Consequences of moral distress among critical care nursing: an integrative review

Moral distress occurs when individuals are unable to act according to their ethical values and beliefs due to constraints. It is a prevalent issue in healthcare settings, particularly among nurses. Critical care nurses (CCNs) confront challenges such as high rates of patient mortality, intense stressors, and end-of-life discussions and decisions, which make them more prone to experience moral distress.

To synthesise the existing literature pertaining to the consequences of moral distress among CCNs.

An integrative review of empirical literature was performed across three online databases: PubMed, CINAHL and PsycINFO using search terms related to nurses, critical care, moral distress, and ethical dilemmas. A total of 366 papers were retrieved. After applying the eligibility criteria and assessing the quality of the included studies using the Johns Hopkins Nursing Evidence-Based Practice tool, nine papers were included in this review and synthesised using content analysis.

Reviewing the included papers revealed three main themes of moral distress consequences: impacts on nurses' well-being and job satisfaction, impact on patient care, and impact on turnover intention and burnout rate.

All studies reported negative consequences of moral distress among CCNs, highlighting the need for further research and organisational efforts to support nurse well-being.