Evidence map›Paper›PMID 36704986›Full record

SynthesisNursing ethics2023

Estimation of moral distress among nurses: A systematic review and meta-analysis.

Zainab Alimoradi, Elahe Jafari, Chung-Ying Lin, Raheleh Rajabi, Zohreh Hosseini Marznaki, Mostafa Soodmand, Marc N Potenza, Amir H Pakpour

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Nursing ethics, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 3 pooled it
25.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 3 syntheses or guidelines pooled it, 59 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Magnet Recognition, Leadership Responsiveness, and Nurse Moral Distress: A Multilevel Mediation Analysis.Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing · 2026
    Observational
  5. Article
  6. Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Review
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 4 countries.

Zainab AlimoradiQazvin University of Medical Sciences, Qazvin, Iran.
Elahe JafariQazvin University of Medical Sciences, Qazvin, Iran.
Chung-Ying LinInstitute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan.
Raheleh RajabiKerman University of Medical Sciences, Iran.
Zohreh Hosseini MarznakiMazandaran University of Medical Sciences, Iran.
Mostafa SoodmandGuilan University of Medical Sciences, Iran.
Marc N PotenzaYale University, USA; Connecticut Council on Problem Gambling, USA; Connecticut Mental Health Center, USA; Wu Tsai Institute, Yale University, USA.
Amir H PakpourJönköping University, Sweden; Qazvin University of Medical Sciences, Iran.ORCID 0000-0002-8798-5345
Qazvin University of Medical Sciences · IRGuilan University of Medical Sciences · IRKerman University of Medical Sciences · IRMazandaran University of Medical Sciences · IRNational Cheng Kung University Hospital · TWYale University · US

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
NCATS NIH HHS UL1 TR001863
6 · The paper itself

Abstract

backgroundMoral distress is a common challenge among professional nurses when caring for their patients, especially when they need to make rapid decisions. Therefore, leaving moral distress unconsidered may jeopardize patient quality of care, safety, and satisfaction.

aimTo estimate moral distress among nurses.

methodsThis systematic review and meta-analysis conducted systematic search in Scopus, PubMed, ProQuest, ISI Web of Knowledge, and PsycInfo up to end of February 2022. Methodological quality of included studies was assessed using the Newcastle Ottawa checklist. Data from included studies were pooled by meta-analysis with random effect model in STATA software version 14. The selected key measure was mean score of moral distress total score with its' 95% Confidence Interval was reported. Subgroup analyses and meta-regressions were conducted to identify possible sources of heterogeneity and potentially influencing variables on moral distress. Funnel plots and Begg's Tests were used to assess publication bias. The Jackknife method was used for sensitivity analysis. ETHICAL CONSIDERATION: The protocol of this project was registered in the PROSPERO database under decree code of CRD42021267773.

resultsEighty-six manuscripts with 19,537 participants from 21 countries were included. The pooled estimated mean score of moral distress was 2.55 on a 0-10 scale [95% Confidence Interval: 2.27-2.84, I

conclusionThe results of the study showed a low level of pooled estimated score for moral distress. Although the score of moral distress was not high, nurses working in developing countries reported higher levels of moral distress than those working in developed countries. Therefore, it is necessary that future studies focus on creating a supportive environment in hospitals and medical centers for nurses to reduce moral distress and improve healthcare.

Indexed as

COVID-19NursesAttitude of Health PersonnelHumansJob SatisfactionMoralsPandemicsSurveys and QuestionnairesCOVID-19 pandemicmeta-analysisMoral distressnursessystematic review

Identifiers

PMID36704986
PMCPMC9902807
OpenAlexW4318218759

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.