The importance of the hidden curriculum is recognised as a practical training ground for the absorption of medical ethics by healthcare professionals. Pakistan’s healthcare sector is hampered by the exclusion of ethics from medical and nursing education curricula and the absence of monitoring of ethical violations in the clinical setting. Nurses have significant knowledge of the hidden curriculum taught during clinical practice, due to long working hours in the clinic and front-line interaction with patients and other practitioners.

Background Moral courage means courage to act according to individual’s own ethical values and principles despite the risk of negative consequences for them. Research about the moral courage of whistle-blowers in health care is scarce, although whistleblowing involves a significant risk for the whistle-blower. Objective To analyse the moral courage of potential whistle-blowers and its association with their background variables in health care. Research design Was a descriptive-correlational study using a questionnaire, containing Nurses Moral Courage Scale©, a video vignette of (...) the wrongdoing situation with an open question about the vignette, and several background variables. Data were analysed statistically and inductive content analysis was used for the narratives. Participants and research context Nurses as healthcare professionals (including registered nurses, public health nurses, midwives, and nurse paramedics) were recruited from the membership register of the Nurses’ Association via email in 2019. A total of 454 nurses responded. The research context was simulated using a vignette. Ethical considerations Good scientific inquiry guidelines were followed. Permission to use the Nurses’ Moral Courage Scale© was obtained from the copyright holder. The ethical approval and permission to conduct the study were obtained from the participating university and the Nurses’ Association. Findings The mean value of potential whistle-blowers’ moral courage on a Visual Analogue Scale (0–10) was 8.55 and the mean score was 4.34 on a 5-point Likert scale. Potential whistle-blowers’ moral courage was associated with their socio-demographics, education, work, personality and social responsibility related background variables. Discussion and conclusion In health care, potential whistle-blowers seem to be quite morally courageous actors. The results offer opportunities for developing interventions, practices and education to support and encourage healthcare professionals in their whistleblowing. Research is needed for developing a theoretical construction to eventually increase whistleblowing and decrease and prevent wrongdoing. (shrink)

Whistleblowing is an effective tool against fraud and corruption in organizations. However, as researchers have struggled to acquire data on actual whistleblowers, research relies on hypothetical intention data and student samples, which is seen as a major limitation. Using a field study of 1,416 employees from China, Germany, and Russia, the purpose of this article is to identify differences and similarities between intention and actual whistleblowing decisions, thus aiding research and interpretation of prior and future studies. I also contribute by (...) analyzing whether findings can be generalized across different cultures and whether status and power influence the whistleblowing process. My results reveal that the key difference between hypothetical and real decisions is not in variables that affect the process, but in effect sizes: Employees underestimate the effect of situational (retaliation) and organizational (compliance measures) variables in hypothetical compared to actual whistleblowing. Thus, reliance on intention research is not inherently problematic, when effect sizes are interpreted with caution. I also find that results are similar across countries and that status and power may not be decisive factors in whistleblowing. My findings should also be of interest to practitioners and policymakers, as they assist in designing effective whistleblowing systems and environments in organizations. (shrink)