Nursing Ethics

Background Storytelling is a frequent practice within nursing education. Stories are thought to be helpful for student learning, engagement, professional role development, and transmission of ethical values. Despite its common use, little is known about the stories told by nurse educators and the implicit ethical values within those stories. Aims To describe the reasons nurse educators tell stories to undergraduate students and examine implicit ethical values within these stories. Research design A qualitative descriptive study with Rubin and Rubin’s responsive interviewing method. Interview transcripts and written stories were analyzed thematically with constant comparison. Participants and research context Participants included 15 nurse educators, primarily from the northeastern United States. Ethical considerations Institutional Review Board (IRB) approval for protection of human subjects was received prior to conducting the study. Informed consent was obtained from all participants. Findings Nurse educators use storytelling to help students understand what it means to be a nurse, to improve student learning, because we are all human, and because the art and science of nursing requires storytelling. Ethical values from these stories were organized into the following themes: advocacy , nurse attributes , importance of the nurse-patient relationship , and reflection . Conclusions Findings suggest that that storytelling in nursing education is used for role development and communicating ethical values. Additional studies are needed to determine the effectiveness of storytelling and how it can be used to improve nursing practice.

Background Most patients in need of palliative care remain in their homes, thus great focus should be placed on the creation of functional palliative homecare. Suffering through an often multifaceted illness and contemplating one’s death can contribute to the loss of one’s sense of dignity, and the preservation of patient dignity is a major challenge for health professionals worldwide. Aim The aim of the study was to explore and describe nurses’ experiences of caring qualities alleviating suffering and preserving the dignity of patients in need of palliative homecare. Research design A qualitative exploratory study. In-depth semi-structured interviews as data collection method, and the qualitative content analysis of Graneheim and Lundman for data analysis. The theoretical perspective was based on Eriksson’s caritative caring theory. Participants and research context A total of nine nurses with extensive work experience from a palliative homecare context participated in the study. Ethical considerations The study was conducted in accordance with the criteria set forth by the Finnish National Board on Research Integrity TENK. Research permission was granted and participants gave their written informed consent to participate in the study. Findings One main theme and three subthemes were found. The main theme was: Being there for the other alleviates suffering while shaping and reshaping dignity preservation in a process. The three subthemes were: (1) Being a sensitive and compassionate witness who becomes responsible, (2) Having compliance, courage, and perception in a deep presence, (3) Being calm and patient while having time for conducting skilled practical knowledge. Conclusions Certain caring qualities are important in the dignity-preserving care of people in need of palliative homecare, and person-centeredness plays a central role in alleviating suffering. Deep and trusting caring relationships and nurses’ ability to customize the care being provided are significant in alleviating patient suffering and preserving dignity.

Background An ethical foundation for caring involves doing good, alleviating suffering, and treating human beings with dignity and respect. While virtual reality (VR) has primarily been used to develop clinical skills, there is limited research on its use for educating healthcare personnel in ethical competence and the use of VR grounded by ethical concepts and theories. This gap has prompted us to develop a theoretical basis grounded in enhancing the ethical competence of health professionals using VR. Aim The study aimed to develop a caring-perception model for enhancing ethical competence in VR environments for educating healthcare personnel. Method and Material The development of the caring-perception model was fundamentally anchored in theoretical frameworks established by the three caring theorists Eriksson, Martinsen, and Koskinen. Hermeneutic reading was used to interpret selected texts, extracting meaningful fragments to form interpretive patterns, leading to the creation of basic elements for a theoretical model. The caring-perception model was then interpreted in the context of developing ethical competence in a VR environment. Results The caring-perception model consists of six fundamental elements: “I am here,” “I see and listen,” “I’m affected,” “I realize,” “I’m responsible,” and a synthesis in “ethical bearing and acting.” The theory model serves as a robust framework aimed at enhancing healthcare personnel’s ethical competence within VR environments. Discussion VR grounded on a theoretical basis and educational model has the potential to offer unique opportunities to enhance healthcare personnel’s ethical competence and to practice ethical decision-making in simulated scenarios, fostering presence, attentiveness, and ethical reflection. Despite challenges such as technical barriers and the need for substantial investment, the potential benefits of using VR for ethical training can promise improved patient outcomes and a more ethically aware healthcare workforce.

The transition from nursing education to professional practice is a critical period for newly graduated nurses, marked by significant moral challenges that can lead to moral distress and impact the development and application of clinical judgment. Understanding how moral distress affects newly graduated nurses is vital to support their integration into professional roles and ensure the delivery of quality care. Newly graduated nurses may experience moral distress due to conflicts between professional values and institutional constraints, which impact their ability to exercise effective clinical judgment. The purpose of this qualitative meta-ethnographic review is to investigate the phenomenon of moral distress among newly graduated nurses and its implications for clinical judgment. The research question is: How do newly graduated nurses experience moral distress, and how does it affect their clinical judgment? Methodologically, the study is grounded in Ricoeur’s three-fold mimesis, which offers a rich interpretative framework for exploring the complexities of moral distress in nursing practice. Guided by the seven steps of meta-ethnography, the analysis reveals significant variations in the conceptualization and experiences of moral distress, thus highlighting inadequacies in existing definitions. The findings from 12 qualitative studies were synthesized into an integrative model of moral challenges. This integrative model presents moral distress as a multifaceted phenomenon that intersects with clinical judgment. The integrative model of moral challenges demonstrates how institutional constraints, moral uncertainty, moral conflict and lack of moral attention can hinder newly graduated nurses' ability to exercise effective clinical judgment and deliver quality care. The integrative model of moral challenges is a crucial contribution to research on moral distress. The review reveals limited research on the way moral distress affects the clinical judgment of newly graduated nurses and highlights the importance of promoting reflective practice and moral deliberation among newly graduated nurses to strengthen their clinical judgment and professional development.

Background Nurses working in a clinic must be morally sensitive to identify unethical circumstances and act morally. Educational strategies that can effectively gain this sensitivity are a matter of curiosity. Objective This study aimed to examine if an interactive ethics training program would benefit (a) moral sensitivity and (b) knowledge. Research Design The present study was quasi-experimental based on a control group pretest/posttest. Participants and Research Context The study involved 53 nurses from 10 hospitals in Istanbul, Türkiye. The intervention group received the 5-week Interactive Ethics Training Program. Data were collected through the Personal Characteristics Form, Moral Sensitivity Questionnaire, and Nursing Ethics Knowledge Test. Ethical Considerations The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Non-Invasive Research Ethics Committee (No. 78/2022) from Istanbul Medipol University. Results There was a statistically significant difference between the two groups in the posttest for moral sensitivity (MD: −10.247; p = .010) and knowledge level (MD: 4178; p = .009). Conclusion An interactive ethics training program in nursing ethics education positively impacts nurses’ moral sense and knowledge. Improving nurses’ moral awareness can facilitate ethical decision-making. Therefore, it is advised that nurse educators design their curricula based on these results.

Background Intensive Care Unit (ICU) nurses face ethical challenges during decision-making in terms of the sophisticated nature of in-patients. Moral comfort is known as a phenomenon with a positive effect on moral decision-making and moral actions of nurses. Aim This study investigated ICU nurses’ level of moral comfort and factors affecting it. Research Design This study used a cross-sectional descriptive design. Participants and research context A total of 350 ICU nurses were selected with the convenience sampling method. The data collection tool included the Demographic Characteristics Questionnaire and the Moral Comfort Questionnaire. The data were analyzed with SPSS19 using descriptive and inferential statistics. Ethical Considerations Upon the Committee of Ethics in Human Research’s acceptance of the research concept, approvals were secured, and informed written consent was acquired from all participants. They were assured of the information confidentiality of participation. Findings The mean moral comfort score was 112.75 ± 13.18. The mean score of personal factors related to ethics was higher than the external factors pertaining to the environment/organization. The mean scores of “moral comfort in a specific situation” and “moral comfort in general” were 50.52 ± 5.08 and 62.32 ± 9.31, respectively. The mean moral comfort score of nurses was significantly correlated with age, clinical work experience, ICU work experience, marital status, education, and employment status (p < .05). Regression analysis revealed that ICU work experience as the strongest predictor variable predicted 17.7% of moral comfort variance. Conclusion Although moral comfort score was at a favorable level, ICU nurses did not feel comfortable when making decisions in moral situations, and nursing managers did not support the decisions of nursing staff. Consequently, this issue warrants the attention of nursing managers and policy-makers. They need to enhance the quality of healthcare by offering more support and addressing the variables influencing the moral comfort of nurses.

The expanding demands of healthcare necessitate novel methods of increasing the supply of trained professionals to enhance the delivery of care services. One means of doing so is to expand allied health professionals’ scope of practice. This paper explores the ethics of two examples of such expansion in ophthalmology, comparing the widely accepted practice of nurses administering intravitreal injections and the relatively less prevalent optometrists functioning as physician extenders. We conducted a literature review of empirical research into both practices and conclude that nurses administering intravitreal injections are ethically justified. With adequate standardized training, optometrists can also function as primary eye care providers to improve accessibility to eye care. We provide an algorithm for the ethical introduction of innovative expanded allied healthcare.

Admission to a nursing home does not automatically blunt the desire or reduce the need for intimacy and sexuality in older residents. This ageist and ableist stereotype that older people are asexual or post-sexual negatively affects nurses and other healthcare professionals, as they are regularly faced with residents’ sexual expressions. How are nurses to view and respond appropriately if a clear understanding of current ethical concepts and argumentations about intimacy and sexuality in older adults is lacking? This study aimed to document and better understand current ethical concepts and arguments about intimacy and sexuality in institutionalised older adults. We used PRISMA and Reporting of Systematic Reviews in Ethics guidelines in a systematic review of current ethical literature (2010 to 2023). Six databases were searched: PubMed, Embase, Web of Science, CINAHL, Atla, and Philosopher’s Index. Inclusion criteria were (1) publication was argument-based; (2) contained ethical concepts and arguments concerning intimacy and/or sexuality in institutionalised older adults; and (3) written in English, French, German, or Dutch. Our search returned 4371 publications; of those, 29 publications met our inclusion criteria. Since all included articles appeared in peer-reviewed journals, article quality was assumed to be sufficiently good. Our use of a modified version of the Qualitative Analysis Guide of Leuven showed that two main approaches characterised discussions of intimacy and sexuality in institutionalised older adults: (1) individual-cognitive–oriented approach and (2) relational-embodied–oriented approach. The first emphasises respect for autonomy and consent, fundamental to protecting rights and dignity. The second focusses on intentional bodily capacities and the interdependent nature of being human, both crucial for the emotional well-being of the residents, even when cognitive abilities decline. We conclude that the ethical landscape on sexuality in ageing has shifted, implying that changes are warranted on how ethicists, society, and healthcare professionals view sexual expressions of older adults.

Background: The guarantee of human rights in the healthcare of individuals with mental disorders is a global challenge. Health practices frequently fail to integrate relational ethical principles in the promotion of holistic and inclusive care. It is therefore crucial to investigate how healthcare professionals perceive and conduct their practices in this context. Objective: To understand, in the light of Relational Ethics, the perceptions and conduct of healthcare professionals regarding the guarantee of human rights and the recovery process of individuals with mental disorders. Research Design: An exploratory study was conducted using ideas storming techniques and field notes for data recording, which were analyzed through Thematic Analysis and discussed in the light of the core elements of Relational Ethics. Participants and Research Context: The study involved 26 healthcare professionals (15 community health workers, 5 nurses, 3 nursing assistants, 2 doctors, and 1 pharmacy assistant) from a primary healthcare unit in a municipality in the state of São Paulo, Brazil, during the application of the module “Recovery and Right to Health” of the WHO QualityRights training. Ethical Considerations: The research project to which this study belongs was approved by the Research Ethics Committee of the School of Nursing at Ribeirão Preto, University of São Paulo (report number 6.257.303). Findings: Three themes were identified: (1) Feeling worthless when facing the lack of structure of mental health services: appearance, accessibility, and privacy; (2) dealing with barriers to the recovery of individuals with psychosocial, intellectual, or cognitive disabilities; and (3) an ethical duty: to understand the roles of families and other supporters in promoting recovery. These themes primarily explored resource scarcity, social stigma, and emotional support. Conclusions: The study reinforces the need for practices that integrate ethical care, respect for autonomy, and dialogue, which are fundamental to ensuring human rights and facilitating the recovery process.

What people value today can differ from what they have valued. But what does this value variability mean in the context of healthcare? We ethically analyze the current state of research on the change of embedded values in healthcare systems and the driving processes behind it. Starting with a systematic literature review and a content analysis, we subject the selected articles to an ethical analysis through three ethical theories: principlism, value ethics, and utilitarianism. The included papers demonstrated how moral dissonance between individual values and behavior leads to moral distress. The occurrence of moral distress was related to current healthcare practices. Beneficence and non-maleficence played a central role where principlism was considered, virtue ethics was criticized for not addressing the structural problems in the healthcare system, and consequences of value change for healthcare professionals and the society were analyzed. Further, principlism cannot fully cover the value change in medical care with its top-down and bottom-up processes leading to consequences for the patients, healthcare professionals, and society as a whole. We found correlations between top-down value change processes in the healthcare system and the quality of care. Health professionals are forced to develop an attitude that does not adhere to traditional medical values any longer and eventually leads to low-value care. Accompanying phenomena like moral distress cause dropout of healthcare workers. These can be hardly slowed down from the bottom-up by the development of resilience and moral courage. More effectively, structural changes through value interventions have the potential to improve working conditions and the quality of care.

Family care—when partners, relatives, or other proxies care for each other in case of illness, disability, or frailty—is increasingly considered an important pillar for the sustainability of care systems. For many people, taking on a caring role is self-evident. Especially in a palliative care context, however, family care can be challenging. Witnessing caregivers’ challenges may prompt compassionate nurses to undertake actions to reduce burden by adjusting tasks or activities. Using a care ethical approach, this theoretical paper aims to provide nurses with an alternative perspective on caregiver burden and support. Drawing on the concepts of relationality and contextuality, we explain that family care often is not a well-demarcated or actively chosen task. Instead, it is a practice of responding to an all-encompassing “call” to care flowing from a relationship, within a social and cultural context where norms, motivations, and expectations shape people’s (sometimes limitless) care. We consider relational interdependence at the root of persisting in care provision. The question is then whether self-sacrifice is a problem that nurses should immediately solve. In ideal circumstances, self-sacrifice is the result of a conscious balancing act between values, but family care in the context of serious illness barely provides room for reflection. Yet, instant attempts to alleviate burden may overlook family caregivers’ values and the inherent moral ambiguities and/or ambivalent feelings within family care. Family care is complex and highly personal, as is finding an adequate balance in fulfilling one’s sometimes conflicting values, motivations, and social expectations. Therefore, we suggest that caregiver experiences should always be interpreted in an explorative dialogue, focused on what caring means to a particular family caregiver. Nurses do not have to liberate family caregivers from the situation but should support them in whatever overwhelms or drives them in standing-by their loved ones until the end.

Background: Moral distress is the inability to do the right thing due to institutional constraints. The Measure of Moral Distress – Healthcare Professionals (MMD-HP) measures this phenomenon and has extensively explored moral distress among nurses. There are limited large-scale research studies using the MMD-HP to identify levels of moral distress across multiple healthcare professionals (HPs) and settings. Research question: What are the overall levels of moral distress among HPs? Research design: A quantitative, exploratory, cross-sectional study of HPs in a healthcare system using the MMD-HP. Participants and research context: Eligible participants included HPs ( N = 8,206) working in all inpatient and outpatient units and centers in a multi-site healthcare system located in the Southeastern United States. Ethical considerations: The Institutional Review Board provided approval for this research. A survey preamble supplied information within the learning management system and consent was presumed with survey completion. Findings: A total of 3,561 HPs completed the MMD-HP. The top three morally distressing items included compromised patient care due to inadequate resources, caring for more patients than is safe, and low quality of patient care due to poor team communication. Intensive care unit (ICU) areas had significantly greater moral distress than all other areas ( p < 0.001). Formal leaders had the greatest moral distress ( p < 0.001). Mixed-acuity and medical-surgical HPs accounted for 22.8% of those who reported considering leaving their current position due to moral distress. Nurses represented 42.2% of those considering leaving their current position due to moral distress. Conclusions: This study uniquely identified that formal leaders and HP participants in the ICU setting had the greatest moral distress. Exploring moral distress is imperative for healthcare systems to decrease turnover, improve engagement, and the quality of patient care.

Background: The relationship between moral resilience, moral distress, and moral injury among nurses during the COVID-19 pandemic has been widely investigated; however, the literature in the post-COVID-19 era is scarce. Research aim: To examine the impact of moral resilience on moral distress and moral injury among nurses after the COVID-19 pandemic. Research design: Cross-sectional study. Participants and research context: We obtained a convenience sample of 1118 nurses in Greece. We collected demographic data (gender, age) and work-related data (understaffed wards, shift work, clinical experience). We measured moral resilience with the revised “Rushton Moral Resilience Scale”, moral distress with the “Moral Distress Thermometer”, and moral injury with the “Moral Injury Symptom Scale-Healthcare Professionals” version. We adjusted all multivariable models for demographic variables. Ethical considerations: The Ethics Committee of the Faculty of Nursing, National and Kapodistrian University of Athens approved our study protocol (approval number; 474, approved: November 2023). Our study followed the Declaration of Helsinki. Findings/results: Multivariable linear regression analysis showed that moral resilience reduced moral distress and moral injury. In particular, we found that increased response to moral adversity was associated with decreased moral distress (adjusted coefficient beta = −1.81, 95% confidence interval [CI] = −2.07 to −1.54). Moreover, we found that increased response to moral adversity (adjusted coefficient beta = −8.24, 95% CI = −9.37 to −7.10) and increased moral efficacy (adjusted coefficient beta = −3.24, 95% CI = −5.03 to −1.45) were associated with reduced moral injury. Conclusions: Moral resilience can reduce the level of moral distress and moral injury among nurses. However, the persistence of moderate moral resilience among Greek nurses does not guarantee its sustainability. To ensure that this resilience is maintained and potentially enhanced, it is imperative for nurse leaders and policymakers to strategically design interventions to address issues at the organizational, team, and individual levels.

Nurses experience various types of violence in healthcare. This violence can be perpetrated by doctors, other nurses, patients, and their families, as well as other members of the healthcare team. While traditionally thought of as physical, violence may also be non-physical, that is, verbal, emotional, and psychological in nature. In this paper, we outline three categories of violence experienced by nurses: vertical, lateral, and angular. When violence occurs by someone in a position of authority like physicians, it is vertical, when occurring by someone in an equal position like other nurses, it is lateral, and when violence occurs by someone in an adjacent position like patients, it is angular. Violence may carry violations of autonomy and justice for nurses. Autonomy and justice are two principles of healthcare ethics, which have traditionally been applied primarily to patients. We expand the application of these principles to healthcare workers and highlight how violence obstructs autonomy and justice for nurses. Some instances of violence obstruct autonomy by undermining nurses’ everyday decision-making while aggregate violence obstructs autonomy by causing some to leave the field altogether. Some instances of violence violate justice by undermining nurses’ epistemic capacities while others concern unfairness produced by unjust distributions of resources.

Many higher-income countries have shortages of care-workers, which is unlikely to change in the foreseeable future as virtually all of these societies are ageing. The philosophical literature on this problem has concentrated mostly on the merits and demerits of different policy solutions, especially on the recruitment of foreign care-workers and on investments in care robots and other relevant technologies. However, the question of what moral duties, if any, private individuals have to help address care-worker shortages has been entirely neglected. In this article, I help to fill this lacuna by arguing that some inhabitants of higher-income countries have moral duties to age abroad in order to reduce the pressure on the aged care-systems of their current societies, whereby ‘ageing abroad’ is defined narrowly as moving to a foreign country to receive residential or non-residential aged care. As I show, these duties are dependent on a number of conditions being met, including the requirement that the host populations not be made worse off.

Background: The experience of racism in healthcare is particularly challenging to address due to misunderstandings of the definition, the complex interplay of other potential discriminations and, at some level, the denial that it occurs. Limited studies have reported racism as an aspect of workplace violence toward nurses and nursing students from both patients and staff. Research aims: To understand nursing students’ experience of unethical behaviour, including racism during clinical placement, the perpetrators, impacts, advocating and reporting. Research design: An interpretive, qualitative design was used, and 15 nursing students were interviewed using semi-structured interview guides. The interview recordings were transcribed and thematically analysed. Participants and research context: Nursing students voluntarily participated and completed the interviews for this study from one undergraduate nursing student cohort in metropolitan South Australia. Ethical considerations: This study received ethical approval from the University Social and Behavioural Research Ethics Committee. Findings/results: The two major themes with subthemes of the findings include (1) The multi-faceted student nurse experience of racism: sub themes – racism from patients to nurses, from nurses to nursing students’ and racism towards patients. (2) The pervasive influence and limited reporting of racism by nursing students: sub themes-feeling disempowered, and barriers to reporting racism. Conclusions: The findings of this study highlight the registered nurse students’ experience of racism in various forms within the clinical environment and the significant negative impact it has on RNS during placements. This evidence calls for systemic changes to create a more inclusive and supportive environment for all RNS.

Background: The Measure of Moral Distress – Healthcare Professionals (MMD-HP) is a 27-item survey that quantifies moral distress. The MMD-HP was distributed to healthcare professionals (HPs), and analysis of a free-text response item revealed information-rich descriptions of morally distressing situations. Research question: What are HPs’ perceptions of their experiences of morally distressing situations? Research design: A descriptive, qualitative approach explored respondents’ free-text responses to the following open-ended response item: “If there are other situations in which you have felt moral distress, please write and score them here.” Participants and research context: Eligible participants were HPs ( N = 8206) working in a large, multi-site healthcare system located in a major, urban city in the Southeastern United States. Ethical considerations: The Institutional Review Board provided approval for this research. A survey preamble supplied information, and consent was presumed with survey completion. Findings: Three themes were identified from 282 free-text responses: Theme 1: Compromised Quality of Care, Theme 2: Hostile Work Environment, and Theme 3: Ineffective Leadership. Conclusions: This study is unique because it provided in-depth qualitative analysis of morally distressing situations in a free-text response item across a wide array of HPs within multiple settings. Responses revealed that moral distress impacted the quality of patient care and provided descriptions of powerlessness to act.

Background Ethically challenging situations are one of the many stressors that strain eldercare employees. Aim The study aimed to examine (1) the mean levels of ethically challenging situations among eldercare employees in different Finnish eldercare service types and (2) the associations between organizational constraints and poor work-unit collaboration with ethically challenging situations. Research design Cross-sectional survey in 2020 including 4,347 Finnish eldercare employees (response rate 67%). These employees provide care and support to older adults, such as assist with daily activities and manage medical needs. Employees were classified into four categories based on the eldercare service type: home care ( n = 1,683), service housing ( n = 1,649), outpatient and ward care ( n = 650), and guidance and activity services ( n = 365). The data was analyzed with variance analysis, t-tests, and linear regression analysis. Ethical considerations The study was approved by the ethical board of the Finnish Institute of Occupational Health. Respondents’ provided informed consent for participation. Findings Analyses showed that the level of ethically challenging situations was highest in service housing, among nurses, and among practical nurses. Organizational constraints—job strain and organizational injustice—had the strongest positive association with ethically challenging situations. Poor work-unit collaboration, instead, had a minor positive association with ethically challenging situations. Conclusions Organizational constraints, especially job strain and organizational injustice, are important to identify to alleviate ethically challenging situations among eldercare workers.

Moral distress among nurses is well researched and well documented, but there is limited research on the moral distress experienced by care leaders, who serve as intermediaries between patient care nurses and higher levels of administration. Healthcare professionals experience moral distress daily in the context of older adult care. The aim of this scoping review was to evaluate recent literature on moral distress in older adult care with the goal of revealing how care leaders’ experiences of moral distress in older adult care have been conceptualized in earlier studies. The research questions were: How is the concept of moral distress as experienced by care leaders in older adult care defined in the existing literature? How is the concept of moral distress conceptualized in the literature? The research has been conducted in accordance with the guidelines set forth by the Finnish National Advisory Board on Research Ethics TENK. We saw that consensus on how moral distress is defined is lacking. Care leaders in older adult care experience substantial moral distress, which could be linked to the duality of their leadership role. Moral distress can be caused by a complex interplay of individual and structural factors and the challenging complex moral issues inherent to older adult care. Moral distress could impact care leaders’ emotional health, job performance, overall job satisfaction and result in higher turnover rates, absenteeism, decreased quality of patient care, and increased organizational costs. Addressing moral distress on the individual, team, and organizational levels is crucial for enhancing care leaders’ well-being and improving the overall quality of care for older adults. A focus on the identification of strategies whereby care leaders can be supported, exploration of the long-term effects of moral distress on healthcare professionals in general, and the organizational outcomes associated with moral distress should be included in future research.

In the current digital era, reliance on technology for communication and the gathering and dissemination of information is growing. However, the information disseminated can be misleading or false. Nurses tend to be trusted by the public, but not all information brought to the public forum is well-informed. Ill-informed discussions have resulted in harm to individuals who take such information as fact and act on it. As technology continues to evolve and fact versus fiction becomes more challenging to discern, it is critical that nurses recognize their ethical responsibility to the public in providing information for which sound evidence exists. This analysis will explore medical misinformation through concepts such as confirmation bias and the politicization of science. Also, the impact of nurses not recognizing the power and responsibility associated with using their credentials in public fora, even when the central motivator is that they believe they are helping other individuals. Using nursing goals and perspectives, we will discuss the ethical responsibility of nurses to be aware of the soundness of what they think they know. Utilizing ideas of professional responsibilities, as outlined by professional codes of ethics as well as the ethical principles of non-maleficence and veracity, we explore the problem of nurses propagating misinformation and suggest strategies to enhance nurse awareness of their ethical responsibilities for veracity and transparency regarding what is known and what is not.

Introduction Patient safety is essential for healthcare quality and a global concern. The rapid advancement of medical technology presents ethical challenges for critical care nurses, who navigate complex decision-making processes. Given their close relationships with patients, nurses are uniquely positioned to address patient safety issues. Thus, enhancing nurses’ moral sensitivity and ethical values is increasingly important. Objective This study aims to explore the relationship between moral sensitivity and attitude towards patient safety in critical care nurses. Methods This cross-sectional, descriptive-correlational study was conducted from June to September 2022 in three hospitals affiliated with Hamadan University of Medical Sciences in Iran. Participants were nurses in intensive care units (ICUs), selected via convenience sampling. A total of 382 nurses completed questionnaires assessing demographic information, moral sensitivity, and patient safety attitudes. Data analysis was performed using descriptive statistics, t-tests, ANOVA, Pearson’s correlation, and multiple regression in SPSS 26. Ethical considerations: This research received ethical approval from the Ethics Committee of Hamadan University of Medical Sciences. Participants provided informed consent regarding the study’s objectives, and their confidentiality was strictly upheld throughout the research. Results The nurses’ average age and work experience were 38.6 years and 12.4 years, respectively. Mean scores for moral sensitivity and patient safety attitude were 81.65 ± 2.69 and 51.47 ± 2.21, indicating high levels and a significant positive correlation. Factors such as increasing age, work experience, fewer working hours, and completion of ethics training were linked to more positive attitudes towards patient safety ( p < .05). Regression analysis showed that 42.8% of the variability in attitudes towards patient safety could be explained by moral sensitivity and demographic characteristics. Conclusion This study highlights the relationship between moral sensitivity and patient safety attitudes among critical care nurses, emphasizing the importance of education, experience, and training in shaping ethical values. Enhancing moral sensitivity is vital for reducing risky behaviors and improving patient safety outcomes in critical care settings.

Background The field of formal nursing ethics is not new, with literature primarily from North America, dating back to the 1880s. The establishment of the international journal Nursing Ethics in 1994 served to stimulate, curate and disseminate research and scholarship in this evolving field. Three decades on, it is timely to review progress and to make recommendations for the future focus of the field. Purpose This article reviews 182 issues of Nursing Ethics over 30 years, focusing on: regions of origin of published articles; methodologies; and topic themes. Research design The process involved documentary analysis, by hand, summarising: (1) regions of origin; (2) most common methodologies - qualitative; quantitative; mixed methods; argument-based; and reviews; and (3) themes relating to topic areas. Ethical considerations The manuscript was reviewed by members of the Nursing Ethics Editorial Board and revised in accord with reviewers’ feedback. The research did not involve human participants nor require consent from individuals. Findings There has been an escalation of scholarship in nursing ethics with significant shifts over 3 decades, as evidenced in the journal Nursing Ethics. This paper focuses on trends relating to: (1) Regions of origin of published papers – initially manuscripts were primarily from Europe and North America and there is now more geographical diversity; (2) Methodologies – there is strong evidence of the ‘empirical turn’ from an initial focus on philosophical perspectives to empirical research, particularly quantitative research; and (3) Topic areas – whilst there is rich diversity, there has been increasing focus on areas such as moral distress, ethical climate and ethics education. Conclusion This review is intended to stimulate reflection on progress made and approaches to future directions. This includes more critical focus on: the meaning and purpose of nursing ethics; impact on practice, education and research; and potential to respond to care challenges.