Predictors of moral distress in nurses of healthcare training centers of medical universities of the North West Provinces in Iran
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In general, the nursing profession is consistent with the high standards of behavior and ethical practice. Nurses work with ethical principles and measure their standards with what a good nurse does. One of the important phenomena in nursing ethics is moral distress. The purpose of this study was to determine the predictive factors of moral distress in nurses working in health care hospitals of North West of Iran. This was a cross-sectional study, in which 418 nurses working in health care centers in the hospitals of the North West of Iran in 2012 participated through multi-stage random sampling. To collect data, moral distress scale and factors influencing moral distress questionnaire with appropriate validity and reliability were used. In order to describe the results, descriptive statistic methods (mean, standard deviation, frequency, and percentage) were used. The Pearson correlation coefficient was used to investigate the relationship between moral distress and factors affecting it. Moreover, to investigate the relationship between basic variables and moral distress, multivariate linear regression analysis were used. Qualitative variables were entered into the analysis as markers. STATA was used for data analysis. All P < 0.05 were considered statistically significant. Among the socio-demographic variables of the nurses, the ratio of nurses to in-patient beds and type of working shifts had significant correlations with the level of moral distress (B = 4.36, P < 0.05). From the three areas of factors affecting moral distress, external factors had a significant relationship with moral distress (P < 0.05). Among the factors related to moral distress, lack of executive support and understanding one's disability had statistically significant relationships with moral distress (P < 0.05). Considering the relationship between external factors, especially administrative support method, with moral distress, nurse managers, as role models of the clinical nurses, can prioritize the existing problems in this area in the organization's operational programs. Using various methods of problem solving, and with the help of colleagues and senior managers, appropriate solutions can be provided with the available resources in order to improve the quality of care and resolve problems in the nursing community. Due to the role of resource shortage in creating moral distress in nurses, by recruiting and training nursing workforce, the increase in moral distress can be largely prevented. Short-term and medium term teaching and training can help in the nurses gaining the required qualifications and can reduce their perceived inability.