The effect of moral distress experienced by intensive care nurses on end-of-life care attitudes and care behaviours: a single-centre cross-sectional and correlational study
BMC Nursing, vol.25, no.1, 2026 (SCI-Expanded, SSCI, Scopus)
- Publication Type: Article / Article
- Volume: 25 Issue: 1
- Publication Date: 2026
- Doi Number: 10.1186/s12912-026-04417-1
- Journal Name: BMC Nursing
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, CINAHL, Directory of Open Access Journals
- Keywords: Attidute, Care behavior, End-of-life care, Intensive care, Moral distress, Nurses
- Kütahya Health Sciences University Affiliated: Yes
Abstract
Objectives: This study aimed to evaluate the effect of moral distress experienced by intensive care nurses on their attitudes toward end-of-life care and their care behaviors. Methods: This cross-sectional and correlational study was conducted with 121 nurses working in intensive care units (ICUs). Data collection tools included the ICU Nurse Information Form, the Moral Distress Scale-Revised (MDS-R), the Caring Behaviors Inventory-24 (CBI-24), and the Nurses’Attitudes and Behaviors of Intensive Care Nurses Toward End-of-Life Care (EoLC) Scale. Results: The moral distress mean score of ICU nurses was 76.61 ± 22.72, attitudes and behaviors toward EoLC mean score 51.56 ± 10.39, and CBI-24 mean score was 122.72 ± 16.39.The correlation coefficients between the Distress subscale of the MDS-R and the mean scores of EoLC Attitudes were found to be positive and significant. (r = 0.200; p < 0.05; p = 0.028). The correlation coefficients between the CBI-24 and the EoLC Attitudes (r = 0.253, p < 0.01, p = 0.005) and Behaviors (r = 0.186, p < 0.05, p = 0.041) subscale were found to be positive and significant. Moral distress did not directly affect attitudes and behaviors toward EoLC, and care behaviour (p < 0.05). Conclusion: In this study, ICU nurses were found to experience moderate levels of moral distress, have good perceptions of caring behaviors, and exhibit moderate levels of attitudes and behaviors toward end-of-life care. However, moral distress was found to have no significant effect on their attitudes toward end-of-life care or on their caring behaviors. Clinical trial number: Not applicable.