title: Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy.
abstract: OBJECTIVE
  To explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses.
  
  
  BACKGROUND
  Poor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions.
  
  
  METHODS
  A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses.
  
  
  RESULTS
  The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P < 0.001); and (2) intention to resign (r = 0.244, P < 0.0001). The frequency of occurrence of moral distress was associated with the intention of nurses to resign (r = -0. 209, P < 0.0001).
  
  
  CONCLUSIONS
  Moral distress seems to be associated with the intention to resign, whereas poor nurse-physician collaboration appears to be a pivotal factor accounting for nurses' moral distress.
  
  
  CONCLUSIONS
  Enhancement of nurse-physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession.
authors.affiliation: Department of Nursing, Cyprus University of Technology, Limassol, Cyprus.
authors.forename: Maria N K
authors.initials: MN
authors.lastname: Karanikola
authors.forename: John W
authors.initials: JW
authors.lastname: Albarran
authors.forename: Elio
authors.initials: E
authors.lastname: Drigo
authors.forename: Margarita
authors.initials: M
authors.lastname: Giannakopoulou
authors.forename: Maria
authors.initials: M
authors.lastname: Kalafati
authors.forename: Meropi
authors.initials: M
authors.lastname: Mpouzika
authors.forename: George Z
authors.initials: GZ
authors.lastname: Tsiaousis
authors.forename: Elizabeth D E
authors.initials: ED
authors.lastname: Papathanassoglou
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D064648:Critical Care Nursing / Q000941:ethics; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics; D007558:Italy; D007588:Job Satisfaction; D008297:Male; D009014:Morals; D019555:Physician-Nurse Relations; D017009:Professional Autonomy; D013315:Stress, Psychological / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: decision-making; ethics; resign; work satisfaction