Critical care nurses providing care for adults at the end of life may encounter moral distress when they cannot do what they believe is ethically correct. Psychological empowerment can decrease moral distress among critical care nurses.


To describe the relationships between moral distress, psychological empowerment, and demographics in critical care nurses caring for patients at the end of life.


A total of 277 critical care nurses were surveyed via the Moral Distress Scale and the Psychological Empowerment Instrument. Responses were scored on a Likert scale of 1 to 7.


Moral distress intensity was high (mean 5.34, SD 1.32) and positively correlated with age (r = 0.179, P = .01). Moral distress frequency was moderate (mean 2.51, SD 0.87) and negatively correlated with nurses’ collaboration in end-of-life patient care conferences (r = −0.191, P = .007). Psychological empowerment scores (mean 5.31, SD 1.00) were high and positively correlated with age (r = 0.139, P = .03), years of experience (r = 0.165, P = .01), collaboration in end-of-life-care conferences (r = 0.163, P = .01), and end-of-life-care education (r = 0.221, P = .001) and were negatively correlated with moral distress frequency (r = −0.194, P = .01). Multiple regression analysis revealed that empowerment was a significant predictor of moral distress frequency (â = .222, P < .01).


The significant negative correlation between psychological empowerment and frequency of moral distress in these nurses indicated that nurses with higher perceived empowerment experience moral distress less often. This finding is of particular interest as interventions to decrease moral distress are sought. (American Journal of Critical Care. 2013;22:143–152)

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