Evaluation of moral sensitivity and moral courage in intensive care nurses in Turkey during the COVID-19 pandemic

The relationship between moral courage, team work, and safe nursing care in clinical nurses: a multicenter cross-sectional study in Iran

BACKGROUND

Moral courage and team work are the most important aspects of professional competence in clinical nurses; nurses with moral courage and team work are thought to be able to deliver safe nursing care to patients. The present study aimed to investigate whether moral courage and teamwork correlate with safe nursing care among clinical nurses.

METHODS

This descriptive cross-sectional multicenter study was carried out from December 2023 to February 2024. A total of 375 nurses who were practicing in four hospitals in the south of Iran were enrolled in this study using convenience sampling. The data collection tools used consisted of a demographics survey, Moral Courage Questionnaire (MCQ), Team STEPPS Team Perception Questionnaire (T-TPQ), and the Assessment of Safe Nursing Care Questionnaire (ASNCQ). The data were analyzed using descriptive statistics, t-test, chi-square, multiple regression analysis, and Pearson's correlation coefficient. SPSS version 22 was used to analyze the data.

RESULTS

The participants' mean age was 32.66 ± 6.63 years, and their work experience was 8.56 ± 6.22 years. The total mean scores for moral courage, teamwork, and safe care were 422.37 ± 52.92, 144.09 ± 18.43, 315.84 ± 41.95, respectively. A statistically significant positive correlation was found between teamwork and safe care (r = 0.57, p < 0.001), teamwork and moral courage (r = 0.49, p = 0.002), and moral courage and safe nursing care (r = 0.59 p < 0.001). According to the results, work experience, moral courage, and teamwork explained 44.4% of the variance in safe nursing care (R2 = 0.44, p < 0.001).

CONCLUSION

The results indicated that the moral courage and teamwork of nurses were positively and significantly correlated with the participants' safe nursing care. Accordingly, since moral courage and teamwork are the qualities that can contribute to improving the quality of care and ensuring safe nursing care, it is recommended that nursing managers pay special attention to these factors.

The relationship between moral courage and lovingkindness-compassion levels in critical care nurses: A cross-sectional study

BACKGROUND

Ethical dilemmas and ethical problems are very common in intensive care units. Nurses need moral courage to deal with these problems. Nurses' high empathy, humility, lovingkindness, and compassion support them to act with moral courage.

OBJECTIVES

The aim of this study was to determine the moral courage, lovingkindness, and compassion levels of critical care nurses and to reveal whether there is a relationship between them.

METHODS

One hundred sixty-eight nurses working in the intensive care unit of a university hospital in Turkey were included in this correlational descriptive cross-sectional study. The data were collected with the Nurses' Moral Courage Scale (NMCS) and the Loving-kindness Compassion Scale (LCS).

RESULTS

There was a positive and significant relationship between the NMCS and the LCS lovingkindness (r = .377, p < .05) and compassion (r = .405, p < .05) subdimensions; on the other hand, a negative and significant relationship was observed with the LCS self-centredness subdimension (r = -.215, p = .025). In addition, the mean scores of the LCS subdimensions of compassion, self-centredness, and lovingkindness were predictors of the NMCS total score (R = .475, R2 = .286, p < .05).

CONCLUSIONS

In this study, it was determined that critical care nurses with high moral courage levels had high levels of compassion and lovingkindness and low levels of self-centredness. A high level of moral courage and compassion in nurses may contribute to quality and safe patient care. In-service trainings may be planned to increase nurses' awareness of moral courage, loving-kindness, and compassion.

The relationship between nurses' moral courage and whistleblowing approaches

BACKGROUND

Whistleblowing is an action that particularly requires moral courage. Understanding the relationship between nurses' levels of moral courage and their whistleblowing approaches is important for reducing adverse situations in healthcare services.

OBJECTIVES

This study aims to understand and analyze the relationship between nurses' levels of moral courage and their whistleblowing approaches.

RESEARCH DESIGN

This is a descriptive and correlational study.

METHODS

The study sample consists of 582 nurses actively working in a province in northwest Türkiye. Research data were collected using an Information Form, the Nurses' Moral Courage Scale, and the Whistleblowing Scale.

ETHICAL CONSIDERATIONS

Ethical approval from the ethics committee, institutional permission, and informed consent from the participants were obtained for data collection.

FINDINGS

Nurses were found to perceive their moral courage as high, and their whistleblowing levels were at a moderate level. There was a significant and moderate relationship between participants' levels of moral courage and whistleblowing levels (p < .05).

CONCLUSIONS

The findings emphasize the importance of promoting moral courage and creating an appropriate environment for exposing ethical violations. This study can contribute to the development of strategies to enhance nurses' moral courage and foster a more ethical working environment in healthcare services.

Nurses' moral courage and related factors: A systematic review

BACKGROUND

Nurses face various ethical conflicts when taking care of patients, and such conflicts require moral courage. This systematic review was conducted with the aim of investigating moral courage and its related factors among nurses.

METHODS

To find related studies, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The PubMed, Web of Science, Google Scholar, Scopus, Embase and Science Direct databases were searched using keywords such as Courage, Moral Courage, and Nurses, and no lower time limit was imposed when conducting the searches. The identified studies were published between January 2000 and March 2023. Quality of articles was assessed using the STROBE checklist.

RESULTS

The pooled sample size for the 19 included studies was 7863. All studies were observational and cross-sectional. The results showed that three categories of factors most related to moral courage are individual, moral, and factors related to the organization. Underlying factors of each category are also provided within this paper.

CONCLUSION

Moral courage is an integral part of nursing, which as a profession, is becoming even more challenging with the advancement of science and technology. Therefore, there is a need for nurses and especially nursing managers to be considerate of factors affecting moral courage of nurses, with a view to strengthening the positive factors and reducing the negative impacts.

Moral courage and its influencing factor among oncology specialist nurses: A multi-centre cross-sectional study

AIM

Moral courage among healthcare workers has been extensively studied. However, few studies have been conducted on oncology specialist nurses, who frequently encounter complex moral situations. This study aimed to describe the current situation regarding moral courage and explored its influence on oncology specialist nurses in China.

DESIGN

This was an exploratory, descriptive study.

METHODS

A convenience sample of 390 nurses was conducted from 15 hospitals in Sichuan Province, China, between March and May 2023. Participants were assessed using the Moral Distress Scale-Revised, Nurses' Moral Courage Scale and the Moral Sensitivity Questionnaire.

RESULTS

The results demonstrated that moral courage was negatively associated with moral distress, and positively associated with moral sensitivity. Having a master's degree or above, an intermediate title or senior title, medical ethics training, moral distress or moral sensitivity contributed to explaining 54.1% of the variance in moral courage.

CONCLUSIONS

Moral courage was associated with several factors. Developing clinical intervention strategies and effective teaching methods will be critical for improving moral courage. No Patient or Public Contribution.

The impact of resilience on clinical nurses' moral courage during COVID-19: A moderated mediation model of ethical climate and moral distress

AIM

The purpose of this study was to explore whether clinical ethical climate mediates the relationship between resilience and moral courage in a population of clinical nurses during COVID-19, and if moral distress faced by nurses is a moderating factor.

BACKGROUND

Resilience can help nurses maintain their personal health during COVID-19 when they face great physical and psychological shock and are prone to health problems. Moral courage, as an ethical competency, helps nursing staff in adhering to the principles and values of professional ethics. There is a strong correlation between resilience and moral courage, but the mechanism by which resilience contributes to moral courage is unclear.

METHOD

A cross-sectional study research is designed. Three hundred thirty clinical nurses from six hospitals in Beijing, Sichuan, and Fujian of China were included between August 2021 and March 2022. The survey instruments include the Nurses' Moral Courage Scale (NMCS), Connor-Davidson Resilience Scale (CD-RISC), Moral Distress Scale-Revised (MDS-R), and Hospital Ethical Climate Scale (HECS).

RESULTS

Ethical climate mediates 15% of the relationship between resilience and moral courage. The association between resilience and ethical climate, as well as the indirect relationship between resilience and moral courage, was modified by moral distress.

DISCUSSION

This study investigated the mechanisms by which resilience affects moral courage in clinical nurses in the context of COVID-19, suggesting that moral courage can be increased by alleviating moral distress and increasing ethical climate.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study confirms the mediating effect of moral climate on the relationship between resilience and moral courage, as well as the moderating effect of moral distress. Hospital policymakers should value nurses' psychological resilience and moral courage, develop effective policies to prevent and manage stressors, build social support systems, and create a positive ethical climate.

A study on different types of moral courage and coping styles of clinical nurses: based on potential profile analysis

BACKGROUND

In professional ethics-related events, there are various unpleasant and complex ethical issues that require strong moral courage. Our aim is to identify and describe the potential categories of moral courage among nurses and to clarify the coping styles of nurses under different categories.

METHOD

A cross-sectional study was conducted using three data collection tools: a self-designed general information questionnaire, a Chinese version of the Moral Courage Scale, and a Trait Coping Style Questionnaire. Three hundred fourteen nurses from a tertiary hospital in Heilongjiang Province, China, were analysed using potential profile analysis, descriptive analysis, and Mann-Whitney U test data.

RESULT

The latent profile analysis (LPA) results indicate that the two-profile model is the most suitable and supports the existence of two different moral courage profiles: the low moral courage group (60.51%) and the high moral courage group (39.49%), with a high relative entropy value (0.922). The results point to a good profile solution, and there are significant differences between the two profiles. The Mann-Whitney U-test results showed that the positive coping scores of the high moral courage group were significantly higher than those of the low moral courage group, and the negative coping scores of the high moral courage group were significantly lower than those of the low moral courage group.

CONCLUSION

Our results reveal the heterogeneity of moral courage in the nurse sample and indicate that nurses in the high moral courage group tend to choose positive coping styles, while nurses in the low moral courage group are more likely to develop negative coping emotions. This provides important significance and reference value for nursing managers, who can propose customised management plans based on the types of moral courage of the nursing community and the coping styles under different categories.

Moral courage, job-esteem, and social responsibility in disaster relief nurses

BACKGROUND

Social responsibility can motivate disaster relief nurses to devote themselves to safeguarding rights and interests of people when facing challenges that threaten public health. However, few studies focused on the relationship of moral courage, job-esteem, and social responsibility among disaster relief nurses.

OBJECTIVE

To explore the influence of moral courage and job-esteem on the social responsibility in disaster relief nurses and clarify the relationship model between them.

METHODS

A cross-sectional study was conducted among 716 disaster relief nurses from 14 hospitals in central China through an online survey, including moral courage scale, job-esteem scale, and social responsibility questionnaire. The data were analyzed by Pearson's correlation, and the mechanism of the effect of moral courage and job-esteem on social responsibility was completed.

ETHICAL CONSIDERATIONS

This study was approved by the Medical Ethics Committee of the Second Xiangya Hospital of Central South University (Approval Number: 2019016).

RESULTS

Disaster relief nurses' moral courage positively impacted social responsibility (r = 0.677, p < 0.01), and moral courage could affect social responsibility through the mediating role of job-esteem.

CONCLUSION

Job-esteem mediated between moral courage and social responsibility among disaster relief nurses. Nursing managers regular assessment of nurses' moral courage and interventions such as meetings and workshops can reduce moral distress, foster morally courageous behavior, enhance job-esteem, and improve social responsibility performance among disaster relief nurses.

The Effect of Burnout and Moral Sensitivity Levels of Surgical Unit Nurses on Job Satisfaction

PURPOSE

This study was carried out to determine the effect of burnout and moral sensitivity levels of surgical unit nurses on their job satisfaction.

DESIGN

A descriptive and correlational design study.

METHODS

The population consisted of 268 nurses working in health institutions in the Eastern Black Sea Region of Turkey. The data were collected online between 1 and 30 April, 2022 using a sociodemographic data form, the Maslach Burnout Inventory, the Minnesota Job Satisfaction Scale, and the Moral Sensitivity Scale. Pearson correlation analysis and logistic regression analysis were used to evaluate the data.

FINDINGS

The nurses' moral sensitivity scale mean score was 105.2 ± 18.8, and the Minnesota job satisfaction scale mean score was 3.3 ± 0.7. The participants' mean emotional exhaustion score was 25.4 ± 7.3, the depersonalization score average was 15.7 ± 4.6, and the personal accomplishment mean score was 20.5 ± 6.7. The factors affecting the job satisfaction of nurses were found to be moral sensitivity, personal accomplishment, and satisfaction with the unit they worked.

CONCLUSIONS

Nurses had high levels of burnout due to emotional exhaustion, one of the subdimensions of burnout, and moderate levels of burnout due to depersonalization and personal accomplishment. The moral sensitivity and job satisfaction of nurses are moderate. As the nurses' accomplishment and ethical sensitivity levels increased and their emotional exhaustion levels decreased, their job satisfaction levels increased.

Critical Care Nurses' Adherence to Ethical Codes and Its Association with Spiritual Well-Being and Moral Sensitivity

Background

Adherence to ethical codes is a major pillar of nursing care that is affected by various factors. Identifying these factors can lead to better ethical performance. The present study was conducted to determine critical care nurses' adherence to ethical codes and its association with spiritual well-being (SWB) and moral sensitivity (MS).

Methods

In this descriptive-correlational study, data were collected using the moral sensitivity questionnaire (MSQ) by Lützén et al., Paloutzian and Ellison's spiritual well-being scale (SWBS), and the adherence to ethical codes questionnaire. The study was conducted on 298 nurses working in critical care units of hospitals affiliated with Shiraz University of Medical Sciences in southern Iran in 2019. This study was examined and approved by the Ethics Committee of Shiraz University of Medical Sciences.

Results

The majority of the participants were female (76.2%) and single (60.1%), with a mean age of 30.69 ± 5.74 years. The mean scores of adherence to ethical codes, SWB, and MS were 64.06 (good), 91.94 (moderate), and 134.08 (moderate), respectively. Adherence to ethical codes had a positive correlation with the total score of SWB (P < 0.001, r = 0.25) and MS (P < 0.001, r = 0.27). A positive correlation was also observed between MS and SWB (P < 0.001, r = 0.41). Meanwhile, MS (β = 0.21) had a greater effect than SWB (β = 0.157) on adherence to ethical codes.

Conclusion

Critical care nurses showed a good adherence to ethical codes. MS and SWB also positively affected their adherence to ethical codes. Nursing managers can use these findings to devise plans for the promotion of MS and SWB in nurses and thus help improve their ethical performance.