A pilot study examining moral distress in nurses working in one United States burn center

J Burn Care Res. Sep-Oct 2013;34(5):521-8. doi: 10.1097/BCR.0b013e31828c7397.


Moral distress is described as the painful feelings and psychological disequilibrium when a person believes she knows the morally right action to take and is unable to carry it out because of external or internal constraints. It has been studied in intensive care unit (ICU) nurses, but to the best of our knowledge not in burn ICU nurses. A pilot study was performed to gather initial data on moral distress among nurses treating burn victims. Findings from an intervention aimed at decreasing the level of moral distress in these nurses are reported. Nurses (n = 13) were recruited from one U.S. burn ICU and were randomized into two groups. A separate sample pretest post-test design was used. Group A completed the Moral Distress Scale-Revised (MDS-R) and Self-efficacy (SE) Scale before a 4-week educational intervention involving weekly 60-minute sessions, and Group B completed both scales afterward. Participants also completed written evaluations after each session. The MDS-R and SE Scale were readministered to both groups 6 weeks after the intervention was completed. Given the size and distribution of the sample, nonparametric data analyses were used. The MDS-R median score for Group B (92.0) was significantly different statistically from Group A (40.5) with P = .032 directly after the intervention was completed. No significant difference was found in the median SE scores between Group A (34.5) and Group B (34.0; P = .616). The median for Group B was 69 and Group A was 60.5 (P = .775). At the 6-week follow up, the difference between the two groups was no longer observed. Defining and discussing moral distress may have contributed to increased awareness and higher levels of moral distress in Group B directly postintervention. The changes in moral distress levels postintervention and at the 6-week follow up highlight the need to examine the intervention in a larger sample.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Burn Units
  • Burnout, Professional
  • Burns / diagnosis
  • Burns / nursing*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Moral Obligations*
  • Nurse-Patient Relations
  • Nursing Staff, Hospital / psychology*
  • Patient Care Team
  • Pilot Projects
  • Risk Assessment
  • Stress, Psychological / diagnosis*
  • Stress, Psychological / epidemiology
  • United States