Explicating the process of moral courage in clinical nurses: a grounded theory study

Abstract

Moral courage in nurses is the product of a complex process and can be enhanced by identifying the steps through which nurses make morally courageous decisions. This qualitative study aimed to explicate the process of moral courage in clinical nurses and present a descriptive model. The study was conducted in Shahrekord University of Medical Sciences in 2022 using the grounded theory approach. Twenty-one clinical nurses were selected through purposive and theoretical sampling. Data were analyzed using Strauss and Corbin's 2015 approach and data management was supported by MAXQDA software (version 11).The core variable identified was moral excellence. When faced with a misalignment between authority and responsibility, nurses experience ambiguity in ethical decision-making. The nurses in this study employed spirituality, legality, and self-sacrifice strategies, which helped them to manage system expectations. In this model, moral courage ultimately gravitates toward managing system expectations—a deviant mechanism failing to yield positive outcomes due to organizational infrastructures and conditions. Therefore, it is recommended that healthcare organizations addressfactors contributing to ambiguity in nurses' decision-making, such as lack of operational protocols for ethical decisions, mismatched expectations and responsibilities, and deficiencies in professional autonomy.