Moral courage of palliative care nurses and affecting factors

Abstract Background Moral courage among palliative care nurses plays a critical role in ensuring high-quality care for patients in the final stages of life. This study aimed to assess the level of moral courage among palliative care nurses and identify the factors that influence it. Methods This descriptive, cross-sectional study was conducted between September 2023 and September 2024, involving 181 palliative care nurses. Data were collected through an online survey distributed to nurses who voluntarily agreed to participate. The survey included a “Personal Information Form” and the “Nurses’ Moral Courage Scale (NMCS).” Results The mean age of participants was 31.82 ± 7.92 years, and their average professional experience was 9.33 ± 9.32 years. Of the nurses, 62.4% were female. The average NMCS score was 82.25 ± 12.21. Nurses with a master’s degree scored significantly higher on the NMCS compared to those with lower educational levels (p < 0.001). Additionally, nurses who had chosen their current unit voluntarily (p = 0.046), and those who rated their knowledge of healthcare ethics as “excellent” (p < 0.001), demonstrated significantly higher moral courage scores. A positive correlation was found between moral courage and age (r = 0.153, p = 0.040), whereas a negative correlation was observed between moral courage and the average number of night shifts per month (r = -0.253, p = 0.001). Conclusion The findings suggest that palliative care nurses generally exhibit high levels of moral courage. Educational attainment, voluntary selection of the work unit, and perceived competence in healthcare ethics were positively associated with moral courage. Conversely, challenging working conditions—such as high workloads, frequent night shifts, and insufficient institutional support—may hinder nurses’ ethical decision-making by fostering caution and hesitation.