Assessing and addressing moral distress and ethical climate, part 1

Dimens Crit Care Nurs. 2014 Jul-Aug;33(4):234-45. doi: 10.1097/DCC.0000000000000050.


Background: There is minimal research exploring moral distress and its relationship to ethical climate among nurses working in acute care settings.

Objectives: Objectives of the study were to explore moral distress, moral residue, and perception of ethical climate among registered nurses working in an academic medical center and develop interventions to address study findings.

Method: A mixed-methods design was used. Two versions of Corley and colleagues' Moral Distress Scale, adult and pediatric/neonatal, were used in addition to Olson's Hospital Ethical Climate Survey. Participants were invited to respond to 2 open-ended questions. This article reports the results for those nurses working in adult acute and critical care units.

Results: The sample (N = 225) was predominantly female (80%); half held a bachelor of science in nursing or higher, were aged 30 to 49 years, and staff nurses (77.3%). The mean item score for moral distress intensity ranged from 3.79 (SD, 2.21) to 2.14 (SD, 2.42) with mean item score frequency ranging from 2.86 (SD, 1.88) to 0.23 (SD, 0.93). The mean score for total Hospital Ethical Climate Survey was 94.39 (SD, 18.3) ranging from 23 to 130. Qualitative comments described bullying, lateral violence, and retribution.

Discussion: Inadequate staffing and perceived incompetent coworkers were the most distressing items. Almost 22% left a previous position because of moral distress and perceived the current climate to be less ethical compared with other participants. Findings may potentially impact nurse retention and recruitment and negatively affect the quality and safety of patient care. Interventions developed focus on the individual nurse, including ethics education and coping skills, intraprofessional/interprofessional approaches, and administrative/policy strategies.

MeSH terms

  • Academic Medical Centers
  • Adaptation, Psychological
  • Adult
  • Burnout, Professional
  • Critical Care Nursing
  • Ethics, Nursing*
  • Female
  • Humans
  • Interprofessional Relations
  • Job Satisfaction
  • Male
  • Middle Aged
  • Morals*
  • Nursing Staff, Hospital / psychology*
  • Organizational Culture
  • Stress, Psychological*