Moral elevation, gratitude, and meaning in nurses' positive mental health

BackgroundNurses often face moral distress and emotional strain, which can undermine psychological well-being and ethical engagement. From a positive ethics perspective, moral emotions may serve as resources for moral flourishing. Moral elevation - the emotion evoked by witnessing moral excellence - may be associated with nurses' mental health through grateful appraisals and work meaning.Research aimTo examine whether moral elevation promotes nurses' positive mental health through the mediating effects of grateful appraisals and work meaning.Research designA cross-sectional survey was conducted, with mediation analyses using PROCESS Model 6 to test independent and sequential pathways.Participants and research contextData were collected from 359 registered nurses working in Chinese public hospitals. Participants completed validated measures of moral elevation, grateful appraisals, work meaning, and positive mental health.Ethical considerationsEthical approval was obtained from the institutional review board, and all participants provided informed consent with assurances of confidentiality and voluntary participation.FindingsMoral elevation was positively associated with positive mental health both directly and indirectly. Grateful appraisals and work meaning each independently mediated this relationship, and their sequential mediation pathway was also significant. The model explained 57.6% of the variance in positive mental health, supporting the proposed ethical-psychological mechanism.DiscussionThese findings show that moral elevation functions as an ethical emotion that builds nurses' emotional and cognitive resources, consistent with the broaden-and-build theory and the positive ethics framework. Grateful appraisals and work meaning transform moral emotion into enduring psychological well-being, highlighting moral flourishing as a promising direction for nursing ethics.ConclusionMoral elevation was associated with nurses' positive mental health through both independent and sequential mediating pathways of grateful appraisals and work meaning. Strengthening moral reflection, gratitude-based practices, and meaning-centred education may renew nurses' ethical commitment and psychological vitality, shifting nursing ethics from preventing moral injury to cultivating moral flourishing.