Iranian Journal of Medical Ethics and History of Medicine

Moral distress is one of ICU nurses' major problems that can happen due to various reasons and may have several consequences. Considering that certain variables can be related to moral distress and turnover intention in nurses, this study was done to determine the correlation between ICU nurses' demographic characteristics and their moral distress and turnover. In this correlational study, 159 ICU nurses were selected from medical universities of Iran. Data collection instruments included a demographic questionnaire, ICU nurses' moral distress scale, and Hinshaw and Atwood's turnover scale. Data analysis was done by using SPSS 17_. The findings showed high level of moral distress and turnover in ICU nurses. The results revealed a positive statistical correlation among ICU nurses' age, their work experience, the ratio of nurses to ICU beds and their moral distress. However, there was no correlation among sex, marital status, educational degree, work shift and moral distress. Similarly, moral distress and intent to turnover did not have a statistical correlation.The results showed that increasing recruitment of young nurses and nursing staff, and diminishing ICU nurses' moral distress and turnover intention are essential.

Nurses nowadays are faced with complex moral problems, which put them in conditions where their proper performance may conflict with the values and beliefs of other health care providers. In such situations, maintaining commitment to patients requires considerable moral courage, and moral sensitivity can play a significant role in the development of moral courage. The present study was performed to investigate the correlation between moral courage and moral sensitivity of the nurses working in selected hospitals of Tabriz University of Medical Sciences.In this study, 260 nurses were selected by randomized sampling. Data were collected through a demographic questionnaire, the Moral Sensitivity Questionnaire by Han et al., and the Professional Moral Courage Scale by Sekerka et al. Content validity and face validity of the moral sensitivity questionnaire and moral courage scale were qualitatively investigated, and Cronbach's alpha was used for assessing their reliability. Data were analyzed by descriptive and analytic statistical tests using SPSS 21.The results indicated that the average score of nurses’ moral courage was 90.36 ± 10.56, and the highest moral courage pertained to the dimension of moral agent. The average score of the nurses’ moral sensitivity was 60.99 ± 17.78, and the highest moral sensitivity was observed in the dimension of respect for the patient. The statistical analysis indicated a positive correlation between moral courage and moral sensitivity (P < 0.05, r = 0.15). The subjects’ moral courage differed according to their age, work experience and employment type, but not according to their gender, marital status, education level and work shift. The results of the present study indicate that there is a positive and significant statistical correlation between moral courage and moral sensitivity. It seems that promoting nurses’ awareness of moral principles and increasing their moral sensitivity lead to the development of courageous moral behaviors in nurses.

Moral distress is a phenomenon that can result in feelings of disappointment, guilt, depression, insecurity, fear, discouragement, and depression in nurses, and can affect their personality and professional performance. Burnout in nurses could cause various complications in their families, personal and social lives, and organizations. The aim of the present study was to determinate the correlation between moral distress and burnout in nurses.

This was a correlative descriptive study conducted on 224 nurses selected by stratified randomized sampling. Data were collected through a demographic characteristics questionnaire Corley’s Moral Distress Scale and the Copenhagen Burnout Inventory. Data analysis was performed by SPSS 20 software and Spearman correlation tests.

In this study, mean of moral distress score, mean of personal burnout score, score of work-related burnout, and mean of client-related burnout were 1.31, 55.97, 54.35 and 51.28 respectively. The findings showed a positive significant correlation (P<0.001) between moral distress and all of its dimensions, and personal burnout, work-related burnout, and client-related burnout, although the correlation was low.

According to these findings, it is recommended to reduce the conditions and situations causing moral distress and burnout in order to promote job satisfaction and quality of nursing care.

Nowadays nurses are faced with numerous complex moral conflicts. As a result, doing what one nurse considers as proper can prove contrary to the values and beliefs of other health care providers. The present study was performed to investigate the efficacy of the negotiating style for reducing the severity of moral conflicts in ICU nurses in selected hospitals of Guilan University of Medical Sciences.

This was a semi-experimental single group study with before and after design. For this purpose, 45 nurses working at ICU Wards of Guilan University of Medical Sciences were selected. Data were collected using the Ethical Conflict in Nursing Questionnaire by Falco-Pegueroles (2013). The questionnaire was first completed by each participant. Consequently, a negotiation style educational workshop was held for the nurses with an average or high score. After 8 weeks of intervention, the questionnaire was distributed among the participants one more time. The results were analyzed using SPSS software version 20, t-test and ANOVA to compare the severity of moral conflict in the samples before and after the intervention.

The average severity of the nurses’ moral conflict before the workshop was 53.22. The mean reduction of the severity of moral conflict was 17.66 after 8 weeks, and the difference was statistically significant (P < 0.05).  The results indicated a decrease in the severity of the nurses’ moral conflict following the intervention. Based on the findings of the research, the negotiating style is recommended for the purpose of reducing the severity of moral conflict in ICU nurses.