The concept of moral courage in nursing belongs to the field of nursing science. It is linked to nurses’ moral actions, standing up for individual and professional values despite personal risks. In the literature, there is an increase in studies related to moral courage, with the main studies presenting partly varying definitions of moral courage and using self-assessment instruments in hospital settings, with varying constructs and contents.
This doctoral study aimed to clarify and refine the concept of moral courage in nursing with the Hybrid Model of Concept Development, comprising theoretical, fieldwork and final analytical phases, including also the evaluation of the maturity of the concept. The theoretical phase comprised an integrative literature review. The fieldwork phase included a survey on nurses’ (n=205) self-assessed level of moral courage and a narrative study on nurses’(n=14) justifications for morally courageous acts and the consequences of the acts. In the analytical phase, a refined concept definition was formed. The maturity of the concept was evaluated in the theoretical and final analytical phases.
Moral courage manifests itself in ethical conflicts. Nurses pondered justifications for morally courageous acts and identified the consequences of their acts for themselves, the patients and the work community. Nurses self-assessed their level of moral courage to be moderate or high. Theoretical knowledge combined with versatile examples in empirical data sets enhanced the formation of a clarified, refined definition of the concept. In the final analytical phase, the concept was evaluated as more mature than in the theoretical phase because of the clarified and refined antecedents, attributes and consequences, which were based on rich empirical data cases.
The refined concept definition provided in this study strengthens the knowledge base of nursing ethics. The development of the conceptual basis of moral courage gives possibilities for developing processes that support nurses’ morally courageous acts, and that further actions are taken in the organisation to improve the situation. Additionally, the results can be used in theory development concerning the concept.