Moral Distress in Intensive Care Unit Nurses: An Integrated Review

Introduction: Moral distress is a serious problem for health care professionals all over the world; it has detrimental effects for patients, nurses and organizations. Nurses in ICUs experience more moral distress due to their daily dealing with ethical problems and the stressful atmosphere. The purpose of this study was to conduct an integrated review and a combination of existing studies on moral distress in Intensive Care Unit nurses. Methods & Materials: In the literature review from 2000 to 2019, various databases including SID, Irandoc, Google Scholar, PubMed, Medline, Scopus, Cochrane Library, and Science Direct were searched with keywords of moral distress, nursing, Intensive Care Units. The modified version of Cooper's fivestage integrated review by Whittemore and Knalf was used for this purpose. Results: Results were presented in four sections on the effects and sources of moral distress on nurses in Intensive Care Units, their psychological reactions, and how they deal with moral distress. Conclusion: Based on a review of the literature, we can say that moral distress can never be completely eliminated, but its causes and effects can be mitigated. As this phenomenon is more common among nurses in intensive care units due to its challenging environment, ethical distress should be identified in nurses and prevention or treatment strategies should be considered.