionally, nurses who are working in the role of clinical ethicist are accountable to the goals of clinical ethics.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1638-1645"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787434","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":"Professionals' perspectives as they negotiate dedication to vulnerable patients and burnout.","authors":"Regina Christiansen","doi":"10.1177/09697330261451351","DOIUrl":"10.1177/09697330261451351","url":null,"abstract":"<p><p>BackgroundBurnout and emotional numbing-known in Scandinavian contexts as <i>forråelse</i>-pose critical challenges for psychiatric healthcare professionals. These phenomena are closely linked to moral distress, ethical dilemmas, and systemic pressures that complicate daily clinical practice. Understanding the interplay between organizational constraints, moral agency, and relational dynamics is essential for ethical and sustainable mental healthcare.Research aimThe study aims to examine how organizational and ethical pressures contribute to burnout and emotional numbing among psychiatric healthcare professionals, and how these professionals experience and respond to moral distress and relational challenges in daily clinical practice.Research designA qualitative ethnographic design was employed, combining prolonged field observation with semi-structured interviews to capture nuanced experiences of staff in real-world clinical settings. Reflexivity and iterative analysis ensured rich, contextually grounded insights.Participants and research contextEighteen psychiatric healthcare professionals were interviewed over 6 months in inpatient psychiatric units. Participants included nurses, social workers, medical doctors, and allied staff, representing a range of clinical roles.Ethical considerationsInformed consent, confidentiality, and participant well-being were prioritized. Reflexive practices were used to acknowledge researcher influence, and ethical approval was obtained from the relevant institutional review board.ResultsFour interrelated themes emerged: workplace dynamics, task management, patient collaboration, and emotional numbing. Systemic pressures-including understaffing, ethical strain, and limited institutional support-were central drivers of burnout. Emotional numbing appeared as an adaptive response to sustained moral distress and relational demands. Participants reported finding meaning through relational commitment, peer support, and small therapeutic successes, despite persistent ethical and organizational challenges.ConclusionsBurnout and emotional numbing are systemically produced phenomena rather than individual failings. Addressing these issues requires structural reforms, reflective supervision, and supportive workplace cultures that integrate ethical deliberation. Recognizing moral distress and fostering relational engagement are critical to safeguarding staff well-being and promoting ethical, patient-centered psychiatric care.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1907-1919"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037089","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 in healthcare workers: An intervention to mitigate distress.","authors":"Kristin Kirchner, Pearce Persaud, Connor Bland, Haley Sherman","doi":"10.1177/09697330261449301","DOIUrl":"10.1177/09697330261449301","url":null,"abstract":"<p><p>BackgroundThe psychological distress of individuals working in high-stakes, value-based environments (e.g., hospitals, nursing homes, and community health centers) is receiving growing recognition as moral injury (MI). While MI and other mental health challenges, like PTSD and burnout, have similarities and overlaps in symptoms, identification of these differences is essential, as the distinct needs of MI treatment require professionals to address its unique characteristics. Further, MI creates dual threats to healthcare operations, affecting workforce stability and individual psychological impact for healthcare workers themselves.Research aimThrough the lens of moral distress framework, our research investigates how a reading-based intervention impacts MI symptoms in healthcare employees.Research designThe research design utilized a 5-week plan to track MI symptoms before and after a self-led coping skill development treatment initiative.Participants and research contextIn total, 40 healthcare workers participated in the study. The majority of the participants were recruited from healthcare centers in Georgia and South Carolina, and a range of medical positions were represented including registered nurses, mental health therapists, emergency medical technicians, trauma technicians, obstetricians, and medical assistants.Ethical considerationsThe present study was approved by Valdosta State University's IRB (reference number 04607-2025). All participants remained anonymous.Findings/resultsOut of all participants, 48.7% experienced at least some improvement to their MI scores; 23.1% experienced notable improvements following the intervention.ConclusionsThe present study provides evidence for a reading-based, self-managed intervention having large impacts on healthcare providers with MI. These results suggest that self-directed interventions will not eliminate MI from an entire workforce but can be effective in providing assistance to individuals, especially those who are already exhibiting high levels of MI.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1920-1938"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037169","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":"33 6","pages":"1634-1637"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888834","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 verge of suicide from a suffering perspective.","authors":"Anita Elvegaard, Dag Karterud, Jessica Hemberg","doi":"10.1177/09697330261441779","DOIUrl":"10.1177/09697330261441779","url":null,"abstract":"<p><p>AimTo uncover the substance of how suffering is associated with human beings with thoughts or plans about ending their lives by suicide and to bring out more diversity, complexity, and contextuality of this phenomenon. Understanding as an important virtue underscores the safeguarding of the patient's dignity as a holy element.BackgroundThe study is grounded in a caring science perspective where suffering is seen as embodied in the human being. Methodology and design: This integrative literature review presents a combination of data from both theoretical and empirical literature with a reading of selected articles. Ethical ontological questions are prerequisites for highlighting caring understanding. Through the reading of a truthful written text of experienced suffering with love and compassion, it is possible to confirm and serve life and health.Data sourcesEmbase, CINAHL, PsycINFO, Scandinavian Journal of Caring Sciences, and Nursing Ethics. Ethical consideration: The study was conducted in accordance with the guidelines of the Finnish National Board on Research Integration.ResultsThree distinct themes were identified as a basis for considerations related to suffering: (a) Suffering in time and space, (b) Bearable and unbearable suffering, and (c) Language as essential for being.ConclusionThe language of suffering in caring science is made visible. Caring understanding has an inherent ought to, embraced by ethos towards alleviation. Life-threatening suffering is revealed. Thinking of suicide as a way out can make it possible to endure the suffering. Lack of caring understanding was a threat to some of the patients' dignity. Lack of evidence exists as to whether telling the suffering story is a movement in the direction of alleviation and this calls for further research to examine if caring and caring science can embrace this suffering.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"1735-1754"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845213","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}