Moral emotional experience and coping strategies of ICU nurses

Moral emotional experience and coping strategies of ICU nurses | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Moral emotional experience and coping strategies of ICU nurses zhenzhen xu, Weifang Mao, Hong Ji, Xiaojing Guo, Yuchen Zhang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6340985/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : The Intensive Care Unit (ICU) is a ethical and moral workplaces characterized by moral sensitivity. Nurses working in ICUs inevitably experience many moral dilemmas, which result in moral emotions that affect nurses' physical and mental health as well as work efficiency and quality. The purpose of this study is to explore the occurrence, impact, and coping experience of moral emotions among ICU nurses, in order to lay the foundation for improving the situation of moral emotions among ICU nurses and exploring moral emotion management programs. Aims and objectives : To understand the occurrence, impact, and coping experience of moral emotions among ICU nurses. Research design : A qualitative descriptive study. Methods : A descriptive qualitative study was conducted, utilizing purposive sampling to select ICU nurses in June 2024 for qualitative interviews, and the Colaizzi 7-step method was used to analyze the data. Results : A total of 13 nurses participated in the interviews, and the results consisted of 3 themes and 9 sub-themes, including the situation of moral emotions experience (positive moral emotions experience, negative moral emotions experience), the impact of moral emotions on nurses (awareness and attitudinal impact, behavioral impact), and the experience of coping with moral emotions (negative avoidance coping, conflict and balance management, value preference choices, whining confabulation, and help-seeking). Conclusion : Managers should pay attention to moral emotions faced by ICU nurses, including negative and positive emotions, actively screen and assess the situation of nurses' moral emotions affecting themselves, and target multi-channel comprehensive intervention strategies to guide nurses to positively view and cope with moral emotions. Relevance for clinical practice : This study makes up for the research gap of nurses' moral emotions in moral dilemmas, and explores the moral emotions and coping situations of ICU nurses, which helps us to better identify and manage moral emotions, and helps to maintain nurses' mental health. intensive care unit moral emotions emotional experience coping strategies 1. Introduction Morality is an agreed upon code of conduct and norms to be followed [1] , and the current definition of morality is divided into two main schools of thought, with some scholars arguing that morality is “a set of universal norms shared by all who are committed to morality”. From these norms, a number of principles about duties, rights and virtues are derived or formulated. It has also been argued that morality is a dynamic process with individualized characteristics, which comes from and influences human behavior, and which is also expressed and reflected through certain media, and that there are differences in the moral norms followed and recognized by people with different characteristics [2] . Emotions are the subjective feelings of an individual after experiencing an event, and a person's emotions reflect the perception and understanding of an event, as well as the most intuitively manifested phenomenon after a person's exposure to an event. It has been pointed out that a person who encounters a morality-related event will produce corresponding emotions, which contain a reflection of the understanding of morality and moral compliance [3] . So there may be some close relationship between morality and emotions. Wilkinson considers moral dilemma as a psychological imbalance and a negative emotional state in which one's moral judgment affects moral action [4] , further analyzing the concept, moral dilemma can be considered as a situation of failure of moral following and emotion regulation. Nowadays, research trends are increasingly emphasizing that reason and emotion play an important role in moral judgment, and Batavia [5] scholars believe that emotion is the basis of moral judgment and decision-making. Based on the results of this research also the additional product of moral emotions was derived from moral dilemmas. Moral emotions were first applied to child psychology, they believe that moral emotions have a close relationship with children's intellectual development, emotional understanding and character formation, and that positive moral emotions lead to sharing desires and pro-social behavior [6] . Some scholars also broadly define their moral emotions as “emotional symptoms” and believe that moral emotions are characterized by transcendence (affecting personality and behavior), communicability (expressed through verbal and nonverbal means), and polarity (fluctuating in dual terms, e.g., joy and sadness) [7] , and that they are the subjective emotions that arise after the occurrence of a person's moral judgment and moral behavior. subjective feelings that arise after the occurrence of a moral act, and also the emotional way in which the judge himself or herself follows moral codes and norms [8] . Moral emotions are more reflective of human moral norms and codes of behavioral activities than other emotions and are more critically accessible, and the study of moral emotions helps us to better understand their inner activities. In medical activities we should pay more attention to the moral and ethical issues in the ICU, which is highly ethically sensitive. Mainly because of the relatively closed environment in which ICU care is carried out (lack of family members), the complexity of the treatment process, the need for ICU patients to undergo many specialized operations, and the rigor of the operation all depends on the prudence of the nurse. In addition, nurses do not have a strong sense of privacy protection for ICU patients, which leads to more ethical problems of the protective principle in nurse-patient interactions [9] . The problems of high economic expenses and bed tension in ICUs can lead to ICU nurses' tendency to choose the admitted patients, which violates the principle of equality of life [10–11] . These problems above are more ethical issues caused by different moral consciousness of nurses, which may not be so common in general wards. It is evident that ICU nurses experience more moral and ethical issues and moral dilemmas. Recent trends in ethical research on nurses have focused on moral courage [12] , moral dilemmas, and moral resilience [13] , while ignoring the nurses' own emotional situations caused by ethical issues. Whereas, moral emotions as experiences and feelings that occur when nurses experience moral dilemmas should be emphasized and paid attention to.Bromley [14] argued that shame is a moral emotion that arises in nurses' work, reflecting their sense of culpability after the presence of nursing laxity and shirking of responsibility in their clinical work, and this study confirms that moral emotions can be used as a kind of atmosphere and intrinsic motivation of ethical endeavors, which can strengthen and improve physicians' understanding of their culpability and responsibility in clinical encounters and as a result of reflecting on their behavior. The results of this study began to draw attention to the moral emotions of nurses, and Söylemez [15] further suggested that aversion is also a moral emotion experienced by nurses, and that the aversion of moral emotions is primarily an aversion to morally detrimental behaviors, which creates a protective mechanism for upholding ethical norms. Previous research on moral emotions in nurses has only focused on one moral emotion, but nurses who experience different moral dilemmas will have different moral emotions, and the impact on themselves will certainly vary. This study focuses on ICU nurses, a morally and ethically sensitive group, to explore the occurrence of moral emotions in them and the impact on them. 2 Methods 2.1 Objectives To explore ICU nurses' experiences of moral emotions, the impact on themselves and the coping strategies adopted. 2.2 Design This research is based on a social constructivist view, which acknowledges that multiple interpretations of reality are individuals who interact with their surroundings through social interactio [16] . Based on this, we adopted a qualitative and descriptive research design [17] . Qualitative description design is based on naturalistic inquiry, believing that reality exists in dynamic changes within different individuals, therefore, reality is multiple, subjective, and can be expressed and explained through language carriers [18] . Our goal of qualitative descriptive research is to fully present a descriptive summary of the experiences and perceptions of a group of people, without abstract data presentation [16] . In the current study, this translates to understanding the large emotional and experiential experiences of nurses working in the ICU. The data collection method followed a qualitative descriptive study in which we used semi-structured interviews to find out the status of the nurses' experiences of moral emotions working in the ICU, to analyze how moral emotions affect them and the nurses' experiences of coping with moral emotions. 2.3 Setting A clinical nurse from the Department of intensive Care Medicine of a Grade III Class A general hospital in Shandong Province. 2.4 Ethical approval This study was approved by the Clinical Research Ethics Committee of the XXXXXXXXX with the ethics batch number (XXXXXXXXXXX). All participants signed informed consent forms and were informed of their right to withdraw from participation at any time without giving reasons. 2.5 Participants Conduct purposeful sampling so that recruited participants can provide a wealth of detailed data on the plight of ICU work. The inclusion criteria were :①Participants were registered nurses;②Work in ICU department;③Volunteer to participate in the study; Exclusion criteria: ①study abroad or practice nurse. Sample size is determined by topic saturation. 2.6 Data collection The data was collected on June 2024 . The definition of moral emotions was explained to the nurses prior to the study to ensure that the nurses understood moral emotions and to avoid understanding bias during the interview process. The study used semi-structured interviews to understand the work dilemma situation of ICU nurses, which was guided by the interview outline, which is detailed in Table 1. Table 1 Interview outline Serial number Outline content ① Please talk about your understanding of moral emotions; ② What ethical emotions do you think you would encounter working in an ICU; ③ Please share specifically what moral emotions arise in which situations specifically in your context; ④ Please share the situation of how moral emotions have affected you after experiencing them in ICU work, specifically based on your experience; ⑤ Please tell me about the moral dilemmas you actually encountered and how you managed to resolve the emotions that arose during the process; ⑥ Any other feelings about moral emotions that need to be shared with me; The researchers who participated in this study were systematically trained in qualitative research, mastered the research methodology of qualitative research, and acquired communication skills. Semi-structured interviews were conducted in the form of face-to-face interviews by the first author, who had more than one year of clinical experience in the ICU. The interview time was agreed with the participant in advance and the researcher conducted the interview with the participant in a quiet, private conference room. The interviews started with some general questions, followed by more discussion on topics related to moral emotions. Each interview lasted about 30 minutes. During the interviews, the researcher recorded the participants' nonverbal behavior. After 13 interviews, data collection was completed and the interviews ended. Each interview was audio-recorded, transcribed verbatim over a 24-hour period, and then listened to again by a second researcher. Initially, 79,654 words were transcribed, and the recordings were re-listened to remove redundancies and invalid off-topic text, resulting in a final transcription of 50,792 words with valid value. 2.7 Data analysis The team's researchers independently examined the contents of the transcriptions to ensure their accuracy. The data is applied to topic analysis, including coding, coding grouping, summarizing coding classification, and identifying topics. First, the first author reads the interview carefully to understand what the participants think. Secondly, the researchers encode the meaningful content of each text, and summarize the similar codes identified in each transcribed text into groups of codes. After that, all the members of the research group checked the coding content and summarized its classification. Finally, the topics and subtopics based on coding and classification groups are refined and summarized. 2.8 Rigour First, open-ended questions are used to ensure the reliability of qualitative data. Second, during the analysis, the two researchers read the text independently to identify themes and categories. Finally, the researchers compare topics and categories and revise them through group discussions until a consensus is reached. 3 Results 3.1 General situation of the research object A total of 13 ICU nurses participated in the interviews, 8 females and 5 males with a mean age of (31.3±5.06) years. The working experience of the participants ranged from 6 months to 17 years.53.8% of the participants were senior nurses and their general demographic information is detailed in Table 2. Table 2 General Demographic Data (n=13) Coding Coding Age (years) Education Title Years of experience in the custodial unit N1 Female 27 Graduate senior 9 months N2 Female 40 Undergraduate Intermediate 17 years N3 Male 39 Undergraduate Intermediate 14 years N4 Female 26 Undergraduate senior 3 years N5 Female 26 Undergraduate senior 6 years N6 Female 36 Undergraduate Intermediate 12 years N7 Female 28 Graduate senior 1 years N8 Male 30 Undergraduate Intermediate 8 years N9 Female 35 Undergraduate Intermediate 9 years N10 Female 34 Undergraduate Intermediate 12 years N11 Male 31 Undergraduate Intermediate 6 years N12 Male 25 Undergraduate senior 6 months N13 Male 30 Undergraduate senior 5 years 3.2 Interview Results Analysis of the interview data yielded the following three themes and nine sub-themes, including the experience of moral emotions (positive moral emotions experience, negative moral emotions experience), the influence of moral emotions on nurses (awareness and attitudinal influence, behavioral influence), and the experience of coping with moral emotions (negative avoidance coping, conflict and equilibrium management, value-preference choices, whiney confabulation, and help-seeking). 3.2.1 Moral Emotional Experience Situation 3.2.1.1 Positive moral emotion experience ① Pride Some respondents said that they feel pride in the treatment of ICU patients, and they believe that this pride is because they conform to their moral beliefs, so they believe that pride is a positive moral emotion. N2: "I will often treat severe patients, and I will feel a sense of accomplishment after successful treatment, have self-satisfaction, and gain positive moral emotions." N5: "I feel that working in ICU is more challenging and needs to face more emergencies than other departments. I am proud of my professional ability." N8: "The patient has survived the critical period under my care, and I feel proud and proud of my family's gratitude every time." ② Sense of mission Most of the nurses who participated in the study said that they, as nurses, are synonymous with "angels in white" and need to take the mission and responsibility to protect patients' lives. Whether it is humanitarian or social responsibility, this is their mission. N7: "Since I decided to become an angel in White, I know I have a certain responsibility and mission, and my work ethic supports me to devote myself to patient care." N10: "My moral sense has always reminded me to devote myself to nursing work, and will guide me to uphold the integrity of my work and fulfill the nursing mission." ③ Sense of responsibility Some respondents said that most nurses working in ICU have a certain sense of responsibility, and in the process of caring for patients, a sense of responsibility is an important guarantee that they can serve patients wholeheartedly. N6: "As the last line of defense to protect the patient's life, I have a certain responsibility to protect his health, and I need to observe the patient's situation at all times to prepare for effective nursing measures in time." N11: "I have a duty in this position to protect the lives and health of my patients, both in terms of professional ethics and humanitarianism." N12: "We must have a sense of responsibility. This is the moral bottom line of our work." 3.2.1.2 Negative moral emotion experience ① Guilt The nurses who participated in the study said that when they were unable to save the lives of patients, or were unable to maintain the lives of patients in high quality, they attacked their moral bottom line and generated feelings of guilt. N7: "I feel guilty when we try all kinds of treatments and we can't save the patient's life." N13: "Nurses have a certain role to play in the ICU, but the patients are seriously ill, and what we can do as nurses is limited, and I still feel guilty when I can't do more." ② Fear Some new nurses said that there are many emergencies when they first enter the work environment, and they are full of fear when facing critically ill patients, and other nurses said that working in the ICU requires many ethical sensitivities, and they are afraid to face these sensitive issues, afraid to break and violate their ethical principles. N1: "As a new nurse, I have a great fear of caring for seriously ill patients, and I am worried about errors in care." N8: "I now face a work environment with a high incidence of medical disputes in the ICU, where there is a keen sense of ethics, and my lack of experience in dealing with ethical and moral dilemmas, I have a corresponding fear." N12: "Compared with other departments, this department needs to learn more things and is highly professional. At first, it is difficult to accept and I am afraid." ③ Helplessness Some interviewees said that in the face of high standards of work requirements, their lack of competence will produce a sense of helplessness, especially the death of patients, for them is a moral impact, followed by the emergence of moral feelings of helplessness. N1: "In theory, I should have the ability to work in a team and deal with emergencies, but in practice, I am not, even not ideal to participate in the first aid of patients, I am really helpless." N3: "When I face the death of a patient, I feel terribly small and helpless." N4: "When the patient's family expects us to save the patient, but the reality is not, I can not rationally achieve communication, I feel at a loss." 3.2.2 Influence of moral emotions on nurses 3.2.2.1 Awareness and Attitude Influence Some nurses indicated that the impact of moral emotions on consciousness and attitudes was mainly in the areas of moral awareness and professional attitudes. Repeatedly experiencing moral emotions affects the formation of their moral consciousness and moral attitudes. N5: “When I feel a sense of responsibility, I will correct my attitude more, and under the influence of this attitude, my moral consciousness will change and some of my previous bad moral concepts will be corrected.” N6: “Positive moral emotions will lead to the establishment of my altruistic consciousness and correct moral outlook, while negative moral emotions will make me reflect on whether there is something wrong with my original consciousness, and I will go ahead and take the initiative to adjust my consciousness, and in time it will lead to the fixation and formation of a new sense of behavior.” Other respondents indicated that pride, responsibility and sense of mission as positive moral emotions are internal drivers for their career development and will correct their professional attitudes, while negative moral emotions such as guilt and helplessness will make them feel frustrated and aggravate burnout. N2: “The pride gained from working in the ICU is a positive moral emotion, and this emotion will greatly enhance my sense of professional value.” N3: “As an ICU nurse I have a certain responsibility and mission, and this responsibility and mission urges me to correct my work attitude and continuously improve my ability.” N9: “When negative moral emotions arise, they can undermine my professional beliefs and can very much affect the quality of my work.” N13: “When I am helpless, I often think about whether I should give up this job or not, and it makes me have a bad opinion about my attitude towards this job as well.” 3.2.2.2 Behavioral Effects The effects of moral emotions on nursing behavior and social behavior were reported in this study. Most of the nurses reported that negative moral emotions affect the quality of work and directly lead to nursing duty deficient behaviors. Whereas positive moral emotions of being in a position of duty and mission push nurses to be more disciplined in caring for their patients, contributing to magnetic nursing care and reducing nursing deficits.N5: “I often fall into self-denial, especially when a patient dies, which makes me unmotivated to care for other patients.” N8: “When faced with ethical dilemmas, I experience fearful moral emotions that can undermine my courage to say ‘no’ and be detrimental to the maintenance of my high quality work.” N12: “I am afraid and fearful, which tends to make me shy away from my nursing work, which results in guilt, but still fear of making mistakes, and the more I fear, the more mistakes I make, which creates a vicious cycle that is not conducive to my nursing responsibilities.” N10: “I feel that I bear certain responsibilities and missions, as a nurse I have to take care of my patients, and being at the bottom of the moral line, I can't afford to be absent from caring for my patients.” And the influence of moral emotions on their social behavior is mainly manifested in the production of pro-social behaviors. Positive moral sentiments motivate them to actively participate in social assistance and contribute to social development. Whereas, negative moral emotions prevent nurses from sharing and avoiding their social duties.N6: “There is a great need to teach the community at large like the first aid competencies acquired in the department, and I feel it is my duty to teach them.” N11: “I am a member of the hospital's science team, and it is all the professional competencies acquired in the department that will enable me to do this job.” N12: “I am now working and living in such a nice environment, and I hope to be able to bring happiness to others through my behavior.” N13: “Some negative moral emotions at work have discouraged me from volunteering for related field activities once I have finished my regular work.” 3.2.3 Coping experience of moral emotions 3.2.3.1 Negative evasive response Some nurses said that they could not take a positive view of moral emotions. They believed that moral emotions were private things and did not want to reveal and share them. Instead, they used evasive and evasive ways to hide moral emotions and their effects. N2: "When I encounter an incident that is inconsistent with my moral concept in my practical treatment work, I will feel moral emotions, but I cannot change many objective conditions, so I have to hide them." N6: "There will be some uncomfortable things, whether it is for patients, family members or colleagues, but also have to work together, can only collect emotions." N9: "As far as moral emotions are concerned, I am not very willing to say that these things can be secretly thought about in my mind." 3.2.3.2 Conflict and Balance Management Respondents said that moral emotion is the product of the conflict between moral consciousness and behavioral rules, and if I can find a balance point, it will be conducive to the adjustment and transformation of my moral emotion. When they have positive moral emotions, they will continue to balance to play a role in promoting positive moral emotions, and when they have negative moral emotions, they will promote the management and transformation of negative moral emotions by managing conflicts to achieve the final emotional balance. N7: "I need to find a balance between my moral level and ethical impact, and reasonably regulate my emotions without breaking the moral bottom line." N9: "When it comes to life and death, I should learn to put myself in others' shoes so that I don't impose my ideas on others, and empathy is a good way to achieve balance." N13 "In the department, there will be positive moral emotions and negative moral emotions. These two emotions are in conflict with each other, but they can be well balanced and can be transformed into each other under certain circumstances. Therefore, when negative moral emotions are in conflict, I will take certain ways to transform them into positive moral emotions, so that moral emotions can be balanced with each other." 3.2.3.3 Value preference selection Some respondents said that they would regulate moral emotions through value selection preferences, selectively play the positive role of positive moral emotions, or look at problems in a respectful way, so as to avoid negative moral emotions generated by critical psychology. N7: "When I encounter moral dilemmas in the department, I will give priority to the behavior of my subjective consciousness, so that I will not have some negative emotions and will not affect my work." N8: "Negative moral emotions at work can affect my mood, so I usually choose to look at problems from a favorable perspective, which helps me to positively adjust my mood." N11: "Everyone has their own moral concepts and principles of doing things, I should choose to respect others, not criticize and compare at will, which can effectively avoid emotional problems caused by prejudice." 3.2.3.4 Grumbling More than half of the nurses in the study said they felt moral feelings when they encountered an incident at work that did or did not align with their moral values, and they were willing to share their complaints with colleagues, friends and family. They believe that complaining is a very relaxing way to express emotions. N2: "I will share with my family what is not satisfactory and some negative emotions in my work, and complain about it, which will make me feel comfortable." N5: "In the department, I often experience moral dilemmas and have negative moral emotions. I think talking is a good way to adjust my emotions and help me to face life and work with a positive attitude." N9: "Complaining makes me more motivated. I think complaining is an interactive process that not only allows me to express my emotions, but also allows me to recognize my shortcomings, especially in the face of moral dilemmas." 3.2.3.5 Seeking Help Nearly all respondents said that they seek help when they encounter moral emotions that cannot be adjusted, including social support, family support, and hospital management support, but they said that family support is relatively easy to obtain, while social and hospital management support is less available. N5: "When we encounter emotional problems in the department, we would like to get the understanding and support from the leaders, but because of the particularity of the work of nurses, it is difficult for us to get understanding and help." N6: "Whether it's positive or negative moral emotions, I'm more willing to share them with my family." N9: "When negative moral emotions occur, I will take the initiative to seek help. I am more willing to get understanding and help from leaders, which will make me more active in work." 4 Discussion In our findings in-depth analysis of the moral emotions situation experienced by ICU nurses, in the results of the study also found out the situation of moral emotions on the nurses and how they cope with them, in the experience of moral emotions appeared positive moral emotions and negative moral emotions, it was also found that the impact of moral emotions on the nurses was mainly in the attitudinal and behavioral impacts, and in the coping experience respectively, five types of coping measures were adopted Five types of coping measures were taken, including negative avoidance coping, conflict and balance management, value preference selection, whiny confabulation, and help-seeking. Based on our analysis of the moral emotions of ICU nurses, we propose several recommendations aimed at facilitating the active management of these emotions, with the ultimate goal of enhancing the moral well-being of nursing professionals. Elucidating the ethical emotions experienced by nurses and to address these moral sentiments in a rational manner In the research, numerous nurses articulated the moral emotions they encountered in their professional environment, encompassing both positive moral emotions—such as pride, a sense of mission, and responsibility—and negative moral emotions, including guilt, fear, and helplessness. These moral emotions are frequently subjective experiences that arise in response to morally relevant actions, and they significantly influence nurses' work experiences and capabilities. Furthermore, these emotions can serve as predictors of subsequent behaviors to a certain degree. Existing literature indicates that moral emotions are pivotal in shaping behavioral cognition, with emotions serving as reflections of individuals' moral understanding. A lack of emotional cognition may diminish the capacity for empathy and potentially foster violent tendencies [19] .Specifically, individuals who do not experience feelings of guilt or shame tend to possess a less robust moral framework, making them more susceptible to engaging in criminal behaviors. Additionally, moral emotions represent a dynamic interplay between rationality and emotion, functioning as indicators of individual moral evolution. Positive moral emotions signify alignment with moral consciousness and behavior, while negative moral emotions often emerge from moral dilemmas that pit moral actions against moral identity. The evolution of moral emotions can enhance the moral equilibrium of nurses [20] . Moreover, moral emotions are integral to moral decision-making processes, which can be elucidated through the analysis of these emotions [21] . However, it has been suggested that moral emotions can be influenced to a certain extent, and their impact on moral decision-making and consciousness is contingent upon the underlying motivations and types of emotions involved. The effects of moral emotions on moral judgments can vary across different contexts, indicating that while moral emotions are universally experienced during moral dilemmas and judgments, their influence may differ based on the roles and situations of individuals. Consequently, it is imperative to focus on the moral and emotional contexts of ICU nurses, who are particularly sensitive to moral issues, in order to provide positive guidance for their moral judgments and behaviors. Paying attention to the influence of moral emotions on nurses to achieve precise intervention People tend to make choices when they experience emotion-related situations. The findings of this study indicate that moral emotions significantly affect nurses' attitudes, with the most pronounced effects observed in their moral awareness and professional demeanor. However, the influence of moral emotions on an individual's moral consciousness is not unequivocal. Emotions such as guilt can prompt individuals to engage in self-reflection regarding their consciousness and actions, leading them to critically assess their moral awareness and selectively modify their moral frameworks in order to adopt behaviors and principles that align with humanistic values [22] . Nurses who have experienced prolonged exposure to moral emotions may develop specific biases and inclinations within their moral consciousness. Especially nurses who can not face the existence of moral emotions will choose to face moral problems with a avoidant attitude, which will also impact the original healthy moral consciousness and moral concepts. Furthermore, the impact of moral emotions on moral consciousness is characterized by its latent, persistent, and dual nature. The influence and transformation of moral emotions on moral consciousness can lead to alterations in both awareness and behavior following numerous challenging experiences, with such changes potentially being enduring. The relationship between emotions and consciousness is reciprocal, with each influencing the other. Moral emotions emerge as a result of the processes of identification and disidentification within moral consciousness, serving as an indirect reflection of the level of moral consciousness present [23] . The modification of moral consciousness can lead to alterations in moral emotions, which in turn can influence personal consciousness and beliefs. Consequently, a thorough evaluation of nurses' moral emotions and their underlying consciousness tendencies is crucial for the development of their moral framework and the adjustment of their professional principles. Research examining the impact of moral emotions on nursing behavior primarily investigates how individual differences in emotional experiences and emotional regulation affect moral decision-making in scenarios involving potential harm to others versus the greater social good. This study specifically delineates the effects of moral emotions on nurses' behaviors that may be detrimental to others, as well as their actions that promote social welfare. The inclination to inflict harm in nursing practice is predominantly reflected in the failure to fulfill nursing responsibilities, while the pursuit of social welfare is characterized by the emphasis on pro-social behaviors exhibited by nurses. Schipper's [24] research results show that moral emotion plays a significant mediating role between moral identification and moral decision making, and moral emotion will affect moral decision making and produce harmful or welfare behaviors. In moral dilemmas, the psychological motivations behind non-utilitarian responses and hurtful behaviors are thought to be mediated by negative emotional responses to moral dilemmas [25] .Individuals who exhibit a deficiency in feelings of guilt frequently demonstrate a diminished capacity for empathy, a factor that is detrimental to the advancement of humanistic nursing practices [26] . Furthermore, the enduring effects of adverse moral emotions, such as fear and helplessness, may hinder their engagement in nursing activities, thereby increasing the likelihood of nursing attrition. Correspondingly, moral emotions associated with pride, mission, and responsibility can encourage individuals to proactively a responsibility and exhibit greater empathy in patient care, thereby enhancing the quality of nursing practice. ICU nurses, in particular, require a heightened sense of professional responsibility to effectively manage the comprehensive nursing needs of patients. Additionally, positive moral emotions, along with feelings of guilt, can serve as catalysts for individuals to empathize with others, fostering a desire to assist and engage in prosocial behaviors that promote the well-being of others. This underscores the importance of moral emotions in stimulating prosocial behaviors through interventions aimed at enhancing empathy [27] .It is human nature to have empathy and prosocial behavior, and moral emotions can reinforce this tendency. People's cognitive cost of prosocial behavior needs to be contextualized under the impetus of empathy. From the perspective of motivation, people develop empathy, enhance their understanding of their emotions, and then judge whether such behavior is prosocial or not [28] .To sum up, reassessment of nurses' emotional state and moral consciousness can predict nurses' choice of obligation, and habitual use of other emotional regulation strategies (namely acceptance, mindfulness, rumination and catastroatization) does not affect individual moral choice, but can effectively reduce emotional arousal. Reevaluation and emotional adjustment can weaken emotion-related biases in moral choice. The negative influence of moral emotion on nurses should be reduced and the positive promotion enhanced [29] . Nonetheless, there is currently a lack of interventions targeting moral emotions, resulting in an inability to effectively manage these emotions within the nursing profession. Evaluating nurses' emotional regulation and optimize nurses' moral emotional coping ability Moral emotion refers to the subjective experiences that arise from nurses' encounters with clinical moral ethics and ethical dilemmas. If these moral emotions are not identified and assessed promptly, they may subtly influence nurses' behaviors. Emotional regulation is likely essential in mitigating the biases and repercussions associated with these emotions. Consequently, interventions aimed at enhancing the experience of moral emotions and the emotional regulation capabilities of ICU nurses can effectively prevent adverse outcomes and further amplify the positive aspects of moral emotions. However, the study revealed that many nurses struggle to cultivate positive moral emotions and often resort to negative coping mechanisms in response to the challenges posed by moral emotions. This tendency is detrimental to the development and enhancement of moral emotions. While employing negative avoidance strategies may temporarily alleviate the emotional fluctuations associated with both negative and positive emotions, the underlying issues related to moral emotions do not dissipate; rather, they are suppressed and concealed. Some nurses, recognizing the impact of moral emotions on their well-being, actively seek to address the root causes of the conflicts that elicit these emotions. They may opt to align their actions with their personal values and moral principles to mitigate and evade negative moral emotions, or they may choose to adopt a stance of respect when confronted with moral dilemmas. Although these approaches can address the issues stemming from moral emotions at their source, they present significant challenges. The ethical dilemmas encountered in the ICU have profound implications for the lives and families of patients, making it difficult for nurses to approach these situations lightly. Consequently, they may resort to confessional practices to express their moral emotions, during which they critically assess immoral behaviors and acknowledge the existence of moral actions. Nonetheless, the scientific validity of this approach remains a subject of debate [30-31] , but it seems to be a more relaxed and preferred way for clinical nurses to vent their emotions. Another form of moral emotional regulation frequently employed by nurses involves seeking support and assistance, which may be derived from the community, healthcare institutions, and familial networks. Such essential external support can enhance their capacity to navigate moral challenges and dilemmas, thereby improving their ability to regulate emotions effectively. Miles [32] highlighted that the recall catharsis method can assist nurses in fostering a positive moral self-assessment and eliciting appropriate emotional responses. Furthermore, this method enables them to develop psychological resilience and enhance their emotional tolerance during the recall process. Metselaar [33] proposed the use of moral case discussions to bolster the moral resilience of nurses operating in ethically challenging contexts, thereby encouraging them to engage in reflective practices concerning moral dilemmas. The development of moral resilience is instrumental in assisting nurses in navigating moral challenges and mitigating associated moral emotions.Greene [34] introduced the significant ethical dual process model (DPM), which posits that cognitive and emotional processes are distinct and may occasionally compete with one another in the realm of ethical decision-making. Consequently, the processes of cognition and emotional expression are not only independent but can also undergo transformation under specific conditions. This framework implies that initiating interventions focused on the dual processes of moral emotion generation and cognition may enhance nurses' capacity to regulate and manage their moral emotions. Therefore, the development of assessment tools aimed at evaluating nurses' moral emotions, along with the precise identification of these emotions, is crucial for implementing targeted intervention strategies that can improve nurses' abilities in moral emotion regulation. Limitations The study has limitations. First, there is an inherent risk of bias during the recruitment of study participants due to sampling methods. Secondly, we only selected nurses from three hospitals in Shandong, China as respondents. Although the data reached saturation, the survey results could not represent the views of all nurses in China. But our findings do explain the moral emotions that exist in ICU nurses and the realities of dealing with them. Conclusion In this study, it is summarized that the moral situation of ICU nurses, the influence of moral emotions and their experience in coping with moral emotions are found. It can be seen that the moral emotions of ICU nurses exist significantly and have a certain impact on their health and work. When they experience moral emotions, some nurses have learned to take certain measures to relieve them. But there are also some nurses who have shortcomings in coping with moral emotions. Therefore, we should pay attention to the moral emotional problems of ICU nurses, and formulate targeted intervention strategies to improve nurses' emotional regulation ability and coping ability, which is conducive to the improvement and development of nursing work. Relevance for clinical practice：This study makes up for the research gap of nurses' moral emotions in moral dilemmas, and explores the moral emotions and coping situations of ICU nurses, which helps us to better identify and manage moral emotions, and helps to maintain nurses' mental health. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the Approved by the Clinical Research Ethics Committee of Affiliated Hospital of Qingdao University(QYFYWZLL29193).In accordance with the Declaration of Helsinki, all subjects were informed of the purpose and method of the study, and agreed that the content of the study would be recorded by means of audio recording. All participants voluntarily participated in the study and signed informed consent forms. All interview materials have been anonymously coded and kept strictly confidential to ensure that they are used only for this study.Informed consent was obtained from all participants prior to the interviews. Participants were free to withdraw from the study at any time. Consent for publication Not applicable. Availability of data and materials Not applicable. Competing Interest The authors declare that they have no known competing ffnancial interests or personal relationships that could have appeared to inffuence the work reported in this paper. Funding This study accepted the 2023 Shandong Medicine and Health Science and Technology project and 2022 Shandong First Medical University （Shandong Province School level education） teaching reform research project of the Academy of Medical Sciences. Clinical Trial Number：No applicable. All participants gave informed consent to publish the study. Author Contribution Study conception and design:WFM Data analysis and interpretation: YCZ,WZZ Drafting of the article: ZZX,XJG,HJ Critical revision of the article: YBG Acknowledgments Thanks are due to the participants for their valuable collaboration and contribution in the study. References Shermer M.(2016). Morality is real, objective, and natural. Ann N Y Acad Sci, 2016,1384(1),57-62. doi:10.1111/nyas.13077 Childress JF, Beauchamp TL. (2022).Common Morality Principles in Biomedical Ethics: Responses to Critics. Camb Q Healthc Ethics, 2022,31(2),164-176. Greene JD, Sommerville RB, Nystrom LE, et al. (2001). An fMRI investigation of emotional engagement in moral judgment. Science, 2001,293(5537),2105-2108. Gallagher A.(2010). Moral distress and moral courage in everyday nursing prac tice. OJIN, 2010,16(2). Batavia C, Nelson MP, Bruskotter JT, et al. (2021).Emotion as a source of moral understanding in conservation. Conserv Biol, 2021,35(5),1380-1387. Gummerum M, López-Pérez B, Ambrona T, et al.(2016). Children's Moral Emotion Attribution in the Happy Victimizer Task: The Role of Response Format. J Genet Psychol, 2016,177(1),1-16. Fitouchi L, André JB, Baumard N. (2022). Moral disciplining: The cognitive and evolutionary foundations of puritanical morality. Behav Brain Sci, 2022,46:e293. Atari M, Mostafazadeh Davani A, Dehghani M .(2020). Body Maps of Moral Concerns. Psychol Sci, 2020,31(2),160-169. Miller AC, Khan AM, Hebishi K, et al.(2020). Ethical Issues Confronting Muslim Patients in Perioperative and Critical Care Environments: A Survey of Islamic Jurisprudence. Anesthesiol Clin, 2020,38(2),379-401. doi:10.1016/j.anclin.2020.01.002 Basar Z, Cilingir D. Evaluating ethical sensitivity in surgical intensive care nurses.(2019) .Nurs Ethics, 2019,26(7-8),2384-2397. doi:10.1177/0969733018792739 Salari N, Shohaimi S, Khaledi-Paveh B, et al.(2022). The severity of moral distress in nurses: a systematic review and meta-analysis. Philos Ethics Humanit Med, 2022,17(1),13. Published 2022 Nov 9. doi:10.1186/s13010-022-00126-0 Pajakoski E, Rannikko S, Leino-Kilpi H, et al.(2021). Moral courage in nursing - An integrative literature review. Nurs Health Sci, 2021,23(3),570-585. doi:10.1111/nhs.12805 Faraco MM, Gelbcke FL, Brehmer LCF, et al.(2022). Moral distress and moral resilience of nurse managers. Nurs Ethics, 2022,29(5),1253-1265. Young PD, Rushton CH.(2017). A concept analysis of moral resilience. Nurs Outlook, 2017,65(5),579-587. doi:10.1016/j.outlook.2017.03.009 Bromley E.(2022). Shame as a moral mood in medicine. J Eval Clin Pract, 2022,28(5),899-908. Söylemez S, Kapucu A. (2024). Disgust as a basic, sexual, and moral emotion. Cogn Process, 2024,25(2),193-204. doi:10.1007/s10339-024-01180-6 Atreya S, Datta SS, Salins N. (2023). Using Social Constructivist Learning Theory to Unpack General Practitioners' Learning Preferences of End-of-Life Care: A Systematically Constructed Narrative Review. Indian J Palliat Care, 2023,29(4),368-374. Doyle L, McCabe C, Keogh B, et al. (2020).An overview of the qualitative descriptive design within nursing research. J Res Nurs, 2020,25(5),443-455. Lindgren BM, Lundman B, Graneheim UH. (2020).Abstraction and interpretation during the qualitative content analysis process. Int J Nurs Stud, 2020,108,103632. Trivedi-Bateman N.(2021). The Combined Roles of Moral Emotion and Moral Rules in Explaining Acts of Violence Using a Situational Action Theory Perspective. J Interpers Violence, 2021,36(17-18),8715-8740. Chang DC, Kelly M, Eva KW. (2024).A Phenomenological Exploration of Physicians' Moral Distress: Situating Emotion Within Lived Experiences. Acad Med, 2024,99(11),1215-1220. doi:10.1097/ACM.0000000000005817 Ugazio G, Lamm C, Singer T. (2012).The role of emotions for moral judgments depends on the type of emotion and moral scenario. Emotion, 2012,12(3),579-590. de Hooge IE, Nelissen RM, Breugelmans SM,et al.(2011). What is moral about guilt? Acting "prosocially" at the disadvantage of others. J Pers Soc Psychol, 2011,100(3),462-473. doi:10.1037/a0021459 Hess U, Landmann H, David S, et al. (2018).The bidirectional relation of emotion perception and social judgments: the effect of witness' emotion expression on perceptions of moral behaviour and vice versa. Cogn Emot, 2018,32(6),1152-1165. doi:10.1080/02699931.2017.1388769 Schipper N, Koglin U.(2021). The association between moral identity and moral decisions in adolescents. New Dir Child Adolesc Dev, 2021,2021(179),111-125. Patil I, Larsen EM, Kichic R, et al.(2021). Moral Cognition About Harm in Anxiety Disorders: The Importance of Experienced Emotion. Psychol Rep, 2021,124(6),2501-2523. Jansen TL, Hem MH, Dambolt LJ, et al.(2020). Moral distress in acute psychiatric nursing: Multifaceted dilemmas and demands. Nurs Ethics, 2020,27(5),1315-1326. doi:10.1177/0969733019877526 Jordan MR, Amir D, Bloom P. (2016).Are empathy and concern psychologically distinct?. Emotion, 2016,16(8),1107-1116. Cameron CD, Conway P, Scheffer JA.(2022). Empathy regulation, prosociality, and moral judgment. Curr Opin Psychol, 2022,44,188-195. Szekely RD, Miu AC. (2015).Incidental emotions in moral dilemmas: the influence of emotion regulation.Cogn Emot, 2015,29(1),64-75. doi:10.1080/02699931.2014.895300 Hess U, Landmann H, David S, et al.(2018) .The bidirectional relation of emotion perception and social judgments: the effect of witness' emotion expression on perceptions of moral behaviour and vice versa. Cogn Emot, 2018,32(6),1152-1165. doi:10.1080/02699931.2017.1388769 Miles A, Upenieks L, Orfanidis C.(2022). Beyond prosociality: Recalling many types of moral behavior produces positive emotion. PLoS One, 2022,17(11),e0277488. Published 2022 Nov 11. doi:10.1371/journal.pone.0277488. Metselaar S, Molewijk B.(2023). Fostering moral resilience through moral case deliberation. Nurs Ethics, 2023,30(5),730-745. doi:10.1177/09697330231183085 Greene JD, Nystrom LE, Engell AD, et al.(2004). The neural bases of cognitive conflict and control in moral judgment. Neuron, 2004,44(2),389-400. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6340985","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453691393,"identity":"4f57e14a-ee1e-4805-9649-ebc2bdd94594","order_by":0,"name":"zhenzhen xu","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"zhenzhen","middleName":"","lastName":"xu","suffix":""},{"id":453691394,"identity":"768acb7a-b3ee-47a6-a699-9d43fd9551e9","order_by":1,"name":"Weifang Mao","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Weifang","middleName":"","lastName":"Mao","suffix":""},{"id":453691396,"identity":"ebb2fcc0-593b-4ff1-a880-a1fb4a930aa2","order_by":2,"name":"Hong Ji","email":"","orcid":"","institution":"Shandong Provincial QianFoShan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Ji","suffix":""},{"id":453691398,"identity":"91eb5caf-b9de-4d38-8b51-d3946ffc78b6","order_by":3,"name":"Xiaojing Guo","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Xiaojing","middleName":"","lastName":"Guo","suffix":""},{"id":453691400,"identity":"c4529c9b-99c2-43c7-b405-6e6ecde676e9","order_by":4,"name":"Yuchen Zhang","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Yuchen","middleName":"","lastName":"Zhang","suffix":""},{"id":453691401,"identity":"49a4971d-f574-40c5-b4af-72043dedaaa6","order_by":5,"name":"Wenzhong Zhang","email":"","orcid":"","institution":"Shandong Provincial QianFoShan Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wenzhong","middleName":"","lastName":"Zhang","suffix":""},{"id":453691402,"identity":"eb546810-1dc7-486b-bb15-30591d02a90d","order_by":6,"name":"yubiao 盖","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYFACxgYgkmBgYG9sfPCBNC08h5sNZ5BiEQODRHqbNAcxquXdD7dJ8+6wkOeXfNggzcBgJ6fbQECL4ZlEoJYzEoYzZyc2GBcwJBubHSCkpQGkpU2CccPtxIbkGQwHErcR1NL/EKzFfsPNgw2HeYjRIi8BsSVxww3GxmaitBhIPGy2nHtGInlmT2Iz4wwDIvwi35/+8MbbHXW2/ezHn//4UGEnR1CLwQEGFgkkLgHlYFsaGJiJTCajYBSMglEwYgEAw/lFEVdq/AgAAAAASUVORK5CYII=","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":true,"prefix":"","firstName":"yubiao","middleName":"","lastName":"盖","suffix":""}],"badges":[],"createdAt":"2025-03-31 02:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6340985/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6340985/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87234078,"identity":"2e715acc-8d6e-4cbd-9652-fad6845dadaf","added_by":"auto","created_at":"2025-07-21 20:31:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":597562,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6340985/v1/4d1c9156-4fad-4746-98e0-e8a6fe4b928f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Moral emotional experience and coping strategies of ICU nurses","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eMorality is an agreed upon code of conduct and norms to be followed\u003csup\u003e[1]\u003c/sup\u003e, and the current definition of morality is divided into two main schools of thought, with some scholars arguing that morality is \u0026ldquo;a set of universal norms shared by all who are committed to morality\u0026rdquo;. From these norms, a number of principles about duties, rights and virtues are derived or formulated. It has also been argued that morality is a dynamic process with individualized characteristics, which comes from and influences human behavior, and which is also expressed and reflected through certain media, and that there are differences in the moral norms followed and recognized by people with different characteristics\u003csup\u003e[2]\u003c/sup\u003e. Emotions are the subjective feelings of an individual after experiencing an event, and a person's emotions reflect the perception and understanding of an event, as well as the most intuitively manifested phenomenon after a person's exposure to an event. It has been pointed out that a person who encounters a morality-related event will produce corresponding emotions, which contain a reflection of the understanding of morality and moral compliance\u003csup\u003e[3]\u003c/sup\u003e. So there may be some close relationship between morality and emotions.\u003c/p\u003e \u003cp\u003eWilkinson considers moral dilemma as a psychological imbalance and a negative emotional state in which one's moral judgment affects moral action\u003csup\u003e[4]\u003c/sup\u003e, further analyzing the concept, moral dilemma can be considered as a situation of failure of moral following and emotion regulation. Nowadays, research trends are increasingly emphasizing that reason and emotion play an important role in moral judgment, and Batavia\u003csup\u003e[5]\u003c/sup\u003e scholars believe that emotion is the basis of moral judgment and decision-making. Based on the results of this research also the additional product of moral emotions was derived from moral dilemmas. Moral emotions were first applied to child psychology, they believe that moral emotions have a close relationship with children's intellectual development, emotional understanding and character formation, and that positive moral emotions lead to sharing desires and pro-social behavior\u003csup\u003e[6]\u003c/sup\u003e. Some scholars also broadly define their moral emotions as \u0026ldquo;emotional symptoms\u0026rdquo; and believe that moral emotions are characterized by transcendence (affecting personality and behavior), communicability (expressed through verbal and nonverbal means), and polarity (fluctuating in dual terms, e.g., joy and sadness) \u003csup\u003e[7]\u003c/sup\u003e, and that they are the subjective emotions that arise after the occurrence of a person's moral judgment and moral behavior. subjective feelings that arise after the occurrence of a moral act, and also the emotional way in which the judge himself or herself follows moral codes and norms\u003csup\u003e[8]\u003c/sup\u003e. Moral emotions are more reflective of human moral norms and codes of behavioral activities than other emotions and are more critically accessible, and the study of moral emotions helps us to better understand their inner activities. In medical activities we should pay more attention to the moral and ethical issues in the ICU, which is highly ethically sensitive. Mainly because of the relatively closed environment in which ICU care is carried out (lack of family members), the complexity of the treatment process, the need for ICU patients to undergo many specialized operations, and the rigor of the operation all depends on the prudence of the nurse. In addition, nurses do not have a strong sense of privacy protection for ICU patients, which leads to more ethical problems of the protective principle in nurse-patient interactions\u003csup\u003e[9]\u003c/sup\u003e. The problems of high economic expenses and bed tension in ICUs can lead to ICU nurses' tendency to choose the admitted patients, which violates the principle of equality of life\u003csup\u003e[10\u0026ndash;11]\u003c/sup\u003e. These problems above are more ethical issues caused by different moral consciousness of nurses, which may not be so common in general wards. It is evident that ICU nurses experience more moral and ethical issues and moral dilemmas. Recent trends in ethical research on nurses have focused on moral courage\u003csup\u003e[12]\u003c/sup\u003e, moral dilemmas, and moral resilience\u003csup\u003e[13]\u003c/sup\u003e, while ignoring the nurses' own emotional situations caused by ethical issues. Whereas, moral emotions as experiences and feelings that occur when nurses experience moral dilemmas should be emphasized and paid attention to.Bromley\u003csup\u003e[14]\u003c/sup\u003eargued that shame is a moral emotion that arises in nurses' work, reflecting their sense of culpability after the presence of nursing laxity and shirking of responsibility in their clinical work, and this study confirms that moral emotions can be used as a kind of atmosphere and intrinsic motivation of ethical endeavors, which can strengthen and improve physicians' understanding of their culpability and responsibility in clinical encounters and as a result of reflecting on their behavior. The results of this study began to draw attention to the moral emotions of nurses, and S\u0026ouml;ylemez\u003csup\u003e[15]\u003c/sup\u003efurther suggested that aversion is also a moral emotion experienced by nurses, and that the aversion of moral emotions is primarily an aversion to morally detrimental behaviors, which creates a protective mechanism for upholding ethical norms. Previous research on moral emotions in nurses has only focused on one moral emotion, but nurses who experience different moral dilemmas will have different moral emotions, and the impact on themselves will certainly vary. This study focuses on ICU nurses, a morally and ethically sensitive group, to explore the occurrence of moral emotions in them and the impact on them.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Objectives\u003c/h2\u003e \u003cp\u003eTo explore ICU nurses' experiences of moral emotions, the impact on themselves and the coping strategies adopted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Design\u003c/h2\u003e \u003cp\u003eThis research is based on a social constructivist view, which acknowledges that multiple interpretations of reality are individuals who interact with their surroundings through social interactio\u003csup\u003e[16]\u003c/sup\u003e. Based on this, we adopted a qualitative and descriptive research design\u003csup\u003e[17]\u003c/sup\u003e. Qualitative description design is based on naturalistic inquiry, believing that reality exists in dynamic changes within different individuals, therefore, reality is multiple, subjective, and can be expressed and explained through language carriers\u003csup\u003e[18]\u003c/sup\u003e. Our goal of qualitative descriptive research is to fully present a descriptive summary of the experiences and perceptions of a group of people, without abstract data presentation\u003csup\u003e[16]\u003c/sup\u003e. In the current study, this translates to understanding the large emotional and experiential experiences of nurses working in the ICU. The data collection method followed a qualitative descriptive study in which we used semi-structured interviews to find out the status of the nurses' experiences of moral emotions working in the ICU, to analyze how moral emotions affect them and the nurses' experiences of coping with moral emotions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Setting\u003c/h2\u003e \u003cp\u003eA clinical nurse from the Department of intensive Care Medicine of a Grade III Class A general hospital in Shandong Province.\u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e2.4 Ethical approval\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Clinical Research Ethics Committee of the XXXXXXXXX with the ethics batch number (XXXXXXXXXXX). All participants signed informed consent forms and were informed of their right to withdraw from participation at any time without giving reasons.\u003c/p\u003e\n\u003cp\u003e2.5 Participants\u003c/p\u003e\n\u003cp\u003eConduct purposeful sampling so that recruited participants can provide a wealth of detailed data on the plight of ICU work. The inclusion criteria were :①Participants were registered nurses;②Work in ICU department;③Volunteer to participate in the study; Exclusion criteria:\u0026nbsp;①study abroad or practice nurse. Sample size is determined by topic saturation.\u003c/p\u003e\n\u003cp\u003e2.6 Data collection\u003c/p\u003e\n\u003cp\u003eThe data was collected on June 2024 . The definition of moral emotions was explained to the nurses prior to the study to ensure that the nurses understood moral emotions and to avoid understanding bias during the interview process. The study used semi-structured interviews to understand the work dilemma situation of ICU nurses, which was guided by the interview outline, which is detailed in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1 Interview outline\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eSerial number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eOutline content\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e①\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePlease talk about your understanding of moral emotions;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e②\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eWhat ethical emotions do you think you would encounter working in an ICU;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e③\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePlease share specifically what moral emotions arise in which situations specifically in your context;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e④\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePlease share the situation of how moral emotions have affected you after experiencing them in ICU work, specifically based on your experience;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e⑤\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003ePlease tell me about the moral dilemmas you actually encountered and how you managed to resolve the emotions that arose during the process;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e⑥\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eAny other feelings about moral emotions that need to be shared with me;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe researchers who participated in this study were systematically trained in qualitative research, mastered the research methodology of qualitative research, and acquired communication skills. Semi-structured interviews were conducted in the form of face-to-face interviews by the first author, who had more than one year of clinical experience in the ICU. The interview time was agreed with the participant in advance and the researcher conducted the interview with the participant in a quiet, private conference room. The interviews started with some general questions, followed by more discussion on topics related to moral emotions. Each interview lasted about 30 minutes. During the interviews, the researcher recorded the participants\u0026apos; nonverbal behavior. After 13 interviews, data collection was completed and the interviews ended. Each interview was audio-recorded, transcribed verbatim over a 24-hour period, and then listened to again by a second researcher. Initially, 79,654 words were transcribed, and the recordings were re-listened to remove redundancies and invalid off-topic text, resulting in a final transcription of 50,792 words with valid value.\u003c/p\u003e\n\u003cp\u003e2.7 Data analysis\u003c/p\u003e\n\u003cp\u003eThe team\u0026apos;s researchers independently examined the contents of the transcriptions to ensure their accuracy. The data is applied to topic analysis, including coding, coding grouping, summarizing coding classification, and identifying topics. First, the first author reads the interview carefully to understand what the participants think. Secondly, the researchers encode the meaningful content of each text, and summarize the similar codes identified in each transcribed text into groups of codes. After that, all the members of the research group checked the coding content and summarized its classification. Finally, the topics and subtopics based on coding and classification groups are refined and summarized.\u003c/p\u003e\n\u003cp\u003e2.8 Rigour\u003c/p\u003e\n\u003cp\u003eFirst, open-ended questions are used to ensure the reliability of qualitative data. Second, during the analysis, the two researchers read the text independently to identify themes and categories. Finally, the researchers compare topics and categories and revise them through group discussions until a consensus is reached.\u003c/p\u003e"},{"header":"3 Results","content":"\u003cp\u003e3.1 General situation of the research object\u003c/p\u003e\n\u003cp\u003eA total of 13 ICU nurses participated in the interviews, 8 females and 5 males with a mean age of (31.3\u0026plusmn;5.06) years. The working experience of the participants ranged from 6 months to 17 years.53.8% of the participants were senior nurses and their general demographic information is detailed in Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2 General Demographic Data (n=13)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eCoding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eCoding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003eAge (years)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eEducation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eTitle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eYears of experience in the custodial unit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eGraduate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003esenior\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e9 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUndergraduate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eIntermediate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e17 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e14 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003esenior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003esenior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e6 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e12 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eGraduate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003esenior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e8 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e12 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e6 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003esenior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eN13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003esenior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.2 Interview Results\u003c/p\u003e\n\u003cp\u003eAnalysis of the interview data yielded the following three themes and nine sub-themes, including the experience of moral emotions (positive moral emotions experience, negative moral emotions experience), the influence of moral emotions on nurses (awareness and attitudinal influence, behavioral influence), and the experience of coping with moral emotions (negative avoidance coping, conflict and equilibrium management, value-preference choices, whiney confabulation, and help-seeking).\u003c/p\u003e\n\u003cp\u003e3.2.1 Moral Emotional Experience Situation\u003c/p\u003e\n\u003cp\u003e3.2.1.1 Positive moral emotion experience\u003c/p\u003e\n\u003cp\u003e① Pride\u003c/p\u003e\n\u003cp\u003eSome respondents said that they feel pride in the treatment of ICU patients, and they believe that this pride is because they conform to their moral beliefs, so they believe that pride is a positive moral emotion.\u003c/p\u003e\n\u003cp\u003eN2: \u0026quot;I will often treat severe patients, and I will feel a sense of accomplishment after successful treatment, have self-satisfaction, and gain positive moral emotions.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN5: \u0026quot;I feel that working in ICU is more challenging and needs to face more emergencies than other departments. I am proud of my professional ability.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN8: \u0026quot;The patient has survived the critical period under my care, and I feel proud and proud of my family\u0026apos;s gratitude every time.\u0026quot;\u003c/p\u003e\n\u003cp\u003e② Sense of mission\u003c/p\u003e\n\u003cp\u003eMost of the nurses who participated in the study said that they, as nurses, are synonymous with \u0026quot;angels in white\u0026quot; and need to take the mission and responsibility to protect patients\u0026apos; lives. Whether it is humanitarian or social responsibility, this is their mission.\u003c/p\u003e\n\u003cp\u003eN7: \u0026quot;Since I decided to become an angel in White, I know I have a certain responsibility and mission, and my work ethic supports me to devote myself to patient care.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN10: \u0026quot;My moral sense has always reminded me to devote myself to nursing work, and will guide me to uphold the integrity of my work and fulfill the nursing mission.\u0026quot;\u003c/p\u003e\n\u003cp\u003e③ Sense of responsibility\u003c/p\u003e\n\u003cp\u003eSome respondents said that most nurses working in ICU have a certain sense of responsibility, and in the process of caring for patients, a sense of responsibility is an important guarantee that they can serve patients wholeheartedly.\u003c/p\u003e\n\u003cp\u003eN6: \u0026quot;As the last line of defense to protect the patient\u0026apos;s life, I have a certain responsibility to protect his health, and I need to observe the patient\u0026apos;s situation at all times to prepare for effective nursing measures in time.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN11: \u0026quot;I have a duty in this position to protect the lives and health of my patients, both in terms of professional ethics and humanitarianism.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN12: \u0026quot;We must have a sense of responsibility. This is the moral bottom line of our work.\u0026quot;\u003c/p\u003e\n\u003cp\u003e3.2.1.2 Negative moral emotion experience\u003c/p\u003e\n\u003cp\u003e① Guilt\u003c/p\u003e\n\u003cp\u003eThe nurses who participated in the study said that when they were unable to save the lives of patients, or were unable to maintain the lives of patients in high quality, they attacked their moral bottom line and generated feelings of guilt.\u003c/p\u003e\n\u003cp\u003eN7: \u0026quot;I feel guilty when we try all kinds of treatments and we can\u0026apos;t save the patient\u0026apos;s life.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN13: \u0026quot;Nurses have a certain role to play in the ICU, but the patients are seriously ill, and what we can do as nurses is limited, and I still feel guilty when I can\u0026apos;t do more.\u0026quot;\u003c/p\u003e\n\u003cp\u003e② Fear\u003c/p\u003e\n\u003cp\u003eSome new nurses said that there are many emergencies when they first enter the work environment, and they are full of fear when facing critically ill patients, and other nurses said that working in the ICU requires many ethical sensitivities, and they are afraid to face these sensitive issues, afraid to break and violate their ethical principles.\u003c/p\u003e\n\u003cp\u003eN1: \u0026quot;As a new nurse, I have a great fear of caring for seriously ill patients, and I am worried about errors in care.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN8: \u0026quot;I now face a work environment with a high incidence of medical disputes in the ICU, where there is a keen sense of ethics, and my lack of experience in dealing with ethical and moral dilemmas, I have a corresponding fear.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN12: \u0026quot;Compared with other departments, this department needs to learn more things and is highly professional. At first, it is difficult to accept and I am afraid.\u0026quot;\u003c/p\u003e\n\u003cp\u003e③ Helplessness\u003c/p\u003e\n\u003cp\u003eSome interviewees said that in the face of high standards of work requirements, their lack of competence will produce a sense of helplessness, especially the death of patients, for them is a moral impact, followed by the emergence of moral feelings of helplessness.\u003c/p\u003e\n\u003cp\u003eN1: \u0026quot;In theory, I should have the ability to work in a team and deal with emergencies, but in practice, I am not, even not ideal to participate in the first aid of patients, I am really helpless.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN3: \u0026quot;When I face the death of a patient, I feel terribly small and helpless.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN4: \u0026quot;When the patient\u0026apos;s family expects us to save the patient, but the reality is not, I can not rationally achieve communication, I feel at a loss.\u0026quot;\u003c/p\u003e\n\u003cp\u003e3.2.2 Influence of moral emotions on nurses\u003c/p\u003e\n\u003cp\u003e3.2.2.1 Awareness and Attitude Influence\u003c/p\u003e\n\u003cp\u003eSome nurses indicated that the impact of moral emotions on consciousness and attitudes was mainly in the areas of moral awareness and professional attitudes. Repeatedly experiencing moral emotions affects the formation of their moral consciousness and moral attitudes.\u003c/p\u003e\n\u003cp\u003eN5: \u0026ldquo;When I feel a sense of responsibility, I will correct my attitude more, and under the influence of this attitude, my moral consciousness will change and some of my previous bad moral concepts will be corrected.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eN6: \u0026ldquo;Positive moral emotions will lead to the establishment of my altruistic consciousness and correct moral outlook, while negative moral emotions will make me reflect on whether there is something wrong with my original consciousness, and I will go ahead and take the initiative to adjust my consciousness, and in time it will lead to the fixation and formation of a new sense of behavior.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eOther respondents indicated that pride, responsibility and sense of mission as positive moral emotions are internal drivers for their career development and will correct their professional attitudes, while negative moral emotions such as guilt and helplessness will make them feel frustrated and aggravate burnout.\u003c/p\u003e\n\u003cp\u003eN2: \u0026ldquo;The pride gained from working in the ICU is a positive moral emotion, and this emotion will greatly enhance my sense of professional value.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eN3: \u0026ldquo;As an ICU nurse I have a certain responsibility and mission, and this responsibility and mission urges me to correct my work attitude and continuously improve my ability.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eN9: \u0026ldquo;When negative moral emotions arise, they can undermine my professional beliefs and can very much affect the quality of my work.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eN13: \u0026ldquo;When I am helpless, I often think about whether I should give up this job or not, and it makes me have a bad opinion about my attitude towards this job as well.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e3.2.2.2 Behavioral Effects\u003c/p\u003e\n\u003cp\u003eThe effects of moral emotions on nursing behavior and social behavior were reported in this study.\u003c/p\u003e\n\u003cp\u003eMost of the nurses reported that negative moral emotions affect the quality of work and directly lead to nursing duty deficient behaviors. Whereas positive moral emotions of being in a position of duty and mission push nurses to be more disciplined in caring for their patients, contributing to magnetic nursing care and reducing nursing deficits.N5: \u0026ldquo;I often fall into self-denial, especially when a patient dies, which makes me unmotivated to care for other patients.\u0026rdquo; N8: \u0026ldquo;When faced with ethical dilemmas, I experience fearful moral emotions that can undermine my courage to say \u0026lsquo;no\u0026rsquo; and be detrimental to the maintenance of my high quality work.\u0026rdquo; N12: \u0026ldquo;I am afraid and fearful, which tends to make me shy away from my nursing work, which results in guilt, but still fear of making mistakes, and the more I fear, the more mistakes I make, which creates a vicious cycle that is not conducive to my nursing responsibilities.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eN10: \u0026ldquo;I feel that I bear certain responsibilities and missions, as a nurse I have to take care of my patients, and being at the bottom of the moral line, I can\u0026apos;t afford to be absent from caring for my patients.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eAnd the influence of moral emotions on their social behavior is mainly manifested in the production of pro-social behaviors. Positive moral sentiments motivate them to actively participate in social assistance and contribute to social development. Whereas, negative moral emotions prevent nurses from sharing and avoiding their social duties.N6: \u0026ldquo;There is a great need to teach the community at large like the first aid competencies acquired in the department, and I feel it is my duty to teach them.\u0026rdquo; N11: \u0026ldquo;I am a member of the hospital\u0026apos;s science team, and it is all the professional competencies acquired in the department that will enable me to do this job.\u0026rdquo; N12: \u0026ldquo;I am now working and living in such a nice environment, and I hope to be able to bring happiness to others through my behavior.\u0026rdquo; N13: \u0026ldquo;Some negative moral emotions at work have discouraged me from volunteering for related field activities once I have finished my regular work.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e3.2.3 Coping experience of moral emotions\u003c/p\u003e\n\u003cp\u003e3.2.3.1 Negative evasive response\u003c/p\u003e\n\u003cp\u003eSome nurses said that they could not take a positive view of moral emotions. They believed that moral emotions were private things and did not want to reveal and share them. Instead, they used evasive and evasive ways to hide moral emotions and their effects.\u003c/p\u003e\n\u003cp\u003eN2: \u0026quot;When I encounter an incident that is inconsistent with my moral concept in my practical treatment work, I will feel moral emotions, but I cannot change many objective conditions, so I have to hide them.\u0026quot; N6: \u0026quot;There will be some uncomfortable things, whether it is for patients, family members or colleagues, but also have to work together, can only collect emotions.\u0026quot; N9: \u0026quot;As far as moral emotions are concerned, I am not very willing to say that these things can be secretly thought about in my mind.\u0026quot;\u003c/p\u003e\n\u003cp\u003e3.2.3.2 Conflict and Balance Management\u003c/p\u003e\n\u003cp\u003eRespondents said that moral emotion is the product of the conflict between moral consciousness and behavioral rules, and if I can find a balance point, it will be conducive to the adjustment and transformation of my moral emotion. When they have positive moral emotions, they will continue to balance to play a role in promoting positive moral emotions, and when they have negative moral emotions, they will promote the management and transformation of negative moral emotions by managing conflicts to achieve the final emotional balance.\u003c/p\u003e\n\u003cp\u003eN7: \u0026quot;I need to find a balance between my moral level and ethical impact, and reasonably regulate my emotions without breaking the moral bottom line.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN9: \u0026quot;When it comes to life and death, I should learn to put myself in others\u0026apos; shoes so that I don\u0026apos;t impose my ideas on others, and empathy is a good way to achieve balance.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN13 \u0026quot;In the department, there will be positive moral emotions and negative moral emotions. These two emotions are in conflict with each other, but they can be well balanced and can be transformed into each other under certain circumstances. Therefore, when negative moral emotions are in conflict, I will take certain ways to transform them into positive moral emotions, so that moral emotions can be balanced with each other.\u0026quot;\u003c/p\u003e\n\u003cp\u003e3.2.3.3 Value preference selection\u003c/p\u003e\n\u003cp\u003eSome respondents said that they would regulate moral emotions through value selection preferences, selectively play the positive role of positive moral emotions, or look at problems in a respectful way, so as to avoid negative moral emotions generated by critical psychology.\u003c/p\u003e\n\u003cp\u003eN7: \u0026quot;When I encounter moral dilemmas in the department, I will give priority to the behavior of my subjective consciousness, so that I will not have some negative emotions and will not affect my work.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN8: \u0026quot;Negative moral emotions at work can affect my mood, so I usually choose to look at problems from a favorable perspective, which helps me to positively adjust my mood.\u0026quot;\u003c/p\u003e\n\u003cp\u003eN11: \u0026quot;Everyone has their own moral concepts and principles of doing things, I should choose to respect others, not criticize and compare at will, which can effectively avoid emotional problems caused by prejudice.\u0026quot;\u003c/p\u003e\n\u003cp\u003e3.2.3.4 Grumbling\u003c/p\u003e\n\u003cp\u003eMore than half of the nurses in the study said they felt moral feelings when they encountered an incident at work that did or did not align with their moral values, and they were willing to share their complaints with colleagues, friends and family. They believe that complaining is a very relaxing way to express emotions.\u003c/p\u003e\n\u003cp\u003eN2: \u0026quot;I will share with my family what is not satisfactory and some negative emotions in my work, and complain about it, which will make me feel comfortable.\u0026quot; N5: \u0026quot;In the department, I often experience moral dilemmas and have negative moral emotions. I think talking is a good way to adjust my emotions and help me to face life and work with a positive attitude.\u0026quot; N9: \u0026quot;Complaining makes me more motivated. I think complaining is an interactive process that not only allows me to express my emotions, but also allows me to recognize my shortcomings, especially in the face of moral dilemmas.\u0026quot;\u003c/p\u003e\n\u003cp\u003e3.2.3.5 Seeking Help\u003c/p\u003e\n\u003cp\u003eNearly all respondents said that they seek help when they encounter moral emotions that cannot be adjusted, including social support, family support, and hospital management support, but they said that family support is relatively easy to obtain, while social and hospital management support is less available.\u003c/p\u003e\n\u003cp\u003eN5: \u0026quot;When we encounter emotional problems in the department, we would like to get the understanding and support from the leaders, but because of the particularity of the work of nurses, it is difficult for us to get understanding and help.\u0026quot; N6: \u0026quot;Whether it\u0026apos;s positive or negative moral emotions, I\u0026apos;m more willing to share them with my family.\u0026quot; N9: \u0026quot;When negative moral emotions occur, I will take the initiative to seek help. I am more willing to get understanding and help from leaders, which will make me more active in work.\u0026quot;\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eIn our findings in-depth analysis of the moral emotions situation experienced by ICU nurses, in the results of the study also found out the situation of moral emotions on the nurses and how they cope with them, in the experience of moral emotions appeared positive moral emotions and negative moral emotions, it was also found that the impact of moral emotions on the nurses was mainly in the attitudinal and behavioral impacts, and in the coping experience respectively, five types of coping measures were adopted Five types of coping measures were taken, including negative avoidance coping, conflict and balance management, value preference selection, whiny confabulation, and help-seeking.\u003c/p\u003e\n\u003cp\u003eBased on our analysis of the moral emotions of ICU nurses, we propose several recommendations aimed at facilitating the active management of these emotions, with the ultimate goal of enhancing the moral well-being of nursing professionals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eElucidating the ethical emotions experienced by nurses and to address these moral sentiments in a rational manner\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the research, numerous nurses articulated the moral emotions they encountered in their professional environment, encompassing both positive moral emotions\u0026mdash;such as pride, a sense of mission, and responsibility\u0026mdash;and negative moral emotions, including guilt, fear, and helplessness. These moral emotions are frequently subjective experiences that arise in response to morally relevant actions, and they significantly influence nurses\u0026apos; work experiences and capabilities. Furthermore, these emotions can serve as predictors of subsequent behaviors to a certain degree. Existing literature indicates that moral emotions are pivotal in shaping behavioral cognition, with emotions serving as reflections of individuals\u0026apos; moral understanding. A lack of emotional cognition may diminish the capacity for empathy and potentially foster violent tendencies\u003csup\u003e[19]\u003c/sup\u003e.Specifically, individuals who do not experience feelings of guilt or shame tend to possess a less robust moral framework, making them more susceptible to engaging in criminal behaviors. Additionally, moral emotions represent a dynamic interplay between rationality and emotion, functioning as indicators of individual moral evolution. Positive moral emotions signify alignment with moral consciousness and behavior, while negative moral emotions often emerge from moral dilemmas that pit moral actions against moral identity. The evolution of moral emotions can enhance the moral equilibrium of nurses\u003csup\u003e[20]\u003c/sup\u003e. Moreover, moral emotions are integral to moral decision-making processes, which can be elucidated through the analysis of these emotions\u003csup\u003e[21]\u003c/sup\u003e. However, it has been suggested that moral emotions can be influenced to a certain extent, and their impact on moral decision-making and consciousness is contingent upon the underlying motivations and types of emotions involved. The effects of moral emotions on moral judgments can vary across different contexts, indicating that while moral emotions are universally experienced during moral dilemmas and judgments, their influence may differ based on the roles and situations of individuals. Consequently, it is imperative to focus on the moral and emotional contexts of ICU nurses, who are particularly sensitive to moral issues, in order to provide positive guidance for their moral judgments and behaviors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePaying attention to the influence of moral emotions on nurses to achieve precise intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePeople tend to make choices when they experience emotion-related situations. The findings of this study indicate that moral emotions significantly affect nurses\u0026apos; attitudes, with the most pronounced effects observed in their moral awareness and professional demeanor. However, the influence of moral emotions on an individual\u0026apos;s moral consciousness is not unequivocal. Emotions such as guilt can prompt individuals to engage in self-reflection regarding their consciousness and actions, leading them to critically assess their moral awareness and selectively modify their moral frameworks in order to adopt behaviors and principles that align with humanistic values\u003csup\u003e[22]\u003c/sup\u003e. Nurses who have experienced prolonged exposure to moral emotions may develop specific biases and inclinations within their moral consciousness. Especially nurses who can not face the existence of moral emotions will choose to face moral problems with a avoidant attitude, which will also impact the original healthy moral consciousness and moral concepts. Furthermore, the impact of moral emotions on moral consciousness is characterized by its latent, persistent, and dual nature. The influence and transformation of moral emotions on moral consciousness can lead to alterations in both awareness and behavior following numerous challenging experiences, with such changes potentially being enduring. The relationship between emotions and consciousness is reciprocal, with each influencing the other. Moral emotions emerge as a result of the processes of identification and disidentification within moral consciousness, serving as an indirect reflection of the level of moral consciousness present\u003csup\u003e[23]\u003c/sup\u003e. The modification of moral consciousness can lead to alterations in moral emotions, which in turn can influence personal consciousness and beliefs. Consequently, a thorough evaluation of nurses\u0026apos; moral emotions and their underlying consciousness tendencies is crucial for the development of their moral framework and the adjustment of their professional principles. Research examining the impact of moral emotions on nursing behavior primarily investigates how individual differences in emotional experiences and emotional regulation affect moral decision-making in scenarios involving potential harm to others versus the greater social good. This study specifically delineates the effects of moral emotions on nurses\u0026apos; behaviors that may be detrimental to others, as well as their actions that promote social welfare. The inclination to inflict harm in nursing practice is predominantly reflected in the failure to fulfill nursing responsibilities, while the pursuit of social welfare is characterized by the emphasis on pro-social behaviors exhibited by nurses. Schipper\u0026apos;s\u003csup\u003e[24]\u003c/sup\u003eresearch results show that moral emotion plays a significant mediating role between moral identification and moral decision making, and moral emotion will affect moral decision making and produce harmful or welfare behaviors. In moral dilemmas, the psychological motivations behind non-utilitarian responses and hurtful behaviors are thought to be mediated by negative emotional responses to moral dilemmas\u003csup\u003e[25]\u003c/sup\u003e.Individuals who exhibit a deficiency in feelings of guilt frequently demonstrate a diminished capacity for empathy, a factor that is detrimental to the advancement of humanistic nursing practices\u003csup\u003e[26]\u003c/sup\u003e. Furthermore, the enduring effects of adverse moral emotions, such as fear and helplessness, may hinder their engagement in nursing activities, thereby increasing the likelihood of nursing attrition. Correspondingly, moral emotions associated with pride, mission, and responsibility can encourage individuals to proactively a responsibility and exhibit greater empathy in patient care, thereby enhancing the quality of nursing practice. ICU nurses, in particular, require a heightened sense of professional responsibility to effectively manage the comprehensive nursing needs of patients. Additionally, positive moral emotions, along with feelings of guilt, can serve as catalysts for individuals to empathize with others, fostering a desire to assist and engage in prosocial behaviors that promote the well-being of others. This underscores the importance of moral emotions in stimulating prosocial behaviors through interventions aimed at enhancing empathy\u003csup\u003e[27]\u003c/sup\u003e.It is human nature to have empathy and prosocial behavior, and moral emotions can reinforce this tendency. People\u0026apos;s cognitive cost of prosocial behavior needs to be contextualized under the impetus of empathy. From the perspective of motivation, people develop empathy, enhance their understanding of their emotions, and then judge whether such behavior is prosocial or not\u003csup\u003e[28]\u003c/sup\u003e.To sum up, reassessment of nurses\u0026apos; emotional state and moral consciousness can predict nurses\u0026apos; choice of obligation, and habitual use of other emotional regulation strategies (namely acceptance, mindfulness, rumination and catastroatization) does not affect individual moral choice, but can effectively reduce emotional arousal. Reevaluation and emotional adjustment can weaken emotion-related biases in moral choice. The negative influence of moral emotion on nurses should be reduced and the positive promotion enhanced\u003csup\u003e[29]\u003c/sup\u003e. Nonetheless, there is currently a lack of interventions targeting moral emotions, resulting in an inability to effectively manage these emotions within the nursing profession.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEvaluating nurses\u0026apos; emotional regulation and optimize nurses\u0026apos; moral emotional coping ability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMoral emotion refers to the subjective experiences that arise from nurses\u0026apos; encounters with clinical moral ethics and ethical dilemmas. If these moral emotions are not identified and assessed promptly, they may subtly influence nurses\u0026apos; behaviors. Emotional regulation is likely essential in mitigating the biases and repercussions associated with these emotions.\u0026nbsp;Consequently, interventions aimed at enhancing the experience of moral emotions and the emotional regulation capabilities of ICU nurses can effectively prevent adverse outcomes and further amplify the positive aspects of moral emotions. However, the study revealed that many nurses struggle to cultivate positive moral emotions and often resort to negative coping mechanisms in response to the challenges posed by moral emotions. This tendency is detrimental to the development and enhancement of moral emotions. While employing negative avoidance strategies may temporarily alleviate the emotional fluctuations associated with both negative and positive emotions, the underlying issues related to moral emotions do not dissipate; rather, they are suppressed and concealed. Some nurses, recognizing the impact of moral emotions on their well-being, actively seek to address the root causes of the conflicts that elicit these emotions. They may opt to align their actions with their personal values and moral principles to mitigate and evade negative moral emotions, or they may choose to adopt a stance of respect when confronted with moral dilemmas. Although these approaches can address the issues stemming from moral emotions at their source, they present significant challenges. The ethical dilemmas encountered in the ICU have profound implications for the lives and families of patients, making it difficult for nurses to approach these situations lightly. Consequently, they may resort to confessional practices to express their moral emotions, during which they critically assess immoral behaviors and acknowledge the existence of moral actions. Nonetheless, the scientific validity of this approach remains a subject of debate\u003csup\u003e[30-31]\u003c/sup\u003e, but it seems to be a more relaxed and preferred way for clinical nurses to vent their emotions. Another form of moral emotional regulation frequently employed by nurses involves seeking support and assistance, which may be derived from the community, healthcare institutions, and familial networks. Such essential external support can enhance their capacity to navigate moral challenges and dilemmas, thereby improving their ability to regulate emotions effectively. Miles \u003csup\u003e[32]\u003c/sup\u003ehighlighted that the recall catharsis method can assist nurses in fostering a positive moral self-assessment and eliciting appropriate emotional responses. Furthermore, this method enables them to develop psychological resilience and enhance their emotional tolerance during the recall process. Metselaar\u003csup\u003e[33]\u003c/sup\u003eproposed the use of moral case discussions to bolster the moral resilience of nurses operating in ethically challenging contexts, thereby encouraging them to engage in reflective practices concerning moral dilemmas. The development of moral resilience is instrumental in assisting nurses in navigating moral challenges and mitigating associated moral emotions.Greene\u003csup\u003e[34]\u003c/sup\u003eintroduced the significant ethical dual process model (DPM), which posits that cognitive and emotional processes are distinct and may occasionally compete with one another in the realm of ethical decision-making. Consequently, the processes of cognition and emotional expression are not only independent but can also undergo transformation under specific conditions. This framework implies that initiating interventions focused on the dual processes of moral emotion generation and cognition may enhance nurses\u0026apos; capacity to regulate and manage their moral emotions. Therefore, the development of assessment tools aimed at evaluating nurses\u0026apos; moral emotions, along with the precise identification of these emotions, is crucial for implementing targeted intervention strategies that can improve nurses\u0026apos; abilities in moral emotion regulation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study has limitations. First, there is an inherent risk of bias during the recruitment of study participants due to sampling methods. Secondly, we only selected nurses from three hospitals in Shandong, China as respondents. Although the data reached saturation, the survey results could not represent the views of all nurses in China. But our findings do explain the moral emotions that exist in ICU nurses and the realities of dealing with them.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, it is summarized that the moral situation of ICU nurses, the influence of moral emotions and their experience in coping with moral emotions are found. It can be seen that the moral emotions of ICU nurses exist significantly and have a certain impact on their health and work. When they experience moral emotions, some nurses have learned to take certain measures to relieve them. But there are also some nurses who have shortcomings in coping with moral emotions. Therefore, we should pay attention to the moral emotional problems of ICU nurses, and formulate targeted intervention strategies to improve nurses\u0026apos; emotional regulation ability and coping ability, which is conducive to the improvement and development of nursing work.\u003c/p\u003e\n\u003cp\u003eRelevance for clinical practice：This study makes up for the research gap of nurses\u0026apos; moral emotions in moral dilemmas, and explores the moral emotions and coping situations of ICU nurses, which helps us to better identify and manage moral emotions, and helps to maintain nurses\u0026apos; mental health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Approved by the Clinical Research Ethics Committee of Affiliated Hospital of Qingdao University(QYFYWZLL29193).In accordance with the Declaration of Helsinki, all subjects were informed of the purpose and method of the study, and agreed that the content of the study would be recorded by means of audio recording. All participants voluntarily participated in the study and signed informed consent forms. All interview materials have been anonymously coded and kept strictly confidential to ensure that they are used only for this study.Informed consent was obtained from all participants prior to the interviews. Participants were free to withdraw from the study at any time.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCompeting Interest\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing ffnancial interests or personal relationships that could have appeared to inffuence the work reported in this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study accepted the 2023 Shandong Medicine and Health Science and Technology project and 2022 Shandong First Medical University\u0026nbsp;（Shandong Province School level education）\u0026nbsp;teaching reform research project of the Academy of Medical Sciences.\u003c/p\u003e\n\u003cp\u003eClinical Trial Number：No applicable.\u003c/p\u003e\n\u003cp\u003eAll participants gave informed consent to publish the study.\u003c/p\u003e\n\u003cp\u003eAuthor Contribution\u003c/p\u003e\n\u003cp\u003eStudy conception and design:WFM\u003c/p\u003e\n\u003cp\u003eData analysis and interpretation: YCZ,WZZ\u003c/p\u003e\n\u003cp\u003eDrafting of the article: ZZX,XJG,HJ\u003c/p\u003e\n\u003cp\u003eCritical revision of the article: YBG\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThanks are due to the participants for their valuable collaboration and contribution in the study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eShermer M.(2016). 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Neuron, 2004,44(2),389-400.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"intensive care unit, moral emotions, emotional experience, coping strategies","lastPublishedDoi":"10.21203/rs.3.rs-6340985/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6340985/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The Intensive Care Unit (ICU) is a ethical and moral workplaces characterized by moral sensitivity. Nurses working in ICUs inevitably experience many moral dilemmas, which result in moral emotions that affect nurses' physical and mental health as well as work efficiency and quality. The purpose of this study is to explore the occurrence, impact, and coping experience of moral emotions among ICU nurses, in order to lay the foundation for improving the situation of moral emotions among ICU nurses and exploring moral emotion management programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAims and objectives\u003c/strong\u003e: To understand the occurrence, impact, and coping experience of moral emotions among ICU nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch design\u003c/strong\u003e: A qualitative descriptive study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A descriptive qualitative study was conducted, utilizing purposive sampling to select ICU nurses in June 2024 for qualitative interviews, and the Colaizzi 7-step method was used to analyze the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 13 nurses participated in the interviews, and the results consisted of 3 themes and 9 sub-themes, including the situation of moral emotions experience (positive moral emotions experience, negative moral emotions experience), the impact of moral emotions on nurses (awareness and attitudinal impact, behavioral impact), and the experience of coping with moral emotions (negative avoidance coping, conflict and balance management, value preference choices, whining confabulation, and help-seeking).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Managers should pay attention to moral emotions faced by ICU nurses, including negative and positive emotions, actively screen and assess the situation of nurses' moral emotions affecting themselves, and target multi-channel comprehensive intervention strategies to guide nurses to positively view and cope with moral emotions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelevance for clinical practice\u003c/strong\u003e: This study makes up for the research gap of nurses' moral emotions in moral dilemmas, and explores the moral emotions and coping situations of ICU nurses, which helps us to better identify and manage moral emotions, and helps to maintain nurses' mental health.\u003c/p\u003e","manuscriptTitle":"Moral emotional experience and coping strategies of ICU nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 07:21:49","doi":"10.21203/rs.3.rs-6340985/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"739ad62a-f094-40d9-a845-9cf3f267a409","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T20:23:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 07:21:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6340985","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6340985","identity":"rs-6340985","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}