Perspectives of nurses and patient representatives on the morally competent nurse: An international focus group study.

Background: Across the world, healthcare systems have become increasingly complex, making it more difficult for nurses to act ethically when faced with moral dilemmas. The COVID-19 pandemic in particular revealed ethical challenges, highlighting the need for nurses to attain high levels of moral competence. Nurses who attain moral competency provide superior patient care because they have integrated clinical competence with sensitivity to moral values. Understanding what comprises moral competence in nursing is crucial to stimulate and support consistent ethical behaviour. However, most studies to date on moral competence in nursing have been conducted at a national level and only from a particular stakeholders' perspective, thereby limiting their utility. Objective: To explore and document the characteristics of the morally competent nurse from the perspectives of nurses and patient representatives practicing in Europe. Design: A descriptive qualitative study was conducted. Methods: Semi-structured focus group discussions were conducted to collect data. Data were analysed with a descriptive thematic method. Participants: A purposive sample of 38 nurses and 35 patient representatives was recruited. They were geographically spread across six European countries. Results: The overarching characteristic of a morally competent nurse that emerged from our thematic analyses of group discussions is that they are person-centred. This person-centred quality is expressed on intrapersonal and interpersonal levels. The theme 'main components of moral competence in nurses' can be divided into three subthemes: knowledge, skills, and attitudes. Conclusions: This study provided a deeper understanding of moral competency in nurses, from both the perspective of nurses and patient representatives in Europe. Morally competent nurses are person-centred and possess the requisite knowledge, skills, and attitudes that foster positive relationships with patients and their families, as well as with their nursing colleagues. Pedagogically, the results should be useful for teaching how moral competence can be supported in practice and how nurses can be better prepared to deal with ethically sensitive care practices in constantly evolving healthcare systems.