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\"A riveting, chilling tale of how a group of ragtag activists infiltrated one of the most secure nuclear weapons sites in the United States, told alongside a broader history of America's nuclear stewardship, from the early stages of the Manhattan Project to our country's never-ending investment in nuclear weaponry. On Saturday, July 28, 2012, three senior citizens broke into one of the most secure nuclear weapons facilities in the world. An eighty-two-year-old Catholic nun, a Vietnam veteran, and a house painter infiltrated the Oak Ridge, Tennessee, complex in the dead of night, smearing the walls with human blood and spray-painting quotes from the Bible. Then they waited to be arrested. What was a simple plan--one far more successful than even its perpetrators expected -- spawned a complex discussion. Among the questions that the infiltration raised: How did three unarmed civilians manage to penetrate one of the most heavily guarded locations in the world, nicknamed the 'Fort Knox of Uranium'? Why does the United States continue to possess more nuclear weaponry than is needed to destroy global civilization many times over? And what does this mean for the day-to-day safety of Americans? In Almighty, Washington Post writer Dan Zak begins with the present-day axis of a seventy-year-old story, exploring how events of the twentieth century -- including the prophecies of a farmer-turned-ascetic named John Hendrix and the early stages of the Manhattan Project in Morningside Heights -- led to one of the most successful and high-profile demonstrations of anti-nuclear activism\"--Amazon.com.

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.

Moral courage in nurses is the product of a complex process and can be enhanced by identifying the steps through which nurses make morally courageous decisions. This qualitative study aimed to explicate the process of moral courage in clinical nurses and present a descriptive model. The study was conducted in Shahrekord University of Medical Sciences in 2022 using the grounded theory approach. Twenty-one clinical nurses were selected through purposive and theoretical sampling. Data were analyzed using Strauss and Corbin's 2015 approach and data management was supported by MAXQDA software (version 11). The core variable identified was moral excellence. When faced with a misalignment between authority and responsibility, nurses experience ambiguity in ethical decision-making. The nurses in this study employed spirituality, legality, and self-sacrifice strategies, which helped them to manage system expectations. In this model, moral courage ultimately gravitates toward managing system expectations—a deviant mechanism failing to yield positive outcomes due to organizational infrastructures and conditions. Therefore, it is recommended that healthcare organizations address *Corresponding Author Mostafa Roshanzadeh Address: Shahrekord University of Medical Sciences, Shahr-e Kord, Iran. Postal Code: 88 71 68 34 85 Tel: (+98) 93 97 95 25 22 Email: roshanzadeh.m@skums.ac.ir Received: 6 Feb 2025 Accepted: 30 Aug 2025 Published:14 Oct 2025 Citation to this article: Davoodvand S, Mohammadi S, Salehi S, Roshanzadeh M. Explicating the process of moral courage in clinical nurses: a grounded theory study. J Med Ethics Hist Med. 2025; 18: 11. factors contributing to ambiguity in nurses' decision-making, such as lack of operational protocols for ethical decisions, mismatched expectations and responsibilities, and deficiencies in professional autonomy.

Nurses need to be resilient to be able to endure their working conditions, and their moral courage can affect their resilience. This work aimed at studying the relationship between resilience and professional moral courage among nurses working in hospitals. This descriptive cross-sectional study was conducted on 375 nurses working in teaching hospitals in the city of Ardabil in Iran in 2019. Data was collected using the following questionnaires: a demographic questionnaire, Sekerka et al. Moral Courage Scale and Davidson-Connor Resilience Scale. The reliability of the Davidson-Connor Resilience Scale, and Moral Courage Scale were found to be 89% and 85% using the test-retest method. The data were analyzed by Pearson correlation coefficient, t-test, variance analysis, and linear regression using the SPSS software version 24. In participating nurses, mean scores were 6.35±0.5 for total moral courage (favorable) and 79.35±0.35 (moderate) for resilience, respectively. A positive and significant relationship was observed between resilience and professional moral courage (P<0.05, r=0.1). Given the positive and significant relationship between resilience and professional moral courage, nurses require to have the high moral courage to enhance their resilience. Determining factors affecting moral courage and resilience, as well as finding strategies and creating an appropriate moral climate can increase nurses' morally courageous behaviors and resilience.

Error reporting and speaking up are mechanisms to reduce the incidence of healthcare errors. However, organizational policies don't always align with individuals' perceptions and beliefs to promote these mechanisms. When this misalignment produces fear, moral courage, which is taking action regardless of personal consequences, becomes necessary. Teaching moral courage in pre-licensure education may set a foundation for individuals to speak up in post-licensure careers. To explore health professionals' perceptions of healthcare reporting and organizational culture to inform pre-licensure education on how to promote moral courage. Thematic analysis of four semi-structured focus groups with fourteen health professions educators followed by in-depth, semi-structured individual interviews. Organizational factors, characteristics that an individual must possess to enact moral courage and priority methods to guide moral courage were identified. This study outlines the need for leadership education in moral courage and offers educational interventions to promote reporting and aid in developing moral courage academic guidelines to improve healthcare error reporting and speaking up behaviors. •Errors are inevitable and occur at an alarming rate, and reporting errors should become a standard of practice.•There is a disconnect between organizational policies and individuals’ beliefs that requires training and education.•Psychological safety is not always achievable, making moral courage exceedingly crucial for patient safety.•Open dialogue about errors allows for process and quality improvement, fewer errors, and improved patient safety.•Future directions include longitudinal and mixed methods studies to determine the best educational interventions to decrease errors.

Healthcare professionals often face complex ethical dilemmas in the workplace. Some professionals confront the ethical issues directly while others turn away. Moral courage helps individuals to address ethical issues and take action when doing the right thing is not easy. In this article the author defines moral courage, describes ongoing discussions related to moral courage, explains how to recognize moral courage, and offers strategies for developing and demonstrating moral courage when faced with ethical challenges

The increasing complexities of health care coupled with the decreasing importance of ethical values held by college students, including nursing students, compel nurse educators to step up efforts to strengthen the moral courage values of their students. While the nursing curriculum is the ideal breeding ground for building moral courage values, few studies describe how these values were embedded in any nursing curriculum, much less an accelerated bachelor’s degree in nursing (ABSN) curriculum. This study outlines an ABSN curriculum with teaching-learning activities designed to build moral courage values in its classroom and clinical settings. Faculty perceptions of 29 ABSN students’ honesty, respectfulness, responsibility, fairness, and compassion were surveyed 4 weeks after beginning, and again at the end of the ABSN program. The ABSN exit questionnaire administered annually by the College Office of Institutional Research, assessed the effectiveness of the ABSN curriculum. Of the 20 learning outcomes on the questionnaire, five related to moral courage values. The 5-point response scale ranged from Not at All, to Somewhat, Moderately, Well, and Extremely Well. t-test calculations revealed significant growth for four of the five values surveyed. Honesty, responsibility, fairness, and compassion were each positively significant at the p < .05 level. For the 27 of the 29 ABSN students who responded to the exit questionnaire, the Well and Extremely Well responses ranged from respectfulness and responsibility at 73%, to compassion and honesty at 78%, and fairness at 82%. Teaching-learning activities to build moral courage values successfully promoted the nursing program objective that the student will demonstrate proficient clinical, technological, and ethical competence in the delivery and management of health care.

Nurses practicing in today’s healthcare environment are confronted with increasingly complex moral and ethical dilemmas. Nurses encounter these dilemmas in situations where their ability to do the right thing is frequently hindered by conflicting values and beliefs of other healthcare providers. In these circumstances, upholding their commitment to patients requires significant moral courage. Nurses who possess moral courage and advocate in the best interest of the patient may at times find themselves experiencing adverse outcomes. These issues underscore the need for all nurses in all roles across all settings to commit to working toward creating work environments that support moral courage. In this manuscript the authors describe moral courage in nursing; and explore personal characteristics that promote moral courage, including moral reasoning, the ethic of care, and nursing competence. They also discuss organizational structures that support moral courage, specifically the organization’s mission, vision, and values; models of care; structural empowerment; shared governance; communication; a just culture; and leadership that promotes moral courage.

The research described here contributes to the extant empirical research on business ethics education by examining outcomes drawn from the literature on positive organizational scholarship (POS). The general research question explored is whether a course on ethical decision-making in business could positively influence students' confidence in their abilities to handle ethical problems at work (i.e., moral efficacy), boost the relative importance of ethics in their work lives (i.e., moral meaningfulness), and encourage them to be more courageous in raising ethical problems at work even if it is unpopular (i.e., moral courage). Specifically, the study used a rigorous quasi-experimental pretest–posttest research design with a treatment (N = 30) and control group (N = 30) to investigate whether a graduate-level course in business ethics could influence students' levels of moral efficacy, meaningfulness, and courage. Findings revealed that participants in the business ethics treatment course experienced significant positive increases in each of the three outcome variables as compared to the control group. The largest increase was in moral efficacy, followed by moral courage, and finally, moral meaningfulness. These findings are discussed in the context of the current research on business ethics education and POS. Implications for future research are discussed.

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.