The mediating role of moral courage in the relationship between ethical leadership and error reporting behavior among nurses in Saudi Arabia: a structural equation modeling approach
Abstract Background Ethical leadership in nursing is pivotal for fostering a transparent workplace culture and encouraging error reporting, a critical behavior for enhancing patient safety. In Saudi Arabia, cultural and organizational factors may influence nurses’ willingness to report errors, makin...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-04-01
|
| Series: | BMC Nursing |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12912-025-03043-7 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850201227539775488 |
|---|---|
| author | Ebtisam A. Elhihi Khadija Lafi Aljarary Maha Alahmadi Jawaher Bakor Adam Ohud Atiah Almwualllad Marwan S. Hawsawei Abdulmajid Ahmad Hamza Ibrahim Abdullatif Ibrahim |
| author_facet | Ebtisam A. Elhihi Khadija Lafi Aljarary Maha Alahmadi Jawaher Bakor Adam Ohud Atiah Almwualllad Marwan S. Hawsawei Abdulmajid Ahmad Hamza Ibrahim Abdullatif Ibrahim |
| author_sort | Ebtisam A. Elhihi |
| collection | DOAJ |
| description | Abstract Background Ethical leadership in nursing is pivotal for fostering a transparent workplace culture and encouraging error reporting, a critical behavior for enhancing patient safety. In Saudi Arabia, cultural and organizational factors may influence nurses’ willingness to report errors, making this an essential area of study. This study investigates the correlation between ethical leadership and error reporting behavior, emphasizing the mediating influence of moral courage among nurses in Saudi Arabia. Methods This cross-sectional research used a simple random sampling technique to recruit 269 clinical nurses from four specialized medical centers affiliated with King Abdullah Medical City in Makkah, Saudi Arabia. Data was collected between October and December 2024 using online self-reported questionnaires that included validated scales for ethical leadership, moral courage, error reporting, and demographic information form. This study was conducted in accordance with the STROBE guidelines. Structural equation modeling was used to investigate hypothesized relationships. Results Ethical leadership significantly impacted error reporting behavior (β = 0.58, p < 0.001) and ethical courage (β = 0.35, p < 0.001). Moral courage was a significant predictor of error reporting behavior (β = 0.30, p = 0.01) and partially mediates the link between ethical leadership and error reporting (β = 0.11, p = 0.01). The total effect of ethical leadership on error reporting behavior was substantial (β = 0.69), with a BC 95% CI of (0.51, 0.89). Conclusions The findings highlight the critical role of ethical leadership in fostering moral courage and promoting error reporting behavior among nurses. The mediation effect of moral courage underscores the importance of cultivating an ethical work environment that empowers nurses to act with integrity and report errors without fear of retaliation. These insights emphasize the need for nursing managers to prioritize ethical leadership practices and create transparent workplace cultures that enhance patient safety. By addressing cultural and organizational barriers, healthcare institutions in Saudi Arabia can further encourage error reporting, ultimately improving the quality of care and patient outcomes. |
| format | Article |
| id | doaj-art-26d2925cdebb4f0f8d8f8bf85ac196e9 |
| institution | OA Journals |
| issn | 1472-6955 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nursing |
| spelling | doaj-art-26d2925cdebb4f0f8d8f8bf85ac196e92025-08-20T02:12:03ZengBMCBMC Nursing1472-69552025-04-0124111210.1186/s12912-025-03043-7The mediating role of moral courage in the relationship between ethical leadership and error reporting behavior among nurses in Saudi Arabia: a structural equation modeling approachEbtisam A. Elhihi0Khadija Lafi Aljarary1Maha Alahmadi2Jawaher Bakor Adam3Ohud Atiah Almwualllad4Marwan S. Hawsawei5Abdulmajid Ahmad Hamza6Ibrahim Abdullatif Ibrahim7Nursing Research and Evidence-Based Practice Department, King Abdullah Medical CityNursing Manager of Critical Care Units, King Abdullah Medical CityHead Nurse of Intensive Care Unit, King Abdullah Medical CityNursing professionals development department, King Abdullah Medical CityCardiac surgery intensive care unit, King Abdullah Medical CityNursing Administration, King Abdullah Medical CityNursing supplies coordinator, King Abdullah Medical CityDepartment of Nursing, College of Applied Medical Sciences, Shaqra UniversityAbstract Background Ethical leadership in nursing is pivotal for fostering a transparent workplace culture and encouraging error reporting, a critical behavior for enhancing patient safety. In Saudi Arabia, cultural and organizational factors may influence nurses’ willingness to report errors, making this an essential area of study. This study investigates the correlation between ethical leadership and error reporting behavior, emphasizing the mediating influence of moral courage among nurses in Saudi Arabia. Methods This cross-sectional research used a simple random sampling technique to recruit 269 clinical nurses from four specialized medical centers affiliated with King Abdullah Medical City in Makkah, Saudi Arabia. Data was collected between October and December 2024 using online self-reported questionnaires that included validated scales for ethical leadership, moral courage, error reporting, and demographic information form. This study was conducted in accordance with the STROBE guidelines. Structural equation modeling was used to investigate hypothesized relationships. Results Ethical leadership significantly impacted error reporting behavior (β = 0.58, p < 0.001) and ethical courage (β = 0.35, p < 0.001). Moral courage was a significant predictor of error reporting behavior (β = 0.30, p = 0.01) and partially mediates the link between ethical leadership and error reporting (β = 0.11, p = 0.01). The total effect of ethical leadership on error reporting behavior was substantial (β = 0.69), with a BC 95% CI of (0.51, 0.89). Conclusions The findings highlight the critical role of ethical leadership in fostering moral courage and promoting error reporting behavior among nurses. The mediation effect of moral courage underscores the importance of cultivating an ethical work environment that empowers nurses to act with integrity and report errors without fear of retaliation. These insights emphasize the need for nursing managers to prioritize ethical leadership practices and create transparent workplace cultures that enhance patient safety. By addressing cultural and organizational barriers, healthcare institutions in Saudi Arabia can further encourage error reporting, ultimately improving the quality of care and patient outcomes.https://doi.org/10.1186/s12912-025-03043-7CourageLeadershipOrganizational culturePatient safetySaudi Arabia |
| spellingShingle | Ebtisam A. Elhihi Khadija Lafi Aljarary Maha Alahmadi Jawaher Bakor Adam Ohud Atiah Almwualllad Marwan S. Hawsawei Abdulmajid Ahmad Hamza Ibrahim Abdullatif Ibrahim The mediating role of moral courage in the relationship between ethical leadership and error reporting behavior among nurses in Saudi Arabia: a structural equation modeling approach BMC Nursing Courage Leadership Organizational culture Patient safety Saudi Arabia |
| title | The mediating role of moral courage in the relationship between ethical leadership and error reporting behavior among nurses in Saudi Arabia: a structural equation modeling approach |
| title_full | The mediating role of moral courage in the relationship between ethical leadership and error reporting behavior among nurses in Saudi Arabia: a structural equation modeling approach |
| title_fullStr | The mediating role of moral courage in the relationship between ethical leadership and error reporting behavior among nurses in Saudi Arabia: a structural equation modeling approach |
| title_full_unstemmed | The mediating role of moral courage in the relationship between ethical leadership and error reporting behavior among nurses in Saudi Arabia: a structural equation modeling approach |
| title_short | The mediating role of moral courage in the relationship between ethical leadership and error reporting behavior among nurses in Saudi Arabia: a structural equation modeling approach |
| title_sort | mediating role of moral courage in the relationship between ethical leadership and error reporting behavior among nurses in saudi arabia a structural equation modeling approach |
| topic | Courage Leadership Organizational culture Patient safety Saudi Arabia |
| url | https://doi.org/10.1186/s12912-025-03043-7 |
| work_keys_str_mv | AT ebtisamaelhihi themediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT khadijalafialjarary themediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT mahaalahmadi themediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT jawaherbakoradam themediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT ohudatiahalmwualllad themediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT marwanshawsawei themediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT abdulmajidahmadhamza themediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT ibrahimabdullatifibrahim themediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT ebtisamaelhihi mediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT khadijalafialjarary mediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT mahaalahmadi mediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT jawaherbakoradam mediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT ohudatiahalmwualllad mediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT marwanshawsawei mediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT abdulmajidahmadhamza mediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach AT ibrahimabdullatifibrahim mediatingroleofmoralcourageintherelationshipbetweenethicalleadershipanderrorreportingbehavioramongnursesinsaudiarabiaastructuralequationmodelingapproach |