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Background <p>Evidence has established that various moral constructs affect nurses negatively (e.g., moral distress, moral injury) and positively (e.g., moral resilience, moral courage). Nevertheless, the protective roles of moral courage and resilience against the effects of compassion fatigue, burnout, and moral distress in intensive care unit (ICU) nurses necessitate further investigation.</p> Objectives <p>To explore the mediating roles of moral courage and moral resilience between compassion fatigue, burnout, and moral distress in ICU nurses.</p> Methods <p>A cross-sectional correlational study was conducted on ICU nurses (<i>n</i> = 250) who were consecutively recruited from five regional hospitals in Saudi Arabia. An online questionnaire with five self-report scales was used for data collection. Covariance-based structural equation modelling was used for data analysis.</p> Results <p>Compassion fatigue negatively influenced moral courage (<i>β</i>=–0.51, <i>p</i> = 0.001). Moral resilience is indirectly associated with moral courage (<i>β</i> = 0.24, <i>p</i> = 0.001), but directly influenced burnout (<i>β</i>=–0.15, <i>p</i> = 0.030). Moral courage negatively influenced moral distress (<i>β</i>=–0.29, <i>p</i> = 0.001) and burnout (<i>β</i>=–0.33, <i>p</i> = 0.001). Moral distress is positively associated with burnout (<i>β</i> = 0.16, <i>p</i> = 0.021). Moral courage mediated between compassion fatigue (<i>β</i> = 0.14, <i>p</i> = 0.001), moral resilience (<i>β</i>=–0.07, <i>p</i> = 0.004), and moral distress. Moral courage mediated between compassion fatigue (<i>β</i> = 0.19, <i>p</i> = 0.001), moral resilience (<i>β</i>=–0.09, <i>p</i> = 0.001), and burnout. Finally, moral distress mediated between moral courage and burnout (<i>β</i>=–0.05, <i>p</i> = 0.044).</p> Conclusion <p>This study identifies moral courage as a protective factor against compassion fatigue, moral distress, and burnout among ICU nurses, while also strengthening the beneficial effects of moral resilience. These findings underscore the importance of ICU practice environments in actively fostering the development of moral courage and resilience through ethics education, reflective practice, and supportive leadership. Organizational cultures that foster ethical advocacy and address structural stressors are crucial for sustaining nurse well-being and delivering high-quality care.</p> Clinical trial number <p>Not applicable.</p>

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Moral courage and resilience protect ICU nurses from compassion fatigue, burnout, and moral distress: a multicenter cross-sectional and structural equation modeling study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月14日

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  • Hazel Novela Villagracia,
  • Ingrid Jacinto-Caspillo,
  • Rizal Angelo N. Grande,
  • Larry Terence O. Cornejo,
  • Niela Sacro-Rosales,
  • Grace Medalyn Tungpalan-Castro,
  • Minerva Pingue-Raguini,
  • Dena Marwan A. Attallah,
  • Samah Abdulwahed Ahmed Ali,
  • Nada Hassan Ahmed Gomma,
  • Anas Motter A. Alsolmi,
  • Rico William A. Villagracia,
  • Noof Khelif Freh AlAnezi,
  • Fahad Falah Mohammed Alharbi,
  • Modi Al-Moteri,
  • Daniel Joseph E. Berdida

摘要

Background

Evidence has established that various moral constructs affect nurses negatively (e.g., moral distress, moral injury) and positively (e.g., moral resilience, moral courage). Nevertheless, the protective roles of moral courage and resilience against the effects of compassion fatigue, burnout, and moral distress in intensive care unit (ICU) nurses necessitate further investigation.

Objectives

To explore the mediating roles of moral courage and moral resilience between compassion fatigue, burnout, and moral distress in ICU nurses.

Methods

A cross-sectional correlational study was conducted on ICU nurses (n = 250) who were consecutively recruited from five regional hospitals in Saudi Arabia. An online questionnaire with five self-report scales was used for data collection. Covariance-based structural equation modelling was used for data analysis.

Results

Compassion fatigue negatively influenced moral courage (β=–0.51, p = 0.001). Moral resilience is indirectly associated with moral courage (β = 0.24, p = 0.001), but directly influenced burnout (β=–0.15, p = 0.030). Moral courage negatively influenced moral distress (β=–0.29, p = 0.001) and burnout (β=–0.33, p = 0.001). Moral distress is positively associated with burnout (β = 0.16, p = 0.021). Moral courage mediated between compassion fatigue (β = 0.14, p = 0.001), moral resilience (β=–0.07, p = 0.004), and moral distress. Moral courage mediated between compassion fatigue (β = 0.19, p = 0.001), moral resilience (β=–0.09, p = 0.001), and burnout. Finally, moral distress mediated between moral courage and burnout (β=–0.05, p = 0.044).

Conclusion

This study identifies moral courage as a protective factor against compassion fatigue, moral distress, and burnout among ICU nurses, while also strengthening the beneficial effects of moral resilience. These findings underscore the importance of ICU practice environments in actively fostering the development of moral courage and resilience through ethics education, reflective practice, and supportive leadership. Organizational cultures that foster ethical advocacy and address structural stressors are crucial for sustaining nurse well-being and delivering high-quality care.

Clinical trial number

Not applicable.