Attitude of Nurses towards Professional Situations that Violate Their Ethical and Deontological Values
Alain Fernand Ingabire *
Food Security and Human Nutrition Program, Faculty of Agricultural and Veterinary Sciences, University of Ngozi, P.O. Box 137, Ngozi, Burundi, Centre for Research in Agriculture and Rural Development (CERADER), University of Ngozi, P.O. Box 137, Ngozi, Burundi, Faculty of Medicine and Health Sciences, University of Ngozi, P.O. Box 137, Bujumbura, Burundi and Doctoral School, Pole of Natural Sciences, Life Sciences and Engineering, University of Burundi, P.O. Box 2700, Bujumbura, Burundi.
Esperance Bedetse
Food Security and Human Nutrition Program, Faculty of Agricultural and Veterinary Sciences, University of Ngozi, P.O. Box 137, Ngozi, Burundi, Centre for Research in Agriculture and Rural Development (CERADER), University of Ngozi, P.O. Box 137, Ngozi, Burundi and Faculty of Medicine and Health Sciences, University of Ngozi, P.O. Box 137, Bujumbura, Burundi.
Julie Bigirimana
Food Security and Human Nutrition Program, Faculty of Agricultural and Veterinary Sciences, University of Ngozi, P.O. Box 137, Ngozi, Burundi, Centre for Research in Agriculture and Rural Development (CERADER), University of Ngozi, P.O. Box 137, Ngozi, Burundi and Faculty of Medicine and Health Sciences, University of Ngozi, P.O. Box 137, Bujumbura, Burundi.
Eric Niyokwizera
Faculty of Medicine and Health Sciences, University of Ngozi, P.O. Box 137, Bujumbura, Burundi.
Kevin Muhoza
Faculty of Medicine and Health Sciences, University of Ngozi, P.O. Box 137, Bujumbura, Burundi.
*Author to whom correspondence should be addressed.
Abstract
Introduction: The nursing profession is grounded in a set of ethical values and deontological rules designed to ensure the quality, safety and humanity of patient care. In daily practice, however, nurses are frequently exposed to professional situations that conflict with these values.
Aim: This study aimed to describe nurses' attitudes towards professional situations that violate their ethical and deontological values and to explore the associated factors and consequences.
Methodology: A descriptive cross-sectional study was conducted from April 1 to April 30, 2026, involving 29 nurses working in the Internal Medicine, Emergency and Surgery departments of the Ngozi Third Reference Hospital. Convenience sampling was used and included all eligible nurses present during the study period. Data were collected using a structured questionnaire. Data processing and descriptive analysis were performed using Microsoft Excel. No inferential statistical tests were conducted because of the descriptive nature of the study and the small sample size.
Results: The study revealed that 79.3% of nurses had often or sometimes experienced situations that violated their ethical values. The most frequently reported situations were a lack of equipment compromising the quality of care (69.0%), inequalities in access to care based on social status (62.0%), and hierarchical pressures contrary to patients' interests (51.7%). Regarding attitudes, 37.9% reported adapting to the situation while experiencing inner discomfort, whereas only 13.8% firmly opposed and reported the situation. The main barriers to responding were workload (65.5%), lack of institutional support (55.2%), and fear of hierarchical reprisals (48.3%). More than 70% reported at least moderate psychological suffering, and 51.7% reported high to very high levels of burnout. Nearly half of the nurses (48.2%) had considered leaving the profession, and 69.0% perceived a negative impact on the quality of care.
Conclusion: The findings suggest that nurses frequently experience situations that violate their ethical and deontological values, with passive adaptation accompanied by inner discomfort being more common than active opposition. These situations appear to be associated with negative consequences for nurses' professional well-being and the perceived quality of care. However, because of the descriptive cross-sectional design, small sample size, and single-centre nature of the study, these results should be interpreted with caution, and causal inferences cannot be drawn. Strengthening ethics training, creating institutional ethics committees, and improving working conditions are potential approaches to supporting nurses and protecting their professional integrity.
Keywords: Nursing ethics, deontology, moral distress, ethical value conflicts, professional values, Burnout, ethical climate, nursing practice, quality of care