Moral Distress and Compassion Fatigue in Nurses: A Narrative Review of Clinical and Professional Consequences
akhlāq-i pizishkī i.e., Medical Ethics,
Vol. 19 (1404),
25 September 2025
,
Page 1-16
https://doi.org/10.22037/mej.v19i-.50698
Abstract
Background and Aim: Despite its vital role in health promotion, the nursing profession is confronted with substantial workload pressures and shortages of human resources, which have contributed to the emergence of challenges such as moral distress and compassion fatigue. If left unaddressed, these phenomena may lead to serious clinical and professional consequences. The present study adopts a narrative review approach to examine these consequences and to propose strategies for improving nurses’ work environments.
Methods: This narrative review was conducted in 2025 with the aim of exploring the clinical and professional consequences associated with moral distress and compassion fatigue among nurses. To this end, a comprehensive literature search was performed using the keywords moral distress, compassion fatigue, ethical consequences, professional consequences and nurses, along with their Persian equivalents. International databases (PubMed and Web of Science), Iranian national databases (SID, Magiran and Irandoc) and the Google Scholar search engine were searched without time restrictions from inception to October 2025. Relevant articles published in Persian and English and aligned with the study objectives were selected and analyzed.
Ethical Considerations: Throughout all stages of manuscript preparation, principles of academic integrity, honesty and fidelity to original sources were strictly observed.
Results: The findings of the reviewed studies were organized into three main themes. First, moral distress and compassion fatigue, which nurses experience to varying degrees, were found to be associated with individual factors such as age, gender, level of education and work experience, as well as organizational factors including workplace conditions. Second, the clinical and professional consequences of moral distress and compassion fatigue were identified as adverse outcomes that significantly affect nurses’ mental health, reduce job satisfaction, increase intentions to leave the profession and compromise the quality of nursing care. Third, evidence-based strategies aimed at improving these conditions were highlighted, including educational interventions (such as ethics education and coping skills training), the creation of supportive work environments and the implementation of spirituality-based approaches. These strategies have been shown to be effective in reducing moral distress and compassion fatigue and in enhancing nurses’ resilience.
Conclusion: Moral distress and compassion fatigue are among the most critical professional challenges faced by nurses, posing threats to their mental health and diminishing the quality of patient care. This review demonstrates that although these conditions may be inevitable in high-stress clinical settings, their severity and consequences can be mitigated through targeted interventions. Training in ethical and psychological strategies, enhancement of communication skills and the development of a supportive workplace culture provide a foundation for strengthening nurses’ resilience and restoring their professional capacity. Moreover, attention to spiritual values and the reinforcement of a team-oriented perspective play a significant role in alleviating ethical pressures and fostering professional solidarity. Accordingly, the findings of this study underscore the need to design comprehensive and sustainable programs to support nurses and to improve the quality and safety of clinical care
- Moral Distress
- Compassion Fatigue
- Nurses
- Clinical Consequences
- Professional Consequences
How to Cite
References
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