Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses’ opinions of the content and function of codes and their use in nursing practice. A total of 49 focus groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be ‘paper tigers’ with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice.

Background: Since 1997, nursing ethics research has focused on solving ethical dilemmas, enhancing decision-making strategies, and introducing professional education. Few studies describe the triggers of ethical dilemmas among primary care nurses. The aim of this study was to explore the moral distress and ethical dilemmas among primary care nurses. Methods: A scoping review was performed following Arskey and O’Malley’s framework. PubMed, CINAHL, PsycINFO, Embase, and Scopus were searched systematically to retrieve relevant titles and abstracts. A temporal filter was applied to focus on the most recent literature (years of 2010–2020). The research was completed on 17 November 2020. Results: Of 184 articles retrieved, 15 were included in the review. Some (n = 7) studies had a qualitative design, and the most productive country was Brazil (n = 7). The total number of nurses involved in quantitative studies was 1137 (range: 36–433); the total number of nurses involved in qualitative studies was 144 (range: 7–73). Three main focus areas were identified: (a) frequent ethical conflicts and moral distress episodes among nurses working in primary care settings; (b) frequent moral distress measures here employed; (c) coping strategies here adopted to prevent or manage moral distress. Conclusion: Further research is needed to examine the differences between moral distress triggers and sources of ethical dilemmas among the different care environments, such as primary care and acute care settings.

Moral distress is a concern for all healthcare professionals working in all care settings. Based on our knowledge, no studies explore the differences in levels of moral distress in hospital and community settings. This study aims to examine the level of moral distress among healthcare professional working in community or hospital settings and compare it by demographic and workplace characteristics. This is a cross-sectional study. All the professionals working in the hospitals or community settings involved received personal e-mail invitations to participate in the study. The Moral Distress Thermometer was used to measure moral distress among healthcare professionals. Before data collection, ethical approval was obtained from each setting where the participants were enrolled. The sample of this study is made up of 397 healthcare professionals: 53.65% of the sample works in hospital setting while 46.35% of the sample works in community setting. Moral distress was present in all professional groups. Findings have shown that nurses experienced level of moral distress higher than other healthcare professionals (mean: 4.91). There was a significant differences between moral distress among different professional categories (H(6) = 14.407; p < 0.05). The ETA Coefficient test showed significant variation between healthcare professionals working in community and in hospital settings. Specifically, healthcare professionals who work in hospital experienced a higher level of moral distress than those who work in community settings (means 4.92 vs. means 3.80). The results of this study confirm that it is imperative to develop educational programs to reduce moral distress even in those settings where the level perceived is low, in order to mitigate the moral residue and the crescendo effect.

In this study, we claim that political liberalism, despite harsh criticism, is still the best option available for providing a just and stable society. However, we maintain that political liberalism needs to be revised so as to be justifiable from the perspective of not only the “reasonable” in a Rawlsian sense (that we define as “fully” reasonable) but also the ones whom Rawls labels as “unreasonable.” To support our claim, going beyond Rawls’s original account, we unpack the concept of unreasonableness and identify three different subsets that we label as the “partially reasonable,” the “non-reasonable,” and the “unreasonable.” We argue that both the “fully” reasonable and the “partially reasonable” would be included into the constituency of public justification; more specifically, we claim that the latter would support liberal institutions out of their reasons: we define these reasons as mutually intelligible reasons and claim that they allow to acknowledge the importance of a convergence approach to public justification. As for the “non-reasonable” and “unreasonable,” we claim that they cannot be included in the constituency of public justification, but they nonetheless could be compliant with liberal institutions if political liberalism offers them some reasons to comply: here, we claim that political liberalism should include them through engagement and propose reasoning from conjecture as an effecting way of offering reasons for compliance. In particular, we claim that through reasoning from conjecture, the “non-reasonable” could find conciliatory reasons to comply with liberal institutions on a stable base. With regard to the “unreasonable” in the strict sense, we claim that through reasoning from conjecture, their unreasonableness could be contained and they could find reasons—even if just self-interested—for complying with liberal institutions rather than defying them. In our discussion, we consider the different subsets not as “frozen” but as dynamic and open to change, and we aim to propose a more complex and multilayered approach to inclusion that would be able to include a wider set of people. To strengthen our argument, we show that the need for a wider public justification and for broader inclusion in liberal societies is grounded in respect for persons both as equal persons and as particular individuals. In particular, we claim that individuals’ values, ends, commitments, and affiliations activate demands of respect and can strengthen the commitment to the liberal–democratic order. Through a reformulation of the role of respect in liberal societies, we also show a kind of social and communitarian dimension that, we claim, is fully compatible with political liberalism and opens it up to “civic friendship” and “social solidarity,” which are constitutive elements for the development of a sense of justice and for the realization of a just and stable society.