Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2018


Doctor of Nursing Practice (DNP)

Primary Advisor

Dr. Qiuping Zhou


Background: Moral distress occurs when one knows the ethically correct action to take but feels powerless or is unable to take that action. Although various sources and common clinical scenarios that often induce distress among registered nurses have been studied, most of the research was qualitative and there was limited evidence regarding moral distress and nursing practice factors.

Objectives: To assess the frequency and intensity of moral distress and compare critical care nurses vs. non-critical care nurses' total moral distress scores.

Methods: A cross sectional survey of 97 registered nurses was conducted through survey monkey. The MDS-R was used to assess baseline intensity and frequency of moral distress.

Results: The mean moral distress composite score was 103 out of a possible 336. There was a small effect in moral distress scores between critical care and non-critical care nurses (122.73 versus 100.16, t=1.15, p=0.255, Cohen's d=0.32). Nurses with 3 or more years of experience reported higher moral distress than those with 2 or fewer years of experience (114.30 versus 77.28, t=2.05, p=0.044). The two most frequent and intense distress scenarios were following the family's wishes to continue life support even though the nurse believes it is not in the best interest of the patient and initiating extensive life-saving actions when the nurse thinks they only prolong death.

Conclusion: Nurses in this community hospital experienced moral distress, with those in critical care reporting higher distress than non-critical care nurses. Coping skills education and ethics consultations are needed to decrease stress and burnout.

Open Access




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