{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:46:40Z","timestamp":1792270000908,"version":"4.4.0"},"reference-count":55,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Goethe-Corona Fond of the Goethe University Frankfurt"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nurs"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Moral suffering in health care is increasingly a focus of research. The extent of and relationship between two distinct forms of moral suffering, namely, moral injury (MI) and moral distress (MD), has not yet been studied in nurses in acute inpatient care in Germany.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to examine the severity of MI and MD in the context of organizational support, the correlation between the two constructs, and the variables associated with the extent of MD and MI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional study including 1323 nurses employed in German hospitals. The data were collected in March and April 2023 in an online survey using the German version of the Moral Distress Scale (MDS), the German Moral Injury Symptom Scale for Health Professionals (G-MISS-HP), the Perceived Organizational Support Scale (POS-s) and an additional questionnaire on the individual perception of ethical and structural conditions in the institution. The data were analyzed descriptively. Partial credit Rasch models were fitted to the item-level responses of the G-MISS-HP and the MDS to obtain interval-level measures of moral injury and moral distress for subsequent analyses. Median regressions with backward variable selection were performed for MD- and MI-Rasch scores to identify variables associated with the level of moral distress\/injury. The associations between the MD and MI-Rasch scores were tested using Spearman\u2019s correlation test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 68.6% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009907; 95% CI: 66.1%\u201371.1%) of the respondents scored above the validated G-MISS-HP screening threshold (\u2265\u200929), which has previously been associated with impairment in family, social, and occupational functioning. Spearman\u2019s correlation analysis revealed statistically significant positive associations between the MD-Rasch score and the MI-Rasch subscores (guilt\/shame subscore:\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.57, 95% CI [0.53; 0.61]; spiritual troubles subscore:\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.22, 95% CI [0.16; 0.27]; condemnation subscore:\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.39, 95% CI [0.34; 0.43], all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Median regression analyses revealed significant associations of both MD and MI with perceived organizational support (POS-s), satisfaction with the treatment team\u2019s consideration of own perspective, responsibility for staff, and participation in interprofessional case discussions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Manifestations of moral suffering are common. Our findings highlight the importance of measures to promote an ethical climate and to address the negative consequences of moral suffering, particularly at the management level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>\n                      German Clinical Trials Register (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.drks.de\/\" ext-link-type=\"uri\">https:\/\/www.drks.de\/<\/jats:ext-link>\n                      ): DRKS00030785 (date: 06 February 2023).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12912-026-05526-7","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:28:14Z","timestamp":1792268894000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Moral distress and moral injury among nurses in German acute inpatient care \u2013 a cross-sectional study"],"prefix":"10.1186","volume":"25","author":[{"given":"Tobias","family":"Mai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna-Henrikje","family":"Seidlein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schilder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iulia","family":"Dahmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"key":"5526_CR1","volume-title":"Nursing practice: The ethical issues: The Ethical Issues","author":"A Jameton","year":"1984","unstructured":"Jameton A. 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