Moral Sensitivity and Moral Distress in Critical Care Unit Nurses

Somayeh Mohammadi, Fariba Borhani, Mostafa Roshanzadeh



Background and Aim: Nurses, as an extensive group of the caring teams, are constantly faced with moral issues, which can play a key role in the quality of the care provided. Of these challenges, one is moral distress which can have different effects on patients, nurses and care systems. In the meantime, another factor that can play a pivotal role in preserving the moral values and the prevention of moral distress in nurses is moral sensitivity. Moral sensitivity enables the nurses to interpret and respond to the needs of their clients in accordance with moral principles, which would play an important role in preventing the conditions causing moral distress. Therefore, the present study was carried out aiming to determine the relationship between moral distress and moral sensitivity among nurses.


Materials and Methods: This descriptive analytical study was conducted on 257 nurses employed in teaching hospitals affiliated to Birjand University of Medical Sciences (South Khorasan) in 2015. The sampling method was available sampling among the nurses working in intensive care units (ICU CCU, NICU, and dialysis) in the whole province meeting the inclusion criteria of the study. The data collection tool was a three-part questionnaire consisting of the demographic information questionnaire, Corly moral distress questionnaire, and the Korean version of the Hun moral sensitivity questionnaire. The demographic information questionnaire examined such characteristics as age, sex, location of work, years of service, and the type of employment. Corly moral distress questionnaire, designed in 1995 and revised in 2001, consists of 21 questions. Each of the questions involves a position indicative of moral distress. The options of the questionnaire are designed based on the two dimensions of intensity and frequency and arranged according to the Likert scale from zero (not at all) to 5 (very much) for the intensity of the distress, and from zero (never) to 5 (repeatedly) for the frequency of the distress. Reliability of the questionnaire, using Cronbach's alpha method, is 0.93 and its validity, using CVI method, is 88 percent. The Korean version of the Hun moral sensitivity questionnaire consists of 25 questions on the three areas of “respect for the patient”, “professional responsibility”, and “moral behavior”. The questionnaire includes five items on a Likert scale from “strongly disagree” (0) to “strongly agree” (4). The reliability of the questionnaire is determined by Cronbach's alpha as 0.79. Having obtained all the necessary permits, the research colleague distributed this questionnaire in the study environment. Of the total 270 questionnaires distributed, 263 questionnaires were collected. A number of questionnaires were excluded due to some errors in the responses. A total of 257 questionnaires were subjected to statistical analysis. Collecting the questionnaires took a month. The collected data were analyzed running descriptive statistics (frequency, percentage, mean, standard deviation) and inferential statistics (Chi-square, t-test, ANOVA, and Pearson correlation coefficient) in SPSS statistical software version 16.


Ethical Considerations: Having received the University Ethics Committee’s formal approval (number 94:145), the questionnaires were distributed among the participants, and the research units were given complete information about the aims of the research and how to respond to the questionnaires. Written consent was collected from all participants in the study. Additionally, all of the nurses were assured of anonymity of the questionnaires and confidentiality of the information.


Findings: There was no significant relationship between the intensity of moral distress and the nurses’ moral sensitivity (P = 0.2). The mean scores (out of 5) were 3.5 ± 0.66 for the total moral distress, 3.5 ± 0.75 for the intensity of moral distress, and 3.54 ± 0.66 for the frequency of moral distress, respectively. The mean for moral sensitivity (out of 4) was 3.1 ± 0.45. There was, however, a statistically significant relationship between moral distress and age, years of service and the type of the ward (P<0.05). Likewise, the relationship between moral sensitivity and the number of years of service and age of the nurses was also significant (P<0.05).


Conclusion: The results of the study indicated that people who do not have sufficient executive power for moral performance will experience moral distress, despite their high and low levels of moral sensitivity. Thus, given the levels of moral distress and moral sensitivity of the nurses in the study, it is necessary for the hospital administrators to take some specific measures to carry out periodic reviews of this phenomenon, and hold some codified trainings in this regard. As for moral sensitivity, some right steps need to be taken in moral performance through increasing the nurses’ awareness and adopting their attitudes towards moral issues, particularly for new moral challenges. According to the obtained results, there was a significant relationship between moral distress, and age and years of service. It can be said that since the mean score for this phenomenon at the ICU was much higher than those of other investigated sections, it is recommended that managers supervise nurses in these sections more, and that nurses in these sections be changed in rotation and be transferred to the sections where such phenomena are less observed. In addition, as the level of distress among nurses in this study in proportion to higher age and service experience was reported lower than others, it can be concluded that the presence of experienced people in of nursing teams can be a controlling factor, especially for the less experienced nurses when facing challenges. Moreover, it is also probable that these people’s experience may reduce other nurses’ distress, especially the novice ones. Furthermore, this phenomena should be monitored in all parts of the hospitals, and many of its consequences be averted through taking such measures as consultation and appraising its main causes from the nurses’ perspectives. 


Please cite this article as: Mohammadi S, BorhaniF, Roshanzadeh F. Moral Sensitivity and Moral Distress in Critical Care Unit Nurses. Med Ethics J 2017; 10(38): 19-28.


Moral Distress; Moral Sensitivity; Critical Care Unit; Nursing

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