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.
