Background: Numerous nurses have often expressed to consider turnover or quit their jobs due to moral distress in the last decades. Moral courage and professional autonomy could alleviate moral distress among nurses by enabling them to practice their ethical beliefs in the health care settings. Thus, it is crucial to verify the impact of both on moral distress, however, there is little research known.
Purpose: The purpose of this study was to investigate the relationship among moral courage, professional autonomy and moral distress and the impact of moral courage and professional autonomy on moral distress among nurses.
Methods: A descriptive and correlational research was adopted by a convenience sample of 283 nurses from 4 general and university hospitals in South Korea. Data was collected from August 1st to 31st in 2020. Instruments used in this study were Korean version of Nurses' Moral Courage Scale, Schutzenhofer Professional Nurse Autonomy Scale, and Korean version of Moral Distress Scale-Revised. Data analysis was performed by SPSS/WIN 23.0 program for t-test, ANOVA, Pearson correlation coefficient, and hierarchical regression analysis.
Ethical considerations: This study was approved by the Institute Review Board of Hallym University before data collection (HIRB-2020-044).
Results: The mean score of moral courage was 3.24 (SD=0.50) out of 5 points, and subdomain of compassion and true presence had the highest score 3.63 (SD=0.65). The mean score of professional autonomy was 156.38 (SD=21.62) out of 240 points, which indicates a moderate level of professional autonomy, and moral distress was 109.44 (SD=68.99) out of 336 points. Moral distress was positively correlated with moral courage (r=.177, p=.003) and professional autonomy (r=.156, p=.009). Also, moral courage was positively correlated with professional autonomy (r=.386, p〈.001). The significant factors influencing moral distress were over 1 year nursing experience, acquired ethical knowledge through self-study, frequency of situations needing moral courage, and three subdomains of moral courage: 'moral integrity', 'commitment to good care' and 'moral responsibility'. These variables explained 30.7% of the total variance in moral distress (F=5.050, p〈.001).
Discussion: To relieve moral distress among nurses, education or program should concentrate on improving individual moral courage, particularly moral integrity, which means practice moral behaviour according to ones` ethical beliefs in spite of taking the risk of disadvantages. In addition, organizations should create atmosphere to enable nurses to achieve moral responsibility and commitment to good care for their patients.