Analysis of the current status and influencing factors of moral courage among operating room nurses in Southwest China: a multi-center study

Abstract 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 cour...

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Main Authors: Xiao Hu, Yu Long, Chenfang Wang, Jianping Yi, Feng Peng, Yidi Chen
Format: Article
Language:English
Published: BMC 2025-03-01
Series:BMC Nursing
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Online Access:https://doi.org/10.1186/s12912-025-02991-4
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author Xiao Hu
Yu Long
Chenfang Wang
Jianping Yi
Feng Peng
Yidi Chen
author_facet Xiao Hu
Yu Long
Chenfang Wang
Jianping Yi
Feng Peng
Yidi Chen
author_sort Xiao Hu
collection DOAJ
description Abstract 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.
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spelling doaj-art-24a49e2c21b34d5e8f07996bedd918522025-08-20T03:04:49ZengBMCBMC Nursing1472-69552025-03-0124111010.1186/s12912-025-02991-4Analysis of the current status and influencing factors of moral courage among operating room nurses in Southwest China: a multi-center studyXiao Hu0Yu Long1Chenfang Wang2Jianping Yi3Feng Peng4Yidi Chen5Medical Simulator Center, The First Affiliated Hospital of Guangxi Medical UniversityMedical Simulator Center, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Anesthesiology, The First Affiliated Hospital of Chengdu Medical CollegeSterilization and Supply Center, The First Affiliated Hospital of Chengdu Medical CollegeDepartment of Anesthesiology, The First Affiliated Hospital of Chengdu Medical CollegeDepartment of Radiology, The First Affiliated Hospital of Guangxi Medical UniversityAbstract 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.https://doi.org/10.1186/s12912-025-02991-4Moral courageOperating room nursesMoral courage scalePsychological empowermentEthical climate
spellingShingle Xiao Hu
Yu Long
Chenfang Wang
Jianping Yi
Feng Peng
Yidi Chen
Analysis of the current status and influencing factors of moral courage among operating room nurses in Southwest China: a multi-center study
BMC Nursing
Moral courage
Operating room nurses
Moral courage scale
Psychological empowerment
Ethical climate
title Analysis of the current status and influencing factors of moral courage among operating room nurses in Southwest China: a multi-center study
title_full Analysis of the current status and influencing factors of moral courage among operating room nurses in Southwest China: a multi-center study
title_fullStr Analysis of the current status and influencing factors of moral courage among operating room nurses in Southwest China: a multi-center study
title_full_unstemmed Analysis of the current status and influencing factors of moral courage among operating room nurses in Southwest China: a multi-center study
title_short Analysis of the current status and influencing factors of moral courage among operating room nurses in Southwest China: a multi-center study
title_sort analysis of the current status and influencing factors of moral courage among operating room nurses in southwest china a multi center study
topic Moral courage
Operating room nurses
Moral courage scale
Psychological empowerment
Ethical climate
url https://doi.org/10.1186/s12912-025-02991-4
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