Moral distress and Moral Sensitivity and their correlation with Safe nursing care

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Vaios Grammatis Ioannis Kouroutzis Nikoletta Apostolidi Ilda Vako Theodora-Paisia Apostolidi Vasiliki Roka Pavlos Sarafis Maria Malliarou


Moral distress is the situation in which nurses know the moral principles that should guide their actions but are not allowed by the constraints of the health system. Moral sensitivity is the ability of nurses to perceive the moral dimensions of certain situations or actions. Safe care is a range of services provided to patients by nurses and consequently nurses with the aim of monitoring, promoting, maintaining or restoring the health of patients. Moral distress negatively affects safe health care, and moral sensitivity is the solution to moral distress. This study investigates the relationship between both moral distress and moral sensitivity of nurses with safe nursing care. A total of 163 nurses from a General Greek Hospital participated in the research. The protocol included the Moral Resilience (RMRS), Moral Distress (MMD-HP) and Moral Sensitivity Control (Byrd's NEST) scales.

For the Moral Resilience scale, higher scores are recorded for the moral efficacy dimension. Moderate scores are recorded for the Moral Distress scale, so nurses are characterized by moderate moral sensitivity. None of the nurses had left or considered leaving the clinic due to moral distress, up to the time of the present study. Health professionals based on Byrd's NEST scale are characterized by moderate moral sensitivity. The greater the integrity of the relationships, the greater the reactions to moral adversity. The greater the moral distress, or the better the perceptions of the security offered by management, the greater nurses’ personal integrity. As relational integrity or the distress decreased, moral efficacy increased. The higher the moral distress of the nurses, the greater the integrity of the relationships. Nurses who had children also felt more secure about working conditions than those who did not. The greater the dynamics of the clinic, the less reactions to moral adversity. Finally, greater moral deadlock was associated with both greater personal integrity and greater relational integrity, and less moral efficacy. Increased moral sensitivity prevents the occurrence of moral distress and has a positive effect on the provision of safe health care.

Keywords: Moral Distress, Moral Resilience, Nurses, MMD-HP and RMRS, Moral Sensitivity Control

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How to Cite
GRAMMATIS, Vaios et al. Moral distress and Moral Sensitivity and their correlation with Safe nursing care. Medical Research Archives, [S.l.], v. 12, n. 1, jan. 2024. ISSN 2375-1924. Available at: <>. Date accessed: 03 mar. 2024. doi:
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