Journal of Medical Ethics and History of Medicine (Dec 2023)

Moral distress and moral courage among Iraqi nurses during the COVID-19 pandemic: a cross-sectional study

  • Layth Hussein Hashim Hthelee,
  • Afsaneh Sadooghiasl,
  • Sima Mohammadkhan Kermanshahi

DOI
https://doi.org/10.18502/jmehm.v16i19.14618
Journal volume & issue
Vol. 16

Abstract

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In the years following its outbreak in 2019, COVID-19 changed the health-care system structures, the context of professional activity, and nurses’ moral performance. The present study aimed to examine the moral distress and moral courage of Iraqi nurses during the COVID-19 pandemic. This cross-sectional and correlational study was conducted in 2021 on 168 nurses selected by convenience sampling methods. Data were collected by self-reported instruments including a demographic questionnaire, the Professional Moral Courage (PMC), and the Moral Distress Scale (MDS). Data were analysed using descriptive statistics, the Spearman, Mann-Whitney and Kruskal-Wallis tests, and SPSS version 22. Most nurses showed a moderate level of moral distress (98.80%) and a high level of moral courage (99.40%).The dimension of multiple values had the highest mean (12.45 ± 1.47) and endurance of threats had the lowest mean (9.15 ± 1.79). There was a statistically significant correlation between moral distress and moral courage (P = 0.007, r = - 0.2), and moral distress and the dimensions of endurance of threat (P < 0.001, r = - 0.26), going beyond compliance (P < 0.001, r = - 0.037), and moral goals (P < 0.001, r = - 0.173). A statistically significant relationship was also found between moral distress and work shift, position and gender (P < 0.05), and between moral courage and position (P < 0.05). We concluded that nurses need more organizational support in terms of protective facilities, job security and organizational incentives to be able to show ethical behaviors.

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