The Association between Moral Distress and Moral Courage in Nurses: A Cross Sectional Study in Iran
Abstract
Background: Moral distress and moral courage among healthcare professionals have received considerable attention in recent years. However, there is a paucity of studies investigating these topics among nurses. Thus, the present study aimed to evaluate the association between moral distress and moral courage among nurses in an Iranian sample population.
Materials and Methods: The present cross-sectional study was conducted during February– December 2018. Corley’s Moral Distress (MDS-R) and Sekerka’s moral courage scales were used to collect the data. MDS-R is a 21-items scale which includes frequency and intensity ranges from 0 (never) to 4 (very frequently) and 0 (none) to 4 (great extent), respectively. In addition, the moral courage scale contains 15 items ranging from “never true” (1 point) to “always true” (7 points). In total, 225 eligible nurses were entered into this study. Finally, SPSS-16 was used for statistical analysis at the á = 0.05 level.
Results: The mean scores of the frequency and intensity of moral distress and moral courage were 45.41 (95% CI = 43.37-47.45), 44.24 (95% CI = 42.98-45.42), and 59.63 (95% CI = 58.50-60.87), respectively. Eventually, a significant relationship was found between the moral courage and frequency of moral distress (r = 0.46, p < 0.001) and the intensity of moral distress (r = 0.73, p < 0.001).
Conclusions: In general, encouraging healthcare managers and administrators is considered as crucial for developing supportive structures and highly sensitive management which promotes moral courage while reducing moral distress in nurses’ work setting.
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Gallagher A. Moral distress and moral courage in everyday nursing practice. Online J Issues Nurs 2011;16:8.
Comer DR, Vega G. Moral Courage in Organizations: Doing the Right Thing at Work. ME Sharpe; 2015.
Borhani F, Abbaszadeh A, Nakhaee N, Roshanzadeh M. The relationship between moral distress, professional stress, and intent to stay in the nursing profession. J Med Ethics Hist Med 2014;7:3.
Escolar-Chua RL. Moral sensitivity, moral distress, and moral courage among baccalaureate Filipino nursing students. Nurs Ethics2018;25:458-69.
Shoorideh FA, Ashktorab T, Yaghmaei F, Alavi Majd H. Relationship between ICU nurses’ moral distress with burnout and anticipated turnover. Nurs Ethics 2015;22:64-76.
Jameton A. What moral distress in nursing history could suggest about the future of health care. AMA J Ethics 2017;19:617-28.
Karagozoglu S, Yildirim G, Ozden D, Çınar Z. Moral distress in Turkish intensive care nurses. Nurs Ethics 2017;24:209-24
Mohammadi S, Borhani F, Roshanzadeh M. Relationship between moral distress and moral courage in nurses. J Med Ethics Hist Med 2014;7:26-35.
De Villers MJ, DeVon HA. Moral distress and avoidance behavior in nurses working in critical care and noncritical care units. Nurs Ethics 2013;20:589-603.
Cummings CL. The effect of moral distress on nursing retention in the acute care setting 2009. UNF graduate theses and dissertations. 371. Available from: https://digitalcommons.unf. edu/etd/371. [Last accessed on 2019 Feb 11].
Lazzarin M, Biondi A, Di Mauro S. Moral distress in nurses in oncology and haematology units. Nurs Ethics 2012;19:183-95.
Abumayyaleh B, Khraisat O, Hamaideh S, Ahmed A, Thultheen I. Moral distress and turnover intention among critical care nurses in Saudi Arabia. Int J Nurs Health Sci 2016;3:59-64.
Sadooghiasl A, Parvizy S, Ebadi A. Concept analysis of moral courage in nursing: A hybrid model. Nurs Ethics 2018;25:6-19.
Lachman VD. Moral courage: A virtue in need of development? Medsurg Nurs 2007;16:131-3.
Borhani F, Mohammadi S, Roshanzadeh M. Moral distress and perception of futile care in intensive care nurses. J Med Ethics Hist Med 2015;8:2.
Kidder RM, McLeod B. Moral Courage. New York: W. Morrow; 2005.
Dinndorf-Hogenson GA. Moral courage in practice: Implications for patient safety. J Nurs Regul 2015;6:10-6.
Jackson D, Peters K, Andrew S, Edenborough M, Halcomb E, Luck L, et al. Understanding whistleblowing: Qualitative insights from nurse whistleblowers. J Adv Nurs 2010;66:2194-201.
Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. J Adv Nurs 2001;33:250-6.
Sekerka LE, Bagozzi RP. Moral courage in the workplace: Moving to and from the desire and decision to act. Bus Ethics Eur Rev 2007;16:132-49
Hamric AB, Borchers CT, Epstein EG. Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Prim Res 2012;3:1-9.
Allen R, Judkins-Cohn T, Forges E, Lee R, Clark L, Procunier M. Moral distress among healthcare professionals at a health system. JONAS Healthc Law Ethics Regul 2013;15:111-8.
Merghati Khoiee E, Vaziri MH, Alizadegan S, Motevallian SA, Omran M Rk, Goushegir SA, et al. Developing the moral distress scale in the population of Iranian nurses. Iranian J Psychiatry 2008;3:55-8.
Sekerka LE, Bagozzi RP, Charnigo R. Facing ethical challenges in the workplace: Conceptualizing and measuring professional moral courage. J Bus Ethics 2009;89:565.
Murray JS. Moral courage in healthcare: Acting ethically even in the presence of risk. Online J Issues Nurs 2010;15. doi: 10.3912/ OJIN.Vol15No03Man02.
Abbaszadeh A, Nakhaei N, Borhani F, Roshanzadeh M. The relationship between moral distress and retention in nurses in Birjand teaching hospitals. J Med Ethics Hist Med 2013;6:57-66.
Pauly B, Varcoe C, Storch J, Newton L. Registered nurses’ perceptions of moral distress and ethical climate. Nurs Ethics 2009;16:561-73.
Ferrell BR, editor Understanding the moral distress of nurses witnessing medically futile care. Oncology nursing forum; 2006: Oncology Nursing Society.
Borhani F, Abbaszadeh A, Mohamadi E, Ghasemi E, Hoseinabad-Farahani MJ. Moral sensitivity and moral distress in Iranian critical care nurses. Nurs Ethics 2017;24:474-82
Huffman DM, Rittenmeyer L. How professional nurses working in hospital environments experience moral distress: A systematic review. Crit Care Nurs Clin 2012;24:91-100.
Ameri M, Mirhashemi B, Hosseini SS. Moral distress and the contributing factors among nurses in different work environments. J Nurs Midwifery Sci 2015;2:44-9.
Wiegand DL, Funk M. Consequences of clinical situations that cause critical care nurses to experience moral distress. Nurs Ethics 2012;19:479-87.
O’Connell CB. Gender and the experience of moral distress in critical care nurses. Nurs Ethics 2015;22:32-42.
Fazljoo E, Borhani F, Abbaszadeh A, Razban F. The relationship between nurses’ perceptions of moral distress and the ethical climate in Shahid Sadoughi University of Medical Sciences of Yazd. J Med Ethics Hist Med 2014;7:80-90.
Janvier A, Nadeau S, Deschenes M, Couture E, Barrington K. Moral distress in the neonatal intensive care unit: Caregiver’s experience. J Perinatol 2007;27:203-8.
Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a medical intensive care unit. Am J Crit Care 2005;14:523-30.
Rice EM, Rady MY, Hamrick A, Verheijde JL, Pendergast DK. Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital. J Nurs Manag 2008;16:360-73.
Yildirim G, Ozden D, Karagozoglu S. Moral distress: An issue not on the agenda in the field of health in Turkey. Cumhuriyet Med J 2013;35:318-25.
Maluwa VM, Andre J, Ndebele P, Chilemba E. Moral distress in nursing practice in Malawi. Nurs Ethics 2012;19:196-207.
Oh Y, Gastmans C. Moral distress experienced by nurses: A quantitative literature review. Nurs Ethics 2015;22:15-31.
Joolaee S, Jalili H, Rafiee F, Haggani H. The relationship between nurses’ perception of moral distress and ethical environment in Tehran University of Medical ScieJ Med Ethics Hist Med 2011;4:56-66.
Maningo-Salinas MJ. Relationship between Moral Distress, Perceived Organizational Support and Intent to Turnover among Oncology Nurses. Capella University; 2010.
Lachman VD, Murray JS, Iseminger K, Ganske KM. Doing the right thing: Pathways to moral courage. Am Nurse Today 2012;7:24-9
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