Navigating ethical complexity: Moral development in pediatric oncology nursing.

Area of Science:

• Nursing Ethics
• Bioethics
• Healthcare Policy

Background:

• Healthcare settings increasingly withdraw or diminish diversity, equity, and inclusion (DEI) frameworks.
• Absence of equity-focused policies creates moral conflict for pediatric oncology nurses.
• Nurses navigate ethical dilemmas without adequate institutional support.

Purpose of the Study:

• To explore ethical challenges faced by pediatric oncology nurses in the absence of DEI frameworks.
• To examine the role of moral development theories in navigating ethical dilemmas.
• To propose strategies for sustaining equitable pediatric oncology care.

Main Methods:

• Conceptual paper integrating Kohlberg's theory of moral development and complementary perspectives (Perry, Gilligan, Tronto, Selman).
• Integration of real-world vignettes from pediatric oncology contexts.
• Analysis of ethical tensions between organizational constraints and professional commitments.

Main Results:

• Nurses increasingly rely on postconventional reasoning to uphold justice, fairness, and patient-centered equity.
• Institutional vulnerabilities, patient needs, and nurse moral distress intersect, jeopardizing well-being.
• Organizational constraints conflict with professional commitments to advocacy, cultural humility, and inclusive care.

Conclusions:

• A dual approach (top-down institutional policy and bottom-up nurse education) is needed to address ethical challenges.
• Healthcare institutions must develop alternative ethical frameworks and supportive policies.
• Strengthening nurses' moral development through ethics education and cultural competence training is crucial.