Moral distress is one of the most complex ethical problems for nurses working in Intensive Care Units. Desired job performance of the nurse guarantees the quality of health care provided to patients and is an important factor in accelerating the process of treatment and recovery of patients. This study was conducted to investigate the predictive factors of job performance in nurses' moral distress.


 

This is a descriptive cross-sectional study, in which 256 nurses working in ICU wards of private and public hospitals of Qazvin province (from January to March 2019) were selected through convenience sampling method. Demographic characteristics questionnaire, Six Dimension Scale of Nursing Performance and Modified Moral Distress Scale-Revised were used for data collection. Statistical analysis was performed using linear regression model test in SPSS 22.

The results of this study indicated that there is less than average moral distress among the participants; while the degree of moral distress in the special sections has been reported in the study of Beikmoradi et al. and the study of Bennett are moderate [25, 13] and high in the study of Cummings [26]. Linear regression analysis in the predictive role of job performance on moral distress in both frequency and quality, indicated a significant relationship between the educational dimension of job performance and moral distress in the field of quality; that is, increasing the quality and frequency of job performance in the educational dimension will reduce the amount of moral distress among nurses and vice versa.
The results of the raw regression model of this study showed that the employment status of nurses is one of the predictors of moral distress in them. In the study of the type of employment variable in this study, the highest frequency of staff (nearly half of it) was related to the formal employment group and the lowest was related to nurses in the contractual employment group. In Iran, the most focus is on formal and contractual employees. Also, the number of project nurses varies according to the output of universities and their demand for work in clinical settings [28]; therefore, it seems that having job security can be one of the effective and predictive factors of moral distress. However, in the studies of Beikmoradi et al. And Abbas Zadeh et al., no significant relationship was found between these two variables. In fact, according to them, moral distress can occur for all nurses regardless of their place of work [28, 13].
 The average monthly overtime hours and the type of nurses' shift work based on the results of the raw regression model of this study are predictive factors of moral distress; while the results of Elpern, Covert, and Kleinpell study showed that the personal characteristics of intensive care unit nurses are not related to the severity of their moral distress [29].
Another result of the raw regression model of this study is the predictive role of all dimensions of job performance (except for the frequency of job performance relationships) for moral distress. Consistent with the results of the present study, which includes almost all aspects of job performance in creating moral distress, in the study of Waziri et al., professional and functional incompetence have been identified as one of the most distressing factors in creating moral distress [13].

 

Based on the results of the present study, educational dimension of job performance is a predictive factor for moral distress. Therefore, steps can be taken to reduce moral distress in clinical settings, such as the use of nurses with specialized training in Intensive Care Units, paying special attention to teaching ethical issues in nursing centers and holding retraining courses for nurses.

 

This article is part of the first author's master's thesis on intensive care nursing. We would like to thank all the professors, participants in this study, as well as the Vice Chancellor for Education, School of Nursing and Midwifery, Qazvin University of Medical Sciences, for their sincere support and assistance in conducting this research.

 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.