Date of Award


Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Joan Kearney


Problem Nurses working on the frontlines in Labor and Delivery and Radiology face moral challenges in the workplace. It can be difficult for theses nurses to take morally courageous action when they lack the knowledge, skills and confidence to do so successfully. The goal of this DNP project was to enable nurses in labor and delivery and radiology settings to practice moral courage by examining relevant skillsets and providing training in core concepts. The program's intent was to support a moral culture and contribute to the retention of frontline nurses and improved safe patient care. Methods This project had three AIMS; (1) To develop a moral courage training program for nurses. (2) To implement and evaluate the program. (3) To make recommendations to stakeholders in the partner organizations with the goal of integration and scaling for broader initiatives promoting a culture of morality A moral courage course was developed based on “Giving Voice to Values” written by Mary Gentile (Gentile, 2009). The course was modified to address the specific work setting of frontline nurses. This training we taught in four-hour virtual sessions via Zoom: Video Conferencing software. Interactive discussion, reflection, and participant activities were the teaching methods utilized in this training. This program used the essential components in curriculum implementation based on the Strategic Instruction Model (Hoover, 2010) as an evidenced based instructional foundational method. The pre- and post-curriculum instrument utilized for assessment was The Nurses Moral Courage Scale (NMCS) in whole and in part respectively (Numminen et al., 2019). This instrument is unique and was selected because it was explicitly designed for nurses to as a scale to measure nurses' moral courage (Numminen et al., 2019). The NMCS categorizes responses into four categories: 1) compassion and true presence, 2) moral responsibility, 3) moral integrity, and 4) commitment to good care (Numminen et al., 2019). Results The project results were evaluated using Kirkpatrick’s Levels of Evaluation (Kirkpatrick, 2007). Kirkpatrick includes four levels of evaluation; (1) Reaction – Engagement, relevance, satisfaction; (2) Learning- Knowledge, skills, attitude, confidence, commitment; (3) Participation and transformation – Confidence, transformation of behavior; (4) Results – Leading indicators, desired outcomes, analyze, disseminate. When the pre course data was compared to the post course data, an overall improvement in the nurse’s willingness to perform acts of moral courage was shown. Conclusion The use of the moral courage in nurses is needed in the health care setting especially with front line nurses where acts of moral courage keep patients safe and maintain a psychological safe environment. It is critical to have nurses who have the skills, knowledge and confidence to be morally courageous when moral challenges present themselves. This moral courage training for nurses was successful in providing nurses with the skills, knowledge and confidence to feel they will be able to improve their ability to morally courageous when needed, for themselves, their colleagues and especially their patients.


Per the author's request, this thesis is now an open access thesis as of 08-28-2023.

Open Access

This Article is Open Access