ArticleBMC nursing2026
Moral courage and resilience protect ICU nurses from compassion fatigue, burnout, and moral distress: a multicenter cross-sectional and structural equation modeling study.
Article in BMC nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Professional Values, Moral Resilience and Professional Competence in Critical Care Nursing: A Mediation Analysis.Nursing in critical care · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEvidence 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.
objectivesTo explore the mediating roles of moral courage and moral resilience between compassion fatigue, burnout, and moral distress in ICU nurses.
methodsA 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.
resultsCompassion 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).
conclusionThis 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.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.