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Moral distress and structural empowerment among a national sample of Israeli intensive care nurses


F.D. Ganz:


ganz f.d., raanan o., khalaila r., bennaroch k., scherman s., bruttin m., sastiel z., fink n.f. & benbenishty j. (2012) Moral distress and structural empowerment among a national sample of Israeli intensive care nurses. Journal of Advanced Nursing69(2), 415–424. doi: 10.1111/j.1365-2648.2012.06020.x


Aim.  The aim of this study was to determine levels of structural empowerment, moral distress, and the association between them among intensive care nurses.

Background.  Structural empowerment is the ability to access sources of power. Moral distress is the painful feelings experienced when a person knows the right thing to do but cannot do so due to external constraints. Several studies suggest a theoretical relationship between these concepts.

Design.  Cross-sectional, descriptive correlational study.

Methods.  Members of the Evidence Based Nursing Practice Committee of the Israeli Society for Cardiology and Critical Care Nurses recruited a convenience sample of intensive care nurses from their respective institutions and units. Nurses were asked to complete three questionnaires (demographic and work characteristics, Moral Distress Scale, and the Conditions of Work Effectiveness Questionnaire-II). Data were collected between May–September 2009.

Results.  Intensive Care nurses had moderate levels of structural empowerment, low levels of moral distress frequency, and moderately high moral distress intensity. A weak correlation was found between moral distress frequency and structural empowerment. No other structural empowerment component was associated with moral distress. Work characteristics as opposed to demographic characteristics were more associated with the study variables.

Conclusions.  This study weakly supports the association between structural empowerment and moral distress. It also provides further evidence to the theory of structural empowerment as characterized in the critical care environment. Further studies are indicated to determine what other factors might be associated with moral distress.