{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:36:44Z","timestamp":1792093004899,"version":"4.4.0"},"reference-count":53,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Centre of Clinical Research S\u00f6rmland, Uppsala University, Sweden","award":["DLL-940876"],"award-info":[{"award-number":["DLL-940876"]}]},{"name":"the Centre of Clinical Research S\u00f6rmland, Uppsala University, Sweden","award":["DLL-969033"],"award-info":[{"award-number":["DLL-969033"]}]},{"name":"the Centre of Clinical Research S\u00f6rmland, Uppsala University, Sweden","award":["DLL-982312"],"award-info":[{"award-number":["DLL-982312"]}]},{"name":"The Regional Research Council in Mid Sweden","award":["RFR-939378"],"award-info":[{"award-number":["RFR-939378"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,11]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to explore the process of moral resilience among frontline healthcare professionals. By delving into experiences of handling moral challenges during a pandemic crisis, we aimed to understand dimensions of moral resilience, affecting factors and consequences. This understanding can inform the implementation of interventions to support healthcare professionals\u2019 well-being and ability to deliver high-quality care, under both routine and extreme conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A qualitative exploratory study was conducted using grounded theory methodology. Data were collected retrospectively through written narratives and individual interviews (September to November 2020).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>General hospital wards allocated for patients with COVID-19 in two Swedish healthcare regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>46 informants, comprising registered nurses, nursing assistants, physicians, managers and allied health professionals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A conceptual model is presented that describes and explains the process of moral resilience among frontline healthcare professionals working in general hospital wards during a pandemic crisis. The model reveals a complex and dynamic iterative process, with components at both the individual and system levels being inevitably inter-related.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings emphasise that moral resilience within healthcare organisations is not solely dependent on individual qualities but also influenced by the working groups or teams, leadership and prevailing organisational structures. Supportive interventions should target workgroup dynamics and organisational culture while providing tailored support for individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-104065","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T16:20:27Z","timestamp":1774282827000},"page":"e104065","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Struggling to cope in an unknown realm: a qualitative study of moral resilience in frontline healthcare professionals in Swedish hospital wards during a pandemic crisis"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0667-7111","authenticated-orcid":false,"given":"Lena","family":"Nordgren","sequence":"first","affiliation":[{"name":"Uppsala universitet Disciplinary Domain of Medicine and Pharmacy, Uppsala, Sweden"},{"name":"Centre for Clinical Research, County Council in S\u00f6rmland, Eskilstuna, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9376-846X","authenticated-orcid":false,"given":"Malin","family":"Lohela Karlsson","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden"},{"name":"Centre for Clinical Research, Region V\u00e4stmanland, V\u00e4stmanland Hospital V\u00e4ster\u00e5s, Uppsala universitet Medicinska fakulteten, V\u00e4ster\u00e5s, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4525-1623","authenticated-orcid":false,"given":"Emelie","family":"Cond\u00e9n Mellgren","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research, Uppsala Universitet, V\u00e4ster\u00e5s, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0883-4072","authenticated-orcid":false,"given":"Camilla","family":"G\u00f6ras","sequence":"additional","affiliation":[{"name":"Department of Caring Sciences, University of Gavle Department of Occupational Health and Psychology, Gavle, Sweden"},{"name":"School of Health and Welfare, Department of Caring Sciences, Dalarna University, Falun, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petronella","family":"Bjurling-Sj\u00f6berg","sequence":"additional","affiliation":[{"name":"Public Health and Caring Sciences, Health Service Research, Uppsala University Faculty of Medicine, Uppsala, Sweden"},{"name":"Department of Patient Safety, Region S\u00f6rmland, Eskilstuna, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"2026032309201383000_16.3.e104065.1","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1177\/0969733016664975","article-title":"Moral distress in critical care nursing: the state of the science","volume":"25","author":"McAndrew","year":"2018","journal-title":"Nurs Ethics"},{"key":"2026032309201383000_16.3.e104065.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12910-023-00919-8","article-title":"Moral distress and positive experiences of ICU staff during the COVID-19 pandemic: lessons learned","volume":"24","author":"van Zuylen","year":"2023","journal-title":"BMC Med Ethics"},{"key":"2026032309201383000_16.3.e104065.3","doi-asserted-by":"publisher","DOI":"10.1177\/0969733012462049"},{"key":"2026032309201383000_16.3.e104065.4","doi-asserted-by":"publisher","DOI":"10.1177\/0969733017724354"},{"key":"2026032309201383000_16.3.e104065.5","doi-asserted-by":"publisher","DOI":"10.1111\/bioe.12064"},{"key":"2026032309201383000_16.3.e104065.6","unstructured":"Jameton A . 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