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Showing 80 results for Moral
Presenting a Structural Model to Explain Compassionate Care of Nurses Based on Moral Identity and Compassion to Others' Lives
Mozaffar Ghaffari, Lotfali Khani, Azam Mahmmodi,
Volume 15, Issue 1 (3-2022)
Abstract
Compassionate care is considered one of the important elements of patient-centered and oriented care that gives health to the patient. Therefore, this study was conducted with the aim of designing and explaining the model of compassionate care of nurses based on moral identity and compassion for the lives of others. The present research method was done according to path analysis. The statistical sample included 250 patients with covid-19 and 250 nurses working in the corona department of hospitals in West Azerbaijan province in 2021, which were selected by available sampling method. Rodriguez's compassionate care questionnaire, Black and Reynolds' moral identity questionnaire, and Chang's scale of compassion for others' lives were used to collect data. The data were analyzed using Pearson, Bootstrap and Sobel tests and also through SPSS and Amos software program, version 24. The results showed that the variable of moral identify in interaction with the mediating role of compassion for the lives of others in explaining the compassionate care of nurses. A total of 0. 41 of the variance of compassionate care was explained through model variables. The direct effect of moral identity (0. 47), compassion for the lives of others (0. 36) was observed and it was significant in explaining the compassionate care model. Also, the result showed that the indirect effect of moral identity was found to be significant through the mediation of compassion and also towards the lives of others (2. 96). Considering the variable mediating effect of compassion towards the lives of others in the relationship between moral identity and compassionate care of nurses, it seems that the growth or strengthening of compassion towards the lives of others and moral identity can promote the compassionate care of nurses.

Investigating the Role of Spiritual Intelligence in Moral Sensitivity of Nursing Students
Maasoumeh Barkhordari-Sharifabad, Seyedeh-Zahra Kaka-Tafti, Parnia Bastani, Farideh Mahmoudi-Hashemi,
Volume 15, Issue 1 (3-2022)
Abstract
Health care providers need moral sensitivity to provide effective ethical care Since spirituality is an integral part of morality, and spiritual intelligence is the basis of an individual's beliefs that affect his performance, this study was conducted to determine the role of spiritual intelligence in moral sensitivity of nursing students. This is a cross-sectional descriptive study that was conducted in 2021. The target population was nursing students studying in the first semester of 2021-2022 in Yazd, of which 153 people were selected by simple random sampling. In order to data gathering, questionnaire of King's spiritual intelligence and Lutzen's moral sensitivity was used. The validity and reliability of the instruments have been determined in previous research. Data were analyzed using descriptive statistics (mean and standard deviation, frequency distribution) and inferential statistics (Pearson correlation test and T test) by SPSS software version 16. Results indicated the mean of moral sensitivity (64.24 ±10.46) and the mean of spiritual intelligence of nursing students (53.90 ±34.13) were moderate. There was no statistically significant relationship between spiritual intelligence and moral sensitivity (P=0.245). Therefore, it is necessary to conduct studies to investigate the mediating factors that may affect these variables for a better and deeper understanding.

Ethical Challenges in Training in Viewpoint of Students in Medical Sciences: A Qualitative Study
Samireh Abedini, Elham Imani,
Volume 16, Issue 1 (3-2023)
Abstract
Face many ethical challenges during this course. Since ethics is an important factor in providing health services to clients, this study was designed to explain the ethical challenges in training in viewpoint of medical students. This qualitative study was conducted with content analysis approach. Purposeful sampling was performed and data were collected using in-depth, face-to-face and semi-structured individualized interviews. Data analysis was done simultaneously with qualitative content analysis using inductive approach according to Elo and Kingaz (2008). In this study, information was gathered after interviewing 40 students of Hormozgan University of Medical Sciences. The mean age of participants was 22/67±1/22 years. After analyzing the text of the interviews, two themes and seven categories were finally obtained. Themes were named under the headings: ethical challenges in clinical field and ethical challenges in clinical training supervisors. According to the results of interviews with different students, it is imperative that the faculty members pay special attention to the ethical challenges in hospitals and clinics and consider the necessary steps to familiarize students with ethical issues, how to deal with these issues and how to make decisions in ethical situations.

Designing a Structural Model for Academic Cheating in Medical Students Based on Moral Metacognition, Moral Identity, and Moral Potency
Mozaffar Ghaffari, Ahmad Esmali, Vahid Abdolmanafi, Mahtab Aligolipour,
Volume 16, Issue 1 (3-2023)
Abstract
The prevalence of academic cheating in educational centers and institutions leads to inefficiency and incapacity of graduates. Accordingly, the current study aimed to design a structural model for academic cheating in medical students based on moral metacognition, moral identity, and moral potency. This correlational study was done using structural equation modeling. The statistical population of the study included the students of Tabriz University of Medical Sciences in 2022, and 350 students were selected for the study using simple random sampling method. Data were collected through the Academic Cheating Scale (ACS) (Parks-Leduc, Guay and Mulligan, 2022), Moral Metacognition Scale (McMahon and Good, 2016), Moral Identity Questionnaire (MIQ) (Black & Reynolds, 2016), and Moral Potency Questionnaire (Hannah and Avolio, 2010). Data were analyzed using Bootstrap, Sobel, and Pearson’s correlation coefficient tests via SPSS and AMOS, version 24. The results indicated that the direct effect of moral potency (-0.34), moral identity (-0.25), and moral metacognition (-0.29) was significant on estimating academic cheating in students. The indirect effect of moral identity (-1.97) and moral metacognition (-2.06) with the mediating role of moral potency on students’ academic cheating was significant. Considering the mediating effect of moral potency in the academic cheating model, it seems that moral potency plays a role in increasing the effects of moral metacognition and moral identity on reducing academic cheating.

Moral Empowerment in Intensive Care Unit Nurses: A Scoping Review
Maryam Kashani, Mansoureh Ashqli Farahani, Fatemeh Golestan,
Volume 17, Issue 0 (12-2024)
Abstract
The intensive care unit (ICU) environment presents numerous ethical challenges, contributing to significant levels of moral distress among ICU nurses. This distress negatively impacts their well-being and job satisfaction. Recognizing this critical issue, researchers have investigated the potential of moral empowerment programs to alleviate moral distress. This scoping review aimed to systematically synthesize existing literature on these programs and evaluate their efficacy in mitigating moral distress among ICU nurses. A comprehensive search of PubMed, Scopus, and CINAHL databases was conducted, utilizing keywords such as "moral empowerment," "moral distress," and "intensive care unit nurses." Fifteen articles meeting predefined inclusion criteria, including publication between 2010 and 2022 and a specific focus on moral empowerment programs for ICU nurses, were selected for analysis. The scoping review revealed that moral empowerment programs demonstrated positive outcomes in reducing moral distress among ICU nurses. These programs, encompassing workshops, case-based discussions, reflective exercises, and role-playing simulations, were designed to enhance moral reasoning, ethical decision-making, and moral resilience. Consistent findings indicated a significant decrease in moral distress among nurses who participated in these programs. Participants reported increased confidence in navigating ethical dilemmas, making sound clinical decisions, and effectively advocating for patients' rights. Moreover, moral empowerment programs fostered a sense of moral agency, empowering nurses to address ethical challenges proactively. Moral distress poses a significant challenge for ICU nurses, impacting their well-being and potentially compromising the quality of patient care. Moral empowerment programs offer a promising approach to mitigating this distress and enhancing ethical decision-making capabilities. The successful implementation of these programs requires a supportive work environment that fosters open dialogue and ethical reflection. Nurse leaders and educators play a crucial role in collaborating with ethics committees to develop and implement tailored interventions, including integrating moral empowerment modules into new nurse orientations and ongoing professional development programs. Continuous support through follow-up sessions, mentoring, and debriefing is essential to sustain the long-term benefits of these programs. Ethical consultation services and interprofessional collaboration further contribute to the ethical well-being of ICU nurses. While this review provides valuable insights, further research is warranted to investigate the long-term effects and broader implications of moral empowerment programs in the ICU setting.

Educational Strategies to Enhance Moral Sensitivity in Nursing Students: A Systematic Review
Pooriya Samadzadehshahri, Reza Mohammadpourhodki, Zahra Delir,
Volume 17, Issue 0 (12-2024)
Abstract
Nursing students, as future healthcare professionals, must develop not only clinical competencies but also ethical competencies to deliver appropriate and professional care. Moral sensitivity is a critical aspect of professional competence, enabling nurses to recognize and respond sensitively to ethical situations as patient advocates. Consequently, fostering moral sensitivity should be prioritized from the beginning of nursing education to ensure quality care. This study aimed to examine the characteristics and effectiveness of educational interventions designed to improve the moral sensitivity of nursing students. In this systematic review, articles were retrieved using Persian and English keywords from international databases, including PubMed, Web of Science, and Scopus, as well as Persian databases such as SID and Magiran, from inception until October 2024. Keywords used in the search included "moral sensitivity," "ethical sensitivity," "nursing students," "ethics," and "moral sensitivity in nursing students." A total of 2,321 articles were identified in the initial search. References for each study were also manually reviewed. Based on inclusion criteria, experimental and quasi-experimental studies published in Persian and English focusing on effective interventions to improve the moral sensitivity of undergraduate nursing students were selected for analysis. Ultimately, six articles met the criteria for thorough review, and relevant data were extracted. Two researchers independently extracted the data and assessed the quality of the studies using the Joanna Briggs Institute (JBI) checklist. A total of 190 nursing students from six selected studies participated in the research, with 60% in intervention groups. The six educational interventions identified included:
  1. Two studies on nursing ethics workshops.
  2. A nursing ethics workshop conducted through a seminar.
  3. A motivational ethical education program.
  4. A virtual narrative ethics workshop.
  5. Problem-based learning.
However, the nursing ethics workshop conducted through a seminar was not effective in improving the moral sensitivity of nursing students. Evidence suggests that while the positive effects of educational interventions on the moral sensitivity of nursing students are limited, they are nonetheless encouraging. This review highlights various approaches to ethics education and moral sensitivity development. The findings can be utilized to enhance students' preparedness and ability to navigate ethically challenging work situations. However, further research is necessary to confirm the effectiveness of these interventions in fostering moral sensitivity among nursing students.

The Relationship Between Ethical Courage and Moral Distress in Nursing Students of Mashhad University of Medical Sciences in 2023
Sepide Ghavidel, Sajedeh Ghaani, Seyedehghodsieh Bahreinitousi, Mohaddeseh Mohsenpour,
Volume 17, Issue 0 (12-2024)
Abstract
Moral distress is a common topic in medical ethics, referring to a state where individuals, despite possessing knowledge and the ability to act ethically, are unable to perform the right ethical actions due to external constraints. Ethical courage is a crucial virtue for conscientious performance by healthcare providers, particularly nurses and nursing students. It facilitates the delivery of nursing care and is especially important in today’s healthcare environment, where factors such as increased patient awareness, evolving health needs, social justice issues, and access to healthcare services have contributed to heightened levels of moral distress among nurses and nursing students. This study aims to investigate the relationship between ethical courage and moral distress in nursing students. This descriptive, cross-sectional study was conducted in 2023 in Mashhad, Iran. The study population consisted of third-semester nursing students at Mashhad University of Medical Sciences. A total of 40 third-semester nursing students, both male and female, participated in the study. Data were collected using two questionnaires: the Moral Distress Scale (Corley) and the Ethical Courage Questionnaire (designed by Sekerka and colleagues). The data were analyzed using SPSS version 25, employing descriptive statistics and Pearson correlation tests. The majority of the students were female (51.2%), while 36.6% were male. The average age of the participants was 21.14 years. Among the students, 75.6% were single, and 4.9% were married. The findings revealed a weak, non-significant negative correlation between moral distress and ethical courage (r = -0.055, p > 0.05). The average moral distress score was 75.34 ± 10.81 (range: 12–16), while the average ethical courage score was 85 ± 9.33 (range: 60–103). The study found a weak, non-significant negative correlation between moral distress and ethical courage among nursing students. Based on these findings, it is recommended to implement workshops focused on ethical motivation and educational programs designed to reduce moral distress and enhance ethical courage among nursing students. Additionally, the non-significant correlation may be attributed to the small sample size. Therefore, future studies with larger sample sizes are suggested to validate these findings.

Moral Courage in Intensive Care Nurses: Exploring the Predictors of a Professional Virtue
Ali Akbari, Alireza Arman, Alireza Nikbakht Nasrabadi,
Volume 17, Issue 0 (12-2024)
Abstract
Moral courage is essential for intensive care unit (ICU) nurses to navigate complex ethical dilemmas and advocate for patient rights. Despite its importance, the factors that influence the expression of moral courage remain poorly understood. This review aims to identify key predictors of moral courage in ICU nurses, offering valuable insights to enhance ethical decision-making and improve patient care in critical care settings. This review followed the Cochrane systematic review principles and adhered to PRISMA guidelines. A comprehensive literature search was conducted using both English and Persian keywords related to "moral courage," "ICU nurses," and "predictors." International databases such as PubMed, Scopus, and Web of Science were searched, along with grey literature from Google Scholar. No time frame restrictions were applied. Inclusion criteria included observational studies that focused on predictors of moral courage in ICU nurses, while studies such as clinical trials, reviews, opinion pieces, and those lacking primary data were excluded. Two authors independently screened and extracted data, resolving discrepancies through consensus with a third author. The Newcastle-Ottawa Scale (NOS) was used to assess study quality, and relevant data were systematically organized into an extraction table. A total of 136 articles were initially identified, with 24 observational studies included after screening. The final selection consisted of 4 cross-sectional studies and 8 cohort studies. Key predictors of moral courage in ICU nurses were identified, including age, gender, professional experience, ethical training, and workplace support. Older and female nurses were more likely to demonstrate moral courage, while nurses with more years of experience and formal ethical training exhibited a stronger ability to confront ethical challenges. Additionally, a supportive work environment and personal ethical beliefs were found to significantly influence the likelihood of nurses advocating for patients and addressing unethical practices. These findings emphasize the importance of both individual and organizational factors in fostering moral courage. This review identifies age, gender, professional experience, ethical training, and workplace support as significant predictors of moral courage in ICU nurses. These findings highlight the critical role of individual characteristics and organizational support in promoting ethical behavior and moral courage in critical care settings.

Moral Sensitivity Among Pre-Hospital Emergency Personnel: A Cross-Sectional Multicenter Study
Mostafa Ghasempour, Abbas Dadashzadeh, Majid Purabdollah, Fezeh Hoseini Lilab,
Volume 17, Issue 0 (12-2024)
Abstract
Moral sensitivity is a crucial attribute for pre-hospital emergency personnel, significantly impacting their ethical decision-making and patient care in urgent and often complex situations. Defined as the capacity to recognize ethical dilemmas and comprehend their implications, moral sensitivity empowers personnel to navigate challenges such as resource limitations, critical patient conditions, and the imperative for rapid, independent decision-making. This study aimed to evaluate the level of moral sensitivity among Emergency Medical Technicians (EMTs) and identify key influencing factors. A cross-sectional study was conducted in 2023, encompassing 245 EMTs selected through cluster random sampling. Data were collected using the Moral Sensitivity Questionnaire (MSQ) and analyzed employing correlation tests and regression analysis. The findings revealed a mean moral sensitivity score of (39.45 ± 7.13) among participants, indicating a moderate-to-high level of ethical awareness. A significant correlation was observed between moral sensitivity and specific demographic and professional characteristics. Notably, work experience emerged as a key determinant (P < 0.001). Regression analysis further emphasized work experience (β = 0.08, P < 0.001) as a strong predictor, demonstrating that increased exposure to clinical and ethical challenges over time enhances moral sensitivity. Enhancing ethical sensitivity among pre-hospital emergency personnel is paramount to improving their ability to identify and address complex ethical challenges and deliver high-quality patient care. Given the unique demands of emergency situations, including time constraints, resource limitations, and the need for immediate action, it is crucial to equip personnel with the tools necessary to recognize and navigate ethical dilemmas. Implementing comprehensive training programs that emphasize ethical awareness and reasoning can empower EMTs to make more informed and empathetic decisions. Furthermore, cultivating a supportive organizational culture that prioritizes ethical performance and provides ongoing training can further enhance their confidence and competence in managing ethically sensitive situations.

Examination of Nursing Students' Moral Sensitivity and Its Relationship with Demographic Characteristics
Maryam Sina, Zahra Keshtkaran, Zinat Mohebbi, Naeimehossadat Asmarian,
Volume 17, Issue 0 (12-2024)
Abstract
Nurses, as the largest healthcare provider group, play a crucial role in patient care and treatment teams. To provide professional and appropriate care, nursing students must possess both clinical and moral competencies. Moral sensitivity, defined as the ability to recognize and understand moral situations, is paramount. It fosters trust and responsiveness to individual patient needs while equipping nurses to navigate ethical challenges within clinical settings. This study aimed to assess the moral sensitivity of nursing students and investigate its relationship with demographic characteristics. This descriptive-cross-sectional study involved 112 third- and fourth-year nursing students. Data were collected using demographic questionnaires and Lutzen's moral sensitivity scale. Data analysis was performed using SPSS version 23, employing descriptive and analytical statistical tests. The highest mean score for moral sensitivity was observed in the area of "honesty in decision-making" (14.71 ± 6.25), while the lowest mean was found in the area of "professional knowledge" (3.70 ± 2.12). The overall mean score for moral sensitivity was 15.87 ± 8.54, indicating a moderate level. Analysis of the relationship between demographic variables, including age, GPA, gender, marital status, living situation, current semester, family financial status, and parental education, revealed a significant positive correlation between moral sensitivity and family economic status only in the area of "experience with moral issues" (P=0.046). The findings of this study underscore the critical need for the development and implementation of structured programs designed to enhance the moral sensitivity of nursing students. Furthermore, this study highlights the importance of considering influential social factors, such as economic conditions, in fostering moral experiences and strengthening ethical sensitivity.

Elucidating the Lived Experiences of Operating Room Nurses Regarding Moral Intelligence: A Hermeneutic Phenomenological Study
Masoomeh Salehi, Behzad Imani, Shirdel Zandi,
Volume 17, Issue 0 (12-2024)
Abstract
The diversity of work environments, regulations, and prevailing atmospheres uniquely influence individuals' moral intelligence. Given the significant role of operating room nurses in patient care and the importance of moral intelligence in enhancing the quality of these services, this study aimed to elucidate the experiences of operating room nurses regarding moral intelligence at Hamadan University of Medical Sciences. A hermeneutic phenomenological study was conducted in hospitals affiliated with Hamadan University of Medical Sciences, Iran, from May to October 2023. Twelve operating room nurses were purposefully selected. Data was collected through in-depth semi-structured interviews and analyzed using van Manen's method. The study's rigor was ensured through four criteria: credibility, dependability, confirmability, and transferability. Three main themes related to moral intelligence were identified by examining the experiences of operating room nurses. These themes include: moral sensitivity (inner guidance, recognizing the rightness or wrongness of actions, having a work ethic), the ability to make sound decisions (ability to make sound judgments, moral courage), and ethical behavior towards patient interests (providing ethical care, preserving patient dignity, ability to work as a team). Operating room nurses with high moral intelligence are sensitive to the rightness or wrongness of actions, guided by inner ideals and professional commitment to doing what is right. They make sound judgments when faced with challenges and defend them courageously, making sound decisions. By providing ethical care, working as a team, and protecting human dignity, they demonstrate ethical behavior towards patient interests.

Investigating the Factors Influencing Moral Courage in Nurses: A Systematic Review
Morteza Javanmardi , Seyede Elahe Karimipour , Zahra Bakhshizadeh , Mohammad Hossein Taklif, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
Moral courage, encompassing the ability to act ethically in the face of adversity and uphold ethical principles, is crucial for nurses. This systematic review aimed to investigate the factors influencing moral courage among nurses. A comprehensive literature search was conducted using keywords such as "moral courage," "ethics," "nurses," and "courage" in major databases, including PubMed/Medline, Web of Science Core Collection, Scopus, Google Scholar, Irandoc, SID, and Magiran. The search included publications in both English and Persian with no time limitations. After excluding duplicates and screening the initial 2577 studies, 21 studies met the inclusion criteria. The review adhered to the PRISMA guidelines for reporting systematic reviews, ensuring ethical considerations were maintained throughout the selection, extraction, and analysis processes. The review revealed that moral courage in nurses is influenced by a multifaceted array of factors. Individual factors such as age, gender, work experience, and type of employment (e.g., permanent vs. temporary) were found to influence moral courage. Higher education, particularly possessing a master's degree or higher, and participation in medical ethics training were significantly associated with increased moral courage. Ethical sensitivity, defined as the ability to recognize and appreciate ethical dilemmas, was a significant facilitator of moral courage. A supportive work environment, characterized by factors such as strong ethical leadership, open communication, and adequate resources, was found to positively influence moral courage. Conversely, ethical distress experienced in challenging clinical situations can negatively impact moral courage. This review demonstrates that moral courage among nurses is influenced by a complex interplay of individual, professional, and environmental factors. Enhancing moral courage requires a multi-pronged approach, including strengthening nursing education with a robust emphasis on ethics training, fostering a supportive and ethically sound work environment, and implementing strategies to mitigate ethical distress. These interventions can significantly contribute to improved clinical practice and enhanced patient care.

Investigating the Relationship Between Moral Intelligence and Clinical Competence of Nurses and Nursing Students: A Systematic Review
Zahra Abdollahi, Marzieh Barahooei Noori, Mohammad Hossein Khani, Mohammad Hossein Taklif, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
Moral intelligence encompasses an individual's ability to discern right from wrong, possess ethical values, and demonstrate ethical behavior in practice. Clinical competence, a crucial aspect of nursing practice, encompasses a combination of knowledge, skills, and attitudes, including adherence to ethical principles. This systematic review aimed to investigate the relationship between moral intelligence and clinical competence among nurses and nursing students. A comprehensive literature search was conducted using keywords related to "moral intelligence," "clinical competence," "nurses," and "nursing students" in major international databases, including Web of Science Core Collection, PubMed/Medline, Scopus, and Google Scholar, as well as national databases such as Irandoc, SID, and Magiran. The search included publications in Persian and English with no time limitations. After removing duplicates and screening the initial 150 identified studies, five studies met the inclusion criteria. Ethical considerations, including minimizing bias in the selection, extraction, and analysis of evidence, were adhered to throughout the review process. The abstract adheres to PRISMA guidelines for reporting systematic reviews. The review revealed a significant positive correlation between moral intelligence and clinical competence across various dimensions. Studies demonstrated that higher levels of moral intelligence were associated with improved clinical competence, including ethical reasoning and clinical self-efficacy. Factors such as age, work experience, educational status, and individual rank were found to influence this relationship. Additionally, some studies indicated that moral intelligence could predict clinical competence scores, while others demonstrated that it could be a significant predictor of clinical competence alongside other factors such as Grade Point Average (GPA). This systematic review provides evidence for a significant positive relationship between moral intelligence and clinical competence among nurses and nursing students. Enhancing moral intelligence through targeted educational interventions can contribute to improved clinical competence and ultimately enhance the quality of patient care. Future research should focus on developing and evaluating educational programs designed to enhance moral intelligence in nursing education and practice.

Moral Sensitivity in Psychiatric Nurses: A Qualitative Content Analysis
Fariba Borhani, Mariye Jenabi Ghods, Ladan Fattah Moghadam, Tahereh Gilvari, Amirreza Rafiei Javazm, Mahshad Naserpour, Mohammad Javad Hosseinabadi ‑farahani,
Volume 17, Issue 0 (12-2024)
Abstract
Moral sensitivity is a fundamental characteristic of professional ethics in nursing, significantly influencing patient care. This qualitative study aimed to explore the concept of moral sensitivity among psychiatric nurses. The study employed a qualitative approach using content analysis. Participants included 15 psychiatric nurses working at Razi Psychiatric Hospital in Iran, selected through purposive sampling based on defined inclusion and exclusion criteria. After obtaining ethical approval, data were collected through semi-structured, in-depth interviews. The interviews were audio-recorded, transcribed, and managed using MAXQDA software. Data analysis was conducted following Granheim and Lundman’s five-step method (2004), and the trustworthiness of the findings was ensured using Guba and Lincoln’s criteria. The findings revealed three main categories and six subcategories:
  1. Ethical Knowledge (comprising clinical experience and education, and professional development).
  2. Ethical and Legal Conflicts (including discrepancies between ethical principles and legal frameworks, and challenges in ethical decision-making within complex legal situations).
  3. Ethical Atmosphere (encompassing individual ethics and organizational ethics).
Based on these findings, it is recommended that these insights be integrated into nursing education, research, and management to enhance care for patients with psychiatric disorders.

The Relationship Between Moral Foundations and Organizational Culture Among Nurses at Vali-e Asr Hospital in Borujen in 2023
Fatemeh Badr, Mostafah Roshanzadeh, Somayeh Mohammadi, Mina Shirvani, Samaneh Dehghan Abnavi,
Volume 17, Issue 1 (3-2024)
Abstract
Considering the important role of health organizations and the behavior and performance of nurses in achieving organizational goals, the moral foundations of nurses can significantly influence their behaviors and decisions and shape the organizational culture and atmosphere. Therefore, the present descriptive-analytical study aimed to investigate the relationship between moral foundations and organizational culture among 200 nurses selected using the census method at Shahrekord University of Medical Sciences in 2023. Data were collected through a demographic information form along with questionnaires to measure moral foundations and organizational culture. Data were analyzed using SPSS software version 16 via descriptive statistics (percentage, mean, and standard deviation) and analytical tests (t-test, analysis of variance (ANOVA), correlation coefficient, and linear regression). Pearson’s correlation coefficient revealed a significant relationship between the mean scores of moral foundations and organizational culture among nurses (r=0.61, P<0.001). The coefficient of determination (R2=0.372) showed approximately 37% of the variance in organizational culture can be predicted by moral foundations. Among the dimensions of moral foundations, loyalty to the group, respect for authority, and purity significantly predicted organizational culture (P<0.001). The mean score of moral foundations among nurses was acceptable at 98.55±15.8, while the mean score of organizational culture was favorable at 105.74±25.7. Based on the findings from the present study it can be concluded that by creating a moral atmosphere and promoting moral values such as loyalty to the group, respect for authority, and purity in nurses, the organizational culture can be enhanced

Association of Moral Reasoning with Clinical Belongingness and Their Influential Factors among ICU Nurses
Simin Kokabi Asl, Sareh Zekavat, Somayeh Rostamkhan, Abolfazl Dehbanizadeh, Mahsa Ghaemizadeh, Milad Amiri,
Volume 17, Issue 1 (3-2024)
Abstract
The intensive care unit (ICU) is a challenging and stressful environment where nurses encounter difficult ethical decisions daily. Therefore, this study aimed to determine the correlation between moral reasoning and clinical belongingness among Iranian ICU nurses. This cross-sectional, descriptive-analytical study was conducted on 126 nurses working in the adult ICUs of hospitals in Yasuj, Iran in 2023 using census sampling. Questionnaires measuring clinical belongingness and moral reasoning were used to collect data. Data were analyzed using independent samples t-test, ANOVA, regression, and Pearson’s correlation coefficient via SPSS-26 software. The findings revealed that the mean scores for clinical belongingness and moral reasoning among the nurses were 109.68 ± 13.75 and 36.07± 5.50, respectively, indicating good clinical belongingness and moderate moral reasoning. Moreover, a statistically significant relationship was identified between the place of service and clinical belongingness (p = 0.02), while no significant relationship was found between clinical belongingness and moral reasoning (p>0.05). Although no significant relationship was established between clinical belongingness and moral reasoning, certain demographic characteristics showed a significant predictive relationship with nurses' clinical belongingness. Accordingly,  it is recommended that nursing officials and managers utilize these findings to improve moral reasoning and the sense of belonging to the clinical environment among nurses.

The Experience of Moral Distress from the Perspective of Emergency Medicine Physicians and Nurses in the Emergency Department: A Qualitative Study
Leila Masoudiyekta, Ehsan Hassanpour Pazevar , Alireza Parsapour, Ehsan Shamsi Gooshki, Mohammd Jalili, Amirahmad Shojaei,
Volume 18, Issue 1 (3-2025)
Abstract
Moral distress constitutes a significant challenge for healthcare professionals, arising when individuals find themselves unable to act in accordance with their personal and professional values due to both internal and external pressures. Healthcare professionals may face scenarios that prompt them to question the ethical acceptability of their decisions and treatment practices, often feeling powerless in the face of perceived unethical changes. This study sought to explore the experiences of moral distress encountered by emergency medicine physicians and nurses in the emergency department. This study was conducted using qualitative content analysis. Data were collected through semi-structured interviews with 25 healthcare providers selected via purposive sampling. Data analysis was conducted using MAXQDA 2018 software. The results indicated that the experiences of moral distress among emergency medicine physicians and nurses in the emergency department can be classified into four primary categories including those related to: 1. patient rights, 2. medical staff and colleagues, 3. management, and 4. professionals. Notably, factors such as overcrowding, inadequate staffing, discrepancies between salaries and workloads, and poor management of human and physical resources emerge as significant contributors to moral distress in the emergency department of Imam Khomeini Hospital. To improve patient care quality, it is essential to implement strategies that enhance triage processes, prioritize human resources, align resources with patient needs, monitor patient attendance, and develop a comprehensive protocol for staff.

The Relationship Between Moral Courage and Occupational Stress in Nurses: A Cross-Sectional Study in Urmia, Iran
Reza Abdollahi, Haleh Ghavami,
Volume 18, Issue 1 (3-2025)
Abstract
Due to the inherently demanding nature of their profession, nurses face significant job-related stress that can adversely affect their lives and the quality of nursing care. Moral courage may serve as a key factor influencing occupational stress among nurses. Accordingly, this study aimed to examine the relationship between moral courage and occupational stress among nurses. This descriptive-analytical cross-sectional study was conducted in 2024 with 120 nurses from emergency departments of educational and therapeutic hospitals in Urmia, Iran, who were selected via two-stage sampling. Data were collected through a demographic information form, Sekerka’s Moral Courage Scale, and Gray-Toft and Anderson’s Nursing Stress Scale. Data were analyzed using Pearson correlation coefficient, multiple linear regression, independent t-test, and one-way ANOVA in SPSS software version 23. The results showed the mean scores for professional moral courage and occupational stress were 85.93 ± 15.68 and 10.77 ± 0.23, respectively. Moreover, there was a significant negative relationship between moral courage and occupational stress in nurses (r = -0.33 and P< 0.05).  Specific dimensions of moral courage, such as moral factor, threat tolerance, and moral purpose, had a significant negative effect on occupational stress (P< 0.05). These findings suggested that moral courage plays a significant role in mitigating occupational stress among nurses, which can influence their performance and, consequently, the quality of nursing care. Therefore, by fostering an environment that promotes moral courage, nursing managers can play a vital role in decreasing and mitigating the occupational stress experienced by nurses as well as enhancing the quality of care.

The Effect of An Intervention Based on the Knowledge-to-Action Model on Moral Distress in Critical Care Nurses
Mohammadmahdi Pazhavand, Maasoumeh Barkhordari-Sharifabad, Khadijeh Nasiriani,
Volume 18, Issue 1 (3-2025)
Abstract
Identifying an effective coping strategy for moral distress, as an important and common phenomenon among intensive care unit nurses, seems essential. The knowledge-to-action model aims to identify effective methods for implementing evidence into clinical practice. The present study sought to determine the effect of an intervention based on the knowledge-to-action model on moral distress among nurses working in intensive care units. This was an experimental study, and the statistical population included nurses working in the intensive care units of Namazi Hospital in Shiraz, Iran. A total of 100 eligible nurses were selected through convenience sampling and then randomly assigned to intervention and control groups. For the intervention group, the knowledge-to-action model was implemented. Data were collected using the Hamric Moral Distress Scale before and one month after the intervention. Both groups completed the questionnaire at these time points. Data were analyzed using descriptive and inferential statistics with SPSS version 19. The findings showed that the two groups were similar in terms of demographic characteristics and mean moral distress scores before the intervention. After the intervention, the mean scores of moral distress in the intervention group were significantly reduced in the frequency dimension (2.12±0.34) and severity dimension (2.32±0.46) compared to the control group (frequency: 2.51±0.43; severity: 2.57±0.55) (p<0.001). The results indicated that implementing the knowledge-to-action model reduces moral distress in intensive care unit nurses. Therefore, it is recommended that nursing managers adopt this model to improve the quality of care.

The Relationship Between Moral Injury and Moral Courage in Nurses Working in Intensive Care Units
Samaneh Fallah-Karimi, Zahra Khalilzadeh-Farsangi, Azizollah Arbabisarjou, Fatemeh Etemadinia,
Volume 18, Issue 1 (3-2025)
Abstract
Nurses working in intensive care units are frequently exposed to complex ethical issues and difficult decision-making, placing them at high risk for moral injury. Such injury can negatively affect their professional performance and mental health. Accordingly, this study aimed to explore the relationship between moral injury and moral courage among nurses working in intensive care units. This descriptive cross-sectional study was conducted in 2024. The study population consisted of 150 nurses working in intensive care units. Data were collected through Sekerka’s Moral Courage Questionnaire and the Moral Injury Symptom Scale for Health Professionals. Data were analyzed using descriptive statistics, Pearson’s correlation coefficient, and the independent samples t-test via SPSS software version 22. The findings revealed a significant inverse relationship between moral injury and moral courage (r = -0.64, p < 0.001). Moreover, moral courage levels were higher among registered nurses compared to nurses in the compulsory service program. Besides, a direct relationship was observed between age and moral courage, suggesting that moral courage increases with age. The results of this study highlight the importance of designing and implementing effective educational programs to reduce moral injury and promote moral courage among this group of nurses.

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