Moral courage in nursing – An integrative literature review

Abstract

Moral courage and understanding of its meaning are essential when nurses face ethical conflicts in their practice. This integrative review aimed to explore moral courage in nursing and possible associated individual and organizational factors. A database search in January 2020 identified 1308 scientific articles of which 25 were selected for the review. Inductive analysis with clear steps for defining and synthesizing themes in research reviews revealed three categories concerning moral courage in nursing: definition and descriptions of moral courage, characteristics of the morally courageous nurse, and skills and acts of the morally courageous nurse. Individual and organizational factors, such as positive personal experiences, commitment to ethical principles, supportive work environment and teamwork, were associated with moral courage in nursing, contributing to a more comprehensive description of nurses' moral courage. Findings indicate that in nursing practice, there is a need for promoting multi‐professional collaboration and discussion of ethical dilemmas to provide opportunities to enhance moral courage. Developing care environments in which hierarchy does not inhibit nurses' moral courage seems justified. Further research on moral courage with varying methodologies and multi‐disciplinary and international approaches is needed.

The relationship between ethical leadership, conscientiousness, and moral courage from nurses’ perspective

“…Conscientious nurses feel more responsible for doing good things. They do not hesitate to do anything for the benefit of their clients [67], and act as the patients' advocates when good care is threatened [68].…”

“…The results also showed that ethical leadership had a positive and significant relationship with moral courage. Because acting morally and courageously can be strenuous, nurses tend to have the support of leaders [25,68,80]. Supportive behavior is a characteristic of ethical leadership that helps nurses perform their duties more effectively [48,51].…”

Nursing Education: Students’ Narratives of Moral Distress in Clinical Practice

“…It is important to question whether nurses have the moral judgment and wisdom to really know the right thing to do [ 17 ], an important issue we believe should be addressed in nursing education. In addition, when encountering challenging situations, both nursing education and practice need to promote interprofessional collaboration and ethical competence to foster “moral courage” [ 31 ]. We suggest that methods other than just classroom teaching may empower students to be better prepared for challenging situations.…”

Blowing the whistle during the first wave of COVID‐19: A case study of Quebec nurses

“…Our findings suggest that blowing the whistle was experienced and seen as an act of moral courage by nurses. Although slight variations exist in the definition of moral courage, we define it here as the courage a person demonstrates when acting in a way that aligns with their values and beliefs despite fear or threat of negative consequences for the acting individual (Pajakoski et al, 2021 ). We use the concept of moral courage to capture the motivations, rationales and intentions cited by nurses across all units.…”