Moral Distress by A Thousand Cuts: A Mixed Methods Study on Nurses in the Wake of the COVID-19 Pandemic - Abstract
Background: Manifestations of Moral Distress (MD) in nurses encompass psychological feelings of frustration, guilt, and inner conflict. Especially following
the pandemic, addressing moral distress is crucial for ethical decision-making and nurse well-being.
Methods: A sequential explanatory mixed-method research design was utilized, combining quantitative data collected via an online survey from July
to August 2023 and qualitative data from interviews in September 2023. Eligibility criteria included registered nurses in Utah, aged 18 and older, with no
restrictions on gender or race. Quantitative data were analyzed using SPSS© version 28, and qualitative data were analyzed using Braun and Clarke’s
thematic analysis. The integration of both datasets was achieved through a critical mixed-methods process to ensure a cohesive examination of experiences.
Results: A total of 191 participants completed the online survey, with an average age of 38 years, predominantly female (83.2%), and mostly identifying
as White (88.9%). Nurses in acute settings did not report higher levels of MD compared to those in non-acute settings, and the overall regression model did
not significantly predict MD. Team dynamics significantly moderated the relationship between resilience and MD, with higher resilience associated with lower
MD in settings with lower team dynamics. Despite the significant interaction, the final regression model explained only a modest portion of the variability in MD,
indicating other factors also influence MD in meaningful ways.
Discussion: Moral distress significantly influences team dynamics, leading to strained communication and decreased collaboration. Positive team dynamics
can mitigate moral distress and enhance patient care. Resilience acts as a protective factor against moral distress, necessitating a supportive work environment.
In this study, nurses described burnout, perceived deficiencies in nursing education, disconnect with management, and systemic challenges.
Conclusion: Moral distress is pervasive in healthcare, exacerbated by the COVID-19 pandemic. Nurses face complex challenges requiring support and
enhanced education. Positive team dynamics, resilience, and coping mechanisms are vital for nurse well-being and patient care. Recognizing moral distress and
fostering post-traumatic growth is integral to nurse empowerment and compassionate care delivery.