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Relationship Between Clinical Decision-Making and Moral Distress in Neonatal Intensive Care Unit Nurses: A
Monir Nobahar1, Raheb Ghorbani, Zeinab Alipour
1Author Affiliations: Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran(Professor Nobahar); Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran(Professor Nobahar); Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran (Professor Ghorbani); Social Medicine Department, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran(Professor Ghorbani); and Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran(Mss Alipour, and Jahan).
Background:
In the neonatal intensive care unit (NICU), nurses care for premature and critically ill neonates, interact with parents, and make clinical decisions regarding the treatment of neonates in life-threatening conditions. The challenges of managing unstable conditions and resuscitation decisions can cause moral distress in nurses.
Purpose:
This study aims to determine the relationship between clinical decision-making and moral distress in NICU nurses.
Methods:
This cross-sectional, multicenter, descriptive correlational study involved 190 nurses working in 7 NICUs across hospitals in Khorramabad and Semnan in 2023. Data were collected using demographic questionnaires, the Clinical Decision-Making Laurie Scale (2001), and the Moral Distress Scale-Revised (MDS-R).
Results:
All nurses in these NICUs were female. No significant correlation was found between clinical decision-making and moral distress (r = -0.03, P = .684). The moral distress score was low. In decision-making, 57.9% of nurses exhibited intuitive analysis (understanding without a rationale). Multiple linear regression analysis revealed that age, education level, and job position were significantly related to clinical decision-making; and being married and having children were inversely correlated with moral distress.
Implications For Practice:
20% of nurses exhibited interpretive intuitive clinical decision-making, which involves care complexities, cognitive understanding, and task-based decisions. Nursing managers should focus on refining these decision-making strategies for NICU nurses.
Implications For Research:
Given the importance of clinical decision-making in the NICU, future research should use quantitative and qualitative methods to explore the decision-making processes and moral distress in NICU nurses.
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