Moral Courage and Ethical Decision-Making Among Registered Psychiatric Nurses in Western Canada: A Cross-Sectional Multiple-Methods Study.

Moral courage is a critical attribute for psychiatric and mental health nurses, who routinely navigate complex ethical dilemmas in mental health care settings. Despite its importance, limited research has explored moral courage and its relationship with ethical decision-making confidence among Registered Psychiatric Nurses. The purpose of this study was to examine the relationship between moral courage, ethical decision-making confidence, education level, and years of practice among Registered Psychiatric Nurses in western Canada. A cross-sectional multiple-methods design that adhered to the STROBE Checklist EQUATOR Network was used, involving 80 participants recruited within western Canada. Data was collected using the Nurses' Moral Courage Scale that utilised open- and close-ended questions as well as the Ethical Decision-Making Confidence scale. Statistical data was analysed using parametric and non-parametric tests to assess group differences. Narrative data was analysed using thematic analysis. The findings revealed a significant positive relationship between moral courage and ethical decision-making confidence. Ethical decision-making confidence scores were higher among nurses with graduate-level education compared to those with diplomas or baccalaureate degrees. However, no significant difference in moral courage scores was observed based on education level or years of practice, and no significant association was found between years of practice and moral courage. Qualitative findings revealed four major themes that included: (1) Advocating; (2) Patient Safety; (3) Reporting Co-Workers; and (4) Standing up to Co-Workers and Superiors. This study highlights the interconnectedness of moral courage and ethical decision-making among psychiatric nurses, while revealing that years of practice alone do not predict moral courage.