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"Courage Psychological aspects."
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Institutional courage buffers against institutional betrayal, protects employee health, and fosters organizational commitment following workplace sexual harassment
Workplace sexual harassment is associated with negative psychological and physical outcomes. Recent research suggests that harmful institutional responses to reports of wrongdoing–called institutional betrayal —are associated with additional psychological and physical harm. It has been theorized that supportive responses and an institutional climate characterized by transparency and proactiveness—called institutional courage —may buffer against these negative effects. The current study examined the association of institutional betrayal and institutional courage with workplace outcomes and psychological and physical health among employees reporting exposure to workplace sexual harassment. Adults who were employed full-time for at least six months were recruited through Amazon’s Mechanical Turk platform and completed an online survey ( N = 805). Of the full sample, 317 participants reported experiences with workplace sexual harassment, and only this subset of participants were included in analyses. We used existing survey instruments and developed the Institutional Courage Questionnaire-Specific to assess individual experiences of institutional courage within the context of workplace sexual harassment. Of participants who experienced workplace sexual harassment, nearly 55% also experienced institutional betrayal, and 76% experienced institutional courage. Results of correlational analyses indicated that institutional betrayal was associated with decreased job satisfaction, organizational commitment, and increased somatic symptoms. Institutional courage was associated with the reverse. Furthermore, results of multiple regression analyses indicated that institutional courage appeared to attenuate negative outcomes. Overall, our results suggest that institutional courage is important in the context of workplace sexual harassment. These results are in line with previous research on institutional betrayal, may inform policies and procedures related to workplace sexual harassment, and provide a starting point for research on institutional courage.
Journal Article
Exploring the foundations and influences of nurses' moral courage: a scoping review
In the realm of healthcare, nurses frequently encounter complex ethical issues that demand moral courage. Nurses'moral courage is defined as the ability to act in alignment with their moral beliefs, even when faced with difficulties and dangers during ethical challenges. This study aims to explore the role of moral courage in nursing practice, highlighting its importance in maintaining patient care standards and fostering ethical decision-making. This scoping review on nurses' moral courage was conducted following Arksey and O'Malley's five-step approach. Relevant literature was sourced from databases such as Embase, PubMed, ScienceDirect, Web of Science, PsycINFO, Scopus, and CINAHL, spanning the years 2000-2024. A total of 40 studies were selected, focusing specifically on the foundations and influences of nurses' moral courage, with data extraction and synthesis for reporting. The study highlights moral courage as crucial in nursing for ethical decision-making and patient care. Global variations in moral courage are influenced by cultural, contextual, and organizational factors. Tools for measurement show score discrepancies. Nursing education shapes moral courage, necessitating tailored programs. Research explores personal and organizational influences on ethical behavior, with factors like age, work experience, and ethics training impacting moral courage. Morning shift nurses and those with official employment exhibit higher moral courage. Gender's impact remains inconclusive, requiring further study. Training in nursing ethics enhances moral courage, emphasizing its role in care quality. In conclusion, understanding the diverse factors shaping moral courage in nursing is vital for navigating ethical challenges and improving patient care quality. Tailored educational strategies are essential to foster moral courage among nursing professionals globally, emphasizing the need for ongoing research and interventions to enhance ethical practice and patient outcomes.
Journal Article
Standing-up against moral violations: The predicting role of attribution, kinship, and severity
Witnesses of moral violations stand up for their moral principles, despite facing substantial costs for intervening. Notwithstanding its importance, little is known whether responsibility attributions and the relation between the victim and a witness (i.e., kinship) have different effects on the intention to intervene in situations of different severity (e.g., moral courage situations). We predict an interaction between the situation’s severity and the victims’ responsibility for their plight. In less-severe situations, witnesses would be less willing to help when they perceive the victim to be responsible for their plight. However, those who are not seen as responsible would receive more help. For more-severe situations, responsibility is predicted to have no effect. Opposite effects are predicted for the relationship between the helper and the victim. We further predict that perceived costs for helping mediates witnesses’ willingness to intervene. Two studies showed that people are more willing to help individuals who are perceived as being innocent, but only in less-severe situations. In more-severe situations, people’s willingness to intervene increases, regardless of responsibility attributions. We did not observe effects for kinship. Moreover, we provide partial evidence that witnesses of more-severe situations indeed accept higher costs for intervention.
Journal Article
Death anxiety, moral courage, and resilience in nursing students who care for COVID-19 patients: a cross-sectional study
Background
Being on the frontline of the battle against COVID-19, nurses and nursing students have been under considerable psychological stress and pressure. The present study is done to explore death anxiety, moral courage, and resilience in nursing students caring for COVID-19 patients in the south of Iran.
Methods
The present study is cross-sectional research conducted between September and December 2021. A total of 420 senior nursing students (nursing interns) who were undergoing their clinical training courses were invited to participate in the study by convenience sampling method from three hospitals affiliated with the University of Medical Sciences of Southern Iran. Data were collected using a demographics survey, Nurses’ Moral Courage Questionnaire, Connor-Davidson Resilience Scale, and Templer’s Death Anxiety Scale.
Results
The nursing students participating in this study had a death anxiety mean score of 12.78 ± 1.17
.
The results showed that there was a significant and indirect correlation between death anxiety on the one hand and moral courage (
r
= -0.91,
p
< 0.001) and resilience (
r
= -0.89,
p
< 0.001) on the other in nursing students caring for patients with COVID-19. Also, it was found that there was a significant and direct correlation between the students’ resilience and moral courage scores (
r
= 0.91,
p
< 0.001).
Conclusion
The nursing students caring for COVID-19 patients had experienced high levels of death anxiety in the past few months. Considering the persistence of the COVID-19 crisis in Iran and other countries, there is an urgent need for measures to preserve and improve the physical, mental, and spiritual health of nursing students, enhance their moral courage and resilience and reduce their death anxiety.
Journal Article
‘Healthcare Heroes’: problems with media focus on heroism from healthcare workers during the COVID-19 pandemic
During the COVID-19 pandemic, the media have repeatedly praised healthcare workers for their ‘heroic’ work. Although this gratitude is undoubtedly appreciated by many, we must be cautious about overuse of the term ‘hero’ in such discussions. The challenges currently faced by healthcare workers are substantially greater than those encountered in their normal work, and it is understandable that the language of heroism has been evoked to praise them for their actions. Yet such language can have potentially negative consequences. Here, I examine what heroism is and why it is being applied to the healthcare workers currently, before outlining some of the problems associated with the heroism narrative currently being employed by the media. Healthcare workers have a clear and limited duty to treat during the COVID-19 pandemic, which can be grounded in a broad social contract and is strongly associated with certain reciprocal duties that society has towards healthcare workers. I argue that the heroism narrative can be damaging, as it stifles meaningful discussion about what the limits of this duty to treat are. It fails to acknowledge the importance of reciprocity, and through its implication that all healthcare workers have to be heroic, it can have negative psychological effects on workers themselves. I conclude that rather than invoking the language of heroism to praise healthcare workers, we should examine, as a society, what duties healthcare workers have to work in this pandemic, and how we can support them in fulfilling these.
Journal Article
Positive personal resources and psychological distress during the COVID-19 pandemic: resilience, optimism, hope, courage, trait mindfulness, and self-efficacy in breast cancer patients and survivors
Purpose
This study aims to understand the association between positive personal resources (i.e., optimism, hope, courage, trait mindfulness, and self-efficacy), resilience, and psychological distress (i.e., anxiety, depression, stress) in women with breast cancer and breast cancer survivors during the COVID-19 pandemic. We hypothesized that personal positive resources can directly influence resilience, which in turn prevented psychological distress.
Methods
The research sample consisted of 409 Italian women (49% patients, 51% survivors) who were administered a questionnaire to assess positive resources, resiliency, and distress. structural equation model (SEM) analysis was carried out to confirm the hypothetical-theoretical model.
Results
Personal positive resources had a direct positive effect on resilience, which prevented from distress. These results were observed across cancer patients and survivors, and regardless the level of direct exposure to COVID-19.
Conclusions
In both patients and survivors, the relationships between positive personal resources, resilience, and psychological distress is strong enough to be not influenced by the level of exposure to COVID-19 and despite COVID-19 pandemic caused the disruption of active treatment plans and delays in routine check-ups.
Implications for cancer survivors
Implications of this study suggest the urgency to screen positive resources and to identify women with lower resilience and a potentially higher susceptibility to develop psychological distress. For these women, our findings suggest the implementation of psychological interventions that build resilience.
Journal Article
A study on different types of moral courage and coping styles of clinical nurses: based on potential profile analysis
Background
In professional ethics-related events, there are various unpleasant and complex ethical issues that require strong moral courage. Our aim is to identify and describe the potential categories of moral courage among nurses and to clarify the coping styles of nurses under different categories.
Method
A cross-sectional study was conducted using three data collection tools: a self-designed general information questionnaire, a Chinese version of the Moral Courage Scale, and a Trait Coping Style Questionnaire. Three hundred fourteen nurses from a tertiary hospital in Heilongjiang Province, China, were analysed using potential profile analysis, descriptive analysis, and Mann-Whitney U test data.
Result
The latent profile analysis (LPA) results indicate that the two-profile model is the most suitable and supports the existence of two different moral courage profiles: the low moral courage group (60.51%) and the high moral courage group (39.49%), with a high relative entropy value (0.922). The results point to a good profile solution, and there are significant differences between the two profiles. The Mann-Whitney U-test results showed that the positive coping scores of the high moral courage group were significantly higher than those of the low moral courage group, and the negative coping scores of the high moral courage group were significantly lower than those of the low moral courage group.
Conclusion
Our results reveal the heterogeneity of moral courage in the nurse sample and indicate that nurses in the high moral courage group tend to choose positive coping styles, while nurses in the low moral courage group are more likely to develop negative coping emotions. This provides important significance and reference value for nursing managers, who can propose customised management plans based on the types of moral courage of the nursing community and the coping styles under different categories.
Journal Article
Analysis of the current status and influencing factors of moral courage among operating room nurses in Southwest China: a multi-center study
Background
Moral courage is crucial for nurses to act ethically despite professional risks. Operating room (OR) nurses frequently encounter ethical dilemmas, requiring a balance between personal convictions and institutional policies. This study investigates the current status of moral courage among OR nurses in Southwest China and explores key influencing factors.
Materials and methods
The cross-sectional, multi-center study was conducted from April to May 2024. A total of 482 operating room nurses from 16 hospitals in Southwest China were surveyed. The nurses were assessed using a self-designed demographic questionnaire, the Nurses’ Moral Courage Scale (NMCS), the Psychological Empowerment Scale (PES), and the Hospital Ethical Climate Survey (HECS). Statistical analyses, including Spearman’s rho and multiple linear regression, were used to explore the relationships between nurses’ moral courage and various influencing factors, such as age, educational level, income, professional title, psychological empowerment, and hospital ethical climate.
Results
The total score for operating room nurses’ moral courage in this study was 80.26 ± 19.30, with subscale scores as follows: moral integrity (26.89 ± 6.73), moral responsibility (15.33 ± 3.92), commitment to providing quality care to patients (18.81 ± 4.77), and compassion and genuine presence with patients (19.23 ± 4.86). The moral courage was positively correlated with age, hospital level, years of experience, professional title, income, psychological empowerment and hospital ethical climate score. The multiple linear regression analysis revealed that work meaning, autonomy, work impact, and relationships with nurses, patients, and the hospital being significant factors influencing moral courage. The correlation analysis showed no significant correlation between educational level and moral courage. Furthermore, although nurses with lower income had lower moral courage scores, there was no significant correlation between income satisfaction and moral courage.
Conclusion
Psychological empowerment and a positive hospital ethical climate are key determinants of moral courage among OR nurses. Hospitals should implement targeted interventions to enhance nurses’ ethical decision-making capacities, foster professional autonomy, and strengthen interpersonal support networks to mitigate ethical distress.
Clinical trial number
Not applicable.
Journal Article