The process of nurses’ confrontation with ethical conflicts in home care: a grounded theory study

Ethical conflicts (ECs) are an inseparable part of nursing care, particularly home care (HC). Nurses’ inability to effectively manage ECs may lead to occupational stress, job burnout, and low patient care quality. Despite various studies on ECs, there is limited research regarding the process of nurses’ confrontation with them in HC settings. This study aimed to explore the process of nurses’ confrontation with ECs in HC. This qualitative study was conducted from February 2023 to August 2025 using Corbin and Strauss’s approach to grounded theory. Twenty-two unstructured and semi-structured interviews were held with sixteen nurses recruited through purposeful and theoretical sampling from HC centers in Tehran, Iran. Data were analyzed using Corbin and Strauss’s approach to grounded theory. The main concern of participants was fear of harming patients, and their four strategies to manage it were expedient thinking, persuading, self-justifying, and disclosing. They used these strategies to balance the interests of all parties involved in the EC situation, including patients, families, colleagues, and HC center authorities. Therefore, the core category of the theory formulated in this study was “Balancing the interests”. Nurses’ confrontation with ECs in HC is a complex process influenced by a variety of contextual factors. Study findings can be used to develop purposeful educational and supportive programs for improving nurses’ ethical decision-making.