The Relationship Between Moral Injury and  Moral Courage in Nurses Working in Intensive Care Units

Samaneh Fallah-Karimi; Zahra  Khalilzadeh-Farsangi; Azizollah Arbabisarjou; Fatemehx Etemadinia

doi:10.18502/ijme.v18i9.19331

Samaneh Fallah-Karimi MSc in Pediatric Nursing, Zahedan University of Medical Sciences, Zahedan, Iran. Instructor, Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
Zahra Khalilzadeh-Farsangi MSc in Community Health Nursing, Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
Azizollah Arbabisarjou Associate Professor of Educational Management, Department of Nursing Management and Techniques, School of Nursing and Midwifery, Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
Fatemehx Etemadinia MSc in Pediatric Nursing, Zahedan University of Medical Sciences, Zahedan, Iran

DOI: https://doi.org/10.18502/ijme.v18i9.19331

Keywords: Nurses, Moral courage, Nursing ethics, Moral injury, Intensive care.

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.