Moral distress among pediatric nurses: a cross-sectional study from Sichuan, China

Moral distress is common among pediatric nurses. However, evidence on moral distress in this population from non-Western healthcare settings remains limited.

This study aimed to assess the level of moral distress among pediatric nurses in China and identify factors influencing moral distress in this population.

A cross-sectional survey was conducted from June to August 2024. Using census sampling, all 29 tertiary A hospitals in Sichuan Province, China, concurrently operating the Pediatric Intensive Care Units (PICUs), Neonatal Intensive Care Units (NICUs), and general pediatric wards were selected. Questionnaire invitations were sent to registered pediatric nurses at these hospitals, and 1,292 nurses meeting the inclusion criteria participated. The valid response rate was 76.8%. Data were collected using a demographic questionnaire, the Revised Moral Distress Scale-Nurse Pediatric Version (MDNPV), the Hospital Ethical Climate Survey (HECS), and the Moral Sensitivity Questionnaire-Revised (MSQ-R). Data analysis employed the Wilcoxon Rank-Sum Test, Kruskal-Wallis H test, Spearman rank correlation, and multiple linear regression.

The median total moral distress score was 64.00 (IQR: 36.00-84.00). Compared with nurses working in general pediatric units, PICUs and NICUs reported higher levels of moral distress (H = 30.828, P<0.01). Those with the title of charge nurse and above experienced higher levels of moral distress than nurses with lower titles (H = 17.620, P<0.01). Female nurses experienced more severe moral distress than male nurses(Z = 2.006, P<0.05). Multiple linear regression identified six independent predictors of moral distress: department, professional title, gender, hospital ethical climate, moral sensitivity, and nurse-physician collaboration, collectively accounting for 40.2% of the variance (R ² = 0.402, adjusted R²  = 0.398, P < 0.05).

In our study, moral distress was prevalent among pediatric nurses in Sichuan Province, China. The levels of moral distress were associated with department, professional title, gender, hospital ethical climate, moral sensitivity, and nurse-physician collaboration.