Abstract
Background:Moral courage as a part of nurses’ moral competence has gained increasing interest as a means to strengthen nurses acting on their moral decisions and offering alleviation to their moral distress. To measure and assess nurses’ moral courage, the development of culturally and internationally validated instruments is needed.Objective:The objective of this study was to validate the Dutch-language version of the four-component Nurses’ Moral Courage Scale originally developed and validated in Finnish data.Research design:This methodological study used non-experimental, cross-sectional exploratory design.Participants and research context:A total of 559 nurses from two hospitals in Flanders, Belgium, completed the Dutch-language version of the Nurses’ Moral Courage Scale.Ethical considerations:Good scientific inquiry guidelines were followed throughout the study. Permission to translate the Nurses’ Moral Courage Scale was obtained from the copyright holder, and the ethical approval and permissions to conduct the study were obtained from the participating university and hospitals, respectively.Findings:The four-component 21-item, Dutch-language version of the Nurses’ Moral Courage Scale proved to be valid and reliable as the original Finnish Nurses’ Moral Courage Scale. The scale’s internal consistency reliability was high (0.91) corresponding with the original Nurses’ Moral Courage Scale validation study (0.93). The principal component analysis confirmed the four-component structure of the original Nurses’ Moral Courage Scale to be valid also in the Belgian data explaining 58.1% of the variance. Confirmatory factor analysis based on goodness-of-fit indices provided evidence of the scale’s construct validity. The use of a comparable sample of Belgian nurses working in speciality care settings as in the Finnish study supported the stability of the structure.Discussion and conclusion:The Dutch-language version of the Nurses’ Moral Courage Scale is a reliable and valid instrument to measure nurses’ self-assessed moral courage in speciality care nursing environments. Further validation studies in other countries, languages and nurse samples representing different healthcare environments would provide additional evidence of the scale’s validity and initiatives for its further development.
Highlights
It is seen as a means to strengthen and empower nurses in their ethical decision-making and its implementation within a multi-professional healthcare team, as well as to offer alleviation to moral distress commonly experienced by nurses.[6,7,8,9,10]
The aim of this study was to assess the psychometric validity of the Dutch-language version of the NMCS in nursing context in Flanders (Belgium)
A methodological non-experimental, cross-sectional exploratory research design was used to study a convenience sample of registered nurses working in various care departments in two hospitals, one in an academic setting and one in a regional setting in Flanders, Belgium
Summary
In the discussion concerning nurses’ ethical competence, the concept of moral courage has gained increasing interest.[1,2,3,4,5] It is seen as a means to strengthen and empower nurses in their ethical decision-making and its implementation within a multi-professional healthcare team, as well as to offer alleviation to moral distress commonly experienced by nurses.[6,7,8,9,10] nurses’ morally courageous action has been seen as a contribution to patient safety and quality nursing care[11,12,13]. Objective: The objective of this study was to validate the Dutch-language version of the four-component Nurses’ Moral Courage Scale originally developed and validated in Finnish data. Participants and research context: A total of 559 nurses from two hospitals in Flanders, Belgium, completed the Dutch-language version of the Nurses’ Moral Courage Scale. Discussion and conclusion: The Dutch-language version of the Nurses’ Moral Courage Scale is a reliable and valid instrument to measure nurses’ self-assessed moral courage in speciality care nursing. Moral courage has been defined as courage in the context of a moral issue.[15] It stems from an individual’s moral stand involving deliberation and careful thought, referring to moral reasoning It is an individual’s ability to use inner principles to do what is right and good for others, regardless of the threat of negative consequences to self. Moral courage refers to the nurse’s ability to rationally defend professional and personal ethical principles and values, and to act despite the anticipated or real adverse consequences of such actions to self.[14,23,24,25] Lack of moral courage undermines nurses’ integrity as autonomous moral agents.[6,26,27,28]
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