{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:56:18Z","timestamp":1793166978983,"version":"4.5.0"},"reference-count":97,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The COVID-19 pandemic has posed unprecedented challenges for nurses, including resource shortages, heavier workloads, and ethical decision-making pressures, putting them at high risk for moral injury. This threatens their physical and mental health, job stability, and the quality of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The aim was to systematically assess the level of moral injury among nurses during the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive search was conducted on 12 databases (PubMed, Web of Science, MEDLINE, ProQuest, Embase, CINAHL, Scopus, PsycINFO, CBM, CNKI, VIP, WanFang Data) for cross-sectional studies published up to 20 July 2025, that reported the level of moral injury among nurses using the Moral Injury Symptoms Scale\u2014Health Professionals Version. A systematic review and meta-analysis were conducted. Two researchers independently screened the literature, extracted data, and assessed methodological quality. The pooled mean score was calculated using random-effects or fixed-effects models, with subgroup analysis to explore heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethical considerations<\/jats:title>\n                    <jats:p>Ethical approval was not required as the review synthesized publicly available data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study included 16 articles, involving 5824 participants. The meta-analysis showed that the pooled mean total MISS-HP score for nurses was 42.12 (95% CI: 40.70\u201343.53). Among the dimensions, the pooled mean score for Loss of religion\/spiritual faith was the highest at 5.68 (95% CI: 4.61\u20136.74), while the pooled mean score for religious struggles was the lowest at 2.26 (95% CI: 1.13\u20133.40). Subgroup analysis results indicated significant differences in moral injury levels among nurses based on Survey year and department (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Under the context of the COVID-19 pandemic, nurses experienced moderate to high levels of moral injury, particularly during the early stages of the pandemic in 2020, with emergency department nurses being most affected. To support nurses\u2019 well-being and mental health, healthcare institutions should strengthen ethical support systems, improve management, and consider the role of religion\/spiritual faith in alleviating moral injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09697330251407217","type":"journal-article","created":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:25:46Z","timestamp":1769214346000},"page":"945-962","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Moral injury in nurses during COVID-19: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2163-9874","authenticated-orcid":false,"given":"Zhehui","family":"Yang","sequence":"first","affiliation":[{"name":"Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9262-3659","authenticated-orcid":false,"given":"Hong","family":"Yan","sequence":"additional","affiliation":[{"name":"Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2562-5721","authenticated-orcid":false,"given":"Shijin","family":"Wang","sequence":"additional","affiliation":[{"name":"Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Liu","sequence":"additional","affiliation":[{"name":"Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuling","family":"Luo","sequence":"additional","affiliation":[{"name":"Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Tang","sequence":"additional","affiliation":[{"name":"Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Zhang","sequence":"additional","affiliation":[{"name":"Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"e_1_3_6_2_2","volume-title":"Strategic plan 2024-2028","author":"International Council of Nurses","year":"2024","unstructured":"International Council of Nurses. 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