Moral Courage and its Related Factors in Nurses: A Cross-Sectional Study

Abstract

Background and purpose: Moral courage is a crucial aspect of the nursing profession that significantly influences the quality of healthcare services. Moral courage refers to the courage or inner strength that an individual exhibits in ethical situations, acting based on their ethical principles, values, and beliefs despite potential negative consequences for themselves. Enhancing moral courage in nurses can lead to better decision-making and improved healthcare quality, thus, the understanding of the various factors related to this characteristic is of great importance. This article aims to investigate the relationship between moral courage and the personal and occupational characteristics of nurses. Materials and methods: This is a cross-sectional descriptive study. The research population in this study consisted of all nurses employed in hospitals affiliated with Mazandaran University of Medical Sciences in the eastern province of Mazandaran. The sample size was determined to be 300 individuals. Sampling was conducted using the convenience sampling method. Data was collected through a questionnaire related to demographic characteristics (age, gender, marital status, education level, type of employment, years of service, service department, shift work, hospital of service, and history of attending ethics courses or seminars), and the Sekerka Ethical Courage questionnaire was utilized. Data analysis was performed using measures of central tendency, standard deviation, independent t-tests, analysis of variance, and multiple linear regression. SPSS 22 software was employed for data analysis, with a significance level of less than 0.05. Results: The average age of the participants was 32.85±7.54 years. The average score of nurses' moral courage was 60.24±4.37 out of (105), indicating a moderate level. The highest score of moral courage was commonly associated with the moral agent dimension (13.87±1.42) and multiple values (13.43±1.54), while the lowest score of ethical courage was related to the threat tolerance dimension (8.82±1.74). Participation in ethics courses had a significant effect on the moral courage score (P=0.004), where nurses with a history of attending ethics courses obtained higher scores in moral courage. Other variables did not have a significant impact on the ethical courage score. Regression analysis results also showed that only participation in ethics courses had a significant effect on the moral courage score, as nurses without a history of attending these courses scored lower (1.26 units). Conclusion: Based on the findings of this study, it was revealed that participation in ethics-related training courses has a significant impact on nurses' ethical courage. These results indicate that ethics-related education (familiarity with professional ethics principles in nursing, values, and ethics in nursing decision-making, ethics in patient confidentiality and privacy, ethical collaboration and interaction with colleagues and other members of the healthcare team, patient involvement in ethical decision-making, ethical relationships with patient's families, and respect for their rights) can help strengthen and enhance nurses' ethical courage. Since ethical courage plays a crucial role in nurses' decision-making in challenging situations, designing effective and appropriate educational programs in this area can contribute to improving the quality of care and fostering a more ethical environment in the nursing setting.

Keywords

• moral courage
• demographic variables
• nurses
• cross-sectional study
• moral factor
• moral education