Moral Distress and its Influencing Factors from the Perspective of Nurses in Teaching Hospitals in North West Iran, 1391

Abstract

Abstract: Generally nursing profession has a strong relationship with high standards of moral behaviors. One of the most important issues in nursing ethics is moral distress which is a severe psychological problem among nurses. The purpose of this study was to determine the nurses’ moral distress and effective factors of moral distress between the working nurses in the north –western medical universities. Method: This was a cross-sectional study in which 418 nurses were selected by randomized multistep sampling method in the northwest of Iran in 2012. Data collection was done using the moral distress standard scale with high reliability and validity. In order to analyze data, descriptive (mean, standard deviation, frequency and percent) and inferential statistics (independent t-test and one way ANOVA) were used. Also for the investigation of the relationship between moral distress and predictive factors on this event, Pearson correlation statistical tests and regression analyses were used. The qualitative variables were used as indices in the analysis. For data analysis the STAT 10 software was used. Its significance was P<0.05. Results:The mean score of nurses’ moral distress was 148.49 ± 32.93, and 222 nurses (53%) suffered from severe moral distress. Of the three provinces under study, Zanjan (152.46 ± 35.88) and intensive care units (152.72±33.36) had the highest moral distress scores. Among the respondents' demographic characteristics, province (P < 0.01), education (P < 0.05), type of shift (P < 0.05) and job status (P < 0.05) were significantly. Between the variables, the social characteristics of the nurses, and the proportion of the nurses to the number of beds (P<0.05), and the type of working shift (P<0.05), had a significant relationship with level of moral distress. 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 factor and understanding their disability had a statistically significant relationship with moral distress (P < 0.05).That had a strong statistical significance with moral distress. They were lack of supportive administration, and lack of understanding ones disabilities Discussion and conclusion: Due to the high level of moral distress in the nursing profession, dealing with it requires a lot of attention. Based on the external factors specially the manner of administrative support on moral distress, nursing managers who act as the paragons of clinical nurses and the other care team can have priority for solving the problems of this field. Furthermore, they can deal with problem with the help of different methods and also can do their best for improvement of health system with the cooperation of their colleagues, top managers, and the other available sources. Lack of human force is an effective factor on the creation of moral distress in nurses. Thus we can avoid this event to a large extent with training more human working force. With short team practical and scientific training and also periodic training, we can qualify the nurses in decreasing the inabilities of the nurses.