Moral distress and the contributing factors among nurses in different work environments

Background and Purpose: Considering the obstacles against the implementation of ethical decisions by nurses, experiencing moral
distress is one of the major issues in this profession. Moral distress could have negative effects on the physical and mental health of
nurses, quality of patient care and performance of health organizations. Given the importance of addressing moral distress in working
environment of nurses, this descriptive study aimed to evaluate the level of moral distress and the contributing factors among nurses in
different hospitals affiliated to Shahroud University of Medical Sciences in 2014.
Methods: This descriptive study was conducted on 122 nurses engaged in intensive care units (ICUs), internal medicine wards, surgical
wards and emergency sections of different hospitals affiliated to Shahroud University of Medical Sciences. Survey sampling was the
method of choice, and all the subjects met the inclusion criteria. Data collection was performed using demographic questionnaires
and Corley’s Moral Distress Scale-Revised (MDS-R). Data analysis was performed using descriptive statistics, including independent
T-test, Pearson's correlation coefficient and one-way ANOVA.
Results: In this study, means of frequency and intensity of moral distress were relatively high among the subjects. Considering the
significant difference between moral distress in nurses engaged in different wards (P=0.01), the highest and lowest rates of intensity
were observed in nurses of ICUs with a mean of 3.29±1.49, and those in surgical wards with a mean of 1.81±0.66. Among professional
and demographic variables, feeling supported by the head nurse (P=0.03) and the age of nurses (P=0.001) had a significant correlation
with the level of moral distress.
Conclusion: According to the results of this study, identification of clinical environments involving high moral distress, as well as the
main causes of moral distress in nursing managements, could contribute to the prevention of this problem among the nursing staff.