title: Moral distress of staff nurses in a medical intensive care unit.
abstract: BACKGROUND
  Moral distress is caused by situations in which the ethically appropriate course of action is known but cannot be taken. Moral distress is thought to be a serious problem among nurses, particularly those who practice in critical care. It has been associated with job dissatisfaction and loss of nurses from the workplace and the profession.
  
  
  OBJECTIVE
  To assess the level of moral distress of nurses in a medical intensive care unit, identify situations that result in high levels of moral distress, explore implications of moral distress, and evaluate associations among moral distress and individual characteristics of nurses.
  
  
  METHODS
  A descriptive, questionnaire study was used. A total of 28 nurses working in a medical intensive care unit anonymously completed a 38-item moral distress scale and described implications of experiences of moral distress.
  
  
  RESULTS
  Nurses reported a moderate level of moral distress overall. Highest levels of distress were associated with the provision of aggressive care to patients not expected to benefit from that care. Moral distress was significantly correlated with years of nursing experience. Nurses reported that moral distress adversely affected job satisfaction, retention, psychological and physical well-being, self-image, and spirituality. Experience of moral distress also influenced attitudes toward advance directives and participation in blood donation and organ donation.
  
  
  CONCLUSIONS
  Critical care nurses commonly encounter situations that are associated with high levels of moral distress. Experiences of moral distress have implications that extend well beyond job satisfaction and retention. Strategies to mitigate moral distress should be developed and tested.
authors.affiliation: Rush University Medical Center, Chicago, Ill., USA.
authors.forename: Ellen H
authors.initials: EH
authors.lastname: Elpern
authors.forename: Barbara
authors.initials: B
authors.lastname: Covert
authors.forename: Ruth
authors.initials: R
authors.lastname: Kleinpell
mesh_terms: D000328:Adult; D003422:Critical Care / Q000941:ethics*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007400:Interprofessional Relations; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009014:Morals; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010558:Personnel Loyalty; D013315:Stress, Psychological; D011795:Surveys and Questionnaires