Nurses’ guilt regarding patient deaths: A concept analysis

Abstract

This concept analysis aims to clarify the definition and key components of nurses’ guilt associated with patient death. Walker and Avant’s methodological approach was employed to identify defining attributes, antecedents, and consequences. A comprehensive literature review was conducted using PubMed, CINAHL, MEDLINE, PsycArticles, Scopus, and the Cochrane Library, focusing on articles published between 2015 and 2025. The literature search and selection process are reported in accordance with PRISMA guidelines. The analysis revealed four defining attributes of nurses’ guilt: (1) Feeling responsible for the patient’s death, (2) Fear of condemnation, (3) Regret, and (4) Self-denial. Antecedents were classified into five domains, namely, the nature of the death, the nurse’s relationship with the patient and family, professional mission and role expectations, ethical dilemmas encountered during care, and concerns regarding one’s involvement in the dying process. The consequences of guilt extended beyond emotional responses, encompassing long-term physical and psychological health effects, self-alienating behaviors, and changes in introspection, meaning-making, and professional identity. These findings suggest that guilt following a patient’s death is a complex, reflective process rooted in nurses’ professional values and moral responsibilities. By clarifying the structure and characteristics of this concept, this analysis provides a shared conceptual framework applicable across diverse cultural and clinical contexts. The findings of this concept analysis suggest that nurses’ guilt related to patient death is not merely an individual psychological reaction but also constitutes a moral injury involving professional judgment and responsibility. The findings highlight the importance of ongoing psychological support for nurses who have experienced the death of a patient. Such support should include educational components that deepen understanding of the guilt experienced by nurses in these situations, as well as opportunities for dialogue and reflection with colleagues who have had similar experiences.