Moral Residue as Structural Burden: A Critical Ethnography of Palliative Care Nurses in Family‐Centred End‐of‐Life Care in Chinese Tertiary Hospitals

AIM: To explore how moral residue is experienced, maintained and partially managed by palliative care nurses in Chinese tertiary hospitals and to identify how family-centred decision-making, professional hierarchies and limited organisational support for ethical reflection shape its development. DESIGN: Critical ethnography. METHODS: Between March 2025 and January 2026, 24 palliative care nurses were purposively recruited from two tertiary hospitals in northern China. Data were generated through over 300 h of non-participant observation, semi-structured interviews and document analysis. Reflexive thematic analysis within a critical interpretive stance was used. Trustworthiness was supported by data source triangulation, reflexive journaling, peer debriefing and member checking. RESULTS: Three themes were identified. 'Carrying unfinished ethical business' described how repeated involvement in family-mediated concealment, decisions to continue burdensome treatment and resource constraints generated enduring moral residue. 'Silenced by hierarchy' revealed how professional hierarchies discouraged ethical dialogue, leaving nurses to manage distress alone. 'Informal repair' captured fragile peer-based coping and small rituals that offered partial relief but lacked organisational support. Across these themes, moral residue was perceived by participants to reduce emotional availability, hinder communication with families and contribute to burnout. CONCLUSION: Moral residue was identified as structurally embedded in Chinese palliative care nursing. Addressing it will require organisational change, including structured ethical reflection spaces, anonymous case discussion platforms and integration of moral residue awareness into nurse education. IMPLICATIONS FOR THE PROFESSION: Healthcare organisations should move beyond individual resilience training and create visible, legitimate spaces for ethical dialogue. Nurses' moral work must be recognised and supported to sustain compassionate end-of-life care. IMPACT: This study explored how 'moral residue' is experienced and sustained among palliative care nurses in Chinese tertiary hospitals. Moral residue was produced through family-centred decision-making, professional hierarchies and limited organisational support for ethical reflection. Findings provide direction for organisational interventions to support nurses' moral capacity and improve the quality of family-centred end-of-life care. REPORTING METHOD: COREQ checklist was followed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.