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Int J Nurs Stud. 2013 Jan;50(1):100-8. doi: 10.1016/j.ijnurstu.2012.08.017. Epub 2012 Sep 16.

Determinants of moral distress in daily nursing practice: a cross sectional correlational questionnaire survey.

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Netherlands Institute for Health Services Research, Utrecht, The Netherlands.



Moral distress is associated with job dissatisfaction, turnover and early retirement. Because of these negative consequences moral distress should be reduced. Little research has been done on what job factors contribute to whether or not a situation causes moral distress.


To identify individual and job characteristics associated with moral distress in nursing staff.


This is a cross sectional correlational study. Nursing staff members completed two survey questionnaires with a time-interval of 3 months. In the first survey questions were asked about job characteristics and job satisfaction. Three months afterwards the respondents answered questions on moral distress.


365 nursing staff members employed in nursing homes, homes for the elderly, home care and acute care hospitals completed both questionnaires.


High moral distress levels were related to lower job satisfaction. Moral distress is higher when nurses perceive less time available to give care to patients. If satisfaction with the consultation possibilities within the team is low and when an instrumental leadership style exists, nursing staff members are also more likely to experience moral distress. Nursing staff members working 30-40h per week experience less moral distress than colleagues working fewer hours per week. Multivariate analyses showed no relations with other individual characteristics measured.


Job characteristics that contribute to moral distress should be an issue for managers because it is related to job satisfaction. Interventions to reduce moral distress should target at organisational issues. The way a team is supported can raise or decrease moral distress levels.

[Indexed for MEDLINE]

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