Abstract
Background
Nurses frequently encounter ethical dilemmas that, when they are unable to act in accordance with perceived ethical standards, may lead to moral distress. Moral distress is associated with a wide range of adverse psychological, physical, and professional outcomes, and its development is influenced by multiple individual, team-related, and organizational factors. Although various interventions have been proposed to reduce moral distress, the existing evidence regarding their effectiveness remains fragmented and heterogeneous.
Research question/aim/objectives
This systematic review aimed to identify, synthesize, and evaluate evidence on interventions designed to address moral distress in nurses across various clinical settings.
Research design
A systematic review study.
Search and quality appraisal
A comprehensive systematic search was conducted in major databases using a PICO-based strategy with no time restrictions, alongside citation tracking and manual searching to ensure completeness. Study selection followed Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 (PRISMA), and risk of bias and certainty of the evidence were assessed independently by three reviewers using Joanna Briggs Institute (JBI) tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.
Findings/results
This review synthesized evidence from 29 studies conducted in various countries and clinical contexts, focusing on interventions designed to reduce moral distress among nurses. The majority of studies, especially those based on educational, cognitive-behavioral, and communication-oriented strategies, indicated a decrease in moral distress alongside improvements in associated professional and psychological outcomes.
Conclusions
This systematic review suggests that educational and skill-based interventions may reduce nurses’ moral distress, particularly in the short term. However, the certainty of evidence is low due to methodological limitations and heterogeneity, and more rigorous, large-scale studies with longer follow-up are needed to confirm their effectiveness and sustainability.