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.

Enhancing the moral courage of nurses: A modified Delphi study

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.

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 Distress, Moral Resilience, Moral Courage, and Moral Injury Among Nurses in the Philippines During the COVID-19 Pandemic: A Mediation Analysis

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.

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.

The relationship between moral courage and providing safe care in nurses: A cross-sectional study

BACKGROUND

Moral courage is one of the moral virtues, which can have a great impact on the provision of safe care for patients. Providing safe care is one of the most significant and fundamental principles of healthcare. This study aimed to determine the relationship between moral courage and safe care among nurses and explain the factors predicting safe care.

MATERIALS AND METHODS

This is a cross-sectional study conducted on 172 nurses who worked in selected hospitals affiliated with the Iran University of Medical Sciences in 2019. For this purpose, self-report questionnaires on moral courage and safe nursing care were used. The collected data were analyzed in the Statistical Package for Social Sciences (SPSS) version 23.0 using descriptive (mean, standard deviation, percentage, and frequency) and inferential (Pearson's correlation coefficient and multiple linear regression) statistics. P values less than 0.05 were considered statistically significant.

RESULTS

Mean scores of nurses' moral courage and safe care were desirable (407.57 ± 53.97) and satisfactory (311.31 ± 39.48), respectively. There was a significant correlation between the scores of nursing safe care and moral courage (r = 0.69, P < 0.001). Moral courage, gender, and work experience explained 54% of the variance of nursing safe care.

CONCLUSION

The results showed that there is a positive and significant relationship between safety care and moral courage. It seems that increasing nurses' awareness of ethical principles leads to their courageous ethical behaviors, and safety and high-quality care should be one of the goals of all healthcare professionals. Also, the results of this study support the need to improve the knowledge and awareness of nurses and nurse managers regarding the importance of moral courage in providing safe nursing care and improving patient safety.

The predictive factors of moral courage among hospital nurses

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.

Is there any relationship between nurses' perceived organizational justice, moral sensitivity, moral courage, moral distress and burnout?

AIM

The present study is an attempt to investigate the relationship between Corley's model variables in mental health nurses.

BACKGROUND

Based on Corley's model, burnout and moral distress in nurses are, in retrospect, the consequences of the interplay of organizational and individual factors such as perceived organizational justice, moral sensitivity, and moral courage. The relationship between two variables or three variables of Corley's moral distress model has been investigated, but the test of Corley's moral distress model with more variables has not been done. Therefore, this research was proposed with the aim of investigating the relationship between the variables of moral courage and moral sensitivity (as characteristics of nurses), perceived organizational justice (as an antecedent), moral distress, and job burnout (as consequences of moral distress).

METHODS

The study was conducted as a descriptive correlational study involving 500 nurses working in the mental health wards of hospitals. Data collection was conducted using perceived organizational justice scale, moral sensitivity scale, moral courage scale, moral distress scale, and burnout inventory.

RESULTS

The results showed a significant relationship between perceived organizational justice, moral sensitivity, moral courage, and moral distress (< 0.05). Moreover, perceived organizational justice and moral distress had an inverse relationship. Moral sensitivity and moral courage had a direct relationship with moral distress (< 0.05). Furthermore, the results showed inadequate model fitness.

CONCLUSIONS

This study adds to the existing knowledge about the experiences of mental health nurses and their interactions with both organizational and individual factors. It highlights that the connections between perceived organizational justice, moral sensitivity, moral courage, moral distress, and burnout are intricate and multifaceted. As we deepen our understanding of these relationships, it opens the door for the development of interventions and strategies to enhance nurses' well-being and the quality of care they deliver in mental health settings. Moreover, future research and ongoing refinement and expansion of Corley's model will be crucial in addressing the complex challenges within the healthcare sector.

The mediating roles of moral courage and moral resilience between nurses' moral distress and moral injury: An online cross-sectional study

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.

Moral courage of master's students of nursing during COVID-19

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.

Perspectives on developing moral courage in pre-licensure education: A qualitative study

BACKGROUND

Error reporting and speaking up are mechanisms to reduce the incidence of healthcare errors. However, organizational policies don't always align with individuals' perceptions and beliefs to promote these mechanisms. When this misalignment produces fear, moral courage, which is taking action regardless of personal consequences, becomes necessary. Teaching moral courage in pre-licensure education may set a foundation for individuals to speak up in post-licensure careers.

AIM

To explore health professionals' perceptions of healthcare reporting and organizational culture to inform pre-licensure education on how to promote moral courage.

METHODS

Thematic analysis of four semi-structured focus groups with fourteen health professions educators followed by in-depth, semi-structured individual interviews.

FINDINGS

Organizational factors, characteristics that an individual must possess to enact moral courage and priority methods to guide moral courage were identified.

CONCLUSIONS

This study outlines the need for leadership education in moral courage and offers educational interventions to promote reporting and aid in developing moral courage academic guidelines to improve healthcare error reporting and speaking up behaviors.

Clinical nurses' moral courage and related factors: an empowerment perspective

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.

The relationship between ethical leadership, conscientiousness, and moral courage from nurses' perspective

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.

Practitioner Bias as an Explanation for Low Rates of Palliative Care Among Patients with Advanced Dementia

Patients with advanced dementia are less likely than those with other terminal illnesses to receive palliative care. Due to the nature and course of dementia, there may be a failure to recognize the terminal stage of the disease. A possible and under-investigated explanation for this healthcare disparity is the healthcare practitioner who plays a primary role in end-of-life decision-making. Two potential areas that might impact provider decision-making are cognitive biases and moral considerations. In this analysis, we demonstrate how the cognitive biases and moral considerations of practitioners related to clinical decision-making are inherent in clinical practice and may impact on providers' accuracy related to diagnostic and treatment related decision-making associated with patients with advanced dementia. Anchoring, default, availability, representativeness and framing biases are cognitive biases based on the "Two System Model" that relate to decision-making in end-of-life care. In patients with advanced dementia, those biases may result in a tendency to adhere to traditional mandatory care, involving an aggressive approach to care, which values saving lives at all costs, without taking into account the possible suffering and long-term consequences. Aspects such as moral sensitivity and moral courage play an important role in ethical decision-making related to advanced dementia. Investigations of clinical decision-making that include the cognitive biases and ethical considerations of practitioners might advance the comprehensive understanding of the clinical decision-making process related to care of patients with advanced dementia and promote the quality of care given to this population.

Iranian nurses' views on barriers to moral courage in practice: A qualitative descriptive study

Background

Nursing is a caring profession. Due to the nature of their work, nurses need to have the moral courage to deliver safe nursing care. Research results have reported a low level of moral courage in the majority of nurses. The current study aimed to identify the barriers to show moral courage in Iranian nurses.

Methods

This study was qualitative research that was conducted using conventional content analysis. Data was gathered using in-person, semi-structured, in-depth interviews. Interviews were conducted from March to September 2020. Purposeful sampling was used and sampling was continued until data saturation was reached. Participants were 19 nurses working in hospitals in Iran.

Results

According to data analysis, six categories and three themes were extracted. Themes are “organizational failure”, “deterrent personal identity” and “defeated professional identity”.

Conclusions

The results of this study revealed the barriers to show moral courage which were usually overlooked in previous quantitative studies. It appears that the elimination of these barriers is an effective step in the improvemalet of nurses’ competencies. The results of this study can be helpful in the developmalet of programs to address the factors affecting nurses’ moral courage.

How prosocial is moral courage?

Moral courage, that is, defending moral beliefs despite personal risks, is often seen as a hallmark of prosocial behavior. We argue that prosociality in moral courage is, however, complex. While its prosociality is often evident at a higher societal level, it can be contested in some aspects of morally courageous acts. We review the literature on two such aspects and highlight that differences and conflicts in moral beliefs, as well as the confrontational nature of many morally courageous acts, call into question prosociality. We recommend that future research takes the complexity of prosociality in moral courage into account to obtain a comprehensive and nuanced understanding of the psychological underpinnings of moral courage and its contributions to the functioning of societies.

Nurses' self-assessed moral courage and related socio-demographic factors

BACKGROUND

Nurses need moral courage to ensure ethically good care. Moral courage is an individual characteristic and therefore it is relevant to examine its association with nurses' socio-demographic factors.

OBJECTIVE

To describe nurses' self-assessed level of moral courage and its association with their socio-demographic factors.

RESEARCH DESIGN

Quantitative descriptive cross-sectional study. The data were collected with Nurses' Moral Courage Scale and analyzed statistically.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 482 registered nurses from a major university hospital in Southern Finland completed the Finnish language version of Nurses' Moral Courage Scale in autumn 2017.

ETHICAL CONSIDERATIONS

Ethical approval was obtained from the university ethics committee and permission for the data collection from the participating hospital. Ethical principles and scientific guidelines were followed throughout the research process.

FINDINGS

Nurses' self-assessed level of moral courage was rather high. On Visual Analogy Scale (0-10), the mean value was 8.20 and the mean score of the four dimensional, 21-item Nurses' Moral Courage Scale was 4.09 on a 5-point Likert-type scale. Respondents' gender, present work role, ethical knowledge base, additional ethics education, self-study as a means to acquire ethical knowledge, and frequency of work situations needing moral courage were statistically significantly associated with nurses' moral courage.

DISCUSSION

Strongest association was found between nurses' higher moral courage level and formal and informal ethics education. Honesty and patient's humane and dignified encounter received the highest scores indicating respondents' internalization of the core values of nursing.

CONCLUSION

Although nurses were fairly morally courageous, moral courage should be a part of nurses' basic and continuing education thus covering its theoretical and practical learning. Since moral courage is a virtue that can be taught, learnt, and practiced, education is a relevant way to maintain and further strengthen nurses' moral courage.

Sense of courage: The mediating role of courage between emotional reflexivity and work-life integration among nurses in Indian hospitals

Objectives

This study aimed to determine the relationship between emotional reflexivity and work-life integration through the mechanism of moral courage and enhance our understanding of the importance of these nursing concepts to enable the nurses to develop better coping strategies for work-life integration.

Methods

A cross-sectional survey was performed with 249 nurses, including staff nurses, ICU and critical care nurses, operation theatre nurses, pediatric nurses from 17 hospitals. Emotional Reflexivity, work-life integration, and courage were measured using a demographic information questionnaire, Life Project Reflexivity Scale (LPRS), Nurse’s Moral Courage Scale (NMCS), and Work-Life Boundary Enactment (WLBE) scale. A series of multiple regressions analyzed the mediating effect.

Results

Emotional Reflexivity was positively correlated with work-life integration (β = 0.66, P < 0.01). There was a positive correlation between emotional reflexivity and moral courage. But the path did not get the necessary support in the structural equation modeling (SEM) (β = −0.13, P = 0.40). When controlling for courage (β = 0.42, P < 0.01), the association was significant between emotional reflexivity and work-life integration with partial mediation.

Conclusion

The study reported a positive correlation between reflexivity and work-life integration. Thus, nurses’ work-life integration becomes better by reinforcing their emotional reflexivity and moral courage.

Moral Resilience for Critical Care Nurses

Ethically challenging situations are an increasing phenomenon in the nurse's environment, and literature on the subject is growing. Morally challenging experiences common in the critical care environment include end-of-life situations, barriers to providing the best care possible, and lack of organizational resources. These experiences can lead to moral distress and subsequent negative impacts on the clinician. Emerging in the literature are strategies to address the impact of moral distress through the development of moral resilience. Moral resilience is gained through personal commitment and organizational support.

Challenging times: ethics, nursing and the COVID-19 pandemic

Globally nurses and midwives are working hard to detect cases of COVID‐19, to save lives or give comfort in the face of death, to educate themselves and the public about protective measures to stop the viral spread, while still caring for those not infected with the virus. In many countries nurses are working under virtual siege from this pandemic, with not enough resources or personal protective equipment, overwhelming numbers of patients, staff shortages, underprepared health systems and supply chain failures. Nurses and other health and emergency workers are suffering physical and emotional stress, and moral distress from conflicting professional values. They are faced with unpalatable and complex ethical issues in practice, with moral conflicts, high levels of acuity and patient deaths, and long working hours. A rising number of nurses are infected with SARS‐CoV‐2 or dying in the line of duty. Nurses need strong moral courage, stamina and resilience to work on the front lines of the pandemic, often while separated from their loved ones.

Moral courage and psychological empowerment among nurses

BACKGROUND

Moral courage is one of the fundamental values of nursing profession and a powerful method of coping with ethical problems. Psychological empowerment is a suitable method of enabling individuals to coping mental pressures of the work environment. This study determined the correlation between moral courage and psychological empowerment of nurses.

METHODS

This was a descriptive cross-sectional study. A total of 180 nurses employed in different wards were selected randomly. Data were collected by Demographics Questionnaire, Sekerka's Moral Courage Scale, and Spreitzer's psychological empowerment Scale and analyzed with SPSS16 using descriptive and inferential statistics.

FINDINGS

The results indicated that the mean score of moral courage was 21.11 ± 69.90 and the greatest amount of moral courage was in the dimension of "going beyond compliance". The mean score of "psychological empowerment" was 30.9 ± 73.58 and the greatest mean belonged to "competence". There was a positive significant correlation between "psychological empowerment" and "moral courage and its dimensions" (P < 0.05).

CONCLUSION

The findings suggested a correlation between moral courage and psychological empowerment. Thus, nurses' moral courage could be enhanced by reinforcing their psychological empowerment leading to increased patient satisfaction and quality care.

Moral distress revisited: the viewpoints and responses of nurses

AIM

To present and discuss the main themes that were revealed following an analysis of the qualitative research findings that were extracted from a national survey regarding the causes and effects of moral distress amongst New Zealand nurses.

BACKGROUND/INTRODUCTION

Moral distress continues to be a major concern amongst nurses around the world. In New Zealand, a country where nurses have just been on strike over their working conditions and the deteriorating state of their roles within the health services, it remains a major issue.

METHOD

In the original research project, large numbers of nurses supplied not only quantitative data that revealed the extent and impact of moral distress on their practices, but also extensive notes that more specifically explained the causes and effects of their moral distress. This material has since been thematically analysed and is now presented.

FINDINGS/RESULTS

The data strongly suggested that New Zealand nurses experienced and attempted to respond to several major issues; that is, they were not properly supported by 'the system', frequently experienced problems with managers and bullying, witnessing poor care practices and collegial incompetence, and suffered from ongoing problems caused by moral residue.

CONCLUSION

Under current working conditions, nurses are struggling under an increasing weight of moral residue to maintain their ethical standards within an increasingly difficult ethical climate.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This research suggests that although nurses clearly seek out and use various ways to cope with moral distress in their practices, there is a continuing need for moral courage and strengthening of moral resilience that involves greater input from not just nurses themselves, but nurse managers, educators and other health services representatives.

Correlation between moral courage score and social desirability score of the medical residents and fellows in Argentina

PURPOSE

Moral courage is the conviction to take action on one's ethical beliefs despite the risk of adverse consequences.. It aimed to evaluate the correlation between social desirability score and moral courage scores of medical residents and fellows, and to explore gender and specialty-based differences of moral courage scores.

METHODS

In April 2018, the Moral Courage Scale for Physicians (MCSP), the Professional Moral Courage (PMC) scale and the Marlowe-Crowne scale to measure social desirability were administered to 87 medical residents from Hospital Alemán of Buenos Aires, Argentina.

RESULTS

Cronbach's alpha coefficients were 0.78, 0.74 and 0.81 for the Marlowe-Crowne, MCSP and PMC scales, respectively. Correlation analysis showed that moral courage scores were poorly correlated with social desirability scores, while both moral courage scales were highly correlated with each other. Physicians who were training in a surgical specialty showed lower moral courage scores than nonsurgical specialty trainees, and male from any specialty tended to have lower moral courage scores than females. Particularly, individuals performing a surgical specialty ranked lower when assessing "multiple values", "endurance of threats", and "going beyond compliance" dimensions from PMC scale. Male individuals tended to rank lower than females on "multiple values", "moral goals" and "endurance of threats" dimensions.

CONCLUSION

There was a poor correlation between two validated moral courage scores and social desirability score of the medical residents and fellows in Argentina. Conversely, both moral courage tools showed a good correlation and concordance between them, making these scales reasonably interchangeable.

Becoming a nurse faculty leader: taking risks by doing the right thing

Risk taking is a key aspect of academic leadership essential to meeting the challenges and opportunities in higher education. What are the practices of risk taking in nurse faculty leaders? This interpretive phenomenological study examines the experience and meaning of risk taking among nurse leaders. The theme of doing the right thing is brought forth through in-depth hermeneutic analysis of 14 individual interviews and two focus group narratives. The practice of doing the right thing is propelled and captured by leaders through a sense professional responsibility, visioning the future, and being true to self and follow one's core values. This study develops an evidence base for incorporating ways of doing the right thing in leadership development activities at a time when there is tremendous need for highly effective leaders in academic settings. Examining the practices of doing the right thing as a part of leadership development lays a foundation for building the next generation of nursing leaders prepared to navigate the ever-changing and complex academic and health care environments.