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Hu K, Zhou Q, Zhang Y, Tian W, Wu M. Latent profile analysis of nurses' moral courage: a professional values perspective. Nurs Ethics 2024:9697330241270734. [PMID: 39126641 DOI: 10.1177/09697330241270734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Nurses' moral courage (NMC) enhances care quality and patient safety. Nurses' professional values promote ethical adherence, moral obligation fulfillment, and compliance to prevent ethical violations. It is necessary to explore the current status and influencing factors of moral courage from the perspective of professional values. AIM To investigate the current situation of nurses' moral courage, analyze the latent profiles of nurses' moral courage, and explore the influencing factors from the perspective of professional values. RESEARCH DESIGN A cross-sectional design was employed. PARTICIPANTS AND RESEARCH CONTEXT Data were collected through convenient sampling at a tertiary hospital during May 2023 in Wuhan, Hubei province, China. A self-designed web-based questionnaire consisting of demographic characteristics, the Chinese Nurses' Professional Values Scale-Revised Version (NPVS-R-CV) and the Nurses' Moral Courage Scale (NMCS) were used for the cross-sectional survey. Latent profile analysis was conducted using the results of 3 explicit indexes of NMCS, and multivariate logistic regression was used to analyze the influencing factors of NMC. ETHICAL CONSIDERATIONS Research ethics approval (with the code of TJ- IRB 20220543) was obtained from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. FINDINGS This study included 966 nurses, predominantly female and under 30 years old, with 91.10% holding a bachelor's degree. Latent profile analysis identified three moral courage profiles: low-level (31.5%), medium-level (47.2%), and high-level (21.3%). Multivariate logistic regression analysis showed significant positive correlations between professional values and moral courage, with head nurses being significantly more likely to exhibit high moral courage (OR = 3.586, p = 0.013). CONCLUSIONS The moral courage of nurses can be classified into 3 subgroups. Nurses' professional values positively correlate with moral courage, with head nurses showing significantly higher levels of moral courage. Strengthening professional values through training can enhance ethical behavior in nursing, potentially improving patient care and safety.
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Affiliation(s)
- Kaili Hu
- Huazhong University of Science and Technology
| | - Quan Zhou
- Huazhong University of Science and Technology
| | - Yufen Zhang
- Huazhong University of Science and Technology
| | - Wei Tian
- Huazhong University of Science and Technology
| | - Minglong Wu
- Huazhong University of Science and Technology
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Li H, Guo J, Ren Z, Bai D, Yang J, Wang W, Fu H, Yang Q, Hou C, Gao J. Moral courage level of nurses: a systematic review and meta-analysis. BMC Nurs 2024; 23:530. [PMID: 39090605 PMCID: PMC11295526 DOI: 10.1186/s12912-024-02082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 06/10/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Moral distress occurs in daily nursing work and plagues nurses. Improving the level of moral courage is one of the main strategies to reduce moral distress, and low levels of moral courage may lead to nurse burnout, increased turnover, and reduced quality of care. METHODS Nine electronic databases in Chinese and English were searched for the level of moral courage among nurses, including PubMed, Web of Science, EMBASE, CINAHL, CNKI, Wan fang, Wei pu, CBM and Cochrane Library, for the period from the date of database creation to April 5, 2023. The Agency for Healthcare Research and Quality (AHRQ) was used to assess the methodological quality of the included studies, followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Meta-analysis and Systematic Reviews of Observational Studies guidelines, and data from the included studies were meta-analyzed in STATA version 15 using a fixed-effects model. RESULTS Seventeen cross-sectional studies of moderate or high quality met the eligibility criteria and involved 7718 nurses, and the Nurses' Moral Courage Scale (NMCS) was used to measure the self-assessed moral courage level of nurses. Eleven of these studies reported total scores for nurses' moral courage, and the meta-analysis results showed a pooled mean score of 78.94 (95% CI: 72.17, 85.72); Fourteen studies reported mean entry scores for nurses' moral courage, and the meta-analysis results showed a pooled mean score of 3.93 (95% CI: 3.64, 4.23). CONCLUSION The results of the meta-analysis showed that nurses' moral courage levels were in the medium to high range, among the nurses who seemed to be male, non-nursing managers, high school education, had not experienced ethical issues, and considering resignation had lower levels of moral courage. The results of the meta-analysis may provide some reference for nursing managers and even hospital administrators to develop strategies to optimize nursing quality.
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Affiliation(s)
- Hang Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - JuLan Guo
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - ZhiRong Ren
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- The Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dingxi Bai
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jing Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Wang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Han Fu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qing Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chaoming Hou
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
| | - Jing Gao
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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Neufeld-Kroszynski G, Michael K, Karnieli-Miller O. Associations between medical students' stress, academic burnout and moral courage efficacy. BMC Psychol 2024; 12:296. [PMID: 38802899 PMCID: PMC11129364 DOI: 10.1186/s40359-024-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Medical students, especially during the clinical years, are often exposed to breaches of safety and professionalism. These contradict personal and professional values exposing them to moral distress and to the dilemma of whether and how to act. Acting requires moral courage, i.e., overcoming fear to maintain one's core values and professional obligations. It includes speaking up and "doing the right thing" despite stressors and risks (e.g., humiliation). Acting morally courageously is difficult, and ways to enhance it are needed. Though moral courage efficacy, i.e., individuals' belief in their capability to act morally, might play a significant role, there is little empirical research on the factors contributing to students' moral courage efficacy. Therefore, this study examined the associations between perceived stress, academic burnout, and moral courage efficacy. METHODS A cross-sectional study among 239 medical students who completed self-reported questionnaires measuring perceived stress, academic burnout ('exhaustion,' 'cynicism,' 'reduced professional efficacy'), and moral courage efficacy (toward others' actions and toward self-actions). Data analysis via Pearson's correlations, regression-based PROCESS macro, and independent t-tests for group differences. RESULTS The burnout dimension of 'reduced professional efficacy' mediated the association between perceived stress and moral courage efficacy toward others' actions. The burnout dimensions 'exhaustion' and 'reduced professional efficacy' mediated the association between perceived stress and moral courage efficacy toward self-actions. CONCLUSIONS The results emphasize the importance of promoting medical students' well-being-in terms of stress and burnout-to enhance their moral courage efficacy. Medical education interventions should focus on improving medical students' professional efficacy since it affects both their moral courage efficacy toward others and their self-actions. This can help create a safer and more appropriate medical culture.
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Affiliation(s)
- Galit Neufeld-Kroszynski
- Department of Medical Education, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, 69778, Israel
| | - Keren Michael
- Department of Human Services, Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Orit Karnieli-Miller
- Department of Medical Education, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, 69778, Israel.
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Fidan Ö, Çunkuş Köktaş N, Şanlialp Zeyrek A. The relationship between moral courage and lovingkindness-compassion levels in critical care nurses: A cross-sectional study. Aust Crit Care 2024; 37:468-474. [PMID: 37263903 DOI: 10.1016/j.aucc.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 06/03/2023] Open
Abstract
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.
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Affiliation(s)
- Özlem Fidan
- Faculty of Health Sciences, Nursing Department, Pamukkale University, Denizli, Turkey.
| | - Nesrin Çunkuş Köktaş
- Faculty of Health Sciences, Nursing Department, Pamukkale University, Denizli, Turkey.
| | - Arife Şanlialp Zeyrek
- Faculty of Health Sciences, Nursing Department, Pamukkale University, Denizli, Turkey.
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Austen K, Hutchinson M, Hurley J. Promoting speaking-up behaviours among nurses working in the care for older people: A scoping review. J Clin Nurs 2024. [PMID: 38685802 DOI: 10.1111/jocn.17199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
AIM To explore interventions employed to foster speaking-up behaviours of registered nurses (RNs) working in the care of older people. DESIGN Scoping review. METHODS The updated Joann Briggs Institute scoping review methodological guidelines were followed. DATA SOURCES CINAHL, PubMed, PsycINFO, and Scopus were searched. RESULTS A total of 1691 titles and abstracts were screened, resulting in 11 articles that met the inclusion criteria. Analysis focused upon intervention types, methodologies, speaking up strategies, barriers and effectiveness. Education was the most used intervention. CONCLUSION There is a lack of published research on successful interventions to promote speaking-up behaviours in the care of older people, particularly relating to poor care practices. Evidence of speaking-up interventions in the residential aged care setting is absent. This highlights the need to develop strategies to support the RN to lead and enable others to raise care concerns. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Developing strategies that enable staff, care recipients and their families to speak up about care concerns is a vital future area for nursing practice development. Nursing leadership of such strategies is central to improving the quality of care for older people, particularly those living in residential aged care. IMPACT Older people receiving care should feel respected and be treated humanely. Evidence suggests this is often not the case. This review found a paucity of interventions to promote speaking-up about poor care practices among RNs working in the care of older people. Future research needs to address this, to empower RNs and improve the care afforded to older people. REPORTING METHOD The PRISMA-ScR (Tricco et al., Annals of Internal Medicine, 169, 467-473, 2018) were adhered to throughout this scoping review. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution in this review.
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Affiliation(s)
- Katrina Austen
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Marie Hutchinson
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - John Hurley
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
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Ruixin Z, Shan H, Yongli T, Chen J, Qianzhu C, Xue W. The influence of psychological resilience and nursing practice environment on nurses' moral courage: A cross-sectional study. Nurs Open 2024; 11:e2163. [PMID: 38642075 PMCID: PMC11032114 DOI: 10.1002/nop2.2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024] Open
Abstract
AIM To determine the relationship between psychological resilience, nursing practice environment, and moral courage of clinical nurses and also the factors influencing moral courage. DESIGN Cross-sectional study. METHODS 586 nurses from a general hospital were selected by convenience sampling method in January 2023. The general information questionnaire, Nurses' Moral Courage Scale (NMCS), Resilience Scale, and Practice Environment Scale (PES) were measured. Hierarchical linear regression analysis was used to explore the influencing factors of clinical nurses' moral courage. RESULTS Nurses' average moral courage score was 79.00 (69.00, 91.00). The nurses' moral courage was positively correlated with psychological resilience and nursing practice environment. Multivariate linear regression analysis showed that psychological resilience and nursing practice environment entered the regression equation, accounting for 23.4% of the total variation. Psychological resilience and nursing practice environment are the main factors affecting the moral courage of clinical nurses. Nursing managers should conduct moral courage training, develop a decent nursing practice environment, pay attention to the psychological emotions of nurses, and actively build a safe, open, and supportive atmosphere for moral behaviour.
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Affiliation(s)
- Zhang Ruixin
- Department of OrthopaedicsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Orthopedic Laboratory of Chongqing Medical UniversityChongqingChina
| | - He Shan
- School of NursingChongqing Medical UniversityChongqingChina
| | - Tang Yongli
- Department of OrthopaedicsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jie Chen
- Department of OrthopaedicsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Chen Qianzhu
- Department of OrthopaedicsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Wang Xue
- Department of OrthopaedicsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Orthopedic Laboratory of Chongqing Medical UniversityChongqingChina
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7
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Huang M, Wei Y, Zhao Q, Dong W, Mo N. Enhancing the moral courage of nurses: A modified Delphi study. Nurs Ethics 2024:9697330231221218. [PMID: 38369759 DOI: 10.1177/09697330231221218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND The urgency of ensuring adequate moral courage in clinical nursing practice is evident. However, currently, there are few formal intervention plans targeted at enhancing the moral courage of nurses. AIM To develop a training program for improving the moral courage of nurses using the modified Delphi method. RESEARCH DESIGN A modified Delphi study. PARTICIPANTS AND RESEARCH CONTEXT From November to December 2022, a literature review and expert group discussion were conducted to develop a preliminary training plan framework. From January to March 2023, a two-round Delphi survey was performed, and a consensus was reached regarding the plan through online questionnaires. Descriptive statistics were used to analyze the data. ETHICAL CONSIDERATIONS This study was approved by the institutional ethics committee (No. 138, 30 August 2021). All participants provided written informed consent. RESULTS Consensus was reached on eight themes and 33 items to strengthen the moral courage training program for nurses. CONCLUSIONS Guided by a unified goal of moral education, a multi-level and acceptable intervention plan was designed to enhance the moral courage of nurses.
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Affiliation(s)
| | | | | | | | - Nan Mo
- Fujian Medical University
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8
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Yılmaz Ş, Özbek Güven G. The relationship between nurses' moral courage and whistleblowing approaches. Nurs Ethics 2024:9697330241230686. [PMID: 38321749 DOI: 10.1177/09697330241230686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
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.
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9
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Yu Q, Huang C, Yan J, Yue L, Tian Y, Yang J, Li X, Li Y, Qin Y. Ethical climate, moral resilience, and ethical competence of head nurses. Nurs Ethics 2024:9697330241230526. [PMID: 38317573 DOI: 10.1177/09697330241230526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND The ethical competence of head nurses plays a pivotal role in nursing ethics. Ethical climate is a prerequisite for ethical competence, and moral resilience can positively influence an individual's ethical competence. However, few studies have focused on the relationship between ethical climate, moral resilience, and ethical competence among them. OBJECTIVES To investigate the relationship between ethical climate, moral resilience, and ethical competence, and examine the mediating role of moral resilience between ethical climate and ethical competence among head nurses. DESIGN A quantitative, cross-sectional study. METHODS A total of 309 Chinese head nurses completed an online survey, including ethical climate questionnaire, Rushton moral resilience scale, and ethical competence questionnaire. Inferential statistical analysis includes Pearson's correlation and a structural equation model. ETHICAL CONSIDERATIONS This study received ethical approval from the Institutional Review Board of Xiangya Nursing School of Central South University (No. E2023146). RESULTS Head nurses' ethical climate score positively impacted ethical competence (r = 0.208, p < .001), and ethical climate could affect ethical competence through the mediating role of moral resilience. CONCLUSION This study emphasized the value of ethical climate in moral resilience of head nurses, ultimately leading to an enhancement in their ethical competence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yuelan Qin
- The First Affiliated Hospital of Hunan Normal University
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10
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Abdollahi R, Ghasemianrad M, Hosseinian-Far A, Rasoulpoor S, Salari N, Mohammadi M. Nurses' moral courage and related factors: A systematic review. Appl Nurs Res 2024; 75:151768. [PMID: 38490799 DOI: 10.1016/j.apnr.2024.151768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/27/2023] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
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.
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Affiliation(s)
- Reza Abdollahi
- Nursing and Midwifery School, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Shabnam Rasoulpoor
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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11
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Zheng H, Luo L, Tan X, Cen Y, Xing N, Huang H, Cai Y. Moral courage and its influencing factor among oncology specialist nurses: A multi-centre cross-sectional study. Nurs Open 2024; 11:e2096. [PMID: 38268282 PMCID: PMC10794856 DOI: 10.1002/nop2.2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/25/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024] Open
Abstract
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.
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Affiliation(s)
- Hongling Zheng
- Nursing DepartmentSichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Lei Luo
- Nursing DepartmentSichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Xiaohui Tan
- Nursing DepartmentSichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Yao Cen
- Nursing DepartmentSichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Naifang Xing
- Nursing DepartmentSichuan Clinical Research Center for CancerSichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Hui Huang
- School of NursingChengdu Medical CollegeChengduChina
| | - Yanling Cai
- School of NursingChengdu Medical CollegeChengduChina
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12
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Berdida DJE, Grande RAN. Moral Distress, Moral Resilience, Moral Courage, and Moral Injury Among Nurses in the Philippines During the COVID-19 Pandemic: A Mediation Analysis. JOURNAL OF RELIGION AND HEALTH 2023; 62:3957-3978. [PMID: 37442900 DOI: 10.1007/s10943-023-01873-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
Investigations about moral resilience and moral courage as mediators between moral distress and moral injury remain underreported among nurses during the COVID-19 pandemic. Nurses (n = 412) from the Philippines were conveniently recruited via social media platforms and completed four self-report scales. The mediation model depicts that moral distress negatively impacts moral resilience and moral courage while positively affecting moral injury. Moral resilience and moral courage negatively impact moral injury, whereas moral resilience directly impacts moral courage. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. Findings indicate that healthcare organizations and nurse managers should nurture morally resilient and courageous therapeutic practices among frontline healthcare professionals to mitigate the negative effects of moral distress and moral injury.
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Affiliation(s)
- Daniel Joseph E Berdida
- College of Nursing, University of Santo Tomas, St. Martin de Porres Bldg., España Boulevard, 1015, Manila, Philippines.
| | - Rizal Angelo N Grande
- Mental Health Nursing Department, College of Nursing, University of Ha'il, Ha'il, 55473, Kingdom of Saudi Arabia
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13
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Hakimi H, Mousazadeh N, Sharif-Nia H, Nazari R, Dehghani M. The predictive factors of moral courage among hospital nurses. Philos Ethics Humanit Med 2023; 18:13. [PMID: 37848922 PMCID: PMC10583343 DOI: 10.1186/s13010-023-00141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/05/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Having moral courage is a crucial characteristic for nurses to handle ethical quandaries, stay true to their professional obligations towards patients, and uphold ethical principles. This concept can be influenced by various factors including personal, professional, organizational, and leadership considerations. The purpose of this study was to explore the predictors of moral courage among nurses working in hospitals. METHODS In 2018, an observational cross-sectional study was carried out on 267 nurses employed in six hospitals located in the northern region of Iran. The participants were selected through a simple random sampling technique. To collect data, a demographic information form was used along with two questionnaires. The first questionnaire was a standard survey on moral courage, while the second questionnaire was designed to assess the ethical climate. Linear regression was used to assess the predictors of moral courage. RESULTS Nurses had an average moral courage score of 87.07 ± 15.52 and an average moral climate score of 96.12 ± 17.17. The study showed that 16% of the variation in moral courage scores among nurses was explained by ethical climate and monthly overtime hours. CONCLUSION This study underscores the significance of establishing an ethical work environment and minimizing overtime hours in order to enhance moral courage among nurses. These findings carry weight for both nursing practice and organizational policies focused on fostering ethical conduct within healthcare settings.
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Affiliation(s)
- Hamideh Hakimi
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Noushin Mousazadeh
- Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran.
| | - Hamid Sharif-Nia
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roghieh Nazari
- Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran
| | - Maryam Dehghani
- Instructor of Pediatric Nursing, Department of Nursing, Zeyinab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Chew QH, Lee TS, Sim K. Moral injury and associated context, contributors and consequences within mental healthcare professionals: a scoping review. Postgrad Med 2023; 135:646-668. [PMID: 37776227 DOI: 10.1080/00325481.2023.2266007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/28/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES We sought to examine the contributory factors as well as consequences of moral injury amongst healthcare workers within mental healthcare settings. METHODS Several databases were searched for relevant studies from database inception until May 2023. Keywords and concepts included moral injury and distress in mental healthcare and psychiatry. We identified 961 studies, of which 48 were assessed for eligibility. Eventually, 35 studies were included in the review. Papers were selected for inclusion if 1) they included mental healthcare professionals (MHP) regardless of practice setting, 2) moral injury as experienced by MHP was one of their main variables of interest, 3) were written in English. Year of publication, location of study, participant characteristics, study design, settings in which injury occur (context), factors contributing to moral injury (contributors), and its effects on MHP (consequences) were extracted from the studies. RESULTS The majority of studies were conducted in the West (n = 26, 74.3%). Contributors to moral injury were found at the individual (e.g. poor competence), practice setting (e.g. lack of resources), and organizational levels (e.g. inconsistent policies). Moral injury had negative repercussions for the individual (e.g. psychological and physical symptoms), healthcare teams (e.g. lack of trust and empathy), and healthcare system (e.g. staff attrition). CONCLUSIONS Seen through the moral habitability framework, interventions must include an acknowledgment of the influence of various factors on the ability of MHP to enact their moral agency, and seek to establish safe moral communities within a supportive moral climate.
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Affiliation(s)
- Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Tih-Shih Lee
- Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Berdida DJE. The mediating roles of moral courage and moral resilience between nurses' moral distress and moral injury: An online cross-sectional study. Nurse Educ Pract 2023; 71:103730. [PMID: 37499534 DOI: 10.1016/j.nepr.2023.103730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
AIMS To investigate the mediating role of moral resilience and moral courage in the association between moral distress and moral injury. BACKGROUND There is a preponderance of nursing literature about moral distress, moral resilience, moral courage and moral injury. However, examining moral resilience and moral courage as mediators remain underreported during the COVID-19 pandemic and in the context of a developing nation. DESIGN Correlational, cross-sectional design compliant with the STROBE guidelines. METHODS A convenience sample of nurses (n = 412) from the Philippines were recruited using social media platforms (e.g., Facebook, Messenger, Twitter). Four self-report and validated scales (8-item Moral-Distress Appraisal Scale, 21-item Nurses' Moral Courage Scale, 17-item Rushton Moral Resilience Scale and 10-item Moral Injury Symptom Scale: Healthcare Professionals Version) were used to collect data from January to July 2022. Pearson's r, bivariate analysis and multistage regression analyses were used for data analysis. RESULTS This study afforded a model that depicted the interrelationships of moral distress, moral resilience, moral courage and moral injury. Moral distress has a negative impact on moral resilience and moral courage while positively affecting moral injury. Moral resilience positively influences moral courage while having a negative impact on moral injury. Moral courage has an indirect impact on moral injury. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. CONCLUSIONS Healthcare organizations, policymakers and nurse managers should include policies and programs that include improving approaches to modifying workplace conditions and evaluating nurses' moral resilience and courage. Nurse managers need to advocate ethics education and professionalism. Nurses must practice self-care strategies to strengthen morally resilient and courageous therapeutic practices.
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Affiliation(s)
- Daniel Joseph E Berdida
- College of Nursing, University of Santo Tomas, Manila 1015, Philippines; College of Graduate Studies and Teacher Education Research (CGSTER), Philippine Normal University, Taft Ave., Manila 1000, Philippines.
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Abstract
BACKGROUND Moral courage is a recognized virtue. In the context of the COVID-19 pandemic, the master's students of nursing (MSNs) in China have shown tenacious moral courage. OBJECTIVE This study elaborates on the moral courage of Chinese MSNs through their experiences of volunteering during the pandemic. RESEARCH DESIGN Descriptive qualitative, interview-based. PARTICIPANTS AND RESEARCH CONTEXT Participants were nursing postgraduate students who participated in the prevention and control of the COVID-19 pandemic selected by purposeful sampling. The sample size was determined by data saturation, which was reached with 10 participants. Data were analyzed using a deductive method of content analysis. Because of the isolation policy, telephone interviews were adopted. ETHICAL CONSIDERATIONS After obtaining the approval of the ethical institution of the author's school (No. 138, 30 August 2021), verbal consent was obtained before the interview with the participants. All data were processed anonymously and confidentially. In addition, we recruited participants through MSNs' counselors, and obtained their phone numbers with their permission. RESULTS Data analysis resulted in 15 subcategories that were subsequently grouped into 3 major categories including proceed without hesitation, the outcome of practicing moral courage, and develop and maintain moral courage. CONCLUSION This qualitative study is based on the special background of the COVID-19 pandemic, and the MSNs in China have shown tenacious moral courage in the work of epidemic prevention and control. Five factors led them to take action without hesitation, and six possible outcomes followed. Lastly, this study provides some suggestions for nurses and nursing students to enhance their moral courage. To better develop and support moral courage in the future, it is necessary to use different methods and multidisciplinary approaches to study moral courage.
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Affiliation(s)
- Mingtao Huang
- School of Health Management, Fujian Medical University, China; Research Centre for Medical Humanities, Fujian Medical University, China
| | - Wenhong Dong
- School of Health Management, Fujian Medical University, China; Research Centre for Medical Humanities, Fujian Medical University, China
| | - Qianqian Zhao
- School of Health Management, Fujian Medical University, China; Research Centre for Medical Humanities, Fujian Medical University, China
| | - Nan Mo
- School of Marxism, Fujian Medical University, China; Research Centre for Medical Humanities, Fujian Medical University, China
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17
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Huang M, Dong W, Zhao Q, Mo N. Factors associated with the moral courage of nurses in China: A cross-sectional study. Nurs Open 2023. [PMID: 36811339 DOI: 10.1002/nop2.1672] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/12/2022] [Accepted: 02/04/2023] [Indexed: 02/24/2023] Open
Abstract
AIM The purpose of this study was to assess the level of moral courage among nurses in China, and to explore related influential factors, to help nursing managers take measures to improve nurses' moral courage. DESIGN A cross-sectional study. METHODS The data adopted a convenient sampling method. From September to December 2021, 583 nurses from five hospitals in Fujian Province completed the Chinese version of the Nurses' Moral Courage Scale (NMCS). Data were analysed using descriptive statistics, chi-square test, T-test, Pearson correlation analysis and multiple regression analysis. RESULTS The Chinese nurses perceived themselves, on average, as morally courageous. The mean NMCS score was 3.64 ± 0.692. The six factors showed statistically significant correlations (p < 0.05) with moral courage. Regression analysis showed that the main factors influencing nurses' moral courage were active learning of ethics knowledge and nursing was a career goal. CONCLUSION This study provides the self-evaluation level and related influencing factors of Chinese nurses' moral courage. There is no doubt that nurses still need strong moral courage to face unknown ethical problems and challenges in the future. Nursing managers should pay attention to the cultivation of nurses' moral courage, using various forms of educational activities to help nurses alleviate moral problems and improve their moral courage, to maintain patients' access to high-quality nursing.
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Affiliation(s)
- Mingtao Huang
- School of Health Management, Fujian Medical University, Fuzhou, China.,Research Centre for Medical Humanities, Fujian Medical University, Fuzhou, China
| | - Wenhong Dong
- School of Health Management, Fujian Medical University, Fuzhou, China.,Research Centre for Medical Humanities, Fujian Medical University, Fuzhou, China
| | - Qianqian Zhao
- School of Health Management, Fujian Medical University, Fuzhou, China.,Research Centre for Medical Humanities, Fujian Medical University, Fuzhou, China
| | - Nan Mo
- Research Centre for Medical Humanities, Fujian Medical University, Fuzhou, China.,School of Marxism, Fujian Medical University, Fuzhou, China
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18
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Peng M, Saito S, Guan H, Ma X. Moral distress, moral courage, and career identity among nurses: A cross-sectional study. Nurs Ethics 2022; 30:358-369. [PMID: 36545793 DOI: 10.1177/09697330221140512] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The concept of career identity is integral to nursing practices and forms the basis of the nursing professions. Positive career identity is essential for providing high-quality care, optimizing patient outcomes, and enhancing the retention of health professionals. Therefore, there is a need to explore potential influencing variables, thereby developing effective interventions to improve career identity. Objectives To investigate the relationship between moral distress, moral courage, and career identity, and explore the mediating role of moral courage between moral distress and career identity among nurses. Design A quantitative, cross-sectional study. Methods A convenient sample of 800 nurses was recruited from two tertiary care hospitals between February and March 2022. Participants were assessed using the Moral Distress Scale-revised, Nurses’ Moral Courage Scale, and Nursing Career Identity Scale. This study was described in accordance with the STROBE statement. Ethical consideration Research ethics approval was obtained from the researcher’s university and hospital where this study was conducted prior to data collection. Findings Moral distress is negatively associated while moral courage is positively associated with career identity among nurses. Moral courage partially mediates the relationship between moral distress and career identity ( β = −0.230 to −0.163, p < 0.01). Discussion The findings reveal a relationship between moral distress, moral courage, and career identity among nurses. Conclusion By paying attention to nurses’ moral distress and courage, healthcare providers can contribute to the development of effective interventions to improve career identity, and subsequently performance, among nurses.
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Affiliation(s)
- Mengyun Peng
- Graduate School of Health Sciences, Okayama University, Japan
| | - Shinya Saito
- Graduate School of Health Sciences, Okayama University, Japan
| | - Hong Guan
- Department of Nursing, The Second Hospital of Dalian Medical University, China
| | - Xiaohuan Ma
- Department of Nursing, The Second People's Hospital of Dalian, China
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Hu K, Liu J, Zhu L, Zhou Y. Clinical nurses' moral courage and related factors: an empowerment perspective. BMC Nurs 2022; 21:321. [PMID: 36419129 PMCID: PMC9685865 DOI: 10.1186/s12912-022-01093-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/02/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Moral courage as part of the moral competence of nurses has received increasing attention. Determination of the factors affecting moral courage is important in improving the quality of care. The purpose of this study was to investigate moral courage and related factors among frontline nurses from an empowerment perspective. METHODS A cross-sectional study was conducted using data collection instruments comprising four main parts: the self-designed form of demographic characteristics, Conditions for Work Effectiveness II (CWEQ-II), Spreitzer's Psychological Empowerment Scale (PES) and Nurses' Moral Courage Scale (NMCS). Data were collected from 226 nurses in a tertiary hospital between February and March 2022 in Wuhan, the capital city of Hubei Province in central China. Descriptive statistics and multiple linear regression were used to analyze the data. RESULTS The means of the total scores for the CWEQ-II, PES and the NMCS were 3.52 (SD = 0.69), 3.85 (SD = 0.53) and 3.90 (SD = 0.67), respectively. All the dimensions and the total scores of the CWEQ-II and PES were significantly correlated with the NMCS (p < 0.001). According to the multivariate stepwise regression analysis, CWEQ-II and PES were determined to be factors affecting NMCS. These variables explained 35.9% of the total variance in the moral courage scores of nurses. CONCLUSION The level of moral courage among nurses is above average. Structural empowerment and psychological empowerment were the key factors affecting the promotion of moral courage. Hospital and organizational administrations should be conscious of the role of attach structural empowerment and psychological empowerment in the nursing workplace in increasing moral courage.
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Affiliation(s)
- Kaili Hu
- grid.33199.310000 0004 0368 7223Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou Wuhan, 430030 P.R. China
| | - Juan Liu
- grid.33199.310000 0004 0368 7223Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou Wuhan, 430030 P.R. China
| | - Lisi Zhu
- grid.33199.310000 0004 0368 7223Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou Wuhan, 430030 P.R. China
| | - Yanrong Zhou
- grid.33199.310000 0004 0368 7223Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou Wuhan, 430030 P.R. China
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Abstract
BACKGROUND Moral courage means courage to act according to individual's own ethical values and principles despite the risk of negative consequences for them. Research about the moral courage of whistle-blowers in health care is scarce, although whistleblowing involves a significant risk for the whistle-blower. OBJECTIVE To analyse the moral courage of potential whistle-blowers and its association with their background variables in health care. RESEARCH DESIGN Was a descriptive-correlational study using a questionnaire, containing Nurses Moral Courage Scale©, a video vignette of the wrongdoing situation with an open question about the vignette, and several background variables. Data were analysed statistically and inductive content analysis was used for the narratives. PARTICIPANTS AND RESEARCH CONTEXT Nurses as healthcare professionals (including registered nurses, public health nurses, midwives, and nurse paramedics) were recruited from the membership register of the Nurses' Association via email in 2019. A total of 454 nurses responded. The research context was simulated using a vignette. ETHICAL CONSIDERATIONS Good scientific inquiry guidelines were followed. Permission to use the Nurses' Moral Courage Scale© was obtained from the copyright holder. The ethical approval and permission to conduct the study were obtained from the participating university and the Nurses' Association. FINDINGS The mean value of potential whistle-blowers' moral courage on a Visual Analogue Scale (0-10) was 8.55 and the mean score was 4.34 on a 5-point Likert scale. Potential whistle-blowers' moral courage was associated with their socio-demographics, education, work, personality and social responsibility related background variables. DISCUSSION AND CONCLUSION In health care, potential whistle-blowers seem to be quite morally courageous actors. The results offer opportunities for developing interventions, practices and education to support and encourage healthcare professionals in their whistleblowing. Research is needed for developing a theoretical construction to eventually increase whistleblowing and decrease and prevent wrongdoing.
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Affiliation(s)
- Johanna Wiisak
- University of Turku, Department of Nursing Science, Turku, Finland
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21
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Pakizekho S, Barkhordari-Sharifabad M. The relationship between ethical leadership, conscientiousness, and moral courage from nurses' perspective. BMC Nurs 2022; 21:164. [PMID: 35751063 PMCID: PMC9229516 DOI: 10.1186/s12912-022-00941-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Nurses' conscientiousness and moral courage are essential to providing high quality care. Leadership is one of the factors that may be very effective in strengthening these characteristics in nurses. Among leadership styles, the ethical leadership has a special value. This study investigated the relationship between ethical leadership of nursing managers, conscientiousness, and moral courage from the nurses' perspective. METHODS In this cross-sectional descriptive study, 180 nurses working in hospitals of Yazd, central Iran, were selected through simple random sampling. Three questionnaires: the "Ethical Leadership", "Conscientiousness", and "Moral Courage" were used to collect data. Data were analyzed with SPSS20 using descriptive and analytical statistics. RESULTS There was a positive and significant relationship between conscientiousness and moral courage with ethical leadership from the nurses' perspective (P < 0.05). The relationship between conscientiousness and moral courage was also significant (P < 0.05). The regression analysis showed that ethical leadership can be considered as a predictor of conscientiousness and moral courage. CONCLUSION The relationship between ethical leadership and conscientiousness and moral courage suggests that nursing managers, by adopting such an approach in leadership, can increase conscientiousness and moral courage in nurses.
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Affiliation(s)
- Samaneh Pakizekho
- Department of Nursing, School of Medical Sciences, Yazd Branch, Islamic Azad University, Shohadaye Gomnam Blvd., Safaiyeh, Yazd, 8916871967 Iran
| | - Maasoumeh Barkhordari-Sharifabad
- Department of Nursing, School of Medical Sciences, Yazd Branch, Islamic Azad University, Shohadaye Gomnam Blvd., Safaiyeh, Yazd, 8916871967 Iran
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