Moral distress among nurses in medical, surgical and intensive-care units

J Nurs Manag. 2017 Sep;25(6):477-485. doi: 10.1111/jonm.12431. Epub 2016 Oct 11.


Aim: To assess the frequency, intensity and level of moral distress perceived by nurses working in medical, surgical and intensive care units.

Background: Moral distress among nurses compromises their ability to provide optimal patient care and may cause them to leave their job.

Methods: A cross-sectional questionnaire survey of 283 registered nurses was conducted to evaluate the frequency, intensity and levels of moral distress. A revised version of the Moral Distress Scale (MDS-R) was used.

Results: The highest level of moral distress was associated with the provision of treatments and aggressive care that were not expected to benefit the patients and the competency of the health-care providers. Multivariate regression showed that nurses working in medical settings, nurses with lower levels of experience working in medical, surgical or intensive care settings, and nurses who intend to leave their job experienced the highest levels of moral distress.

Conclusions: The present study indicates that nurses experience an overall moderate level of moral distress.

Implications for nursing management: Gaining further insight into the issue of moral distress among nurses and the clinical situations that most frequently cause this distress will enable development of strategies to reduce moral distress and to improve nurse satisfaction and, consequently, patient care.

Keywords: burnout; ethics; medical care; moral distress; registered nurse; surgical and intensive care.

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Cross-Sectional Studies
  • Female
  • Humans
  • Intensive Care Units / standards*
  • Italy
  • Job Satisfaction*
  • Male
  • Middle Aged
  • Morals*
  • Nurses / psychology*
  • Psychometrics / instrumentation
  • Psychometrics / methods
  • Stress, Psychological / complications
  • Stress, Psychological / psychology*
  • Surveys and Questionnaires
  • Workload / standards
  • Workplace / standards