Background A key pillar of the nursing profession is to care for and to bear responsibility for people experiencing illness, support needs or older age. Many nurses experience inner conflicts between their commitment to deliver the best possible care, their own needs, employers’ interests and structural conditions within which they work. Research aim This study explores nurses’ experience of inner conflicts around their roles and the patterns of interpretation and action nurses follow to manage those conflicts. Research design Based on grounded theory methodology, this study analyses episodic narrative interviews. It creates a typology of nurses’ dealings with their inner conflicts, drawing on elements of critical theory, especially with the terms recognition and reification taken from Honneth. Participants and research context Participants were home care staff working largely with people living alone with dementia, due to the significantly increased potential for inner conflict around care in this setting. I interviewed 16 nursing professionals with a range of qualifications, all of whom delivered care for clients’ day-to-day needs in Germany. Ethical considerations The study adhered to the guidelines of the Declaration of Helsinki and German Society for Nursing Science. The study did not require formal ethical review under the institutional regulations. All participants provided informed consent. Findings Facing inner conflicts, participants reported experiencing a sense of being torn between their personal involvement with their clients and their tendency to reify them, that is, to treat them as objects. I identified four distinct types of interpretive and practical responses to this sense of diremption. Conclusions The prevailing conditions of professional nursing care enable reification and alienation to permeate nurse-client relationships to an extent that ultimately frustrates any attempt of individual nurses to resolve their intractable inner conflicts. Systemic and societal changes are necessary to find a lasting solution to these incompatibilities.
Globalisation and migration have transformed healthcare environments into increasingly multicultural settings where health professionals, healthcare students, institutions and patients may hold different understandings of identity, responsibility and professional obligations. These encounters frequently generate tensions that are often interpreted as conflicts between competing autonomies, rights or claims. Although such situations are commonly approached through Principlism and deliberative ethics, the possibility of reaching different yet ethically defensible conclusions may leave important normative questions unresolved. This article explores Ontological Personalism as an alternative framework for analysing such situations. Using the triangular method and a hierarchy of ethical principles, the paper examines three documented cases involving tensions between personal identity and clinical requirements: two Muslim healthcare professionals facing restrictions associated with ‘bare below the elbows’ policies, a Catholic nursing student required to modify religious attire during clinical training and Sikh healthcare professionals confronted with personal protective equipment requirements during the COVID-19 pandemic. The analysis suggests that these situations should not be understood merely as conflicts between competing autonomies and institutional rules, but as ethical tensions involving multiple actors, responsibilities and goods in need of reconciliation. By integrating respect for life, freedom and responsibility, totality and proportionality, and sociability and subsidiarity within a structured ethical framework, Ontological Personalism provides a coherent approach for analysing identity–safety conflicts across diverse cultural contexts. The article argues that Ontological Personalism offers a coherent framework for analysing identity–safety conflicts by integrating empirical information, anthropological understanding and ethical obligations within a structured methodology.
In April 2026, the new ‘Code of Ethics and Deontology of the Spanish Nurse’ (CDE 2026) came into force, approved by the General Assembly of the General Council of Official Colleges of Nursing with an endorsement exceeding 93%. This article analyzes the new Spanish nursing code, focussing on the novelties introduced relative to the previous code. A narrative review was conducted through qualitative documentary analysis with a hermeneutic-critical approach. The primary corpus comprised two documents: the ‘Deontological Code of Spanish Nursing’ (CDE 1998) and the CDE 2026. A comparative analysis of both documents was first carried out to identify the novelties and modifications in the CDE 2026 relative to the CDE 1998, followed by a complementary literature review to enrich the hermeneutic-critical analysis. The CDE 2026 maintains continuity with the core values of the nursing profession. However, it represents a qualitative and quantitative leap compared with the CDE 1998, incorporating previously non-existent subjects such as artificial intelligence, health digitalisation, sexual diversity, organ donation, assisted reproduction, genetic counselling, decision-making in disability, obstetric care, expert testimony, end-of-life management (including euthanasia), and global health. The study identifies areas for improvement that do not obscure an overall positive assessment but rather point the way forward for successive revisions. The CDE 2026 represents a profound update of professional nursing deontology, aligned with its international benchmarks and underpinned by a solid ethical and legal framework. It clarifies the disciplinary regime, advances nurse accountability, and, through its commitment to continuing ethics education and its mandatory periodic review, is configured as a living framework capable of evolving.
Background Confidential conversations between nurses and patients are considered important in person-centred palliative care, as they provide opportunities for patients to share matters of personal significance within a trusting relationship. Yet, less is known about the ethical challenges nurses encounter when receiving and responding to what patients disclose in these conversations. Research question/aim/objectives To deepen the understanding of the ethical challenges nurses encounter in confidential conversations with patients in palliative care. Research design An interpretive qualitative design was used. The study comprised a secondary analysis of an existing dataset. Data were analysed using reflexive thematic analysis. Participants and research context The dataset comprised five focus groups with 22 registered nurses working in specialised palliative care in Northern Sweden. Ethical considerations The original study received ethical approval from the appropriate review board. All participants provided informed consent. Participation was voluntary and could be withdrawn at any time. Findings/results The analysis generated an overarching theme: Confidential conversations expose ethical challenges where professional intervention reaches its limits. Three interpretive themes were identified: Creating possibilities while accepting the uncertainty of not knowing ; Remaining present with patients whose suffering cannot be relieved ; and Maintaining professional responsibility while being affected . The findings suggest that responsibility persists despite limited control over disclosure, the possibility of alleviating suffering, and nurses’ emotional responses to patients’ experiences. Responsibility was exercised within uncertainty rather than through control or intervention. Conclusion Confidential conversations with patients in palliative care involve ethical challenges that persist when professional control is limited. Patients retain authority over what they disclose, while nurses remain responsible for how disclosures are received and responded to. Sustaining this form of ethical practice requires organisational conditions that support nurses in remaining present, responsive, and professionally responsible when intervention cannot provide a clear solution.
