Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Significance: Nurses facing impediments to what they perceive as moral practice may experience inner turmoil, frustration, and moral distress. These scenarios may culminate in resignation from employment at the individual level, increased attrition at the systems level, and poor patient outcomes, including increased morbidity and mortality.

Purpose: To explore the relationships between moral distress and avoidance thoughts and behavior between nurses currently practicing in critical care and non-critical care settings.

Methods: A descriptive cross-sectional comparative design was used. The sample was comprised of a randomized subset of 370 critical care nurses, a convenience sample of 87 nurses from a nursing organization, and 225 nurses from two nursing programs in the Midwest. The Moral Distress Scale (MDS) and Impact of Event Scale (IES) were used to measure the variables of interest.

Results: Critical care nurses were significantly older than non-critical care nurses (t = 3.18, p = .002) with mean ages of 43 and 35 respectively. Moral distress scores were higher for critical care nurses compared to non-critical care nurses, but the difference was not statistically significant (t (94) = 1.31, p = 0.25). Critical care nurses reported higher levels of moral distress intensity and frequency, but there was no statistically significant difference (F (2, 93) = .90, p = .41). After adjusting for age, there was no significant difference between critical care nurses and non-critical care nurses on MDS and IES scores. There was an extremely small positive correlation between moral distress and avoidance (r = 0.107, n = 96, p = .298).

Discussion: Knowing that nurses do experience moral distress is a concern for both nurses providing direct patient care and administrators. If nurses are avoiding patients due to moral distress, the well-being of the patients and nurse may be compromised. It is important that those responsible for recruiting and retaining nurses are aware of the presence of moral distress and avoidance as part of nursing practice and that they develop strategies to help nurses manage its effects.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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