{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:19:45Z","timestamp":1789042785678,"version":"build-2803163510"},"reference-count":45,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100005911","name":"Najran University","doi-asserted-by":"crossref","award":["NU\/CPL\/MRC\/14\/4617-2"],"award-info":[{"award-number":["NU\/CPL\/MRC\/14\/4617-2"]}],"id":[{"id":"10.13039\/501100005911","id-type":"DOI","asserted-by":"crossref"}]}],"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>Vaccine hesitancy can generate moral distress when nurses\u2019 duty to protect children conflicts with parental decision-making authority, family dignity, and longitudinal trust.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research question\/aim\/objectives<\/jats:title>\n                    <jats:p>To interpret how primary health care nurses experience and negotiate moral distress during vaccine-hesitancy encounters with families in culturally diverse Saudi primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design<\/jats:title>\n                    <jats:p>A qualitative Interpretive Description study informed by moral distress theory. In-person semi-structured interviews were analysed using reflexive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>and research context: Twenty-two registered nurses from 20 primary health care centres in one southern Saudi health cluster participated. Purposive recruitment lacked a fixed sampling frame or approach log; therefore, a conventional response rate was not calculable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethical considerations<\/jats:title>\n                    <jats:p>Najran University Research Ethics Committee approved the study, and the health cluster granted permission. Written informed consent, confidentiality, and voluntary participation were maintained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings\/results<\/jats:title>\n                    <jats:p>Participants\u2019 retrospective accounts generated four themes: constrained action despite knowing what responsible practice required; moral agency negotiated through family, faith, and gendered authority; cumulative moral residue; and organisational ethical responsibility. Family decision hierarchy was the most consistently described cultural constraint, while religious interpretation and gendered credibility shaped particular encounters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Within this single-cluster sample, nurses\u2019 moral distress was interpreted as a relationally and organisationally mediated ethical burden shaped by family hierarchy, religious reasoning, gendered credibility, and limited organisational support. Participant-informed ethics case forums, shared escalation pathways, and team-based support warrant local piloting and evaluation as potential strategies to support nurses\u2019 moral voice while preserving respectful dialogue and longitudinal trust.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09697330261483628","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:17:17Z","timestamp":1788758237000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Caught between care and conviction: Primary health care nurses\u2019 moral distress during vaccine-hesitancy encounters in a culturally diverse context"],"prefix":"10.1177","author":[{"given":"Ghada Elsaid Ali","family":"Elsayed","sequence":"first","affiliation":[{"name":"Najran University"},{"name":"Najran University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9616-8590","authenticated-orcid":false,"given":"Osama Mohamed Elsayed","family":"Ramadan","sequence":"additional","affiliation":[{"name":"Jouf University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wargaa Hashim","family":"Taha","sequence":"additional","affiliation":[{"name":"Najran University"},{"name":"Najran University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"Majmaah University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahad Rubayyi T.","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Ministry of Health, Jouf Health Cluster"},{"name":"King Abdulaziz Specialist Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamda Ahmed Mohamed","family":"Eldesoky","sequence":"additional","affiliation":[{"name":"Najran University"},{"name":"Najran University"},{"name":"Medical-Surgical Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2015.04.036"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines9070713"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/jan.16468"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733017724354"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733020966776"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733019889400"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines11091400"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-13232-7"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S559857"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.752323"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2023.2190716"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/10436596241291839"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-022-00868-8"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/nup.12419"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780198237907.001.0001"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9566.13209"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/nup.70101"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2025.105313"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18147565"},{"key":"e_1_3_6_21_2","volume-title":"Nursing practice: the ethical issues","author":"Jameton A","year":"1984","unstructured":"Jameton A. 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