ArticleBMJ quality & safety2023
Complex interplay between moral distress and other risk factors of burnout in ICU professionals: findings from a cross-sectional survey study.
Article in BMJ quality & safety, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 3 of them syntheses that pooled it.
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Who cites it
30 citing papers in PubMed, 3 syntheses or guidelines pooled it, 65 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
- European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.Intensive care medicine · 2024Guideline
- Estimation of moral distress among nurses: A systematic review and meta-analysis.Nursing ethics · 2023Pooled it
- Moral distress and moral injury in healthcare: A review and instrument analysis.Journal of health psychology · 2026Review
- The ICUPASS Study: Variability, Influencing Factors, and Clinician Stress in ICU Admission Decisions.Cureus · 2026Article
- Nurses' experiences of moral suffering: A qualitative interview study.Nursing ethics · 2026Article
- Occupational burnout and the protective role of sports viewing among male ICU physicians in China: a nationwide survey on influencing factors and pathways.BMC health services research · 2026Article
- Burnout among healthcare workers in Lebanon: a multicentred cross-sectional study.BMJ public health · 2026Article
- Family satisfaction and healthcare providers' moral distress in intensive care units: a cross-sectional study.Scientific reports · 2025Article
- Experiences of Moral Distress in Canadian Intensive Care Unit Professionals During and After the COVID-19 Pandemic: A Qualitative Exploratory Multiple Case Study in Ontario and Alberta, Canada.Journal of intensive care medicine · 2025Article
- Burnout among intensive care physicians and nurses in the post-pandemic era in China: a national cross-sectional study.BMJ open · 2025Article
- Exposure to distressing situations among registered nurses during the COVID-19 pandemic: a cross-sectional study.BMC nursing · 2025Article
- Risk management during times of health uncertainty in Spain: A qualitative analysis of ethical challenges.Risk analysis : an official publication of the Society for Risk Analysis · 2025Article
- Moral Distress and Emotional Exhaustion in Healthcare Professionals: A Systematic Review and Meta-Analysis.Healthcare (Basel, Switzerland) · 2025Review
- Article
- Working with people living with motor neurone disease and the impact on professionals' emotional and psychological well-being: A scoping review.Palliative medicine · 2025Article
- 'As You Set Out for Ithaca': VIEW- A Visual Tool for Teaching Ethical Decision Making in Medical Practice.Perspectives on medical education · 2025Article
- The Role of Leadership in Supporting and Mitigating Moral Distress in Nursing: A Scoping Review.Journal of nursing management · 2025Article
- Experience of Early Postgraduate Transition to Intensive Care Medicine: A Phenomenological Study.Cureus · 2024Article
- Moral Distress and Moral Injury in Military Healthcare Clinicians: A Scoping Review.AJPM focus · 2024Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBurnout threatens intensive care unit (ICU) professionals' capacity to provide high-quality care. Moral distress is previously considered a root cause of burnout, but there are other risk factors of burnout such as personality, work-life balance and culture. This study aimed to disentangle the associations of ICU professionals' moral distress and other risk factors with the components of burnout-emotional exhaustion, depersonalisation and personal accomplishment-suggesting informed burnout prevention strategies.
methodsCross-sectional survey completed in 2019 of ICU professionals in two Dutch hospitals. The survey included validated measure for burnout (the Dutch Maslach Burnout Inventory), moral distress (Moral Distress Scale), personality (short Big Five Inventory), work-home balance (Survey Work-Home Interaction Nijmegen) and organisational culture (Culture of Care Barometer). Each of the three components of burnout was analysed as a separate outcome, and for each of the components, a separate regression analysis was carried out.
results251 ICU professionals responded to the survey (response rate: 53.3%). Burnout prevalence was 22.7%. Findings showed that moral distress was associated with emotional exhaustion (β=0.18, 95% CI 0.9 to 0.26) and depersonalisation (β=0.19, 95% CI 0.10 to 0.28) and with increased emotional exhaustion mediated by negative work-to-home spillover (β=0.09, 95% CI 0.04 to 0.13). Support from direct supervisors mitigates the association between moral distress and emotional exhaustion (β=0.16, 95% CI 0.04 to 0.27).
conclusionsUnderstanding moral distress as a root cause of burnout is too simplified. There is an important interplay between moral distress and work-home imbalance. Interventions that support individual coping with moral distress and a work-home imbalance, and the support of direct supervisors, are paramount to prevent burnout in physicians and nurses.
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