Evidence map›Paper›PMID 42366492›Full record

ArticleJournal of nursing management2026

Nursing Leadership Styles and Moral Courage: The Mediating Role of Ethical Dilemma Identification and the Moderating Effects of Ethical Climate and Compassion Fatigue.

Mei Xie, Zefeng Shao, Huimin Su, Quanyi Long, Nik Mohd Hazrul Nik Hashim, Kifayat Nahiyan Rafi, Yuanyuan Zou

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In one paragraph

Article in Journal of nursing management, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

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.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Mei XieDepartment of Psychology of Developmental and Socialization Processes, Sapienza University of Rome, Rome, Italy, uniroma1.it.ORCID https://orcid.org/0000-0002-5988-3464
Zefeng ShaoGraduate School of Business, National University of Malaysia, Bangi, Malaysia, ukm.my.
Huimin SuDepartment of Internal Medicine II, The Third Affiliated Hospital of Kunming Medical University, Kunming, China, kmmc.cn.
Quanyi LongSchool of Nursing, Kunming Medical University, Kunming, China, kmmc.cn.
Nik Mohd Hazrul Nik HashimGraduate School of Business, National University of Malaysia, Bangi, Malaysia, ukm.my.
Kifayat Nahiyan RafiGraduate School of Business, National University of Malaysia, Bangi, Malaysia, ukm.my.
Yuanyuan ZouDepartment of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy, uniroma1.it.ORCID https://orcid.org/0009-0004-5043-9123

Funding

China Scholarship Council 202207000022China Scholarship Council 202208530084CRUI-CARESapienza Università di Roma
6 · The paper itself

Abstract

In healthcare organizations, ethical conduct is strongly influenced by nursing leadership. Although prior research has emphasized the role of leadership in shaping professional behavior, limited attention has been given to how different leadership styles affect nurses' moral courage through ethical decision-making processes. This study examines the effects of three leadership styles-ethical, empowering, and authoritarian-on nurses' moral courage, with ethical dilemma identification as a mediator and perceived ethical climate and compassion fatigue as moderators. A cross-sectional survey was conducted among registered nurses in a Chinese tertiary hospital (N = 314). A moderated mediation model was tested using structural equation modeling. The results show that ethical and empowering leadership are positively associated with moral courage, whereas authoritarian leadership is negatively associated. These relationships are mediated by ethical dilemma identification, suggesting that leadership shapes moral courage by influencing nurses' recognition of ethical issues. Moreover, a supportive ethical climate strengthens the positive effects of ethical and empowering leadership, while compassion fatigue weakens these relationships. These findings highlight the critical role of leadership in promoting ethical practice in nursing. Practically, healthcare organizations should foster ethical and empowering leadership, strengthen ethical climates, and address compassion fatigue to enhance nurses' moral courage in clinical settings.

Indexed as

Compassion FatigueCourageLeadershipNursesAdultChinaCross-Sectional StudiesEthical DilemmasFemaleHumansMaleMiddle AgedMoralsSurveys and Questionnairescompassion fatigueethical climateethical dilemma identificationmoral couragenursing leadership

Identifiers

PMID42366492
PMCPMC13310961

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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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.