{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:08:36Z","timestamp":1793038116317,"version":"4.5.0"},"reference-count":31,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Moral distress is the inability to do the right thing due to institutional constraints. The Measure of Moral Distress \u2013 Healthcare Professionals (MMD-HP) measures this phenomenon and has extensively explored moral distress among nurses. There are limited large-scale research studies using the MMD-HP to identify levels of moral distress across multiple healthcare professionals (HPs) and settings.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Research question:<\/jats:bold>\n                    What are the overall levels of moral distress among HPs?\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Research design:<\/jats:bold>\n                    A quantitative, exploratory, cross-sectional study of HPs in a healthcare system using the MMD-HP.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Participants and research context:<\/jats:bold>\n                    Eligible participants included HPs (\n                    <jats:italic toggle=\"yes\">N<\/jats:italic>\n                    = 8,206) working in all inpatient and outpatient units and centers in a multi-site healthcare system located in the Southeastern United States.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Ethical considerations:<\/jats:bold>\n                    The Institutional Review Board provided approval for this research. A survey preamble supplied information within the learning management system and consent was presumed with survey completion.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Findings:<\/jats:bold>\n                    A total of 3,561 HPs completed the MMD-HP. The top three morally distressing items included compromised patient care due to inadequate resources, caring for more patients than is safe, and low quality of patient care due to poor team communication. Intensive care unit (ICU) areas had significantly greater moral distress than all other areas (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001). Formal leaders had the greatest moral distress (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001). Mixed-acuity and medical-surgical HPs accounted for 22.8% of those who reported considering leaving their current position due to moral distress. Nurses represented 42.2% of those considering leaving their current position due to moral distress.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    This study uniquely identified that formal leaders and HP participants in the ICU setting had the greatest moral distress. Exploring moral distress is imperative for healthcare systems to decrease turnover, improve engagement, and the quality of patient care.\n                  <\/jats:p>","DOI":"10.1177\/09697330251324296","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T13:51:49Z","timestamp":1741096309000},"page":"1629-1643","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["System-wide assessment using the Measure of Moral Distress \u2013 Healthcare professionals"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8497-7693","authenticated-orcid":false,"given":"Adam T","family":"Booth","sequence":"first","affiliation":[{"name":"University of Louisville (UofL) Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn L","family":"Robinson","sequence":"additional","affiliation":[{"name":"University of Louisville (UofL) Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/23294515.2019.1586008"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/21507716.2011.652337"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1086\/JCE200920406"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/NJH.0000000000000104"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2020.05.017"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.22.00641"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.21037\/apm-22-916"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/09697330241238337"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/09697330231191279"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.13045"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/NCQ.0000000000000596"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/ANC.0000000000000891"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15966"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733021996028"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951522001341"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1080\/07380577.2023.2181625"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpe.2023.100610"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-021-00641-3"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-022-00775-y"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-023-00919-8"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-068918"},{"key":"e_1_3_4_23_2","unstructured":"NSI Nursing Solutions Inc. 2024. 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