Moral Courage Research Articles

Moral courage level of nurses: a systematic review and meta-analysis

BackgroundMoral 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.MethodsNine 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.ResultsSeventeen 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).ConclusionThe 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.

Keep quiet or act? Challenges in integrating ethical theory into gerontological nursing care during students’ first clinical rotation: A discussion paper

AimThe aim of the paper is twofold: 1. To present observations based on first-year nursing students’ narratives during clinical rotation in gerontological nursing care; and 2. Explore a nursing educator’s reflections on these observations in relation to the didactic and ethical challenges that occurred. BackgroundThe teaching of ethics is included in nurse education worldwide. Students are in their first clinical placement in residential care of older persons confronted with the moral complexities of gerontological care, where they get little possibility to share emotions and thoughts about ethically challenging nursing situations with a supervising registered nurse. DesignA critical discussion paper. MethodThe educator’s reflections in this discussion paper are based on a narrative assignment in ethics where first-year nursing students reflect on and describe a nursing situation during their clinical rotation in the residential care of older persons. ResultsMost students were acting as mere spectators in the described nursing situation where an older person, ethical standards, or evidence-based care was violated. Some students acted as advocates to the older person and intervened in the situation and a few as inspirers showing alternative ways of handling ethically challenging situations. ConclusionsEducators in nursing programs at the undergraduate level require time for student-centered formative guidance to foster moral courage and practice. During first-year students’ clinical rotation, the learning goals in long-term residential care of older persons are focused on evidence-based basic nursing care. In this, students are confronted with ethically challenging situations, where the possibility to learn from a critical reflective practice is rare. When observing situations where an older person is subjected to unethical or unsafe nursing care it is common that the students take the spectators’ role, not knowing how to deal with what is observed. Some students are taking an intervening role by trying to alleviate the vulnerability of the older person. A few are showing moral courage by directly intervening when experiencing unethical or unsafe nursing care or conduct. In this the student can inspire fellow students or staff during their clinical rotation in alternative ways of handling ethically challenging situations. As older persons are the largest demographic group that nurses will experience, educators need a sound knowledge of ethics as well as gerontological care to be able to meet and nurture students’ ethical reflections during clinical practice and to foster practical wisdom in nursing.

Courageous Role Model or Threatening Villain: A Parallel Mediation Model of Corporate Activism and Citizen Political Engagement

Through their sociopolitical activism, business leaders increasingly call for citizens to become more politically engaged in favor of a partisan position. This research develops and tests a framework that reveals that corporate sociopolitical activism can indeed elicit such political engagement but runs the risk of simultaneously inciting backlash from citizens who oppose the company’s envisioned political ends. Whereas politically congruent citizens perceive a company’s activism to be morally courageous and are thus inspired to support the company’s stance, politically incongruent citizens feel threatened by the company’s activism and become politically engaged in protection of their political identity. Companies may, however, succeed in increasing moral courage attributions without simultaneously affecting citizens’ political identity threat by acting as first movers in their activism. A series of experiments, including a stimulus sampling approach with 30 real cases of corporate sociopolitical activism, lend support for this framework. The results provide several implications for the political responsibilities of business leaders in contemporary democracies.

The Mediating Role of Moral Courage in the Relationship Between Authentic Leadership and Teachers’ Positive Psychological Capital

The Mediating Role of Moral Courage in the Relationship Between Authentic Leadership and Teachers’ Positive Psychological Capital

Moral courage of emergency nurses in care-limited environments: A mixed-methods study.

Professional ethics in nursing exist to guide care and allow for decision-making to be patient-centered. In the current medicolegal landscape post-Roe and in light of bans on gender-affirming care, the decision-making processes of emergency nurses in the clinical environment of care as informed by both professional and personal ethics are an important area of inquiry. The aim of this study was to examine the contribution of moral courage to decision-making by emergency nurses. A mixed-methods exploratory sequential approach was used, using a standard demographics form and the Nurses Moral Courage Scale to collect quantitative data. These data were used to inform an interview guide for qualitative data collection. Situational analysis was used to analyze the interview data. Prior to recruitment, this study was reviewed and approved by the University of Massachusetts IRB (#00003909). Participants were provided with an informed consent document at the time of registration and at the time of interview; participants provided both signed consent and verbal assent. Participants were assigned study codes to maintain anonymity and data were maintained in a secure University cloud. US-based emergency nurses working in environments with care limitations. 70% of respondents reported that they would speak up if they were aware of a situation that was ethically challenging. Respondents reported that it was fairly easy or very easy to defend their values when addressing ancillary staff, coworkers, authorities outside the organization, patients, and patient families. Respondents reported challenges in defending their professional values to charge nurses, physicians, or administrators. In response to a serious ethical problem, 65.8% of respondents answered that they would bring up the problem for discussion, 21.1% would file an internal report, and 13.2% would report externally. Interview participants reported significant social and professional barriers to acting in response to an ethical violation. Willingness to act centered on personal values and not professional codes of ethics. While emergency nurses in this study reported high perceived levels of moral courage, they also reported low willingness to act directly, citing burnout and significant social and professional barriers. Adherence to professional codes of ethics is not the primary driver of moral courage.

Technological solutions to fostering students’ moral courage: an augmented reality-based contextual gaming approach

Technological solutions to fostering students’ moral courage: an augmented reality-based contextual gaming approach

Powderly and the worker awakening: speaking to the South in 1885

ABSTRACT Throughout his 1885 speaking tour across the South, Terence Powderly both respected and challenged the region’s color line. Dedicated to growing the Knights of Labor (KOL) membership in the rapidly industrializing South, Powderly asked white and black workers to recognize their common cause in protesting their new wage slavery. Recognizing that the KOL’s vision of a cooperative commonwealth depended on a racially unified and enlarged union membership, Powderly pushed the notion of worker equality while respecting the South’s views of social inequality. His variegated approach to racial relations at speaking engagements across seven southern states over a four-week period reflected both a pragmatic approach to growing union membership and a moral courage in pressing against the south’s racial boundaries.

Designing an Interpretative Structural Model of the Antecedents of Employees' Morally Courageous Behaviors in Pervasive Crises (Case Study: Kerman University of Medical Sciences)

Background and objective Moral courage is necessary to observe moral behavior when dealing with moral challenges raised at the time of crisis. The purpose of this study is to present an interpretive structural model (ISM) of the antecedents of moral courage during crises among the staff of Kerman University of Medical Sciences, Iran. Method This is a descriptive-analytical survey. After reviewing the literature and identifying the antecedents of moral courage, a questionnaire with semi-closed questions was designed and distributed among 18 managers and expert from the university, who were selected using non-probability purposive sampling method. The data were analyzed in MATLAB software, version 9 and MICMAC software, version 2. Results Based on the findings, the antecedents included individual factors (self-esteem, personal values, moral model, personality type), managerial factors (leadership, criticism acceptance, honesty, leader-member exchange), organizational factors (organizational transparency, accountability, culture), and environmental factors (economic, cultural, political/legal). Conclusion The results can help relevant authorities to plan and make appropriate decisions in this field.

Investigating the Relationship between Forgotten Nursing Care and Moral Courage of Nurses during the COVID-19 Pandemic

Investigating the Relationship between Forgotten Nursing Care and Moral Courage of Nurses during the COVID-19 Pandemic

The relationship between professional moral courage and individual characteristics among emergency medical services providers

PurposeEmergency Medical Services (EMS) providers are often faced with a range of ethical dilemmas in their line of work that require moral courage to make a quick and ethical decision. The purpose of this study is to investigate the level of professional moral courage (PMC) in EMS providers and its relationship with their demographic characteristics.Design/methodology/approachIn 2022, a cross-sectional descriptive study was conducted on 175 EMS providers at the Hamadan Emergency Medical Center. The study utilized an available sampling method. Data was collected using a demographic information form and Sekerka's moral courage questionnaire, which was distributed electronically. The collected data was analyzed using SPSS 26 software with descriptive and analytic tests.FindingsAccording to the findings, the average age of the participants was 34.57 ± 3.46 years. The majority of participants were married (50.3%), had work experience ranging from 8 to 14 years (49.7%), and held a degree in emergency medicine (52.6%). The participants displayed a high level of PMC, with an average score of 62.5 ± 8.14. Notably, age, work experience, educational level, and employment status were all found to have a significant relationship with moral courage (p < 0.05) among the demographic characteristics.Research limitations/implicationsThe study has a limitation in terms of the sampling method employed, which may impact the generalizability of the results. Another limitation, by a narrow margin, is that the sample size is smaller than what was estimated. Furthermore, using various measurement tools to assess PMC might lead to varying outcomes. Consequently, it is recommended that future research incorporates random sampling and devises a dedicated psychometric instrument to assess the PMC of EMS providers.Originality/valueThe results revealed a positive correlation between work experience and PMC among providers. This can be attributed to the challenges and outcomes they have encountered throughout their careers. Moreover, EMS providers with higher educational qualifications and job stability demonstrated higher levels of moral courage.

The relationship between moral courage, team work, and safe nursing care in clinical nurses: a multicenter cross-sectional study in Iran

BackgroundMoral courage and team work are the most important aspects of professional competence in clinical nurses; nurses with moral courage and team work are thought to be able to deliver safe nursing care to patients. The present study aimed to investigate whether moral courage and teamwork correlate with safe nursing care among clinical nurses.MethodsThis descriptive cross-sectional multicenter study was carried out from December 2023 to February 2024. A total of 375 nurses who were practicing in four hospitals in the south of Iran were enrolled in this study using convenience sampling. The data collection tools used consisted of a demographics survey, Moral Courage Questionnaire (MCQ), Team STEPPS Team Perception Questionnaire (T-TPQ), and the Assessment of Safe Nursing Care Questionnaire (ASNCQ). The data were analyzed using descriptive statistics, t-test, chi-square, multiple regression analysis, and Pearson’s correlation coefficient. SPSS version 22 was used to analyze the data.ResultsThe participants’ mean age was 32.66 ± 6.63 years, and their work experience was 8.56 ± 6.22 years. The total mean scores for moral courage, teamwork, and safe care were 422.37 ± 52.92, 144.09 ± 18.43, 315.84 ± 41.95, respectively. A statistically significant positive correlation was found between teamwork and safe care (r = 0.57, p < 0.001), teamwork and moral courage (r = 0.49, p = 0.002), and moral courage and safe nursing care (r = 0.59 p < 0.001). According to the results, work experience, moral courage, and teamwork explained 44.4% of the variance in safe nursing care (R2 = 0.44, p < 0.001).ConclusionThe results indicated that the moral courage and teamwork of nurses were positively and significantly correlated with the participants’ safe nursing care. Accordingly, since moral courage and teamwork are the qualities that can contribute to improving the quality of care and ensuring safe nursing care, it is recommended that nursing managers pay special attention to these factors.

The Influence of Crucibles of Experience in Moral Development & Psychology of Public Relations Exemplars

ABSTRACT This study conducted life story interviews with 40 members of the PRSA College of Fellows to examine the influence of crucibles (i.e. trials, challenges or growth opportunities) in the moral development and psychology of public relations exemplars. The outcomes were the development of an illustration of their moral and leader development journey drawing on Rest’s four-component model of ethical decision making, and a moral psychology profile of the key characteristics of public relations exemplars. The profile that emerged is that of leaders who exemplify moral courage, resilience, generosity, genuine care about others and are willing to listen and learn. When they faced trials, they emerged stronger and stayed true to their values and character.

The Relationship among Internet Addiction, Moral Potency, Mindfulness, and Psychological Capital.

This research aimed to contribute to the literature on internet addiction (IA) and moral development among university students. Moral potency (MP) encompasses the interconnected dimensions of moral courage, moral ownership, and moral efficacy. Studies on the relationships between students' problematic behaviors (e.g., IA) and cognitive processes like MP, mindfulness (MI), and psychological capital (PsyCap) are scarce in educational research. Therefore, this study investigated the relationships among IA, MP, MI, and PsyCap in university students. This study included 868 undergraduate students from a state university in Ethiopia, with 526 male students (60.6%) and 342 female students (39.4%). Participants' ages ranged from 21 to 29 years, with a mean age of 22.31 and a standard deviation of 4.03. The findings indicated that IA was negatively correlated with MI, PsyCap, and MP. Both MI and PsyCap showed positive correlations with MP. Importantly, this study revealed that IA had a direct and negative impact on MI, PsyCap, and MP. Further, MI and PsyCap partially mediated and fully mediated the relationship between IA and MP. These findings suggest that cultivating MI and positive PsyCap among university students could be an important strategy to reduce the risks of IA and enhance their moral development. This study contributes to the limited research on the complex relationships between technology use, psychological resources, and moral functioning in emerging adulthood.

Associations between medical students' stress, academic burnout and moral courage efficacy.

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. 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. 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. 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.

Ruben Salazar: Beyond Postage Stamp Memory

ABSTRACT In 2008, Ruben Salazar was memorialized on a US postage stamp, one of several media icons of moral courage that included John Hersey, George Polk, and Martha Gellhorn, so honored at the same time. Unlike most postage stamp journalists, Salazar—whose career is a study in civil rights reportage—has largely faded from public memory and journalism history. Salazar lived and died civil rights reporting, killed by authorities while covering a Mexican American Vietnam War protest. This essay traces Salazar’s impact as a narrator of the Mexican American freedom struggle, putting his work at the Los Angeles Times, and at Spanish-language station KMEX, in context with the broader civil rights movement.

Generating the Moral Agency to Report Peers’ Counterproductive Work Behavior in Normal and Extreme Contexts: The Generative Roles of Ethical Leadership, Moral Potency, and Psychological Safety

Generating the Moral Agency to Report Peers’ Counterproductive Work Behavior in Normal and Extreme Contexts: The Generative Roles of Ethical Leadership, Moral Potency, and Psychological Safety

Standing up for close others: the relationship effect on moral courage across care and fairness contexts / En defensa de los más allegados: el efecto de la relación en la valentía moral en contextos de cuidado y de equidad

Moral courage is defined as standing up for others and intervening when a norm is violated. This research aimed to examine the effect of relationship type between the bystander and the victim (close or distant) and the moral context in which the norm violation occurs (care/harm or fairness/reciprocity) on moral courage. Two studies ( n = 164 and n = 200) utilized a scenario method in which participants were presented with short vignettes of another person (close or distant) being victimized (in either a care or a fairness context) and were asked to indicate their willingness to intervene, representing degree of moral courage. As expected, participants reported greater levels of moral courage when the victim was their family member or friend (vs. stranger) and this effect was stronger in the care (vs. fairness) context. Moreover, anger — a moral emotion — mediated the relationship effect on moral courage in both contexts. Consequently, relationship type and context should be considered when addressing interventions against norm violations.

The influence of psychological resilience and nursing practice environment on nurses' moral courage: A cross-sectional study.

To determine the relationship between psychological resilience, nursing practice environment, and moral courage of clinical nurses and also the factors influencing moral courage. Cross-sectional study. 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. 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.

Skeletons in the closet: How and when internal and external corporate social responsibility affect employees' internal whistleblowing behaviors

AbstractThe micro‐level corporate social responsibility (CSR) literature has underscored the economic benefits of an organization's CSR investments, such as bolstering employees' organizational commitment and improving work performance. Yet, research on the potential influence of CSR in fostering socially oriented outcomes among employees has been rather scarce. This study aims to investigate the influence of CSR on employees' internal whistleblowing behaviors and the underlying mechanisms. A three‐time‐point survey was distributed across the service, manufacturing, construction, and financial insurance industries in Chinese enterprises. The findings reveal that both internal and external CSR positively impact employees' internal whistleblowing behaviors through the mediating role of moral courage, with internal CSR demonstrating a stronger effect. Organizational loyalty positively moderates the mediating role of moral courage in the relationship between internal CSR/external CSR and internal whistleblowing behaviors. Theoretically, this study presents a pioneering endeavor in establishing the link between CSR and employees' internal whistleblowing behaviors, underscoring the significant role that employees' perceptions of CSR play in enhancing societal well‐being and ethical governance. Besides contributing to the micro‐level CSR literature, this study also provides practical insights for organizations seeking to leverage CSR as a tool for promoting employees' ethical conduct.

Ethical Leadership in Educational Administration: International Perspectives and Lessons Learned

&#x0D; &#x0D; &#x0D; Ethical leadership in educational administration is a crucial component in fostering integrity, accountability, and trust within educational institutions. This article explores international perspectives and lessons learned regarding ethical leadership in educational administration through qualitative analysis, literature review, and library research. By examining various case studies, scholarly articles, and theoretical frameworks, this study elucidates the significance of ethical leadership in promoting organizational effectiveness and student success. The analysis delves into key principles and practices of ethical leadership, including transparency, fairness, moral courage, and ethical decision-making. Moreover, it examines the challenges and opportunities faced by educational leaders in upholding ethical standards amidst complex educational landscapes and diverse cultural contexts. Through this comprehensive exploration, the article aims to contribute to a deeper understanding of ethical leadership in educational administration and provide insights for practitioners, policymakers, and researchers worldwide.&#x0D; &#x0D; &#x0D;