Concept analysis of moral disengagement among nurses in the intensive care unit: A hybrid model

Ali  Khanipour-Kencha; Alun C.  Jackson; Fatemeh  Bahramnezhad

doi:10.18502/npt.v12i4.19654

Ali Khanipour-Kencha Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Alun C. Jackson Center on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong, China
Fatemeh Bahramnezhad Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/npt.v12i4.19654

Keywords: moral disengagement; nurses; intensive care unit; concept analysis; hybrid model

Abstract

Background & Aim: Moral disengagement may result in unethical behavior, compromising patient safety in Intensive Care Units. This study aims to provide a clear and culturally grounded definition of moral disengagement among Iranian ICU nurses.

Methods & Materials: This research employed a hybrid concept analysis model based on Schwartz-Barcott and Kim’s approach in three phases: 1) Theoretical phase: A comprehensive literature review was conducted using relevant keywords in Iranian and international databases. Sixteen relevant peer-reviewed articles were selected and analyzed using conventional content analysis based on Graneheim and Lundman’s method. 2) Fieldwork phase: In-depth semi-structured interviews were conducted with 20 ICU nurses selected via purposive sampling. Data were coded and analyzed using qualitative content analysis to extract themes. 3) Final analysis phase: The data from the previous phases were integrated to develop a refined and context-based definition.

Results: In the theoretical phase, key attributes included moral justification, cognitive reconstruction, detachment from ethical standards, and absence of moral emotions. Fieldwork analysis yielded 301 codes categorized into three main themes and seven subthemes, emphasizing illegitimate legitimization through commitment avoidance, self-justification, and cognitive reconstruction, as well as assurance of job and psychological security, and feelings of individual and organizational satisfaction. The findings from these phases contributed to the final definition.

Conclusion: Moral disengagement among ICU nurses is defined as: “The employment of protective mechanisms of justification, pleasant cognitive reconstruction of the event, and commitment avoidance to legitimize unethical activities aimed at preserving job security, psychological safety, and individual and organizational satisfaction.” This definition offers a practical foundation for future research and ethical interventions in critical care.