Iranian nurses’ views on barriers to moral courage in practice: A qualitative descriptive study

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Abstract

Background

Nursing is a caring profession. Due to the nature of their work, nurses need to have the moral courage to deliver safe nursing care. Research results have reported a low level of moral courage in the majority of nurses. The current study aimed to identify the barriers to show moral courage in Iranian nurses.

Methods

This study was qualitative research that was conducted using conventional content analysis. Data was gathered using in-person, semi-structured, in-depth interviews. Interviews were conducted from March to September 2020. Purposeful sampling was used and sampling was continued until data saturation was reached. Participants were 19 nurses working in hospitals in Iran.

Results

According to data analysis, six categories and three themes were extracted. Themes are “organizational failure”, “deterrent personal identity” and “defeated professional identity”.

Conclusions

The results of this study revealed the barriers to show moral courage which were usually overlooked in previous quantitative studies. It appears that the elimination of these barriers is an effective step in the improvemalet of nurses’ competencies. The results of this study can be helpful in the developmalet of programs to address the factors affecting nurses’ moral courage.

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Most cited references 37

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Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.

U.H. Graneheim, B Lundman (2004)

Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.

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When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates.

Giulia Lamiani, Piergiorgio Argentero, Lidia Borghi (2017)

Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions. This review describes the publication trend on moral distress and explores its relationships with other constructs. A bibliometric analysis revealed that since 1984, 239 articles were published, with an increase after 2011. Most of them (71%) focused on nursing. Of the 239 articles, 17 empirical studies were systematically analyzed. Moral distress correlated with organizational environment (poor ethical climate and collaboration), professional attitudes (low work satisfaction and engagement), and psychological characteristics (low psychological empowerment and autonomy). Findings revealed that moral distress negatively affects clinicians' wellbeing and job retention. Further studies should investigate protective psychological factors to develop preventive interventions.

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Is Open Access

Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world?

Tobias Freund, Christine Everett, Peter Griffiths … (2015)

World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered nurses and other clinical staff members. Although this development is observed internationally, skill mix in the primary care team and the speed of progress to deliver team-based care differs across countries. This work aims to provide an overview of education, tasks and remuneration of nurses and other primary care team members in six OECD countries. Based on a framework of team organization across the care continuum, six national experts compare skill-mix, education and training, tasks and remuneration of health professionals within primary care teams in the United States, Canada, Australia, England, Germany and the Netherlands. Nurses are the main non-physician health professional working along with doctors in most countries although types and roles in primary care vary considerably between countries. However, the number of allied health professionals and support workers, such as medical assistants, working in primary care is increasing. Shifting from 'task delegation' to 'team care' is a global trend but limited by traditional role concepts, legal frameworks and reimbursement schemes. In general, remuneration follows the complexity of medical tasks taken over by each profession. Clear definitions of each team-member's role may facilitate optimally shared responsibility for patient care within primary care teams. Skill mix changes in primary care may help to maintain access to primary care and quality of care delivery. Learning from experiences in other countries may inspire policy makers and researchers to work on efficient and effective teams care models worldwide.

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Author and article information

Contributors

Mahnaz Rakhshan:

ORCID: https://orcid.org/0000-0003-1687-5154

rakhshanm@sums.ac.ir

Noushin Mousazadeh:

ORCID: https://orcid.org/0000-0002-0516-4325

somaye87@gmail.com

Hamideh Hakimi: hakimi.hb@gmail.com

Fahimeh Alsadat Hosseini:

ORCID: https://orcid.org/0000-0001-5943-9294

fhosseini23@yahoo.com

Journal

Journal ID (nlm-ta): BMC Nurs

Journal ID (iso-abbrev): BMC Nurs

Title: BMC Nursing

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6955

Publication date (Electronic): 6 November 2021

Publication date PMC-release: 6 November 2021

Publication date Collection: 2021

Volume: 20

Electronic Location Identifier: 221

Affiliations

[1 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Community Based Psychiatric Care Research Center, Departmalet of Medical-Surgical Nursing, , Shiraz University of Medical Sciences, ; Shiraz, Iran

[2 ]GRID grid.411623.3, ISNI 0000 0001 2227 0923, Departmalet of Nursing, Amol Faculty of Nursing and Midwifery, , Mazandaran University of Medical Science, ; Sari, Iran

[3 ]GRID grid.469939.8, ISNI 0000 0004 0494 1115, Departmalet of Nursing, , Lahijan Branch, Islamic Azad University, ; Lahijan, Iran Iran

[4 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, ; Shiraz, Iran

Author information

Mahnaz Rakhshan https://orcid.org/0000-0003-1687-5154

Noushin Mousazadeh https://orcid.org/0000-0002-0516-4325

Fahimeh Alsadat Hosseini https://orcid.org/0000-0001-5943-9294

Article

Publisher ID: 728

DOI: 10.1186/s12912-021-00728-7

PMC ID: 8571867

PubMed ID: 33388055

SO-VID: 59058553-349f-4a85-a10c-ecca986df62c

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 20 December 2020

Date accepted : 4 October 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004160, Mazandaran University of Medical Sciences;

Award ID: 8064

Award Recipient : Noushin Mousazadeh

Custom metadata

ScienceOpen disciplines: Nursing

Keywords: courage,moral courage,nurses,content analysis

Data availability:

ScienceOpen disciplines: Nursing

Keywords: courage, moral courage, nurses, content analysis

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Iranian nurses’ views on barriers to moral courage in practice: A qualitative descriptive study

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Most cited references 37

Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.

When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates.

Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world?

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