Background: Moral sensitivity, moral injury, and compassion fatigue are critical factors affecting the mental health and professional development of nursing interns, which have been studied in recent years. Moral development and mental health of nursing interns directly impact the quality of nursing care and patient safety.Aim: To explore the relationship among moral sensitivity, compassion fatigue, and moral injury among nursing interns and to analyze the role of moral injury in the relationship between moral sensitivity and compassion fatigue among nursing interns.Design: A correlational study design was employed. From October 2024 to January 2025, 206 eligible full-time nursing interns were recruited from Xi'an Medical University, Shaanxi Province. Data collection involved demographic questionnaires, Moral Sensitivity Questionnaire, Moral Injury Symptom Scale-Healthcare Professionals version, and the Compassion Fatigue-Short Scale. The relationships between moral sensitivity, moral injury, and compassion fatigue were examined using Pearson's correlation coefficient. Statistical significance was determined by a p-value of 0.05 or below. The mediation effect analysis was performed using the bootstrap method with 5000 bootstrap values. Data analysis was conducted using SPSS 27.0 and STATA 18.0.Ethical Considerations: This study was approved by Xi'an Medical University (XYLS2025001). The researchers ensured that participants were fully informed about the study's purpose and guaranteed that non-participation or withdrawal would not adversely affect their academic or internship outcomes. Informed consent was obtained from all participants.Results: There was a positive correlation between moral sensitivity and moral injury (r = 0.783, p < .001), and a positive correlation between moral sensitivity and compassion fatigue (r = 0.869, p < .001). The findings indicated a positive correlation between moral injury and compassion fatigue (r = 0.644, p < .001). The relationship between moral sensitivity and compassion fatigue was fully mediated by moral injury (β = 1.707, 95% CI: 1.252-2.162).Conclusion: Future studies could explore strategies to mitigate the adverse impact of moral sensitivity and moral injury on compassion fatigue among nursing interns.

Background: Ambulance staff face ethical demands to safeguard patient dignity and autonomy in situations where these values may be threatened. However, influences on how patients are understood can undermine this safeguarding, potentially impacting health outcomes. To address this, increased knowledge of these influences is needed as well as how they may form the ability to protect ethical values.Aim: The aim was to explore ambulance staff's view of what influences their understandings of encounters with persons living in stigmatized neighborhoods.Research Design: Transcripts from semi-structured interviews with ambulance staff were analyzed with content analysis.Participant and Research Context: Twenty-seven ambulance staff members were included from two different Swedish ambulance districts.Ethical Considerations: The study was conducted based on the Declaration of Helsinki and approved by the Swedish Ethical Review Authority.Findings: Six categories emerged; Individual values; Colleagues; Associated organizations; Societal information; Professional experiences; and Management.Conclusion: Ambulance staff's understandings are influenced in a multifaceted way that can produce processes of othering toward persons tied to specific neighborhoods, ethnicities, or cultures. This process endangers the safeguarding of dignity and autonomy due to understandings of the patient as of less value. However, critical reflection and exposure to diverse perspectives can counteract this and protect these ethical values.

Background Ethical challenges and moral uncertainty are inevitable during infectious disease crises. To support ethical nursing practices, understanding the ethical competencies required in such contexts is essential.ObjectivesThe aim of this study was to explore the phenomenon related to ethical competence among clinical nurses during the COVID-19 pandemic.Research Design, Participants and Research ContextA qualitative explorative approach was used. Data were collected through focus group interviews from 10 clinical nurses working in general and tertiary hospitals in Korea, and analyzed using content analysis.Ethical ConsiderationsThis study was approved by the institutional review board of the university to which the researchers belonged.ResultsThis study derived five core categories-moral solidarity, moral courage, ethical knowledge, ethical decision-making, and ethical reflection-along with their respective components.ConclusionsThis study provides empirical evidence that can contribute to a structured conceptualization of nursing ethical competence for infectious disease crises. Further research is suggested to contribute to practical educational and institutional support to strengthen this competence.

BackgroundAustralia faces a critical shortage of nurses, yet international nursing graduates (INGs) encounter significant barriers to securing employment after graduation. Current policies often prioritize domestic graduates, creating systemic disadvantages for INGs, particularly those on temporary visas. This inequity raises ethical concerns and undermines Australia’s ability to fully utilize its nursing workforce, potentially compromising the quality of healthcare services.AimThis study explores the lived experiences of INGs regarding employment challenges in Australia, critically examining the ethical and equity implications of existing practices.Research Design A qualitative study employing a combined phenomenological and exploratory approach was conducted. Data were analyzed using a thematic analysis framework.Participants and Research ContextTwelve international nursing students in their final semester of the Bachelor of Nursing program at two metropolitan universities in Australia participated in semi-structured interviews.Ethical ConsiderationsEthical approval was obtained from the Monash University Human Research Ethics Committee (MUHREC-44400) and the University of Technology Sydney (ETH24-10028). Informed consent was obtained from all participants, who were assured of their right to confidentiality and to withdraw from the study at any time.ResultsFive overarching themes emerged: (1) Economic Disparity and Ethical Considerations, (2) Systemic Discrimination and Inequality, (3) Mental Health and Well-being, (4) Policy and Regulatory Barriers, and (5) Lack of Cultural Inclusion and a Sense of (Un)Belongingness.ConclusionsThe findings highlight urgent ethical concerns and equity challenges that demand comprehensive reforms to create a more inclusive and ethically sound environment for INGs in Australia. These reforms necessitate policy changes to address discriminatory practices and visa restrictions, enhanced institutional support to facilitate INGs’ transition into the workforce, and a commitment to cultural competence and inclusion at all levels of the healthcare system. Addressing these systemic barriers is not only a matter of fairness and justice but is also crucial for ensuring a robust and ethically sustainable healthcare workforce in Australia.

BackgroundPatients with intellectual developmental disabilities (IDDs), as members of a vulnerable population, require specialized care that many ICU nurses feel inadequately prepared to provide. The complexity of caring for IDD patients often leads to feelings of moral distress, self-doubt, and a struggle to maintain resilience among ICU nurses.Research question/aim/objectivesThis study aims to explore ICU nurses' lived experiences caring for patients with IDD.Research designA descriptive, phenomenological qualitative approach was used along with inductive analysis to explore the meanings ICU nurses attribute to experiences caring for IDD patients.Participants and research contextICU nurses (N = 20) who met inclusion criteria were purposively sampled.Ethical considerationsThe study received ethical approval from an institutional review board. Informed consent was obtained from all participants.Findings/resultsThree main themes emerged from the analysis. First, in main theme 1, If Only I Had Known More, nurses reported insufficient training specific to IDD care, expressing shame about their knowledge gaps. Second, in main theme 2, They Deserve Better, nurses highlighted the lack of resources and institutional support, complicating efforts to deliver appropriate care. Finally, in main theme 3, It Weighs on My Soul, nurses reflected on the emotional toll of caring for IDD patients, discussing subthemes such as self-doubt, emotional detachment, coping efforts, witnessing isolation, and moral distress.DiscussionThese findings highlight personal, educational, and systemic gaps shaping ICU nurses' experiences with IDD patients. Limited training and insufficient resources intensified moral distress. There is an urgent need for IDD-oriented education, institutional support, and policies that promote compassionate, tailored care.ConclusionsFindings suggest there is a strong alignment with the ethics of care framework. Such a connection emphasizes the need for systemic changes to empower ICU nurses to deliver compassionate, individualized care to IDD patients and enhance professional resilience and patient outcomes.

Background: Body touch and close physical proximity are inevitable in some healthcare procedures and can evoke feelings of shame, humiliation, and anger in patients. Given the increasing recognition of human dignity, exploring the occurrence of these negative emotional experiences and identifying mechanisms for their prevention are crucial.Aim: To develop and define the concept of "patient's sexual dignity discomfort." Design: A hybrid model of concept development was utilized.Methods: In the theoretical phase, a scoping review was conducted to establish a working definition of patient's sexual dignity discomfort. This definition was refined and validated using qualitative data collected during the fieldwork phase. In the analytical phase, a final conceptual model of patient's sexual dignity discomfort was proposed by integrating findings from both the theoretical and fieldwork phases.Ethical considerations: All participants completed an informed consent process, and interviews were conducted via Zoom or phone by a certified psychiatric nurse to ensure confidentiality, anonymity, and comfort.Results: Four themes describing attributes of patient's sexual dignity discomfort were explored: experiencing shame and embarrassment, vulnerability-induced loss of control, dehumanization and objectification, and uncertain sexual autonomy. Patient's sexual dignity discomfort occurs when patients perceive care procedures as sexually inappropriate or as involving unnecessary sexual activity, particularly when healthcare providers display unprofessional attitudes or when patients lack consent or are not mentally prepared for the procedure because of insufficient information. This discomfort leads patients to refuse or avoid healthcare treatments and prioritize finding better healthcare services over their health. It can also prompt providers to avoid patients, resulting in a compromised quality of care and poor health outcomes.Conclusions: Patient's sexual dignity discomfort poses a significant threat to the quality of patient care and preservation of dignity. Nurses can trigger this intentionally or unintentionally, highlighting the need for comprehensive education and training to prevent it.

BackgroundHealthcare workers (HCWs) can face situations that conflict with their moral beliefs, leading to moral injury, an adverse psychological consequence that was more frequent during the COVID-19 pandemic. Self-compassion is a potential coping mechanism for moral injury by encouraging acceptance of human limitations and suffering.ObjectivesThis study aimed to examine the associations between self-compassion components and moral injury prevalence among HCWs in Quebec, Canada, during the COVID-19 pandemic.Research designA cross-sectional study design was employed. Participants: and research context: The sample of this study consisted of HCWs and leaders from the Quebec province. Participants completed validated self-administered questionnaires assessing both positive and negative self-compassion components (self-kindness vs self-judgment; common humanity vs isolation; and mindfulness vs overidentification) and moral injury dimensions (self-oriented and other-oriented). Prevalence ratios (PRs) and 95% confidence intervals (CIs) for the associations between self-compassion components and moral injury dimensions were modeled using Poison robust regressions. The models were adjusted for various covariates, including sex, age, gender, and socio-demographic and lifestyle factors.Ethical considerationsEthical approval for this study was obtained from the ethics committee of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale in Quebec, Canada. All participants provided written informed consent prior to participating in the study. Additionally, permission was sought and obtained from the original authors of the tools used in this study, including the self-compassion and moral injury scales.ResultsThe study involved 572 HCWs (60.5% nurses) and leaders. Around half of the participants (50.70%) exhibited moderate levels of self-compassion, while the prevalence of low levels of self-compassion ranged from 21.68% to 48.08% for the positive subscales and from 23.78% to 44.41% for the negative subscales. Regarding moral injury, 10.14% of participants reported moderate to high self-oriented moral injury, 29.19% reported moderate to high other-oriented moral injury, and 13.81% demonstrated moderate to high total moral injury. Higher self-compassion levels were associated with lower moral injury prevalence. HCWs with high self-compassion had a 93% lower likelihood of experiencing moral injury (PR: 0.07, 95% CI: 0.03-0.19). Self-kindness demonstrated the strongest association with reduced moral injury (PR: 0.24, 95% CI: 0.11-0.52), followed by mindfulness (PR: 0.37, 95% CI: 0.18-0.75). However, common humanity did not show a statistically significant association with moral injury prevalence.ConclusionThese findings suggest a potential association between self-compassion and reduced prevalence of moral injury among HCWs, highlighting promising interventions to manage moral injury during crises. Such initiatives could promote the mental wellbeing of HCWs and preventing the negative consequences of moral injury, including anxiety, depression, and burnout.

Background: Advocacy and activism are dynamic terms representing a spectrum of political action, aiming to achieve social or political change. The extent to which nursing advocacy and activism are legitimate nursing roles has been debated for around 50 years. Nursing regulatory documents, such as codes of conduct and professional standards, may provide direction to nurses on how they should act in the context of advocacy and activism.Aim: To explore what regulatory documents say about advocacy and activism, either explicitly or implicitly, and how they shape advocacy and activism.Research design: We used a Reflexive Qualitative Document Analysis approach with a Critical Feminist lens to analyse contemporary nursing regulatory documents from the USA, UK and Australia.Ethical considerations: This article has no human participants, and informed consent was not required.Findings: We identified eight nursing regulatory documents from the American Nurses Association, Nursing and Midwifery Council and Nursing and Midwifery Board of Australia. We constructed two major themes that reveal how nursing advocacy and activism are conceived and shaped in regulatory documents. Theme 1, Ideological arena describes the gendered and neoliberal subtexts influencing advocacy and activism. Theme 2, A five-pointed star, describes the shape of advocacy and activism in the regulatory documents.Conclusions: Regulatory documents from the USA, UK and Australia support diplomatic nursing advocacy and activism for people, equity, ourselves (nurses), the profession and systems change. However, more oppositional and disruptive advocacy and activism are potentially constrained by gendered and neoliberal subtexts that depoliticise nurses’ roles.

Background: People living with advanced dementia risk being seen as someone without personhood in contemporary societies, an understanding that has been described and challenged for decades in dementia scholarly literature. Such perception can be characterised as forms of existential dehumanisation, which still asserts itself in dementia care practices, adversely affecting the ethical and caring aspects of such care.Aim: To challenge dehumanisation in dementia care, we must first learn to recognise what foster it in caring relations. Thus, the aim of our study is to identify existing perceptions of care recipients living with advanced dementia, which elicit dehumanising attitudes among formal caregivers.Research design: We conducted an integrative review based on Whittemore and Knafl’s updated methodology. This allowed us to identify and analyse 26 articles incorporating both qualitative- and quantitative studies as well as theoretical- and grey literature all describing perceptions of care recipients living with dementia that lead to dehumanisation.Ethical considerations: Studying the darker sides in caring relations was to be beneficial in improving dementia care practices.Findings: Through an analytical process five themes that can sprout dehumanising attitudes in caring relations were identified, which include perceiving people living with advanced dementia as (1) absurd, (2) shadow, (3) perilous, (4) void, or (5) repugnant. We argue that these perceptions can be seen as unintentional and stem from a misled embodied perception, which caregivers should learn to recognise and consequently be able to resist through virtue ethics.Conclusion: Our study indicates that challenging dehumanisation is a practical matter of identifying and reacting in a timely way to ones misled embodied perceptions. We suggest the five themes offer a potential means to warn formal caregivers of impending dehumanising attitudes and help them to review how they ethically are thinking and perceiving the person living with advanced dementia.