Moral resilience in the face of ethical conflicts in hospital nursing practice: a qualitative study.

Résumé

BACKGROUND: Moral resilience has become an increasingly relevant capacity in nursing, particularly in hospital settings, where recurring ethical dilemmas and organizational constraints may compromise nurses' moral judgment and professional well-being. In this context, the present study aimed to understand moral resilience among nurses working in hospital practice.METHODS: This qualitative, exploratory, and descriptive study included 30 clinical nurses working in adult and pediatric medical and surgical units of a university hospital. Data were collected between July and August 2025 through semi-structured interviews. The textual corpus was processed using IRAMUTEQ software, applying the Descending Hierarchical Classification (DHC) method, and analyzed according to the principles of Discursive Textual Analysis.RESULTS: The textual corpus generated five lexical classes, organized into three emergent categories: "Ethical dilemmas and learning processes in the construction of moral resilience," "Interpersonal relationships, communication, and institutional limits in the exercise of moral resilience," and "Processes of moral transformation and strengthening." The findings revealed that nurses experience recurrent ethical conflicts in everyday hospital practice, which challenge their moral integrity, particularly when reconciling personal values, professional principles, and institutional demands. Moral resilience emerged as a dynamic and relational process, developed through experience, ethical reflection, interpersonal relationships, spirituality, and the confrontation of situations involving suffering, finitude, and organizational constraints.CONCLUSIONS: The findings indicate that strengthening moral resilience depends not only on individual attributes but is deeply influenced by workplace relationships, institutional ethical climate, and organizational conditions. These results underscore the importance of educational and institutional strategies that promote dialogue, ethical reflection, interprofessional collaboration, and professional support in daily clinical practice, contributing to quality of care, patient safety, and nurses' ethical well-being.