Moral Courage As a Predictor of Patient Safety: Reflections From the Covid-19 Era Publisher Pubmed



N Dehgahn Nayeri NAHID ; M Shahmari MEHRABAN ; S Shifteh SHAHIN ; K Rasouli KIAN ; A Ranjbar ARASH ; L Zare LEILY
Source: BMC Health Services Research Published:2025

Abstract

Background: The moral courage of nurses is crucial for complex decision-making, patient safety, and communication. However, the direct relationship between nurses’ moral courage and patient safety, particularly during the COVID-19 pandemic, remains unconfirmed. This study aims to investigate this relationship in both COVID-19 and non-COVID-19 departments. Methods: A cross-sectional analytical design was employed, with a sample of 300 nurses from five public hospitals in northwestern (…) affiliated with the University of Medical Sciences. Data were collected between 2021 and 2022 using the validated (…) version of the Hospital Survey on Patient Safety Culture and the Sekerka Moral Courage Scale. Descriptive and inferential statistical analyses were conducted. Results: The safety climate scores were 23.7% in the COVID-19 ward and 25.8% in the non-COVID-19 ward, with no significant difference between the two sectors. Moral courage scores were 50.4% in the COVID-19 wards and 44.9% in the non-COVID-19 wards, showing no significant difference. A strong relationship between moral courage and safety climate was observed in both wards. Regression analysis indicated a Cohen’s f² effect size of 1.77 for moral courage, suggesting a significant impact on patient safety culture. Conclusions: This study found no significant differences in moral courage or patient safety culture between COVID-19 and non-COVID-19 departments. However, moral courage can predict improvements in patient safety, even in complex situations like the COVID-19 crisis. To enhance patient safety, it may be necessary to strengthen nurses’ moral courage through experiential training, supportive environments, and leadership workshops emphasizing empathy and ethical decision-making. Additionally, integrating these educational components into nursing education is important. By enhancing these skills in nursing education, we may improve patient safety and better prepare them to tackle future challenges and crises effectively. © 2025 Elsevier B.V., All rights reserved.