The impact of hospital ethical climate on ICU nurses' ethical behavior: mediated by moral courage

This study purpose to explore the influence of hospital ethical climate on moral courage and ethical behavior of ICU nurses and to examine the mediating role of moral courage.

Nurses were selected from the intensive care units (ICUs) of three Grade-A tertiary hospitals in Henan Province by convenience sampling and data collated from General Information Questionnaire, Hospital Ethical Climate Scale, Nurses' Moral Courage Scale and Ethical Behavior Scale for Nurses-Revised. Pearson correlation analysis was used to evaluate associations among the three variables and structural equation modeling to test the influence of hospital ethical climate and ICU nurses' moral courage on ethical behavior.

A total of 243 questionnaires were distributed, and 222 valid responses were returned, yielding an effective response rate of 91.4%. Correlation analysis revealed significant positive pairwise correlations among hospital ethical climate, ICU nurses' moral courage, and ethical behavior (r = 0.740 ~ 0.814, p < 0.01). Further mediation analysis indicated than there was a positive association between hospital ethical climate and ICU nurses' ethical behavior (t = 17.032, p < 0.01), moral courage was also positively associated with ethical behavior (t = 3.877, p < 0.01). Moreover, moral courage partially mediated the relationship between hospital ethical climate and ethical behavior, with the mediating effect accounting for 32.1% of the total effect.

Moral courage plays a mediating role between perceived hospital ethical climate and ethical behavior in ICU nurses. Accordingly, nursing managers are advised to implement multiple strategies to promote a supportive ethical climate and nurture moral courage, so as to improve ethical conduct among ICU nurses, guarantee patient safety and care quality, and maintain their professional competency and psychological well-being.