Iranian Journal of Psychiatry and Behavioral Sciences

Published by: Kowsar

Intensity and Frequency of Moral Distress among Iranian Nurses: A Systematic Review and Meta-Analysis

Mohammad Hossein YektaKooshali 1 , Mohammad Esmaeilpour-Bandboni 2 , * and Mohsen Andacheh 1
Authors Information
1 Student Research Committee, School of Nursing, Midwifery and Paramedicine, Guilan University of Medical Sciences, Rasht, Iran
2 School of Nursing, Midwifery and Paramedicine, Guilan University of Medical Sciences, Rasht, Iran
Article information
  • Iranian Journal of Psychiatry and Behavioral Sciences: June 2018, 12 (2); e10606
  • Published Online: January 27, 2018
  • Article Type: Review Article
  • Received: January 20, 2017
  • Revised: March 25, 2017
  • Accepted: July 10, 2017
  • DOI: 10.5812/ijpbs.10606

To Cite: YektaKooshali M H, Esmaeilpour-Bandboni M, Andacheh M. Intensity and Frequency of Moral Distress among Iranian Nurses: A Systematic Review and Meta-Analysis, Iran J Psychiatry Behav Sci. 2018 ;12(2):e10606. doi: 10.5812/ijpbs.10606.

Copyright © 2018, Iranian Journal of Psychiatry and Behavioral Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited
1. Context
2. Evidence Acquisition
3. Results
4. Discussion
  • 1. Shafipour V, Esmaeili R, 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(126):58-67. Persian.
  • 2. Nathaniel AK. Moral reckoning in nursing. West J Nurs Res. 2006;28(4):419-38. discussion 439-48. doi: 10.1177/0193945905284727. [PubMed: 16672631].
  • 3. Beikrnoradi A, Rabiee S, Khatiban M, Cheraghi MA. Nurses distress in intensive care unit: a survey in teaching hospitals. Iran J Med Ethics History Med. 2012. Persian.
  • 4. Range LM, Rotherham AL. Moral distress among nursing and non-nursing students. Nurs Ethics. 2010;17(2):225-32. doi: 10.1177/0969733009352071. [PubMed: 20185446].
  • 5. Mohammadi S, Borhani F, Roshanzadeh L, Roshanzadeh M. Moral distress and compassion fatigue in patient care: a correlational study on nurses. Iran J Med Ethics History Med. 2014;7(2):69-79. Persian.
  • 6. Janvier A, Nadeau S, Deschenes M, Couture E, Barrington KJ. Moral distress in the neonatal intensive care unit: caregiver's experience. J Perinatol. 2007;27(4):203-8. doi: 10.1038/ [PubMed: 17304208].
  • 7. Jones A. Moral distress among nurses. J Emerg Nurs. 2014;40(1):4. doi: 10.1016/j.jen.2013.03.022. [PubMed: 24384480].
  • 8. Cronqvist A, Theorell T, Burns T, Lutzen K. Caring about--caring for: moral obligations and work responsibilities in intensive care nursing. Nurs Ethics. 2004;11(1):63-76. doi: 10.1191/0969733004ne667oa. [PubMed: 14763651].
  • 9. Harrowing JN, Mill J. Moral distress among Ugandan nurses providing HIV care: a critical ethnography. Int J Nurs Stud. 2010;47(6):723-31. doi: 10.1016/j.ijnurstu.2009.11.010. [PubMed: 20004395].
  • 10. Hart TJ. Moral distress in a non-acute continuing care setting: The experience of registered nurses. [dissertation]. Canada: Queen's Univ., Kingston, Ont; 2009.
  • 11. Corley MC, Minick P, Elswick RK, Jacobs M. Nurse moral distress and ethical work environment. Nurs Ethics. 2005;12(4):381-90. doi: 10.1191/0969733005ne809oa. [PubMed: 16045246].
  • 12. Redman BK, Fry ST. Nurses' ethical conflicts: what is really known about them? Nurs Ethics. 2000;7(4):360-6. doi: 10.1177/096973300000700409. [PubMed: 11221412].
  • 13. Russell AC. Moral distress in neuroscience nursing: an evolutionary concept analysis. J Neurosci Nurs. 2012;44(1):15-24. quiz 25-6. doi: 10.1097/JNN.0b013e31823ae4cb. [PubMed: 22210300].
  • 14. Borhani F, Abbaszadeh A, Arab M, Faramarzpor M. Moral Distress in Nurses. Med Ethics J. 2013;7(26):135-57. Persian.
  • 15. Shafiea A, Ravanipour M, Yazdankhah-Fard MR, Mirzaei K. [The relationship between moral distress and burnout among nurses of Shahid Ganji Hospital, Borazjan in 1394]. nursing of the vulnerable journal. 2(5). 2016. p. 15-26. Persian.
  • 16. Jameton A. Dilemmas of moral distress: moral responsibility and nursing practice. AWHONN's Clin Issues Perinatal Women's Health Nurs. 1993;4(4):542-51. [PubMed: 8220368].
  • 17. Hamric AB, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med. 2007;35(2):422-9. doi: 10.1097/01.CCM.0000254722.50608.2D. [PubMed: 17205001].
  • 18. Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a medical intensive care unit. Am J Crit Care. 2005;14(6):523-30. [PubMed: 16249589].
  • 19. Corley MC. Moral distress of critical care nurses. Am J Crit Care. 1995;4(4):280-5. [PubMed: 7663591].
  • 20. Corley MC. Nurse moral distress: a proposed theory and research agenda. Nurs Ethics. 2002;9(6):636-50. doi: 10.1191/0969733002ne557oa. [PubMed: 12450000].
  • 21. Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. J Adv Nurs. 2001;33(2):250-6. [PubMed: 11168709].
  • 22. YektaKooshali MH, Esmaeilpour-Bandboni M, Sharemi SH, Alipour Z. Survival Rate and Average Age of the Patients with Breast Cancer in Iran: Systematic Review and Meta-Analysis. J Babol Univ Med Sci. 2016;18(8):29-40. Persian.
  • 23. Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006-12. doi: 10.1016/j.jclinepi.2009.06.005. [PubMed: 19631508].
  • 24. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7. doi: 10.1016/s0140-6736(07)61602-x.
  • 25. 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(4):474-82. doi: 10.1177/0969733015604700.
  • 26. Borhani F, Mohammadi S, Roshanzadeh M. Moral distress and perception of futile care in intensive care nurses. J Med Ethics Hist Med. 2015;8:2. [PubMed: 26839676].
  • 27. Mohammadi S, Talebi F, Borhani F, Roshanzadeh M. Moral distress and attitude to euthanasia: A correlation study in nurses. Med Ethics J. 2014;8(28). Persian.
  • 28. Borhani F, Abbaszadeh A, Nakhaee N, Roshanzadeh M. The relationship between moral distress, professional stress, and intent to stay in the nursing profession. J Med Ethics Hist Med. 2014;7:3. [PubMed: 25512824].
  • 29. Zadeh AA, Borhani F, Ameri GF, Dolat-Abadi SN. Relation between moral distress and Work engagement in nurse’s cross-sectional-correlation study. Med Ethics J. 2015;7(24):33-53. Persian.
  • 30. Abbaszadeh A, Nakhaei N, Borhani F, Roshanzadeh M. The relationship between moral distress and retention in nurses in Birjand teaching hospitals. Iran J Med Ethics History Med. 2013;6(2):57-66. Persian.
  • 31. Nafchi SM, Borhani F, Roshanzadeh M. Relationship between moral distress and environmental empowerment for nurses in education hospitals in Kerman. Med Ethics J. 2015;8(26):91-113. Persian.
  • 32. Abbaszadeh A, Borhani F, Sharif F, Toghrai FAS. The relationship between nurse’s moral distress and end of life decision making in ICU. Med Ethics J. 2016;7(22):117-33. Persian.
  • 33. Heidari MR, Norouzadeh R. Supporting families of dying patients in the intensive care units. Holist Nurs Pract. 2014;28(5):316-22. doi: 10.1097/HNP.0000000000000045. [PubMed: 25099985].
  • 34. Vaziri MH, Merghati-Khoei E, Tabatabaei S. Moral Distress among Iranian Nurses. Iran J Psychiatry. 2015;10(1):32-6. [PubMed: 26005478].
  • 35. Keighobadi F, Sadeghi H, Keighobadi F, Tabaraei Y. The relationship between moral distress and emotional exhaustion in nurses. Iran J Med Ethics History Med. 2014;7(3):36-47. Persian.
  • 36. Fazljoo E, Borhani F, Abbaszadeh A, Razban F. The relationship between nurses' perceptions of moral distress and the ethical climate in Shahid Sadoughi University of Medical Sciences of Yazd. Iran J Med Ethics History Med. 2014;7(2):80-90. Persian.
  • 37. Ameri M, Safavibayatneed Z, Kavousi A. Moral distress of oncology nurses and morally distressing situations in oncology units. Aust J Adv Nurs. 2016;33(3):6.
  • 38. Shoorideh FA, Ashktorab T, Yaghmaei F, Alavi Majd H. Relationship between ICU nurses' moral distress with burnout and anticipated turnover. Nurs Ethics. 2015;22(1):64-76. doi: 10.1177/0969733014534874. [PubMed: 24948793].
  • 39. Atashzadeh Shorideh F, Ashktorab T, Yaghmaei F. Iranian intensive care unit nurses' moral distress: a content analysis. Nurs Ethics. 2012;19(4):464-78. doi: 10.1177/0969733012437988. [PubMed: 22691602].
  • 40. Dargahi H, Shaham G. Life Change Units (LCU) rating as stressors in Iranian hospitals' nurses. Acta Med Iran. 2012;50(2):138-46. [PubMed: 22359085].
  • 41. Soleimani MA, Sharif SP, Yaghoobzadeh A, Sheikhi MR, Panarello B, Win MT. Spiritual well-being and moral distress among Iranian nurses. Nurs Ethics. 2016. doi: 10.1177/0969733016650993. [PubMed: 27312198].
  • 42. Abbasi M, Hajatmand F, Khaghanizadeh M, Gashtroudkhani AA. Moral distress in nurses employed in selected hospitals of Shahid Beheshti University of Medical Sciences. Med Ethics J. 2015;9(32):121-40. Persian.
  • 43. Rathert C, May DR, Chung HS. Nurse moral distress: A survey identifying predictors and potential interventions. Int J Nurs Stud. 2016;53:39-49. doi: 10.1016/j.ijnurstu.2015.10.007. [PubMed: 26515025].
  • 44. Prentice T, Janvier A, Gillam L, Davis PG. Moral distress within neonatal and paediatric intensive care units: a systematic review. Arch Dis Childhood. 2016;101(8):701-8. doi: 10.1136/archdischild-2015-309410.
  • 45. Mansouri A, Norouzi S, Sharifi A, YektaKooshali MH, Azami M. The relationship of maternal subclinical hypothyroidism during pregnancy and preterm birth: a systematic review and meta-analysis of cohort studies. Iran J Obstetr Gynecol Infertil. 2017;19(40):69-78. Persian.
  • 46. Azami M, Shamloo MBB, Nasirkandy MP, Veisani Y, Rahmati S, YektaKooshali MH, et al. Prevalence of vitamin D deficiency among pregnant women in Iran: a systematic review and meta-analysis. Koomesh. 2017;19(3). Persian.
  • 47. Mansouri A, Adhami Mojarad MR, Badfar G, Abasian L, Rahmati S, Kooti W, et al. Epidemiology of Toxoplasma gondii among blood donors in Iran: A systematic review and meta-analysis. Transfus Apher Sci. 2017;56(3):404-9. doi: 10.1016/j.transci.2017.03.011. [PubMed: 28433405].
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments