Evidence map›Paper›PMID 40782310›Full record

ArticleHEC forum : an interdisciplinary journal on hospitals' ethical and legal issues2026

Evaluating Nurse Conscientious Objection: Application of a Novel Framework.

Maya Zumstein-Shaha, Lucia D Wocial, Vicki D Lachman, Norah Louise Johnson, Cynda Hylton Rushton, Pamela J Grace

Abstract read
In one paragraph

Article in HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Maya Zumstein-ShahaDepartment of Health, Bern University of Applied Sciences Health, Murtenstrasse 10, Bern, CH-3008, Switzerland. maya.zumsteinshaha@bfh.ch.ORCID 0000-0003-4253-3123
Lucia D WocialJohn J. Lynch Center for Ethics, MedStar Washington Hospital Center (MWHC), Washington, DC, USA.ORCID 0000-0003-4701-0794
Vicki D LachmanV.L. Associates, Sarasota, USA.
Norah Louise JohnsonCollege of Nursing, Marquette University, Milwaukee, USA.ORCID 0000-0001-6030-6739
Cynda Hylton RushtonJohns Hopkins University School of Nursing & Berman Institute of Bioethics, Baltimore, USA.ORCID 0000-0001-7582-5849
Pamela J GraceBoston College, Chestnut Hill, USA.ORCID 0000-0003-1487-844X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Certain moral beliefs and/or values about what is good or harmful can cause nurses and other healthcare professionals to object to participating in some clinical actions. Such objections are also called conscientious objections. Invocation of a conscientious objection (CO) can produce complexities in patient care and health care delivery and must be mindfully evaluated for its soundness. In this manuscript, a recently developed framework, The Ethical Evaluation of a Nurse's Conscientious Objection (EENCO), is applied to expose hidden elements and nuances in a proposed or actual CO by nurses or other healthcare professionals, thereby illuminating strategies that can lessen associated harms. The EENCO is utilized to explore two types of situations where a nurse makes a CO claim. Scenario 1 involves a nurse's reluctance to follow provider medication orders intended to relieve pain and suffering at the end-of-life. In scenario 2, nurses object to a visitation policy during the COVID-19 pandemic. Additionally, we provide a summary of the necessary elements of institutional policy to address claims of CO using the EENCO. Drawing on the EENCO, the two scenarios were analyzed for their ethical implications. This framework contributes to the exposure, scrutiny, and clarification of potentially unappreciated aspects of CO claims. Steps for developing institutional policy are identified. Application of the EENCO guides the analysis of the two scenarios. CO claims are explored more deeply, thereby revealing implications for those involved. Additionally, the EENCO provides guidance for the development of institutional CO policies.

Indexed as

Attitude of Health PersonnelConscienceConscientious Refusal to TreatEthics, NursingRefusal to TreatCOVID-19HumansPandemicsSARS-CoV-2Conscientious commitmentConscientious objectionFramework for evaluation conscientious objectionPalliative sedationVisitor restriction

Identifiers

PMID40782310
PMCPMC13194231

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.