Other Titles
Interventions Addressing Moral Distress in Nurses Working in the Acute Care Setting: A Systematic Review [Title Slide]
Abstract
Background. Moral distress (MoD), or psychological distress resulting from acting against one’s ethics, and its consequences is a growing concern in healthcare. Nurses experiencing MoD are at greater risk of experiencing burnout, workplace stress and fatigue, anxiety, and depression. There is a gap in the literature regarding MoD interventions in nurses working in the acute care setting. The purpose of this systematic review was to identify interventions that reduce MoD in registered nurses (RNs) and licensed practical nurses (LPNs) working in the acute care setting.
Methods. We searched PubMed, CINAHL, and PsycINFO in September 2025. Search string results revealed 3,637 articles, and of those 47 were accessed for eligibility. The inclusion criteria were studies with direct care RNs and LPNs, that used an intervention to reduce MoD, and that used a MoD instrument. We excluded studies that did not use research methodology, non-peer reviewed papers, review papers, qualitative studies, and studies that did not separate nurse data from other participants. PRISMA guidelines were followed. Quality appraisals were assessed using the Cincinnati Children’s Let Evidence Guide Every Decision (LEGEND) tool.
Results. We found 14 experimental studies that used an intervention to address MoD in nurses working in acute care settings. The overall body of evidence grade was low. The studies included 1,082 nurses between ages 20-67. Participants were mostly female, bachelor’s prepared, and with nurse experience ranging between 1- 38 years. 54% of the studies took place in critical care. Three studies were randomized control trials, five studies used a 2-group experimental design, 3 studies used a mixed methods design, and 3 studies used a single group experimental design. Nine of the studies reported a significant decrease in MoD scores after the intervention. Most studies (77%) used education as a primary intervention or within an investigator-created program to reduce MoD. Combined interventions using nurse leader involvement, nurse staff input, and education resulted in statistically significant decreases in MoD scores.
Conclusion. Although MoD interventions were identified in this review, rigorous studies are needed to determine best practices for addressing MoD in acute care nurses. Combining education, nurse input, and leader involvement show promise in reducing MoD.
Notes
Presenter notes available in attached slide deck. To see the notes in Adobe Acrobat, go to Tools > Comment or look at your Layers Panel. If the notes were saved as comments or layers, you can toggle them visible.
Extensive reference list included in attached slide deck.
Sigma Membership
Delta Psi at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Systematic Review
Research Approach
Other
Keywords:
Ethics, Acute Care, Stress and Coping, Nursing Ethics, Nurses' Attitudes, Critical Care Medicine, Intensive Care Nursing, Ethical Problems, Moral Distress
Recommended Citation
Harris, Maira Alejandra; Owens, Sarah; Baser, Louis; and Edward, Jean, "Interventions Addressing Moral Distress in Acute Care Nurses: A Systematic Review" (2026). International Nursing Research Congress (INRC). 319.
https://www.sigmarepository.org/inrc/2026/presentations_2026/319
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-09-26
Interventions Addressing Moral Distress in Acute Care Nurses: A Systematic Review
Toronto, Ontario, Canada
Background. Moral distress (MoD), or psychological distress resulting from acting against one’s ethics, and its consequences is a growing concern in healthcare. Nurses experiencing MoD are at greater risk of experiencing burnout, workplace stress and fatigue, anxiety, and depression. There is a gap in the literature regarding MoD interventions in nurses working in the acute care setting. The purpose of this systematic review was to identify interventions that reduce MoD in registered nurses (RNs) and licensed practical nurses (LPNs) working in the acute care setting.
Methods. We searched PubMed, CINAHL, and PsycINFO in September 2025. Search string results revealed 3,637 articles, and of those 47 were accessed for eligibility. The inclusion criteria were studies with direct care RNs and LPNs, that used an intervention to reduce MoD, and that used a MoD instrument. We excluded studies that did not use research methodology, non-peer reviewed papers, review papers, qualitative studies, and studies that did not separate nurse data from other participants. PRISMA guidelines were followed. Quality appraisals were assessed using the Cincinnati Children’s Let Evidence Guide Every Decision (LEGEND) tool.
Results. We found 14 experimental studies that used an intervention to address MoD in nurses working in acute care settings. The overall body of evidence grade was low. The studies included 1,082 nurses between ages 20-67. Participants were mostly female, bachelor’s prepared, and with nurse experience ranging between 1- 38 years. 54% of the studies took place in critical care. Three studies were randomized control trials, five studies used a 2-group experimental design, 3 studies used a mixed methods design, and 3 studies used a single group experimental design. Nine of the studies reported a significant decrease in MoD scores after the intervention. Most studies (77%) used education as a primary intervention or within an investigator-created program to reduce MoD. Combined interventions using nurse leader involvement, nurse staff input, and education resulted in statistically significant decreases in MoD scores.
Conclusion. Although MoD interventions were identified in this review, rigorous studies are needed to determine best practices for addressing MoD in acute care nurses. Combining education, nurse input, and leader involvement show promise in reducing MoD.
Description
This systematic review summarizes interventions that address moral distress in acute care nurses. After searching PubMed, PsycINFO, and CINAHL in September 2025, 14 studies met inclusion criteria. Although interventions were identified, this review highlights the need for rigorous studies to address moral distress in acute care nurses.