ArticleBMC medical ethics2022
Ethical decision-making climate, moral distress, and intention to leave among ICU professionals in a tertiary academic hospital center.
Article in BMC medical ethics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 71 citations in OpenAlex.
- European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.Intensive care medicine · 2024Guideline
- Organisational ethical climate and nurses' work performance: A cross-sectional analysis of the indirect association through job crafting.Work (Reading, Mass.) · 2026Article
- The moderating effects of racial climate and racial microaggressions on moral distress & intent to leave in nursing: A cross-sectional study.International journal of nursing studies advances · 2026Article
- Moral Courage Mediates the Relationship Between Ethical Climate and Sustainable Environmental Health Literacy Among Nurses.International journal of environmental research and public health · 2026Article
- Moral distress of primary health care workers during the global pandemic.Scientific reports · 2026Article
- Organizational Climate, Ethical Work Environment, and Turnover Intentions Among Healthcare Workers in a Romanian Chronic Care Hospital: A Multidimensional Analysis.Healthcare (Basel, Switzerland) · 2026Article
- Ethical climate in the primary health care workplace: a mixed-method study.Revista latino-americana de enfermagem · 2026Article
- Stabilizing and Destabilizing Factors of Nurse Retention: A Comparative Analysis of Two Healthcare Settings in Austria.Journal of nursing management · 2026Article
- Professional Values, Perceived Ethical Climate, and Dignity-Protecting Behaviors Among Intensive Care Nurses: A Moderation Analysis.Journal of nursing management · 2026Article
- Ability and utility of the Physician Well-Being Index to identify distress among Chinese physicians.Annals of medicine · 2025Article
- Moral Distress, Professional Burnout, and Potential Staff Turnover in Intensive Care Nursing Practice in Latvia-Phase 1.International journal of environmental research and public health · 2025Article
- Turnover intention among intensive care nurses and the influence of the COVID-19 pandemic: a scoping review.Human resources for health · 2025Article
- Article
- Perception of the ethical climate among hospital employees in a public healthcare system: a cross-sectional survey at the University Hospital of Split, Croatia.BMC medical ethics · 2025Article
- 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
- Moral courage approach-based ethics education effect on clinical decision making of emergency nurses.Journal of education and health promotion · 2025Article
- Preventing burnout from moral distress among prehospital emergency personnel through action research and targeted clinical ethics support.Scientific reports · 2024Article
- Clinical decision making and moral distress among intensive care units nurses in Iran.BMC psychology · 2024Article
- "The Patient Is Being Pressured!" Coercion Versus Relational Autonomy.Journal of palliative medicine · 2024Article
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Authors and funding
14 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundCommentators believe that the ethical decision-making climate is instrumental in enhancing interprofessional collaboration in intensive care units (ICUs). Our aim was twofold: (1) to determine the perception of the ethical climate, levels of moral distress, and intention to leave one's job among nurses and physicians, and between the different ICU types and (2) determine the association between the ethical climate, moral distress, and intention to leave.
methodsWe performed a cross-sectional questionnaire study between May 2021 and August 2021 involving 206 nurses and physicians in a large urban academic hospital. We used the validated Ethical Decision-Making Climate Questionnaire (EDMCQ) and the Measure of Moral Distress for Healthcare Professionals (MMD-HP) tools and asked respondents their intention to leave their jobs. We also made comparisons between the different ICU types. We used Pearson's correlation coefficient to identify statistically significant associations between the Ethical Climate, Moral Distress, and Intention to Leave.
resultsNurses perceived the ethical climate for decision-making as less favorable than physicians (p < 0.05). They also had significantly greater levels of moral distress and higher intention to leave their job rates than physicians. Regarding the ICU types, the Neonatal/Pediatric unit had a significantly higher overall ethical climate score than the Medical and Surgical units (3.54 ± 0.66 vs. 3.43 ± 0.81 vs. 3.30 ± 0.69; respectively; both p ≤ 0.05) and also demonstrated lower moral distress scores (both p < 0.05) and lower "intention to leave" scores compared with both the Medical and Surgical units. The ethical climate and moral distress scores were negatively correlated (r = -0.58, p < 0.001); moral distress and "intention to leave" was positively correlated (r = 0.52, p < 0.001); and ethical climate and "intention to leave" were negatively correlated (r = -0.50, p < 0.001).
conclusionsSignificant differences exist in the perception of the ethical climate, levels of moral distress, and intention to leave between nurses and physicians and between the different ICU types. Inspecting the individual factors of the ethical climate and moral distress tools can help hospital leadership target organizational factors that improve interprofessional collaboration, lessening moral distress, decreasing turnover, and improved patient care.
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