Clinical decision making and moral distress among intensive care units nurses in Iran

Intensive care units are often presented as environments where ethical issues are common and decisions can determine the life or death of patients, and these units have unique challenges due to critical health care. In these units, the relationship between the medical team and the patient's relatives, their refusal of treatment, informed consent causes the nurses to have conflict in their decision making, therefore, this study aims to determine the level of clinical decision-making and moral distress and the relationship between them in intensive care units nurses.

This cross-sectional study was conducted with a descriptive-analytical approach in 2023 in Gorgan city. The number of 198 nurses in the intensive care units of Gonbad Kavos hospitals in the north of Iran were investigated and evaluated using the Corley Moral Distress questionnaire (2002), and Laurie's Clinical Decision questionnaire (2001) in 2023. Independent T-test and anova analysis of variance were used for bivariate analysis. The significance level in this study was considered 0.05.

The results of the study showed that the mean and standard deviation of clinical decision making was 60.98 ± 10.25 (analytical-systematic level) and moral distress was 92.2 ± 23.61 (moderate level). There was a statistically significant relationship between clinical decision-making and nurses' moral distress (P < 0.001 and r = 0.370). The moral distress score had a statistically significant relationship with marriage, employment status, education level, age, work experience and duration of employment in the special department. Also, the clinical decision score had a statistically significant relationship with employment status, education level, age and work experience.

According to these results, it seems that more attention should be paid to the moral distress of nurses in intensive care units, and it is necessary to improve their decision-making towards intuitive interpretation, which is done by designing and compiling training programs and workshops for nurses can be done, so that we can provide optimal nursing services to the patients of this department.