Relationship between Moral Distress and Moral Courage in Nurses Working in Selected Hospitals of Hamadan University of Medical Sciences during the Covid-19 Pandemic

Moral distress is a harmful factor in nursing and nursing care. Ethical courage helps nurses to perform nursing care. The present study aimed to determine the relationship between moral distress and moral courage of nurses working in selected hospitals of Hamadan University of Medical Sciences during the Covid-19 pandemic.

This cross-sectional study was conducted with the participation of 204 nurses working in selected educational hospitals by random sampling method. Data were collected by the self-report method using a demographic checklist, as well as Corelli Moral Distress and Sekerka Moral Courage questionnaires. The data were analyzed in SPSS software (version 21) using independent t-test, ANOVA, and regression analysis. A P≤0.050 was considered statistically significant.

The results demonstrated that the majority of nurses were male (55.40%) with a mean age of 41.96±9.53 years, working in the emergency department (43.20%), with 5-10 years of work experience (51.38%), and contract employment (57.45%). Moral distress was significantly correlated with gender, place of service, and work experience; moreover, moral courage and age were significantly associated (P≤0.050). Nevertheless, no significant relationship was detected between moral distress and the type of employment. Moral courage was not correlated with the type of employment, work experience, gender, and place of service (P≥0.050). There was a significant negative relationship between moral distress and moral courage (R=-0.863, P≤0.050). The results of the adjusted regression model illustrated that with each unit increase in the moral distress score, the moral courage score decreases by 0.33. This relationship was statistically significant (β=-.033, P<0.001). The mean scores of moral distress and moral courage were 57.61±3.32 and 36.92±2.46, respectively.

Since there is a significant negative relationship between moral distress and moral courage, it is recommended to hold moral motivation workshops to reduce moral distress and increase moral courage for nurses.