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Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital


Elizabeth M. Rice
Mayo Clinic Hospital
5777 East Mayo Boulevard
Phoenix, AZ 85054


Aim  To determine the prevalence and contributing factors of moral distress in medical and surgical nurses.

Background  Moral distress from ethical conflicts in the work environment is associated with burnout and job turnovers in nurses.

Method  A prospective cross-sectional survey using the Moral Distress Scale tool was administered to medical and surgical nurses at an adult acute tertiary care hospital.

Results  The survey was completed by 260 nurses (92% response rate). The intensity of moral distress was uniformly high to situations related to physician practice, nursing practice, institutional factors, futile care, deception and euthanasia. Encounter frequencies for situations associated with futile care and deceptions were particularly high. Encounter frequencies increased with years of nursing experience and caring for oncology and transplant patients.

Conclusion  Moral distress is common among nurses in acute medical and surgical units and can be elicited from different types of situations encountered in the work environment. Nursing experience exacerbated the intensity and frequency of moral distress.

Implications for nursing management  Strategies aimed to minimize exposure to situations of moral distress and augment mechanisms mitigating its effect on nurses are necessary to enhance job satisfaction and retention.