Moral injury and its effects on academic performance of student nurses in South Africa

Background: Morals are norms of conduct, behaviour and guidelines that nurses must uphold and observe in nursing. Moral codes require nurses and student nurses to respect human rights and dignity, and act with sound ethical judgement. However, when student nurses witness and fail to prevent acts that transgress their deeply held moral beliefs, their moral code is damaged, and deep emotional wounds ensue, leading to moral injury. Objectives: This study aimed to investigate the prevalence and effects of moral injury in student nurses at a higher education institution in South Africa. Method: A quantitative, non-experimental cross-sectional survey was relied upon. The total population sampling method was applied, resulting in 124 respondents. Data were collected among the undergraduate student nurses registered at a higher education institution in Johannesburg from first to final year using a self-administered Moral Injury Symptom Scale – Healthcare Professionals questionnaire. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 28 software. Results: The results indicated that more than a third (34%) of students experienced moral injury. Furthermore, a positive significant relationship between the presence of moral injury and academic performance among the students was noted (p = 0.029). Conclusion: In this study, the prevalence of moral injury among student nurses was investigated and its effects on academic performance were reported. Contribution: The effects of moral injury among student nurses indicate a need for higher education institutions to design and implement nursing curriculum that would assist students to develop moral resilience and ethical behaviour.