Sir Özkan, Kaşıkçı Mağfiret, Kaplan Ebubekir
Department of Fundamentals of Nursing, Van Yuzuncu Yil University, Van, Turkey.
Department of Fundamental of Nursing, Atatürk University, Erzurum, Turkey.
Nurs Crit Care. 2025 Sep;30(5):e70171. doi: 10.1111/nicc.70171.
Intensive care nurses experience moral distress due to moral conflicts, which negatively impact their attitudes and behaviours towards end-of-life care. Moral resilience is considered a potential factor in mitigating these negative effects.
This study aims to examine the mediating role of moral resilience in the relationship between moral distress and intensive care nurses' attitudes and behaviours towards end-of-life care.
A descriptive and cross-sectional study was conducted in accordance with the guidelines for observational studies (STROBE). The study was conducted with 228 intensive care nurses between December 2024 and February 2025. Data were collected using the 'Personal Information Form', 'Moral Distress Scale', 'Moral Resilience Scale' and 'Scale of Attitudes and Behaviours of Intensive Care Nurses Towards End-of-Life Care'. Statistical analyses were performed using SPSS 26.0 and AMOS V 24.0.
The moral distress levels of female nurses were higher and significantly higher than male nurses (OR 0.245; 95% CI 0.074-0.598; p = 0.011). Nurses with 11 years or more of work experience had a higher and significant level of moral distress compared to other nurses (OR 0.053; 95% CI 0.080-0.115; p = 0.012). The moral resilience level of nurses with 3-6 years of work experience was higher and significantly higher than other nurses (OR 0.067; 95% CI 0.048-0.107; p = 0.023). Moral distress negatively affects nurses' attitudes and behaviours towards end-of-life care. Moral resilience has a significant and positive effect on attitudes and behaviours. Moreover, moral resilience mediated the relationship between moral distress and attitudes and behaviours towards end-of-life care (β;-0.266, CI 95% -0.301-0.197).
Moral distress negatively influences intensive care nurses' attitudes and behaviours in end-of-life care. Enhancing moral resilience can help mitigate these effects. The findings highlight the need for nursing education programmes and workplace interventions to strengthen nurses' moral resilience and improve their ability to manage moral distress.
While moral distress damages intensive care nurses' attitudes towards end-of-life care, moral resilience may help to reduce its negative effects. Supporting nurses is thought to improve the quality of adverse end-of-life care.
重症监护护士因道德冲突而经历道德困扰，这对他们对临终关怀的态度和行为产生负面影响。道德复原力被认为是减轻这些负面影响的一个潜在因素。
本研究旨在探讨道德复原力在道德困扰与重症监护护士对临终关怀的态度和行为之间关系中的中介作用。
根据观察性研究指南（STROBE）进行了一项描述性横断面研究。该研究于2024年12月至2025年2月对228名重症监护护士进行。使用“个人信息表”、“道德困扰量表”、“道德复原力量表”和“重症监护护士对临终关怀的态度和行为量表”收集数据。使用SPSS 26.0和AMOS V 24.0进行统计分析。
女护士的道德困扰水平更高，且显著高于男护士（OR 0.245；95%CI 0.074 - 0.598；p = 0.011）。工作经验11年及以上的护士与其他护士相比，道德困扰水平更高且具有显著性（OR 0.053；95%CI 0.080 - 0.115；p = 0.012）。工作经验3 - 6年的护士的道德复原力水平更高，且显著高于其他护士（OR 0.067；95%CI 0.048 - 0.107；p = 0.023）。道德困扰对护士对临终关怀的态度和行为产生负面影响。道德复原力对态度和行为有显著的积极影响。此外，道德复原力介导了道德困扰与对临终关怀的态度和行为之间的关系（β；-0.266，CI 95% -0.301 - 0.197）。
道德困扰对重症监护护士在临终关怀中的态度和行为产生负面影响。增强道德复原力有助于减轻这些影响。研究结果凸显了护理教育项目和工作场所干预措施的必要性，以增强护士的道德复原力并提高他们应对道德困扰的能力。
虽然道德困扰损害了重症监护护士对临终关怀的态度，但道德复原力可能有助于减少其负面影响。支持护士被认为可以提高临终不良护理的质量。
