Analysis of graduating nursing students’ moral courage in six European countries

Koskinen, Sanna, Pajakoski, Elina, Fuster, Pilar, Ingadottir, Brynja, Löyttyniemi, Eliisa, Numminen, Olivia, Salminen, Leena, Scott, P Anne, Stubner, Juliane, Truš, Marija and Leino-Kilpi, Helena (2021) Analysis of graduating nursing students’ moral courage in six European countries. Nursing Ethics, 28 (4). pp. 481-497. ISSN 0969-7330



Moral courage is defined as courage to act according to one’s own ethical values and principles even at the risk of negative consequences for the individual. In a complex nursing practice, ethical considerations are integral. Moral courage is needed throughout nurses’ career.

To analyse graduating nursing students’ moral courage and the factors associated with it in six European countries.
Research design:

A cross-sectional design, using a structured questionnaire, as part of a larger international ProCompNurse study. In the questionnaire, moral courage was assessed with a single question (visual analogue scale 0–100), the questionnaire also covered several background variables.
Participants and research context:

The sample comprised graduating nursing students (n = 1796) from all participating countries. To get a comprehensive view about graduating nursing students’ moral courage, the views of nurse managers (n = 538) and patients (n = 1327) from the same units in which the graduating nursing students practised were also explored, with parallel questionnaires.
Ethical considerations:

Ethical approvals and research permissions were obtained according to national standards in every country and all participants gave their informed consent.

The mean of graduating nursing students’ self-assessed moral courage was 77.8 (standard deviation 17.0; on a 0–100 scale), with statistically significant differences between countries. Higher moral courage was associated with many factors, especially the level of professional competence. The managers assessed the graduating nursing students’ moral courage lower (66.5; standard deviation 18.4) and the patients slightly higher (80.6; standard deviation 19.4) than the graduating nursing students themselves.
Discussion and conclusions:

In all countries, the graduating nursing students’ moral courage was assessed as rather high, with differences between countries and populations. These differences and associations between moral courage and ethics education require further research.

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