Abstract
Morals are norms of conduct, behaviour and guidelines that nurses must uphold and observe in the nursing profession. Morals require nurses and nursing students to have respect for human rights and dignity, and sound ethical judgement. However, when nursing students witness and fail to prevent acts that transgress their deeply held moral beliefs, their moral code is damaged, leaving deep emotional wounds that lead to moral injury. The purpose of this study was to investigate the prevalence and effects of moral injury in nursing students at a higher education institution in Gauteng.
A quantitative, non-experimental research design and a descriptive cross-sectional survey research method was employed. Data were collected from a population of undergraduate nursing students of all four-year study levels, who were registered to undergo education and training at a Higher Education Institution in the province of Gauteng, South Africa using the modified and adapted Moral Injury Symptom Scale – Healthcare Professionals questionnaire. The total population sampling method was applied to select the sample, resulting in 124 respondents (n=124) as the sample size.
The ethical principles of autonomy, beneficence, non-maleficence and justice were adhered to throughout the research process. The study information and the researcher's contact details were given to the respondents. They also received a consent form that they had to sign before taking part in the study. Participation was anonymous. The Statistical Package for the Social Sciences (SPSS) software version 28.0 was employed to analyse inferential and descriptive statistics. Data analysis involved descriptive and inferential statistics. The descriptive statistics summarised the data using numbers, percentages, means and standard deviations. The inferential statistics tested the correlations and provided interpretations of the constructs related to moral injury.
The results showed that 34% of the respondents experienced moral injury. The researcher concluded that nursing students who encountered moral injury demonstrated a decline in academic performance. The recommendations of this study included implementation of a module that specifically addresses the concepts of moral resilience, moral courage and spiritual well-being in ethics education and regular assessments of moral and ethical
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competency in nursing students and professional nurses. These strategies will assist in the identification of areas of strength and improvement in addressing ethical dilemmas in the pursuit of preventing moral injury.
Key words: moral injury, nursing students, poor academic perfomance, moral distress, anxiety, depression