Moral Distress and Emotional Exhaustion in Healthcare Professionals: A Systematic Review and Meta-Analysis

Moral distress is commonly experienced by healthcare professionals (i.e., nurses) as ethical conflict. Previous literature suggests that moral distress contributes to emotional exhaustion in these professionals. We aimed to synthesize and analyze studies that examined the relationship between moral distress and emotional exhaustion in healthcare professionals.

Web of Science, Scopus, PubMed, Medline, and PsycInfo were used to search targeted studies written in English, Spanish, French, Italian, and Portuguese. The correlation coefficients of each study were extracted and converted into Fisher's z. Finally, pooled r was calculated by Fisher's z and standard error. The meta-analysis was performed with the R statistical program.

A total of 14 studies with 2425 healthcare professionals were included. The Moral Distress Scale Revised (MDS-R) and the Maslach Burnout Inventory (MBI) were the most used scales to measure moral distress and emotional exhaustion, respectively. The pooled correlation coefficient between moral distress and emotional exhaustion was 0.33 (p < 0.001, 95%CI: 0.27, 0.39).

Moral distress is strongly correlated to emotional exhaustion in healthcare professionals. Future studies should focus on exploring the causal relationships between both variables as well as investigating potential moderators.