Moral courage, moral resilience, and ethical behavior among pediatric nurses: A cross-sectional study

To explore the relationships between moral courage, moral resilience, and ethical behavior among pediatric nurses, and to examine the mediating effects of moral resilience in the relationship between moral courage and ethical behavior.

A quantitative, multicenter, cross-sectional study.

A total of 327 Chinese pediatric nurses from 13 public hospitals completed an online survey. They completed the Nurses' Moral Courage Scale (NMCS), the Rushton Moral Resilience Scale (RMRS), and the Ethical Behavior Scale for Nurses (EBSN). The mediating effect of moral resilience was assessed using the bootstrap method through IBM SPSS Amos 26.0.

Pediatric nurses' moral courage was positively associated with moral resilience (r = 0.485, p < 0.001) and ethical behavior (r = 0.448, p < 0.001); both moral courage and moral resilience were directly associated with ethical behavior, with moral resilience mediating this relationship.

Moral courage has a positive effect on ethical behavior among pediatric nurses, and this relationship is further strengthened through moral resilience. These findings underscore the importance of integrating ethics education and resilience-building strategies into nursing management and professional development programs to promote sustained, high-quality ethical practice.

This study provides a practical basis for strengthening ethical practice among pediatric nurses. It highlights the need for targeted strategies to enhance nurses' moral courage and moral resilience, particularly through structured ethics education and resilience-building programs. Future longitudinal studies with larger and more diverse samples are needed to examine the pathways through which moral courage and moral resilience influence ethical behavior.