Investigating the Relationship Between Moral Distress and Alexithymia Levels Among Intensive Care Nurses: A...

Intensive care nurses are frequently exposed to emotionally demanding and ethically challenging situations, which may affect their emotional awareness and moral functioning. Alexithymia, characterised by difficulties in identifying and expressing emotions, may be an important factor contributing to moral distress in intensive care settings.

This study aimed to examine the relationship between alexithymia and moral distress among intensive care nurses and to compare their levels according to sociodemographic and professional characteristics.

A descriptive and correlational design was employed. Data were collected from intensive care nurses in Sivas, Türkiye, using the Personal Information Form, the Toronto Alexithymia Scale-20 (TAS-20) and the Moral Distress Scale-Revised (MDS-R). Data were analysed using Pearson's correlation analysis, independent samples t-test, one-way ANOVA and Welch's ANOVA (p < 0.05).

Among the 146 intensive care nurses included in the study, 34 (23.3%) were classified as alexithymic, 37 (25.3%) as possibly alexithymic, and 75 (51.4%) as non-alexithymic. A moderate, positive and statistically significant correlation was found between total alexithymia and moral distress scores (r = 0.623, p < 0.001). Moral distress was positively associated with all alexithymia subdimensions, including difficulty identifying feelings, difficulty describing feelings and externally oriented thinking (p < 0.001). Higher levels of alexithymia and moral distress were observed among female nurses, single nurses, those with postgraduate education, longer intensive care experience and nurses with prior or current intentions to leave the profession (p < 0.05).

Alexithymia was significantly associated with higher levels of moral distress among intensive care nurses. Interventions aimed at enhancing emotional awareness and adaptive coping may help mitigate moral distress in intensive care settings.

Integrating emotion-focused support strategies into intensive care practice may strengthen nurses' psychological resilience and contribute to workforce sustainability.