The buffering structure of moral injury in nursing internship students: A network analysis based on moral courage,...

Nursing interns face a higher risk of moral injury during clinical transitions, and moral injury may negatively impact their mental health, leading to diminished confidence and enthusiasm for nursing. However, relevant studies have indicated that moral courage, self-compassion, and professional values may all potentially influence an individual's moral injury, respectively, but their specific relationship and complex mechanisms have not been fully explored in nursing interns.

To determine the complex relationships of moral courage, self-compassion, professional values in constructing an interconnected network structure for moral injury towards nursing interns.

This cross-sectional study recruited 429 nursing interns between August 21, 2024, and February 10, 2025, using convenience sampling. The online questionnaires used included the Demographic Questionnaire, Moral Injury Symptoms Scale-Health Professional, Nurses' Moral Courage Scale, Self Compassion Scale, Nursing Professional Values Scale - Revised. Gaussian graphical models were used for analysing network structure, centrality and bridging expected influence (BEI) to clarify the complex structure of relationships between moral injury and moral courage, self-compassion, and professional values.

The moral injury network structure comprised 63 non-zero edges (edge weights = -0.421 to 0.573) out of 136 possible connections. Isolation in self-compassion exhibited the highest centrality (strength = 1.296). Mistrust in moral injury showed the strongest bridge strength and negative BEI (BEI = -0.524), while mindfulness in self-compassion demonstrated the strongest positive BEI (BEI = 0.341).

This study highlights the critical bridging role of mistrust and the negative association of isolation with moral injury among nursing interns. Moral courage, self-compassion, and professional values collectively constituted a relatively stable network structure associated with moral injury in nursing interns, providing focal points for observation and intervention to detect and prevent moral injury. Nursing educators should prioritize cultivating professional values and designing interventions targeting self-compassion and moral courage to safeguard interns' mental health.