Values and self-perception of behaviour among critical care nurses

Nurs Ethics. 2021 Nov-Dec;28(7-8):1348-1358. doi: 10.1177/0969733021999738. Epub 2021 Jun 2.


Background: Moral distress has various adverse effects on nurses working in critical care. Differences in personal values, and between values and self-perception of behaviour are factors that may cause moral distress.

Research aims: The aims of this study were (1) to identify ethical values and self-perception of behaviour of critical care nurses in Japan and (2) to determine the items with a large difference between value and behaviour and the items with a large difference in value from others.

Research design: A nationwide, cross-sectional study was conducted.

Participants and research context: We developed a self-administered questionnaire with 28 items, which was completed by 1014 critical care nurses in Japan. The difference between value and self-perception of behaviour was calculated from the score of each value item minus the score of each self-perception of behaviour item. The size of the difference in value from the others was judged by the standard deviation of each item.

Ethical considerations: The study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214, M2019-045).

Results: The items with a large difference between value and behaviour sources were related to the working environment and decision-making support. The items with a large difference in value from others were related to hospital management and disclosure of information to patients.

Discussion: Improving the working environment for nurses is important for reducing moral distress. Nurses are faced with a variety of choices, including advocating for patients and protecting the fair distribution of medical resources, and each nurse's priorities might diverge from those of other team members, which can lead to conflict within the team.

Conclusion: This study revealed items with particularly high risks of moral distress for nurses. The results provide foundational information that can guide the development of strategies to mitigate moral distress.

Keywords: Clinical ethics; clinical practice; cross-sectional survey; intensive care; moral distress; nursing ethics.

MeSH terms

  • Attitude of Health Personnel*
  • Critical Care
  • Cross-Sectional Studies
  • Humans
  • Morals
  • Nurses*
  • Self Concept
  • Stress, Psychological
  • Surveys and Questionnaires