moral distress and moral courage among iraqi nurses during the covid-19 pandemic: a cross-sectional study

In the years following its outbreak in 2019, covid-19 changed the health-care system structures, the context of professional activity, and nurses’ moral performance. the present study aimed to examine the moral distress and moral courage of iraqi nurses during the covid-19 pandemic. this cross-sectional and correlational study was conducted in 2021 on 168 nurses selected by convenience sampling methods. data were collected by self-reported instruments including a demographic questionnaire, the professional moral courage (pmc), and the moral distress scale (mds). data were analysed using descriptive statistics, the spearman, mann-whitney and kruskal-wallis tests, and spss version 22. most nurses showed a moderate level of moral distress (98.80%) and a high level of moral courage (99.40%).the dimension of multiple values had the highest mean (12.45 ± 1.47) and endurance of threats had the lowest mean (9.15 ± 1.79). there was a statistically significant correlation between moral distress and moral courage (p = 0.007, r = - 0.2), and moral distress and the dimensions of endurance of threat (p < 0.001, r = - 0.26), going beyond compliance (p < 0.001, r = - 0.037), and moral goals (p < 0.001, r = - 0.173). a statistically significant relationship was also found between moral distress and work shift, position and gender (p < 0.05), and between moral courage and position (p < 0.05). we concluded that nurses need more organizational support in terms of protective facilities, job security and organizational incentives to be able to show ethical behaviors.