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Fuladvandi M, Fouladvand G, Malekyan L, Maleki S, Nourmohammade N. The Relationship between Moral Distress and Quality of Work Life and among Nurses in Southeastern Iran. IJN 2025; 38 (S1 )
URL: http://ijn.iums.ac.ir/article-1-3839-en.html
URL: http://ijn.iums.ac.ir/article-1-3839-en.html
Masoumeh Fuladvandi1 
, Gholamreza Fouladvand2 , Leila Malekyan3 , Sohila Maleki4 , Nadia Nourmohammade5
, Gholamreza Fouladvand2 , Leila Malekyan3 , Sohila Maleki4 , Nadia Nourmohammade5
1- Social Determinants of Health Research Center, Aligoudarz School of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran
2- Faculty of Psychology, Allameh Tabataba'i University, Tehran, Iran
3- Clinical Research Center, Paster Educational Hospital, Bam University Of Medical Sciences, Bam, Kerman ,l.malkyan@gmail.com
4- Faculty of Psychology, Islamic Azad University of Najaf Abad, Isfahan, Iran
5- Clinical Research Center, Shafa Hospital, Kerman University Of Medical Sciences, Kerman, Kerman
2- Faculty of Psychology, Allameh Tabataba'i University, Tehran, Iran
3- Clinical Research Center, Paster Educational Hospital, Bam University Of Medical Sciences, Bam, Kerman ,
4- Faculty of Psychology, Islamic Azad University of Najaf Abad, Isfahan, Iran
5- Clinical Research Center, Shafa Hospital, Kerman University Of Medical Sciences, Kerman, Kerman
Abstract: (46 Views)
Background: Nurses, as a central component of healthcare systems, play a vital role in delivering ethical and high-quality services. Due to spending more time with patients compared to other healthcare providers, they are constantly confronted with complex ethical issues, which may expose them to moral distress. This condition, initially described by Jameton, occurs when individuals, despite having adequate knowledge, are unable to act ethically due to organizational constraints, leading to internal conflict and helplessness. Various studies, including those in Iran and Brazil, have reported moderate levels of moral distress among nurses. This phenomenon has several negative consequences, including burnout, job dissatisfaction, a desire to leave the profession, and even a decline in the quality of patient care. As a result, moral distress affects not only nurses' personal lives but also their professional performance, particularly in organizational culture and service quality. On the other hand, Quality of Work Life (QWL), which refers to the ability of nurses to meet both personal and professional needs in the workplace, is recognized as a key factor in enhancing job satisfaction and mitigating ethical problems. Poor quality of work life can threaten patient safety and reduce care quality. Studies also indicate that burnout and low quality of work life are associated with higher turnover intentions and lower professional behavior. Focusing on QWL not only improves organizational productivity but also contributes to the recruitment and retention of nurses. In other words, improving nurses' quality of life is considered a crucial factor in ensuring the stability of the healthcare system. Furthermore, given the concerns in hospitals regarding non-compliance with certain ethical standards and lack of awareness of ethical principles, moral distress is currently one of the growing issues in the nursing profession, significantly impacting nurses' work and potentially undermining their performance. Therefore, this study aimed to determine the relationship between moral distress and quality of work life among nurses..
Methodology: : This descriptive-analytical study was conducted from April to July 2023 in teaching hospitals of Kerman (Kerman, Bam, Jiroft), Iran.. 290 Nurses with at least a bachelor's degree and a minimum of six months of full-time work experience were selected through simple random sampling, after providing informed consent. Incomplete questionnaires were excluded from the analysis (number of excluded questionnaires). Data collection tools included three questionnaires. The first questionnaire gathered demographic information, including age, gender, department, work experience, job position, and education level.
The second questionnaire assessed moral distress, which was designed by Corley et al. in 1995 and revised in 2001. It consists of 21 items, with response options divided into two dimensions: intensity and frequency. Intensity is rated on a Likert scale from 0 (not at all) to 4 (very much), and frequency is rated from 0 (never) to 4 (frequently). The reliability of this questionnaire was reported by Abbaszadeh et al. with a Cronbach’s alpha coefficient of 0.93, and its validity was confirmed through the Content Validity Index (CVI) method at 88%.
The third questionnaire was the Quality of Work Life (QWL) scale for nurses, developed by Brooks, which includes four dimensions and 42 items, rated on a six-point Likert scale. The dimensions are: personal life (items 1 to 7), work context (items 8 to 17), work environment (items 18 to 37), and global work (items 38 to 42). Each item is scored from 1 to 6, and the total score is the sum of all item scores, with a minimum score of 42 and a maximum score of 252. According to the designer of the questionnaire, the average scores for the three scales are grouped as "disagree" for scores from strongly disagree to disagree, and "agree" for scores from agree to strongly agree. This questionnaire was reviewed by 10 experts and faculty members both within and outside of Kerman University of Medical Sciences, with suggested revisions implemented (content validity index: 81%). After confirming content validity, the QWL tool was tested on a sample of 20 nurses, and its reliability coefficient was calculated using Cronbach’s alpha, yielding a value of 0.83. The data were analyzed using SPSS version 20 software, and the significance level for the tests was set at 95%.
Results: This study involved 290 nurses from hospitals affiliated with Kerman University of Medical Sciences, with 258 nurses (89%) of participants being female and 32 (11%) male. The average age of the nurses was 27.34 ± 1.02 years, with96 )33.1%( falling between the ages of 31 and 40. Most participants 227 (78.3%) were married, and121 )41.7%( had more than 10 years of work experience. A majority 236 (81.4%) held nursing positions, with 87(30%( working in specialized units and 61 (21%) in surgical departments. Furthermore, 263 )90.7% (of the nurses had a bachelor’s degree, and 164 (56.6%) were employed in formal roles, with 209 )72.1%( working rotational shifts. The average score for Moral Distress among participants was 140.61 ± 43.795, while the average score for work life quality was 155.9 ± 25.077. Levels of Moral Distress were classified as high in 67 )23.1%( of the nurses, moderate in 217 )73.8%(, and low in 6 ) 2.1%(. Regarding work life quality,249 )85.9%( of the participants reported moderate levels, with 21 )7.2%( experiencing high work life quality and 20 )6.9%( reporting low levels. Multivariate analysis of variance revealed a significant positive relationship between moral distress and age (R = 0.728, P < 0.05) as well as work experience (R = 0.607, P < 0.05). Quality of work life was also significantly associated with demographic variables such as work experience (R = 0.105, P < 0.05), marital status (R = 0.031, P < 0.05), and job position (R = 0.119, P < 0.05). Additionally, a moderate inverse relationship was found between moral distress and quality of work life (R = -0.562, P < 0.05). There was also a weak negative correlation between the intensity (R = -0.042, P < 0.05) and frequency (R = -0.063, P < 0.05) of moral distress and quality of work life.
Conclusion: This study demonstrates a significant negative correlation between moral distress and work life quality among nurses in Kerman, Iran. As moral distress increases, work life quality decreases, highlighting the need for targeted interventions to reduce moral distress and improve the working conditions for nurses. Healthcare managers should prioritize creating environments where nurses can address ethical challenges effectively without compromising their well-being. Providing support, improving staffing levels, offering ethics education, and refining hospital policies can all help to reduce moral distress. By improving the work environment, healthcare organizations can enhance nurses’ job satisfaction, which will, in turn, lead to better patient outcomes and more sustainable healthcare systems. In summary, the relationship between moral distress and work life quality is a critical factor in nursing care, and addressing it is essential for ensuring both nurse well-being and high-quality healthcare delivery. Future research should explore these dynamics further, using more in-depth methodologies such as interviews, to provide a richer understanding of how to mitigate moral distress in nursing practice.
Methodology: : This descriptive-analytical study was conducted from April to July 2023 in teaching hospitals of Kerman (Kerman, Bam, Jiroft), Iran.. 290 Nurses with at least a bachelor's degree and a minimum of six months of full-time work experience were selected through simple random sampling, after providing informed consent. Incomplete questionnaires were excluded from the analysis (number of excluded questionnaires). Data collection tools included three questionnaires. The first questionnaire gathered demographic information, including age, gender, department, work experience, job position, and education level.
The second questionnaire assessed moral distress, which was designed by Corley et al. in 1995 and revised in 2001. It consists of 21 items, with response options divided into two dimensions: intensity and frequency. Intensity is rated on a Likert scale from 0 (not at all) to 4 (very much), and frequency is rated from 0 (never) to 4 (frequently). The reliability of this questionnaire was reported by Abbaszadeh et al. with a Cronbach’s alpha coefficient of 0.93, and its validity was confirmed through the Content Validity Index (CVI) method at 88%.
The third questionnaire was the Quality of Work Life (QWL) scale for nurses, developed by Brooks, which includes four dimensions and 42 items, rated on a six-point Likert scale. The dimensions are: personal life (items 1 to 7), work context (items 8 to 17), work environment (items 18 to 37), and global work (items 38 to 42). Each item is scored from 1 to 6, and the total score is the sum of all item scores, with a minimum score of 42 and a maximum score of 252. According to the designer of the questionnaire, the average scores for the three scales are grouped as "disagree" for scores from strongly disagree to disagree, and "agree" for scores from agree to strongly agree. This questionnaire was reviewed by 10 experts and faculty members both within and outside of Kerman University of Medical Sciences, with suggested revisions implemented (content validity index: 81%). After confirming content validity, the QWL tool was tested on a sample of 20 nurses, and its reliability coefficient was calculated using Cronbach’s alpha, yielding a value of 0.83. The data were analyzed using SPSS version 20 software, and the significance level for the tests was set at 95%.
Results: This study involved 290 nurses from hospitals affiliated with Kerman University of Medical Sciences, with 258 nurses (89%) of participants being female and 32 (11%) male. The average age of the nurses was 27.34 ± 1.02 years, with96 )33.1%( falling between the ages of 31 and 40. Most participants 227 (78.3%) were married, and121 )41.7%( had more than 10 years of work experience. A majority 236 (81.4%) held nursing positions, with 87(30%( working in specialized units and 61 (21%) in surgical departments. Furthermore, 263 )90.7% (of the nurses had a bachelor’s degree, and 164 (56.6%) were employed in formal roles, with 209 )72.1%( working rotational shifts. The average score for Moral Distress among participants was 140.61 ± 43.795, while the average score for work life quality was 155.9 ± 25.077. Levels of Moral Distress were classified as high in 67 )23.1%( of the nurses, moderate in 217 )73.8%(, and low in 6 ) 2.1%(. Regarding work life quality,249 )85.9%( of the participants reported moderate levels, with 21 )7.2%( experiencing high work life quality and 20 )6.9%( reporting low levels. Multivariate analysis of variance revealed a significant positive relationship between moral distress and age (R = 0.728, P < 0.05) as well as work experience (R = 0.607, P < 0.05). Quality of work life was also significantly associated with demographic variables such as work experience (R = 0.105, P < 0.05), marital status (R = 0.031, P < 0.05), and job position (R = 0.119, P < 0.05). Additionally, a moderate inverse relationship was found between moral distress and quality of work life (R = -0.562, P < 0.05). There was also a weak negative correlation between the intensity (R = -0.042, P < 0.05) and frequency (R = -0.063, P < 0.05) of moral distress and quality of work life.
Conclusion: This study demonstrates a significant negative correlation between moral distress and work life quality among nurses in Kerman, Iran. As moral distress increases, work life quality decreases, highlighting the need for targeted interventions to reduce moral distress and improve the working conditions for nurses. Healthcare managers should prioritize creating environments where nurses can address ethical challenges effectively without compromising their well-being. Providing support, improving staffing levels, offering ethics education, and refining hospital policies can all help to reduce moral distress. By improving the work environment, healthcare organizations can enhance nurses’ job satisfaction, which will, in turn, lead to better patient outcomes and more sustainable healthcare systems. In summary, the relationship between moral distress and work life quality is a critical factor in nursing care, and addressing it is essential for ensuring both nurse well-being and high-quality healthcare delivery. Future research should explore these dynamics further, using more in-depth methodologies such as interviews, to provide a richer understanding of how to mitigate moral distress in nursing practice.
Type of Study: Research |
Subject:
nursing
Received: 2024/09/16 | Accepted: 2025/03/21 | Published: 2025/03/21
Received: 2024/09/16 | Accepted: 2025/03/21 | Published: 2025/03/21
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