Moral Distress and its Influential Factors in the Nurses of the Nursing Homes in Khorasan Provinces in 2019: A Descriptive‑Correlational Study

Ali Sedaghati, Abdolghader Assarroudi, Rahim Akrami, Mostafa Rad


Background: Nurses in nursing homes are constantly faced with various moral decisions in terms of elderly care, which in turn causes moral distress. This study aimed to evaluate the moral distress status and its influential factors in the nursing homes in Khorasan provinces, Iran.

Materials and Methods: This descriptive‑correlational study was conducted on 227 nurses engaged in the nursing homes of Khorasan provinces in 2019. The subjects were selected via census sampling. Data were collected using demographic, occupational, and care center characteristics questionnaire and a moral distress questionnaire. Data analysis was performed in SPSS version 16 using the Mann–Whitney U and Kruskal–Wallis test.

Results: The mean (SD) score of moral distress was 28.68 (19.19), and 93.83% of the subjects reported low levels of moral distress. Significant correlations were observed between moral distress and age, work experience, workplace, nurse–physician relations, motivation of the nurses, care facilities, and medical equipment. Furthermore, the highest mean (SD) score of moral distress belonged to the items regarding the lack of work experience 12.19 (3.12).

Conclusions: According to the results, moral distress in the nurses of the studied nursing home was relatively low. Despite the favorable outcome of the study, the age discrimination of nurses by nursing homes should not be overlooked.  


Aged, morals, nurses, nursing homes

Full Text:



Fuji S, Tanioka T, Yasuhara Y, Sato M, Saito K, Purnell MJ, et al. Characteristic autonomic nervous activity of institutionalized elders with dementia. OJPsych 2016;6:34-49. doi: 10.4236/ ojpsych.2016.61004.

Gibson G, Dickinson C, Brittain K, Robinson L. The everyday use of assistive technology by people with dementia and their family carers: A qualitative study. BMC Geriatr 2015;15:89.

Jo H, Kim S. Moral sensitivity, empathy and perceived ethical climate of psychiatric nurses working in the national mental hospitals. J Korean Acad Psychiatr Ment Health Nurs 2017;26:204‑15.

Pijl‑Zieber EM, Awosoga O, Spenceley S, Hagen B, Hall B, Lapins J. Caring in the wake of the rising tide: Moral distress in residential nursing care of people living with dementia. Dementia 2018;17:315‑36.

Lusignani M, Giannì ML, Re LG, Buffon ML. Moral distress among nurses in medical, surgical and intensive-care units. J Nurs Manag 2017;25:477‑85.

Berhie AY, Tezera ZB, Azagew AW. Moral distress and its associated factors among nurses in northwest amhara regional state referral hospitals, Northwest Ethiopia. Psychol Res Behav Manag 2020;13:161‑7.

Parandeh A, Khaghanizade M, Mohammadi E, Mokhtari‑Nouri J. Nurses’ human dignity in education and practice: An integrated literature review. Iran J Nurs Midwifery Res 2016;21:1‑8.

Shafipour A, Ravanbakhsh Esmaeili V, Heidari MR, Aghaei N, Saadatmehr SR, Sanagoo A. Investigating the level of moral distress and its related factors among nurses in Mazandaran Burn Center.” J Mazandaran Univ Med Sci 2015;25:58‑67. [In Persian].

Dzeng E, Colaianni A, Roland M, Levine D, Kelly MP, Barclay S, et al. Moral distress amongst American physician trainees regarding futile treatments at the end of life: A qualitative study. J Gen Intern Med 2016;31:93‑9.

Borhani F, Abbaszadeh A, Mohamadi E, Ghasemi E, Hoseinabad‑Farahani MJ. Moral sensitivity and moral distress in Iranian critical care nurses. Nurs Ethics 2017;24:474‑82.

Barlem EL, Lunardi VL, Lunardi GL, Tomaschewski‑Barlem JG, Almeida AS, Hirsch CD. Psycometric characteristics of the Moral Distress Scale in Brazilian nursing professionals. Texto Contexto Enfermagem 2014;23:563‑72. Doi: 07072014000060013.

Hamric AB, Borchers CT, Epstein EG. Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Prim Res 2012;3:1‑9.

Motevallian SA, Alizadegan S, Hossein Vaziri M, Khoiee EM, Goushegir SA, Ghoroubi J. Developing the moral distress scale in the population of Iranian nurses. Iran J Psychiatry 2008:55‑8.

Williams B, Onsman A, Brown T. Exploratory factor analysis: A five‑step guide for novices. Aust J Paramed 2010;8:1‑13.

Corley MC, Minick P, Elswick R, Jacobs M. Nurse moral distress and ethical work environment. Nurs Ethics 2005;12:381‑90.

Joolaee S, Jalili HR, Rafii F, Hajibabaee F, Haghani H. Relationship between moral distress and job satisfaction among nurses of Tehran University of Medical Sciences Hospitals. Hayat 2012;18:42‑51. [In Persian].

Abbaszadeh A, Nakhaei N, Borhani F, Roshanzadeh M. The relationship between moral distress and retention in nurses in Birjand teaching hospitals. IJME 2013;6:57‑66. [In Persian].

Nelson TD. Promoting healthy aging by confronting ageism. Am Psychol 2016;71:276‑82.

Robaee N, Atashzadeh‑Shoorideh F, Ashktorab T, Baghestani A, Barkhordari‑Sharifabad M. Perceived organizational support and moral distress among nurses. BMC Nurs 2018;17:2.

Rushton CH, Kaszniak AW, Halifax JS. A framework for understanding moral distress among palliative care clinicians. J Palliat Med 2013;16:1074‑9.

Ebrahimi H, Kazemi A, Asghari Jafarabadi M, Azarm A. Moral distress in nurses working in educational hospitals of Northwest Medical Universities of Iran. IJME 2013;6:80‑8. [In Persian]. 22. Henrich NJ, Dodek PM, Gladstone E, Alden L, Keenan SP, Reynolds S, et al. Consequences of moral distress in the intensive care unit: A qualitative study. Am J Crit Care 2017;26:e48‑57.

Heydari A, Ahrari S, Toghian Chaharsoughi N. Moral distress in nursing and its contributors in the context of Iran. Health Spiritual Med Ethics J 2018;5:


  • There are currently no refbacks.