Purpose: To identify effective teaching strategies for cultivating ethical sensitivity and judgment in undergraduate nursing, given the daily ethical dilemmas of clinical practice and the continued reliance on lecture-based ethics education in Korea. Methods: A systematic review of international studies (2015–2025) was conducted using PubMed, CINAHL, Embase, and the Cochrane Library. Eligible studies addressed undergraduate nursing ethics education, reported learning outcomes, and detailed instructional strategies. Data were extracted on strategy type and outcome measures, and synthesized narratively with attention to comparators. Results: Twenty-five studies frequently employed simulation (e.g., standardized patients, ethics committees with structured debriefing), problem-based learning, e-learning, and blended formats. Across studies, these active approaches improved ethical awareness, empathy, moral sensitivity, decision-making, and judgment, with greater gains where scenarios were authentic, feedback was structured, and interaction was high. Lecture-only formats rarely produced comparable effects. Few studies reflected Korean programs, where pedagogical variety remains limited. Conclusion: Active, practice-oriented strategies show advantages over lectures for developing ethical competence in nursing students. Korean curricula should diversify pedagogy, invest in faculty development for simulation/debriefing and case facilitation, and adopt structured evaluation tools aligned with clinical ethics. Future work should standardize measures and test feasibility in local contexts.

Purpose: Nurses frequently encounter morally complex clinical situations that generate moral distress, which, if unresolved, may accumulate as moral residue and progress to moral injury. This review synthesizes current evidence on moral resilience and ethical practice environments and proposes an integrated framework for sustainable ethical practice in hospitals. Methods: A narrative review of literature was conducted to examine moral distress, moral injury, moral resilience, ethical climate, psychological safety, and speaking-up climate. Conceptual integration was undertaken to present a multilevel strategy framework and a stepwise model linking individual, relational, and organizational factors. Results: Moral resilience, defined as the capacity to maintain or restore moral integrity under moral adversity, comprises four domains: response to moral adversity, personal integrity, relational integrity, and moral efficacy. Higher moral resilience is associated with lower burnout, turnover intention, and quiet quitting and may mediate the relationship between ethical climate and work engagement. However, individual resilience alone is insufficient in hierarchically structured and psychologically unsafe environments. In such contexts, sustainable ethical practice requires institutionalized ethical climate, psychological safety, protected speaking-up systems, and structured ethics support. Conclusion: Sustainable ethical practice is achieved when moral resilience is strengthened at the individual level and embedded within team culture and organizational policy.

The climate crisis poses a growing threat to public health and healthcare system sustainability, while the healthcare sector itself contributes substantially to greenhouse gas emissions. This commentary compares healthcare carbon reduction policies in major countries—the United Kingdom, the United States, and South Korea—and examines the role of the nursing profession within these frameworks. The United Kingdom has implemented a legally mandated decarbonization strategy through the National Health Service, achieving measurable emission reductions via integrated governance and accountability. The United States has adopted a decentralized, largely voluntary approach led by federal initiatives and institutional pledges. In contrast, South Korea lacks a healthcare-specific national decarbonization strategy and relies mainly on general climate and energy policies that indirectly include healthcare institutions. Across countries, nurses are increasingly recognized as key actors in reducing healthcare-related emissions through clinical practice and policy advocacy; however, this role remains insufficiently institutionalized in Korea. This commentary argues that South Korea should establish a dedicated national governance framework for healthcare decarbonization and reposition the nursing profession as a core implementation partner and policy advocate. Integrating climate change, sustainability, and resilience into nursing education and ensuring adequate workforce support are essential to advancing a low-carbon, climate-resilient healthcare system.