ArticleBMJ open2023
Moral distress among intensive care unit professions in the UK: a mixed-methods study.
Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled 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.
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.
Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 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
- 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
- Beyond the pilot analogy.Critical care (London, England) · 2026Article
- Article
- Moral distress of intensive care unit nurses: a systematic review and meta-analysis.BMC nursing · 2026Article
- In harm's way: moral injury and the erosion of trust for emergency responders in the United Kingdom.European journal of psychotraumatology · 2025Article
- Intensive care of the very old - questioning the relationship between illness severity and the moral imperative to deliver life-saving care.Philosophy, ethics, and humanities in medicine : PEHM · 2025Article
- Article
- 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
- Posttraumatic Growth in Intensive Care Unit Health Care Professionals After COVID-19.JAMA network open · 2025Article
- Coping with moral distress: a qualitative study exploring psychological strategies used by healthcare professionals.BMC psychology · 2025Article
- Exploring the experience of cardiothoracic ICU clinicians during the COVID-19 pandemic: A grounded theory study.Nursing in critical care · 2025Article
- Nurse retention in peri- and post-COVID-19 work environments: a scoping review of factors, strategies and interventions.BMJ open · 2025Article
- Prehospital critical care beyond advanced life support for out-of-hospital cardiac arrest: A systematic review.Resuscitation plus · 2025Review
- Article
- Inductive process of moral distress development in viewpoints from surgical nurses: a mixed-method study.BMC nursing · 2024Article
- Moral Distress, Burnout, Turnover Intention, and Coping Strategies among Korean Nurses during the Late Stage of the COVID-19 Pandemic: A Mixed-Method Study.Journal of nursing management · 2024Article
- Observational
- Treatment patterns and clinician stress related to care of out-of-hospital cardiac arrest patients with a do not attempt resuscitation order.Resuscitation plus · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the experience of moral distress among intensive care unit (ICU) professionals in the UK.
designMixed methods: validated quantitative measure of moral distress followed by purposive sample of respondents who underwent semistructured interviews.
settingFour ICUs of varying sizes and specialty facilities.
participantsHealthcare professionals working in ICU.
results227 questionnaires were returned and 15 interviews performed. Moral distress occurred across all ICUs and professional demographics. It was most commonly related to providing care perceived as futile or against the patient's wishes/interests, followed by resource constraints compromising care. Moral distress score was independently influenced by profession (p=0.02) (nurses 117.0 vs doctors 78.0). A lack of agency was central to moral distress and its negative experience could lead to withdrawal from engaging with patients/families. One-third indicated their intention to leave their current post due to moral distress and this was greater among nurses than doctors (37.0% vs 15.0%). Moral distress was independently associated with an intention to leave their current post (p<0.0001) and a previous post (p=0.001). Participants described a range of individualised coping strategies tailored to the situations faced. The most common and highly valued strategies were informal and relied on working within a supportive environment along with a close-knit team, although participants acknowledged there was a role for structured and formalised intervention.
conclusionsMoral distress is widespread among UK ICU professionals and can have an important negative impact on patient care, professional wellbeing and staff retention, a particularly concerning finding as this study was performed prior to the COVID-19 pandemic. Moral distress due to resource-related issues is more severe than comparable studies in North America. Interventions to support professionals should recognise the individualistic nature of coping with moral distress. The value of close-knit teams and supportive environments has implications for how intensive care services are organised.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.