Factors affecting moral distress in nurses working in intensive care units: A systematic review

Abstract

Background Moral distress is a major issue in intensive care units that requires immediate attention since it can cause nurses to burnout. Given the special conditions of patients in intensive care units and the importance of the mental health of nurses, the present study was designed to systematically review the factors affecting moral distress in nurses working in intensive care units. Methods PubMed, EMBASE, Web of Science, Scopus, and Science Direct were systematically searched for papers published between 2009 and 2019. Original articles from quantitative and qualitative studies were reviewed. The CONSORT and STROBE checklists were used to assess the quality of the quantitative papers. The JBI checklist was applied for qualitative studies. Results Factors affecting moral distress in nurses include lack of nursing staff, nurses with inadequate experience, lack of support from organizations and colleagues, inadequate education and lack of knowledge of nurses, poor collaboration of physicians with nurses, ethical insensitivity and lack of teamwork, heavy workload, poor quality of care and moral violence and they are considered as risk factors for moral distress. Conclusion Many of the related causes are due to the nature of nurses’ work and it is necessary to manage the underlying conditions of this phenomenon so that it can be effectively prevented from spreading. Levels of moral distress require more attention of authorities in the use of prevention strategies and the reduction of effective factors in distress.

Levels of Moral Distress among Health Care Professionals Working in Hospital and Community Settings: A Cross Sectional Study

“…These findings agree with recent studies and reviews with the purpose of identifying the determinants of moral distress in care settings [ 4 , 36 ]. These results provide an indication of the impact of specific workplace characteristic on moral distress scores in healthcare professionals.…”

“…Early studies on this topic were confined to the intensive care setting [ 4 , 5 ], specifically related to end-of-life treatment [ 6 , 7 ]. However, empirical research on this topic has seen exponential growth in recent years, intensifying the study of moral distress in any other clinical care setting (long-term care facilities, pediatric or neonatal settings and emergency or mental health departments) [ 8 , 9 , 10 ].…”

Moral sensitivity and moral distress correlation in nurses caring of patients with spinal cord injury

“…9,12 Literature indicates the negative impacts of moral distress on the selfefficacy, professional commitment, self-confidence, and hope of nurses. [13][14][15][16] Shafeei conveys from Corley that moral distress causes conflict for a nurse concerning diagnostictherapeutic practices leading to the reduced quality of care. These points might result in the problematic recovery of patients and increased hospitalization duration.…”

“…12 Several studies noted the influence of individual, environmental, and background factors on the rate of moral distress in nurses. 12,14 Some of the major factors contributing to ethical distress in the personnel of health system include working in the special units with higher responsibility, limited nursing force, high workload, conflicts between treatment teams and colleagues, incorrect policies of institutions, invasive treatments, patients near to death, unnecessary tests, cheating in tests, insufficient and incomplete treatments by the coworkers. 15,18,19 Ethical sensitivity is one of the leading factors regarded as the predictors of moral distress.…”

Factors Associated with Moral Distress and Caring Behavior of Nurses Working in Emergency Departments of Mazandaran University of Medical Sciences During COVID-19 Pandemic

“…Moral distress means that, although a nurse has the true awareness of his/her job, because of the limitations forced from organization or the higher levels (such as lack of sufficient time, medical limitations, and religious and moral observations, higher-level officials disagreement), it is not possible to implement the right action (4). Findings of one study shows that among factors affecting and creating moral distress and consequently, affecting clinical performance and caring quality of nurses are: insufficient resources, providing fruitless medical care, ignoring patient's independence, inability to prevent death, direct interaction with patient, nurses and doctors' interrelationship (5). This can have various occupational and personal negative impacts (such as job dissatisfaction, mental and physical problems, job abandonment, spiritual, material, and organizational damages (2).…”