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REVIEW • Rev. Bras. Enferm. 76 (Suppl 3) • 2023 • https://doi.org/10.1590/0034-7167-2022-0225 copy

Analysis of moral courage and related factors among undergraduate nursing students: a scoping review

Análisis del coraje moral y factores relacionados entre estudiantes de graduación en enfermería: scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze scientific evidence on moral courage and related factors among nursing undergraduate students.

Method:

the protocol of this scoping review was registered on Open Science Framework. A search was performed in five databases, according to the method provided by Joanna Briggs Institute Reviewers, the mnemonic strategy Population, Concept and Context, and a specific checklist.

Results:

a total of 2,812 results were identified, but only nine studies were eligible and presented three thematic approaches: Moral courage from the perspective of nursing students; Moral courage and related factors; and The teaching of moral courage in the training of nursing students. The factors related to moral courage include moral distress, moral sensitivity, age, and having a previous degree in the health field.

Final Considerations:

few studies were found with a low evidence level. Most were performed in developed countries, indicating some gaps that need to be addressed in the future.

Descriptors:
Nursing Students; Nursing Ethics; Courage; Morale; Review.

Databases	Search strategies
Web of Science	(“moral courage”) AND (“nursing students”) (ALL (“moral courage”) OR ALL (“moral strength”) OR ALL (“moral integrity”) AND ALL (“nursing students” OR “nursing student”)
MEDLINE/Pubmed	(“moral courage”) AND (“nursing students”) (“moral courage”) OR (“moral strength”)) OR (“moral integrity”)) AND (“nursing students”) OR (“nursing student”) ((((“moral courage”) OR (“moral strength”)) OR (“moral integrity”))) AND (“nursing students” OR “nursing student”)
Scopus	(“moral courage”) AND (“nursing students”) (ALL (“moral courage”) OR ALL (“moral strength”) OR ALL (“moral integrity”) AND ALL (“nursing students” OR “nursing student”)
CINAHL	(“moral courage”) AND (“nursing students”) ((((“moral courage”) OR (“moral strength”)) OR (“moral integrity”))) AND (“nursing students” OR “nursing student”)
LILACS	(“moral courage”) AND (“nursing students”) (“moral courage” OR “moral strength” OR “moral integrity”) AND (“nursing students”) (“moral courage” OR “moral strength” OR “moral integrity”) AND (“nursing student”)

ID	Country	Periodical	Methodological Design	Participants	EL
A1(¹⁴14 Bickhoff L, Levett-Jones T, Sinclair PM. Rocking the boat - nursing students’ stories of moral courage: a qualitative descriptive study. Nurse Educ Today. 2016; 42:35-40. https://doi.org/10.1016/j.nedt.2016.03.030 https://doi.org/10.1016/j.nedt.2016.03.0... )	Australia	Nurse Education Today	Descriptive	Nursing students (n=9) and a recently graduated nurse (n=1)	VI
A2(¹⁵15 Echeverria I, Peraire M, Haro G, Mora R, Camacho I, Almodóvar I, et al. “Healthcare Kamikazes” during the COVID-19 pandemic: purpose in life and moral courage as mediators of psychopathology. Int J Environ Res Public Health. 2021;18(14). https://doi.org/10.3390/ijerph18147235 https://doi.org/10.3390/ijerph18147235... )	Spain and Mexico	International Journal of Environmental Research and Public Health	Cross-sectional	90 Spanish, 59 Mexican health workers; 56 medical and nursing students	VI
A3(¹⁶16 Escolar-Chua RL. Moral sensitivity, moral distress, and moral courage among baccalaureate Filipino nursing students. Nurs Ethics. 2018;25(4):458-69. https://doi.org/10.1177/0969733016654317 https://doi.org/10.1177/0969733016654317... )	Philippines	International Journal Eating Disorders	Cross-sectional	293 Philippine undergraduate nursing students	VI
A4(¹⁷17 Gibson E, Duke G, Alfred D. Exploring the relationships among moral distress, moral courage, and moral resilience in undergraduate nursing students. J Nurs Educ. 2020;59(7):392-5. https://doi.org/10.3928/01484834-20200617-07 https://doi.org/10.3928/01484834-2020061... )	United States of America	The Journal of nursing education	Cross-sectional	Nursing students from three locations	VI
A5(¹⁸18 Koskinen S, Pajakoski E, Fuster P, Ingadottir B, Löyttyniemi E, Numminen O, et al. Analysis of graduating nursing students’ moral courage in six european countries. Nurs Ethics. 2021;28(4):481-97. https://doi.org/10.1177/0969733020956374 https://doi.org/10.1177/0969733020956374... )	Spain, Philippines, Iceland, Germany, Lithuania, and Ireland	Nursing ethics	Cross-sectional	Graduate nursing students (n=1,796); nurse managers (n=538); and patients (n=1,327)	VI
A6(¹⁹19 Mollaei F, Abbaszadeh A, Loghmani L, Khabazkhob M, Borhani F. Moral courage of nursing students: a descriptive study in Iran 2017. Astra Salvensis [Internet]. 2018 [cited 2022 Apr 30];6:39-44. Available from: https://sciexplore.ir/Documents/Details/319-785-968-485 https://sciexplore.ir/Documents/Details/... )	Iran	Astra Salvensis	Cross-sectional	Nursing students (n= 185)	VI
A7(²⁰20 Black S, Curzio J, Terry L. Failing a student nurse: a new horizon of moral courage. Nurs Ethics. 2014;21(2):224-38. https://doi.org/10.1177/0969733013495224 https://doi.org/10.1177/0969733013495224... )	United Kingdom	Nursing Ethics	Descriptive	Mentors/supervisors of nursing students (n=19)	VI
A8(²¹21 DeSimone BB. Curriculum redesign to build the moral courage values of accelerated bachelor’s degree nursing students. SAGE Open Nurs. 2019;5,1-10. https://doi.org/10.1177/2377960819827086 https://doi.org/10.1177/2377960819827086... )	United States of America	SAGE open nursing	Cross-sectional	Nursing students (n=19) and nursing professors (n=8)	VI
A9(²²22 Nash W, Mixer SJ, McArthur PM, Mendola A. The moral courage of nursing students who complete advance directives with homeless persons. Nurs Ethics. 2016;23(7):743-53. https://doi.org/10.1177/0969733015583926 https://doi.org/10.1177/0969733015583926... )	United States of America	Nursing Ethics	Descriptive	Nursing students (n=15)	VI

Thematic approach	Studies ID	n	%
Moral courage from the perspective of nursing students	A1	1	11.1
Moral courage and related factors	A2, A3, A4, A5, A6	5	55.6
The teaching of moral courage in the training of nursing students	A7, A8, A9	3	33.3

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