An ethical framework for hemodialysis nurses: A qualitative study

Background Hemodialysis nurses face complex ethical challenges in their practice. However, a few studies have comprehensively integrated relevant factors to investigate the ethical issues. Aim To develop a systematic framework to categorize and analyze the ethical challenges encountered by hemodialysis nurses. Research design This study follows a qualitative descriptive study. Participants and research context The sample comprised 31 hemodialysis nurses from seven hospitals (six Traditional Chinese Medicine hospitals and one general hospital) across six cities in Shandong Province, China. Data were collected through focus group discussions and in-depth individual interviews, and analyzed using inductive thematic analysis. An ethical framework was constructed based on the social-ecological theory. Ethical considerations The proposal was approved by the Ethics Committee of the local university. Participation in this study was voluntary. Written or electronic informed consent was obtained, and confidentiality was ensured. Results Ethical dilemmas experienced by hemodialysis nurses were grouped into three themes with eight subthemes and 21 subcategories, and a multi-systemic ethical dilemma model was developed, encompassing macro-level dilemmas involving policy and organizational dimensions; meso-level interactions among healthcare providers and patients; and micro-level individual struggles. Conclusion This study introduces a multi-systemic model that elucidates the permeation of ethical stress across societal, interpersonal, and individual levels in hemodialysis nursing. By demonstrating how ethical dilemmas are systemically produced and sustained, this framework fundamentally shifts the discourse from mere description to theoretical explanation. The findings underscore that synergistic, multi-level interventions—integrating organizational and policy changes with individual support—are imperative. We therefore advocate for the adoption of this integrated perspective across research, policy, and clinical management to develop sustainable solutions that bolster hemodialysis nursing practice and fortify the entire care ecosystem.