Volume 75, February 2024, 151768Author links open overlay panel, , , , , Highlights•

Finding relevant studies was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

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The PubMed, Web of Science, Google Scholar, Scopus, Embase, and Science Direct databases were searched.

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The results showed that three categories of factors most related to moral courage are individual, moral, and factors related to the organization.

AbstractBackground

Nurses face various ethical conflicts when taking care of patients, and such conflicts require moral courage. This systematic review was conducted with the aim of investigating moral courage and its related factors among nurses.

Methods

To find related studies, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The PubMed, Web of Science, Google Scholar, Scopus, Embase and Science Direct databases were searched using keywords such as Courage, Moral Courage, and Nurses, and no lower time limit was imposed when conducting the searches. The identified studies were published between January 2000 and March 2023. Quality of articles was assessed using the STROBE checklist.

Results

The pooled sample size for the 19 included studies was 7863. All studies were observational and cross-sectional. The results showed that three categories of factors most related to moral courage are individual, moral, and factors related to the organization. Underlying factors of each category are also provided within this paper.

Conclusion

Moral courage is an integral part of nursing, which as a profession, is becoming even more challenging with the advancement of science and technology. Therefore, there is a need for nurses and especially nursing managers to be considerate of factors affecting moral courage of nurses, with a view to strengthening the positive factors and reducing the negative impacts.

Section snippetsBackground

Today, nurses are increasingly facing complex moral and spiritual challenges, that sometimes include aggressive treatment of dying patients, unnecessary tests, and fraudulent report of experiments, inadequate and incomplete treatment, unfair distribution of power among employees and lack of organizational support (Abdollahi et al., 2021; Shorideh et al., 2012; Stutzer & Rodriguez, 2020). On the other hand, ethics is an integral part of the nursing system, considering the nature of nursing which

Methods

The study selection and reporting of this systematic review have been conducted in accordance with PRISMA 2020 (Antoniou et al., 2021). The focus of the study was on moral courage and its affecting factors among nurses. The identified articles have been published between January 2000 and March 2023.

Study selection

As shown in Fig. 1, 890 studies were identified after a systematic search of the above-mentioned databases, and also through the manual search of reference lists (850 studies in the review of sources and 40 studies through the review of the reference list of articles and gray literature). Subsequently, 470 duplicate articles were omitted. Moreover, 337 studies were removed due to not fulfilling the inclusion criteria. Then, a further 64 articles were excluded due to lack of access to their full

Discussion

This study was conducted with the aim of investigating moral courage and its related factors, as one of the necessities within the nursing profession to provide nursing care in challenging clinical conditions. According to the systematic review, the factors that can affect the moral courage of nurses are divided into the following three categories:

According to the studies of Abdollahi and Goktas, there is a direct relationship between age and years of nursing experience, with moral courage of

Conclusion

Moral courage is an integral part of caring for patients in the challenging profession of nursing. In this systematic review, factors affecting the moral courage of nurses were investigated and these factors were divided into three categories: individual, organizational, and moral. Nurses and especially nursing managers can play an instrumental role in identifying factors within their organisations that affect nurses' moral courage and contribute to the formation and promotion of moral courage

AbbreviationsEthics approval and consent to participate

Ethics approval was received from the ethics committee of deputy of research and technology, Kermanshah University of Medical Sciences (IR.KUMS.REC.1402.126).

Consent for publication

Not applicable.

Funding

By Deputy for Research and Technology, Kermanshah University of Medical Sciences (IR) (4020708). This deputy has no role in the study process.

CRediT authorship contribution statement

RA and SHR contributed to the design, MM and NS and AH prepared the manuscript. MG and MM and SHR assisted in designing the study, and helped in the, interpretation of the study. All authors have read and approved the content of the manuscript.

Declaration of competing interest

The authors declare that they have no conflict of interest.

Acknowledgements

We would like to the Student Research Committee of Kermanshah University of Medical Sciences.

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