Evaluating the moral courage of nurses and its relationship with their caring behaviors

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In this regard, the present study aimed to determine the relationship between ethical courage and care behaviors of nurses in the year 2023. Method In this cross-sectional study, 146 nurses employed in educational hospitals in the city of Hamadan were selected using stratified sampling method. Data collection instruments included: a checklist of demographic characteristics, Sekerka and colleagues' Ethical Courage Questionnaire, and the Caregiver Behavior Inventory (CDI-25) questionnaire. Data were analyzed using SPSS 24 software and descriptive statistics, Pearson correlation coefficient, t-test, and ANOVA. Findings: The results showed that the majority of participating nurses were female (67.1%) and had a bachelor's degree (89%). The mean ± standard deviation of ethical courage and nurses' care behaviors were 9.26 ± 3.15 and 13.254 ± 101.164, respectively. Also, there was a significant and positive correlation between ethical courage and nurses' care behaviors (P < 0.001, r = 0.264). Conclusion Considering the direct relationship between ethical courage and care behaviors, it is recommended that relevant managers strive to promote ethical courage among all nurses by supporting and encouraging those who demonstrate ethical courage, thus playing an influential role in achieving a higher level of desired care behaviors. Ethical Courage Care Behaviors Nurses Introduction Nurses play a crucial and fundamental role in the quality of care delivery and the promotion of patient health as a significant workforce in hospitals and the healthcare system. They are considered essential members of the healthcare team, possessing knowledge, professional skills, and academic qualifications. Nurses are the primary caregivers responsible for upholding the ethics of patient care and are constantly confronted with ethical dilemmas and challenges ( 1 – 3 ). They serve as ethical agents in fulfilling professional commitments, managing ethical situations appropriately, preventing unethical conduct, and strongly advocating for patient-centered care within acceptable standards for patients, their families, and society. Therefore, they require ethical courage, which is a worthy characteristic in nurses ( 3 – 5 ). Ethical courage has a long history, emerging in response to ethical dilemmas, and is defined as a value and steadfastness in facing what is right ( 3 ). Ethical courage necessitates proper action based on conditional ethics values and personal criteria, enabling nurses to exert their utmost effort in achieving their ultimate goals. This includes adherence to ethical norms without disregarding social costs and fostering effective communication and collaboration with patients and physicians. Furthermore, it not only contributes to professional success but also aids in personal growth for nurses ( 6 ). The occurrence of ethical courage in nurses' decision-making prevents them from facing ethical and unethical dilemmas, ethical conflicts, and ensures the protection of ethical principles, thus providing safe care ( 7 , 8 ). Gallagher concludes that performance based on courage and ethical principles leads to less ethical inadequacy in clinical settings ( 9 ). The absence of ethical courage in nurses leads to problems such as compromising patient privacy, delivering bad news to patients, caring for infectious patients, and inadequate care by colleagues. In such circumstances, nurses require behaviors based on professional ethics principles to perform ethical actions without fear of negative reactions from colleagues, losing their professional status, ethical distress, depression, guilt, powerlessness, and experiencing a wide range of emotional reactions and violence ( 10 , 11 ). Nursing care is the foundation of the nursing profession and an essential component of quality healthcare. Nurses meet patients' health needs through their care behaviors. Nursing care behaviors encompass all the perceptions, beliefs, actions, thoughts, movements, gestures, and measures by which nurses care for patients, and these behaviors should be based on ethics. Nursing care behaviors are a combination of various nursing attitudes and actions that reduce patients' distress and address their unanticipated needs. Nursing care is a continuous process, and nurses spend the most time with patients among all healthcare team members, which exposes them to more suffering and ethical challenges. Therefore, it is essential for nurses to strengthen their ethical courage and ability to confront these challenges to provide desirable and ethically based care to patients.( 12 , 13 ). The essential role of nurses in the treatment and recovery of patients is evident. Given that the most significant interaction occurs between patients and nurses, it is evident that various ethical challenges exist. Making the right decision depends on nurses' courageous ethical behaviors to achieve patients' recovery. Discovering the relationship between ethical courage and nurses' care behaviors can pave the way for improving the quality of patient services. Hence, the present study was conducted to determine the ethical courage of nurses and its relationship with their care behaviors among nurses employed in educational hospitals in Hamadan. Method This cross-sectional study was conducted from June 2023 to December 2023 in educational hospitals in the city of Hamadan, a province in the southwest of Iran. Out of all nurses working in these hospitals, a total of 146 individuals were selected through stratified random sampling with proportional allocation from five affiliated educational hospitals of Hamadan University of Medical Sciences. The sample size was determined using the sample size formula and Pearson correlation coefficient test, considering a confidence interval of 95%, α = 0.05, power of 95%, and due to the lack of previous knowledge and studies, a pilot study with a sample size of 30 individuals was conducted to determine the required sample size for estimating the correlation coefficient. The inclusion criteria for the study included: having at least one year of work experience, absence of diseases related to neurological disorders and memory impairments, absence of psychosis and psychiatric disorders, willingness to cooperate, and holding at least a bachelor's degree. The exclusion criteria included incomplete or incomplete completion of the questionnaires. To collect data, a demographic characteristics form (including age, gender, marital status, work experience, weekly working hours, type of employment, and educational level) and the Sekerka and colleagues' Ethical Courage Questionnaire for Nurses and the Caregiver Behavior Inventory (CDI-25) questionnaire were used. The Ethical Courage Questionnaire for Nurses was developed by Sekerka and colleagues in 2009. This questionnaire consists of 15 questions and 5 subscales (ethical agent, multiple values, tolerance for risks or threats beyond obedience, and ethical goals) answered on a seven-point Likert scale, with a total score ranging from 15 to 105. Higher scores indicate higher levels of ethical courage ( 2 ). The reliability of this questionnaire was calculated by Cannon using Cronbach's alpha coefficient of 0.85. Its reliability was confirmed in Iran by Mahdaviseresht with a Cronbach's alpha of 0.81 ( 14 ). The Caregiver Behavior Inventory (CDI-25) questionnaire consists of 25 questions answered on a five-option Likert scale, assessing five subscales (physical-technical behaviors, inappropriate behaviors, psychosocial behaviors, professional behaviors, and unnecessary behaviors). Questions 3 and 16 of this questionnaire are reverse-scored. The minimum score for this tool is 25 and the maximum is 125 ( 15 ). The validity of the questionnaire was reported by Baljani et al. with Cronbach's alpha of 0.93 ( 16 ) . The research procedure involved obtaining ethical code from the Deputy of Research and Technology of Hamadan University of Medical Sciences and obtaining necessary permits. Selected nurses meeting the inclusion criteria were briefed on the study objectives, methodology, and procedures. Informed written consent was obtained from the participants. Next, data collection tools were provided to them. After completion by the participants, the questionnaires were collected. All data were checked for normality using Kolmogorov-Smirnov tests. Assuming normality, Pearson correlation coefficient, t-test, and ANOVA were employed for data analysis. All analyses were performed at a significance level of less than 0.05 using SPSS 24 software. Findings The results indicated that the majority of participating nurses in the study were female (67.1%), married (56.8%), holding a bachelor's degree (89%), and employed formally (39.7%). The mean age of the participants was 31.94 ± 7.01 years (Table 1 ). Table 1 Descriptive Statistics of Demographic Variables and Their Correlation with Ethical Courage and Nursing Care Behavior of Nurses (n = 146) Variable Frequency Percentage Ethical Courage Nursing Care Behavior Gender Female 98 67.1% 0.222 (Pb) 0.481 (Pb) Male 48 32.9% Marital Status Single 63 43.2% 0.613 (Pb) 0.501 (Pb) Married 83 56.8% Work Experience 1–5 years 56 38.4% 0.060 (Pc) 0.000 (Pc) 6–10 years 44 30.1% ˃ 10 years 46 31.5% Weekly Hours ˂ 30 hours 18 12.3% 0.898 (Pb) 0.044 (Pb) ˃ 30 hours 128 87.7% Employment Type Informal 88 60.3% 0.243 (Pc) 0.286 (Pc) Formal 58 39.7% Education B.Sc. 130 89.0% 0.756 (Pc) 0.791 (Pc) M.Sc. 15 10.3% Ph.D 1 0.7% Age 31.7 ± 6.31 0.194 (Pa) 0.001 (Pa) Pb = Pearson correlation coefficient for binary variables. Pc = Pearson correlation coefficient for categorical variables. Pa = Pearson correlation coefficient for continuous variables. a: Pearson correlation coefficient test b: Independent t-test c: ANOVA test Table 2 Descriptive statistics of scores for ethical courage and caregiving behaviors and their subscales, among nurses Variables Mean ± SD Upper limit - lower limit Moral courage Moral factor 12.78 ± 1.61 9–21 Multiple values 13.98 ± 2.07 10–21 Bearing risks or threats 13.60 ± 2.33 5–21 Beyond obedience 14.49 ± 3.82 3–21 Moral goals 15.47 ± 3.21 3–21 Total 70.32 ± 9.93 40–105 Caregiving Behaviors Physical-technical behaviors 45.18 ± 6.31 24–55 Inappropriate behaviors 6.51 ± 1.89 2–10 Psychosocial behaviors 40.66 ± 5.45 22–50 Professional behaviors 4.68 ± 3.37 1–44 Non-violent behaviors 4.14 ± 0.77 1–5 Total 101.16 ± 13.25 53–135 The mean scores for ethical courage and caregiving behaviors were 70.32 ± 9.93 and 101.16 ± 13.25, respectively (Table 2 ). Table 3 Pearson correlation matrix of ethical courage scores and nursing care behaviors in nurses Variables Caregiving Behaviors Physical-technical behaviors Inappropriate behaviors Psychosocial behaviors Professional behaviors Non-violent behaviors Moral courage p = 0.001 r = 0.26 P = 0.000 r = 0.30 p = 0.514 r = 0.09 p = 0.000 r = 0.30 p = 0.48 r=-0.06 p = 0.000 r = 0.40 Moral factor p = 0.002 r = 0.25 p = 0.001 r = 0.27 p = 0.493 r = 0.06 p = 0.002 r = 0.26 p = 0.996 r = 0.00 p = 0.006 r = 0.23 Multiple values p = 0.002 r = 0.26 p = 0.002 r = 0.26 p = 0.916 r = 0.009 p = 0.000 r = 0.30 p = 0.84 r = 0.02 p = 0.0001 r = 0.29 Bearing risks or threats p = 0.49 r = 0.06 p = 0.39 r = 0.07 p = 0.415 r = 0.07 p = 0.822 r = 0.02 p = 0.894 r=-0.01 p = 0.051 r = 0.16 Beyond obedience p = 0.02 r = 0.19 p = 0.009 r = 0.22 p = 0.187 r=-0.11 p = 0.003 r = 0.24 p = 0.61 r=-0.04 p = 0.001 r = 0.28 Moral goals p = 0.002 r = 0.25 p = 0.000 r = 0.10 p = 0.142 r = 0.26 p = 0.000 r = 0.29 p = 0.183 r=-0.11 p = 0.000 r = 0.33 To determine the relationship between ethical courage scores and nursing care behaviors, first, the normality of the data was assessed using the Kolmogorov-Smirnov test. Given the normal distribution of the data, Pearson correlation test was employed. According to the results of this test, a significant and direct correlation was observed between ethical courage scores and nursing care behaviors (P = 0.001, r = 0.26) (Table 3 ). Discussion This study aimed to determine the relationship between ethical courage and nursing care behaviors in nurses working in educational and therapeutic centers in Hamadan city. The results indicated that the level of ethical courage among nurses was at a high level. Similar to the findings of the present study, studies conducted by Huang et al., Luo et al., and Zheng et al. also reported high levels of ethical courage ( 17 – 19 ). The results of the study by Hakimi et al. were also consistent with the present study ( 20 ). According to the researchers of the present study, since a high percentage of participating nurses in both studies were formally employed in hospitals, it can be argued that factors such as high job security and organizational support may have contributed to higher levels of ethical courage among nurses in clinical settings. Previous studies have indicated that one of the inhibitory factors in ethical courage is job insecurity and fear of job loss ( 21 ). In the study by Lotfi-Bejestani et al., unlike the present study, the level of ethical courage was reported to be average ( 22 ). Hong et al. reported the level of moral courage of Chinese nurses to be lower than average, which is contrary to our study ( 23 ). Researchers believe that this difference could be attributed to the different nature of ethical challenges, particularly those faced by nurses in psychiatric wards, such as patients' involuntary behaviors, the risk of harm to oneself or others by patients in those wards, and challenges related to patient autonomy. Another influential factor in the difference in results could be the sample size, which was almost three times larger in the comparison study. The level of nursing care behaviors among nurses in the present study was higher than average. In this regard, studies by Basit et al., Assefa et al., Ozkan et al., and Karabey et al. also reported higher scores of nursing care behaviors than average ( 24 – 27 ). Seyyed Fatemi et al. also reported higher scores of nursing care behaviors than average ( 28 ). Since in both studies a significant number of nurses had less than 5 years of work experience, the higher scores of nursing care behaviors could possibly be attributed to the shorter distance between the learning units and the timing of their delivery in clinical settings. In the study by Babapour et al., unlike the present study, the level of nursing care behaviors was below average, which they attributed to various factors such as nursing education, job stress, and the high patient-to-nurse ratio ( 15 ). Finally, it was evident that there is a direct and significant relationship between nurses' ethical courage and their nursing care behaviors, which is consistent with the findings of the study by Taylan et al., indicating that nurses' ethical sensitivity can act as an effective predictor of their care behaviors ( 29 ). Similarly, in the study by Karabey et al., there was a positive and significant relationship between levels of moral intelligence and nursing care behaviors ( 26 ). In Kaya et al.'s study conducted on nursing students in Turkey in 2022, a positive and significant relationship was found between professional nursing values, ethical sensitivity, and nursing care behaviors ( 30 ). In a semi-experimental controlled study, training in ethical principles led to an increase in nursing care behavior scores ( 31 ). Given that the results of the reviewed studies indicate the influence of nurses' ethics and ethical atmosphere on their care behaviors, the researchers of this study believe that organizations' support and defense of nurses' developed ethical courage increase their motivation, leading to an increase in their ethical courage and subsequently better nursing care behaviors. One limitation of the present study is that it was specific to educational and therapeutic hospitals in Hamadan city, and its results may not be generalizable to nurses working in healthcare centers in other cities, private centers, and clinics. Conclusion The results of the present study indicated that the level of ethical courage and nursing care behaviors among nurses employed in educational and therapeutic hospitals in Hamadan city was higher than average. The findings showed a significant and direct relationship between ethical courage and nursing care behaviors, such that an increase in ethical courage was associated with an increase in nursing care behaviors. It seems that healthcare managers should support nurses who exhibit ethical courage and defend them against those who engage in unethical behaviors in the workplace in order to improve nursing care behaviors. This support will prevent nurses from hesitating to perform ethical behaviors, leading to higher and more desirable levels of nursing care behaviors. Abbreviations Caregiver Behavior Inventory= CDI Analysis of variance= ANOVA Declarations • Ethics approval and consent to participate This study was derived from a student project approved by the Research and Technology Deputy of Hamadan University of Medical Sciences with project number 140203302447 and ethics code IR.UMSHA.REC.1402.126.. • Consent for publication Consent for publication has been obtained by Hamadan University of Medical Sciences. Written consent was obtained from all participants. This study does not contain any identifying images or personal or clinical details of participants that would compromise anonymity. • Availability of data and materials Data and materials are available upon request. • Competing Interests There is no conflict of interest among the authors of this article. • Funding This study was financially supported by Hamadan University of Medical Sciences. The role of the funding body was in the design of the study and collection, analysis, interpretation of data, and the writing of the manuscript. • Authors' contributions AF, ABS, KA, SY, AP conceived and designed the study. AF and AP performed the data generation. AF, ABS, KA, and SY analyzed and interpreted data generation. All authors Contributed reagents, materials, analysis data; wrote the paper • Acknowledgements The authors would like to express their gratitude to the respected Research and Technology Deputy of Hamadan University of Medical Sciences and all participants in the study. References Mirzadeh S, Asgharzadeh A. Developing human resources empowerment model in the nursing practice: A qualitative study. 2021. Pakizekho S, Barkhordari-Sharifabad M. The relationship between ethical leadership, conscientiousness, and moral courage from nurses’ perspective. BMC Nurs. 2022;21(1):164. Safarpour H, Ghazanfarabadi M, Varasteh S, Bazyar J, Fuladvandi M, Malekyan L. 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Perspect Psychiatr Care. 2021;57(2):734–46. Kaya A, Düzgün MV, Boz İ. The relationship between professional values, ethical sensitivities and caring behaviors among nursing students: A structural equation modeling approach. Nurse Educ Pract. 2023;70:103676. Bagherzadeh M, Jafari H, Charati JY, Shafipour V. The effect of an empowerment program on the moral sensitivity and caring behaviors of emergency nurses in Iran. Nurse Educ Pract. 2021;57:103243. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4197135","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":288558212,"identity":"1eb3fa87-3fee-433f-bcac-bc16072c54d4","order_by":0,"name":"Fatemeh Abbasi","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Abbasi","suffix":""},{"id":288558214,"identity":"aaad515b-c788-4f5d-9882-68855a3ab6d7","order_by":1,"name":"Arezou Karampourian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYFACNgTzAEMFkJSAcHiI1HKGVC0MjG0ILTgBfwNb4ueKmm15/BK5Dw8XzjscLT+7+QHDjxoGGfMG7FokDrAdljxz7Hax5Ix0g8Mztx3O3XDnmAFjzzEGHpkDOKw5wN4g2cB2O3HDjTSGw7wgLRIJBgy8DQw8uBwof4C9+WfDP5iWOYdz589I/8D4F48WgwNsxyQb22BaGg7nNtzIMWDGZ4vhYbY0y8Y+oF96njEc5jmWnrvhRk7BYZljEji1yB1vM77Z8O12Hj97GvNnnhprkMM2PnxTY2OPM7CZIVQCapgQjh10LaNgFIyCUTAKkAEA70JcCcLafGcAAAAASUVORK5CYII=","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Arezou","middleName":"","lastName":"Karampourian","suffix":""},{"id":288558217,"identity":"9db7da6d-70d4-4239-82dd-0bd980d4dcae","order_by":2,"name":"Sajjad Amiri Bonyad","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sajjad","middleName":"Amiri","lastName":"Bonyad","suffix":""},{"id":288558218,"identity":"be919afc-8b43-46ef-bc1f-05810064cb28","order_by":3,"name":"Yahya Shadi","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Yahya","middleName":"","lastName":"Shadi","suffix":""},{"id":288558219,"identity":"9a731be7-3091-48a2-b0d3-2eecf8d6c18f","order_by":4,"name":"Pouneh Ashbeh","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Pouneh","middleName":"","lastName":"Ashbeh","suffix":""}],"badges":[],"createdAt":"2024-03-31 21:44:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4197135/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4197135/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74981790,"identity":"9f274010-9738-4f4e-83fe-213eb9c46b8f","added_by":"auto","created_at":"2025-01-29 05:01:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":659289,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4197135/v1/00ba27fb-d051-4a32-b721-d8a479f82e48.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating the moral courage of nurses and its relationship with their caring behaviors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNurses play a crucial and fundamental role in the quality of care delivery and the promotion of patient health as a significant workforce in hospitals and the healthcare system. They are considered essential members of the healthcare team, possessing knowledge, professional skills, and academic qualifications. Nurses are the primary caregivers responsible for upholding the ethics of patient care and are constantly confronted with ethical dilemmas and challenges (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). They serve as ethical agents in fulfilling professional commitments, managing ethical situations appropriately, preventing unethical conduct, and strongly advocating for patient-centered care within acceptable standards for patients, their families, and society. Therefore, they require ethical courage, which is a worthy characteristic in nurses (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEthical courage has a long history, emerging in response to ethical dilemmas, and is defined as a value and steadfastness in facing what is right (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Ethical courage necessitates proper action based on conditional ethics values and personal criteria, enabling nurses to exert their utmost effort in achieving their ultimate goals. This includes adherence to ethical norms without disregarding social costs and fostering effective communication and collaboration with patients and physicians. Furthermore, it not only contributes to professional success but also aids in personal growth for nurses (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The occurrence of ethical courage in nurses' decision-making prevents them from facing ethical and unethical dilemmas, ethical conflicts, and ensures the protection of ethical principles, thus providing safe care (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Gallagher concludes that performance based on courage and ethical principles leads to less ethical inadequacy in clinical settings (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The absence of ethical courage in nurses leads to problems such as compromising patient privacy, delivering bad news to patients, caring for infectious patients, and inadequate care by colleagues. In such circumstances, nurses require behaviors based on professional ethics principles to perform ethical actions without fear of negative reactions from colleagues, losing their professional status, ethical distress, depression, guilt, powerlessness, and experiencing a wide range of emotional reactions and violence (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNursing care is the foundation of the nursing profession and an essential component of quality healthcare. Nurses meet patients' health needs through their care behaviors. Nursing care behaviors encompass all the perceptions, beliefs, actions, thoughts, movements, gestures, and measures by which nurses care for patients, and these behaviors should be based on ethics. Nursing care behaviors are a combination of various nursing attitudes and actions that reduce patients' distress and address their unanticipated needs. Nursing care is a continuous process, and nurses spend the most time with patients among all healthcare team members, which exposes them to more suffering and ethical challenges. Therefore, it is essential for nurses to strengthen their ethical courage and ability to confront these challenges to provide desirable and ethically based care to patients.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe essential role of nurses in the treatment and recovery of patients is evident. Given that the most significant interaction occurs between patients and nurses, it is evident that various ethical challenges exist. Making the right decision depends on nurses' courageous ethical behaviors to achieve patients' recovery. Discovering the relationship between ethical courage and nurses' care behaviors can pave the way for improving the quality of patient services. Hence, the present study was conducted to determine the ethical courage of nurses and its relationship with their care behaviors among nurses employed in educational hospitals in Hamadan.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThis cross-sectional study was conducted from June 2023 to December 2023 in educational hospitals in the city of Hamadan, a province in the southwest of Iran. Out of all nurses working in these hospitals, a total of 146 individuals were selected through stratified random sampling with proportional allocation from five affiliated educational hospitals of Hamadan University of Medical Sciences. The sample size was determined using the sample size formula and Pearson correlation coefficient test, considering a confidence interval of 95%, \u0026alpha;\u0026thinsp;=\u0026thinsp;0.05, power of 95%, and due to the lack of previous knowledge and studies, a pilot study with a sample size of 30 individuals was conducted to determine the required sample size for estimating the correlation coefficient.\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" height=\"62\" width=\"209\"\u003e\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for the study included: having at least one year of work experience, absence of diseases related to neurological disorders and memory impairments, absence of psychosis and psychiatric disorders, willingness to cooperate, and holding at least a bachelor\u0026apos;s degree. The exclusion criteria included incomplete or incomplete completion of the questionnaires.\u003c/p\u003e\n\u003cp\u003eTo collect data, a demographic characteristics form (including age, gender, marital status, work experience, weekly working hours, type of employment, and educational level) and the Sekerka and colleagues\u0026apos; Ethical Courage Questionnaire for Nurses and the Caregiver Behavior Inventory (CDI-25) questionnaire were used.\u003c/p\u003e\n\u003cp\u003eThe Ethical Courage Questionnaire for Nurses was developed by Sekerka and colleagues in 2009. This questionnaire consists of 15 questions and 5 subscales (ethical agent, multiple values, tolerance for risks or threats beyond obedience, and ethical goals) answered on a seven-point Likert scale, with a total score ranging from 15 to 105. Higher scores indicate higher levels of ethical courage (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e). The reliability of this questionnaire was calculated by Cannon using Cronbach\u0026apos;s alpha coefficient of 0.85. Its reliability was confirmed in Iran by Mahdaviseresht with a Cronbach\u0026apos;s alpha of 0.81 (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe Caregiver Behavior Inventory (CDI-25) questionnaire consists of 25 questions answered on a five-option Likert scale, assessing five subscales (physical-technical behaviors, inappropriate behaviors, psychosocial behaviors, professional behaviors, and unnecessary behaviors). Questions 3 and 16 of this questionnaire are reverse-scored. The minimum score for this tool is 25 and the maximum is 125 (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e). The validity of the questionnaire was reported by Baljani et al. with Cronbach\u0026apos;s alpha of 0.93 (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e) .\u003c/p\u003e\n\u003cp\u003eThe research procedure involved obtaining ethical code from the Deputy of Research and Technology of Hamadan University of Medical Sciences and obtaining necessary permits. Selected nurses meeting the inclusion criteria were briefed on the study objectives, methodology, and procedures. Informed written consent was obtained from the participants. Next, data collection tools were provided to them. After completion by the participants, the questionnaires were collected. All data were checked for normality using Kolmogorov-Smirnov tests. Assuming normality, Pearson correlation coefficient, t-test, and ANOVA were employed for data analysis. All analyses were performed at a significance level of less than 0.05 using SPSS 24 software.\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eThe results indicated that the majority of participating nurses in the study were female (67.1%), married (56.8%), holding a bachelor's degree (89%), and employed formally (39.7%). The mean age of the participants was 31.94\u0026thinsp;\u0026plusmn;\u0026thinsp;7.01 years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive Statistics of Demographic Variables and Their Correlation with Ethical Courage and Nursing Care Behavior of Nurses (n\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEthical Courage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNursing Care Behavior\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.222 (Pb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.481 (Pb)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.613 (Pb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.501 (Pb)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWork Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.060 (Pc)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000 (Pc)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e˃ 10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWeekly Hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e˂ 30 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.898 (Pb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.044 (Pb)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e˃ 30 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmployment Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInformal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.243 (Pc)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.286 (Pc)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB.Sc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.756 (Pc)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.791 (Pc)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM.Sc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePh.D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e31.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.194 (Pa)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001 (Pa)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePb\u0026thinsp;=\u0026thinsp;Pearson correlation coefficient for binary variables.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePc\u0026thinsp;=\u0026thinsp;Pearson correlation coefficient for categorical variables.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePa\u0026thinsp;=\u0026thinsp;Pearson correlation coefficient for continuous variables.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ea: Pearson correlation coefficient test b: Independent t-test c: ANOVA test\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics of scores for ethical courage and caregiving behaviors and their subscales, among nurses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUpper limit - lower limit\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eMoral courage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMoral factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultiple values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBearing risks or threats\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeyond obedience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.49\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMoral goals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e70.32\u0026thinsp;\u0026plusmn;\u0026thinsp;9.93\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e40\u0026ndash;105\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eCaregiving Behaviors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical-technical behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.18\u0026thinsp;\u0026plusmn;\u0026thinsp;6.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u0026ndash;55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInappropriate behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychosocial behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.66\u0026thinsp;\u0026plusmn;\u0026thinsp;5.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-violent behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e101.16\u0026thinsp;\u0026plusmn;\u0026thinsp;13.25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e53\u0026ndash;135\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean scores for ethical courage and caregiving behaviors were 70.32\u0026thinsp;\u0026plusmn;\u0026thinsp;9.93 and 101.16\u0026thinsp;\u0026plusmn;\u0026thinsp;13.25, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson correlation matrix of ethical courage scores and nursing care behaviors in nurses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCaregiving Behaviors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysical-technical behaviors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInappropriate behaviors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePsychosocial behaviors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eProfessional behaviors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNon-violent behaviors\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMoral courage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.514\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.48\u003c/p\u003e \u003cp\u003er=-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoral factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.493\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.996\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.006\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple values\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.916\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.84\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0001\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBearing risks or threats\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.49\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.39\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.415\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.822\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.894\u003c/p\u003e \u003cp\u003er=-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.051\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeyond obedience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.02\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.009\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.187\u003c/p\u003e \u003cp\u003er=-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.003\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.61\u003c/p\u003e \u003cp\u003er=-0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoral goals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.142\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.183\u003c/p\u003e \u003cp\u003er=-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTo determine the relationship between ethical courage scores and nursing care behaviors, first, the normality of the data was assessed using the Kolmogorov-Smirnov test. Given the normal distribution of the data, Pearson correlation test was employed. According to the results of this test, a significant and direct correlation was observed between ethical courage scores and nursing care behaviors (P\u0026thinsp;=\u0026thinsp;0.001, r\u0026thinsp;=\u0026thinsp;0.26) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e This study aimed to determine the relationship between ethical courage and nursing care behaviors in nurses working in educational and therapeutic centers in Hamadan city. The results indicated that the level of ethical courage among nurses was at a high level. Similar to the findings of the present study, studies conducted by Huang et al., Luo et al., and Zheng et al. also reported high levels of ethical courage (\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The results of the study by Hakimi et al. were also consistent with the present study (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). According to the researchers of the present study, since a high percentage of participating nurses in both studies were formally employed in hospitals, it can be argued that factors such as high job security and organizational support may have contributed to higher levels of ethical courage among nurses in clinical settings. Previous studies have indicated that one of the inhibitory factors in ethical courage is job insecurity and fear of job loss (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In the study by Lotfi-Bejestani et al., unlike the present study, the level of ethical courage was reported to be average (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Hong et al. reported the level of moral courage of Chinese nurses to be lower than average, which is contrary to our study (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Researchers believe that this difference could be attributed to the different nature of ethical challenges, particularly those faced by nurses in psychiatric wards, such as patients' involuntary behaviors, the risk of harm to oneself or others by patients in those wards, and challenges related to patient autonomy. Another influential factor in the difference in results could be the sample size, which was almost three times larger in the comparison study.\u003c/p\u003e \u003cp\u003eThe level of nursing care behaviors among nurses in the present study was higher than average. In this regard, studies by Basit et al., Assefa et al., Ozkan et al., and Karabey et al. also reported higher scores of nursing care behaviors than average (\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Seyyed Fatemi et al. also reported higher scores of nursing care behaviors than average (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Since in both studies a significant number of nurses had less than 5 years of work experience, the higher scores of nursing care behaviors could possibly be attributed to the shorter distance between the learning units and the timing of their delivery in clinical settings. In the study by Babapour et al., unlike the present study, the level of nursing care behaviors was below average, which they attributed to various factors such as nursing education, job stress, and the high patient-to-nurse ratio (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, it was evident that there is a direct and significant relationship between nurses' ethical courage and their nursing care behaviors, which is consistent with the findings of the study by Taylan et al., indicating that nurses' ethical sensitivity can act as an effective predictor of their care behaviors (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Similarly, in the study by Karabey et al., there was a positive and significant relationship between levels of moral intelligence and nursing care behaviors (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In Kaya et al.'s study conducted on nursing students in Turkey in 2022, a positive and significant relationship was found between professional nursing values, ethical sensitivity, and nursing care behaviors (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In a semi-experimental controlled study, training in ethical principles led to an increase in nursing care behavior scores (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Given that the results of the reviewed studies indicate the influence of nurses' ethics and ethical atmosphere on their care behaviors, the researchers of this study believe that organizations' support and defense of nurses' developed ethical courage increase their motivation, leading to an increase in their ethical courage and subsequently better nursing care behaviors.\u003c/p\u003e \u003cp\u003eOne limitation of the present study is that it was specific to educational and therapeutic hospitals in Hamadan city, and its results may not be generalizable to nurses working in healthcare centers in other cities, private centers, and clinics.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of the present study indicated that the level of ethical courage and nursing care behaviors among nurses employed in educational and therapeutic hospitals in Hamadan city was higher than average. The findings showed a significant and direct relationship between ethical courage and nursing care behaviors, such that an increase in ethical courage was associated with an increase in nursing care behaviors. It seems that healthcare managers should support nurses who exhibit ethical courage and defend them against those who engage in unethical behaviors in the workplace in order to improve nursing care behaviors. This support will prevent nurses from hesitating to perform ethical behaviors, leading to higher and more desirable levels of nursing care behaviors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCaregiver Behavior Inventory= CDI\u003c/p\u003e\n\u003cp\u003eAnalysis of variance= ANOVA\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u0026bull; Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was derived from a student project approved by the Research and Technology Deputy of Hamadan University of Medical Sciences with project number 140203302447 and ethics code IR.UMSHA.REC.1402.126..\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026bull; Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publication has been obtained by Hamadan University of Medical Sciences. Written consent was obtained from all participants. This study does not contain any identifying images or personal or clinical details of participants that would compromise anonymity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026bull; Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and materials are available upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026bull; Competing Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest among the authors of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026bull; Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was financially supported by Hamadan University of Medical Sciences.\u0026nbsp;The role of the funding body was in the design of the study and collection, analysis, interpretation of data, and the writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026bull; Authors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAF, ABS, KA, SY, AP conceived and designed the study. AF and AP performed the data generation. AF, ABS, KA, and SY analyzed and interpreted data generation. All authors Contributed reagents, materials, analysis data; wrote the paper\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e\u0026bull;\u0026nbsp;\u003c/strong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to the respected Research and Technology Deputy of Hamadan University of Medical Sciences and all participants in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMirzadeh S, Asgharzadeh A. Developing human resources empowerment model in the nursing practice: A qualitative study. 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePakizekho S, Barkhordari-Sharifabad M. The relationship between ethical leadership, conscientiousness, and moral courage from nurses\u0026rsquo; perspective. 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Nurse Educ Pract. 2021;57:103243.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ethical Courage, Care Behaviors, Nurses","lastPublishedDoi":"10.21203/rs.3.rs-4197135/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4197135/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and Aim:\u003c/h2\u003e \u003cp\u003e Nurses need ethical courage to make correct decisions in various clinical situations and to engage in proper care behaviors based on ethical principles. In this regard, the present study aimed to determine the relationship between ethical courage and care behaviors of nurses in the year 2023.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, 146 nurses employed in educational hospitals in the city of Hamadan were selected using stratified sampling method. Data collection instruments included: a checklist of demographic characteristics, Sekerka and colleagues' Ethical Courage Questionnaire, and the Caregiver Behavior Inventory (CDI-25) questionnaire. Data were analyzed using SPSS 24 software and descriptive statistics, Pearson correlation coefficient, t-test, and ANOVA.\u003c/p\u003e\u003ch2\u003eFindings:\u003c/h2\u003e \u003cp\u003eThe results showed that the majority of participating nurses were female (67.1%) and had a bachelor's degree (89%). The mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation of ethical courage and nurses' care behaviors were 9.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15 and 13.254\u0026thinsp;\u0026plusmn;\u0026thinsp;101.164, respectively. Also, there was a significant and positive correlation between ethical courage and nurses' care behaviors (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, r\u0026thinsp;=\u0026thinsp;0.264).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eConsidering the direct relationship between ethical courage and care behaviors, it is recommended that relevant managers strive to promote ethical courage among all nurses by supporting and encouraging those who demonstrate ethical courage, thus playing an influential role in achieving a higher level of desired care behaviors.\u003c/p\u003e","manuscriptTitle":"Evaluating the moral courage of nurses and its relationship with their caring behaviors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-09 09:41:19","doi":"10.21203/rs.3.rs-4197135/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a874d320-4c59-4a62-b068-6c9c6ea20538","owner":[],"postedDate":"April 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-29T04:53:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-09 09:41:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4197135","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4197135","identity":"rs-4197135","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}