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Background: Existing literature on moral conflicts that healthcare professionals encounter in dementia care has explored, amongst others, issues related to autonomy, decision-making capacity, privacy, and more. Notably, conflicts related to healthcare professionals who support informal dementia caregiving and who are confronted with family members being overburdened with their care responsibly remains an underexplored topic in the current literature, particularly in the context of Low-and Middle-Income Countries. The present paper introduces such an encounter, presenting an ethical case analysis of a conflict that occurred during a larger research project conducted in North Macedonia. Case to be studied: Due to the absence of formal care services that could have relieved an overburdened family caregiver, healthcare professionals felt compelled to reach out to the uninvolved adult daughters, requesting them to participate in their parents' care. Wondering about whether their reaching out to the daughters might count as an attempt of pressure and undue interference, professionals conflicted over the appropriateness of their action. This paper follows up on their concern, ethically assessing the professionals' action. To answer the question on whether the healthcare professionals acted appropriately or not, and to what extent, theories of filial duties are applied, embedding their action in the larger context of dementia care in North Macedonia. Results and conclusion: It is argued that the lack of formal care services in North Macedonia is of utmost relevance to the conflict. Thus, the conclusion is that the ethical inappropriateness of the case is to be located not so much with the action of the healthcare professionals but with the state because of its failure to provide professional care services that allow healthcare professionals to take ethically sound actions to counteract overarching burdens that family members face when providing informal dementia care [ABSTRACT FROM AUTHOR]

Objective: This integrative review aimed to identify the common characteristics of moral distress in nursing and distinguish it from other types of distress by examining nurses’ perspectives in the literature. These insights will help update existing tools and create new ones to capture moral distress better, guiding the development and implementation of strategies to support nurses in addressing this challenge. Methods: Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in three databases (EBSCO Medline, CINAHL, and PubMed). Additionally, two journals, Bioethics and Nursing Ethics, were manually searched to reduce search bias. The included studies were primary resources published in English between 2018 and 2023, utilizing quantitative, qualitative, or mixed methods to examine moral distress’s characteristics, components, and definitions. All of identified studies were screened, extracted, and analyzed independently by two researchers. Results: Nineteen studies were included. The results were grouped into five themes shaping the main characteristics of moral distress: 1) experiencing a moral situation, with five ethically conflicted situations identified, including treatment plans, professional and personal moral values, team dynamics, complex contexts, clinical practices, and patient-centered care; 2) making a moral judgment, where nurses experience moral distress when they cannot act consistently with their values, ethical principles, and moral duties; 3) the presence of constraints, categorized at three levels: individual factors related to the nurse, patient, and patient’s family; team factors related to the team or unit involved; and system factors, including institutional and policy elements; 4) moral wrongdoing, which occurs when nurses are unable to perform the right moral action; and 5) moral suffering, with studies showing that moral distress impacts physical, emotional, and psychological well-being. Conclusion: The findings enhance the understanding of moral distress characteristics among nursing staff, highlighting the concept of the crescendo effect, which underscores the cumulative and escalating nature of unresolved moral distress, emphasizing the need to address moral conflicts proactively to prevent the erosion of moral integrity and professional satisfaction.

Ethical conflicts (ECs), dilemmas auditors face when personal values or professional obligations clash with their actions, pose significant challenges to the auditing profession, potentially influencing turnover intention (TI). This study addresses a knowledge gap in the related research by focusing on two critical EC triggers: workload (WL) and perceived auditor ethical failure (PAEF: ethical sensitivity), which refers to auditors' perceptions of ethical violations within their profession. Grounded in role theory and ethical climate theory, our study investigates the impact of WL and PAEF on ECs and explores how these conflicts mediate the relationship between PAEF/WL and TI. Additionally, we examine the moderating role of organisational ethical climate (EtC) in these relationships. Using a survey of auditors and employing partial least squares structural equation modelling (PLS-SEM), our results reveal that both WL and PAEF increase ECs, thus escalating TI. The findings suggest that a firm's perceived EtC can negatively moderate the relationship between PAEF and ECs. The study underlines the importance of fostering a strong EtC to manage ECs effectively and provides valuable implications for professionals, regulators, and academics seeking to improve ethical practices within auditing firms and to reduce auditor turnover. [ABSTRACT FROM AUTHOR]

BackgroundExisting literature on moral conflicts that healthcare professionals encounter in dementia care has explored, amongst others, issues related to autonomy, decision-making capacity, privacy, and more. Notably, conflicts related to healthcare professionals who support informal dementia caregiving and who are confronted with family members being overburdened with their care responsibly remains an underexplored topic in the current literature, particularly in the context of Low-and Middle-Income Countries. The present paper introduces such an encounter, presenting an ethical case analysis of a conflict that occurred during a larger research project conducted in North Macedonia.Case to be studiedDue to the absence of formal care services that could have relieved an overburdened family caregiver, healthcare professionals felt compelled to reach out to the uninvolved adult daughters, requesting them to participate in their parents’ care. Wondering about whether their reaching out to the daughters might count as an attempt of pressure and undue interference, professionals conflicted over the appropriateness of their action. This paper follows up on their concern, ethically assessing the professionals’ action. To answer the question on whether the healthcare professionals acted appropriately or not, and to what extent, theories of filial duties are applied, embedding their action in the larger context of dementia care in North Macedonia.Results and conclusionIt is argued that the lack of formal care services in North Macedonia is of utmost relevance to the conflict. Thus, the conclusion is that the ethical inappropriateness of the case is to be located not so much with the action of the healthcare professionals but with the state because of its failure to provide professional care services that allow healthcare professionals to take ethically sound actions to counteract overarching burdens that family members face when providing informal dementia care

BACKGROUND: Ethical conflict among nurses has a significant impact on their health and the quality of nursing care. The lack of specific ethical and legal signs and obstacles for reporting ethical conflict in nurses has made diagnosis and the management of its negative consequences difficult. This study aims to develop a valid, reliable, evidence-based instrument to assess the ethical conflict of nurses in the sociocultural and managerial context of Iran. MATERIALS AND METHODS: This is an exploratory mixed-method study that will be conducted using a sequential qualitative–quantitative design (QUAL → quan) consisting of four sequential phases to develop the instrument. In the first phase, a qualitative study (semistructured interview) will be conducted to explain nurses’ experiences and perceptions of ethical conflict. In the second phase, a literature review, along with textual content analysis, will be used. In the third phase, the items will be developed and the primary instrument will be designed based on the findings of the qualitative study and the literature review by a panel of experts. Finally, in the fourth phase, the psychometric properties of the Instrument, including validity (face, content, construct, and criterion validities) and reliability (internal consistency and stability) are evaluated. CONCLUSION: The findings of our study will enrich the description of ethical conflict in nursing and will facilitate advancing research in ethical conflict in nursing, a new but important concept in Nursing management. Thus, laying the groundwork for more targeted and effective knowledge-translation interventions in the future.

Aim: The aim of this study was to develop and psychometrically test the Ethical Conflict Scale for Nurses in Extraordinary Circumstances (ECSNEC). Design: This study is designed to develop and validate an instrument. Methods: There are four basic steps in the development process of ECSNEC: (1) establishment of the conceptual framework, (2) creation of the item pool, (3) preliminary evaluation and (4) psychometric evaluation. The data were gathered from 519 nurses who worked in two different hospitals operating in Istanbul between June 2022 and October 2022. Results: The scale had good content validity. The exploratory factor analysis revealed a three-factor construct which explained 47.31% of the total variance in the measured variable. The corresponding construct was confirmed by the confirmatory factor analysis. The Cronbach's alpha coefficients were greater than .60 for all dimensions. The test--retest reliability coefficient value of the scale was 0.90. Conclusion: ECSNEC is a valid and reliable tool to determine the ethical conflict experienced by nurses in extraordinary circumstances. Impact: The established scale allows the identification of factors influencing the ethical challenges nurses face in extraordinary circumstances. Thus, policies can be developed to prevent such ethical conflicts. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Abstract Background The critical conditions and life risk scenarios make intensive care nurses susceptible to ethical conflict. Negative consequences were recognized at both the individual level and the professional level which highly compromised the patient care and nurses’ well-being. Therefore, ethical conflict has become a major concern in nursing practice. However, the experience of coping with ethical conflict among intensive care nurses remains unclear. Aims This study aims to explore the experience of intensive care nurses coping with ethical conflict in China. Methods From December 2021 to February 2022, in- depth interviews with 15 intensive care nurses from five intensive care units in a tertiary general hospital in China was performed using purposive sampling. An inductive thematic analysis approach was used to analyze the data. We applied the consolidated criteria for reporting qualitative research for this study. Results Two distinctive themes were found: detachment and engagement, which contained four subthemes: ignoring ethical problems in the workplace, seeking ways to express emotions, perspective-taking, and identifying positive assets. Theses coping strategies demonstrated an ongoing process with different essential features. Conclusion This study provides a new insight into the experience of intensive care nurses coping with ethical conflict in clinical nursing. Intensive care nurses demonstrated differential experience of coping with ethical conflict including problem-focused, emotion-focused and meaning-making strategies. These findings have implications for policymakers and nursing administrators to develop ethical education and training and supportive environment for intensive care nurses to tackle this issue.

Oncology residents routinely engage in ethically complex decision-making discussions with patients, while observing and interacting with their teaching consultant. If clinical competency in oncology decision-making guidance is to be taught deliberately and effectively, it is necessary to understand resident experiences in this context to develop appropriate educational and faculty development initiatives. Four junior and two senior postgraduate oncology residents participated in semi-structured interviews during October and November 2021 which explored their experiences of real-world decision-making scenarios. Van Manen's phenomenology of practice was used in an interpretivist research paradigm. Transcripts were analysed to articulate essential experiential themes, and composite vocative narratives were created. Three essential themes were identified: (1) residents often endorsed different decision-making approaches than supervising consultants, (2) residents experienced inner conflict, and (3) residents struggled to find their own approach to decision-making. Residents experienced being torn between a perceived obligation to defer to consultant directives, and a desire for increasing ownership of decision-making while not feeling empowered to discuss their opinions with the consultants. Residents described their experiences around ethical position awareness during decision-making in a clinical teaching context as challenging, with experiences suggesting moral distress combined with inadequate psychological safety to address ethical conflicts and unresolved questions of decision ownership with supervisors. These results suggest the need for enhanced dialogue and more research to reduce resident distress during oncology decision-making. Future research should be aimed at discovering novel ways in which residents and consultants could interact in a unique clinical learning context including graduated autonomy, a hierarchical gradient, ethical positions, physician values, and sharing of responsibility. [ABSTRACT FROM AUTHOR]

Background: The critical conditions and life risk scenarios make intensive care nurses susceptible to ethical conflict. Negative consequences were recognized at both the individual level and the professional level which highly compromised the patient care and nurses' well-being. Therefore, ethical conflict has become a major concern in nursing practice. However, the experience of coping with ethical conflict among intensive care nurses remains unclear. Aims: This study aims to explore the experience of intensive care nurses coping with ethical conflict in China. Methods: From December 2021 to February 2022, in- depth interviews with 15 intensive care nurses from five intensive care units in a tertiary general hospital in China was performed using purposive sampling. An inductive thematic analysis approach was used to analyze the data. We applied the consolidated criteria for reporting qualitative research for this study. Results: Two distinctive themes were found: detachment and engagement, which contained four subthemes: ignoring ethical problems in the workplace, seeking ways to express emotions, perspective-taking, and identifying positive assets. Theses coping strategies demonstrated an ongoing process with different essential features. Conclusion: This study provides a new insight into the experience of intensive care nurses coping with ethical conflict in clinical nursing. Intensive care nurses demonstrated differential experience of coping with ethical conflict including problem-focused, emotion-focused and meaning-making strategies. These findings have implications for policymakers and nursing administrators to develop ethical education and training and supportive environment for intensive care nurses to tackle this issue. [ABSTRACT FROM AUTHOR]

BackgroundIn the context of the COVID-19 pandemic, health teachers who are responsible for the health of school staff and students are experiencing many ethical conflicts, and research on this is needed.ObjectiveThis study was to investigate and explore the ethical conflicts experienced by health teachers during the COVID-19 pandemic situation.MethodsThis was a qualitive study using directed content analysis applied to the four principles of biomedical ethics. Study participants were a total of 26 health teachers in Seoul, South Korea. In-depth individual interviews were conducted with 14 health teachers, and focus group interviews were conducted with the other 12 (2 teams with each 6 persons). Data were collected between May–June 2022, and analyzed using a deductive approach among the qualitative content analysis of Elo and Kyngäs. This study satisfied the four aspects of credibility, transferability, dependability, and confirmability presented by Guba and Lincoln (1989) to secure the reliability of qualitative research.ResultsThe ethical conflicts related to the four principles of biomedical ethics advocated by Beauchamp and Childress (autonomy, non-maleficence, beneficence, and justice), and the ethical conflicts in which overlap with the two principles of autonomy and non-maleficence, and the ethical conflicts related to miscellaneous matters or relationships, which were not included in the four principles, were investigated as the main 6 categories of ethical conflicts experienced by health teachers. Based on this, 10 generic categories and 17 subcategories were derived.ConclusionThis study could be used as primary data for policy development and intervention research. Such engagements can help identify ethical conflicts faced by health teachers in infectious disease crises, thus improving their ability to cope.

BackgroundPotentially inappropriate treatment in critically ill adults is associated with healthcare provider distress and burnout. Knowledge regarding perceived potentially inappropriate treatment amongst pediatric healthcare providers is limited.ObjectivesDetermine the frequency and factors associated with potentially inappropriate treatment in critically ill children as perceived by providers, and describe the factors that providers report contribute to the distress they experience when providing treatment perceived as potentially inappropriate.MethodsProspective observational mixed-methods study in a single tertiary level PICU conducted between March 2 and September 14, 2018. Patients 0–17 years inclusive with: (1) ≥1 organ system dysfunction (2) moderate to severe mental and physical disabilities, or (3) baseline dependence on medical technology were enrolled if they remained admitted to the PICU for ≥48 h, and were not medically fit for transfer/discharge. The frequency of perceived potentially inappropriate treatment was stratified into three groups based on degree of consensus (1, 2 or 3 providers) regarding the appropriateness of ongoing active treatment per enrolled patient. Distress was self-reported using a 100-point scale.ResultsOf 374 patients admitted during the study, 133 satisfied the inclusion-exclusion criteria. Eighteen patients (unanimous - 3 patients, 2 providers - 7 patients; single provider - 8 patients) were perceived as receiving potentially inappropriate treatment; unanimous consensus was associated with 100% mortality on 3-month follow up post PICU discharge. Fifty-three percent of providers experienced distress secondary to providing treatment perceived as potentially inappropriate. Qualitative thematic analysis revealed five themes regarding factors associated with provider distress: (1) suffering including a sense of causing harm, (2) conflict, (3) quality of life, (4) resource utilization, and (5) uncertainty.ConclusionsWhile treatment perceived as potentially inappropriate was infrequent, provider distress was commonly observed. By identifying specific factor(s) contributing to perceived potentially inappropriate treatment and any associated provider distress, organizations can design, implement and assess targeted interventions.

Aim and Objectives: The aim of this study was to explore the sources of ethical conflict and the decision‐making processes of ICU nurses and physicians during the first and subsequent waves of the COVID‐19 pandemic. Background: Depside several studies exploring ethical conflicts during COVID‐19 pandemic, few studies have explored in depth the perceptions and experiences of critical care professionals regarding these conflicts, the decision‐making process or which have analysed the complexity of actually implementing the recommendations of scientific societies and professional/healthcare institutions in interdisciplinary samples. Design: A descriptive phenomenological study. Methods: Thirty‐eight in‐depth interviews were conducted with critical care nurses and physicians from five hospitals in Spain and Italy between December 2020 and May 2021. A thematic content analysis of the interview transcripts was conducted by two researchers. Consolidated criteria for reporting qualitative research (COREQ) were employed to ensure the quality and transparency of this study. Results: Two main themes emerged as sources of ethical conflict: the approach to end of life in exceptional circumstances and the lack of humanisation and care resources. The former comprised two subthemes: end‐of‐life care and withholding and withdrawal of life‐sustaining treatment; the latter comprised three subthemes: the impossibility of guaranteeing the same opportunities to all, fear of contagion as a barrier to taking decisions and the need to humanise care. Conclusions: Professionals sought to take their decisions in line with professional ethics and bioethical principles, but, nevertheless, they experienced moral dilemmas and moral distress when not being able to care for, or to treat, their patients as they believed fit. Relevance to Clinical Practice: Further education and training are recommended on the provision of end‐of‐life and post‐mortem care, effective communication techniques via video calls, disclosure of bad news and bioethical models for decision‐making in highly demanding situations of uncertainty, such as those experienced during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The purpose of this paper was to clarify the concept of ethical conflict in nursing and highlight the importance of tackling this issue. Background: Ethical conflict is on the rise in the nursing context. It is associated with the compromise of nurses' well‐being and patient care. However, there is no thorough conceptual understanding of this concept. Design: Concept analysis. Methods: Databases (PubMed, PsycINFO, CINAHL, Scopus, Embase, Web of Science and SocINDEX) were searched for studies between 1984 and 2021. Both quantitative and qualitative studies related to ethical conflict in nursing were included. Walker and Avant's method of concept analysis was used to identify the defining attributes, antecedents and consequences of the concept of ethical conflict in nursing. We followed the PRISMA‐ScR checklist to report the study. Results: Thirty studies were included for conceptualization. Defining attributes were divided into four categories: (1) emotional responses, (2) incompatible values, (3) competing interests and (4) ambiguous obligations. The antecedents were (1) ethical sensitivity, (2) negative ethical climate, (3) insufficient authority, (4) unrealistic expectations, (5) poor collaboration and (6) inadequate resources. The consequences were identified as (1) moral residue, (2) loss of identity, (3) professional burnout and (4) poor patient care. Conclusions: A unified conceptual model of ethical conflict in nursing shed light on the ethical issues nurses might come across in practice. Despite the fact that ethical conflict is inherently negative, we conceptualised this concept as a neutral fact and an opportunity for nursing action. The construct identification provides basis for both the development of practice and the development of staff support and education. Relevance to Clinical Practice: A clearer understanding of such an important facet of nursing practice helps nurses raise awareness of ethical conflict and implement effective coping strategies to improve their well‐being and patient care. No Patient or Public Contribution: This is a review article conducted by the researchers, so there is no patient or public contribution. [ABSTRACT FROM AUTHOR]

Since the 1960s, it has been recognized that "medical ethics," the area of inquiry about the obligations of practitioners of medicine, is inadequate for capturing and addressing the complexities associated with modern medicine, human health, and wellbeing. Subsequently, a new specialty emerged which involved scholars and professionals from a variety of disciplines who had an interest in healthcare ethics. The name adopted is variously biomedical ethics or bioethics. The practice of bioethics in clinical settings is clinical ethics and its primary aim is to resolve patient care issues and conflicts. Nurses are among these clinical ethicists. They are drawn to the study and practice of bioethics and its applications as way to address the problems encountered in practice. A significant number are among the ranks of clinical ethicists. However, in the role of bio- or clinical ethicist, some retained the title of their original profession, calling themselves nurse ethicists, and some did not. In this article, we explore under which conditions it is permissible or preferable that one retains one's prior profession's nomenclature as a prefix to "ethicist," under which conditions it is not, and why. We emphasize the need for transparency of purpose related to titles and their possible influence on individual and social good. [ABSTRACT FROM AUTHOR]

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Copyright of Interdisciplinary Studies of Literature is the property of Interdisciplinary Studies of Literature Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Veterinary professionals are often confronted with moral conflicts from which moral distress can develop. Moral distress can lead to a cascade of deleterious processes and outcomes including emotional anguish, distress, reduced patient care, and attrition from both the workplace and workforce. The current study established a pilot measure for moral distress in Australian veterinary clinicians, as well as reporting additional sources of moral and ethical conflicts in veterinary practice. The pilot scale was based on adapting the Measure of Moral Distress for Healthcare Professionals (MMD-HP) to the veterinary context and analysing responses from 643 veterinarians in Australia to create the Measure of Moral Distress for Veterinary Clinicians (MMD-VC). The MMD-VC comprised three sub-scales: (1) team communications that compromise patient care, (2) conflicting client interactions and (3) situations perceived as a personal threat. The additional sources of moral and ethical conflict that were reported by respondents to an open-ended survey question reflected two themes: (1) Animal Health, where the conflict arises from the effect of a situation on the animal patient and (2) Human Interactions, where the conflict relates to interpersonal relationships rather than to the animal patient. The results contribute towards developing comprehensive measures of moral and ethical conflict in clinical practice, and these measures can inform and evaluate intervention strategies designed to mitigate the harmful effects of moral distress in veterinarians., (© 2025 Australian Veterinary Association.)

Aims: To explore the relationships of ethical climate, physician–nurse collaboration and psychological empowerment with ethical conflict in critical care nurses. Background: Ethical conflict is a major ethical issue in nursing practice. Little research has been done on the associated factors from both organizational and personal perspectives, especially in China. Methods: From October 2021 to March 2022, we collected the data from 342 critical care nurses in three tertiary general hospitals in China via questionnaires about four variables (ethical climate, physician–nurse collaboration, psychological empowerment and ethical conflict). Data were analysed using Spearman's correlation and a structural equation model through statistical product and service solutions (SPSS) and analysis of moment structure (AMOS). Results: Critical care nurses' ethical conflict showed a negative correlation with ethical climate (r = −0.351), physician–nurse collaboration (r = −0.347) and psychological empowerment (r = −0.259) (all p < 0.001). Physician–nurse collaboration partially mediated the relationship between ethical climate and ethical conflict. Additionally, physician–nurse collaboration and psychological empowerment served as sequential mediators in the association. Conclusions: These findings suggested that negative ethical climate can lead to poor physician–nurse collaboration and ultimately ethical conflict. The intermediary role of psychological empowerment and physician–nurse collaboration was also identified. Implications for Nursing Management: Nursing managers should use the study as a fundamental basis to evaluate factors that can affect nurses' ethical conflict and develop effective strategies to mitigate this issue, which may help improve nurses' wellbeing and quality of patient care. [ABSTRACT FROM AUTHOR]

Approximately 3% of all pregnancies are affected by fetal anomalies; consequently, mothers face the difficult decision of whether to continue or terminate their pregnancy. An estimated 47% – 90% of women choose to terminate these pregnancies. Induction of labor in cases of fetal demise is thought of as less controversial than induction termination, but nurses may resist and even refuse to care for women in these cases.

Abstract Background Ethical conflicts are common in the critical care setting, and have compromised job satisfaction and nursing care quality. Using reliable and valid instruments to measure the ethical conflict is essential. This study aimed to translate the Ethical Conflict in Nursing Questionnaire — Critical Care Version into Chinese and determine the reliability and validity in the population of Chinese nurses. Methods Researchers obtained permission and followed the translation-backward method to develop the Chinese version of the Ethical Conflict in Nursing Questionnaire — Critical Care Version (ECNQ-CCV-C). Relevant psychometric properties were selected according to the Consensus-based standards for the selection of health status measurement instruments checklist. Critical care nurses were recruited from two tertiary public hospitals in Hangzhou, Zhejiang Province, and Kunming, Yunnan Province. Of the 264 nurses we approached, 248 gave their consent and completed the study. Results The ECNQ-CCV-C achieved Cronbach’s alphas 0.902 and McDonald’s omega coefficient 0.903. The test-retest reliability was satisfactory within a 2-week interval (intraclass correlation coefficient = 0.757). A unidimensional structure of the ECNQ-CCV-C was determined. Confirmatory factor analysis supported acceptable structure validity. Concurrent validity was confirmed by a moderate relation with a measure for hospital ethical climate (r = − 0.33, p

Purpose: Drawing on social exchange theory (SET), this study explores the mediating role of quiescent silence as a link between organizational stressors and turnover intentions among Russian frontline employees (FLEs). Furthermore, we aim to investigate whether coworker support moderates the relationship between quiescent silence and turnover intentions.

Background: Moral courage is defined as the courage to act in ethical conflicts based on individual or professional values despite the personal risks involved. Nurses justify their decisions to act morally courageously as part of their ethical decision-making. Objective: To describe registered nurses’ justifications for acting morally courageously, or not, in ethical conflicts where they needed moral courage. Research design: A narrative inquiry with a holistic content approach was used. Individual, in-depth interviews were conducted in January–February 2023. The data were analysed using holistic content analysis. Participants and research context: Fourteen registered nurses with experience in situations where they needed moral courage participated. The nurses came from the somatic, palliative, mental health, and substance abuse care fields in Finland. Ethical considerations: Good scientific practice was followed. Ethical approval was obtained before data collection from the university’s ethics committee. Findings: The nurses needed moral courage in ethical conflicts with patients present and between professionals. Individual responsibility, professional ethics, and emotions were identified as bases of nurses’ justifications for morally courageous acts. The justifications for acting morally courageously, or not, had individual, contextual, and organisational perspectives. Morally courageous acts included starting a discussion about the conflict with other professionals and reporting the situation in writing within one’s organisation. Discussion and conclusions: The identified bases and perspectives of justifications illustrate the complexity of nurses’ decision-making in ethical conflicts, either leading to morally courageous acts or not. These results can inform nursing practice and research in developing processes to strengthen nurses’ moral courage and examining relationships between moral courage and other concepts, such as moral resilience. [ABSTRACT FROM AUTHOR]

Due to the unique nature of the neonatal intensive care unit (NICU) and its moral distress, this study aimed to investigate moral distress in the NICU. This cross-sectional study was conducted on 234 physicians and nurses working in the neonatal wards of eight hospitals. The Corley’s Moral Distress Scale was used to collect data. Findings showed that 25 of the participants were physicians and 209 were nurses. The intensity and frequency of distress among physicians and nurses were assessed as moderate. The mean intensity and frequency of moral distress among nurses and physicians were 48.3%, 41.5% and 46.46%, 15.62% respectively. The results showed that the mean intensity and frequency of distress were higher, however not significantly, among nurses. The intensity and frequency of moral distress had a statistically significant and direct correlation with the intention to leave and the number of staff in each working shift among the nurses. Moral distress in the NICU practitioners was moderate, so addressing this issue and trying to alleviate it was important. Identifying the causes behind moral distress can help adopt appropriate measures to prevent and reduce them. [ABSTRACT FROM AUTHOR]

Due to the unique nature of the neonatal intensive care unit (NICU) and its moral distress, this study aimed to investigate moral distress in the NICU. This cross-sectional study was conducted on 234 physicians and nurses working in the neonatal wards of eight hospitals. The Corley’s Moral Distress Scale was used to collect data. Findings showed that 25 of the participants were physicians and 209 were nurses. The intensity and frequency of distress among physicians and nurses were assessed as moderate. The mean intensity and frequency of moral distress among nurses and physicians were 48.3%, 41.5% and 46.46%, 15.62% respectively. The results showed that the mean intensity and frequency of distress were higher, however not significantly, among nurses. The intensity and frequency of moral distress had a statistically significant and direct correlation with the intention to leave and the number of staff in each working shift among the nurses. Moral distress in the NICU practitioners was moderate, so addressing this issue and trying to alleviate it was important. Identifying the causes behind moral distress can help adopt appropriate measures to prevent and reduce them.

This research explores the ethical judgment process encountered regarding the conflict of interests between companies and employees in workplace counseling services. We interviewed with an in-depth method and established qualitative data analysis by utilizing the purpose sampling method. The qualification of participants all have counseling psychologist licenses and more than two years of workplace counseling experience. They also had experiences of encountering ethical judgments issues due to conflicts of interest between the company and employees. In this study, we selected five counseling psychologists for personal in-depth interviews. Template analysis was used for data analysis. We found that different types of conflict of interests between companies and employees could involve workplace counseling, and would experience conflict judgment and influenced various stages: Initially at the first stage which is identified as the conflict stage. These psychologists would encounter: (1) The conflict between the company's productivity and the needs of employees' mental health; (2) The conflict between the company's management and the rights of employees; (3) The conflict between the company's labor needs and the needs of employees' career development; (4) Company performance regarding the conflict between management and employees' job security; (5) The conflict between the protection of corporate interests and the protection of employees' rights. The subsequent stage, which is identified as the judgment stage, will consider three aspects. First of all, judging whether the rights and interests of employees have been jeopardized; second of all, judging whether the interests of the enterprise have been compromised. Finally, it is about the judgment regarding relevant labor laws and regulations. At this stage, there are three ways of managing different matters. First, enterprises consider labor costs and refer to external resources, then make good use of informed consent; and finally, is to seek expert consultation and refer to industry practices. At the last stage, which refers to the impact phase, these psychologists would assist and find adaptation methods through the support system via four steps: (1) to establish a relationship and obtain approval from the organization or supervisor; (2) to adjust role functions regarding multi-role burden; (3) to take into accounts the voices or needs of dual customers; and the last, to expand the organization view or system view. Managing the ethical judgment process of the conflict of interest between the enterprise and its employees, making decisions based on the dual-axis concept of enterprise system and employee welfare is necessary. Psychologists must understand the system perspective and change their perspectives from a single situation to dual situations. In summary, the ethical judgment process that encounters the conflict of interest between the company and its employees in corporate consulting indeed may experience a process of conflict, consideration, action, result, influence, and adjustment. This study at the end proposed recommendation as followed: (1) Suggestions to workplace counselors: Facing the context of the dual clients of organization and employees, workplace counselors need more knowledge in addition to the professional education of "counselors" or theoretical knowledge of psychology, as well as business management human resources, labor laws, and EAPs. And other related professional knowledge. (2) Suggestions for training institutions for counselors: The training institution for counselors should offer courses on workplace counseling and EAPs to enhance learners' understanding of the workplace environment. In the curriculum planning, adding the theme of workplace organizational culture, value system, management system, and workplace counseling ethics can enhance the ability to respond to and judge the conflicts of workplace counseling ethics. A more comprehensive review of the ethical conflicts in workplace counseling presented by different industries and members of different organizations. (3) Suggestions for future research: Future research may consider including male counselors and different industry categories. In addition to counselors, research objects may include workplace employees and their organization's supervisors. [ABSTRACT FROM AUTHOR]

This study aims to investigate impact of moral hazing on knowledge hiding over mediating role of ethical conflict. In this regard, data has been collected from academic institute of Punjab province through cross sectional research design and non-probability convenience sampling technique was used. This study used 400 questionnaires were distributed among participants and out of which 250 were received back. After disposal partially filled and incomplete questionnaires, two hundred and thirty-one were left. These have been used for data analysis purpose. Data was analyzed over descriptive and inferential statistics. Demographic features were analyzed through descriptive statistics while inferential statistics has been used to draw inference over correlation and regression. Results shows that the moral hazing increases knowledge hiding. Similarly ethical conflict increases chances of knowledge hiding. Moreover, ethical conflict is predicted by moral hazing. Moreover, it has been proved that ethical conflict mediates the relationship of moral hazing and knowledge hiding. From practical perspective this study will provide guidelines to the practitioners regarding role of hazing in predicting knowledge hiding. Also, this study will help to devise the policies to control knowledge hiding within the academia. [ABSTRACT FROM AUTHOR]

Background: Ethical conflicts are common in the critical care setting, and have compromised job satisfaction and nursing care quality. Using reliable and valid instruments to measure the ethical conflict is essential. This study aimed to translate the Ethical Conflict in Nursing Questionnaire — Critical Care Version into Chinese and determine the reliability and validity in the population of Chinese nurses. Methods: Researchers obtained permission and followed the translation-backward method to develop the Chinese version of the Ethical Conflict in Nursing Questionnaire — Critical Care Version (ECNQ-CCV-C). Relevant psychometric properties were selected according to the Consensus-based standards for the selection of health status measurement instruments checklist. Critical care nurses were recruited from two tertiary public hospitals in Hangzhou, Zhejiang Province, and Kunming, Yunnan Province. Of the 264 nurses we approached, 248 gave their consent and completed the study. Results: The ECNQ-CCV-C achieved Cronbach's alphas 0.902 and McDonald's omega coefficient 0.903. The test-retest reliability was satisfactory within a 2-week interval (intraclass correlation coefficient = 0.757). A unidimensional structure of the ECNQ-CCV-C was determined. Confirmatory factor analysis supported acceptable structure validity. Concurrent validity was confirmed by a moderate relation with a measure for hospital ethical climate (r = − 0.33, p < 0.01). The model structure was invariant across different gender groups, with no floor/ceiling effect. Conclusions: The ECNQ-CCV-C demonstrated acceptable reliability and validity among Chinese nurses and had great clinical utility in critical care nursing. [ABSTRACT FROM AUTHOR]

Aim: To identify factors underlying ethical conflict occurring during the current COVID‐19 pandemic in the critical care setting. Background: During the first wave of the COVID‐19 outbreak, Spanish and Italian intensive care units were overwhelmed by the demand for admissions. This fact revealed a crucial problem of shortage of health resources and rendered that decision‐making was highly complex. Sources of evidence: Applying a nominal group technique this manuscript identifies a series of factors that may have played a role in the emergence of the ethical conflicts in critical care units during the COVID‐19 pandemic, considering ethical principles and responsibilities included in the International Council of Nurses Code of Ethics. The five factors identified were the availability of resources; the protection of healthcare workers; the circumstances surrounding decision‐making, end‐of‐life care, and communication. Discussion: The impact of COVID‐19 on health care will be long‐lasting and nurses are playing a central role in overcoming this crisis. Identifying these five factors and the conflicts that have arisen during the COVID‐19 pandemic can help to guide future policies and research. Conclusions: Understanding these five factors and recognizing the conflicts, they may create can help to focus our efforts on minimizing the impact of the ethical consequences of a crisis of this magnitude and on developing new plans and guidelines for future pandemics. Implications for nursing practice and policy: Learning more about these factors can help nurses, other health professionals, and policymakers to focus their efforts on minimizing the impact of the ethical consequences of a crisis of this scale. This will enable changes in organizational policies, improvement in clinical competencies, and development of the scope of practice. [ABSTRACT FROM AUTHOR]

Background: A growing body of evidence about nurses' ethical conflicts has been added to nursing science in recent decades, but no research has been done in Estonia. Ethical conflicts are a cultural and context sensitive phenomenon, so the historical, legal, social, economic and political backgrounds and position of nursing have had an impact on ethical conflict experiences. Aim: Describe nurses' experiences of ethical conflicts. Method: A qualitative, descriptive study was conducted among nurses (n = 21) in May-October 2018 in Estonia. The data were collected in the form of semi-structured individual interviews and analysed using the inductive content analysis method. Ethical considerations: Due to the sensitive nature of the research topic, only individual interviews were carried out. Findings: Nurses' ethical conflicts were related to situations that violated the rights, safety or well-being of the patient or relatives, caused them suffering, were against their will or threatened nurses' dignity and professionalism through a variety of practices, attitudes and relationships. The insufficiency of patient care and professional collaboration emerged as important sources of nurses' ethical conflicts and were connected to historical and societal factors. Conclusions: In order to achieve good quality of care, nurses need to have appropriate education and organisational support to carry out ethical daily care. More research is needed to understand the multidimensional cultural and contextual knowledge of ethics and nurses' ethical conflicts. [ABSTRACT FROM AUTHOR]

Background: Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit (ICU). There is a gap in our understanding of nurses' perceptions of how organizational resources support them in addressing ethical conflict in the intensive care unit. Research question/objectives/methods: The aim of this qualitative, descriptive study was to explore how nurses experience ethical conflict and use organizational resources to support them as they address ethical conflict in their practice. Participants and research context: Responses to two open-ended questions were collected from critical care nurses working in five intensive care units at a large, academic medical center in the Midwestern region of the United States. Ethical considerations: This study was approved by the Institutional Review Board at the organization where the study took place. Findings: Three main interwoven themes emerged: nurses perceive (1) intensive care unit culture, practices, and organizational priorities contribute to patient suffering ; (2) nurses are marginalized during ethical conflict in the intensive care unit ; and (3) organizational resources have the potential to reduce nurse moral distress. Nurses identified ethics education, interprofessional dialogue, and greater involvement of nurses as important strategies to improve the management of ethical conflict. Discussion: Ethical conflict related to healthcare system challenges is intrinsic in the daily practice of critical care nurses. Nurses want to be engaged in discussions about their perspectives on ethical conflict and play an active role in addressing ethical conflict in their practice. Organizational resources that support nurses are vital to the resolution of ethical conflict. Conclusion: These findings can inform the development of interventions that aim to proactively and comprehensively address ethical conflict in the intensive care unit to reduce nurse moral distress and improve the delivery of patient and family care. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to examine the frequency of ethical conflicts amongst social workers, deriving from dual obligations to clients and employers, as associated with their organisational affiliation and professional seniority. The sample included 723 social workers from three organisational sectors in Israel: the government sector, the third sector and the for-profit sector. Two-way analysis of variance (ANOVA) was conducted to examine the main and interaction effects of organisational affiliation and seniority on the frequency of ethical conflicts amongst social workers. Social workers in the for-profit and third sectors experienced a significantly higher frequency of ethical conflicts than those in the government sector. In addition, social workers with moderate seniority were found to experience ethical conflicts more frequently than those with low and high seniority. These findings have an important contribution to the ongoing public debate on the privatisation of social services, by pointing to the difficulties encountered by social workers employed in partially privatised social services in meeting their obligations to clients. Better public monitoring and adequate supervision of social workers are recommended. In addition, it is suggested that partial privatisation processes be reconsidered in the case of vulnerable populations. [ABSTRACT FROM AUTHOR]

Introduction: Ethical conflict is a phenomenon that has been under study over the last three decades, especially the types moral dilemma and moral distress in the field of nursing care. However, ethical problems and their idiosyncrasies need to be further explored. Aim: The objectives of this study were, first, to obtain a transcultural Portuguese-language adaptation and validation of the Ethical Conflict Nursing Questionnaire–Critical Care Version and, second, to analyse Portuguese critical care nurses' level of exposure to ethical conflict and its characteristics. Methods: A cross-cultural validation and descriptive, prospective and correlational study. The sample was made for 184 critical care nurses in 2016. Ethical Considerations: The study was authorised by Bioethics Commission of the University of Barcelona, the Associaçâo de Apoio ao Serviço de Cuidados Intensivos do Centro Hospitalar do Porto and the Sociedade Portuguesa de Enfermagem de Saúde Mental. Findings: The Portuguese version of the Ethical Conflict Nursing Questionnaire–Critical Care Version was a valid and reliable instrument to measure exposure to conflict. Moral outrage was the most common type of conflict. The most problematic situations were the ineffectiveness of analgesic treatments, the administration of treatments considered futile and the mismanagement of resources. [ABSTRACT FROM AUTHOR]

Introduction: Ethical conflict is one of ICU nurses’ main problems, which rise for several reasons that must be measured. Unfortunately, there is no native instrument for measuring ethical conflicts for ICU nurses in Iran. One of the more suitable and new tools for the measurement of ethical conflict is called the “Ethical Conflict in Nursing Questionnaire: Critical Care Version (ECCNQ-CCV).” This study was aimed to translate and investigate psychometric properties of the ECCNQ-CCV in Iranian nurses. Methods: In this methodological study, after translation and cultural adaptation, face validity, content validity, and construct validity were assessed. Then, internal consistency and stability were measured for reliability. Two software programs (SPSS version 20 and AMOS) were used for data analysis. Result: Face and content validities were acceptable. Confirmatory factor analysis was not fitted. Thus, exploratory factor analysis was done, which showed five factors. However, some of the scenarios in a factor were not compatible with each other, and choosing the fit name for factors was not possible. Thus, all the scenarios were put into one factor, which has been proposed by the developer in the original version. The alpha Cronbach was 0.92 for the total scale. Conclusions: Findings show that the one factor Persian version of the ECNQ-CCV has acceptable psychometric properties. It can be used to evaluate ethical conflicts in Iranian ICU nurses.

Background: Frequent exposure to ethical conflict and a perceived lack of organizational support to address ethical conflict may negatively influence nursing family care in the intensive care unit. Research aims: The specific aims of this study were to determine: (1) if intensive care unit climate of care variables (ethical conflict, organizational resources for ethical conflict, and nurse burnout) were predictive of nursing family care and family wellbeing and (2) direct and indirect effects of the climate of care on the quality of nursing family care and family wellbeing. Research design: A cross-sectional, correlational design was used. Participants and research context: Convenience sample of 111 nurses and 44 family members from five intensive care units at a Midwest hospital in the United States. Instruments: The Ethical Conflict Questionnaire-Critical Care Version, Maslach Burnout Inventory-Human Services Survey and Hospital Ethical Climate Scale were used to measure climate of care. The Family-Centered Care-Adult Version and Nurse Provided Family Social Support Scale were family measures of the quality of nursing family care. The Family Wellbeing Index was used to measure family wellbeing. Data analysis: Hierarchical regression and mediation analysis were used to answer the study aims. Ethical considerations: The study was approved by the Institutional Review Board at the study site. Findings: In separate regression models, organizational resources for ethical conflict (β =.401, p =.006) and depersonalization (β = −.511, p =.006), a component of burnout, were significant predictors of family-centered care. In simple mediation analysis the relationship between organizational resources for ethical conflict and family-centered care was mediated by depersonalization (β =.341, 95% confidence interval (.015,.707)). Discussion: Inadequate organizational resources and depersonalization may be related to family care delivery, and present obstacles to family-centered care in the intensive care unit. Conclusion: Further research to explicate the relationships among organizational resources, ethical conflict, burnout, and family-centered care is needed to guide the development of effective interventions that enhance the quality of nursing family care in the intensive care unit. [ABSTRACT FROM AUTHOR]