Registered Nurses' and nursing students' perspectives on moral distress and its effects: A mixed‐methods systematic review and thematic synthesis

Abstract

AimTo examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well‐being and professional and career intentions.DesignJoanna Briggs Institute mixed‐methods systematic review and thematic synthesis. Registered in Prospero (Redacted).MethodsFive databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction.ResultsSearches yielded 2343 hits. Seventy‐seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well‐being.Patient or Public ContributionNo patient or public contribution to this systematic review.

Nurses’ experiences of moral distress and how it affects daily work in surgical care—a qualitative study

“…The results of our study show that patient-related care is deprioritized because administrative tasks take up a large part of nurses' working time. Studies have shown that nurses signalled this problem many years ago, yet they still experience the same problem today (Coster et al, 2018;McHugh et al, 2021;Watts et al, 2023).…”

“…In the shadow of the COVID-19 pandemic, which put pressure on individual nurses, the nursing shortage is increasing globally and is expected to increase further over the next decade (Boone et al, 2023;Guttormson et al, 2022;Watts et al, 2023). A report states that the pandemic has increased the pressure on an already pressured professional group (International Centre on Nurse Migration, 2022).…”

“…Although moral distress is a topic of research, a recent systematic review identified a dearth of evidence from a surgical nursing perspective (Watts et al, 2023). An alarming number of nurses choose to leave surgical inpatient care, and it has also been identified that there are limited interview studies to understand moral distress in surgical care.…”