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To examine the relationship between ethical conflicts and ethical decision-making ability, ethical sensitivity and demographic factors as mediator/moderator roles.
A cross-sectional survey was conducted from June to December 2024.
This study involved 503 intensive care unit nurses from eight tertiary hospitals across Zhejiang, Guangdong and Guangxi provinces. Participants completed validated instruments including the Ethical Conflict Nursing Questionnaire-Critical Care Version, the Chinese Moral Sensitivity Questionnaire-Revised version and the Chinese Version of Judgement About Nursing Decision. SPSS 27.0 was used for descriptive statistics and Pearson correlation analysis, while PROCESS macro handled mediation and moderation analysis.
The relationship between ethical conflict and decision-making ability was significantly mediated by both moral responsibility/strength and burden, with the latter demonstrating a stronger indirect effect. Furthermore, exploratory moderated mediation analysis showed that this mediation model varied significantly across different levels of work experience and types of intensive care unit. Given the exploratory nature of these findings, they require verification in future confirmatory studies.
The association between ethical conflict and decision-making ability was mediated by ethical sensitivity. This pathway was moderated by work environment and qualifications, indicating the need for tailored interventions.
Developing nurses' ethical sensitivity is a key strategy for managers aiming to improve ethical decision-making when nurses face ethical conflicts.
This study addressed ambiguous findings regarding the relationship between ethical conflict and nurses' decision-making ability. For nurse managers, fostering ethical sensitivity among staff represents a key strategy for mitigating the ethical conflicts that are negatively associated with decision-making ability.
The strengthening the reporting of observational studies in epidemiology statement (STROBE) was followed.
No patient or public contribution.
Chinese Clinical Trial Registry (ChiCTR): MR-33-24-032956
To examine how gender differences in the nursing work environment shape nurses' perceived quality of care and to identify gender-specific predictors and evaluative mechanisms.
A mixed-methods design was employed, integrating quantitative data analysis with qualitative in-depth individual interviews.
This study was conducted in two phases: The first phase was a quantitative analysis, based on a large national dataset from the 2017 Chinese Nursing Work Environment Survey (N = 16,382), in which secondary analysis was performed using hierarchical linear regression, relative importance analysis, and network analysis to identify key predictors. The second phase was a qualitative study, in which in-depth individual interviews were conducted with 30 clinical nurses (15 male and 15 female), and thematic analysis was applied to explore gender-differentiated experiences.
The core finding of this study is that gender-differentiated factors within the work environment significantly shape nurses' perception of care quality. Quantitative results showed that the strongest predictor for female nurses was professional development, whereas recognition of value was most salient for male nurses. Qualitative results corroborated these findings: female nurses emphasised continuing education and emotional support, while male nurses emphasised fair evaluation and professional identity. Both groups reported that high-intensity workloads hindered the delivery of ideal humanistic care, inducing moral distress and emotional suppression and exposing ethical gaps in organisational support.
Gender differences in the nursing work environment shape pathways to perceived care quality and expose deeper managerial and ethical challenges. A gender-sensitive, ethics-oriented management approach can enhance nurse satisfaction and care quality, providing empirical support for optimising workforce allocation and sustaining healthcare systems.
Findings direct nurse leaders to tailor improvement strategies—enhancing professional-development infrastructure for women and strengthening recognition mechanisms for men—while embedding explicit ethical support to reduce moral distress and improve both workforce well-being and patient outcomes.
No patient or public contribution.
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