Moral resilience among nurses: A systematic review and meta-analysis
Chaochao Yang1, Kexin Xue1, Jingxian Shang1
1College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Nursing Ethics
|November 18, 2025
Summary
Nurses exhibit moderate moral resilience globally, with lower scores in responding to moral adversity. Enhancing ethical practice and well-being requires targeted support, especially for high-stress areas and temporary staff.
Area of Science:
- Nursing Ethics
- Healthcare Professional Well-being
- Moral Psychology
Background:
- Moral resilience is crucial for nurses facing ethical challenges and moral distress.
- It supports nurse well-being and ensures high-quality patient care.
- Understanding the level of moral resilience and its moderators is essential.
Purpose of the Study:
- To systematically review and meta-analyze the level of moral resilience among nurses.
- To identify factors that may moderate nurses' moral resilience.
Main Methods:
- Systematic review and meta-analysis of 24 observational studies (9510 nurses).
- Data synthesized from studies using the Rushton Moral Resilience Scale (RMRS).
- Random-effects meta-analysis, subgroup analyses, and meta-regression were employed.
Main Results:
- The pooled mean moral resilience score was 2.88, indicating a moderate level globally.
- Nurses scored lowest in 'response to moral adversity' (2.66) and highest in 'moral efficacy' (3.19).
- Clinical department and employment type were significant moderators of moral resilience.
Conclusions:
- Nurses worldwide possess moderate moral resilience, but face challenges in responding to moral adversity.
- Targeted training and systemic support are necessary to improve ethical practice and nurse well-being.
- Interventions should focus on high-stress clinical departments and non-permanent nursing staff.
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