From the goodness of our hearts: a scoping review of qualitative literature on altruism as a reward mechanism for nursing

Abstract

Introduction

Altruism, the desire to help others, is a common motivation for choosing a career in nursing. Improved understanding of the role of altruism as a reward or motivation for currently-practicing nurses may inform future interventions to improve effort-reward balance among practicing nurses. Therefore, the purpose of this study was to collect, examine, and present literature on how altruism has been described as a reward mechanism or motivation for engaging in professional nursing.

Methods

This scoping review of literature used the Arksey & O’Malley method, PRISMA-ScR reporting checklist, and Rayyan review management platform. PubMed, Web of Science, and CINAHL were searched for: “nurs* AND ((reward OR compensation OR motivation) AND qualitative).” Inclusion criteria included peer-reviewed empiric study in English, pertaining to nurses employed in a patient-facing role, and pertaining to altruism or a similar concept (e.g., benevolence, helping others) as a reward, motivator, or compensation mechanism for professional nursing work. No date limitations were imposed.

Findings

Thirty-nine studies met search criteria. Three themes were identified: (1) work engagement (n = 30), e.g. personal connectedness with their work through altruism (2), barriers to altruism, self-sacrifice (n = 15), e.g. lack of resources in the workplace and (3) spirituality (n = 15). Nurses described engagement with their work through altruism. Barriers to altruism were described, particularly due to lack of resources in the workplace, and some nurses engaged in self-sacrificing behaviors to compensate for unmet needs. Many nurses described spiritual fulfillment and nursing as a religious practice through altruism.

Conclusions

Work engagement and spiritual fulfillment through altruism is described as a reward or motivation by nurses. However, barriers to altruism and self-sacrifice to overcome barriers were described.

The desire to help others, altruism, is often described as a central value to what it means to be a professional nurse [1, 2]. In addition to being a professional value, altruism has been considered as a reward mechanism for nurses [3]. Past literature has focused on nurse altruistic behaviors such as being compassionate, providing quality care, volunteering, and helping colleagues [4]. Given the role of altruism as a reward mechanism or motivation for practicing professional nurses, an improved understanding of altruism as a potential work reward for professional nurses may inform a healthy work environment that meets the needs of both patients and nurses.

Nurses are consistently rated the most trusted profession in part because altruism is considered an integral part of a nurse’s professional identity [1, 5]. Accordingly, one of the most common rationales students give for entering nursing school is the desire to behave altruistically toward others [6].

Effort-reward balance in the professional setting is the concept that there is an equilibrium between personal effort extended in the work environment and the rewards one obtains from professional work [7]. An adequate balance between nurses’ efforts on behalf of patients and rewards is an essential component of a healthy work environment [8, 9].

The imbalance between effort and reward is associated with intention to leave the nursing profession and decreased empathy towards patients [10, 11]. A healthy balance between efforts and rewards associated with the nursing workplace must be considered holistically, including intangible rewards for nursing work like altruism.

Examining the state of the science would help determine how altruism is described as a reward mechanism or motivation for engaging in professional nursing. Therefore, the purpose of this scoping review was to collect, examine, and present literature on how altruism has been described as a reward mechanism or motivation for engaging in professional nursing.

Theoretical framework

The Effort-Reward Imbalance model that informed this work describes reciprocity between efforts extended and the rewards received through the course of one’s professional work [7]. In this framework, appropriate reward reciprocity is hypothesized to predict positive emotional response, worker well-being, and intention to stay in the profession. There are three types of rewards outlined by the effort-reward imbalance model: money, esteem, and career opportunities. This review was focused on evaluating research on how altruism is described as a form of esteem (reward) that nurses value.

Methods

This scoping review was developed using the Arksey and O’Malley method and utilized the PRISMA-ScR 2018 reporting guidelines [12, 13]. The Arksey and O’Malley method was selected because it was best suited to the purpose of this study: to map the field of research on altruism by providing a narrative account of existing literature, but not to appraise the quality of evidence, provide evidence synthesis, or recommend that the findings of studies are generalizable [12].

PubMed, Web of Science, and CINAHL were searched using the following keyword string: “nurs* AND ((reward OR compensation OR motivation) AND qualitative).” Based on pilot searches performed, we noted that some articles did not include terms like altruism, beneficence, or other similar terms as keywords but nonetheless described altruism as a reward mechanism. Therefore, we chose to exclude ‘altruism’ and like terms (e.g., magnanimity, beneficence, helping others, etc.) from the search terms to avoid inadvertently excluding relevant articles. We chose to include only articles with a qualitative component out of desire to include only data that describes the experience of motivation or reward through altruism. The search took place on September 14th, 2023 and was updated on January 23rd, 2026. Inclusion criteria for this review included full-text availability in English, peer reviewed, and empirical study of nurses employed in a patient-facing role pertaining to altruism as a motivator, compensation mechanism, or reward for professional work. No date criterion was implemented for this review. However, due to the digital nature of search keyword indexing it was anticipated that there could be fewer results from articles published earlier than the 1990s. Exclusion criteria for this review included studies on volunteer or student nurses, studies on nurses that were not primarily patient-facing (e.g., nurse managers), studies that did not discuss altruism or a similar concept (helping others, benevolence, charity towards others, magnanimity, etc.) within the context of a reward structure for professional work, studies that did not include a focus on nurses.

The titles and abstracts were reviewed for relevancy by three researchers ([initials redacted for blinding]) using Rayyan [14]. The full text review was completed by three research team members individually, who met to discuss and come to a consensus on article inclusion based upon inclusion and exclusion criteria. Articles that discussed either altruism (operationally defined as an expressed desire to help others) or rewards/motivations for work, but not altruism as one of the rewards or motivations for professional nursing work, were excluded. There were several instances of publications written by one of the three research reviewerers. In these cases neutrality for relevance was maintained by cross-checking among the other two reviewers. Thematic synthesis, a three-step process in which text is analyzed and interpreted to generate new constructs or explanations, was utilized to synthesize data [15]. Findings were extracted and coded by all three researchers; in the one instance where a reviewer was also an author of an included manuscript, the reviewer recused themselves from analyzing their own manuscript. The researchers met to discuss and agree upon codes. The codes were organized into categories and abstracted into broader themes to describe the categories of findings, which were discussed and agreed upon by all three researchers. All findings were synthesized and presented in a narrative summary. Diverging opinions at all stages of coding, theme derivation, and synthesis of findings were agreed upon via discussion and group consensus. This method was chosen a priori due to the expected heterogeneity in group cultures within studies identified. This review was registered via the Open Science Framework registries.

Results

The search yielded 14,437 results; 10,335 unique results remained after duplicates were removed, of which 10,200 were excluded. 135 full texts were reviewed, 39 articles met inclusion criteria after full-text review (Fig. 1). Articles were excluded at this stage for the following reasons: [1] conceptual mismatch (e.g., article is not about altruism as motivation for nursing work, n = 91) [2], population mismatch (e.g., article is not about nurses or about nurses working in a professional context, n = 5). Eight studies used the term ‘altruism’ [16–23]. Summary data from included studies is presented in an evidence table (Table 1).

Fig. 1.

PRISMA diagram

Table 1.

Evidence summary

Author	Year	Research Purpose and/or Questions	Design, data source(s)	Sample, setting, *Country	Key Findings
Adib-Hajbaghery et al.	2021	To explore nurses’ perceptions of factors contributing to development of love of the nursing profession.	Content analysis of semi-structured interviews.	N = 13 Iranian nurses and nurse managers who were identified by colleagues as having love of the nursing profession.	Themes: (1) public perception of nursing profession, with subtheme ‘holiness of nursing’ e.g. spiritual satisfaction derived from helping others. (2) structure of nursing educational system, (3) characteristics of the profession, and (4) self-evaluation, e.g.job satisfaction when nursing interventions help patients.
Ali & Shaban	2025	To explore how early career nurses navigate decisions to stay or leave clinical practice.	Phenomenology, semi-structured interviews.	N = 21 Saudi Arabian nurses with < 5 years of experience who worked in a tertiary care hospital setting.	Themes: (1) wrestling with reality, (2) seeking belonging and recognition, (3) balancing passion and exhaustion, (4) staying though meaning, straying through neglect.
Asadi et al.	2019	To explore the factors that affect caring motivation from the perspectives of nurses in Iran.	Content analysis of semi-structured interviews.	N = 17 Nurses who had worked as nurses for between two and 18 years in Iran.	Themes: (1) self-valuation and (2) providing beneficial care, e.g. high-quality, individualized patient care free from discrimination was a motivating factor for participants. Helping patients achieve discharge, reduce pain, or improve their condition was motivating to participants.
Atefi et al.	2014	Examine Iranian nurses’ job satisfaction and dissatisfaction in a large hospital following implementation of a national policy limiting the number of hours that may be worked.	Qualitative description of focus group sessions.	N = 85 Convenience sampling of nurses who worked in the medical, surgical, or critical care wards of a large hospital in Iran and had at least two years of experience; ten focus groups were held.	Themes: (1) spiritual feeling, e.g. religious satisfaction through their nursing work by helping patients with their needs. (2) work environmental factors, e.g. long working hours and high workloads were barriers to helping patients through their work, and required tasks and limited workplace autonomy were also identified as barriers to providing high-quality patient care, and (3) motivation from altruistic desires.
Atefi et al.	2016	Explore the factors related to job satisfaction and dissatisfaction experienced by registered nurses in a large hospital.	Thematic analysis of focus group sessions.	N = 46 Convenience sampling of nurses in Malaysia working in the medical, surgical, or critical care wards of a large hospital; seven focus groups were held.	Themes: (1) nurses personal values and beliefs, (2) work environment factors, and (3) motivation factors. Giving holistic care to help patients was satisfying to participants. Participants described heavy workloads as a barrier to providing high-quality patient care.
Atkinson	2015	Examine the perceptions of Muslim nurses of how religion informs their nursing practice.	Ethnography, semi-structured interviews.	N = 18 Nurses working in Kuwait of Muslim faith.	Themes: (1) altruistic relationships as a core value, (2) all care as spiritual care, (3) desire for greater understanding and respect as nurses (4) and as Muslims, (5) professional kinship that transcends culture religion and nationality, (6) nursing ethics from divine ethics, and (7) radical acceptance of God’s will balanced with hope of reward. Altruism and service, charity to others was a source both of spiritual obligation and spiritual satisfaction.
Banks & Bailey	2010	Examine the lived experiences of newly licensed registered nurses early in their careers.	Phenomenology, semi-structured interviews.	N = 14 Nurses working in two hospitals, unspecified country.	Themes: (1) altruism, (2) influence of role models, (3) self fulfillment, (4) challenging career.
Christianson et al.	2022	Examine the impact of the Covid-19 pandemic on the duty of care balance among ICU nurses who manage Covid-19 patients.	Content analysis, semi-structured interviews.	N = 13 Practicing critical care nurses in the United States working with Covid-19 patients.	Themes: (1) perceptions of betrayal or abandonment of nurses, (2) deviations from the normalized standard of care expectations, (3) feeling a moral obligation to care for Covid-19 patients, and (4) expectation of self-sacrifice contributing to the experience of burnout e.g. desire to provide patient care, but some felt they were unable to provide enough care.
Cohen et al.	1994	Describe oncology nurses’ perceptions of the rewards and difficulties of their work.	Phenomenology, content analysis of semi-structured interviews.	N = 38 Nurses working in an oncology setting in the United States.	Sources of both rewards and difficulties: patients, coworkers, and skills. Rewards included fulfillment at patient comfort and/or improvement, collegial relationships, and confidence associated with professional skill development. Difficulties included frustrations associated with patient families, patient loss, hostility between coworkers, and poor job autonomy.
Coverston et al.	2004	Identify factors that discourage nurses and those that motivate nurses to continue in their practice despite the drawbacks.	Content analysis of semi-structured interviews.	N = 10 Five nurses practicing in Guatemala, five nurses practicing in the United States, all working as nurses in an acute care setting.	In both locations fulfillment was associated with making a positive difference in the lives of their patients and patient families. Workloads were a barrier to providing the high-quality patient care.
de Benedictis et al.	2022	Explore the experiences of nurses involved in frontline Covid-19 care during the pandemic.	Content analysis of semi-structured focus groups.	N = 9 Nurses working in an Italian hospital designated as a Covid-19 center; two focus groups were held.	Themes: (1) motivation and sense of mission, (2) development of professional and personal skills, (3) spirituality feelings and emotion, (4) person-centered care, and (5) uniqueness of the lived experience. Participants described the importance of interpersonal connectedness with patients and provision of care, which conflicted with the dearth of resources during the pandemic.
de Oliveira et al.	2019	Investigate the satisfaction and difficulties of the work of primary health care nurses in rural areas.	Content analysis of semi-structured interviews.	N = 11 Nurses who worked in the health units serving a rural area near Paraiba, Brazil.	Improved patients’ health, appreciation from the community, and relationships with the community were described as job satisfiers. Barriers to providing care: lack of equipment and infrastructure, and high workloads that interfere with providing quality patient care as dissatisfiers.
Desroches et al.	2024	Explore medical-surgical nurses perspectives on significant influences, challengers, enablers, and rewards of caring for adults with intellectual disabilities.	Qualitative description, semi-structured interviews.	N = 13 United States inpatient medical-surgical nurses.	Four categories of rewards were described: (1) connecting, (2) making a difference, (3) enjoyment, and (4) learning opportunity.
Dino et al.	2022	Investigate how motivation and resilience influence nurses to serve and cater to patients during the Covid-19 pandemic.	Mixed methods; quantile regression for quantitative data, thematic analysis for qualitative data. Data consisted of surveys comprised of the Connor-Davidson Resilience Scale, Work Extrinsic and Intrinsic Motivations Scale, Garbee and Killacky’s Intent to Stay Scale, and semi-structured interviews.	N = 50, of whom n = 8 were interviewed for the qualitative analysis. Filipino nurses working in the metropolitan Manila area.	Greater resilience was not significantly correlated with greater intention to stay in the nursing profession. Themes from the interviews: (1) motivation, e.g. a calling to provide care as a nurse and religious motivation to continue to work as nurses. (2) resilience, and (3) intention to stay, reported fulfillment through providing care to patients, which provided motivation to stay in the nursing profession.
Drimousi et al.	2025	Explore the lived experiences and the job satisfaction of nurses working in Greek home health care settings.	Phenomenology, thematic analysis, interviews.	N = 9 Nurses working in home health care settings in Greece.	Themes: (1) nurse as guest, (2) understanding the world of home health care, (3) walking along a difficult road towards reward, and (4) looking forward to a better tomorrow.
Eder & Meyer	2022	Develop a more specific understanding of psychological mechanisms in the development of burnout in long-term care as a basis for potential new intervention strategies aimed at improving nurses’ mental health.	Thematic analysis, focus groups and semi-structured interviews.	Sample comprised of two studies. Study 1 N = 110 Focus groups comprised of nurses that took place after workshops in eight different nursing homes in Germany. Study 2 N = 14 Semi-structured individual interviews with German nurse executives in long-term care settings.	Study 1 Themes: (1) causes of challenges, e.g. structural challenges that made it difficult to impossible to accomplish patient care. (2) employees’ opportunities for change, and (3) organizational opportunities for change e.g. personal feelings of guilt or responsibility for understaffing Study 2 Themes : (1) job motives, (2) reasons for filling in for others, and (3) employee self-care. Nurse executives perceived that nurses were motivated by the desire to help others, which often provided sufficient motivation for taking on difficulty or stressful work. Desire to help others is a barrier to self-care. Nurse executives observed self-endangering behavior, defined as a cycle of high-stress work, low self-care, resulting in health problems and absenteeism. Participants identified self-sacrificing behaviors as employee difficulty saying ‘no’ to requests to work extra hours.
Franco et al.	2021	Know the meaning of the role of nurses in the hospital environment.	Descriptive research with a qualitative approach, similarity analysis, semi-structured interviews.	N = 50 Nurses with a minimum of one year of experience working in the hospital environment in Minas Gerais, Brazil.	Themes: (1) nurses’ daily work in the hospital environment, (2) work motivation as an influential factor in the meaning of work, and (3) two faces of the meaning of work: pleasure and suffering. Providing high-quality care to patients was a motivation and provided meaning as well as satisfaction to their work. Participants identified suffering due to lack of materials or an inability to relieve the suffering of others.
Friedrich et al.	2011	Discover what rewards inspire seasoned nurses to continue in acute care practice after the normal age of nurse retirement.	Grounded theory, interviews.	Sample comprised of two study phases Phase 1 N = 13 Nurses over the age of 62 engaged in acute care nursing in the United States. Phase 2 N = 12 Nurses in active practice but anticipating retirement (age 55–62) in the United States.	Themes: (1) attitudes and experiences, (2) retention factors, (3) important needs, and (4) unique contributions. Participants described their ability to make a difference in patient well-being as a unique contribution that motivated them to continue nursing.
Gimba & Duma	2015	Explore barriers to provision of psychiatric nursing care in a hospital in Plateau State, Nigeria.	Case study methodology, grand tour interviews, individual interviews, and participant observation.	N = 12 Psychiatric nurses working in a hospital in Plateau State, Nigeria with at least one year of experience.	Barriers to psychiatric nursing care included personal, relationship, environmental, public-related, and organizational barriers. Motivators to overcome barriers to psychiatric nursing included love for psychiatric patients, psychiatric nursing, desire to provide quality care, and religious beliefs.
Haberman et al.	1994	Identify the factors that influence oncology nurses’ decisions to enter nursing and specialize in oncology, and describe the role dimensions of oncology nursing practice.	Phenomenology, content analysis of interviews.	N = 38 Oncology nurses working in the United States.	Themes: (1) factors that influenced the decision to enter nursing and to specialize in oncology, (2) factors that make oncology nursing special, e.g. rewarded by their ability to help patients, and by the cultivation of relationships with patients and families. (3) factors that make caring for people with cancer difficult, e.g. blurring of the boundaries between their work and their personal lives and perceived overinvolvement with patients and families, and (4) key role dimensions of practice and caring behaviors performed by oncology nurses.
Harding	2009	Investigate factors that influenced men to become nurses	Thematic analysis, semi-structured interviews	N = 18 Male nurses in New Zealand.	Personal connection with the concepts of altruism, personal fulfillment through caregiving, and self-sacrifice were factors in participants’ decision making around choosing and remaining in the nursing profession.
Hjerrild et al.	2025	Explore how ICU nurses in Denmark define and experience the provision of spiritual care to patients and families in the ICU.	Phenomenology, semi-structured interviews.	N = 5 ICU nurses who work in a university hospital in Denmark.	Themes: defining spiritual care, (2) empathy in the face of suffering, (3) getting to know the patients and family, (4) the timing and prioritization of spiritual care.
Horberg et al.	2023	Explore what factors motivate experienced nurses in the workplace and underlying reasons for strong intention to leave the profession.	Content analysis, open ended survey questions.	N = 1146 Nurses who graduated from one of 26 Swedish universities 11, 13, or 15 years post-graduation.	Three subject areas were analyzed: motivation, intention to leave, and turnover. Within the motivation subject area, there were four categories: (1) organizational characteristics, (2) work characteristics, (3) relationships at work, and (4) recognition.
Huang et al.	2025	Explore the factors influencing the retention behavior of experienced nurses in China.	Qualitative description, semi-structured interviews.	N = 22 Hospital nurses who work in the Guangdong-Hong Kong-Macao Greater Bay Area of China.	Themes: (1) capability, (2) motivation, (3) opportunity.
Khanjarian & Sadat-Hoseini	2021	Explain the lived experiences of nurses providing altruistic care to COVID-19 patients.	Phenomenology, open interviews.	N = 12 Hospital nurses managing COVID-19 patients in Tehran, Iran.	Three stages were identified: (1) disquietude, intellectuality, and human transcendence. Participants described conflict between personal priorities like personal needs, family’s health conflicted with altruistic ideals when managing Covid-19 patients under high-stress and high-risk circumstances. (2) Self-sacrifice was described as necessary to continue to behave altruistically within the context of the professional nursing work performed during Covid-19 and likened the pandemic to a war. (3) Nurses described spiritual growth related to their work with Covid-19 patients.
Liao et al.	2024	Investigate nurses’ challenges in their daily professional activities in the aftermath of the Covid-19 pandemic.	Thematic analysis, focus group sessions.	N = 33 Taiwanese hospital nurses.	Themes: (1) invisibility of nurses, and (2) the moral duty of nursing practice.
Mahmoodishan et al.	2010	Explore nurse perceptions of spirituality and spiritual care.	Content analysis, semi-structured interviews.	N = 20 Purposefully selected sample of Iranian nurses from the Muslim faith.	Themes: (1) meaning and purpose of work and life, (2) religious attitude, and (3) transcendence-seeking. Altruism was tied to both spiritual rewards and personal satisfaction. Working with the ill and behaving altruistically was a form of worship and produced positive feelings for nurses.
Mair et al.	2022	Explore why staff continue to work in acute inpatient mental health facilities in New Zealand.	Thematic analysis, interviews.	N = 42 Acute inpatient mental health nurses in New Zealand.	Themes: (1) work that matters, (2) the people, (3) physical and social environment, (4) extrinsic rewards/personal benefits.
Morgan & Lynn	2009	Identify central themes that nurses identify as important to their overall evaluation of their work.	Content analysis, interviews.	N = 20 Currently employed nurses working in one of the following selected study sites in the United States: two academic medical centers, a federal hospital, an urban hospital, or a long-term care center.	Themes: (1) defining the nursing shortage, (2) intrinsic factors: making nursing meaningful, and (3) extrinsic factors: evaluating the job of nursing. Nurses described the nursing shortage as an insufficient amount of help to meet patient needs, which combined with highly demanding positions interfered with provision of high-quality patient care.
Nizzer et al.	2024	Explore how the Covid-19 pandemic shaped the working experience, motivation, and attitudes of home and community care nurses.	Thematic analysis, interviews.	N = 16 Home and community care nurses working in the greater Toronto, Ontario, Canada region.	Themes: (1) motivations to work in home and community care, (2) adjusting to the pandemic working conditions, (3) self-preservation after crisis, (4) sustaining a workforce.
Perry	2008	Evaluate the experience of career satisfaction in nurses who are highly satisfied with their work.	Phenomenology, narrative analysis, poetic interpretation, semi-structured interviews.	N = 8 Random sample of nurses who self-reported high levels of career satisfaction, geographic location not specified.	Themes: (1) upholding the vulnerable, (2) going the extra mile, (3) attending to the essential ordinary. The ability to protect and help the vulnerable was described by participants as a motivation for working in nursing. Going the ‘extra mile’ referred to doing more than the minimum required for patients and was described as a motivation for nursing.
Ravari et al.	2009	Identify and describe Iranian staff nurses’ views on their spiritual job satisfaction.	Content analysis, unstructured and semi-structured interviews.	N = 25 Nurses who worked in a hospitals in Tehran, Iran.	Themes: (1) spiritually pleasant feelings, (2) patients as celestial gifts, e.g. patients to religious figures that are highly respected and as sources of divine blessings for the nurses. (3) spiritual commitment, (4) spiritual penchant, (5) spiritual rewards, e.g. caring for and making patients feel happy, (6) spiritual dilemmas. Participants felt that in innate interest in serving or helping others was a prerequisite to choosing and remaining in nursing.
Rezaie et al.	2025	Explore and clarify the concept of professional engagement among clinical nurses.	Content analysis, semi-structured interviews.	N = 16 Hospital nurses across Iran with at least 6 months of work experience.	Themes: (1) benevolence, (2) vigor, (3) professional emotional belonging, (4) meaningful care.
Salaree et al.	2014	Explore burnout among Iranian nurses and the coping strategies adopted by them to deal with burnout.	Content analysis, interviews.	N = 21 Nurses working in ward hospitals in Iran who experienced long-term stress or high levels of burnout with a minimum of five years of nursing experience.	Themes: (1) religious responsibility, e.g. perceived religious duty to provide care to the vulnerable (2) approximation to God, (3) spiritual reward, e.g. felt rewarded by closeness to God when they provided care. “If you work for God, he pays you well.” (4) holiness of the job, and (5) spiritual journey.
Shih et al.	2009	Identify important contemporary values in professional nursing from the perspectives of Taiwanese nursing clinicians and educators.	Content analysis, focus group sessions.	N = 300 Nurses working as clinicians in the hospital setting, administrators, or faculty for a minimum of six months in Taiwan; twenty-two focus groups were held.	Themes: (1) caring for clients with a humanistic spirit, (2) providing professionally competent and holistic care, (3) fostering growth and discovering the meaning of life, (4) experiencing the give-and-take of caring for others, (5) receiving fair compensation, and (6) raising public awareness of health promotion. Participants described reward and emphasis on empathy toward patients as a central value of the nursing profession.
Sousa-Ribeiro et al.	2024	Explore the dimensions underlying the subjective experience of meaningful work among nurses and nursing assistant age 55–75.	Phenomenology, semi-structured interviews.	N = 27 Nurses and nursing assistants aged 55–75 years working in a Swedish hospital.	Themes: (1) personal identity, (2) purpose and contribution, (3) competence and accomplishment, (4) social contacts and belongingness, (5) activity, routines, and purposeful use of time, and (6) economic security and freedom.
Yau et al.	2024	Explore the positive meaning of care work with older people and its implications for healthcare workers’ job satisfaction and motivation to work in long-term care.	Thematic analysis, semi-structured interviews.	N = 30 Nurses (n = 13), health workers (n = 8), and personal care workers (n = 9) in Hong Kong, China.	Themes: (1) helping older people to age comfortably, (2) building meaningful relationships, (3) forming a professional identity of older people care, (4) ensuring job security, and (5) barriers to attaining the positive meaning of work.
Yu et al.	2020	Explore Chinese nurses’ experiences with empathy motivation.	Content analysis, semi-structured interviews.	N = 21 Nurses who worked in one of four hospitals in China with a good level of spoken Chinese and had worked as a nurse for at least one year.	Themes: (1) autonomous motivation, (2) controlled motivation, and (3) lack of empathetic motivation. Participants reported motivation derived from empathy and desire to help others, however some nurses felt coerced to show empathy toward patients. Some nurses prioritized clinical work over empathy towards patients and perceived empathy as unnecessarily taxing to the nurse.
Zamanzadeh et al.	2018	Explore what facilitates compassionate care in daily practice from the perspective of Iranian nurses.	Content analysis, semi-structured interviews.	N = 16 Nurses working in four hospitals in Iran.	Theme: (1) deepening individual’s capacity for compassionate care. Participants described personal desire to provide compassionate care to patients as a motivation or perceived duty with regards to their nursing careers. Altruism and desire to improve patient experiences motivated some participants to work as nurses.

Characteristics of included articles

Of the thirty-nine included studies, thirty-eight were qualitative, and one was mixed method. Only the qualitative data from the mixed-method study was included in data extraction. With regards to data analysis, fifteen studies employed content analysis, eight employed thematic analysis, nine employed phenomenology, one employed grounded theory, one employed ethnography, three employed qualitative description, and two did not specify. One study collected data via open-ended survey questions, all other studies collected data with individual (thirty-two) or focus group (six) interviews.

The included studies were geographically diverse and included Brazil (n = 2), Canada (n = 1), China (n = 3), Denmark (n = 1), Iran (n = 9), Kuwait (n = 1), Germany (n = 1), Greece (n = 1), Italy (n = 1), Malaysia (n = 1), New Zealand (n = 2), Nigeria (n = 1), Philippines (n = 1), Saudi Arabia (n = 1), Sweden (n = 2), Taiwan (n = 2), United States (n = 6), Guatemala and the United States (n = 1), and no specified location (n = 2). Qualitative data included in this scoping review was collected from 2372 unique participants (n = 1226 interview or focus group participants and n = 1146 survey participants).

Key findings

Three themes were identified: [1] work engagement [2], barriers to altruism, self-sacrifice, and [3] spirituality. Table 2 outlines a matrix of which studies were associated with each theme. Description of the themes with references is provided below.

Table 2.

Study x Theme Matrix

Author (year)	Theme 1: Work Engagement	Theme 2: Barriers to Altruism, Self-Sacrifice	Theme 3: Spirituality
Adib-Hajbaghery et al. (2021)	X		X
Ali et al. (2025)	X		X
Asadi et al. (2019)	X
Atefi et al. (2014)		X	X
Atefi et al. (2016)	X	X
Atkinson (2015)	X		X
Banks & Bailey (2010)	X		X
Christianson et al. (2022)	X	X
Cohen et al. (1994)	X
Coverston et al. (2004)	X	X
De Benedectis et al. (2022)	X	X	X
de Olivera et al. (2019)	X	X
Desroches et al. (2024)	X	X
Dino et al. (2022)	X		X
Drimousi et al. (2025)	X
Eder et al. (2022)	X	X
Franco et al. (2022)	X	X
Friedrich et al. (2011)	X
Gimba & Duma (2015)		X	X
Haberman et al. (1994)	X	X
Harding (2009)		X
Hjerrild et al. (2025)			X
Horberg et al. (2023)	X
Huang et al. (2025)	X
Khanjarian & Sadat-Hoseini (2021)		X	X
Liao et al. (2024)	X
Mahmoodishan et al. (2010)			X
Mair et al. (2022)	X
Morgan & Lynn (2009)		X
Nizzer et al. (2024)	X
Perry (2008)	X
Ravari et al. (2009)			X
Rezaie et al. (2025)	X		X
Salaree et al. (2014)			X
Shih et al. (2009)	X		X
Sousa-Riberiro (2024)	X
Yau et al. (2024)	X	X
Yu et al. (2020)	X
Zamanzadeh et al. (2018)	X

Work engagement

Work engagement through altruistic behavior was a prevalent theme in the literature reviewed and was found in n = 30 articles. Nurses in numerous studies reported engagement or felt fulfillment through providing holistic and/or high-quality patient care [18, 22, 24–29], making a positive difference in patients’ lives [22, 30–35], relieving suffering and/or witnessing improvement in their condition [23, 24, 35–40], or developing caring relationships with patients [16, 35, 39–42]. Nurses in the one study reported that it was personally rewarding to “go the extra mile” by doing more than their minimum required patient care duties to help their patients, and that helping others was the primary driver of their job satisfaction [43]. Desire to help families was also described in six studies [22, 30, 32, 40, 41, 44]. The desire to provide patient care despite poor patient care conditions was a motivator for some nurses who worked on the frontlines during the Covid-19 pandemic [17, 23, 26, 40, 45]. Not all behaviors perceived as altruistic were perceived positively as motivators. Some of the participants in the one study reported they felt coerced by others and their own perceived social desirability into showing empathy towards patients [28].

Engagement through helping others was not limited to patient care. Participants in five studies also reported desire or a perceived responsibility to help colleagues or the profession [18, 22, 31, 37, 46]. Participants in two studies also described motivation to help or serve the community [47, 48].

Barriers to altruism, self-sacrifice

Fifteen articles described either barriers that made it more difficult to help patients or self-sacrifice to overcome barriers. Barriers described included lack of equipment or infrastructure [27, 33, 35, 47, 49, 50], limited workplace autonomy [51], excessive workloads or working hours [18, 25, 30, 47, 51, 52], and inconsistent standards of care [17, 50].

Nurses in six studies described self-sacrifice (including: working through meal breaks or scheduled time off, working under hazardous circumstances, and excessive work-related emotional labor) as a compromise required to overcome barriers and meet patient care needs [17–19, 41, 45, 50]. Participants described the realities of an under-resourced workplace and the need to sacrifice personal needs to meet patient needs given workplace limitations [18, 50], and the blurring of the boundaries between professional work and one’s personal life [18, 41]. In studies that focused on the Covid-19 pandemic, nurses reported their conflict between their perceived duty or mission to care for patients and lack of resources [17, 45]. In another study, perceived obligation and desire to help others contributed to a social expectation that nurses would engage in self-sacrifice to overcome the dearth of resources [17]. Not all nurses described self-sacrifice as a negative attribute, some described self-sacrifice as a motivation for remaining in nursing [19] and as an act of philanthropy to benefit the public [50].

Spirituality

Participants in fifteen studies described a religious or spiritual fulfillment from the altruism performed in their nursing practice. Many participants felt that their spiritual satisfaction through their nursing practice held religious significance associated with their faith or a higher power [16, 20, 22, 23, 26, 49–51, 53, 54]. One participant noted that: “When you work for God, he pays you well” [54]. Five studies that addressed religious faith specified that participants were Muslim [16, 20, 50, 53, 54]. Participants in one of these studies reported that working with the ill and behaving altruistically was a form of worship and produced positive feelings for nurses [51]. Five articles discussed religious faith but did not specify a faith tradition held by participants [22, 23, 26, 49, 51]. Participants in three studies described a similar spiritual fulfillment through nursing work but did not explicitly connect their perceived spiritual rewards with organized religion or a higher power [23, 32, 36, 45, 48, 55].

Discussion

To our knowledge, this is the first scoping review on how altruism has been described as a reward mechanism or motivation for engaging in professional nursing. Thirty-nine articles were included in this review. The studies included present data on altruism as a reward mechanism or motivator for nurses engaging in professional nursing that were grouped in themes: [1] work engagement (n = 30); [2] barriers to altruism (n = 15), self-sacrifice; and [3] spirituality (n = 15). The findings are important because an imbalance between work efforts and reward are often associated with intention to leave the profession and decreased empathy towards patients [10, 11].

Work engagement

Work engagement was the most commonly reported theme and reflected the commonly held meanings of altruism, i.e. the feelings of satisfaction from helping others via providing high-quality care, making a positive difference in patients’ lives, and developing relationships with patients [16, 18, 22–41, 43, 44]. Literature in this review described altruism, the feeling of being rewarded by one’s work, and work engagement as interconnected. The findings align with the Effect-Reward model, which predicts that altruism is a form of esteem (reward) that nurses value [7]. There was insufficient evidence to determine if most or all nurses are motivated by altruism, and there was limited evidence to suggest that some nurses feel coerced to behave altruistically [28]. Nurses who are altruistically motivated may engage with their work because they are seeking out the satisfaction associated with helping others, and altruism in the workplace in turn serves as a reward which motivates nurses to continue to be highly engaged with their work. Altruistic behavior in the workplace is correlated with greater job satisfaction [3, 56].

Previous studies have highlighted the relationships between low work engagement and poor effort-reward balance [57]. While it is outside of the scope of this study to determine causation, our findings support the notion that nurses who felt rewarded by altruism in the workplace may also experience engagement with their work. Future research is needed to investigate interventions to promote altruism in the nursing workplace and examine the effects of such interventions on improving job satisfaction or work engagement.

Barriers to altruism, self-sacrifice

Barriers to altruism due to excessive workloads/working hours and/or insufficient infrastructure (e.g., resources) were identified in this literature review [18, 25, 27, 30, 35, 47, 49–52, 58]. Barriers to altruism created conflict in which nurses wanted to behave altruistically but felt they did not have the resources necessary to do so. This conflict mirrors the definition of moral distress, a syndrome which occurs when one perceives an action to be morally correct yet simultaneously feels unable to act [59]. Self-sacrifice was described as a method used to manage barriers to altruism [17–19, 41, 50].

Some participants in reviewed studies described self-sacrifice as motivating or fulfilling in its own right [19, 50], while twice it was described it as coercive or unwelcome [17, 18]. Scholarly perspectives on self-sacrifice and altruism are similarly varied: some scholars regard self-sacrifice as an attribute of moral intelligence for nurses [1], where others argue that self-sacrifice is harmful to professionals because it places an undue personal burden upon caregivers engaged in professional work [60].

One study in this literature review described concerns for the well-being of nurses who work in chronically under-resourced settings and display a willingness to engage in self-sacrifice [18]. Nurses who view altruism as a gratifying reward for their work may engage in self-sacrificing behavior as an underrecognized strategy to cope with under-resourced workplaces and manage poor effort-reward balance. Further research is needed to better understand the phenomenon of self-sacrifice in the context of professional nursing. Specifically, research identifying who the nurses that engage in self-sacrificing behaviors are, what are the potential links between the desire to behave altruistically and self-sacrificing behaviors, and the [positive or negative] consequences of self-sacrificing behavior would be helpful to better characterize this phenomenon.

Spirituality

Several studies in this review included participants who described altruism through their nursing practices as spiritually rewarding [16, 20, 22, 23, 26, 32, 49–51, 53–55]. When nurses are spiritual and behave altruistically, they may see this as a form of worship and their behavior can produce positive feelings [20, 54]. These feelings may serve as a reward and foster work engagement. This finding matches the ERI model prediction, but in a more nuanced way because it extends beyond the traditional definition of esteem as the reward and explains that spiritual reward may be as powerful. Furthermore, spiritual reward may be associated with esteem, and it may prevent moral distress.

Some nurses described work engagement through the spiritual engagement they experienced while performing nursing work. However, based upon literature presented, it was unclear if the spiritual rewards described were distinct from the rewards nurses described in a non-spiritual context. It is possible that spiritual rewards are a subtheme of the ‘work engagement’ theme, but the literature reviewed did not present clear evidence if the elements of religious practice described were conceptually congruent with work engagement described in a secular context. Further research may be helpful to better define if spiritual fulfillment through altruism is a distinct type of reward from the more generalized fulfillment that some nurses described (e.g., in the work engagement theme).

Strengths and limitations

The review had strengths and limitations. One strength was that we did not limit the country of origin, time of study publication, or sample size. Thus, we were able to capture as many potentially relevant articles as possible. However, it is possible that relevant papers were not captured through our search strategy. Describing the quality and contextual differences of the primary studies is beyond the scope of this review. The concept of altruism within the professional space as a reward mechanism for nurses may be underrecognized, which may have consequently limited our results. This analysis was limited to thematic analysis of qualitative papers and was performed to best summarize key concepts that pertain to altruism as a motivation or reward for nursing work. Our findings may be subject to publication bias as we did not include publications on preprint servers, theses, or dissertations. Though our sample was geographically diverse, our findings may have limited transcultural generalizability as the definition and/or importance of altruism may differ between cultures.

Implications for practice

Efforts to improve nurse workplace well-being must holistically address the balance between efforts and rewards, including intangible rewards like altruism that professional nurses may value or seek out. Three themes identified were: work engagement, barriers to altruism and self-sacrifice, and spirituality. Some nurses viewed self-sacrifice as a negative consequence of imbalance between professional duty of care and resource availability, where others saw self-sacrifice as a way to form camaraderie with other nurses or as a spiritual exercise of their professional and personal commitments. Promoting altruism and highlighting how nursing work positively impacts others may be an effective part of a holistic approach to improving nurses’ workplace well-being.

Conclusion

While it is perhaps unsurprising that nurses find work engagement through altruism, the implications for working in an environment that makes it difficult to fulfill altruistic desires may be underrecognized. Further research is needed to better understand the role of altruism as a motivator in the professional setting, particularly with regards to potential association of unfulfilled altruistic desires on effort-reward balance, moral distress, and nurse burnout. Additional philosophical examination of altruism as a reward for professional work may be warranted to more closely examine altruism as a relevant reward in a professional employment setting.

Author contributions

JC, MM, BSO, and EM performed the literature review including development of search criteria, obtaining reference materials, critically appraising and determining if materials meet inclusion criteria, and synthesizing findings. JC and NJ wrote the main manuscript text.

Funding

No funding to disclose.

Data availability

Data used in this study is available upon request to the corresponding author.

Declarations

Ethical approval and informed consent

This literature review did not meet criteria for human subjects research, thus IRB approval was not obtained.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.