“Whose voice should we listen to?”: Confucian relational ethics, fractured loyalties, and moral distress among Chinese pediatric nurses–A qualitative study

Moral distress is well documented in Western nursing literature, yet existing theories insufficiently explain how family-centered authority, filial piety, and hierarchical norms shape the moral experiences of pediatric nurses in non‑Western contexts. In China, Confucian relational ethics grant parents strong moral legitimacy in clinical decision-making, creating culturally specific tensions when parental choices conflict with the child’s best interests or with nurses’ professional judgment.