Moral distress among senior nursing students: A mixed-methods study.

Area of Science:

• Nursing Education
• Bioethics
• Medical Psychology

Background:

• Moral distress impacts nursing students during clinical training, causing ethical and emotional strain.
• Students often face challenging ethical situations despite lacking decision-making authority.

Purpose of the Study:

• To explore causes, effects, coping mechanisms, and predictors of moral distress in senior nursing students.
• To integrate quantitative and qualitative evidence for a comprehensive understanding.

Main Methods:

• Convergent parallel mixed methods design combining quantitative (predictive correlational) and qualitative (descriptive phenomenological) phases.
• Data collected from 200 senior nursing students via surveys and 25 through in-depth interviews.

Main Results:

• Higher moral distress linked to public university study, limited ethics courses, lower role preparedness, lack of confidence, and poor legal knowledge.
• Causes include ethical violations, team conflicts, and systemic inadequacies; effects involve negative emotions and questioning commitment.
• Coping strategies varied from seeking support to moral disengagement or courage; students recommended improved ethics training and support.

Conclusions:

• Senior nursing students report moderate-to-high moral distress, primarily from educational/systemic gaps and limited clinical authority.
• Enhancing ethics education, role preparation, legal literacy, and supportive environments are key to reducing distress and building resilience.