AbstractOrganizations receive multiple benefits when their members act ethically. Of interest in this study is if the actors receive benefits as well, especially as individuals look to work to fulfill psychological and social needs in addition to economic ones. Specifically, we highlight a series of ongoing ethical practices embodied in professional moral courage and their relationship to actor’s work meaningfulness and life well-being. Drawing on self-determination theory and affective events theory, we explore how exercising professional (...) class='Hi'>moral courage in one’s work leads to positive work and life outcomes. Data from 106 administrative staff of non-profit organizations demonstrates the positive benefits of adopting ethical practices at work. Specifically, professional moral courage is found to be significantly related to both work meaningfulness and individual eudaimonic life well-being. Our findings note positive benefits for individuals who incorporate professional moral courage into their daily lives and provide support for organizations seeking to encourage it from their employees; benefits for organizations and employees go beyond just the gains from ethical behavior into other positive psychological processes. Implications for future work that considers both the psychological and normative approaches to meaningful work are discussed. (shrink)

Scholars have shown renewed interest in the construct of courage. Recent studies have explored its theoretical underpinnings and measurement. Yet courage is generally discussed in its broad form to include physical, psychological, and moral features. To understand a more practical form of moral courage, research is needed to uncover how ethical challenges are effectively managed in organizational settings. We argue that professional moral courage (PMC) is a managerial competency. To describe it and (...) derive items for scale development, we studied managers in the U.S. military and examined prior work on moral courage. Two methods were used to measure PMC producing a five dimensional scale that organized under a single second-order factor, which we termed overall PMC. The five dimensions are moral agency, multiple values, endurance of threats, going beyond compliance, and moral goals. Convergent and discriminant validity are analyzed by use of confirmatory factor analysis procedures. We conclude by presenting a framework for proactive organizational ethics, which reflects how to support PMC as a management practice. (shrink)

BackgroundMoral courage is the ability to defend and practice ethical and moral action when faced with a challenge, even if it means rejecting pressure to act otherwise. However, moral courage rema...

Once anesthetized, patients are inherently “compliant” with surgical interventions because they can no longer intervene on their own behalf. In their target article, Minkoff et al. (2024) reasonabl...

BackgroundHaving moral courage is a crucial characteristic for nurses to handle ethical quandaries, stay true to their professional obligations towards patients, and uphold ethical principles. This concept can be influenced by various factors including personal, professional, organizational, and leadership considerations. The purpose of this study was to explore the predictors of moral courage among nurses working in hospitals.MethodsIn 2018, an observational cross-sectional study was carried out on 267 nurses employed in six hospitals located in (...) the northern region of Iran. The participants were selected through a simple random sampling technique. To collect data, a demographic information form was used along with two questionnaires. The first questionnaire was a standard survey on moral courage, while the second questionnaire was designed to assess the ethical climate. Linear regression was used to assess the predictors of moral courage.ResultsNurses had an average moral courage score of 87.07 ± 15.52 and an average moral climate score of 96.12 ± 17.17. The study showed that 16% of the variation in moral courage scores among nurses was explained by ethical climate and monthly overtime hours.ConclusionThis study underscores the significance of establishing an ethical work environment and minimizing overtime hours in order to enhance moral courage among nurses. These findings carry weight for both nursing practice and organizational policies focused on fostering ethical conduct within healthcare settings. (shrink)

Background:Nursing as an ethical practice requires courage to be moral, taking tough stands for what is right, and living by one’s moral values. Nurses need moral courage in all areas and at all levels of nursing. Along with new interest in virtue ethics in healthcare, interest in moral courage as a virtue and a valued element of human morality has increased. Nevertheless, what the concept of moral courage means in nursing contexts (...) remains ambiguous.Objective:This article is an analysis of the concept of moral courage in nursing.Design:Rodgers’ evolutionary method of concept analysis provided the framework to conduct the analysis.Data sources:The literature search was carried out in September 2015 in six databases: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and The Philosopher’s Index. The following key words were used: “moral” OR “ethical” AND “courage” OR “strength” AND “nurs*” with no time limit. After applying inclusion and exclusion criteria, 31 studies were included in the final analysis.Ethical considerations:This study was conducted according to good scientific guidelines.Results:Seven core attributes of moral courage were identified: true presence, moral integrity, responsibility, honesty, advocacy, commitment and perseverance, and personal risk. Antecedents were ethical sensitivity, conscience, and experience. Consequences included personal and professional development and empowerment.Discussion and conclusion:This preliminary clarification warrants further exploring through theoretical and philosophical literature, expert opinions, and empirical research to gain validity and reliability for its application in nursing practice. (shrink)

Background: Empathy and moral courage are important virtues in nursing and nursing ethics. Hence, it is of great importance that nursing students and nurses develop their ability to empathize and their willingness to demonstrate moral courage. Research aim: The aim of this article is to explore third-year undergraduate nursing students’ perceptions and experiences in developing empathy and moral courage. Research design: This study employed a longitudinal qualitative design based on individual interviews. Participants and research (...) context: Seven undergraduate nursing students were interviewed during or immediately following their final clinical placement. Ethical considerations: The Norwegian Social Science Data Services (NSD) approved the study. Participants were informed that their participation was voluntary and were assured confidentiality. They were informed that they could withdraw from the study at any time, without providing reasons. Findings: Affective empathy seemed to be strong among third-year undergraduate nursing students. However, they tried to handle the situations in a ‘professional’ way, and to balance their emotions. At the same time, they expressed how difficult it can be to show moral courage when confronted with poor patient care. In addition, they spoke about a lack of role models during clinical practice and supervision. Conclusions: Undergraduate nursing students are in a vulnerable position throughout their journey to become professional and to develop empathy and moral courage. The professional socialisation and forming of professional empathy and moral courage among nursing students, may be seen as a complex interaction of formal and hidden curriculum, where role models play an important role. We argue that the main theme ‘Vulnerable students – a journey towards professional empathy and moral courage’ may cover the longitudinal project as a whole. This vulnerability is something both teachers and supervisors should be aware of when following up with students in their clinical placements. (shrink)

Background Moral courage means courage to act according to individual’s own ethical values and principles despite the risk of negative consequences for them. Research about the moral courage of whistle-blowers in health care is scarce, although whistleblowing involves a significant risk for the whistle-blower. Objective To analyse the moral courage of potential whistle-blowers and its association with their background variables in health care. Research design Was a descriptive-correlational study using a questionnaire, containing Nurses (...) Moral Courage Scale©, a video vignette of the wrongdoing situation with an open question about the vignette, and several background variables. Data were analysed statistically and inductive content analysis was used for the narratives. Participants and research context Nurses as healthcare professionals (including registered nurses, public health nurses, midwives, and nurse paramedics) were recruited from the membership register of the Nurses’ Association via email in 2019. A total of 454 nurses responded. The research context was simulated using a vignette. Ethical considerations Good scientific inquiry guidelines were followed. Permission to use the Nurses’ Moral Courage Scale© was obtained from the copyright holder. The ethical approval and permission to conduct the study were obtained from the participating university and the Nurses’ Association. Findings The mean value of potential whistle-blowers’ moral courage on a Visual Analogue Scale (0–10) was 8.55 and the mean score was 4.34 on a 5-point Likert scale. Potential whistle-blowers’ moral courage was associated with their socio-demographics, education, work, personality and social responsibility related background variables. Discussion and conclusion In health care, potential whistle-blowers seem to be quite morally courageous actors. The results offer opportunities for developing interventions, practices and education to support and encourage healthcare professionals in their whistleblowing. Research is needed for developing a theoretical construction to eventually increase whistleblowing and decrease and prevent wrongdoing. (shrink)

Background: Nurses encounter complex ethical dilemmas in everyday nursing care. It is important for nurses to have moral courage to act in these situations which threaten patients’ safety or their good care. However, there is lack of research of moral courage. Purpose: This study describes nurses’ experiences of care situations demanding moral courage and their actions in these situations. Method: A qualitative descriptive research design was applied. The data were collected with an open-ended question (...) in the questionnaire used in validation of the Nurses’ Moral Courage Scale. The sample consisted of 286 nurses from four different clinical fields in a major university hospital in Finland, providing a total of 611 answers. Data were analyzed using inductive content analysis. Ethical considerations: The study followed the commonly recognized principles of good scientific practice. The use of data was authorized by the developer of the instrument, the data collector, and the participating hospital. Ethical approval was obtained from the university ethics committee. Findings: Nurses acted morally courageously in most situations but sometimes they failed to do so. Although situations demanding moral courage varied, they could be categorized into seven main domains relating to colleagues, physicians, patients, relatives, nurses themselves, managers, and organizations. Nurses acted in the situations in different ways. The main acts in solving the situations were verbal communication or immediate action, such as interrupting of action. Conclusion: Care situations demanding moral courage focus on good and safe patient care and the patient’s good is at the center of attention. The situations are mostly related to the activities of other healthcare professionals. Findings may be applied in developing ethical nursing care through basic and continuing nursing education. Research is needed on the moral courage of physicians and managers, as well as on patients’ and their relatives’ experiences of care situations demanding moral courage. (shrink)

Background:Moral courage is defined as courage to act according to one’s own ethical values and principles even at the risk of negative consequences for the individual. In a complex nursing practice, ethical considerations are integral. Moral courage is needed throughout nurses’ career.Aim:To analyse graduating nursing students’ moral courage and the factors associated with it in six European countries.Research design:A cross-sectional design, using a structured questionnaire, as part of a larger international ProCompNurse study. In (...) the questionnaire, moral courage was assessed with a single question (visual analogue scale 0–100), the questionnaire also covered several background variables.Participants and research context:The sample comprised graduating nursing students (n = 1796) from all participating countries. To get a comprehensive view about graduating nursing students’ moral courage, the views of nurse managers (n = 538) and patients (n = 1327) from the same units in which the graduating nursing students practised were also explored, with parallel questionnaires.Ethical considerations:Ethical approvals and research permissions were obtained according to national standards in every country and all participants gave their informed consent.Results:The mean of graduating nursing students’ self-assessed moral courage was 77.8 (standard deviation 17.0; on a 0–100 scale), with statistically significant differences between countries. Higher moral courage was associated with many factors, especially the level of professional competence. The managers assessed the graduating nursing students’ moral courage lower (66.5; standard deviation 18.4) and the patients slightly higher (80.6; standard deviation 19.4) than the graduating nursing students themselves.Discussion and conclusions:In all countries, the graduating nursing students’ moral courage was assessed as rather high, with differences between countries and populations. These differences and associations between moral courage and ethics education require further research. (shrink)

Background: The 21-item Nurses’ Moral Courage Scale was developed and validated in 2018 in Finland with the purpose of measuring moral courage among nurses. Objectives: The objective of this study was to make a Dutch translation of the Nurses’ Moral Courage Scale to describe the level of nurses’ self-assessed moral courage and associated socio-demographic factors in Flanders, Belgium. Research design: A forward–backward translation method was applied to translate the English Nurses’ Moral (...) Courage Scale to Dutch, and a pilot study was conducted to improve readability and understandability. A non-experimental, descriptive cross-sectional exploratory design was used to conduct a survey. Descriptive analysis was used. Participants: The data were collected from a convenience sample of 559 nurses from two hospitals in Flanders. Ethical considerations: Ethical approval was obtained from the university ethics committee, permission to conduct the study was obtained from the participating hospitals. Participants received a guide letter and gave their informed consent. Findings: The readability and understandability of the Dutch Nurses’ Moral Courage Scale were positively evaluated, and the scale revealed a good level of internal consistency for the total scale and all subscales. Nurses’ mean score of the 21-item Nurses’ Moral Courage Scale was 3.77. The total Nurses’ Moral Courage Scale score was associated with age, experience, professional function, level of education and personal interest. Discussion and Conclusion: The Nurses’ Moral Courage Scale was successfully translated to Dutch. The Flemish nurses perceived themselves as morally courageous, especially when they were in a direct interpersonal relationship with their patients. Acting courageously in ethical dilemmas that involved other actors or organizations appeared to be more challenging. The results strongly suggest the important role of education and ethical leadership in developing and supporting this essential virtue in nursing practice. (shrink)

BackgroundThe concept of career identity is integral to nursing practices and forms the basis of the nursing professions. Positive career identity is essential for providing high-quality care, optimizing patient outcomes, and enhancing the retention of health professionals. Therefore, there is a need to explore potential influencing variables, thereby developing effective interventions to improve career identity.ObjectivesTo investigate the relationship between moral distress, moral courage, and career identity, and explore the mediating role of moral courage between (...) class='Hi'>moral distress and career identity among nurses.DesignA quantitative, cross-sectional study.MethodsA convenient sample of 800 nurses was recruited from two tertiary care hospitals between February and March 2022. Participants were assessed using the Moral Distress Scale-revised, Nurses’ Moral Courage Scale, and Nursing Career Identity Scale. This study was described in accordance with the STROBE statement.Ethical considerationResearch ethics approval was obtained from the researcher’s university and hospital where this study was conducted prior to data collection.FindingsMoral distress is negatively associated while moral courage is positively associated with career identity among nurses. Moral courage partially mediates the relationship between moral distress and career identity ( β = −0.230 to −0.163, p < 0.01).DiscussionThe findings reveal a relationship between moral distress, moral courage, and career identity among nurses.ConclusionBy paying attention to nurses’ moral distress and courage, healthcare providers can contribute to the development of effective interventions to improve career identity, and subsequently performance, among nurses. (shrink)

Organizations constitute morally-complex environments, requiring organization members to possess levels of moral courage sufficient to promote their ethical action, while refraining from unethical actions when faced with temptations or pressures. Using a sample drawn from a military context, we explored the antecedents and consequences of moral courage. Results from this four-month field study demonstrated that authentic leadership was positively related to followers’ displays of moral courage. Further, followers’ moral courage fully mediated the (...) effects of authentic leadership on followers’ ethical and pro-social behaviors. Theoretical and practical implications for further integrating the work on moral courage, authentic leadership and ethics are discussed. (shrink)

Background:Moral distress, moral sensitivity, and moral courage among healthcare professionals have been explored considerably in recent years. However, there is a paucity of studies exploring these topics among baccalaureate nursing students.Aim/objective:The purpose of this study was to explore the relationship between and among moral distress, moral sensitivity, and moral courage of undergraduate baccalaureate nursing students.Research design:The research employed a descriptive-correlational design to explore the relationships between and among moral distress, moral (...) sensitivity, and moral courage of undergraduate nursing students.Participants and research context:A total of 293 baccalaureate Filipino nursing students who have been exposed to various clinical areas participated in the study.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Results indicate that a majority of the nursing students in the clinical areas encounter morally distressing situations that compromise quality patient care. However, despite the fact that they want to do what is in the best interest of their patients, their perception of being the inexperienced among the healthcare team drives the majority of them to ignore morally distressing situations to avoid conflict and confrontation. Another interesting finding is that 79.20% of the respondents hardly consider quitting the nursing profession even if they frequently encounter morally distressing situations. Analysis also shows associations between moral distress intensity and frequency ( r = 0.13, p < 0.05) and moral distress intensity and moral sensitivity ( r = 0.25, p < 0.05). The dimensions of moral courage are also related to both moral distress and moral sensitivity.Conclusion:Results of the study imply that moral distress is a reality among all healthcare professionals including nursing students and requires more consideration by nurse educators. (shrink)

Ethics research literature often uses Rest’s Four Component Model of ethical behavior as a framework to teach business and accounting ethics. Moral motivation, including resolve to have moral courage, is the third component of the model and is the least-tested component in ethics research. Using a quasi-experimental design with pretest and posttest measurements, we compare the effectiveness of several methods (traditional, exhortation, reflection, moral exemplar) for developing resolve to have moral courage in 211 accounting (...) students during one semester. Results show that traditional, reflection, moral exemplar methods increased resolve to have moral courage, and that the reflection and moral exemplar methods were more effective than the other methods. (shrink)

Comer and Schwartz argue that the business ethics course should aim to cultivate moral courage within our students. Essential to their argument is the use of fictional exemplars of moral courage to motivate our students. I argue that the classroom, even when supplemented by good fiction, is not the right context by which to practice moral courage—the habituation of moral courage requires a context of risk. I suggest a virtue that can be (...) practiced in the classroom—intellectual courage. By aiming at this virtue, we will also get the virtue of moral courage. (shrink)

Ethics research literature often uses Rest’s Four Component Model of ethical behavior as a framework to teach business and accounting ethics. Moral motivation, including resolve to have moral courage, is the third component of the model and is the least-tested component in ethics research. Using a quasi-experimental design with pretest and posttest measurements, we compare the effectiveness of several methods (traditional, exhortation, reflection, moral exemplar) for developing resolve to have moral courage in 211 accounting (...) students during one semester. Results show that traditional, reflection, moral exemplar methods increased resolve to have moral courage, and that the reflection and moral exemplar methods were more effective than the other methods. (shrink)

The Board of Directors of Vermilion Iron Mining Company was faced with a difficult decision. Since the early 1900s Vermilion operated in the tiny town of Ely, Minnesota. In 1967 Vermilion abandoned its operations in Ely due to the increased cost to mine hematite (high grade iron ore) deep within the ore fields. Vermilion’s departure from Ely was economically devastating to the town. Recent research (2008) found that it was now possible to extract the remaining hematite in Ely’s ore fields (...) and the option to return to the mines of Ely was on the table with the Board of Directors of Vermilion. However, the hematite supply would only last for three to four years. Should Vermilion return to Ely to mine the remaining hematite for the sake of the shareholders or should they consider the potential impacts on the town and other stakeholders? (shrink)

There is a perpetrator historiography of the Holocaust and a Jewish historiography of the Holocaust. The former has received the lion’s share of attention in bioethics, particularly in the form of warnings about medicine’s potential for complicity in human atrocity. However, stories of Jewish physicians during the Holocaust are instructive for positive bioethics, one that moves beyond warnings about what not to do. In exercising both explicit and introspective forms of resistance, the heroic work of Jewish physicians in the ghettos (...) and concentration camps tells us a great deal about the virtues and values of medicine. In this article, we frame the stories of four of these Jewish physicians in ways that are instructive for contemporary medicine. By far, the most widely recognized and discussed figure is Viktor Frankl, whose work on hope and the meaning of suffering remains essential insofar as medicine inherently confronts disease and death. Less discussed in bioethics and medical humanities are the cases of Mark Dworzecki, Karel Fleischmann, and Gisella Perl. Dworzecki’s efforts to encourage others in the Vilna Ghetto to document their experiences illustrates the power of narrative for the human experience and the notion of ethics as narrative in the face of suffering. Fleischmann’s art underscores not only the importance of reflective practices for professionals as a form of simultaneous introspection and testimonial, but illuminates hope amid sheer hopelessness. This hope, which was comparatively implicit in much of Fleishmann’s art, is explicated as a method by Frankl, becoming a form of therapy for both physicians wrestling with their professional work, and patients wrestling with their illnesses and diseases. Finally, Perl’s resistance to Mengele’s orders highlights the importance of moral action, not just reflective reaction. The experiences of each of these figures, while certainly located in the unique horrors of Holocaust Germany, portends lessons for today’s physicians faced with moral distress and ethical dilemma in the face of suffering, interpersonal relationships, and socio-political conflicts that increasingly test the professed ideals of medicine. In this article we briefly tell the story of each of these physicians and connect the lessons therein to contemporary medical practice. (shrink)

This paper presents an experiential exercise introducing the concept of the personal ethical threshold (PET) to help explain why moral behavior does not always follow moral intention. An individual’s PET represents the individual’s vulnerability to situational factors, i.e., how little or much it takes for members of organizations to cross their proverbial line to act in a way they deem unethical. The PET reflects the interplay among the situation, the particular ethical issue, and the individual. Exploring the PET (...) can help account for why some people are sometimes able to withstand substantial organizational pressures to behave in congruence with their ethical intentions, whereas others crumble in the face of apparently minimal situational forces. We hope that students’ exposure to and subsequent reflection upon their PET, by means of the exercise we present, will foster the development of their moral courage. (shrink)

"[This book is] focused on the place of character and virtue in professional practice. Professional practices usually have codes of conduct designed to ensure good conduct; but while such codes may be necessary and useful, they appear far from sufficient, since many recent public scandals in professional life seem to have been attributable to failures of personal moral character. This book argues that there is a pressing need to devote more attention in professional education to (...) the cultivation or development of such moral qualities as integrity, courage, self-control, service and selflessness... [This] volume looks beyond traditional professions to explore the ethical dimensions of a broad range of important professional practices. Inspired by a successful international and interdisciplinary conference on the topic, the book examines various ways of promoting moral character and virtue in professional life from the general ethical perspective of contemporary neo-Aristotelian virtue theory."--. (shrink)

The picture of classical antiquity most of us learned in school is framed in certain ways -- glossing over misogyny while omitting the seeds of feminist resistance. Many of today's harmful practices, like school dress codes, exploitation of the environment, and rape culture, have their roots in the ancient world. But in Antigone Rising, classicist Helen Morales reminds us that the myths have subversive power because they are told -- and read -- in different ways. Through these stories, whether it's (...) Antigone's courageous stand against tyranny or the indestructible Caeneus, who inspires trans and gender queer people today, Morales uncovers hidden truths about solidarity, empowerment, and catharsis. Antigone Rising offers a fresh understanding of the stories we take for granted, showing how we can reclaim them to challenge the status quo, spark resistance, and rail against unjust regimes. (shrink)

I present here a case against the evidentialist approach that claims that in so far as our interests are epistemic what should guide our belief formation and revision is always a strict adherence to the available evidence. I go on to make the stronger claim that some beliefs based on admittedly “insufficient” evidence may exhibit epistemic virtue. I propose that we consider a form of courage to be an intellectual or epistemic virtue. It is through this notion of (...) class='Hi'>courage that we can see a weakness in the evidentialist position. Adopting a doxastically courageous approach allows us to acknowledge the role that evidence has in epistemic justification and its connection with promoting epistemic value, but it avoids the narrowness of an evidentialist position. The epistemically courageous agent is not one who disregards the evidence entirely, but she also realizes that taking risks will not necessarily keep her from her epistemic goals. Believing something in the face of insufficient evidence is not always an epistemic vice to be avoided, and the agent that recognizes this is better off for it. (shrink)

Cases of poor care have been documented across the world. Contrary to professional requirements, evidence indicates that these sometimes go unaddressed. For patients, the outcomes of this inaction are invariably negative. Previous work has either focused on why poor care occurs and what might be done to prevent it, or on the reasons why those who are witness to it find it difficult to raise their concerns. Here, we build on this work but specifically foreground the responsibilities of registrants (...) and students who witness poor care. Acknowledging the challenges associated with raising concerns, we make the case that failure to address poor care is a breach of moral expectation, professional requirement and, sometimes, legal frameworks. We argue that reporting will be more likely to take place if those who wish to enter the profession have a realistic view of the challenges they may encounter. When nurses are provided with robust and applied education on ethics, when “real‐world” cases and exemplars are used in practice and when steps are taken to develop and encourage individual moral courage, we may begin to see positive change. Ultimately however, significant change is only likely to take place where practice cultures invite and welcome feedback, promote critical reflection, and where strong, clear leadership support is shown by those in positions of influence across organisations. (shrink)

Positive Psychology has turned its attention to the study of emotions in a scientific and rigorous way. Particularly, to how emotions influence people’s health, performance, or their overall life satisfaction. Within this trend, Flow theory has established a theoretical framework that helps to promote the Flow experience. Flow state, or optimal experience, is a mental state of high concentration and enjoyment that, due to its characteristics, has been considered desirable for the development of the performing activity of performing musicians. Musicians (...) are a population prone to health problems, both psychological and physical, owing to different stressors of their training and professional activity. One of the most common problems is Musical Performance Anxiety. In this investigation, an electronic intervention program was carried out for the development of psychological self-regulation skills whose main objective was to trigger the Flow response in performing musicians and the coping mechanism for Musical Performance Anxiety. A quasi-experimental design was used with a control group in which pre- and post-measures of Flow State, Musical Performance Anxiety and, also, Social Skills were taken. Sixty-two performing musicians from different music colleges in Spain participated in the program. Results indicated that the intervention significantly improved Flow State, and Sense of Control, and decreased Music Performance Anxiety, and self-consciousness of the participants in the EG but not CG. The changes in the EG after the program showed the inverse relationship between Flow and Anxiety. Two important theoretical factors of both variables, such as worry and the feeling of lack of control, could be involved. The results are under discussion and future lines of research are proposed. (shrink)

The notion of virtue in general, and courage in particular, has had a hard time integrating itself into the everyday lexicon of bioethics. Following the lead of enlightenment moral philosophy, which concentrates on the theory of right action as opposed to the ancient Greeks' emphasis on the development of good character, bioethics, with some notable exceptions, has tended to relegate consideration of the virtues to the sidelines of moral argument. Recently, however, there have been calls for the (...) necessity of “moral courage” in the context of clinical ethics. As nurses, physicians, and other health care professionals confront a variety of moral contexts in which the virtue of courage is invoked to "do the right thing," stand up for patients' rights, and uphold the ethical standards of their professions, they are increasingly reminded of their moral duty to exhibit courage in the face of institutional obstacles to the proper care of their patients. For example, a nurse's hesitation to approach a physician to request increased sedation for an agitated patient out of fear of retaliation is represented in one article as a lack of courage.In this paper we offer a critical assessment of such invocations of courage. While we find courage to be an indispensable virtue in some challenging contexts, in other settings we find invocations of courage to be both an unfortunate endorsement of an oppressive status quo that can divert attention from the real problems and an undesirable and potentially destructive strategy within health care institutions whose goal is medically excellent and morally good clinical practice. As we shall argue, a call to virtuousness is not always virtuous. (shrink)

Background This study introduces an empirical approach for studying the role of prudence in physician treatment of end-of-life (EOL) decision making.Methods A mixed-methods analysis of transcripts from 88 simulated patient encounters in a multicenter study on EOL decision making. Physicians in internal medicine, emergency medicine, and critical care medicine were asked to evaluate a decompensating, end-stage cancer patient. Transcripts of the encounters were coded for actor, action, and content to capture the concept of Aristotelian prudence, and then quantitatively and qualitatively (...) analyzed to identify actions associated with preference-concordant treatment.Results Focusing on codes that describe characteristics of physician-patient interaction, the code for physicians restating patient preferences was associated with avoiding intubation. Multiple codes were associated with secondary measures of preference-concordant treatment.Conclusions Prudent actions can be identified empirically, and research focused on the virtue of prudence may provide a new avenue for assessment and training in EOL care. (shrink)

This article aims to deepen the understanding of courage through a theoretical analysis of classical philosophers’ work and a review of published and unpublished empirical research on courage in nursing. The authors sought answers to questions regarding how courage is understood from a philosophical viewpoint and how it is expressed in nursing actions. Four aspects were identified as relevant to a deeper understanding of courage in nursing practice: courage as an ontological concept, a moral (...) virtue, a property of an ethical act, and a creative capacity. The literature review shed light on the complexity of the concept of courage and revealed some lack of clarity in its use. Consequently, if courage is to be used consciously to influence nurses’ ethical actions it seems important to recognize its specific features. The results suggest it is imperative to foster courage among nurses and student nurses to prepare them for ethical, creative action and further the development of professional nursing practices. (shrink)

Se realizó una investigación en sistemas y servicios de salud de tipo descriptiva transversal, con el objetivo de elaborar un sistema de acciones de capacitación para el profesional de la enfermería comunitaria en la prevención del embarazo en la adolescencia. Se aplicaron métodos teóricos y empíricos propios de la investigación científica. El universo lo constituyeron 20 profesionales de enfermería que laboran en consultorios del Área Salud "Tula Aguilera". La muestra quedó conformada por los 12 profesionales que aceptaron participar en el (...) estudio. El criterio de exclusión fue la libre decisión de cada individuo para participar o retirarse de la investigación. Se aplicó una encuesta estandarizada, previo consentimiento informado, para determinar el nivel de conocimientos sobre salud reproductiva en la adolescencia. Los resultados constatados reflejaron que la mayoría de los encuestados tenían criterios estrechos, no fundamentados científicamente ni actualizados sobre el tema, por lo que se diseñó un sistema de acciones de capacitación basado en conocimientos científicos actualizados, pertinentes y contextualizados. Cada actividad se propuso demostrar la factibilidad e importancia de utilizar técnicas participativas y la fundamentación de las ventajas de su uso en diferentes actividades comunitarias, encaminadas a enfatizar en la organización, movilización, concientización y capacitación a los diferentes sujetos sociales involucrados en la prevención del embarazo en la adolescencia, para que estos se conviertan en transformadores de su propia realidad, en correspondencia con sus necesidades y demandas sociales. A descriptive transversal study was carried out on health systems and services aiming at designing a system of training actions for the community professional nurses in order to prevent pregnancy in adolescence. Theorical and empirical methods were applied. The universe was made up of twenty professionals who consented to participate in the study. The inclusion criterion was the free decision of each individual on either participating or not in the investigation. A standard survey was applied -with a previous informed consent , to determine the knowledge about reproductive health in adolescence. The results revealed that most of the surveyed people had narrow criteria with no updated scientific grounds on the issue, thus a system of training actions based on updated scientific pertinent contextualized information was designed Each activity aimed at demonstrating the feasibility study of using participative techniques as well as the reasons for the advantages of their use in a variety of community activities to emphasize the organization and understanding of the different social subjects involved in the prevention of pregnancy in adolescence. (shrink)

The paper examines the problematic understanding of “risk” in entrepreneurial literature that locates courage in either the loss orgain of having or in the difficulty and hardship of the doing. We argue in this paper that what is lost in this vernacular view of courage is a deeper notion of the subjective dimension of work and the social need of society. Grounded within the Catholic social and moral tradition, we find a richer notion of courage, which (...) in part corrects and rounds out the insufficient description of the vernacular understanding of courage in entrepreneurship. What we also find in this account of the virtues and subjective dimension of work is greater explanatory power of what happens to the entrepreneur in the work that he or she does. The end result of this analysis is a more spiritual, ethical and social understanding of entrepreneurship. (shrink)

Background:The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing needs, different stakeholders and patients’ rights. Evidence-based strategies and interventions for the development of procedures and practice have been used to improve care and services. However, it is not known whether and to what extent ethics can be developed using interventions.Objectives:To examine ethics interventions conducted on healthcare professionals and healthcare students to (...) achieve ethics-related outcomes.Research design:A systematic review.Methods:Five electronic databases were searched: CINAHL, the Cochrane Library, Philosopher’s Index, PubMed and PsycINFO. We searched for published articles written in English without a time limit using the keywords: ethic* OR moral* AND intervention OR program OR pre-post OR quasi-experimental OR rct OR experimental AND nurse OR nursing OR health care. In the four-phased retrieval process, 23 full texts out of 4675 citations were included in the review. Data were analysed using conventional content analysis.Ethical consideration:This systematic review was conducted following good scientific practice in every phase.Findings:It is possible to affect the ethics of healthcare practices through professionals and students. All the interventions were educational in type. Many of the interventions were related to the ethical or moral sensitivity of the professionals, such as moral courage and empowerment. A few of the interventions focused on identifying ethical problems or research ethics.Conclusion:Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals. Such outcomes are promising in developing ethical safety for healthcare patients and professionals. (shrink)

The paper examines the problematic understanding of “risk” in entrepreneurial literature that locates courage in either the loss orgain of having or in the difficulty and hardship of the doing. We argue in this paper that what is lost in this vernacular view of courage is a deeper notion of the subjective dimension of work and the social need of society. Grounded within the Catholic social and moral tradition, we find a richer notion of courage, which (...) in part corrects and rounds out the insufficient description of the vernacular understanding of courage in entrepreneurship. What we also find in this account of the virtues and subjective dimension of work is greater explanatory power of what happens to the entrepreneur in the work that he or she does. The end result of this analysis is a more spiritual, ethical and social understanding of entrepreneurship. (shrink)

Neonatal professionals encounter many ethical challenges especially when it comes to interventions at the limit of viability (weeks 22–25 of gestation). At times, these challenges make the moral dilemmas in neonatology tragic and they require a particular set of intellectual and moral virtues. Intellectual virtues of episteme and phronesis, together with moral virtues of courage, compassion, keeping fidelity to trust, and integrity were highlighted as key virtues of the neonatal professional. Recognition of the role of (...) ethics requires a recognition that answering the obvious question (what shall we do?) does not always suffice. Acknowledging the tragic question (is any of the alternatives open to us free from serious moral wrongdoing) and recognizing the ethical dilemmas, where the lines between right and wrong are blurred, leads to actions taken towards establishing ethics frameworks to support decision-making. In neonatology units, such organizational support can help in allowing the team members to recognize the ethical dilemmas, avoid moral distress, and improve team cohesion and the quality of care provided. Only when the organizational structure allows ethical dilemmas to be recognized, adequate decisions can be made. (shrink)

Runaway climate change and persistent inequality are ravaging the world and humanity. Who can help lead us to a better future? Business. These massive dual challenges-and other profound shifts like pandemics, resource constraints, and shrinking biodiversity-threaten our very existence on the planet. Yet division and discord risk undermining our response, just when we need to come together. Global partnership and leadership are lacking, free trade and globalization are under attack, and populism continues to breed intolerance and disruption. At this critical (...) time in history, the imperative to reimagine our economies and companies could not be more urgent. Fortunately, many in the business community-from large corporations to microenterprises-are helping to solve our most profound challenges by deploying long-term, purpose-led business models that put people and planet first. And they are profiting on this new path with new tools, AI and data-driven transparency, and radical improvements in the economics of clean technologies. The key question has flipped from "Why would you do sustainability?" to "Why wouldn't you?" In this paradigm-shifting book, former Unilever CEO Paul Polman and sustainable-business guru Andrew Winston provide a model to help leaders build companies that contribute more to the world than they use or take-that is, net positive companies. They bypass the last gasps of denial to show how purpose and profits are inextricably linked and how collective action can deliver the scale of change and transformation the world needs. Net Positive outlines the principles and practices for surviving and thriving, based on the experience of one world-leading company, Unilever, and other groundbreaking global organizations. This essential book is for leaders, executives, managers, and professionals who want to succeed, but know that winning requires caring deeply about serving the world. Building a net positive company is the key, and this book shows the way. (shrink)

Creativity in science and engineering has moral significance and deserves attention within professional ethics, in at least three areas. First, much scientific and technological creativity constitutes moral creativity because it generates moral benefits, is motivated by moral concern, and manifests virtues such as beneficence, courage, and perseverance. Second, creativity contributes to the meaning that scientists and engineers derive from their work, thereby connecting with virtues such as authenticity and also faults arising from Faustian trade-offs. (...) Third, morally creative leadership is important at all levels of science and engineering. (shrink)

This insightful book uniquely charts the events, experiences and challenges faced by teachers during and beyond the COVID-19 pandemic including periods of national lockdowns and school closures. Research-based and evidence informed, this key title explores the multiple media outputs created by teachers in a variety of different socio-economic contexts. The authors reflect on their stories through a series of themed analyses, as well as describe and discuss key issues related to the enactment of teacher professionalism in challenging times. With fascinating (...) vignettes and interview extracts that reinforce the idea that teachers can manage rather than survive, this book unveils a strong sense of moral purpose, professional identity, commitment, care, and resilience. It will be of interest to teachers, headteachers and teacher educators internationally. (shrink)

How can a course on engineering ethics affect an undergraduate student’s feelings of responsibility about moral problems? In this study, three groups of students were interviewed: six students who had completed a specific course on engineering ethics, six who had registered for the course but had not yet started it, and six who had not taken or registered for the course. Students were asked what they would do as the central character, an engineer, in each of two short cases (...) that posed moral problems. For each case, the role of the engineer was successively changed and the student was asked how each change altered his or her decisions about the case. Students who had completed the ethics course considered more options before making a decision, and they responded consistently despite changes in the cases. For both cases, even when they were not directly involved, they were more likely to feel responsible and take corrective action. Students who were less successful in the ethics course gave answers similar to students who had not taken the course. This latter group of students seemed to have weaker feelings of responsibility: they would say that a problem was “not my business.” It appears that instruction in ethics can increase awareness of responsibility, knowledge about how to handle a difficult situation, and confidence in taking action. (shrink)

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a (...) do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of ‘DNR’ to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed. (shrink)

The aims of the study were to identify coach profiles and examine whether participants from distinct profiles significantly differed on burnout, emotions and coping. A sample of 268 athletes (Mage = 29.34; SD = 12.37), completed a series of self-reported questionnaires. Cluster analyses revealed two coach leadership profiles: (a) profile 1 with high scores of training and instruction, authoritarian behavior, social support and positive feedback, and a low score of democratic behavior; and (b) profile 2 with low levels in training (...) and instruction, authoritarian behavior, social support and positive feedback and high levels in democratic behavior. Results of MANOVAs indicated significant differences across coach profiles on reduced accomplishment, sport devaluation, happiness and seeking support and marginal differences on dejection, logical analysis, imagery/thought control, and excitement. Moreover, coach leadership profiles were not confounded by demographic variables (level of competition, gender, age, number of practice hours, professional versus no professional athletes). As a conclusion, the profile approach offered a holistic way to examine coach leadership in sport as two distinct coach profiles emerged from the cluster analyses with an unexpected combination of coach leadership dimensions. (shrink)

Background The birth plan is a tool that allows the self-learning and thoughtful analysis of the women during the birthing process, facilitating their making of decisions and participation, in agreement with the bioethical principles of autonomy and no malfeasance. Goal: To understand the perception and satisfaction of women who presented a birth plan. Methodology: Qualitative, descriptive, observational, retrospective and cross-sectional study. The population of the study was composed of 21 women who presented a birth plan regulated in a Hospital ever (...) since the recording of the presentation of the birth plan was started until 2015. Place: Cartagena. Techniques/methods: Semistructured interview. Results-Discussion: Most women considered the plan as a useful self-learning tool on the meaning of the birthing process, as it favored the communication between the expectant mothers/health professionals. Our informants sought information related to the birthing process from informal sources; most perceived a level of respect of their wishes during the process of giving birth. The use of the birth plan did not imply the perception of loss of the degree of control during the birth, although attention to the written document could be improved. Conclusions The use of the birth plan is a very satisfactory and useful experience for their involvement in their self-care, although in some cases, the births did not proceed according to their plans. Nevertheless, the prevalence of the principle of Non-Malfeasance over Autonomy was evidenced. (shrink)

Progress towards Universal Health Coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the WHO Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases and how should one adjudicate between them when their demands conflict? This paper by some (...) members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three principal dimensions of progress towards UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to pre-payment with pooling of funds. Our cases are simplified to highlight common trade-offs. While we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC. (shrink)

The importance of developing cultural competence among healthcare professionals is well recognized. However, the widespread reports of insensitivity and deficiencies in care for culturally diverse patients illuminate the need to review how cultural competence development is taught, learnt and applied in practice. Unless we can alter the ‘hearts and minds’ of practising nurses to provide the care that they know they should, culturally insensitive care will continue operating in subtle ways. This paper explores the ideas behind nurses’ actions and omissions (...) when caring for culturally diverse patients and proposes the need to examine cultural competence development through a moral reasoning lens. Examining cultural competence development through a moral reasoning lens can help empower nurses, whilst nurturing commitment and courage to providing quality care that meets the needs of culturally diverse patients. The model of morality provides a framework that explores how moral motivation and behaviour occur and can provide a vehicle for critically examining the knowledge, skills and attitudes required to provide culturally responsive care. (shrink)

BackgroundImplementing the routine consultation of patient advance directives in hospital emergency departments and emergency medical services has become essential, given that advance directives constitute the frame of reference for care personalisation and respect for patients’ values and preferences related to healthcare. The aim of this study was to assess the levels and relationship of knowledge and attitudes of nursing and medical professionals towards advance directives in hospital emergency departments and emergency medical services, and to determine the correlated and predictor variables (...) of favourable attitudes towards advance directives.MethodsObservational, descriptive, and cross-sectional study. The study was conducted in the emergency department of a second-level hospital and in the emergency medical service. Data collection was performed from January 2019 to February 2020. The STROBE guidelines were followed for the preparation of the study.ResultsA total of 173 healthcare professionals responded to the questionnaire. Among them, 91.3% considered that they were not sufficiently informed about advance directives, and 74% acknowledged not having incorporated them into their usual practice. Multinomial analysis indicated a statistically significant relationship between the variable emergency medical service and having more favourable attitudes towards consulting the advance directives in their practical application (OR 2.49 [95% CI 1.06–5.88]; p = 0.037) and compliance in complex scenarios (OR 3.65 [95% CI 1.58 − 8.41]; p = 0.002). Working the afternoon and night shift was a predictor variable for obtaining a higher score with respect to attitudes in complex scenarios.ConclusionThere is an association between the level of knowledge that nursing and medical professionals have about advance directives and the scores obtained on the attitude scales at the time of practical implementation and in complex scenarios. This shows that the more knowledge professionals have, the more likely they are to consult patients' advance directives and to respect their wishes and preferences for care and/or treatment. (shrink)

El presente estudio se realizó con el objetivo de evaluar el impacto del estrés emocional en la adecuada toma de decisiones y práctica médica oportuna y de calidad de los estudiantes que cursan el quinto año de la carrera en la Facultad de Medicina de la Universidad Nacional Autónoma de México. Se utilizó una lista de valoración para las competencias de la simulación de reanimación cardiopulmonar avanzada, y un Cuestionario de Maslach Burnout Inventory para valorar los sentimientos, actitudes y de (...) desgaste profesional. Los resultados muestran que aquellos que estaban expuestos a mayor cantidad de labores recientes y estrés fueron más propensos de incidir en errores médicos durante la toma de decisiones y su aprendizaje. This study was conducted with the aim of assessing the impact of emotional stress in the appropriate decision-making and quality medical practice of fifth year medical students from the Faculty of Medicine of the National Autonomous University of Mexico. It was used an assessment list for cardiopulmonary resuscitation simulation competence and a Maslach Burnout Inventory Questionnaire was used to assess feelings, attitudes and professional wear and tear. Results show those who were exposed to a greater number of recent tasks and to greater stress were more likely to make medical mistakes while making decisions and learning. (shrink)

Moral courage involves acting in the service of one’s convictions, in spite of the risk of retaliation or punishment. I suggest that moral courage also involves a capacity to face others as moral agents, and thus in a manner that does not objectify them. A moral stand can only be taken toward another moral agent. Often, we find ourselves unable to face others in this way, because to do so is frightening, or because (...) we are consumed by blinding anger. But without facing others as moral subjects, we risk moral cowardice on the one hand and moral fanaticism on the other. (shrink)

Background Moral courage is a recognized virtue. In the context of the COVID-19 pandemic, the master’s students of nursing (MSNs) in China have shown tenacious moral courage. Objective This study elaborates on the moral courage of Chinese MSNs through their experiences of volunteering during the pandemic. Research Design Descriptive qualitative, interview-based. Participants and Research Context Participants were nursing postgraduate students who participated in the prevention and control of the COVID-19 pandemic selected by purposeful sampling. (...) The sample size was determined by data saturation, which was reached with 10 participants. Data were analyzed using a deductive method of content analysis. Because of the isolation policy, telephone interviews were adopted. Ethical considerations After obtaining the approval of the ethical institution of the author’s school (No. 138, 30 August 2021), verbal consent was obtained before the interview with the participants. All data were processed anonymously and confidentially. In addition, we recruited participants through MSNs’ counselors, and obtained their phone numbers with their permission. Results Data analysis resulted in 15 subcategories that were subsequently grouped into 3 major categories including proceed without hesitation, the outcome of practicing moral courage, and develop and maintain moral courage. Conclusion This qualitative study is based on the special background of the COVID-19 pandemic, and the MSNs in China have shown tenacious moral courage in the work of epidemic prevention and control. Five factors led them to take action without hesitation, and six possible outcomes followed. Lastly, this study provides some suggestions for nurses and nursing students to enhance their moral courage. To better develop and support moral courage in the future, it is necessary to use different methods and multidisciplinary approaches to study moral courage. (shrink)

Background:While there have been studies exploring moral habitability and its impact on the work environments of nurses in Western countries, little is known about the moral habitability of the work environments of nurses and midwives in resource-constrained settings.Research objective:The purpose of this research was to examine the moral habitability of the work environment of nurses and midwives in Ghana and its influence on their moral agency using the philosophical works of Margaret Urban Walker.Research design and participants:A (...) critical moral ethnography was conducted through the analysis of interviews with 30 nurses and midwives, along with observation, and documentary materials.Ethical considerations:After receiving ethics approval, signed informed consent was obtained from participants before data collection.Results:Five themes were identified: (1) holding onto the values, identities, and responsibilities of being a midwife/nurse; (2) scarcity of resources as limiting capacity to meet caring responsibilities; (3) gender and socio-economic inequities shaping the moral-social context of practice; (4) working with incoherent moral understandings and damaged identities in the context of inter- and intra-professional relationships; and (5) surviving through adversity with renewed commitment and courage.Discussion:The nurses and midwives were found to work in an environment that was morally uninhabitable and dominated by the scarcity of resources, overwhelming and incoherent moral responsibilities, oppressive conditions, and workplace violence. These situations constrained their moral agency and provoked suffering and distress. The nurses and midwives negotiated their practice and navigated through morally uninhabitable work environment by holding onto their moral values and commitments to childbearing women.Conclusion:Creating morally habitable workplaces through the provision of adequate resources and instituting interprofessional practice guidelines and workplace violence prevention policies may promote safe and ethical nursing and midwifery practice. (shrink)