BackgroundMoral distress occurs when ethically appropriate actions cannot be implemented, resulting in cognitive and emotional strain linked to outcomes like burnout and staff turnover. Despite extensive cross-cultural validation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP), no Italian adaptation currently exists, limiting research in Italian contexts.AimTo culturally adapt and validate the Italian version of the Measure of Moral Distress for Healthcare Professionals (MMD-HP-ITA) within two major Italian healthcare settings.MethodsAn observational multicenter cross-sectional study was conducted from December 2022 to September 2023. The original questionnaire underwent forward-backward translation. Confirmatory and exploratory factor analyses evaluated structural validity, and Cronbach's alpha assessed internal consistency. Construct validity was tested by correlating scores with the Ethical Leadership Scale.ParticipantsA sample of 567 healthcare professionals (median age 43 years; 74% female; 74% nurses) was recruited and completed the Italian version of the questionnaire online.Ethical considerationThe study was approved by the Ethics Committees of the two healthcare institutions involved. Informed consent was obtained from all participants.ResultsThe Italian version demonstrated strong internal consistency (Cronbach's α = 0.96). Exploratory factor analysis supported a three-factor model explaining 58.6% of the variance, with dimensions reflecting: (1) System-level constraints, (2) Team-level dynamics, and (3) Patient/family-level conflicts. Convergent validity was confirmed via significant associations with related constructs: moral distress scores were higher among nurses, younger professionals, and those considering job departure, and negatively correlated with ethical leadership ratings (r = -0.375, < 0.001).ConclusionThe Italian version of the Measure of Moral Distress for Healthcare Professionals is a reliable and valid instrument for assessing moral distress among Italian healthcare professionals, effectively capturing the multidimensionality of the construct in a culturally relevant way.

BackgroundNurses' innovative behavior serves as a crucial driver for organizational improvement and technological advancement. However, the demanding nature of the nursing work environment (characterized by high intensity, risk, and pressure) hinders the sustained development and quality of such innovation. Investigating the factors influencing nurses' innovative behavior is therefore essential for enhancing overall nursing quality and patient recovery outcomes, yet research on these factors and their underlying mechanisms remains limited.AimTo examine the effect of ethical leadership on nurses' innovative behavior and explore the longitudinal mediating role of moral sensitivity.DesignA longitudinal mediated follow-up study with three waves (January-July 2024).Participants: and research Context397 nurses from three Chinese hospitals via multicenter stratified cluster sampling. Inclusion criteria: registered nurses with ≥1 year of experience.Ethical considerationsApproved by the relevant Ethics Subcommittee. Anonymous surveys with informed consent; voluntary participation.FindingsSignificant positive correlations existed between innovative behavior and both ethical leadership and moral sensitivity at each time point (T1, T2, T3). Longitudinal path analysis demonstrated that T1 ethical leadership significantly predicted T2 moral sensitivity (β = 0.26, < .001), T2 moral sensitivity significantly predicted T3 innovative behavior (β = 0.24, < .001), and T1 ethical leadership significantly predicted T3 innovative behavior (β = 0.14, < .001). Moral sensitivity significantly mediated the relationship between ethical leadership and innovative behavior, accounting for 30.24% of the total effect.DiscussionEthical leadership fosters innovation both directly (through psychological safety) and indirectly by strengthening moral sensitivity, which empowers nurses to identify ethical dilemmas and develop novel solutions.ConclusionsHealthcare institutions should cultivate ethical leadership in nurse managers and implement moral sensitivity training (e.g., ethics case discussions) to sustainably promote nurses' innovative behavior and care quality.

BackgroundDying with dignity in intensive care units (ICUs) presents ethical and practical challenges, particularly within high-tech environments that often prioritize life-saving interventions over holistic end-of-life care. Respecting patient dignity requires attention to physical, emotional, and spiritual needs, as well as to privacy and family involvement.AimThis study aimed to explore the experiences of intensive care nurses in providing a dignified death to their patients, with a focus on understanding the factors that influence this process, the challenges encountered, and the care approaches employed.Research designA descriptive qualitative design was employed. Data were collected through in-depth semi-structured interviews and analyzed using Braun and Clarke's thematic analysis framework.Participants and research contextTwenty ICU nurses from eight different hospitals participated in the study. Participants were selected through purposive and snowball sampling techniques.Ethical considerationsEthical approval was obtained from the institutional review board. All participants gave informed consent, and the study followed COREQ guidelines.FindingsTwo main themes and eight sub-themes were identified. The first theme, Practices that support death with dignity, included peace of body, ensuring privacy, space for family farewells, fulfilling last wishes, and meeting spiritual needs. The second theme, Obstacles to death with dignity, included lack of staff, desensitization to death, and lack of knowledge.ConclusionsICU nurses play a vital role in promoting dignified death by addressing patients' physical, emotional, and spiritual needs. However, systemic barriers such as limited staffing, emotional burnout, and insufficient training hinder the consistent delivery of such care. Institutional reforms focusing on workforce support, education, and culturally sensitive protocols are essential to improve the quality of end-of-life care in ICUs.

Nurses and social workers play central roles in palliative care. While moral agency and professional identity have been widely studied, they are rarely examined together, leaving their intersection in palliative care insufficiently understood. The aim of this integrative review was to identify and analyze the key enablers and barriers influencing the construction of professional identity and the enactment of moral agency among nurses and social workers in the context of palliative care. The synthesis followed Whittemore and Knafl's integrative review methodology. 12 databases were queried between February 2022 and November 2023, and a manual search was conducted to identify additional publications. Qualitative analysis was performed using the three concurrent analytic activities proposed by Miles, Huberman, and Saldaña. Of the initial 1448 articles retrieved, 34 were selected through screening, and 4 additional articles were included through manual search, for a total of 38 articles reviewed. For moral agency, the enablers were supportive cultures, relationships with patients and their relatives, and moral capacities and inner dispositions. The barriers identified were restrictive cultures, insufficient resources and workload, and interpersonal value conflicts and moral dissonance. For professional identity, the enablers included making a difference for patients, advocating for patient choices, and patient gratitude as a recursive loop. The main barriers were biomedical dominance and professional devaluation, and value tensions and emotional norms. This review revealed that both concepts are predominantly explored within the nursing literature, are deeply interconnected, and tend to reinforce each other. They also share common enablers and barriers in palliative care settings. The findings suggest the importance of incorporating both concepts into nursing education to support ethical competence in palliative care and to help mitigate the moral distress often experienced by nurses.Hoping this resolves the issue.

BackgroundMoral injury, first identified in military settings, is increasingly recognised in healthcare, yet little is known about its impact on psychiatric nurses, particularly in Japan. Japanese psychiatric care remains heavily institutionalised, with widespread use of involuntary treatment and mechanical restraint, raising ethical concerns.AimThis study explores the experiences and causes of moral injury among psychiatric nurses in Japan who resigned due to moral or ethical distress.Research designA qualitative descriptive design was adopted.Participants and research contextSemi-structured interviews were conducted with 12 former psychiatric nurses between May 2024 and February 2025. Participants were nurses who had worked in psychiatric settings and quit due to ethical problems. They were recruited through purposive and snowball sampling. Data were analysed thematically.Ethical considerationThe study was conducted after the research ethics committees had approved, written informed consent was obtained from the participants, and their privacy was carefully considered.ResultsIn this study, two of six main themes are reported: (1) causes of moral injury and (2) experiences of moral injury. Nurses reported morally injurious practices such as unjustified mechanical restraints, neglect of patients, long-term institutionalisation for profit, physical abuse, and coercive treatments. These actions often conflicted with their personal and professional values, leading to negative feelings including guilt, shame, anger, and isolation. Many attempted to resist or improve care but faced institutional backlash or apathy from colleagues. Cultural norms valuing conformity and professional hierarchies further hindered ethical action and reinforced silence.ConclusionMoral injury among psychiatric nurses in Japan is deeply tied to systemic and cultural factors that normalise unethical practices and discourage dissent. The findings underscore the need for structural reform in psychiatric care, greater ethical support for nurses, and recognition of resistance not as insubordination but as a vital expression of professional integrity.

BackgroundNurses' innovative behaviors play an irreplaceable role in advancing nursing practice, improving healthcare service quality, and driving transformation in the nursing profession. However, existing studies on the factors influencing nurses' innovative behaviors and their underlying mechanisms remain limited, necessitating further investigation.ObjectiveThis study investigated the impact of ethical leadership on nurses' innovative behaviors, examining the mediating roles of innovative climate and self-efficacy.Research designThis is a multicenter longitudinal study with three-wave data collection (February-August 2024) following STROBE guidelines. Structural equation modeling was employed to examine mediation effects.Participants and research contextA total of 1,522 nurses from 16 tertiary hospitals in China completed baseline assessments (T1), with 1,409 (T2) and 1,298 (T3) completing follow-ups. Participants were registered nurses with ≥1 year of experience, sampled through stratified cluster sampling across clinical departments.Ethical considerationsapproved by the Henan University Biomedical Research Ethics Committee (HUSOM2023-478). Participants provided informed consent, data were collected anonymously, and confidentiality was maintained throughout.ResultsEthical leadership significantly predicted innovative behavior (β = 0.334, 95% CI [0.284,0.386]). Both innovative climate (β = 0.059 [0.046, 0.072]) and self-efficacy (β = 0.017 [0.011, 0.023]) served as partial mediators, with a significant chain mediation effect (β = 0.021 [0.015, 0.027]) accounting for 4.87% of total effect.ConclusionEthical leadership not only directly promotes nurses' innovative behaviors but also strengthens this effect indirectly through the chain-mediated roles of innovative climate and self-efficacy. Enhancing ethical leadership can optimize the innovative climate in nursing departments and improve nurses' self-efficacy, thereby effectively fostering their innovative behaviors.

BackgroundThe rapid integration of artificial intelligence (AI) into healthcare has transformed how health professionals learn, communicate, and make clinical decisions. However, AI-generated images and digital outputs often reproduce societal stereotypes, particularly regarding gender and race.AimThis study examined how nursing students' perceptions of gender, race, and professional roles are shaped by AI-generated images of healthcare professionals, and how these perceptions influence their communication styles and ethical awareness in interactions with AI.DesignA multimethod, cross-sectional design integrating quantitative and qualitative approaches was used. Quantitative data assessed gender attitudes in the nursing profession, while qualitative data explored visual interpretations and language patterns in AI interactions.Participant PopulationThe sample included 132 second- and fourth-year nursing students from a health sciences faculty in Türkiye.Ethical ConsiderationThe study was approved by the institutional ethics committee.FindingsResults indicated that nursing students largely relied on visual cues particularly clothing and posture when identifying professional roles in AI-generated images. Despite claiming objectivity, students frequently associated doctors with men and nurses with women, reflecting persistent gender schemas. Female participants demonstrated greater sensitivity to both gender and racial imbalances, whereas males perceived AI-generated visuals as more neutral. Language analysis revealed two main communication styles in chatbot interactions: polite and direct. Quantitative findings showed that being female, having lower income, and higher GPA were associated with more egalitarian attitudes.ConclusionNursing students' perceptions and interactions with AI are influenced by implicit gender and racial stereotypes embedded in visual and linguistic representations. Integrating AI ethics, gender equity, and digital literacy into nursing curricula will foster critical awareness, algorithmic fairness, and equitable professional identity formation among future nurses.

BackgroundWith the widespread adoption of artificial intelligence (AI) in healthcare and nursing, nurses' subjective perception of AI has become a key indicator of their professional adaptability. However, the underlying mechanisms shaping this perception remain insufficiently understood. This study adopts a dual-perspective approach, integrating organizational management and individual psychology, to investigate the synergistic role of ethical leadership and moral sensitivity in facilitating nurses' technological adaptation. The findings provide new insights into the development of a supportive and ethically grounded nursing work environment in the digital era.ObjectiveTo examine how ethical leadership influences nurses' AI perception over time and the mediating role of moral sensitivity.MethodsData were collected in three waves from 584 nurses across six tertiary hospitals in China. Cross-lagged panel modeling and structural equation modeling were used to analyze the temporal predictive pathways and mediating mechanisms among the key variables.ResultsEthical leadership measured at Time 1 (T1) significantly and positively predicted AI perception at Time 2 (T2; β = 0.25, < .001) and Time 3 (T3; β = 0.26, < .001) and also significantly enhanced nurses' moral sensitivity (T2: β = 0.36, < .001; T3: β = 0.18, < .001). Further mediation analysis revealed that moral sensitivity at T2 partially mediated the effect of ethical leadership on AI perception at T3, accounting for 18.50% of the total effect. These results highlight a synergistic mechanism between the organizational ethical climate and individual moral resources in the process of adapting to AI technologies.ConclusionsEthical leadership and moral sensitivity jointly promote nurses' understanding and acceptance of AI systems, thereby strengthening their psychological adaptability and professional integration during technological transitions. These factors serve as essential supports for fostering a healthy nursing work environment.

BackgroundCompassion fatigue is a significant problem faced by nurses. Understanding the relationship between compassion fatigue and caring behaviors is essential in terms of reducing situations that negatively affect nurses and, thus, care.AimThis study aimed to investigate the relationship between compassion fatigue and caring behaviors among oncology nurses.Research designThis study employs a descriptive and correlational approach.Participants and research contextThe study was conducted with 241 oncology nurses working in hospitals with oncology inpatient services located within the provincial borders of Ankara. Data were collected face-to-face between July 15, 2023, and July 1, 2024, using the Descriptive Characteristics Form for Nurses, the Caring Behaviors Inventory-24, and the Compassion Fatigue-Short Scale. The data obtained from the study were analyzed with IBM SPSS 26. The analysis involved t-tests, ANOVA, Tukey tests, and Pearson correlation analysis.Ethical considerationsData were collected after obtaining ethics committee approval, institutional permissions, and informed consent from the nurses.ResultsThe mean total score of Caring Behaviors Inventory was 5.22, and the mean total score of Compassion Fatigue Scale was 67.71. There was a very weak positive correlation between the Caring Behaviors Inventory sub-dimension "respectful" and the Compassion Fatigue Scale sub-dimension "secondary trauma" (r = 0.153, = .017). According to the findings obtained from the study, it was determined that oncology nurses had a high level of perception of caring behaviors and experienced compassion fatigue at a moderate level.ConclusionCompassion fatigue and caring behaviors are affected by many situations. Despite these situations, oncology nurses with empathic thinking, altruism, and ethical and professional values continue to care for their patients.

PurposesThe aim of this study was to deeply explore and elucidate the factors that trigger moral distress in dementia nursing staff based on society ecosystems theory (SET), to provide a theoretical basis for alleviating the experience and severity of moral distress among dementia nursing staff.MethodsThis study was a mixed-methods systematic review that searched eight electronic databases, including PubMed, Web of Science, EMBASE, CINAHL, PsycINFO, EBSCO, Cochrane, and Scopus. And we searched the literature from 1984 until June 2025. Studies were selected based on predetermined inclusion and exclusion criteria, focusing on factors that contribute to moral distress in dementia nursing staff. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT), and data were analyzed and synthesized to extract relevant themes.FindingsThe study identified 21 studies that categorized factors contributing to moral distress as macro (nursing staff prevalent issues, dementia nursing staff specific issues), mezzo (relationships with others, caregiving conflicts), and micro (individual differences, conflicting values, psychological imbalances, or feelings of distress).ConclusionsMoral distress among dementia nursing staff is driven by dementia symptoms, artificial nutritional issues, resource constraints, and caregiving conflicts. Synergistic interventions can be made at the micro, mezzo, and macro levels. However, systematic interventions for dementia nursing staff are currently inadequate, and effective and sustainable interventions need to be developed in clinical practice in the future.

BackgroundAmbulance clinicians regularly encounter medical, caring, existential and ethical challenges. Meeting patients with complex medical presentations underscore the need for holistic decision-making and actions as ambulance clinicians struggle to strike a balance between addressing medical and caring needs.AimThis study aimed to explore action alternatives considered and discussed during ethics case reflections in response to care-related challenges in ambulance services.Research designA qualitative descriptive study design was applied. Data were analyzed using conventional and summative content analysis.Participants and research contextEthics case reflections were performed with 14 groups comprising a total of 78 ambulance clinicians. Prior to the reflections, a video depicting the encounter between two ambulance clinicians and an older patient and his spouse was viewed.Ethical considerationsThe principles of the Declaration of Helsinki were applied throughout the research process, and an advisory statement was obtained from the Swedish Ethical Review Authority (No. 2019-02127 and 2021-03490).FindingsThe ethics case reflections generated a variety and breadth of action alternatives to manage challenges in caring, suggesting that this format is suitable for discussing ethical issues in clinical cases that depart from standard medical emergencies. Furthermore, the breadth of the results reveals the wide professional discretion afforded to ambulance clinicians and suggest the presence of tacit competences embedded in professional practice.ConclusionsEthics case reflection has a potential to enhance ambulance clinicians' ethical decision-making by deepening reflections about patient autonomy as well as highlighting the potential for a caring approach and promoting holistic care. By generating a breadth of specific action alternatives, many possible ways forward even in situations with complex care-related challenges are illustrated. Further investigation regarding the role of ethics case reflections to articulate implicit attitudes and tacit competencies is warranted.

BackgroundThe entitlements and rights related to eating for patients with terminal cancer have long been challenged, particularly as deteriorating health conditions may compromise their autonomy in food choices and dietary preparation. Their vulnerable situation remains poorly understood, and limited research has explored the ethical dimensions of their eating-related experiences in the context of home-based hospice care.Research aimThe aim of this study was to gain an in-depth understanding of eating-related experiences in terminally ill cancer patients from an ethical perspective.Research design and participantsThe descriptive qualitative method was conducted to explore the eating-related experience of 11 patients with terminal cancer who receiving home-based hospice care services.Ethical considerationsApproval was obtained from the Biomedical Research Ethics Committee of the corresponding author's University.FindingsThe following three interconnected main themes were identified in patients with terminal cancer: eating not for pleasure but as a form of torture, erosion of existential meaning in dietary restrictions, and social isolation in shared spaces.Conclusion and final considerationsPatients with terminal cancer may face a dilemma as they navigate the balance between their right to enjoy food, cherish their remaining days, and sustain a desire for longevity. It is essential to consider significant ethical concerns surrounding nutrition and emphasize the patients' needs to maintain eating autonomy, dignity, and meaningful communication until their final moments. Future research is needed to explore the ways to foster an environment where both patients and caregivers can engage in effective and equitable dialogue, thereby bridging the gap in perceptions related to eating habits and the deeper existential meanings attached to nourishment.

This paper explores how contemporary US healthcare, shaped by neoliberal biopolitics and thanatopolitics, functions as a death-making institution that commodifies care while systematically disposing of certain lives, reflecting an ethics not of care but of capital. Drawing from critical theory, historical analysis, and lived experience, we examine how death is deeply embedded in the structures of power and capitalism. Through the lens of haunting and organized forgetting, we analyze how institutions sanitize death, muting human loss into metrics and decontextualized data points, while erasing the tragedies of systemic violence. We argue that nurses, who are situated in physical and spiritual proximity to death, are uniquely positioned to act as witnesses, truth-tellers, and conjurers of the dead. Rather than comply with the institutional imperative to forget, we advocate for a practice of conjuring; calling forth the ghosts of those lost to violence of medical neglect, structural racism, and economic abandonment as a form of parrhesia: dangerous, necessary truth-telling. We explore how organized forgetting rewrites radical histories into palatable myths, disciplining contemporary activism and muting its transformative potential. We turn to examples like the Marys of ACT UP, whose embodied activism illustrates the power of public grief and haunting to incite justice. Inspired by theorists such as Foucault, Giroux, Derrida, and Ahmed, we locate in mourning a form of resistance, in memory a political act, and in storytelling a path to rehumanization. Ultimately, we argue that to conjure our dead is not only to remember them but to be transformed by them, allowing their voices to shape our ethical responsibilities, professional identities, and collective futures. In being possessed by our dead, we foreclose upon the institutional disavowal of suffering and reclaim a politics rooted in compassionate reckoning and the belief that another world is possible.

BackgroundNursing turnover rates are among the highest measured in recent years, contributing to financial and staffing challenges in the healthcare industry. Citing ethical challenges and subsequent moral distress, nurses have increasingly turned to travel nurse positions. Current literature regarding moral distress and ethical challenges has largely focused on staff nurses, and it is unknown how travel nurses experience ethical challenges and any associated moral distress.AimTo explore travel nurses' experiences with ethical challenges, inclusive of how they respond and feel or mitigate moral distress related to these challenges. Sources of support will be identified, with a focus on personal and organizational resources.Research designA qualitative descriptive study conducted through individual interviews. Participants were recruited with a purposive sampling strategy through flyers and social media. The data was analyzed using inductive and deductive content analysis. Participants and research context: Nurses ( = 15) working as travel nurses in the United States of America. Data was collected between August 2024 and February 2025.Ethical considerationsThis study received approval by the Institutional Review Board at the UMass Chan Medical School and Baystate Medical Center.FindingsThree themes described the participants' experience of ethical challenges. Strategies that travel nurses use to address and cope with ethical challenges include reflective thought, formation of a support network, and contemplation of action strategies.DiscussionTravel nurses' experience with ethical challenges has some unique qualities, and coping strategies have some distinctions from recommended strategies to avoid and mitigate moral distress.ConclusionThis study will inform practice models of travel nursing and strategies to support all nurses encountering ethical challenges in their practice. Nursing leaders should foster strategies for feedback from travel nurses, including ways to improve the ethical environment.

BackgroundLarge-scale disasters, such as the February 6, 2023, Kahramanmaraş-centred earthquakes, significantly affect healthcare systems and frontline professionals, including nurses. Understanding the ethical experiences of nurses' in such contexts is crucial for disaster preparedness and nursing ethics.AimThis study aimed to explore the ethical challenges and moral distress experienced by nurses providing care after the 2023 earthquakes, as well as their coping strategies. The focus was on their lived experiences and professional responsibilities, and the influence of cultural and systemic factors.Research designA qualitative phenomenological approach was adopted to gain an in-depth understanding of the experiences of nurses.Participants and research contextSeventeen nurses were interviewed. The interviews were conducted between June and August 2024. They used a semi-structured guide. All coding and theme development were conducted manually to ensure close engagement with the data.Ethical considerationsEthical approval was obtained from Adiyaman University Social and Human Sciences Ethics Committee (Decision No: 69, 05.06.2024), and all participants provided informed consent, and anonymity was maintained throughout the study.FindingsThe main theme of 'Staying in Limbo' reflects nurses' feelings about being in a state between their personal needs and their professional duties. Three subthemes were identified: (1) Professional Responsibility, which encompasses moral distress, motivation, and ethical values; (2) Managerial Problems, which highlight resource scarcity, organisational deficiencies, and training gaps; and (3) Lessons Learned and Recommendations, which emphasise teamwork, collective ethical decision-making, and systemic preparedness. As they navigated ethical dilemmas within personal, cultural, and institutional frameworks, nurses experienced moral ambiguity, temporal disorientation, and identity fragmentation.ConclusionFactors such as culture, structure, and institutions affect nurses' ethical decision-making in disasters. The findings show the importance of disaster preparedness and response strategies that support nurses in making ethical decisions and provide them with the necessary support.

This conceptual paper explores the ethical challenges faced by pediatric oncology nurses in healthcare settings where diversity, equity, and inclusion (DEI) frameworks are withdrawn, diminished, or absent. The removal of equity-focused policies heightens moral conflict for pediatric nurses, forcing them to navigate ethical dilemmas without clear institutional support. Drawing on Kohlberg's theory of moral development, alongside complementary perspectives from Perry, Gilligan, Tronto, and Selman, this paper demonstrates how nurses must increasingly depend on postconventional reasoning to protect justice, fairness, and patient-centered equity in culturally complex care. To bridge theory and practice, the discussion integrates real-world vignettes from pediatric oncology contexts, illustrating how institutional vulnerabilities, patient needs, and the moral distress of nurses can intersect in ways that jeopardize health, safety, and overall well-being. These scenarios reveal the ethical tensions that arise when organizational constraints conflict with professional commitments to advocacy, cultural humility, and inclusive care. Framed as a conceptual construction, we have argued for a dual approach to addressing these challenges: a top-down strategy in which healthcare institutions develop alternative ethical frameworks and supportive policies to preserve equity in the absence of formal DEI structures, and a bottom-up approach in which future research explores how individual nurses' moral development can be strengthened through ethics education, reflective practice, and cultural competence training. Ultimately, sustaining equitable pediatric oncology care in the current sociopolitical climate requires more than individual moral courage, it demands institutional accountability, policy innovation, and a reinvigorated commitment to justice in healthcare. This work offers recommendations for nursing educators, clinical practice, and policy to safeguard the dignity, safety, and well-being of every child and family they serve.

BackgroundDignity is a fundamental value and right of every human being and a central concept in nursing care. Due to radical life changes caused by neurodegenerative diseases, there is an increased risk of experiencing impaired dignity.Research aimThe aim was to gain an understanding of how people suffering from selected neurodegenerative diseases make sense of their dignity.Research design and participantsA qualitative, multiperspective interpretative phenomenological design was used, collecting data through semi-structured, face-to-face interviews with 9 participants with multiple sclerosis and 5 participants with Parkinson's disease.Ethical considerationsThe study was approved by the faculty Ethical Committee (No. EK 49/2021).FindingsTwo overlapping themes were identified: Embodiment and new identity affecting self-worth, and Desire to be accepted. The dignity of the participants was shaped by reframing values, active determination to fight for the highest possible quality of life, and receiving support from the community and relationships. Conversely, bodily limitations with unpredictable symptoms, stigmatization, expressions of pity, and loss of independence negatively impacted their sense of identity. In the context of dignified healthcare, participants emphasized the importance of a partnership approach, the need to be heard, and the ability to rely on healthcare professionals. The inhumane approach, disinterest, and paternalism were seen as aspects that increased vulnerability and diminished dignity.ConclusionsIndividual narratives provide valuable insights into the dynamic and relational nature of dignity. Identifying unique lived experiences of dignity shaped by illness and understanding the needs of a particular person is an integral part of dignified life and person-centered care.

BackgroundMoral resilience enables nurses to navigate ethical challenges and mitigate moral distress, supporting well-being and high-quality care.AimTo synthesize evidence on the level of moral resilience among nurses and identify potential moderating factors.MethodsA systematic review and meta-analysis were conducted across nine electronic databases from inception to December 2024, updated in August 2025. Observational studies reporting quantitative data using the Rushton Moral Resilience Scale (RMRS) were included. Two reviewers independently performed study selection, data extraction, and quality assessment. Random-effects meta-analysis, subgroup analyses, and meta-regression were used to pool data and explore heterogeneity.Ethical considerationsEthical approval was not required as the review synthesized publicly available data.ResultsTwenty-four cross-sectional studies comprising 9510 nurses from seven countries were included. The pooled mean moral resilience score was 2.88 (95% CI: 2.78-2.99), indicating a moderate level. Subscale means were: response to moral adversity 2.66 (95% CI: 2.45-2.87), relational integrity 2.79 (95% CI: 2.62-2.96), personal integrity 2.95 (95% CI: 2.80-3.11), and moral efficacy 3.19 (95% CI: 3.06-3.32). Clinical department and employment type significantly moderated moral resilience.ConclusionsNurses globally demonstrate moderate moral resilience, with the lowest capacity in responding to moral adversity. Targeted training and systemic support are needed, particularly for high-stress departments and non-permanent staff, to enhance ethical practice and safeguard nurse well-being.

BackgroundThe use of assisted reproductive technology (ART) in individuals with intellectual disabilities raises significant ethical tensions between reproductive autonomy and the welfare of future offspring. Global guidelines addressing this dilemma remain absent. In China, nurses frequently encounter these dual responsibilities without clear operational frameworks.AimTo explore how nursing interventions can support ethical decision-making and reproductive safety for an intellectually disabled patient undergoing ART.DesignA qualitative, exploratory single-case study.MethodsThe study followed a 27-year-old woman with mild intellectual disability through an in vitro fertilization (IVF) pathway. A nurse-led dual-intervention strategy was implemented: (1) cognitively adaptive decision-making tools (pictogram-based IVF guides, emoji risk charts, visual medication calendars); and (2) government-integrated perinatal care services, including prenatal registration, structured follow-up, and postpartum home visits.Ethical ConsiderationsEthical approval was obtained, and the study adhered to strict ethical standards, including a tailored informed consent process and robust guarantees of confidentiality.FindingsThe intervention ensured informed consent completion, medication adherence without errors, and comprehensive prenatal tracking via the national maternal health system. The patient delivered a healthy infant (Apgar score = 10). These outcomes demonstrate that nurse-designed cognitive adaptations, combined with systemic safeguards, enhance patient autonomy and reproductive safety.ConclusionThis study illustrates an ethical and practical paradigm for reconciling reproductive justice and cognitive equity in ART. Nurse-led innovations, supported by institutional governance, may inform global frameworks for ethically complex fertility care.

BackgroundMoral suffering is a growing concern in healthcare, especially in the nursing profession. It encompasses various forms, such as moral distress and moral injury, both of which impact nurses' professional integrity and mental and physical health. Despite extensive research, there is still no consensus on their definitions, distinctions, or causes, which impedes effective interventions. However, given their overlapping characteristics and consequences, joint consideration could offer critical insights to refine existing concepts.AimTo explore how nurses in clinical practice perceive moral suffering and analyze the essence of their experience of moral suffering.Research designData were collected through qualitative, semi-structured online interviews. The interview transcripts were analyzed using qualitative content analysis.Participants and research contextA total of 47 registered nurses from different clinical settings in German hospitals participated in the study.Ethical considerationsThe study protocol was approved by the Institutional Review Board at University Medicine Greifswald. All participants provided written informed consent.FindingsThe essence of moral suffering was determined in five main categories with corresponding subcategories: A trigger situation (1) in which a person in a specific moral disposition is present (2), whereupon they assess the situation as morally meaningful (3) and, accordingly, moral suffering is experienced in its three specific dimensions: (4) the (dynamic, context-dependence, temporality, fuzziness), (rational and emotional integrity-related manifestation), and (handling, coping, prevention). This experience of moral suffering has consequences (5).ConclusionsThis study illuminates the complex nature of moral suffering among nurses, revealing its multidimensional essence and the interplay between personal and professional factors. The results underscore the need for a systemic approach to address moral suffering in nursing, emphasizing the importance of ethical leadership and workplace health promotion, and fostering shared values within healthcare teams.