The Association Between Moral Courage, Psychological Resilience, and Workplace Violence Among Emergency Department Nurses in China: A Structural Equation Model

AIM: The objective of this study is to examine the association between moral courage, psychological resilience, and the occurrence of workplace violence among emergency department nurses. BACKGROUND: Workplace violence represents a major occupational hazard in healthcare institutions worldwide. Moral courage refers to nurses' ability to make principled decisions when facing ethical conflicts, thereby avoiding moral distress. Psychological resilience is defined as an individual's positive internal capacity to cope with adversity and stress. Such violent incidents severely undermine nurses' physical and mental well-being, while moral courage plays a pivotal role in enhancing nurses' psychological resilience and improving their mental health. However, the underlying mechanism through which moral courage influences nurses' experiences of workplace violence remains unexplored. METHODS: This study surveyed 325 emergency nurses in Liaoning Province, China, using the Nurses' General Information Form, the Nurses' Moral Courage Scale, the Psychological Resilience Scale, and the Workplace Violence Scale. Descriptive analysis, correlation analysis, and analysis of influencing factors were conducted using SPSS 27.0, while AMOS 27.0 was employed for the verification and analysis of structural equation modeling. RESULTS: The final model explained 35.0% of the total variance in workplace violence among emergency department nurses. Moral courage had a positive impact on psychological resilience, with a path coefficient β = 0.710 (t = 15.347, p < 0.001). Psychological resilience negatively predicted workplace violence, with a path coefficient β = -0.210 (t = -2.466, p = 0.014). Similarly, moral courage negatively predicted workplace violence, with a path coefficient β = -0.231 (t = -2.709, p = 0.007). Psychological resilience played a partial mediating role between moral courage and workplace violence, accounting for 35.89% of the mediating effect. CONCLUSIONS: This study employed structural equation modeling and found a significant negative correlation between moral courage and workplace violence, as well as a partial mediating effect of psychological resilience in the relationship between moral courage and workplace violence. IMPLICATIONS FOR NURSING MANAGEMENT: In the future, training measures can be developed from enhancing nurses' moral courage and psychological resilience, and constantly optimize and improve the existing interventions. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.