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Abstract

Introduction

Understanding the experiences of nurses involved in moral disengagement is essential for ensuring high-quality care and maintaining a skilled healthcare workforce.

Objectives

The purpose of this study is to examine how nurses experience moral disengagement as a cognitive strategy used to defy moral standards.

Methods

A phenomenological perspective was taken, with nine nurses from three different teaching hospitals participating in semi-structured interviews with the researchers.

Results

The transcripts were analyzed using Van Manen's phenomenological approach to thematic analysis. The research identified four overarching themes: subjective appraisals of the usefulness of tasks engaged in, justification, the difference between “how I appear to be” and “what I actually am,” and the “contagion” of moral disengagement.

Conclusions

These findings highlight the complexity of moral disengagement and the potential impact it can have on nursing and perceptions in health care. This study calls for a re-evaluation of nursing policies and increasing the professional awareness of ethics to strive for best practices in the profession.

Keywords

Ethics nursing moral disengagement phenomenological study

Introduction

Moral disengagement, a term introduced by Bandura, involves rationalizing immoral behavior, a process common to nurses who experience moral distress, especially in high-stress and crisis-impacted underdeveloped contexts (Alimoradi et al., 2023; Bandura, 2017; Getahun et al., 2024). Moral disengagement can lead to harmful behaviors in the workplace, increased turnover intentions, and decline of organizational citizenship (Ogunfowora et al., 2022). Acute stressful situations such as that which may occur in emergency departments and critical care units can escalate moral disengagement (Mahmood et al., 2020; Mansor et al., 2023). Ethical dilemmas, especially regarding end-of-life care creating a lens of limited resources and limited communication, increase ethical distress (Işık & Yıldırım, 2023; Langley et al., 2015). A study demonstrated suggest interventions such as ethics education and accountability may reduce ethical distress and disengagement, while feeling guilt may support ethical decision making (Detert et al., 2008).

Review of Literature

Research on moral disengagement in nursing is scarce and sporadic. Thus far, it has been found to mediate the association between nurses’ negative emotions and knowledge withholding and could reflect factors like dehumanization and diffusion of responsibility into ethical dilemmas and subsequent stress (Babalola et al., 2016; Fida et al., 2016). Moral disengagement has a negative influence on patient care, represents an increase in errors, and lowers the quality of care (Ke & Li, 2025). Ethical leadership could mitigate the influence of moral disengagement (Zhao & Xia, 2019). However, further exploring in-depth studies on nurses’ lived experiences regarding moral disengagement is warranted, especially in high-intensity environments, such as intensive care units (ICUs) (Neubauer et al., 2019; Yıldız et al., 2022). No studies have examined nurses’ personal lived experiences in Iran about this matter. For these reasons, exploring the issues surrounding moral disengagement and/or ethical dilemmas is paramount; such a study could contribute to addressing the well-being of nurses, and they will in turn uphold nursing standards for optimum patient care.

With regard to the significance of this research, the researchers believe that articulating these factors is essential in furthering the knowledge of moral disengagement among nurses working in high-stress environments. Qualitative research, and specifically phenomenological studies, is fundamental to nursing, as it generates knowledge about what the lived experience of healthcare professionals is and what that means for practice (Thorne et al., 2016). If the researchers frame the importance of these findings, the researchers can create a bridge from theory to practice and create meaningful knowledge that may help with ethical decision-making and patient care. Also, an extensive review for the literature will add to the knowledge base and suggest future directions for research about the complexities of moral disengagement in nursing.

Methods

Study Design

This study utilizes Van Manen's hermeneutic phenomenology, based on Heidegger's inquiry of “being” and the essence of being-in-the-world, with the emphasis being a return to “the things themselves,” through this analytical examination of experience using conversational interviews. This study examined moral disengagement in nurses’ throughout the acute care environments of ICUs and EDs, in order to understand their lived experiences, and understand the meaning of the daily phenomena. The purpose of phenomenological reflection is to uncover the original meaning of phenomena by interpreting lived experience, involving thematic analysis to establish essential themes (Flood, 2010; Van Manen, 1997).

Setting and Participants

The study was conducted using registered nurses who were selected based on established criteria, which included a minimum of a year of experience in emergency and critical care and an experience of moral disengagement. Because the study was conducted in three teaching hospitals in northern provinces of Golestan with a diverse cultural background, the selection was varied in terms of ethnicity. There were no exclusion criteria established other than participants self excluding or wishing to withdraw their data, which did not happen.

Data Generation

The data for this study was collected through semi-structured in-depth interviews over nine months, with oversight from two professors. Participants were recruited from the hospital and were informed about ethical considerations and their rights prior to granting consent for the interview. Each interview was conducted in private settings, the nurses’ break room, lasted between 35 and 60 min, and continued until there was data saturation with a sample of nine interviews.

Interviews

The interviews were guided by an interview guide. The questions were reviewed and revised before each interview based on the existing knowledge of the topic so those are valid. The researchers initiated the interviews with open-ended questions, such as, “Tell me about one of your work shifts,” and “What comes to your mind when I say moral disengagement? How do you behave after a moral disengagement? Can you describe your feelings?” “How do you think moral disengagement affects your interactions with patients?” As the interview progressed, the researchers asked more probing follow-up questions based on the participants’ earlier responses, such as, “Can you provide a specific example?,” “Do you mean…?,” “How…?”

Thematic Analysis

The qualitative portion of the research study was analyzed by the primary researcher and the two professors with experience in phenomenology. The three researchers transcribed all of the audio recordings without exclusion by adhering to Van Manen's phenomenological method (Dowling, 2007). The goal of the analysis was to find themes related to “moral disengagement” and describe the participants’ lived experiences. Since phenomenology is flexible in nature, it requires little theoretical knowledge (Earle, 2010). The phenomenological analysis in this research adheres to six steps of Van Manen's method, while there is a linear order of these steps, phenomenological analysis involves subjective and interpretation procedures that are cyclical. The six steps were: focusing on the lived experience, investigating the experience, reflecting the essence of themes, writing the phenomenon, keeping the lived experience, and balancing the research (Errasti-Ibarrondo et al., 2018). This systematic process raises and documents useful and powerful themes and patterns that reflects the participants’ experiences of moral disengagement in nursing.

Trustworthiness

The study addressed reliability through the use of criteria defined by Lincoln and Guba: credibility, dependability, confirmability, and transferability. Credibility was established by detailed and thorough reflections on each participant and the revisions to the data were based on this immersion in the data. Dependability was established through readings of the data by the supervisor and by the confirmability from faculty in the university department. Transferability was established by purposing a different sample of participants and detailed reporting of the researchers’ thoughts. Data was collected following COREQ guidelines and was done by an experienced nurse to establish participant confidence in the researcher. Coding of the data was done with a psychiatric nurse and a doctoral student and findings were reviewed by qualitative research and ethics experts to attain consensus on the themes.

Results

In this study, nine nurses from emergency and intensive care wards participated. The demographic characteristics of the participants are presented in Table 1. Four themes were extracted from the analysis (shown in Table 2), which describe the lived experiences of Iranian nurses regarding “moral disengagement.” Quotes from the participants are provided to illustrate the findings under each theme.

Table 1.

Descriptive Characteristics of the Participants.

No.	Age (years)	Sex	Marriage	Ward	Work experience (years)	Education	Interview length (min)
1	47	Male	Married	ICU	21	Bachelor	34
2	29	Female	Single	Emergency	4	Master	47
3	34	Female	Married	CCU	9	Bachelor	38
4	41	Male	Married	ICU	13	Bachelor	43
5	33	Female	Married	ICU	6	Bachelor	37
6	45	Male	Married	CCU	20	Bachelor	51
7	37	Male	Single	ICU	12	Bachelor	43
8	31	Female	Single	Emergency	6	Master	52
9	44	Male	Married	Emergency	19	Master	58

Table 2.

Themes and Subthemes of Extraction Data.

Themes	Sub-themes	Meaning units
Subjective weighing of the usefulness of tasks	Deliberately not doing work	Not informing the patient—Failure to administer the medicine on time—Neglecting the right to treat the patient—We do not perform the main task of explaining and educating the patient—Not explaining well to the patient—Not arriving and not giving time to the patient—not intervening in solving—The patient's discomfort despite having a prescription
	Erasing the problem instead of solving the problem	It is easier to start the work of the patient without registering for the trouble—It is easier to suppress the symptoms with medicine—Things that cannot be done and not be noticed—It is difficult to find the cause of the patient's bad vital signs—It is easier to find other tricks to do the work—Finding other ways to do things—We don't get paid, so why should we file a case for the patient? Relieve the patient with the consent of discharge. In short, the brain of the patient is affected and we get the patient's disapproval that we do not do the work
	Procrastination	To delay some work—To be lazy to do some work—To delay visits
Justification	Marginal patients	Patients who have been stabbed, so I don't give them pain reliever—if the patient doesn't have money, favoritism, and support, then it's a shame—To judge patients and take care of them—He screams, and it gave me a great glee when I remember the swear word he gave − When the patient swears, we also hit him without anesthesia − According to the politeness of the patient, anesthetize Dispatch patients—Busy—Unstable—On the nerves—Being alert—Sick and receiving better work—Nagging—Taking too much medicine, sick—impolite—Inconsiderate and complaining—Hasty—Creditor—Aggressive—Culture.
	Futility of orders	Considering some things to be ineffective—not tolerating the patient's fever and acting contrary to the order—if the patient returns, he will go to the ICU—very old and sick patients—a patient who has been dead for a long time—not following the doctor's order due to not believing—Presuming the patient's pain.
	Improper delegation of authority	They ask one person to do the work of several people—here the nurse should do the work of the doctor, crew and supervisors—not reaching all the patients—don't expect me to pay attention to all the patients—things that need to be done with the help of another person, done by one person—having few servants and not doing work—there are too many patients compared to nurses—there is not enough nursing staff—A servant who is on duty 24 hours a day cannot be called in at 3 o'clock in the morning. The doctor wants a phone consultation, we have to call—instead of the doctor, carrying out routine orders in the middle of the night—being responsible for the doctor's lack of work—covering up the doctor's ugly work—being forced to give incomplete information to the consulting doctor on the phone—he is not in the mood at three o'clock in the morning, the doctor's answer—give me why the patient's blood pressure is low—the doctor asks us the name of the patient even in the crowd—why the companions give us their work tasks for the patient—here the nurse should do the work of the doctor, crew, and supervisors
	Incorrect organization routine	Paying more attention to the case than the patient (finally being called to account because of the report)—not having a rotation due to the difficulty of the work—not monitoring the mistakes of the nurses and doctors—admitting 20 patients in the evening shift by two nurses—the normalization of the lack of work—the prevalence of misses Some care in ICU—low quality of work—night shift and lack of supervision by the head nurse.
	Susceptible context	No one expects to get out of the ICU alive—overcrowding of patients—don't expect to get sick from the ICU patient— crowding—CCU's sensitivity to ICU—crowding and riotous noise—working in a closed environment—paternalist—Lack of ICU nurses
Right appearance–wrong essence	Formal shift delivery	Keeping the appearance of the case at the time of handing over the shift—handing over the patient without any problems—postponing the death of the patient to the next shift
Right appearance–wrong essence	False registration	The patient has nausea and vomiting, we write that this is ok − as soon as the doctor leaves the CPR room, we also stop CPR − performing the CPR formality—the doctors are happy and think that their drugs will be implemented.
Contagiousness of the phenomenon	Forced collusion	Treating emergency patients—we convince the patient to go to the clinic or somewhere else—when he comes with a fracture at 4 in the morning, the orthopedic doctor is not there at that time and we send him to come the next morning—treating the patient in favor of the doctor and our lack of work.
Contagiousness of the phenomenon	Do as the romans do	The effect of coworkers’ cooperation on the way of working—not having access to a doctor—unprofessional behavior and communication of co-workers—the doctor not coming when calling Even in times of emergency—the number of conscientious nurses is low—doctors impose extra cost and extra commute on the patient—the sensitivity of emergency room colleagues—witnessing the negligence of doctors—referring the patient to earn income and reducing the work—scaring her for not accepting the patient

Subjective Weighing of the Usefulness of Tasks

The lived experiences of emergency and ICU nurses regarding moral disengagement can be likened to placing a mental scale to weigh the importance of their duties. This mental scale for nurses encompasses the following three themes:

Deliberately Not Doing Work

Nurses reported experiencing instances where they intentionally chose not to perform certain duties while caring for patients. A nurse's failure to fulfill their responsibilities, or a deficiency in care, constitutes a fault. This fault refers to the deliberate avoidance or refraining from actions that the individual is aware of and capable of performing. One participant stated:

When suturing patients, I know one set of sterile dressings should be opened for each patient, but I open one for every patient because I have to close all these sets of dressings afterwards. I feel pressure because my work is getting too much. (p1)

Erasing the Problem Instead of Solving the Problem

The lived experiences of healthcare participants illustrate major problems in the healthcare system, particularly the notion of putting in a Band-Aid rather than getting to the root. Nurses described how Band-Aids lead to a culture of not solving problems. Besides, participants faced moral disengagement, which resulted in feelings of despair and moral distress.

When the ward is very busy and I'm tired, I do these things, but when I have one patient, the probability of doing this becomes zero, I try to take care of it more. The rest of the nurses have three patients in the ICU and it becomes very busy, no matter how I want to maintain the balance, I have at least two busy patients and one good patient, and I don't get all the care. For example, in the evening shift, I close my eyes and see that it is quarter past 7. There is no more than 10 cc in the patient's urine bag, so I take 100 cc and cover it. What I am saying is difficult even for me. Instead of calling the doctor during the delivery of the shift I have to change the urine bag quickly so that no one knows, of course, this happens when at the end of the shift I am not able to get a phone order from the doctor. (p7)

Procrastination

One of the experiences of nurses after mentally weighing their duties is the feeling of procrastination. Procrastination in this context means deferring tasks to the next shift instead of addressing them in the current shift—a deliberate choice. However, not all delays are indicative of procrastination stemming from moral disengagement. In this type of negligence, nurses actually felt the necessity to perform their duties and were aware of the potential harm to the patient, yet they did not express feelings of reproach. This incorrect process forced nurses to use various reasons to justify their negligence.

One participant said,

He has been sick for a long time, he is on CPAP mode, we put him on T-piece and we can even extubate him when he is sick, but because the patient is restless, we bother him on our shift, we keep him until this work is assigned to the next shift. (p5)

Justification

Moral justification entails reinterpreting unethical actions as contributing to a socially valuable or honorable objective. Nurses may rationalize their conduct, believing that, despite its unethical nature, it is essential for a higher purpose or to secure a positive result for the patient or the healthcare system.

Marginal Patients

Participants expressed that they provide more attentive care to polite patients and exert less effort for those with disrespectful behaviors. These lived experiences highlighted how nurses’ personal judgments influence their clinical decision-making and the quality of care they provide to patients.

One nurse said,

It has even happened to get suture, I look at how rude the patient is, so I should apply less anesthesia or, for example, I am Suturing and applying, and I am trying to make the work done more nicely by the person who was polite. In terms of conscience, I am also affected, but I will do it. (p2)

Futility of Orders

The lived experiences of nurses demonstrated that they frequently find themselves in situations where they perceive some of the physicians’ orders for patient treatment as unnecessary or ineffective. This doubt stems from their clinical experiences and observations of the lack of improvement in patients’ conditions. As a result, nurses question the rationale behind certain medical interventions. This belief in the futility of some physicians’ orders can lead to incomplete execution of those orders by nurses.

For example, I called a doctor once and told him that the head trauma patient had high blood pressure and head trauma, but he was okay. The surgeon calls and says to take an IV & oral abdominal and pelvic CT scan with contrast, so why?? You didn't come to see me sick at all. We had a patient who expired because of an allergy to the contrast material. Why haven't you seen a patient yet? Such a heavy request that may damage the kidneys can cause allergies without having visited the patient. Because he is taking time for himself, he says to send some X-ray or CT scan so that I can come. They buy time for themselves to express. What are the orders that you don't need at all? You will damage both the device and the patient. When I witness these behaviors, I no longer believe in their orders and I do not oblige myself to carry out all of them. (p9)

Improper Delegation of Authority

Most nurses frequently expressed concern about the shortage of human resources in healthcare facilities and the subsequent mandatory delegation of authority to cope with the workload. Nurses believed that the shortage of human resources negatively impacts patient care and safety, as they are required to perform additional tasks outside their job scope. This improper delegation of authority places nurses in an unsafe position, as they may lack the necessary knowledge to effectively carry out certain responsibilities. Additionally, less experienced nurses reported feeling exhausted and burnt out due to the constant pressure and stress resulting from the shortage of human resources and improper delegation of authority of duties.

During the shift, it often happens that due to the lack of services, the patient is left waiting for hours for CT and X-ray, there is no one to take him, he cannot find services at all. It is so busy that the services of several people are done by one person. In the end, I have to take patients alone. When the we want the work of several people from one person, that's why the quality of the work decreases. When I am on duty in the evening shift of two people and admit 20 patients, they should definitely not expect that I will pay attention to all the patients. I am more concerned about how to collect reports because in Finally, they are asking me for the report…. (p8)

Incorrect Organization Routine

Nurses believed that incorrect organization routine, such as judging the quality of nursing based on report-writing skills, negatively impact the quality of services they provide. They felt that their performance should not be evaluated solely based on their ability to document patient care, as this overlooks their clinical skills and the quality of the services they deliver.

One nurse stated,

When a patient is admitted to the emergency department, the first thing the nurses should do is to go up to the patient while they start writing the file. It's too bad that you don't care about the patient and don't care about the case if the clinical assessment needs to be checked first, because the organization asks us for this. (p2)

Susceptible Context

When expressing their lived experiences of moral disengagement, nurses referred to susceptible environments such as ICU units. One nurse in particular described this feeling with the statement: One participant said,

Looking at the ICU is a situation where no one expects the patient to come out alive, but the CCU is not like that. It means that they don't expect much from the ICU patient to return to normal life, he wants to live a vegetarian life. (p6)

This highlights the unpredictable nature of the ICU environment and the impact it has in contributing to moral disengagement.

Formal Shift Delivery

Shift handover is a critical aspect for ensuring the continuity of care to maintain patient safety and well-being. The foundation of providing safe and effective patient care lies in effective communication during shift handover and rapid assessment.

We had a case in order to follow up the patient to the next shift. During the delivery of the patient's shift, the blood pressure does not go above 5. Well, I inject 10 cc of norepinephrine or dopamine. He is a normal patient, but it is for two minutes … until we go to deliver the next patient, his pressure is 5 again. (p5)

False Registration (Formality Reports)

Incorrect documentation in nursing reports is a serious concern in the healthcare system. It occurs through the fabrication of information or the omission of important details. This behavior not only tarnishes the professional image of nursing but also jeopardizes patient safety.

It happens in some shifts, for example, I didn't raise the bedside, I didn't take vital signs, but when I write a report, it was taken. Sometimes the patient is nauseous Now because of hunger or anything. However, I write in the report that there is no nausea or vomiting or the patient is okay. Or, for example, the pressure is high, but for the sake of responsibility, I don't record 10 more pressures at different hours. If the blood pressure is 17, I will write 14, things like this…. (p7)

Forced Collusion

The lived experiences of participants revealed that nurses are often forced to collude with physicians against patients. The root of this belief lies in the power dynamics within healthcare environments, particularly in a context like Iran, where physicians have traditionally been seen as authority figures, while nurses are viewed as assistants. This power imbalance can lead to situations where nurses may feel pressured to follow physicians' decisions, even if they have concerns about the care being provided to patients.

Our doctor sits in his office, the patient stays here for two hours, maybe ten hours, we also lie and say that the doctor is visiting the patient and … we lie so that the patients don't make noise, but the doctor is sitting in his office to make money, we have an ugly job and we cover it up. This is unethical. But we have to…. (p2)

Do As the Romans Do

In the healthcare profession, nurses frequently encounter ethical dilemmas that challenge their moral compass. One of the common phenomena observed among participants is “do as the romans do” in engaging in unethical practices. This concept refers to following the crowd and conforming to the prevailing norms in the workplace, despite the ethical principles and codes of conduct governing the nursing profession. Some nurses may be pressured to engage in unethical behavior due to various factors such as organizational culture, peer influence, or job insecurity.

The patient who came with severe pain in his side must have been so severe that he came to the hospital at night, but we do not call the doctor for fear that the doctor will be upset and curse us Because the doctor asked us, then says, “I fell asleep, don't call me for outpatient visits” so we also tell the patient and his companion that we don't have a doctor. Even though I am on shift, he is also on shift, his duty and responsibility is to come and see the patient, and then I feel that I am being wronged in addition to the patient. There is a doctor in my hospital, why doesn't he come to see patient? We can't fight for fear of losing our position and we say “we don't have a doctor, So I will be like her.” (p9)

Discussion

Research on moral disengagement in nursing has produced a number of relevant conclusions. For example, an exploration of moral disengagement among nurses has revealed themes related to the ethical dilemmas nurses face as part of their role, including moral disengagement experiences as subjective task evaluation (e.g., not considering the potential negative consequences for patients and their interdisciplinary colleagues), and justification of their actions (e.g., blaming stressors in their environment), and the impact of organizational culture on ethical practices. These themes are widely relevant due to the rapidly evolving context of ethical dilemmas in quickly evolving nursing care, that Nightingale carefully articulated with her 10 ethical principles that are still relevant today (Fowler, 2021).

As nursing roles grow more complex, many of them with increased value, both lawfully and ethically (Datrika & Arokiaraj, 2022) nurses may be experiencing serious ethical paradoxes and an associated widening scope of responsibility (or liability). There is a corresponding need for nursing professional values to adapt to modern society needs, which can lead to moral disengagement feelings of indecision, procrastination, and avoidance of their professional responsibility (Morley et al., 2023).

The theme of “justification” arose out of the type of ethical dilemmas faced by nurses, in trying to ensure patient care when basic community resources are limited (Bagheri & Heydari, 2022). The literature indicates critical care nurses have experienced morality distress in typical ethical dilemmas face making end-of-life care decisions, with similarly related struggles with ethical conflicts (Palmryd et al., 2025).

Additionally, the culture of organizations that emphasize paperwork versus patient care can also cause job dissatisfaction and burnout for nurses (Davey et al., 2018; Kiptulon et al., 2024). The idea of “contagion” within unethical behavior demonstrates that nurses may engage in behaviors inappropriate to their profession because their peers are behaving in a manner consistent with those behaviors in the nursing practice environment. It is crucial to build a welcoming, embedded ethical practice where nurses learn to support one another as ethical advocates (Chen et al., 2023; Epstein & Delgado, 2010).

Strengths and Limitations

The phenomenological approach provides in-depth qualitative understanding of nurses lived experiences about moral disengagement, which is especially relevant in high-stress situations experienced in settings like intensive care or emergency departments even though the scope of the study was small, it addresses an important issue in nursing ethics since, if not addressed, moral disengagement can lead to impaired patient care. The findings may provide insights and the establishment of informed strategies to move forward in enhancing ethical practice of nurses.

Even though this phenomenological inquiry attempts to explore the understanding of lived experiences, there are limitations to consider. The ethical complexities surrounding moral disengagement made participant recruitment difficult due to possible variations in wanting to share clinical experiences. Further, while participants varied in gender, department, and work experience, they all resided in the same province which would indicate that a wider recruitment strategy may improve insight into the phenomena.

Implications for the Profession

The research indicates that moral disengagement in nursing starts in justification and can continue with other personnel. Nursing managers must encourage ethical empowerment, reflection, and training, while creating a space for ethical discussions that is free from judgment. Furthermore, organizations must enhance nurses’ working conditions to promote better workplace conditions.

Recommendations for Further Research

Ethical training and ethical narrative are both major components that are important for nurses to navigate the risks of moral disengagement. Future studies should look to advance the understanding of how organizations, culture, and policy influence moral disengagement, especially around institutional policy, resource allocations, and workload within an acute context.

Conclusion

The research indicates that emergency and intensive care nurses report feelings of moral disengagement that lead to an endorsement of prioritizing more simplistic tasks over more complex tasks to the detriment of patients. This is done while rationalizing their work internally but also distorting the moral implications surrounding the actions to make them acceptable. This process of moral disengagement can spread throughout an organization; therefore, it is crucial to address it to prevent the conscious errors that erode the profession of nursing's dignity. The study implies that ethical resilience should be a priority for nurses as they continue to provide patient care. Meeting nurses’ basic needs was emphasized as a significant approach to limit the impact of moral disengagement within the wider context of the nursing profession. Practical recommendations were to reassess human resource policies and nurse ethical development and awareness in their nursing practice.

Supplemental Material

sj-docx-1-son-10.1177_23779608251395004 - Supplemental material for Lived Experiences of Moral Disengagement Among Intensive Care and Emergency Department Nurses: A Phenomenological Study

Supplemental material, sj-docx-1-son-10.1177_23779608251395004 for Lived Experiences of Moral Disengagement Among Intensive Care and Emergency Department Nurses: A Phenomenological Study by Fatemeh Talebian, Homa Vejdani, Akram Sanagoo and Leila Jouybari in SAGE Open Nursing

Supplemental Material

sj-docx-2-son-10.1177_23779608251395004 - Supplemental material for Lived Experiences of Moral Disengagement Among Intensive Care and Emergency Department Nurses: A Phenomenological Study

Supplemental material, sj-docx-2-son-10.1177_23779608251395004 for Lived Experiences of Moral Disengagement Among Intensive Care and Emergency Department Nurses: A Phenomenological Study by Fatemeh Talebian, Homa Vejdani, Akram Sanagoo and Leila Jouybari in SAGE Open Nursing

Footnotes

Author Contributions

L.J. developed and designed the research, performed data analysis, and checked the manuscript. F.T. conducted interviews with participants, transcribed the interviews, performed data analysis, and drafted the article. H.V. conducted interviews with participants and transcribed the interviews. A.S. conceptualized the research, supervised the project, and conducted formal analysis. All authors participated in the analysis and interpretation of the data. All authors have reviewed the content and have read and approved the final version.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval and Consent to Participate

The research design received approval from the medical ethics committee of Golestan University (IR.GOUMS.REC.1402.235). Prior to the interviews, each participant completed and signed an informed consent form. The interviews were conducted at a previously arranged time and location in a private setting within the hospitals. Audio recordings of the interviews were made, and all files were secured with password protection to ensure confidentiality. Furthermore, the findings reported in this study were anonymized to safeguard the identities of the participants. All ethical principles in human research were observed in accordance with the Declaration of Helsinki.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

ORCID iDs

Fatemeh Talebian

Homa Vejdani

Akram Sanagoo

Leila Jouybari

References

Alimoradi

Jafari

Lin

C.-Y.

Rajabi

Marznaki

Z. H.

Soodmand

Potenza

M. N.

Pakpour

A. H.

(2023). Estimation of moral distress among nurses: A systematic review and meta-analysis. Nursing Ethics, 30(3), 334–357. https://doi.org/10.1177/09697330221135212

Babalola

M. T.

Stouten

Euwema

(2016). Frequent change and turnover intention: The moderating role of ethical leadership. Journal of Business Ethics, 134(2), 311–322. https://doi.org/10.1007/s10551-014-2433-z

Bagheri, F., & Heydari, A. (2022). Jürgen Habermas's critical social theory and its role in the health system and the nursing profession: A narrative review. Navid No, 25(83), 80–88. https://doi.org/10.22038/nnj.2023.67756.1367

Bandura

(2017). Mechanisms of moral disengagement. In Insurgent terrorism (pp. 85–115). Routledge.

Chen

Pan

Cui

Yang

(2023). The contagion of unethical behavior and social learning: An experimental study. Behavioral Sciences, 13(2), 172. https://doi.org/10.3390/bs13020172

Datrika

V. M. R.

Arokiaraj

D. A.

(2022). Refined model of Maslow’s needs theory in the internet era. Organization and Human Capital Development (ORCADEV), 1(1), 1–11. https://doi.org/10.31098/orcadev.v1i1.858

Davey

G. E.

Halbesleben

J. R. B.

Wakefield

B. J.

Wakefield

D. S.

Cooper

L. B.

(2018). Nurse burnout and patient safety outcomes: Nurse safety perception versus observed safety performance. Western Journal of Nursing Research, 40(5), 658–671. https://doi.org/10.1177/0193945907311322

Detert

J. R.

Treviño

L. K.

Sweitzer

V. L.

(2008). Moral disengagement in ethical decision making: A study of antecedents and outcomes. Journal of Applied Psychology, 93(2), 374–391. https://doi.org/10.1037/0021-9010.93.2.374

Dowling

(2007). From Husserl to van Manen: A review of different phenomenological approaches. International Journal of Nursing Studies, 44(1), 131–142. https://doi.org/10.1016/j.ijnurstu.2005.11.026

10.

Earle

(2010). Phenomenology as research method or substantive metaphysics? An overview of phenomenology's uses in nursing. Nursing Philosophy, 11(4), 286–296. https://doi.org/10.1111/j.1466-769X.2010.00458.x

11.

Epstein

Delgado

(2010). Understanding and addressing moral distress. Online Journal of Issues in Nursing, 15(3), 1. https://doi.org/10.3912/OJIN.Vol15No03Man01

12.

Errasti-Ibarrondo

Jordán

J. A.

Díez-Del-Corral

M. P.

Arantzamendi

(2018). Conducting phenomenological research: Rationalizing the methods and rigor of the phenomenology of practice. Journal of Advanced Nursing, 74(7), 1723–1734. https://doi.org/10.1111/jan.13569

13.

Fida

Tramontano

Paciello

Kangasniemi

Sili

Bobbio

Barbaranelli

(2016). Nurse moral disengagement. Nursing Ethics, 23(5), 547–564. https://doi.org/10.1177/0969733015574924

14.

Flood

(2010). Understanding phenomenology. Nurse Researcher, 17(2), 7–15. https://doi.org/10.7748/nr2010.01.17.2.7.c7453

15.

Fowler

M. D.

(2021). The nightingale still sings: Ten ethical themes in early nursing in the United Kingdom, 1888-1989. Online Journal of Issues in Nursing (OJIN), 26(2), 1–12. https://doi.org/10.3912/OJIN.Vol26No02PPT72

16.

Getahun

M. S.

Gurara

A. M.

Bekele

N. T.

Yilma

A. A.

Abebe

T. A.

Tadesse

A. A.

(2024). Moral distress and associated factors among nurses working in central Ethiopia: A cross-sectional study. Discover Social Science Health, 4(1), 15. https://doi.org/10.1007/s44155-024-00072-6

17.

Işık

M. T.

Yıldırım

(2023). Individualized care perceptions and moral distress of intensive care nurses. Nursing in Critical Care, 28(2), 184–192. https://doi.org/10.7196/SAJCC.2015.V31I2.235

18.

(2025). Moral disengagement, moral identity, and counterproductive work behavior among emergency nurses. Nursing Ethics, 32(1), 111–124. https://doi.org/10.1177/09697330241238336

19.

Kiptulon, E. K., Elmadani, M., Limungi, G. M., Simon, K., Tóth, L., Horvath, E., & Siket, A. U. (2024). Transforming nursing work environments: The impact of organizational culture on work-related stress among nurses: A systematic review. BMC Health Services Research, 24(1), 1–16. https://doi.org/10.1186/s12913-024-12003-x

20.

Langley

G. C.

Kisorio

Schmollgruber

(2015). Moral distress experienced by intensive care nurses. South African Journal of Critical Care, 31(2), 36–41. https://doi.org/10.1111/nicc.12715

21.

Mahmood

Ali

M. M.

Punjwani

F. S. A.

Bardai

S. S.

Sultan

Shamim

(2020). Comparison of level of stress among bedside nurses working in different specialties at a private sector tertiary care hospital in Karachi, Pakistan. Journal of Research and Development in Nursing and Midwifery, 17(2), 4–6. https://doi.org/10.52547/jgbfnm.17.2.4

22.

Mansor

Afthanorhan

Mohd Ibrahim

Mohd Salleh

A. M.

(2023). The mediating role of moral disengagement in predicting deviant workplace behavior among nurses in Malaysia. Journal of Client-Centered Nursing Care, 9(2), 143–156. https://doi.org/10.32598/JCCNC.9.2.502.1

23.

Morley, G., Ives, J., Bradbury-Jones, C., & Irvine, F. (2023). Moral distress in critical care nursing practice: A concept analysis. Journal of Clinical Nursing, 32(13–14), 3362–3373. https://doi.org/10.1111/jocn.16744

24.

Neubauer

B. E.

Witkop

C. T.

Varpio

(2019). How phenomenology can help us learn from the experiences of others. Perspectives on Medical Education, 8(2), 90–97. https://doi.org/10.1007/s40037-019-0509-2

25.

Ogunfowora

B. T.

Nguyen

V. Q.

Steel

Hwang

C. C.

(2022). A meta-analytic investigation of the antecedents, theoretical correlates, and consequences of moral disengagement at work. Journal of Applied Psychology, 107(5), 746–775. https://doi.org/10.1037/apl0000912

26.

Palmryd

Rejnö

Å.

Alvariza

Godskesen

(2025). Critical care nurses’ experiences of ethical challenges in end-of-life care. Nursing Ethics, 32(2), 424–436. https://doi.org/10.1177/09697330241252975

27.

Thorne

Stephens

Truant

(2016). Building qualitative study design using nursing's disciplinary epistemology. Journal of Advanced Nursing, 72(2), 451–460. https://doi.org/10.1111/jan.12884

28.

Van Manen

(1997). From meaning to method. Qualitative Health Research, 7(3), 345–369. https://doi.org/10.1177/104973239700700303

29.

Yıldız

Harun

Özbilgin

(2022). How do compulsory citizenship behaviors affect moral disengagement in organizations? Significance of anger toward the organization during the COVID-19 pandemic. Frontiers in Psychology, 13(1), Article 1038860. https://doi.org/10.3389/fpsyg.2022.1038860

30.

Zhao

Xia

(2019). Nurses’ negative affective states, moral disengagement, and knowledge hiding: The moderating role of ethical leadership. Journal of Nursing Management, 27(2), 357–370. https://doi.org/10.1111/jonm.12675

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