The Effect of Moral Injury Symptoms of Intensive Care Nurses on their Attitudes and Behaviors Towards End-of-Life Care: A Cross-Sectional and Analytical Study in Turkey.

This study examined the effects of moral injury symptoms on attitudes and behaviors toward end-of-life care in intensive care nurses. A total of 124 nurses participated in the study. Data were collected using a Personal Information Form, the Moral Injury Symptom Scale: Health Care Professionals Version (MISS-HCP), and the Intensive Care Nurses' Attitudes and Behaviors Toward End-of-Life Care Scale. Female nurses had higher total mean scores on the end-of-life care attitude subscale and attitudes and behaviors toward end-of-life care than males (p < 0.05). Nurses who cared for 1-4 patients daily, were dissatisfied with their work, and encountered patients during the dying process once a week had significantly higher mean moral injury symptom scores (p < 0.05). No statistically significant relationship was found between the individuals' MISS-HCP and the end-of-life care attitude subscale, behavior subscale, and scale total score (r = 0.119, p = 0.188; r = 0.144, p = 0.110; r = 0.161, p = 0.074). These findings indicate that symptoms of moral trauma are common among intensive care nurses, but these symptoms do not have a direct determining effect on attitudes and behaviors towards end-of-life care. However, individual and work-environmental factors such as gender, job satisfaction, number of patients cared for, and frequency of encountering the dying process appear to influence both the level of moral trauma and attitudes towards end-of-life care. These results highlight the importance of supportive interventions and improving working conditions for intensive care nurses.