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. 2025 May 15;24(1):538.
doi: 10.1186/s12912-025-03170-1.

The relationship between ethical leadership, moral sensitivity, and moral courage among head nurses

Juntong Meng  1 , Xiaoling Guo  2
Affiliations

The relationship between ethical leadership, moral sensitivity, and moral courage among head nurses

Juntong Meng et al. BMC Nurs. .

Abstract

Background: Moral courage is a key factor in accelerating the implementation of moral behavior. Effective ethical leadership can enhance head nurses' moral competence-particularly moral sensitivity, which serves as a cornerstone of the moral decision-making process. However, there is limited evidence on how ethical leadership influences moral courage. This study aimed to examine the mediating role of moral sensitivity in the relationship between ethical leadership and moral courage among head nurses in China.

Methods: A cross-sectional study was conducted between April and May 2024. The study sample consisted of 202 head nurses who agreed to participate in the study. Data were collected using the Ethical Leadership Scale, the Moral Sensitivity Scale, and the Moral Courage Scale.

Results: A total of 212 head nurses participated in this study. The total scores of ethical leadership, moral sensitivity and moral courage of Chinese head nurses were 92.66(16.34), 45.05(6.40) and 84.64(14.84), respectively. Ethical leadership was positively correlated with moral sensitivity (r = 0.16, P < 0.05), ethical leadership was positively correlated with moral courage (r = 0.32, P < 0.01), and moral sensitivity was positively correlated with moral courage (r = 0.31, P < 0.01). Process analysis showed that ethical leadership enhanced the moral courage of head nurses through moral sensitivity, which was a partial mediating effect model, and the total indirect effect accounted for 13.79%.

Conclusions: This study demonstrates that ethical leadership significantly enhances head nurses' moral sensitivity and courage, with moral sensitivity serving as a critical mediating factor. The study reveals a cascade effect: the moral quality of senior managers shapes the ethical standards of head nurses, and then affects the behavior of clinical nurses, and ultimately forms the ethical organizational culture.

Clinical trial number: Not applicable.

Keywords: Ethical leadership; Head nurses; Moral courage; Moral sensitivity; Nursing ethics.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study has received ethical approval from the Ethics Committee of the School of Nursing and Rehabilitation, Shandong University under the approval number (2023-180R) and complies with the Declaration of Helsinki. All participants were informed and signed informed consent before completing the questionnaire. Human ethics and content to participate: This study was approved by the School of Nursing and Rehabilitation of Shandong University, and the approval number was 2023-R-180. Consent for publication: Consent for publication was obtained from the participants. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual research model
Fig. 2
Fig. 2
Model of the moderating effects of moral sensitivity. Note: EL, ethical leadership; MS, moral sensitivity; MC, moral courage; *, P < 0.05; **, P < 0.01
See this image and copyright information in PMC

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