Cognitive Dissonance in Nursing: A Mixed Systematic Review of Its Impact and Coping Strategies

AIM: This mixed-method systematic review synthesised quantitative and qualitative empirical evidence on how cognitive dissonance triggered by care experiences and circumstances affects nurses' well-being, professional behaviour, patient care and on the coping strategies nurses use to manage these experiences. DESIGN: Following Joanna Briggs Institute guidance, a convergent integrated synthesis approach combined qualitative and quantitative findings. DATA SOURCES: Sixteen studies were included following a comprehensive search across five databases in August 2024. RESULTS: Sixteen studies were included: 12 qualitative, two quantitative and two mixed-methods. Four key themes were identified: (i) dissonance is triggered by conflicting demands, (ii) dissonance discomfort may generate lasting distress, (iii) dissonance influences nursing practice and quality of care and (iv) dissonance reduction efforts varied. Overall, the evidence base was limited in scope and predominantly qualitative, with included studies generally showing moderate to high methodological quality. CONCLUSION: Cognitive dissonance is a common but under-recognised challenge in nursing. It arises when actions conflict with professional standards or when nurses are prevented from providing necessary care. If unresolved, it harms nurses' psychological well-being, causing stress, emotional strain and reduced job satisfaction. It may also reduce the quality of care in nursing practice. There is a need for validated measurement tools, longitudinal research exploring long-term impacts and targeted interventions to support nurses. IMPACT: This review is the first to systematically synthesise qualitative and quantitative evidence on cognitive dissonance in nursing. It addresses an important gap by bringing together findings on how dissonance arises in clinical settings, how nurses experience and manage it and its effects on practice and patient care. It also contributes to our understanding of coping strategies nurses use to cope with cognitive dissonance. The findings will support future research, education and interventions aimed at improving care quality and nurse well-being. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement.