<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_FON-2019-0037_s_006_w2aab3b7ab1b6b1aab1c17b1Aa"><h3>Objective</h3><p>Nursing profession conventionally meets a high standard of ethical behavior and action. One of the ethical challenges in nursing profession is moral distress. Nurses frequently expose to this phenomenon which leads to different consequences such as being bored by delivering patient care that decline care quality and make it challenging to achieve health purposes. This study was conducted to investigate the association between the aspects of moral distress and care quality.</p></sec><sec id="j_FON-2019-0037_s_007_w2aab3b7ab1b6b1aab1c17b2Aa"><h3>Methods</h3><p>In this descriptive–analytical study, 545 nurses of intensive and cardiac care units and dialysis and psychiatric wards were recruited by census sampling. Three questionnaires, Sociodemographics, Moral Distress Scale, and Quality Patient Care Scale, were distributed among the participants and collected within 9 months. Data analysis was conducted by descriptive statistics, analysis of variance, and the least significant difference in SPSS 13.</p></sec><sec id="j_FON-2019-0037_s_008_w2aab3b7ab1b6b1aab1c17b3Aa"><h3>Results</h3><p>Investigating moral distress domains (ignoring patient, decision-making power, and professional competence) and care quality domains (psychosocial, physical, and communicational) demonstrated that in being exposed to moral distress, ignoring patient had no effect on psychosocial domain (<italic>P</italic>=0.056), but decision-making and professional competence of moral distress had positive effect on psychosocial, physical (bodily), and communication domains of care quality.</p></sec><sec id="j_FON-2019-0037_s_009_w2aab3b7ab1b6b1aab1c17b4Aa"><h3>Conclusions</h3><p>Because moral distress domains are effective on patient care quality, it is recommended to enhance the knowledge of nurses, especially beginners, about moral distress, increase their strength alongside standardizing nursing services in decision-making domains, improve the professional competence, and pay attention to patients.</p></sec></abstract>

ObjectiveNursing profession conventionally meets a high standard of ethical behavior and action. One of the ethical challenges in nursing profession is moral distress. Nurses frequently expose to this phenomenon which leads to different consequences such as being bored by delivering patient care that decline care quality and make it challenging to achieve health purposes. This study was conducted to investigate the association between the aspects of moral distress and care quality.MethodsIn this descriptive–analytical study, 545 nurses of intensive and cardiac care units and dialysis and psychiatric wards were recruited by census sampling. Three questionnaires, Sociodemographics, Moral Distress Scale, and Quality Patient Care Scale, were distributed among the participants and collected within 9 months. Data analysis was conducted by descriptive statistics, analysis of variance, and the least significant difference in SPSS 13.ResultsInvestigating moral distress domains (ignoring patient, decision-making power, and professional competence) and care quality domains (psychosocial, physical, and communicational) demonstrated that in being exposed to moral distress, ignoring patient had no effect on psychosocial domain (P=0.056), but decision-making and professional competence of moral distress had positive effect on psychosocial, physical (bodily), and communication domains of care quality.ConclusionsBecause moral distress domains are effective on patient care quality, it is recommended to enhance the knowledge of nurses, especially beginners, about moral distress, increase their strength alongside standardizing nursing services in decision-making domains, improve the professional competence, and pay attention to patients.

Analytical study of care quality and moral distress in clinical situations and patient care

Frontiers of Nursing

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

ObjectiveNursing profession conventionally meets a high standard of ethical behavior and action. One of the ethical challenges in nursing profession is moral...

Sociodemographic characteristics of studied nurses	n (%)
Hospital
Shohada	28 (5.1)
Alzahra	15 (2.8)
ShahidMadani	150 (27.5)
Children Cure & Health Hospital	47 (8.6)
Alavi	9 (1.6)
Imam Reza	160 (29)
Taleghani	13 (2.9)
Nikoukari	8 (1.4)
Razi	90 (16.5)
Sina	25 (4.6)
Ward
Special	455 (83.5)
Psychiatric	90 (16.5)
Gender
Female	472 (86.6)
Male	73 (13.4)
Marital status
Single	239 (43.9)
Married	306 (56.1)
Education
Bachelor	511 (93.8)
Master & Higher	34 (6.2)
Occupation
Employed	157 (28.8)
Contract and Project	388 (71.2)

Items	Psychosocial domain (df = 2)			Physical domain (df = 2)			Communication domain (df = 2)
	SBB	F	P	SBB	F	P	SBB	F	P
Ignoring patient domain	1122.44	2.89	0.056	2665.82	6.92	0.001	1746.78	4.51	0.011
Decision-making domain	839.68	3.62	0.027	1766.18	7.69	0.001	1052.22	4.54	0.011
Professional competence domain	311.76	3.68	0.026	572.02	6.80	0.001	570.33	6.79	0.001

Items (n)	Low level (16–47)	Moderate level (48–80)	High level (81–112)
Ignoring domain patients (16)	A	B	C
Decision-making domain (8)	D	E	F
Professional competence domain (6)	G	H	K
Items		Number of items	Item score
Psychosocial domain		32	32–128
Physical domain		23	23–92
Communication domain		13	13–52

Analytical study of care quality and moral distress in clinical situations and patient care

Article Category: Original article

Published Online: Dec 31, 2019

Page range: 327 - 334

Received: Aug 04, 2018

Accepted: Nov 05, 2018

DOI: https://doi.org/10.2478/FON-2019-0037

Keywords
quality of healthcare, moral distress, clinical situations, nurse, patients

© 2019 Masoumeh Hasanlo et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

The sociodemographic characteristics of studied nurses

Relationship among low, moderate, and high levels of moral distress domains and quality of care domains.

Moral Distress Scale 7-point Likert 30 questions

Analytical study of care quality and moral distress in clinical situations and patient care

Article Category: Original article

Published Online: Dec 31, 2019

Page range: 327 - 334

Received: Aug 04, 2018

Accepted: Nov 05, 2018

DOI: https://doi.org/10.2478/FON-2019-0037

Keywordsquality of healthcare, moral distress, clinical situations, nurse, patients

© 2019 Masoumeh Hasanlo et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

The sociodemographic characteristics of studied nurses

Relationship among low, moderate, and high levels of moral distress domains and quality of care domains.

Moral Distress Scale 7-point Likert 30 questions

Keywords
quality of healthcare, moral distress, clinical situations, nurse, patients