Nurses’ moral decision-making in practice through Kantian duty ethics

BackgroundNurses frequently encounter ethical dilemmas, moral distress, and situations in which they must balance professional duties, personal values, and organizational constraints. Deontological ethics, particularly Kant's ethics of duty, offers a normative framework that emphasizes moral action grounded in duty rather than consequences. However, limited empirical research explores how nurses understand and enact Kantian principles in everyday clinical practice.Research aimTo explore how nurses understand and enact principles of Kant's ethics of duty in clinical decision-making and how this philosophical framework shapes their moral judgement, sense of duty, and professional integrity.Research designA qualitative descriptive research design.Participants and research contextBetween November and December 2025, 17 nurses were recruited from various clinical settings in Slovenia through purposive sampling. Data were collected through semi-structured in-person interviews focused on moral decision-making, professional duty, moral autonomy, and institutional constraints. Braun and Clarke's thematic analysis approach was employed to analyze the data.Ethical considerationsThe study was approved by the university ethics committee. Participation was voluntary and anonymous, and written informed consent was obtained from all participants.FindingsThe data analysis developed five major thematic categories: perceptions of the demands and responsibilities of nursing work, understanding of duty and professional ethics, ethical decision-making and moral autonomy, the emotional dimension and humanized nurse-patient relationships, and organizational conditions and systemic ethical challenges.ConclusionsThe findings suggest that nurses largely enact Kantian ethics of duty through internalized professional values and commitment to patient dignity. However, organizational and systemic factors significantly limit their capacity for autonomous moral action. Strengthening ethical practice in nursing requires improved working conditions, enhanced professional autonomy, and structured support through ethics education, supervision, and team-based ethical reflection.