Convergences and divergences in nursing ethics across the European Union: A qualitative comparative analysis of national codes

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BACKGROUND: Nursing ethics guides practice, but European Union national codes were developed in diverse socio-legal contexts, generating heterogeneous emphases. PURPOSE: To compare European Union nursing codes of ethics, mapping convergences, divergences, and emerging ethical dimensions. METHODS: Qualitative documentary analysis with thematic content analysis examined 22 European Union member-state codes plus the European Nursing Council and International Council of Nurses (ICN) codes, with input from nursing, qualitative, and health-law experts. DISCUSSION: Fourteen themes were identified: Dignity, Respect and Non-Discrimination; Autonomy and Informed Consent; Professional Secrecy and Data Protection; Safety and Evidence-Based Practice (EBP); Interprofessional Collaboration and Shared Responsibility; Protection of Vulnerable Groups and Violence Prevention; Palliative Care and Dignity at the End of Life; Conscientious Objection and Continuity of Care; Technologies and Artificial Intelligence; Environmental Sustainability and Public Health; Social Justice and Advocacy; Organizational Well-being; Governance, Integrity, and Professional Discipline; Training and Professional Development. Fundamental principles showed strong convergence, while newer areas (AI, One Health, organizational well-being) appeared unevenly. The findings suggest the existence of a shared ethical core across European nursing while highlighting differences in the formalization of emerging ethical challenges. These variations may reflect contextual priorities, regulatory traditions, and different stages of ethical adaptation across national frameworks. CONCLUSION: This study provides an updated overview of the European nursing ethics landscape and may inform future discussions on the evolution of ethical guidance in response to contemporary healthcare challenges while respecting national contexts.

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