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

Background: 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. Aim: To synthesise the existing literature pertaining to the consequences of moral distress among CCNs. Methods: 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. Results: 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. Conclusions: All studies reported negative consequences of moral distress among CCNs, highlighting the need for further research and organisational efforts to support nurse well-being.