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.

Ethics and frontline nursing during COVID-19: A qualitative analysis.

BACKGROUND: Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. RESEARCH AIM: To analyze frontline U.S. nurses' experiences of ethics during the COVID-19 pandemic. RESEARCH DESIGN: Qualitative analysis using a directed content methodology. PARTICIPANTS AND RESEARCH CONTEXT: The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. ETHICAL CONSIDERATIONS: Participant privacy and data confidentiality were addressed. FINDINGS: Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. DISCUSSION: This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. CONCLUSIONS: Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available.

Evaluation of moral sensitivity and moral courage in intensive care nurses in Turkey during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, intensive care nurses may experience ethical issues related to fear of transmission, limited resources, and increased workload. Nurses' moral sensitivity and courage may have a role in dealing with these problems. AIM AND OBJECTIVE: The purpose of this study was to assess intensive care nurses' moral sensitivity and moral courage during the COVID-19 pandemic. DESIGN: Descriptive cross-sectional survey. METHODS: A total of 362 nurses working in the intensive care units of pandemic hospitals in Turkey participated in the study between January and March 2021. Data were obtained using a personal information form, the Moral Sensitivity Questionnaire, and the Nurses' Moral Courage Scale. A link to the online data collection tools was sent to the management of participating institutions, who forwarded it to nurses. Reporting followed the CHERRIES guidelines. RESULTS: In this study, the response rate of nurses was 89%. The nurses' total mean moral sensitivity score was 90.70 ± 28.89 and their mean moral courage score was 82.08 ± 13.51. A weak inverse correlation was found between the nurses' moral sensitivity and moral courage scores (r = -.176, p = .001). Total moral sensitivity score differed significantly according to years of Intensive care unit (ICU) experience (p = .007). Total moral courage scores increased significantly with education level (p = .012), years of nursing experience (p = .016), and willingness to work in the ICU (p < .001). CONCLUSION: The study suggests that nurses working in the intensive care unit during the pandemic had moderate moral sensitivity and high levels of moral courage. Nurses' sociodemographic characteristics and ICU work conditions may affect their moral sensitivity and moral courage. RELEVANCE TO CLINICAL PRACTICE: The results of this study can help guide efforts to improve moral courage and sensitivity and address ethical issues among ICU nurses.

Purpose in Life and Character Strengths as Predictors of Health Sciences Students' Psychopathology During the COVID-19 Pandemic.

Background: Health sciences students experience high levels of psychopathology conditioned by psychosocial, financial, and academic factors. However, COVID-19 pandemic might even have worsened their mental health. Thus, this article aims to evaluate how the exposure to COVID-19 pandemic has affected these students' mental health and to determine the effect of purpose in life and character strengths on this psychopathology. Methods: A cross-sectional study of unpaired samples was carried out in Spain during the first and third waves of the pandemic in 70 medical and 52 nursing students. Results: The risk factor that most determined the appearance of anxiety was the exposure of family and friends to COVID-19 (OR = 4.01; p < 0.001), while the most protective factors were honesty (OR = -1.14; p = 0.025) and purpose in life (OR = -0.18; p < 0.001). Purpose in life also protected against the onset of depression and total psychopathology. In addition, we observed studying medicine was a protective factor against total psychopathology while being a nursing student was associated with high levels of acute stress. Conclusion: Exposure of the students' family and friends to SARS-CoV-2 favored the appearance of symptoms of anxiety. Honesty had a preventing role in the onset of anxiety and a high purpose in life was protective against the appearance of anxiety, depression, and total psychopathology.

Moral Courage and Its Related Factors in Emergency Medical Technicians during the Covid-19 Pandemic in 2021: A Cross-sectional Study

Background: Emergency medical technicians (EMTs) at the forefront of the health system face Covid-19 cases. In such situation, they may have doubts about their abilities or priorities and may not make the right decisions. They need moral courage to survive this global crisis's stress and strengthen their decision-making power. Aim: The present study aimed to investigate the moral courage and its related factors in EMTs during the Covid-19 pandemic. Method: This cross-sectional study was performed in 2021 on 194 EMTs of Zanjan University of Medical Sciences. Sampling was done by the cluster random method. A demographic information questionnaire and standard moral courage questionnaire were used to collect data. Data were analyzed using independent t-test, ANOVA, Pearson correlation coefficient and Logistic regression. P<0.05 was considered statistically significant. Results: The mean total score of moral courage was high in 88.1% of EMTs (433.31± 49.70 out of 510). The mean score of moral courage in the dimensions of moral self-actualization was 228.98±32.46, risk-taking was 159.04±15.68, and the ability to defend the right was 45.28±7.70. There was statistically significant relationship between the mean score of total moral courage and marital status, age, work experience, and number of working hours (p <0.05). Implications for Practice: The findings of this study showed that EMTs had a high level of moral courage, so it is possible to maintain this important ethical virtue through reinforcements, planning, effective training, and organizational support, and consequently increase the quality of pre-hospital care. Copyright © 2022 Mashhad University of Medical Sciences, All rights reserved.

Employee-organization connectedness: ethical behavior and moral courage

Purpose>This paper aims to review the latest management developments across the globe and pinpoint practical implications from cutting-edge research and case studies.Design/methodology/approach>This briefing is prepared by an independent writer who adds their own impartial comments and places the articles in context.Findings>Employee – organizational connectedness had a significant positive impact on ethical behavior. Along with moral courage connectedness explains more than half the variance on ethical behavior. Social learning and strong employee-organizational connectedness facilitate the development of moral courage. The effect of connectedness on ethical behavior is partially mediated by moral courage.Originality/value>The briefing saves busy executives, strategists and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy-to-digest format.

Employee–organisation connectedness and ethical behaviour: the mediating role of moral courage

Purpose>How employees connect with their work organisation and how it may play a role in their moral courage and ethical behaviour remain under-explored. This study, using Psychological Contract Theory, aims to explore how employee–organisation connectedness influences employees' moral courage and ethical behaviour.Design/methodology/approach>The hypotheses were tested using Partial Least Squares Structural Equation Modelling (PLS-SEM) on data collected through a questionnaire survey from 212 Australian healthcare professionals.Findings>Employee connectedness with their work organisations showed a significant and direct impact on ethical behaviour. Along with moral courage, connectedness explained over half of the variance in ethical behaviour. Furthermore, moral courage partially mediated the effect of employee connectedness on ethical behaviour.Research limitations/implications>The overall theoretical implication of this study is that psychological contracts between employees and their organisations operationalised through employee–organisation connectedness can explain the role of moral courage in ethical behaviour.Practical implications>With increasing borderless management of organisations, organisational connectedness can be a critical factor in developing employees' moral courage and ethical behaviour within organisations. Socialisation interventions can be useful to promote employee–organisation connectedness.Originality/value>The study developed a higher-order connectedness model and validated it with PLS-SEM. The study provides novel empirical evidence on the relationships between employee–organisation connectedness, moral courage and ethical behaviour.

Happiness and Moral Courage Among Iranian Nurses During the COVID-19 Pandemic: The Role of Workplace Social Capital.

Background: COVID-19 has become a major global health problem, and healthcare professionals are facing lot of pressure and stress. Accumulated resources and energy obtained via interpersonal relationships is called social capital, which can reduce the negative effects of pressure and stress related to the workplace by impacting happiness and moral courage. This study explored the effect of workplace social capital on moral courage and happiness in nurses working in the COVID-19 wards. Methods: In this cross-sectional study, using a random sampling method, 169 nurses from three hospitals in East Mazandaran province, Iran, participated who worked in COVID-19 wards. The Onyx and Bullen Social Capital Questionnaire, the Sekerka's Moral Courage Scale, and the Oxford Happiness Inventory were used in this study. Descriptive analysis, Pearson correlation analyses, and stepwise multiple regression were performed for data analysis. Results: The mean age of nurses was 31.38 ± 6.82 years. Socio-demographic factors such as age, gender, educational level, and employment status were significant predictors of workplace social capital. Social capital was positively correlated with moral courage (r = 0.29, p < 0.01) and happiness (r = 0.32, p < 0.01). In addition, social capital explained 6.8 and 8.6% variance in predicting moral courage and happiness, respectively. Conclusions: Workplace social capital is a vital organizational phenomenon affecting nurses' moral courage and happiness, especially during the COVID-19 pandemic. Thus, hospitals should be aware of the importance of social capital; they should ensure that all the practices and policies are in place to develop and increase it.

Crisis, ethical leadership and moral courage: Ethical climate during COVID-19.

BACKGROUND: The global COVID-19 pandemic has challenged nurse leaders in ways that one could not imagine. Along with ongoing priorities of providing high quality, cost-effective and safe care, nurse leaders are also committed to promote an ethical climate that support nurses' moral courage for sustaining excellence in patient and family care. AIM: This study is directed to develop a structure equation model of crisis, ethical leadership and nurses' moral courage: mediating effect of ethical climate during COVID-19. ETHICAL CONSIDERATION: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University, Egypt. METHODS: A cross-sectional design was used to conduct this study using validated scales to measure the study variables. It was conducted in all units of two isolated hospitals in Damanhur, Egypt. A convenient sample of 235 nurses was recruited to be involved in this study. RESULTS: This study revealed that nurses perceived a moderate mean percent (55.49 ± 3.46) of overall crisis leadership, high mean percent (74.69 ± 6.15) of overall ethical leadership, high mean percent (72.09 ± 7.73) of their moral courage, and moderate mean percent of overall ethical climate (65.67 ± 12.04). Additionally, this study declared a strong positive statistical significant correlation between all study variables and indicated that the independent variable (crisis and ethical leadership) can predict a 0.96, 0.6, respectively, increasing in the dependent variable (nurses' moral courage) through the mediating impact of ethical climate. CONCLUSION: Nursing administrators should be conscious of the importance of crisis, ethical leadership competencies and the role of ethical climate to enhance nurses' moral courage especially during pandemic. Therefore, these findings have significant contributions that support healthcare organizations to develop strategies that provide a supportive ethical climate. Develop ethical and crisis leadership competencies in order to improve nurses' moral courage by holding meetings, workshops, and allowing open dialogue with nurses to assess their moral courage.

A most vulnerable population: Black men.

Black men disproportionately experience the worst health outcomes among U.S. populations. Systemic social, political, and healthcare problems are important intersecting issues of Black men's poor health outcomes. As nursing is one of the most trusted professions, it is nurses' responsibilities to include care for vulnerable populations. In this creative controversy an alternative perspective of Black men as a vulnerable population is proposed. Potential tensions and an introspective call to action for all nurses is included.

"Healthcare Kamikazes" during the COVID-19 Pandemic: Purpose in Life and Moral Courage as Mediators of Psychopathology.

Although the required personal protective equipment was not available during the first wave of the COVID-19 pandemic, Spanish healthcare workers continued to work, being dubbed as 'healthcare kamikazes'. Two possible reasons are moral courage and purpose in life that, in turn, would modulate the appearance of psychopathology. Cross-sectional study was carried out in 90 Spanish and 59 Mexican healthcare professionals, and 56 medical and nursing students. Spanish professionals had suffered more work and overall exposure (M = 8.30; SD = 2.57 and M = 9.03; SD = 2.66) than Mexican (M = 5.10; SD = 1.87 and M = 5.55; SD = 2.35). Mexican professionals had fewer anxiety disorders (30.5%; n = 18) and a lower depression score (M = 4.45; SD = 5.63) than the Spanish (43.7%; n = 38; and M = 8.69; SD = 8.07). Spanish professionals more often experienced acute stress disorder (32.6%; n = 29). Purpose in life, in addition to having a direct protective effect on psychopathology, also modulated the relationship between personal and family exposure and psychopathology. In conclusion, purpose in life protects against the appearance of psychopathology in healthcare workers with personal and family exposure to SARS-CoV-2.

Moral courage, moral sensitivity and safe nursing care in nurses caring of patients with COVID-19.

AIM: Evaluation the moral courage, moral sensitivity and safe nursing care in nurses caring of infected patients by the COVID-19. DESIGN: This study employed cross-sectional research. METHODS: 520 nurses caring for COVID-19 patients in 5 hospitals were selected via convenience sampling. They completed questionnaires online. Data were analysed by SPSS software version 22. RESULTS: Findings showed that moral courage has a strong and direct correlation with moral sensitivity (p < .001, r = 0-.70) and safe nursing care (p < .001, r = 0-.74). Variables of moral sensitivity, safe nursing care, work experience, age and employment status can predict 64.76% of the variance in moral courage in these nurses. Nursing care of patients with COVID-19 have reported high moral courage in recent months, and in spite of the numerous tensions and stresses in terms of caring these patients during this relative long period, they are still diligent in providing safe and high sensitive care to these patients.

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.