Professional identity and moral agency in palliative care: A review

Background: Nurses and social workers play central roles in palliative care. While moral agency and professional identity have been widely studied, they are rarely examined together, leaving their intersection in palliative care insufficiently understood. Aim: The aim of this integrative review was to identify and analyze the key enablers and barriers influencing the construction of professional identity and the enactment of moral agency among nurses and social workers in the context of palliative care.Methods: The synthesis followed Whittemore and Knafl's integrative review methodology. 12 databases were queried between February 2022 and November 2023, and a manual search was conducted to identify additional publications. Qualitative analysis was performed using the three concurrent analytic activities proposed by Miles, Huberman, and Saldaña.Results: Of the initial 1448 articles retrieved, 34 were selected through screening, and 4 additional articles were included through manual search, for a total of 38 articles reviewed. For moral agency, the enablers were supportive cultures, relationships with patients and their relatives, and moral capacities and inner dispositions. The barriers identified were restrictive cultures, insufficient resources and workload, and interpersonal value conflicts and moral dissonance. For professional identity, the enablers included making a difference for patients, advocating for patient choices, and patient gratitude as a recursive loop. The main barriers were biomedical dominance and professional devaluation, and value tensions and emotional norms. This review revealed that both concepts are predominantly explored within the nursing literature, are deeply interconnected, and tend to reinforce each other. They also share common enablers and barriers in palliative care settings.Conclusion: The findings suggest the importance of incorporating both concepts into nursing education to support ethical competence in palliative care and to help mitigate the moral distress often experienced by nurses.Hoping this resolves the issue.