ArticleBMC medical ethics2021
Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study.
Article in BMC medical ethics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 77 papers, 4 of them syntheses that pooled it.
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Who cites it
77 citing papers in PubMed, 4 syntheses or guidelines pooled it, 174 citations in OpenAlex.
- Severity and associated factors of moral injury in healthcare workers during the coronavirus pandemic: a comprehensive meta-analysis.Archives of public health = Archives belges de sante publique · 2025Pooled it
- Impact of restricted family presence during the COVID-19 pandemic on critically ill patients, families, and critical care clinicians: a qualitative systematic review.BMC health services research · 2024Pooled it
- Estimation of moral distress among nurses: A systematic review and meta-analysis.Nursing ethics · 2023Pooled it
- Influencing Factors of Nurses' Well-Being in Critical Care During Pandemic Era: A Systematic Review.Public health nursing (Boston, Mass.)Pooled it
- Trial
- The Relationship Between Nurses' Ethical Behaviours for Protecting Patients' Rights and Patient-Centred Care Competencies: A Cross-Sectional Study.Nursing open · 2026Article
- Resource allocation decisions faced by health care providers during the COVID-19 pandemic in a community intensive care unit in Ontario, Canada: a qualitative study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2026Article
- Stepping outside the clinic walls: health professionals' encounters with place during the COVID-19 pandemic.BMC public health · 2026Article
- Perception of the Ethical Climate Among Hospital Employees in a Public Healthcare System: A Qualitative Study at the University Hospital of Split, Croatia.Healthcare (Basel, Switzerland) · 2026Article
- Moral Distress and Occupational Burnout in US Physicians.JAMA network open · 2026Article
- Moral distress of intensive care unit nurses: a systematic review and meta-analysis.BMC nursing · 2026Article
- Professional Values, Perceived Ethical Climate, and Dignity-Protecting Behaviors Among Intensive Care Nurses: A Moderation Analysis.Journal of nursing management · 2026Article
- Navigating the "Moral Maze": A Flourishing-Centered Reflective Inquiry for Healthcare Leadership.Journal of healthcare leadership · 2026Article
- Moral resilience, hospital ethical climate, moral courage, and moral sensitivity among intensive care unit nurses: a structural equation model.Frontiers in psychology · 2026Article
- The Outcomes of A Multifaceted Educational Intervention to Reduce Moral Distress Among Critical Care Nurses.Journal of clinical nursing · 2025Article
- Article
- Relationship of intensive care unit nurses' attitudes towards futile treatment with compassion fatigue and turnover intention.Nursing in critical care · 2025Article
- Perceptions of ethical decision-making climate among clinicians working in European and US ICUs: differences between religious and non-religious healthcare professionals.BMC medical ethics · 2025Observational
- [Lessons from the COVID-19-Pandemic : Experiences of critical care nurses during the COVID-19 pandemic: a qualitative explorative study].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Article
- Article
17 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
10 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.
methodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19.
resultsThree hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. "Inadequate emotional support for patients and their families" was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. "Culture of not avoiding end-of-life-decisions" and "Self-reflective and empowering leadership" received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.
conclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.