Factors Contributing to Discriminatory Nursing Care: A Qualitative Study From Nurses' Experiences.

backgroundJustice and non-discrimination are core principles of professional nursing ethics. Yet, growing evidence shows that discriminatory behaviours still occur in clinical environments. This study seeks to explore clinical nurses' experiences and perceptions regarding the factors that lead to discrimination in nursing care.

methodsThis qualitative secondary analysis employed a conventional content analysis. The dataset comprised 13 in-depth, semi-structured interviews with clinical nurses working in public and private hospitals in Tehran, Iran. These data were originally collected between June 2023 and May 2024 for two primary studies by the same research team. Purposive sampling with maximum variation was used. The data analysis was conducted manually following the method outlined by Graneheim and Lundman. Trustworthiness was maintained by applying Lincoln and Guba's criteria, including member checking, peer debriefing, and external audit.

resultsThree main categories of factors contributing to discrimination in nursing care were identified: (1) patient-related factors (including social and economic status, demographic characteristics, clinical condition, and interaction and behavioural characteristics); (2) organizational factors (including hospital policies and guidelines, resource constraints, workload pressures, external influence or interference, and lack of formal education on discrimination and justice); and (3) nurse-related factors (including receipt of informal benefits and nurses' prior experiences and emotions).

conclusionDiscrimination in nursing care is a complex, systemic issue that results from the interactions between patient traits, organizational needs, and individual nurse factors. Addressing this effectively involves shifting from a solely individual approach to implementing organizational changes, alleviating systemic pressures, and offering focused education on justice and non-discrimination within nursing practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The findings provide a multi-level causal framework to guide interventions at the point of care, the unit level, and the educational level. Addressing organizational pressures, informal referrals, and educational gaps can reduce discriminatory practices and promote equitable, dignity-conserving care. IMPACT: This study addresses the question of why discriminatory nursing care occurs, moving beyond descriptive accounts to identify actionable contributing factors. The findings benefit nurses, nursing managers, educators, and policymakers by providing an evidence base for targeted interventions. REPORTING

methodThe study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.