Moral distress and associated factors among nurses working in public hospitals in West Arsi Zone, Ethiopia. a cross-sectional study

Abstract

BACKGROUND: Moral distress occurs when nurses recognize an ethically appropriate action but feel unable to act due to institutional or systemic constraints. It is a major concern in nursing practice because ethical conflicts, limited autonomy, inadequate resources, and poor organizational support may affect nurses' well-being and quality of patient care. Evidence on moral distress in Ethiopia remains limited. This study aimed to assess the prevalence of moral distress and factors associated with moral distress among nurses working in public hospitals in the West Arsi Zone, Ethiopia. METHODS: An analytical cross-sectional study was conducted from February 13 to March 2, 2023, among 349 nurses selected by simple random sampling from four public hospitals. Nurses with at least six months of work experience were included, while those unavailable during data collection were excluded. Data were collected using a structured self-administered questionnaire comprising the Moral Distress Scale-Revised (MDS-R) and measures of personal and environmental factors. Data were entered into EpiData version 4.6 and analyzed using SPSS version 26. Moral distress was categorized into low and high levels using the sample mean. Factors associated with moral distress were identified using logistic regression analysis. Statistical significance was declared at p < 0.05 with 95% confidence intervals. RESULTS: Of the 349 eligible nurses, 344 participated (98.5% response rate). The mean (± SD) age of respondents was 31.92 ± 7.0 years, and 194 (55.6%) were female. Overall, 73.1% of nurses experienced high moral distress. Male nurses were less likely to experience high moral distress compared with female nurses (AOR = 0.46; 95% CI: 0.27-0.91). Nurses who were dissatisfied with their jobs had nearly eight times higher odds of experiencing high moral distress (AOR = 7.67 [3.08, 19.12]). Similarly, nurses working in a non-conducive environment had four times higher odds of experiencing high moral distress (AOR = 4.07 [1.92, 8.65]). CONCLUSIONS: A high proportion of nurses experienced moral distress in West Arsi Zone public hospitals. Improving job satisfaction and creating supportive work environments may help reduce moral distress and improve nursing practice.