The association between moral distress and mental health among nurses working at selected hospitals in Iran during the COVID-19 pandemic

Abstract

BACKGROUND: In the event of an epidemic outbreak, the mental health of medical staff, including nurses who serve on the frontlines of hospitals, can be affected; thus, the identification of factors affecting nurses’ mental health is of importance. OBJECTIVE: This study aimed to examine the association between moral distress and the mental health of nurses working at four selected hospitals in Iran during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A cross-sectional questionnaire survey was conducted on 296 nurses working at the selected hospitals in Bushehr and Shiraz (south of Iran) at the time of the COVID-19 outbreak. The collected data were analyzed via logistic regression analysis. RESULTS: The mean scores for nurses’ moral distress were low (54.31±24.84). The results of this study indicated more symptoms of mental issues among nurses (73.60%). Moreover, a significant association was observed between mental health and moral distress. Among the examined demographic variables, only gender had a significant association with mental health (p-value = 0.014). CONCLUSION: The results of this study indicated that an increase in moral distress would lead to a significant increase in mental health issues of the examined nurses. Nurse managers and hospital policymakers should develop strategies to enhance nurses’ level of mental health, as well as providing adequate emotional and family support for nurses. Considering the intensifying role of gender in this association, timely interventions are necessary to reduce the negative effects of workplace pressure/stress on female nurses.

An integrative review of factors and interventions affecting the well‐being and safety of nurses during a global pandemic

“…Feelings of mistrust occurred when leadership communication was unclear and inconsistent specifically related to planning, policies, and equitable workload (Cho et al, 2021; Huang et al, 2021; Ralph et al, 2021). Guidelines which protected both patients and nurses were nonexistent or frequently changed, highlighting a lack of preparedness as well as a lack of awareness of the impact on bedside nurses providing patient care (Cho et al, 2021; Gray et al, 2021; Mekonen et al, 2020; Leng et al, 2021; Nemati et al, 2021; Patton, 2021; Ralph et al, 2021). Bedside nurses experienced a lack of emotional support from leadership, family, and friends (Cho et al, 2021; Huang et al, 2021; Ralph et al, 2021; Shahrour & Dardas, 2020).…”

“…Insufficient PPE and other supplies contributed to increased stress and anxiety, physical discomfort from reuse of PPE, and moral distress caused by rationing supplies (Cho et al, 2021; Foli et al, 2021; Jeffs et al, 2020; Leng et al, 2021; Mekonen et al, 2020; Nemati et al, 2021; Patton, 2021; Ralph et al, 2021; Shahrour & Dardas, 2020). Nurses were concerned for their patients, their own family members, and for themselves.…”

“…Nurses were concerned for their patients, their own family members, and for themselves. Inadequate staffing also contributed to stress and trauma, while adequate staffing resulted in less pandemic fatigue (Foli et al, 2021; Labrague, 2021; Nemati et al, 2021; Patton, 2021). Nurses also experienced increased stress due to feeling unprepared for the pandemic, described as a lack of training, experience, or clear guidelines, while nurses who had completed such training reported less stress (Da Rosa et al, 2021; Leng et al, 2021; Mekonen et al, 2020; Patton, 2021; Shahrour & Dardas, 2020).…”

Effect of the COVID-19 pandemic on depression, perceived stress and hypochondria of frontline dental staff (FDS): A cohort study

“…Therefore, lockdown cancelation could be an important reason to decrease depression and other mental disorders related to COVID-19. In addition, increasing protective protocols because of COVID-19 such as social distance effect on population mental health status, where several studies detected this positive correlation [44][45][46].…”

A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic

“…However, the intensity (severity) of moral distress among health workers during the pandemic, in those studies that reported mean moral distress levels, has been found to be low in most [ 11 , 13 – 21 ] though not all [ 22 – 24 ] studies. Among these studies, some assessed the intensity of moral distress for specific situations [ 15 , 20 ], some assessed both the frequency and intensity of moral distress for specific situations [ 13 , 14 , 17 , 18 , 21 , 22 , 24 , 25 ] and others assessed it with a global measure of moral distress without anchoring the assessment to specific potentially-morally-distressing situations [ 11 , 19 , 23 ]. The systematic reviews by Gianetta and colleagues [ 1 ] and by Tian and colleagues [ 26 ] provide comprehensive discussions of instruments that have been used to measure moral distress.…”