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Ethics is a foundational competency in healthcare inherent in everyday nursing practice. Therefore, the promotion of qualified nurses' and nursing students' moral competence is essential to ensure ethically high-quality and sustainable healthcare. The aim of this integrative literature review is to identify the factors contributing to the promotion of qualified nurses' and nursing students' moral competence. The review has been registered in PROSPERO (CRD42023386947) and reported according to the PRISMA guideline. Focusing on qualified nurses' and nursing students' moral competence, a literature search was undertaken in January 2023 in six scientific databases: CINAHL, Cochrane Library, PsycINFO, PubMed Medline, Scopus and Web of Science. Empirical studies written in English without time limitation were eligible for inclusion. A total of 29 full texts were retrieved and included out of 5233 citations. Quality appraisal was employed using Joanna Briggs Institute checklists and the Mixed Method Appraisal Tool. Data were analysed using inductive content analysis. Research about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence is limited and mainly explored using descriptive research designs. The contributing factors were identified as comprising two main categories: (1) human factors, consisting of four categories: individual, social, managerial and professional factors, and ten sub-categories; and (2) structural factors, consisting of four categories: educational, environmental, organisational and societal factors, and eight sub-categories. This review provides knowledge about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence for the use of researchers, nurse educators, managers, organisations and policymakers. More research about the contributing factors is needed using complex intervention, implementation and multiple methods designs to ensure ethically sustainable healthcare., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: We developed the ACP+ intervention to support nursing home staff with implementation of advance care planning. While ACP+ was found to improve staff's self-efficacy, it did not change their knowledge about advance care planning., Aim: To describe the level of implementation, mechanisms of impact, and contextual factors., Design: Process evaluation embedded in a cluster randomized controlled trial in nursing homes (NCT03521206). Throughout and immediately following the 8-month ACP+ implementation, we collected weekly diaries, post-training surveys, attendance records, facility data, and conducted interviews ( n  = 32). We applied descriptive statistics and thematic analysis., Setting and Participants: Management, staff, and ACP+ trainers in seven intervention homes., Results: Although most participants reported they valued ACP+, 33% of eligible staff across nursing homes attended training (range: 6%-69%) and only a few reported they felt ready to engage in actual care planning conversations. Half of all nursing homes adapted parts of the intervention (e.g., more/fewer/shortened training; assigning a coordinating role for practical management). Enough time to consolidate skills, and management support were key for staff engagement in advance care planning, and limited time and staff shortages were significant barriers. Staff reported increased awareness of the importance of advance care planning and felt there was a more systematic way of organizing advance care planning., Conclusions: There was limited staff engagement. Management ownership, clear roles, and collaborative practices may enhance nursing home advance care planning. Accessible and ongoing training for all staff, and ample practical learning opportunities are needed.

Background: The ethical challenges faced by undergraduate nursing students and nurses may lead to moral distress, negatively affecting learning capacity and self-confidence and potentially influencing the quality of patient care. Objective: To examine the state of knowledge regarding the moral distress among undergraduate nursing students during clinical practice. Methods: This scoping review followed JBI guidelines. First, the LILACS, Web of Science, Scopus, CINAHL, PubMed/MEDLINE, PsycINFO, Embase, and ProQuest databases were consulted. Next, the reference lists of the studies included in the sample were checked. Studies exploring moral distress among undergraduate nursing students during clinical practice were included regardless of language or date of publication. Two independent reviewers simultaneously selected the studies. Results: The sample included 12 articles with different research designs. Three conditions that trigger moral distress among undergraduate nursing students emerged: Interpersonal relationships between students and preceptors/supervisors and multidisciplinary teams; interpersonal relationships between students and patients; and the relationship between students and health services. Conclusions: This review identified the various circumstances that lead to moral distress among undergraduate nursing students. Therefore, these results highlight the importance of preventing moral distress in this group through teaching, especially before students begin their clinical practices., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: One of the authors is a member of the Editorial Board.

Background: Undergraduate nursing students may experience several ethical challenges during their clinical learning placement that can lead to moral distress and intention to leave the profession. Ethical challenges are complex phenomena and ethical frameworks may help improve their understanding and provide actionable recommendations to enhance students' readiness for practice., Aim: To explore undergraduate nursing students' ethical challenges experienced during their clinical learning and their suggestions for better ethics education; to illuminate students' experience against a foundational ethical framework., Research Design: Qualitative study based on interpretative phenomenology. Semi-structured, in-person or at distance, one-to-one interviews were performed, audio-recorded, and transcribed verbatim. The 'Dignity-enhancing care framework' was employed to frame the study findings., Participants and Research Context: Nineteen nursing graduands attending seven sites of one Northwestern Italian University were interviewed., Ethical Consideration: The study protocol was approved by the Ethics Committee of the University of Torino (number 0187646/2023). All participants provided written informed consent., Findings: Students experienced several ethical challenges concerning daily practice such as pain control or the decision to restrain patients, and reported deficient professional ethics with healthcare professionals who demonstrated poor caring attitudes and teamwork. Moreover, they perceived professionals poorly committed to their role of educators and complained of poor support in the learning process. When a supportive, dialogical, and relational context lacked, students experienced negative feelings about the profession and the healthcare system and reported the intention to leave the profession. Dialogue with peers, family members or significant others, nursing educators, and clinical nurse supervisors, as well as self-learning activities and discussion-based teaching methods grounded on real scenarios helped to overcome challenging situations., Conclusion: While complying with normative standards, nursing education policies should encourage the adoption of dynamic teaching methods and sustain a regular, dialogical approach within and between the clinical and academic contexts to improve readiness for practice., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.