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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. [ABSTRACT FROM AUTHOR]

Aim Background Methods Results Conclusion Implications for nursing and health policy To describe how nurses’ moral competence can be supported from the perspective of nurses, nurse managers, researchers, educators, and nursing students.Moral competence is the capacity or ability of nurses to recognise one's own emotions of what is right or wrong, to reflect on these emotions, to make decisions, and to act in ways that bring the highest level of benefit to patients. Moral competence is part of professional competence. However, little is known about how nurses’ moral competence can be supported.A qualitative descriptive study design was applied. Stratified purposive sampling was employed and focus group discussions were conducted in Belgium, Cyprus, Finland, Greece, Ireland, and Italy in 2023. A total of 38 informants (5–8 per focus group) who were registered nurses or nursing students participated. The data were analysed using both deductive and inductive content analysis. The COnsolidated criteria for REporting Qualitative research were adhered to.Seven themes were developed following analysis, which suggested that support for nurses’ moral competence can be located at individual‐relational, organisational, and societal levels. Several approaches and/or tools were also identified to support moral competence.Nurses’ moral competence could benefit from continuous support from colleagues, those in leadership positions, organisations and society. Practical tools and approaches can also successfully support nurses’ moral competence.Support for nurses’ moral competence forms a continuum from the beginning of nursing studies throughout nursing careers. Thus, educational interventions and training programmes are needed both at basic and continuous ethics education. There is also a need for investments in and development of strategies and regulations on ethics management in health systems, national‐ and international‐level ethics indicators for health policy‐making, and implementation of existing practices, interventions, and procedures in nursing practice. [ABSTRACT FROM AUTHOR]

Background: Whistleblowing is recognised as part of solving wrongdoing. It requires individual reasoning as it is a potentially complicated process with a risk of possible negative consequences for oneself. Knowledge on how individuals reason for whistleblowing in healthcare context is lacking. Aim: This study aimed to create a theoretical construct to describe individual reasoning for whistleblowing. Methods: The methodology was grounded theory, with 244 nurses as informants. The data consisted of nurses' written narratives in response to a wrongdoing situation presented in a video vignette. To ensure the heterogeneity of the population and variation in nurses' professional expertise, experiences and geographical locations in health care to capture the multidimensionality of the responses, nurses were invited to participate, and data were collected electronically from the membership register of the Finnish Nurses' Association on a national level. Constant comparison was used to analyse the open data. Results: The core category of the theoretical construct, 'The formation of morally courageous intervening', was discovered, reflecting individual's values and beliefs. It forms mentally as an integration of cognition and emotion for recognising one's own strengths and limits to act to do the right thing despite the risk of negative consequences for oneself. The core category consists of three dimensions of reasoning: (1) Reasoning Actors, (2) Reasoning Justifications and (3) Reasoning Activities, their categories and three patterns of reasoning connecting the dimensions and their categories with each other: (I) Individual Reasoning, (II) Collaborative Reasoning and (III) Collective Reasoning. Discussion and conclusion: The theoretical construct indicate that reasoning is a multidimensional phenomenon. In future, a theoretical construct could be further developed. In health care, managers could use the theoretical construct to support employees in their whistleblowing. [ABSTRACT FROM AUTHOR]