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. (shrink)

The allocation of healthcare resources takes place at two distinct levels. At the macroeconomic level, policymakers decide on budgets, staffing, cost‐effectiveness thresholds, clinical guidelines and insurance payments; at the microeconomic level, healthcare professionals decide on whom to treat, what the appropriate treatment is, how much time and effort should each patient receive and how urgent the need for care is. At both levels, there is a constant social need for just allocation. Policymakers are mostly guided by abstract principles of justice, (...) thinking in terms of groups of patients, epidemiological data, impersonal statistics and economic costs. On the other hand, healthcare professionals understand the need for justice at a more personal level, as they interact with patients and, in a sense, put theory into practice. Nurses hold a unique position in healthcare systems, as, traditionally, they are closer to patients than other health professionals. This means that they have a firsthand view of the effect that their decisions have on specific patients and, therefore, nurses tend to get more influenced by their personal feelings, values and beliefs at the microeconomic level. This presentation shall examine the gap between abstract macroeconomic and concrete microeconomic health resources allocation decisions, with a particular emphasis on the role of the nurse. (shrink)

The concept of equality is subject to many different interpretations, and it is closely connected to similar concepts such as equity, justice, fairness, and human rights. As an ideal, equality entails many aspects that are untenable. For instance, genetic and social inequalities may never be extinct, but they can both be ameliorated by proper distribution of society's resources. Likewise, within the context of health care, equality can be promoted by proper rationing of health resources, amongst which nursing care stands out. (...) In the field of nursing, the principle of equality presents itself in various forms of ethical and deontological mandates. However, beyond good intentions and abstract notions, there is a need to examine the ways in which nurses enforce this principle in practice, within the reality of modern health systems. Although there is scarcity of qualitative evidence in the nursing care rationing literature, existing studies suggest that fair treatment pertains to a largely intuitive sense of equality which involves subjective perceptions and judgements about rationing. Nurses’ initial predisposition is to view all patients as equal and treat them in an equal manner; yet, on an individual basis, each patient has a different starting point, different needs and different prospects that render rationing decisions complex and uncertain. Equality should be accepted with its unavoidable limitations in practice and be further examined within the context of nursing care rationing, in the hope that it can be advanced in a consistent way, despite the idealistic nature in many of its aspects. (shrink)

Background Ensuring morally competent nurses depends on many factors, such as environmental, social, political, and cultural. However, several inadequacies in nursing education have been documented, and no common framework has been established for how nursing ethics should be taught in undergraduate education. Research questions What are the different approaches across nursing programmes established in teaching ethics? What are the main similarities and differences across programmes facilitating a common understanding in developing a curriculum capable of preparing a morally competent nurse? Research (...) design International comparative education study in five steps: (1) formulating the initial question; (2) defining the units of comparison; (3) determining the variables of comparison; (4) describing the findings; (5) interpreting the findings. The comparative variables were identified, extracted, and populated in a piloted grid. Participants Six universities were purposefully selected by the Promoting a Morally Competent Nurse project partners for their nursing education curricula as delivered in 2022–2023. Ethical considerations No ethical approval was required, given no human participants and public data regarding nursing curricula. Findings Variability emerged in the terminologies used in naming the courses, the numbers of credits and hours devoted to teaching ethics, when the courses are delivered (since the initial semesters of nursing education or concentrated in the final years), and their main modes of delivery (a single or separate module or integrated across the curriculum). Contents have some similarities, whereas the teaching methods varied and included (or not) explicit connections with clinical practice. Attendance is mandatory in all courses. The assessment methods used varied from knowledge-based to more competence-based approaches involving multidimensional strategies. Conclusions This comparative study explored similarities and differences across nursing programmes in six different European countries. The reviewed ethics curricula lack significant clarity, and they offer important areas to consider for future development. Issues emerged regarding terminologies, learning workloads, when to deliver, how to deliver, the main contents, and the teaching and assessment methods that merit further discussion. (shrink)

Background Ethics is a fundamental component of nursing education to increase students’ moral competence and moral reasoning abilities. However, the core ethics content that should be included in undergraduate education has not been established to date at the international level. Aim To identify the core contents required in formal undergraduate education to ensure morally competent nurses. Research Design An international workshop-research study design in 2023 reported here according to the COnsolidated criteria for REporting Qualitative research. Participants and Research Context Five (...) countries in the context of Promoting a Morally Competent Nurse project participated. In each country, two workshops took place, one with nurse professionals and one with patients’ representatives for a total of 58 individuals (32 and 26, respectively). After being translated into English language, data were categorized deductively. The Dublin Learning Outcomes Descriptors and the blueprint methodology were applied. Ethical Considerations The research protocol was ethically approved in every country where the study was performed. Results A total of 59 core content elements emerged, with ‘ethics of individualized/tailored/patient-centred care’ ( n = 8) and ‘empathy’ ( n = 6) as the most suggested. Nearly half ( n = 26) of the core content items suggested were reported only once (e.g. ‘priority setting’) while overall several referred to ‘communication skills’ ( n = 17). A diverse richness across countries emerged, with some suggesting a few items, and others providing several. Similarly, professionals and patients in most countries agreed that some contents of individualized care, empathy and responsibility should be taught in nursing education, but several core contents were mentioned by only one group of participants and in one country. Conclusion The lack of convergence on core content to be taught suggests that different views are still present. Merging these perspectives may stimulate a reciprocal understanding between professionals and patients, as well as across countries, and support the identification of commonalities and differences to further harmonize undergraduate education in the field. (shrink)

Background: The relationship between moral resilience, moral distress, and moral injury among nurses during the COVID-19 pandemic has been widely investigated; however, the literature in the post-COVID-19 era is scarce. Research aim: To examine the impact of moral resilience on moral distress and moral injury among nurses after the COVID-19 pandemic. Research design: Cross-sectional study. Participants and research context: We obtained a convenience sample of 1118 nurses in Greece. We collected demographic data (gender, age) and work-related data (understaffed wards, shift (...) work, clinical experience). We measured moral resilience with the revised “Rushton Moral Resilience Scale”, moral distress with the “Moral Distress Thermometer”, and moral injury with the “Moral Injury Symptom Scale-Healthcare Professionals” version. We adjusted all multivariable models for demographic variables. Ethical considerations: The Ethics Committee of the Faculty of Nursing, National and Kapodistrian University of Athens approved our study protocol (approval number; 474, approved: November 2023). Our study followed the Declaration of Helsinki. Findings/results: Multivariable linear regression analysis showed that moral resilience reduced moral distress and moral injury. In particular, we found that increased response to moral adversity was associated with decreased moral distress (adjusted coefficient beta = −1.81, 95% confidence interval [CI] = −2.07 to −1.54). Moreover, we found that increased response to moral adversity (adjusted coefficient beta = −8.24, 95% CI = −9.37 to −7.10) and increased moral efficacy (adjusted coefficient beta = −3.24, 95% CI = −5.03 to −1.45) were associated with reduced moral injury. Conclusions: Moral resilience can reduce the level of moral distress and moral injury among nurses. However, the persistence of moderate moral resilience among Greek nurses does not guarantee its sustainability. To ensure that this resilience is maintained and potentially enhanced, it is imperative for nurse leaders and policymakers to strategically design interventions to address issues at the organizational, team, and individual levels. (shrink)