Predictive Factors for Moral Distress among Intensive Care Nurses and its Consequences in Intensive Care Nurses, Patients and Organisations

Abstract

Background: ICU nurses report higher levels of moral distress (MD) compared with physicians and other healthcare workers in intensive care units (ICUs), as well as nurses in non-critical (e.g. surgical) units. The present review critically appraises relevant studies to determine the predictors of MD among ICU nurses and its impact on nurses, organisations and patients. Methods: A systematised review and mixed-method approach were conducted. The review was structured according to the PRISMA guideline. Keywords were applied to four databases (MEDLINE, PsycINFO, CINAHL and EMBASE), and the relevant articles were selected based on definite criteria. The QATSDD tool was utilised to assess the quality of the included studies and risk of biases. Four stages—data reduction, data display, data comparison and verification—were followed to ensure specificity of data synthesis and analysis. Equal weighting was given to qualitative and quantitative findings and reported side-by-side via the narrative approach. Results: Twelve studies were included (eight quantitative, three qualitative, one mixed-method). The quality of these studies was illustrated in QATSDD scores of 48%–86%. Four categories summarised MD predictors, including external constraints, internal constraints, clinical situations and demographics. While three categories showed that MD had negative impacts on nurses, patients and organisations. Thirteen sub-categories emerged as predictors, such as futile treatment and poor work environments. Conclusions: Futile treatment in end-of-life situations is a key predictor of MD among ICU nurses. Negative impact of MD directly affect ICU nurses and indirectly affect patients and organisations.