Comparison of moral courage of the nurses and nursing managers working in hospitals affiliated to Shahid Beheshti University of Medical Sciences

摘要

Background and Aim : Courage is one of the moral virtues and the source of many personal and social achievements that are essential for providing quality care. Moral courage is to take action act fearlessly and act on the basis of will; that is, the individual acts without regard to other factors, only on the basis of values and what is good to others. Nurses are the ethical focus of the professional career group and inspiration source for moral care and compassionate. Moral courage is a professional management competence and the most important elements among the four virtues necessary for management; including foresight, justice and moderation, as well as a factor stabilizing the action. By seeing managers as ethical and behavioral models, nurses learn the correct and expected performance, and the courage to respond correctly to one situation is strengthened in them. The purpose of this study was to compare the mean moral courage of nurses and nursing managers working in hospitals affiliated to Shahid Beheshti University of Medical Sciences. Materials and Methods : This descriptive cross-sectional study was conducted for 3 months starting from September to November 2015. A total of 70 nurses and 61 nurse managers were selected using convenient sampling method. Data collection was carried out using the Moral Courage Scale developed by Sekerka et al. in 2009. This scale consists of 15 questions categorized into five areas of moral agency, multiple values, endurance of threats, going beyond compliance, and moral goals. The response scale is 5-point Likert scale that is always arranged from Never (1) to Always (5). This scale was translated and back translated by Mohammadi et al. in Iran, and its validity was assessed through a survey of 10 experts in the field of medical ethics and content validity index (CVI) of 81% was obtained. Cronbach's alpha coefficient of 0.85 was obtained for the instrument reliability. To determine the reliability, the scale was completed by 20 nurses and nurse managers and the Cronbach's alpha of 0.86 was obtained. Data analysis was carried out by SPSS ver.22. Descriptive analysis of data was performed using central indices and comparison of mean moral courage in two groups using independent t-test. Pearson correlation coefficient was used to determine the relationship between age, work experience and moral courage. The response rate was 100% and 87% in the nurses and nursing managers groups, respectively. Ethical considerations: To carry out the research, the relevant permission was obtained from Ethics Committee of the Shahid Beheshti University of Medical Sciences. The informed consent was obtained from participants after explaining the research aims and its implementation procedure. Also, the researcher assured participants about the confidentiality of their information and documents and explained to them about the freedom to withdraw from the research at any stage without being suffered from any adverse consequences. Findings: A total of 40 (30.5%), 21 (16%), 38 (29%) and 32 (24.4% ) of cases of the 131 nurses and nursing managers participating in the study, were employed in internal medicine, surgical wards, ICU and emergency departments and the nursing office, respectively. Nursing managers included 31 (23.7%) head nurses, 27 (20.6%), educational and clinical supervisors, and 3 matrons (3.2%). The mean moral courage was 4.31 ± 0.40 and 4.33 ± 0.32 among nurses and nursing managers, respectively. The mean moral courage of the two groups was not significantly different (P= 0.06). There was a significant relationship between age, nursing management experience and moral agency (P= 0.04), as well as nurses' work experience, and then multiple values and going beyond compliance (P= 0.035). The mean moral courage was desirable among nurses and nursing managers. There was no significant difference between nurses and nursing managers in terms of mean of moral courage and its 5 items (moral agency, multiple values, endurance of threats, going beyond compliance, and moral goals). Conclusion: The desirability of the mean moral courage of nurses and nursing directors in this study is a clear and positive point for health service providers that can be used to promote professional performance. Regarding the fact that there was a significant relationship between increase in age and work experience and the dimensions of moral courage in both groups, and considering that moral behavior and courage may decrease over time due to the influence of anxiety, fear and its negative consequences; therefore, to increase the moral courage of members of the organization, appropriate planning for training staffs, holding workshops and discourse sessions and encouraging and protecting moral behaviors are recommended. Also, strengthening the moral capabilities of managers and nurses having a higher work experience can provide the appropriate models for promoting moral performance in the organization. Please