ABSTRACT Aim To examine moral distress and associated factors among nurses involved in hospice care in China and explore how these experiences are shaped across individual, relational, organisational and sociocultural contexts. Background Hospice nurses frequently encounter ethically challenging situations. In China, moral distress may be further shaped by organisational constraints, family‐centred decision‐making and sociocultural expectations surrounding end‐of‐life care. Methods A convergent parallel mixed‐methods design was used and reported in accordance with the Good Reporting of a Mixed‐Methods Study (GRAMMS) guidelines. Quantitative data were collected from 295 nurses using measures of moral distress, moral resilience, work–family conflict and hospital ethical climate. Semi‐structured interviews were conducted with 15 nurses purposively selected from the quantitative sample. The datasets were analysed separately and integrated during interpretation. Findings Moral distress was associated with factors across individual, relational and organisational contexts. Greater moral resilience and a more supportive ethical climate were associated with lower moral distress, whereas greater work–family conflict was associated with higher moral distress. Qualitative findings complemented these associations by highlighting how nurses described ethically challenging care in relation to sociocultural expectations surrounding life preservation and family‐led decision‐making. Discussion The integrated findings suggest that moral distress is best understood within overlapping individual, relational, organisational and sociocultural contexts rather than through any single factor in isolation. Conclusion Supporting hospice nurses experiencing moral distress may require multilevel support addressing resilience‐related resources, work–family needs, organisational ethical support and culturally responsive care. Implications for Nursing and Health Policy Support should extend beyond individual resilience‐building to include family‐supportive work arrangements, accessible organisational ethics resources and culturally responsive approaches to end‐of‐life communication and decision‐making.
ABSTRACT Aim To explore the effects of AI‐generated and human‐generated real‐time feedback on learning outcomes and experiences among undergraduate nursing students. Background Timely, high‐quality feedback is crucial in nursing education to support clinical reasoning, skill development, and student engagement. While human‐generated feedback remains central to pedagogy, emerging AI offers real‐time feedback that complements traditional approaches. Understanding how both interventions influence student learning is critical to informing future curriculum and clinical practice. Methods We conducted a rapid systematic review of quantitative, qualitative, and mixed‐methods studies across major databases from 2018 to 2025. Eligible studies involved undergraduate nursing students receiving real‐time feedback generated from AI or humans. The Sample, Phenomenon of Interest, Design, Evaluation, and Research Type framework guided inclusion, and the Mixed Methods Appraisal Tool assessed methodological quality. Findings Nine studies were included. AI‐generated tools supported timely, consistent, and individualised learning, contributing to student engagement, confidence, and skill development. Educator‐mediated feedback, including technology‐assisted and conventional human feedback approaches, supported student satisfaction, reflection, and emotional support. One study directly comparing AI‐generated and human‐generated feedback found that AI‐generated feedback offered greater consistency and objectivity, whereas human‐generated feedback provided contextual sensitivity and interpersonal connection; however, this comparison should not be generalised across the wider evidence base. Discussion AI offers opportunities to address scalability and access challenges in feedback delivery but does not fully replicate the relational aspects of educator feedback. Conclusion AI‐generated and human‐generated feedback demonstrate distinct yet complementary strengths. A hybrid feedback model is proposed as a plausible approach that may optimise educational outcomes in nursing; however, the included studies have not directly evaluated it, and future empirical testing is needed before it can be recommended as the most effective approach. Implications for Nursing Combining AI‐generated and human‐generated feedback demonstrates complementary strengths, and integrating them may optimise learning outcomes. Implications for Health Policy Investment in digital education and faculty development is needed to support scalable feedback strategies globally. Reporting Method This systematic review adhered to relevant EQUATOR guidelines and followed the PRISMA guidelines (see Appendix ).
ABSTRACT Aim Using network analysis to examine the relationships between nurses’ perceived organizational support, perceived professional benefits, and flourishing. Background Nurses work in high‐pressure and high‐risk environments over the long term, making their mental health of paramount importance. Flourishing, as a more comprehensive and objective new indicator for assessing mental health, has not been fully explored in terms of its complex interactions with perceived organizational support and perceived professional benefits. Methods A total of 586 nurses were recruited for this study. An online survey was conducted using the Chinese versions of the Perceived Organizational Support Scale, Nurses’ Perceived Professional Benefits Scale, and Flourishing Scale. Descriptive statistics for baseline participant characteristics were analyzed using IBM SPSS Statistics. Network analysis was performed using R, with network visualization achieved via the “qgraph” package. Network centrality indices were calculated via the “qgraph” and “networktools” packages. Additionally, network accuracy estimation and stability testing were conducted using the “bootnet” package. Results We estimated a cross‐sectional network model specifying the interrelationships across the three targeted constructs, which yielded a network density of 0.562. “I am deeply interested in the tasks I undertake every day,” “I feel good about myself and am satisfied with my current life state,” and “Good nurse‐patient relationship” are three nodes with relatively high connectivity within the network. Meanwhile, “Positive perception of career” exhibited the highest bridge strength. Discussion The flourishing level of Chinese nurses still has room for improvement, with centrally located nodes and bridge nodes holding prominent positions in their psychological flourishing network. Conclusions The central and bridge nodes identified in this network may offer a pathway for future hypothesis‐driven research. Longitudinal and intervention studies are warranted to examine whether these nodes represent modifiable factors that could strengthen nurses’ flourishing. Implications for nursing and health policy Identifying central and bridge nodes within the network provides valuable insights for nursing administrators when designing subsequent exploratory intervention studies.
ABSTRACT Aim To examine the relationship between nurses’ ethical and professional attitudes, to compare ethical attitude scores according to gender, educational level, and professional experience, and to examine the association between ethical and professional attitudes after accounting for age, professional experience, and weekly working hours. Background Ethical and professional attitudes are fundamental to nursing practice and influence nurses’ decision‐making, responsibilities, and relationships with patients and healthcare teams. Understanding how these attitudes are related may inform strategies to strengthen nursing practice. Design A descriptive, cross‐sectional study was conducted among nurses working in public hospitals. Methods Nurses working in two public hospitals in Bursa, Turkey, were recruited using convenience sampling. Data were collected using a sociodemographic information form and validated instruments assessing ethical and professional attitudes. Descriptive and inferential analyses were performed to examine relationships between ethical and professional attitudes and demographic and work‐related characteristics. Results Ethical and professional attitudes were positively associated, although the strength of the relationship was modest ( r s = 0.284, p < .001). The overall multiple regression model was not statistically significant ( F (4, 151) = 1.715, p = .150) and explained only 4.3% of the variance in professional attitude scores ( R 2 = .043). Within this nonsignificant model, the coefficient for ethical attitude was statistically significant (β = .183, p = .024) and should therefore be interpreted cautiously. Ethical attitude scores did not differ significantly according to gender, educational level, or professional experience. Conclusion Nurses’ ethical and professional attitudes were positively but modestly associated. However, the multivariable model was not statistically significant and explained only a small proportion of the variance in professional attitude scores; therefore, the statistically significant coefficient observed for ethical attitude within this model should be interpreted cautiously. Nursing education and institutional policies should support ethics education and professional development. Implications for Nursing The observed modest association highlights the relevance of considering ethical and professional attitudes together in nursing education and professional development. Further research is needed to determine whether educational or professional‐development interventions can strengthen these attitudes. Implications for Health Policy The findings may inform consideration of ethical and professional attitudes in organizational and workforce‐development initiatives; however, the present study does not provide evidence regarding the effectiveness of specific institutional policies or interventions.
