Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare (...) context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration. (shrink)

Background:The decision-making process should be done according to a set of rules and principles so as to be fairly understood.Objectives:The aim of this study was to identify the basic principles and rules used by nurses to understand justice in nurse managers’ decision-making processes based on a procedural justice model.Research design and participants:This research was a qualitative study based on directed content analysis, which was performed on a group of 15 nurses working in different hospitals in Tehran, Iran. An in-depth semi-structured (...) interview was used as the method of data collection for this study.Ethical consideration:This research has been approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences. The respondents were informed about the aim of the study, about voluntary participation, anonymity and confidentiality.Findings:The results of this study showed that in order to understand procedural justice, nurses use several rules, including: duties organization, managerial support, consistency, bias-suppression, accuracy, correctability, representativeness, and ethicality.Conclusion:Nursing leaders must consider the importance of justice rules as one of many strategies to ensure the nurses’ perception of fairness in decision-making processes. (shrink)

Background Managerial ethical principles and behaviours guide the roles, duties, responsibilities, behaviours, and relationships of nurse managers in healthcare institutions. Research objectives The aim of this study was to establish the managerial ethical principles and behaviours for nurse managers. Research question What are the managerial ethical principles and behaviours for nurse managers? Research design The Delphi method, one of the qualitative research methods, was used in this study. The Delphi process consisted of two rounds. Data were collected by e-Delphi technique. (...) Participations 42 experts were included in the first Delphi round and 39 in the second Delphi round. These experts consisted of nurse managers, academicians studying in the field of ethics and nursing management. Ethical considerations Participation in the study was voluntary and informed consent of the experts was obtained before the study. Approval was obtained from the ethics committee of the university at which the researcher worked (Approval date: 24.07.2020, Decision No: 2020/12-16). Findings At the end of the Delphi rounds, eight managerial ethical principles and 29 ethical behaviours of these principles were identified. The distribution of these behaviours and principles were: justice (six behaviours), equality (two behaviours), honesty (two behaviours), fairness (two behaviours), responsibility (eight behaviours), confidentiality (two behaviours), clarity (two behaviours), and humanity (five behaviours). Conclusion These managerial ethical principles and behaviours are intended to guide nurse managers when providing nursing services but should be updated accordingly in line with changing conditions and developments. (shrink)