Moral resilience, hospital ethical climate, moral courage, and moral sensitivity among intensive care unit nurses: a...

To investigate the association between intensive care unit nurses' moral resilience and the hospital ethical climate, moral courage, and moral sensitivity, and to determine whether moral courage and moral sensitivity mediate the relationship between ethical climate and moral resilience.

A descriptive, cross-sectional study. Overall, 363 intensive care unit nurses from eight tertiary hospitals in Southwest China were recruited using convenience sampling. The Moral Resilience Scale, Hospital Ethical Climate Scale, Moral Courage Scale, and Moral Sensitivity Scale were used. Data were analyzed using SPSS 26.0 and AMOS 29.0, and mediation was tested using the bootstrap method.

Intensive care unit nurses demonstrated a moderate moral resilience level (49.71 ± 5.53), which was positively correlated with hospital ethical climate (r = 0.38, p < 0.01) and moral courage (r = 0.44, p < 0.01), but not with moral sensitivity. Structural equation modeling showed that hospital ethical climate was closely associated wth moral resilience (effect size = 42.86%) and moral courage acted as chain mediators between hospital ethical climate and moral resilience (effect size = 58.93%). The model demonstrated a good fit (χ²/df = 2.39, RMSEA = 0.06).

Intensive care unit nurses in Southwest China demonstrated moderate moral resilience. Both hospital ethical climate and moral courage was linker with nurses' moral resilience. Hospitals should improve their ethical climate and provide moral courage training to enhance intensive care unit nurses' moral psychological resources systematically.

This study identifies key factors influencing moral resilience among intensive care unit nurses, highlights the central role of moral courage in the relationship between hospital ethical climate and moral resilience, and provides practical guidance for nursing managers in developing effective interventions.