{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:25:51Z","timestamp":1787300751850,"version":"build-2736575974"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"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"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Violations in healthcare practice represent significant ethical and clinical challenges. Although often categorized as technical failures, they are strongly influenced by organizational culture and professional decision-making. Understanding how frontline practitioners conceptualize these deviations is essential for strengthening patient safety and ethical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the meanings attributed by healthcare professionals to violations in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This qualitative study employed online focus groups with 26 healthcare professionals from different disciplines, predominantly from the nursing workforce (73%). Data were collected using a structured discussion script, transcribed verbatim and analysed through Bardin\u2019s thematic content analysis. The study followed the COREQ guidelines to ensure methodological rigor. Ethical approval was obtained (Protocol 5.871.911).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethical considerations<\/jats:title>\n                    <jats:p>The study was approved by the relevant Research Ethics Committee (Protocol No. 5.871.911). All participants received information about the study and provided informed consent before data collection. Participation was voluntary, and confidentiality and anonymity were protected throughout data collection, analysis and reporting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants described violations as conscious deviations from safe practice and acknowledged their potential consequences for patient safety. The findings reveal a process of normalization of deviance driven by precarious working conditions, institutional traditions, and resource constraints. Although participants\u2019 perceptions converged with theoretical definitions regarding the operational characteristics of violations, their formal conceptual understanding remained limited. A tension also emerged between learning-oriented strategies and persistent punitive approaches focused on individual culpability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Healthcare professionals recognize key elements of violations and emphasize the role of continuing education in addressing them. However, conceptual gaps and punitive cultures hinder the full appropriation of the construct in clinical practice. These findings contribute to nursing ethics by highlighting how organizational conditions shape the ethical management of deviations from safe practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09697330261474059","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T09:12:08Z","timestamp":1787044328000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare professionals\u2019 conceptualisation of care violations as deviance: a qualitative study"],"prefix":"10.1177","author":[{"given":"Natana de","family":"Morais Ramos","sequence":"first","affiliation":[{"name":"State University of Cear\u00e1 (UECE)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4188-0115","authenticated-orcid":false,"given":"Matheus Tavares Fran\u00e7a da","family":"Silva","sequence":"additional","affiliation":[{"name":"State University of Cear\u00e1 (UECE)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Beatriz Nunes de","family":"Carvalho","sequence":"additional","affiliation":[{"name":"State University of Cear\u00e1 (UECE)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8600-4413","authenticated-orcid":false,"given":"Adriana","family":"Catarina de Souza Oliveira","sequence":"additional","affiliation":[{"name":"Facultad de Enfermer\u00eda Universidad Cat\u00f3lica de Murcia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3406-9685","authenticated-orcid":false,"given":"Rhanna Emanuela Fontenele Lima","family":"de Carvalho","sequence":"additional","affiliation":[{"name":"State University of Cear\u00e1 (UECE)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"issue":"4","key":"e_1_3_4_2_2","article-title":"Adhering to patient safety standards: a healthcare imperative for the 21st century","volume":"6","author":"Researcher, Medical Ethics and Law, College of Medicine, University Y, Mokeke IR, Centre Hospitalier Universitaire Renaissance, Kinshasa, Congo DR, Kim SY, Professor, Director of Yonsei University Medical Law and Ethics Research Institute, Yonsei University Graduate School of Public Health, Korea, Young-soon C","year":"2024","unstructured":"Researcher, Medical Ethics and Law, College of Medicine, University Y, Mokeke IR, Centre Hospitalier Universitaire Renaissance, Kinshasa, Congo DR, Kim SY, Professor, Director of Yonsei University Medical Law and Ethics Research Institute, Yonsei University Graduate School of Public Health, Korea, Young-soon C, et al. Adhering to patient safety standards: a healthcare imperative for the 21st century. Med Clin Sci 2024; 6(4). https:\/\/doi.org\/10.33425\/2690-5191.1127","journal-title":"Med Clin Sci"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.4324\/9781315543543"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-25559-0"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2025.1579265"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-175"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1201\/9781315607511"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/01939459211030334"},{"key":"e_1_3_4_9_2","doi-asserted-by":"crossref","unstructured":"Beyamo A Dodicho T Facha W. Compliance with standard precaution practices and associated factors among health care workers in Dawuro Zone South West Ethiopia cross sectional study. BMC Health Serv Res 2019; 19(1): 381. 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