Research for Evidence Based Practice 

This is a graded discussion: 100 points possible


Read a selection of your colleagues’ responses and  respond to two of your colleagues in one or more of the following ways:

· Ask a probing question, substantiated with additional background information, evidence, or research.

· ·Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

· Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

· Validate an idea with your own experience and additional research.

· Suggest an alternative perspective based on additional evidence drawn from readings or after synthesizing multiple postings.

· Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.




Kendra Kendrick


· Week 7 – Main Post


Edmonson’s (2015) article is a must-read for Nurse Leaders who want to enhance their moral courage. Nurse Leaders can apply the valuable insights and practical strategies offered by Edmonson’s (2015) article in various healthcare settings.

This article, written by Edmonson in 2015, comprehensively analyzes moral distress among nurses. It highlights the crucial role of nurse leaders in promoting a culture of moral courage. By examining existing literature and a study, the author emphasizes the importance of moral fitness in nursing leadership and the necessity of interventions that can enhance moral courage. The article also highlights the significance of healthcare leaders in demonstrating moral courage and creating an environment that encourages morally courageous behavior. Such an environment enables nurses to prioritize patient care and serve communities with distinction.

Scope of the study

The Edmonson 2015 study aimed to boost nurses’ morality, inspire leadership, and pinpoint factors that encourage courageous behavior during stressful situations. The study seeks to achieve a goal and fulfill a purpose. To ensure that nurses stay dedicated to patients, families, and communities, the study suggests that healthcare leaders should establish safe environments that foster morally courageous behaviors. Links to an external site.

Regression Study

The literature review discusses moral distress and courage among nurses, outlines an intervention to bolster nurse leaders’ courage, and reports on implementing the intervention. Regression analysis allows researchers to estimate relationships between variables. Studying historical data and detecting patterns facilitates the anticipation of future results. Researchers widely use regression analysis in various fields, such as medicine, economics, and social sciences.


Researchers conducted a recent systematic review examining the experiences of direct care professional nurses in hospitals. The review confirmed biological, emotional, and moral stress among morally distressed nurses. Nurses, in response to moral distress, reported feelings of anger, loneliness, depression, guilt, powerlessness, anxiety, and emotional withdrawal. Moral distress in healthcare causes nurses to leave stressful environments for less stressful ones, leading to turnover. If left unresolved, moral distress can cause negative emotions towards oneself or the source of distress. Data is the backbone of making informed decisions, and regression analysis is the tool that can help you achieve this. By analyzing the collected data, regression analysis can provide valuable insights that can lead to better and more accurate decision-making. Data is crucial as it helps researchers determine the importance of their study and understand the relationships between different variables.

Strength or Weakness

The current literature needs more information about how nurse leaders can be prepared to lead with moral courage and transformational skills in today’s healthcare corporate environments and hierarchies. In this article, Edmonson 2021, the author reviews the literature about moral distress and courage among direct care nurses. The author also describes the development of an intervention that aims to strengthen the moral courage of nurse leaders, reports a study that involved implementing this intervention, presents the findings of this study, evaluates the effectiveness of the intervention, and discusses the findings in terms of lessons learned and future directions.


Maeland’s (2021) article focuses on the “moral distress” encountered by nursing students in their clinical placements. The author assessed 36 stories written by students about challenging work situations. According to the researchers ‘ findings, many students experienced moral distress and felt powerless to act despite knowing what was ethical.

Ethical challenges during the COVID-19 pandemic have confronted nurses, resulting in mental health issues and moral distress. In Lemmo’s (2022) article, the moral distress model acknowledges five event categories that result in moral distress: constraint, dilemma, uncertainty, conflict, and tension. Each category has a link to different emotions. A recent study examined 43 Italian nurses who worked during the pandemic to explore their memories and feelings about situations where they could not provide optimal patient care. To gather information, the researchers used a narrative interview to prompt nurses to recollect events and articulate their emotions.


Edmonson, C. (2015).  Strengthening moral courage among nurse leaders Links to an external site Links to an external site. . Online Journal of Issues in Nursing, 20(2). doi:10.3912/OJIN.Vol20No20PPT01

Gray, J. R., & Grove, S. K. (2020). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Elsevier.

Lemmo, D., Vitale, R., Girardi, C., Salsano, R., & Auriemma, E. (2022). Moral Distress Events and Emotional Trajectories in Nursing Narratives during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 19(14). https://doi.org/10.3390/ijerph19148349

Maeland, M. K., Tingvatn, B. S., Rykkje, L., & Drageset, S. (2021). Nursing Education: Students’ Narratives of Moral Distress in Clinical Practice. Nursing Reports, 11(2), 291–300. https://doi.org/10.3390/nursrep11020028

Collapse Subdiscussion Roslyn Stewart




Roslyn Stewart

Revised with APA citations:

Of the articles listed in this week’s learning week assignment, the article that stands out most to me is the “relationship between sense of coherence, health and work engagement among nurses” (Malagon-Aguilera et al., 2019).

Brief Description

The article evaluates the relationship between sense of coherence with health and work engagement. The researchers use a cross-sectional study design with a sample size of 109 nurses in a long-term care facility setting. Sense of coherence is divided into three independent variables: meaningfulness (mean= 22.85, standard deviation= 3.04), manageability (mean= 20.43, standard deviation= 3.91), and comprehensibility (mean= 24.67, standard deviation= 5.2). These variables are then compared to the dependent variables of self-reported health (mean= 0.918, standard deviation=0.106) and work engagement (mean= 4.31, standard deviation=0.86). The study confirms a positive relationship between the variables (Malagon-Aguilera et al., 2019).

Goals and Purposes

The purpose of the study is to determine a relationship between a sense of coherence with health and work engagement. The goal is to predict whether sense of coherence positively impacts health and engagement. The researchers hypothesize that sense of coherence will have a positive relationship with health and work engagement. The benefit of this correlation is to bring to light implications for practice changes. After confirming positive relationships between sense of coherence and work engagement, the researchers recommend nursing leaders modify policies with emphasis on work-life balance to allow for increased sense of coherence. The researchers also recommend ensuring nurses are assigned meaningful tasks at the unit level and that strategies are in place to encourage strengthened peer social support within the unit and throughout the organization (Malagon-Aguilera et al., 2019).

Linear or Logistic Regression Use 

The article uses a multiple linear regression analysis. Since independent variables can be applied to only one dependent variable, there must be more than one analysis performed. One table evaluates sense of coherence (independent variable) with self-reported health status (dependent variable). A separate table evaluates sense of coherence (independent variable) to work engagement (dependent variable) (Malagon-Aguilera et al., 2019).  

The results demonstrate both positive relationships between sense of coherence with self-reported health (B=0.276, p=0.003) and work engagement (B=0.196, p=0.054). There is a stronger relationship between self-reported health than work engagement. It is also important to note the significance for work engagement is slightly greater than 0.05, which questions the internal validity of the questionnaire. This note is later mentioned as a weakness of the study (Malagon-Aguilera et al., 2019).

Other Possible Quantitative and Statistical Methods

The researchers were diligent and robust in their use of statistical methods.  When reviewing the statistical approaches studied thus far in the course, I am not able to find a missing method to be added in this study.  The researchers use t-tests and one-factor ANOVA to compare mean scores. Descriptive and inferential statistics compare demographic and variable data. The Kolmogorov-Smirnov test is used to determine normality of variables. ANOVA is used to find the relationship between the sense of coherence to the demographic, social and workplace variables. Spearman’s rho test assesses relationship of sense of coherence with self-reported health status and work engagement (Malagon-Aguilera et al., 2019).

Strengths of the Study

The participants are voluntary, reducing the incidence of conflict of interests or coercion. The sample size is adequate based on the total population as 109 nurses agreed to participate out of 156 invited (Malagon-Aguilera et al., 2019).

The questionnaires are anonymous and included demographic data, occupational data, and health variables including chronic health conditions along with the main measures of sense of coherence, self-reported health, and work engagement. The additional collected data is useful especially age, gender, and number of years in nursing (Malagon-Aguilera et al., 2019). Including these demographics in the study reduces discrepancies that can possibly be seen when demographics are introduced later. For example, Clark & Shi (2020) conducts a study and finds that results are affected based on the demographics. The researchers study family economic status and race/ethnicity on highest grade completed. When including gender in the evaluation, the entire correlation shifts from a direct relationship to an inverse relationship, thus changing the outcome when compared to studies that did not include gender (Clark & Shi, 2020).

Weaknesses of the Study

The study is not possible to infer causality (Malagon-Aguilera et al., 2019). The relationship is correlational and not causative. A qualitative study may be more useful as this will allow causation.

The results of the multiple linear regression models are limited. The coefficient values are low and the internal validity of the questionnaire (work engagement) is greater than p=0.50 (Malagon-Aguilera et al., 2019).

The research is limited to long term care facility nurses (Malagon-Aguilera et al., 2019). Recommendations are to expand the study to other healthcare settings. It will be interesting to see if similar results are seen in inpatient hospital units or outpatient surgical centers for examples. Zhang et al. (2023) conducts a study to determine whether higher sense of coherence causes better work engagement in a tertiary hospital care setting. The researchers in this, when comparing with other levels of hospitals, finds lower results (medium level) for sense of coherence and work engagement (means= 4.39 & 3.75, standard deviations=0.92 & 1.21 respectively) due to the larger number of patients, more serious conditions resulting in more stress on the nursing staff, and a large nursing workload (Zhang et al., 2023).

Importance of the Study

The study has benefits to evidence-based practice and the nursing profession. As discussed earlier, there are recommended implications for nursing leaders to modify policies with emphasis on work-life balance to allow for increased sense of coherence. The researchers also recommend leaders ensure nurses are assigned meaningful tasks at the unit level and that strategies are in place to encourage strengthened peer social support within the unit and throughout the organization (Malagon-Aguilera et al., 2019).



Clark, B. & Shi, Y. (2020). Low-income female students and the reversal of the black-white gap in high school graduation. AERA Open, 6.  https://doi.org/10.1177/2332858420915203Links to an external site. Links to an external site.

Malagon-Aguilera, M. C., Suñer-Soler, R., Bonmatí-Tomas, A., Bosch-Farré, C., Gelabert-Vilella. S., & Juvinyà-Canal, D. (2019). Relationship between sense of coherence, health and work engagement among nurses. Journal of Nursing Management, 27(8), 1620–1630. doi:10.1111/jonm.12848

Zhang, Y., Peng, Q., Dong, W., Hou, C., & Chen, C. (2023). Professional identity and sense of coherence affect the between compassion fatigue and work engagement among Chinese hospital nurses. BMC Nursing, 22(1), 1–12. https://doi.org/10.1186/s12912-023-01596-z

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