UT SON Dissertations (Open Access)

Date of Award

Spring 5-2018

Degree Name

Doctor of Philosophy in Nursing (PhD)


Joan Engebretson, DrPH - Chair

Second Advisor

Elizabeth Ulrich, EdD

Third Advisor

Deborah J. Jones, PhD

Fourth Advisor

Courtenay Bruce, J.D.


Background: Moral distress is the psychological response to knowing the right action required by a healthcare professional but being unable to act upon the right course of action due to internal, external, and institutional constraints.

Purpose: The study investigated: 1. the level of moral distress among interprofessional healthcare providers working in four ICUs of a single academic hospital as measured by the 21-item Moral Distress Scale-Revised (MDS-R), 2. the differences in moral distress among interprofessional healthcare providers based on demographic characteristics and rankings of clinical scenario on the MDS-R.

Method: Descriptive, cross-sectional design using survey methodology.

Outcomes: Significant differences in mean moral distress (F = 4.105, p = .001), moral distress frequency (F = 2.868, p = .016), and moral distress intensity (F = 4.341, p = .001) were found between professional roles. Significant differences in moral distress frequency among the ICUs (F = 3.871, p = .010) and differences in mean moral distress between levels of education (F= 5.849, p = .001) and years of ICU experience (F = 3.180, p = .009) was found. RNs (28.09) (±12.26) and respiratory therapists (28.45) (±11.92) reporting high moral distress also reported high moral distress frequency. Significant differences in moral distress intensity were found between professional roles with clergy reporting the highest and physicians reporting the lowest. Differences in moral distress between RNs (t (9.953) = 6.68, p = .000), clergy (t (14) = -2.44, p = .029), respiratory therapists (t (30) = -3.72, p = .001), and physicians (t (83) = -2.50, p = .014) were found. A significant relationship between moral distress scores and team dynamics (rs= .423, p = .000) and team communication (rs= .447, p = .000) was found.

Conclusion: Low to moderate moral distress was found among all professional roles with significant differences seen between direct and indirect healthcare providers. Mean moral distress scores were highest in respiratory therapists and RNs compare to dieticians. Moral distress was highest in adult ICUs compared to pediatric ICUs.


Moral Distress, Communication, Interprofessional team

Included in

Nursing Commons