Moral courage in nursing students before internship: A network analysis

Abstract

Background Moral courage helps nursing students respond to ethically difficult situations, yet little is known about how its dimensions relate to ethical sensitivity, professional identity, and emotional intelligence at the dimension level. Research objective This study examined the dimension-level network structure of moral courage, ethical sensitivity, professional identity, and emotional intelligence among undergraduate nursing students. Research design A cross-sectional online survey was conducted. Dimension scores were standardized and analyzed with an EBICglasso Gaussian graphical model. Strength and bridge centrality were estimated, and network accuracy and stability were assessed using bootstrap procedures. Participants and research context Participants were 494 full-time third-year undergraduate nursing students from one university who were approaching a mandatory clinical internship. Ethical considerations This study was approved by the ethics committee of North China University of Science and Technology(approval no. 2024185). Informed consent was obtained from all participants. Results The network included 16 nodes and 51 non-zero edges. Within moral courage, moral integrity showed two of the largest conditional associations, with compassion and true presence with the patient (0.383) and moral responsibility (0.369). Cross-community associations were generally smaller. Compassion and true presence with the patient had the highest bridge expected influence point estimate (0.180), whereas social comparison and self-reflection had the highest bridge strength (0.207). The leading bridge expected influence estimates were close. Correlation stability coefficients were 0.749 for strength, 0.516 for bridge expected influence, and 0.439 for bridge strength, warranting cautious interpretation. Conclusion Among nursing students approaching clinical internship, moral courage showed relatively strong within-community associations and smaller cross-community associations with related constructs. Different bridge rankings indicated that cross-community connectivity was not concentrated in a single consistently highest-ranked dimension. These findings support longitudinal and educational research during the transition to clinical practice.