Nursing Ethics

Research involving older adults who have experienced elder abuse and neglect often attracts scrutiny from institutional review boards (IRBs) because of concerns relating to distress, disclosure, coercion, dependency, capacity and participant safety. However, experiencing elder abuse and neglect does not in itself make an older adult vulnerable as a research participant; vulnerability arises from personal, relational and contextual circumstances. Although ethical oversight is essential,...

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PURPOSE: Ethical decision-making remains a critical concern within the nursing profession due to the moral complexities and time-sensitive nature of healthcare delivery. Although moral intelligence has been recognised as an important ethical resource in organisational settings, the intervening mechanisms that influence the relationship among nurses remain inadequately explored. This study assesses the mediating role of ethical responsibility in the relationship between moral intelligence and...

Background/Objectives: Ethical decision-making in neonatal intensive care units (NICUs) requires the integration of clinical evidence, prognostic evaluation, and relational perspectives to determine the newborn's best interests. Pellegrino's concept of bedside ethics emphasizes the moral significance of proximity and the knowledge generated through the clinical encounter. However, the specific contribution of NICU nurses to ethical deliberation remains insufficiently explored. This conceptual...

Surrogacy remains an important option for some individuals and couples hoping to build a family, especially people with reproductive health issues, including those unable to carry a pregnancy, and some same-sex couples. However, advances in reproductive technology have raised complex ethical concerns, particularly around commercial surrogacy arrangements, where financial incentives, power imbalances, and conflicting interests may complicate the ethical landscape. This paper critically examines...

Artificial intelligence is increasingly deployed in healthcare not only to provide information or perform clinical tasks, but also to offer reassurance, companionship, and emotional support. This paper introduces the concept of engineered care to describe technological practices designed to generate the experiential effects of caregiving through system design rather than through the relational and moral practices that have traditionally constituted care. Its characteristic product is engineered...

Embodied responsiveness is central to nursing, yet its bodily, relational, and care-oriented character does not in itself establish that a response is caring. This theoretical paper asks how embodied responsiveness may take a caring form when the orientation guiding a nurse's response becomes insufficient in relation to the patient. It focuses on situations in which non-coincidence places the sufficiency of the operative prior orientation in question. Drawing narrowly and reconstructively on...

CONCLUSION: This study demonstrates that the relationship between moral distress and quiet quitting among intensive care nurses operates through moral injury. The findings indicate that moral injury constitutes a key mechanism that negatively affects nurses' professional engagement and organisational commitment. In this context, quiet quitting may be seen as an outcome arising from unresolved ethical problems. Strengthening ethical support mechanisms to prevent moral injury is therefore...

Climate change reflects social, political, and ecological harms that shape clinical care and health inequities. This article offers a justice-oriented, public health-informed framework for clinical nursing practice, showing how climate-related exposures and structural vulnerability appear in patient presentations, care transitions, and recovery. Drawing on structural competency, Cultural Safety, planetary health ethics, and the Global Nurse Agenda for Climate Justice, the article illustrates how...

BackgroundNurses are widely recognized as patient and family advocates and are among the most trusted professionals globally. Nurses are expected to uphold high ethical standards, including protection of vulnerable populations, through clinical competency and conscious advocacy. Advocacy grows complex when ethical dilemmas arise. Conflicts can occur between expected care, organizational requirements, and/or regulatory directives, and a nurse's own values. Amid social upheaval, political and...

BackgroundNurse managers play a pivotal role in fostering organizational justice. Empirical understanding of their lived experiences when enacting this role amid organizational injustice affecting bedside nurses remains scarce.Research aimTo analyze the ethical trajectories of nurse managers navigating organizational injustice.Research designA secondary data analysis was conducted on nurse managers' narratives drawn from a primary dataset that explored healthcare managers' perspectives on, and...

BackgroundPatient safety is fundamental to universal health coverage and the health-related Sustainable Development Goals. Safety behavior among nurses, especially those in the operating room, effectively supports the achievement of patient safety objectives. However, evidence on their safety behavior levels and associated factors remains limited.AimTo investigate the mediating role of moral efficacy in the relationship between patient safety culture and safety behavior among operating room...

CONCLUSIONS: UPBs among emergency nurses constitute a vicious cycle fueled by workplace stressors, implicit cues, and coping strategies, which profoundly affects individual well-being and organizational ethics. These findings suggest that source-oriented humanistic interventions, including environmental optimization, ethical support, competence enhancement, and cultural reshaping, are essential for practice.

The operating room is a distinctive moral space: the patient is unconscious, the body is draped and much of what happens is never witnessed. This paper examines why a nurse does the right and safe thing when the patient is anaesthetised and no one is checking, drawing on Levinas's ethics of responsibility and Benner's concept of ethical comportment. Three arguments are advanced. First, anaesthesia does not diminish the patient's claim on the nurse but intensifies it. Second, right action is...

BackgroundWorkplace violence is common in intensive care units and is often regarded as an inevitable aspect of the job. This normalisation may obscure the emotional impact of violence on healthcare professionals and the ethical tensions that arise when altruistic caregiving values conflict with personal safety. Therefore, this study was conducted to explore healthcare professionals' emotional experiences of workplace violence within the context of intensive care.Research designThis study...

Nurses work within finite time, competing demands and increasingly auditable systems. This philosophical paper asks what care is lost when organisations and nurses commit scarce time and attention to comparatively lower-value work, and when that loss becomes morally significant. It introduces nursing capacity, the moral economy of nursing time and moral opportunity cost to examine that question. Moral opportunity cost is conditional: it applies only where scarcity is genuine, competing claims...

Pediatric palliative care is increasingly recognized as an established practice yet less than ten percent of children who need it access it worldwide. Contributing to this gap is an absence of pediatric-specific bioethics frameworks to guide the care of dying children. Because philosophies influence cohesive care provision, the purpose of this review was to critically examine the international, scholarly literature on the ethical content of pediatric end-of-life care guidelines to ascertain what...

Moral distress is recognized as a major contributor to burnout and attrition among nurses. While the sequelae of moral distress are profound, the antecedents of moral distress are multi-factorial and therefore the phenomenon is challenging to address. Many interventions target individual-level factors such as moral resilience; however, moral distress is a system-level problem. As such, there is a growing focus on developing upstream, system-level interventions to mitigate or prevent moral...

BackgroundMoral distress is an increasingly recognized ethical concern in healthcare, particularly in older adult care, where it is associated with negative consequences for nurses, patients, and healthcare organizations. Although widely studied, its emotional dimensions, particularly the role of shame, remain insufficiently understood.AimTo explore nurses' experiences of moral distress, shame, and professional identity in older adult care, as well as their perspectives on support and...

This study explores the ethical tensions experienced by self-employed registered nurses in their daily practice. Based on a focus group conducted within a territorial professional health community, it highlights tensions relating to autonomy, responsibility, administrative constraints, interprofessional coordination and recognition of skills. These issues may affect quality of working life and call for stronger support for multiprofessional practices.

BackgroundHealthcare resource cutbacks create organizational conditions that may constrain moral agency and contribute to moral distress, yet little is known about how leaders and healthcare professionals experience these ethical challenges.AimThe aim of this study was to explore how leaders and healthcare professionals experience moral distress associated with healthcare resource cutbacks. The research question was: How do leaders and healthcare professionals experience moral distress...

Creative Nursing 2026, with its overarching theme of The Sociology of Nursing, has illuminated the social dimensions of health, illness, and health-care delivery. This issue of the journal contains articles by authors from Austria, Brazil, Canada, China, Egypt, Ghana, Japan, New Zealand, Norway, Pakistan, Saudi Arabia, Sri Lanka, and the US, on topics that have resonance far beyond the countries in which they were written. Categories include internationality in diverse global contexts, climate...

Background: Professional ethical principles are fundamental to nursing practice, and ethics education is therefore embedded as a continuous component throughout nursing education. Objective: This study aims to present a bibliometric and scientific mapping analysis of nursing ethics education research. Methods: Web of Science and Scopus databases were searched for the keywords "ethic* education," "nurs*," and similar terms, and 514 documents published between 1964 and 2024 were analyzed....

BackgroundMedical assistance in dying (MAID) raises complex ethical and professional questions for nurses, whose attitudes may vary across legal, sociocultural, and clinical contexts. Although nurses' experiences and attitudes toward assisted dying have been extensively examined, the prevalence and contextual variation of nurses' support for MAID across the international evidence remain unclear.Research aimTo estimate the prevalence of nurses' support for MAID and examine whether support varies...

BackgroundPatient safety is commonly conceptualized through ethical reductionism, risk management, and technical performance indicators. However, such approaches may insufficiently address the ethical, relational, spiritual, and culturally embedded dimensions of nursing care. Within Islamic ethical thought, the principle of Hifz al-Nafs (protection of life) offers a holistic moral framework for understanding patient protection beyond biomedical risk prevention.AimThis study aimed to explore...

CONCLUSION: Nurses' ethical and professional attitudes were positively but modestly associated. However, the multivariable model was not statistically significant and explained only a small proportion of the variance in professional attitude scores; therefore, the statistically significant coefficient observed for ethical attitude within this model should be interpreted cautiously. Nursing education and institutional policies should support ethics education and professional development.

BackgroundMoral courage helps nursing students respond to ethically difficult situations, yet little is known about how its dimensions relate to ethical sensitivity, professional identity, and emotional intelligence at the dimension level.Research objectiveThis study examined the dimension-level network structure of moral courage, ethical sensitivity, professional identity, and emotional intelligence among undergraduate nursing students.Research designA cross-sectional online survey was...

Ethical behavior is fundamental to psychiatric nursing practice; however, its association with workplace stressors and professional self-efficacy remains unclear. This study examines these relationships while controlling for demographic characteristics. A cross-sectional web-based survey was conducted in Japan from November to December 2024, and data from 575 psychiatric nurses and licensed practical nurses were analyzed. Job stressors were measured using the Psychiatric Nurse Job Stressor...

Narrative medicine has emerged as an influential framework in contemporary healthcare, arguing that attending to patients' stories improves the quality of clinical practice and ethical reasoning. Yet the conversation surrounding narrative practice has developed largely within medicine, leaving nursing positioned as a secondary site of application rather than a primary source. This paper challenges that positioning. The paper argues that narrative nursing is not an extension of narrative medicine...

BackgroundEuthanasia remains a highly debated issue in end-of-life care because it raises ethical concerns surrounding patient autonomy, relief of suffering, professional responsibilities, and the sanctity of life. Nurses and midwives frequently face these ethical challenges in caring for patients with advanced illness, yet evidence on their perspectives within sub-Saharan African cancer care settings remains limited.AimThis study explored nurses' and midwives' ethical perspectives and perceived...

BackgroundNurses frequently encounter ethical dilemmas that, when they are unable to act in accordance with perceived ethical standards, may lead to moral distress. Moral distress is associated with a wide range of adverse psychological, physical, and professional outcomes, and its development is influenced by multiple individual, team-related, and organizational factors. Although various interventions have been proposed to reduce moral distress, the existing evidence regarding their...

Resilience is an established concept in family-caregiver research, where it is used to describe how caregivers maintain functioning and adapt to sustained adversity. In long-term family care for older adults with disabilities, however, resilience is ethically ambiguous. Continued care may reflect adaptive capacity, relational commitment and caregiving competence, but it may also be shaped by dependency, moral obligation, cultural expectations and limited alternatives. This article critically...

BackgroundProfessional values guide nurses' ethical judgments, care relationships, and professional responsibilities. However, evidence on culturally grounded educational approaches that connect local moral traditions with nursing professional values remains limited.Research question and aimThis study aimed to compare the professional values of nursing students who received Ahi-based education with those who did not.Research designA non-randomized pretest-posttest quasi-experimental design with...

BackgroundInterprofessional collaboration is a component of healthcare. However, responsibilities distributed across professional boundaries may create ethical challenges concerning decision-making authority, communication responsibility and professional accountability. Treatment decisions may be made by one professional while another communicates information and facilitates patient participation.AimThis theoretical article introduces Ethical Responsibility Displacement (ERD), a phenomenon in...

BackgroundWhen transplant clinicians encounter ethical challenges and are constrained by their institution from acting in a manner within their professional ethical obligations, they may experience moral distress. Moral distress has been associated with negative effects such as burnout and turnover. Conversely, high grit has been positively correlated with job satisfaction, job performance, and organizational commitment.Research questionsWhat is the level of grit and moral distress among...

BackgroundCompassionate care is a core ethical obligation in nursing, yet the processes through which nurses enact and sustain it remain insufficiently theorized. Existing grounded theory models have not examined an East Asian care context in which nursing staff may assume both clinical and daily living care.Research question/aim/objectivesHow do clinical nurses experience, construct, and sustain compassionate care, and what ethical challenges shape this process?Research designA grounded theory...

BackgroundChina's rapidly aging population and the implementation of long-term care insurance have increased the demand for long-term care givers (LTCGs), a certified non-nursing workforce with both practical and ethical responsibilities. Research on moral sensitivity has predominantly focused on nurses, leaving the experiences of LTCGs underexplored, particularly through qualitative inquiry.Research aimThis study characterizes how moral sensitivity is experienced and enacted by certified...

CONCLUSION: The 2026 evidence update strengthens the empirical basis for treating problematic smartphone use as a nursing practice, leadership and organisational governance issue, but it does not establish that smartphone use directly causes patient harm. Nursing organisations should distinguish purposeful clinical use from avoidable personal engagement, provide secure and accessible digital alternatives, strengthen digital professionalism, and apply proportionate, non-punitive governance....

CONCLUSIONS: Israel's experience demonstrates that robust statutory mandates and top-down regulatory directives successfully drive formal structural consolidation, yet remain insufficient on their own to ensure active clinical utilization. Bridging the gap between structural existence and functional engagement requires institutional integration-specifically through accredited training, designated points of contact, internal ethics advisors, and an institutional culture of deliberation. For...

CONCLUSION: Discrimination in nursing care is a complex, systemic issue that results from the interactions between patient traits, organizational needs, and individual nurse factors. Addressing this effectively involves shifting from a solely individual approach to implementing organizational changes, alleviating systemic pressures, and offering focused education on justice and non-discrimination within nursing practice.

CONCLUSIONS: Head nurses play a central role in the AI era by modelling ethical standards that encourage the responsible use of GenAI. When nurses use these tools ethically and possess high technological compatibility, they are better equipped to provide creative solutions in patient care.

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CONCLUSION: The AI-Ren Ethics in Healthcare Scale provides a reliable and culturally grounded instrument for assessing nurses' ethical perceptions of artificial intelligence in clinical practice. The scale may support ethical evaluation, education and culturally responsive implementation of artificial intelligence in healthcare environments.

CONCLUSION: Improvement over current practice does not establish adequate person-centred fundamental care. Replacing an activity does not establish replacement of the care relationship. The questions require participatory refinement and empirical testing.

Brain death, or death by neurologic criteria (BD/DNC), is commonly presented as a determination that, performed correctly, yields a settled fact. Yet at the bedside it often functions less like discovery than conversion: a protocolized sequence authorizes a rapid shift in what the patient is understood to be and what families are expected to accept. This paper reframes BD/DNC disputes as boundary decisions that join physiology to moral status and institutional authority. Taking thanatopolitics,...

BackgroundIn allogeneic haematopoietic stem cell transplantation, paediatric donors may have limited involvement in donation decisions, as their psychological experiences and ethical needs may receive less attention when prioritising the recipient's survival.ObjectiveThis study explored paediatric donors' experiences of autonomy, competence, and relatedness throughout the donation process, using Self-Determination Theory (SDT) as a sensitising interpretive lens to examine implications for...

Psychiatry sometimes treats patients who do not acknowledge or resist treatment and who continue to face stigma in our society. Across the country, psychiatric inpatient units operate under a wide variety of service models, which influences how patients' rights are exercised and the nature of the caregiving work. Healthcare professionals from Brittany and Île-de-France highlight the importance of an ethical approach that fosters the therapeutic alliance. Breaking down barriers will help bring...

Vulnerability is widely invoked in healthcare, bioethics, and nursing, yet it remains poorly defined because universal human susceptibility, situational exposure to harm, and clinical frailty are frequently treated as interchangeable. This conceptual ambiguity is particularly significant following a fall, when older adults may be understood predominantly through physical risk, functional decline, and the need for protection. Through an interpretative analysis drawing on nursing philosophy,...

BackgroundDignity is a core concept in geriatric care. However, current attention to dignity-related care issues faced by older adults in nursing homes remains insufficient. There is a notable lack of systematic and proactive support measures in both theoretical research and practical interventions.AimsThe aim of this scoping review was to describe literature focussing on older adults' dignity in the context of nursing homes, in order to identify research gaps in this field and provide evidence...

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...