logo
Volume 14, Issue 4 (11-2024)                   PCNM 2024, 14(4): 1-10 | Back to browse issues page

Ethics code: IR.ZUMS.REC.


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Gheiasi S F, Abedi A R, Khosravani M, Rafiei F, Fournier A, Ebrahimabadi M. Levels of generalized anxiety, moral distress, and moral courage among nurses: A comparative study in COVID-19 and non-COVID-19 wards. PCNM 2024; 14 (4) :1-10
URL: http://nmcjournal.zums.ac.ir/article-1-901-en.html
Department of Nursing, Arak Branch, Islamic Azad University, Arak, Iran , mebrahimi141@iau.ac.ir
Abstract:   (1042 Views)
Background: During the COVID-19 pandemic, nurses faced high levels of anxiety and moral distress. Nurses need moral courage to uphold proper moral performance.
Objectives: This study aimed to compare the levels of anxiety, moral distress, and moral courage of nurses working in COVID-19 and non-COVID-19 wards.
Methods: This descriptive comparative study was conducted on 107 nurses working in COVID-19 (n=53) and non-COVID-19 (n=54) wards at Zanjan University of Medical Sciences. Participants were selected using a convenience method. Data were collected using the Generalized Anxiety Disorder (GAD), Moral Distress Scale (MDS), and Professional Moral Courage (PMC) questionnaires. Data analysis was performed using descriptive and inferential statistics in SPSS 16 software.
Results: The majority of participants in the study were female (66%) and married (54.7%). There was no statistically significant difference in the mean (SD) generalized anxiety score between nurses in COVID-19 and non-COVID-19 wards [5.51 (2.53) vs. 4.83 (2.50), p=0.168]. The comparison of the mean (SD) moral distress score in nurses in COVID-19 and non-COVID-19 wards did not show a statistically significant difference [1.48 (0.71) vs. 1.70 (0.58), p=0.078]. Similarly, no significant difference was found in the mean (SD) score of moral courage between the two groups caring for COVID-19 and non-COVID-19 patients [59.66 (8.28) vs. 60.46 (6.06), p=0.983].
Conclusion: The study reveals elevated generalized anxiety in COVID-19 ward nurses compared to non-COVID-19 counterparts. No significant differences in moral distress severity or moral courage highlight shared resilience and commitment, emphasizing tailored support for nurses in varied environments.

Full-Text [PDF 896 kb]   (487 Downloads)    
Type of Study: Orginal research | Subject: Nursing
Received: 2023/12/18 | Accepted: 2024/11/28 | Published: 2024/11/28

References
1. 1. Al Thobaity A, Alshammari F. Nurses on the frontline against the COVID-19 pandemic: an integrative review. Dubai Medical Journal. 2020;3(3):87-92. [https://doi.org/10.1159/000509361]
2. Vejdani M, Foji S, Jamili S, Salehabadi R, Adel A, Ebnehoseini Z. Challenges faced by nurses while caring for COVID-19 patients: a qualitative study. Journal Of Education And Health Promotion. 2021;10:423. [https://doi.org/10.4103/jehp.jehp_1550_20] [PMID]
3. Grasmann L, Morawa E, Adler W, Schug C, Borho A, Geiser F, et al. Depression and anxiety among nurses during the COVID-19 pandemic: longitudinal results over 2 years from the multicentre VOICE-EgePan study. Journal Of Clinical Nursing. 2024. [https://doi.org/10.1111/jocn.17079] [PMID]
4. Naeinian MR, Shaeiri MR, Sharif M, Hadian M. To study reliability and validity for a brief measure for assessing generalized anxiety disorder (GAD-7). Clinical Psychology And Personality. 2011;2(4):41-50. [http://cpap.shahed.ac.ir/article-1-719-fa.html]
5. Moradzadeh A, Namdar Joyami E. Corona nurses' lived experience of moral distress while performing organizational duties. Quarterly Journal Of Nursing Management. 2020;9(3):59-73. [http://ijnv.ir/article-1-760-en.html]
6. Chan GK, Bitton JR, Allgeyer RL, Elliott D, Hudson LR, Burwell PM. The impact of COVID-19 on the nursing workforce: a national overview. Online Journal Of Issues In Nursing. 2021;26(2):1-17. [https://doi.org/10.3912/OJIN.Vol26No02Man02]
7. Salari N, Shohaimi S, Khaledi-Paveh B, Kazeminia M, Bazrafshan MR, Mohammadi M. The severity of moral distress in nurses: a systematic review and meta-analysis. Philosophy, Ethics, And Humanities In Medicine. 2022;17(1):13. [https://doi.org/10.1186/s13010-022-00126-0] [PMID]
8. Poortaghi S, Ebadi A, Salsali M, Raiesifar A, Davoudi N, Pourgholamamiji N. Significant influencing factors and practical solutions in improvement of clinical nursing services: a Delphi study. BMC Health Services Research. 2020;20(1):1-10. [https://doi.org/10.1186/s12913-019-4781-y] [PMID]
9. Moshtagh M, Mohsenpour M. Moral distress situations in nursing care. Clinical Ethics. 2019;14(3):141-5. [https://doi.org/10.1177/1477750919851058]
10. Jameton A. Dilemmas of moral distress: moral responsibility and nursing practice. AWHONN's Clinical Issues In Perinatal And Women's Health Nursing. 1993;4(4):542-51.
11. Hariharan S, Jonnalagadda R, Walrond E, Moseley H. Knowledge, attitudes and practice of healthcare ethics and law among doctors and nurses in Barbados. BMC Medical Ethics. 2006;7:1-9. [https://doi.org/10.1186/1472-6939-7-7] [PMID]
12. Bathaie FS, Larijani BA, Farzadfar F, Nedjat S, Emami-Razavi SH, Kadivar M, et al. Provision of healthcare services for children in Iran: common ethical principles and obstacles to successful implementation. Acta Medica Iranica. 2018:457-64. [https://acta.tums.ac.ir/index.php/acta/article/view/6812]
13. Tehrani H, Fallahi-Khoshknab M, Ebadi A, Gillespie M. Respecting the privacy of hospitalized patients: an integrative review. Nursing Ethics. 2018;969733018759832. [https://doi.org/10.1177/0969733018759832]
14. Araghian Mojarad F, Hosseini Karnami SH, Malekzadeh R, Assadi T, Khazaee-Pool M, Abedi G, et al. Nurses' experiences of moral conflicts in the educational and medical centers of Mazandaran University of Medical Sciences in 2019. Journal Of Religion And Health. 2021;9(1):24-36. [http://jrh.mazums.ac.ir/article-1-892-en.html]
15. Atashzade Shoorideh F, Ashktorab T, Yaghmaei F. Responses of ICU nurses to moral distress: a qualitative study. Critical Care Nursing. 2012;4(4):159-68. [http://jccnursing.com/article-1-199-fa.html]
16. Arafat R, Tahir T, Harisa A. Moral distress among nurses in caring COVID-19 patients. Clinical Ethics. 2023;18(1):62-6. [https://doi.org/10.1177/14777509211057251] [PMID]
17. Hashemiparast M, Aliafsari Mamaghani E, Soleimani F. Severity and frequency of moral distress among nurses in clinical settings at teaching hospitals during the outbreak of COVID-19. Journal Of Hayat. 2022;28(2):216-25. [http://hayat.tums.ac.ir/article-1-4557-en.html]
18. Ahmadi SR, Vafadar-Moradi E, Mahmoudi M, Sadrzadeh SM, Khadem-Rezaiyan M, Nakhaei A, et al. Evaluation of the level of moral distress in nurses and physicians involved with patients with new coronavirus (COVID-19). International Journal Of Medical Investigation. 2021;10(2):176-85. [http://intjmi.com/article-1-635-en.html]
19. Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a medical intensive care unit. American Journal Of Critical Care. 2005;14(6):523-30. [https://doi.org/10.4037/ajcc2005.14.6.523] [PMID]
20. Numminen O, Repo H, Leino-Kilpi H. Moral courage in nursing: a concept analysis. Nursing Ethics. 2017;24(8):878-91. [https://doi.org/10.1177/0969733016634155] [PMID]
21. Aminizadeh M, Arab M, Mehdipour R. Relationship moral courage to moral distress in nurses the intensive care unit. Journal Of Medical Ethics And History Of Medicine. 2017;10(1):131-40. [http://ijme.tums.ac.ir/article-1-5954-en.html]
22. Black LM. Tragedy into policy: a quantitative study of nurses' attitudes toward patient advocacy activities. American Journal Of Nursing. 2011;111(6):26-35. [https://doi.org/10.1097/01.NAJ.0000398537.06542.c0] [PMID]
23. Dodek P, Norena M, Ayas N, Dhingra V, Brown G, Wong H. Moral distress in intensive care unit personnel is not consistently associated with adverse medication events and other adverse events. Journal Of Critical Care. 2019;53:258-63. [https://doi.org/10.1016/j.jcrc.2019.06.023] [PMID]
24. Mobley MJ, Rady MY, Verheijde JL, Patel B, Larson JS. The relationship between moral distress and perception of futile care in the critical care unit. Intensive And Critical Care Nursing. 2007;23(5):256-63. [https://doi.org/10.1016/j.iccn.2007.03.011] [PMID]
25. Petrișor C, Breazu C, Doroftei M, Mărieș I, Popescu C. Association of moral distress with anxiety, depression, and an intention to leave among nurses working in intensive care units during the COVID-19 pandemic. Healthcare. 2021;9(10):1377. [https://doi.org/10.3390/healthcare9101377] [PMID]
26. Hthelee LHH, Sadooghiasl A, Kermanshahi SM. Moral distress and moral courage among Iraqi nurses during the COVID-19 pandemic: a cross-sectional study. Journal Of Medical Ethics And History Of Medicine. 2023;16:19. [https://doi.org/10.18502/jmehm.v16i19.14618] [PMID]
27. Newman MG, Zuellig AR, Kachin KE, Constantino MJ, Przeworski A, Erickson T, et al. Preliminary reliability and validity of the Generalized Anxiety Disorder Questionnaire-IV: a revised self-report diagnostic measure. Behavior Therapy. 2002;33(2):215-33. [https://doi.org/10.1016/S0005-7894(02)80026-0]
28. Edrissi F, Khanzadeh M, Bahrainian A. Structural model of emotional regulation and symptoms of generalized anxiety disorder in students. Clinical Psychology Studies. 2015;5(20):203-26. [https://jcps.atu.ac.ir/article_1870_8eac17aa1c9305ab43a1c540c918b298.pdf]
29. Shoorideh FA, Ashktorab T, Yaghmaei F, Alavi Majd H. Relationship between ICU nurses' moral distress with burnout and anticipated turnover. Nursing Ethics. 2015;22(1):64-76. [https://doi.org/10.1177/0969733014534874] [PMID]
30. Sekerka L, Bagozzi R, Charnigo R. Facing ethical challenges in the workplace: conceptualizing and measuring professional moral courage. Journal Of Business Ethics. 2009;89(4):565-79. [https://doi.org/10.1007/s10551-008-0017-5]
31. Tehranineshat B, Mousazadeh N, Bagherian S. Validity and reliability of the Persian moral courage questionnaire in Iranian nurses. Scientific Journal Of Medical Sciences. 2022;1(4):187-92. [http://sjiums.irshums.ac.ir/article-1-78-en.html]
32. Tamrakar P, Pant SB, Acharya SP. Anxiety and depression among nurses in COVID and non-COVID intensive care units. Nursing In Critical Care. 2023;28(2):272-80. [https://doi.org/10.1111/nicc.12685] [PMID]
33. Heidarijamebozorgi M, Jafari H, Sadeghi R, Sheikhbardsiri H, Kargar M, Gharaghani MA. The prevalence of depression, anxiety, and stress among nurses during coronavirus disease 2019: a comparison between frontline and second-line nurses. Nursing And Midwifery Studies. 2021;10(3):188-93. [http://nmsjournal.com/]
34. Ahmadidarrehsima S, Salari N, Dastyar N, Rafati F. Exploring the experiences of nurses caring for patients with COVID-19: a qualitative study in Iran. BMC Nursing. 2022;21(1):16. [https://doi.org/10.1186/s12912-022-00805-5] [PMID]
35. Wang QQ, Fang YY, Huang HL, Lv WJ, Wang XX, Yang TT, et al. Anxiety, depression and cognitive emotion regulation strategies in Chinese nurses during the COVID-19 outbreak. Journal Of Nursing Management. 2021;29(5):1263-74. [https://doi.org/10.1111/jonm.13265] [PMID]
36. Sarkoohijabalbarezi Z, Ghodousi A, Davaridolatabadi E. The relationship between professional autonomy and moral distress among nurses working in children's units and pediatric intensive care wards. International Journal Of Nursing Sciences. 2017;4(2):117-21. [https://doi.org/10.1016/j.ijnss.2017.01.007] [PMID]
37. Behbodi M, Shafipour V, Amiri M. Comparison of moral distress severity between pediatric ward and pediatric intensive care unit nurses. Religion And Health. 2018;6(1):19-28. [http://jrh.mazums.ac.ir/article-1-502-en.html]
38. Miljeteig I, Forthun I, Hufthammer KO, Engelund IE, Schanche E, Schaufel M, et al. Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway. Nursing Ethics. 2021;28(1):66-81. [https://doi.org/10.1177/0969733020981748] [PMID]
39. Hamric AB, Davis WS, Childress MD. Moral distress in health care professionals. Pharos. 2006;69(1):16-23. PMID: 16544460. [https://www.alphaomegaalpha.org/wp-content/uploads/2021/08/Hamric-etal.pdf]
40. Hart TJ. Moral distress in a non-acute continuing care setting: the experience of registered nurses. Queen's University, Kingston, Ontario, Canada. 2009. [https://www.collectionscanada.gc.ca/]
41. Tuite AR, Bogoch II, Sherbo R, Watts A, Fisman D, Khan K. Estimation of coronavirus disease 2019 (COVID-19) burden and potential for international dissemination of infection from Iran. Annals Of Internal Medicine. 2020;172(10):699-701. [https://doi.org/10.7326/M20-0696] [PMID]
42. Lazzarin M, Biondi A, Di Mauro S. Moral distress in nurses in oncology and haematology units. Nursing Ethics. 2012;19(2):183-95. [https://doi.org/10.1177/0969733011416840] [PMID]
43. Guttormson JL, Calkins K, McAndrew N, Fitzgerald J, Losurdo H, Loonsfoot D. Critical care nurses' experiences during the COVID-19 pandemic: a US national survey. American Journal Of Critical Care. 2022;31(2):96-103. [https://doi.org/10.4037/ajcc2022312] [PMID]
44. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. New England Journal Of Medicine. 2020;382(8):727-33. [https://doi.org/10.1056/NEJMoa2001017] [PMID]
45. Namadi F, Shahbazi A, Khalkhali H. Moral courage of nurses in educational and therapeutic centers of Urmia University of Medical Sciences. Nursing And Midwifery Journal. 2019;17(7):574-81. [http://unmf.umsu.ac.ir/article-1-3826-en.html]
46. Shafipour V, Esmaeili R, Heidari MR, Aghaei N, Saadatmehr SR, Sanagoo A. Investigating the level of moral distress and its related factors among nurses in Mazandaran Burn Center. Journal Of Mazandaran University Of Medical Sciences. 2015;25(126):58-67. [http://jmums.mazums.ac.ir/article-1-5933-en.html]
47. Murray JS. Moral courage in healthcare: acting ethically even in the presence of risk. Online Journal Of Issues In Nursing. 2010;15(3). [https://doi.org/10.3912/OJIN.Vol15No03Man02]
48. Sadooghiasl A, Parvizy S, Ebadi A. Concept analysis of moral courage in nursing: a hybrid model. Nursing Ethics. 2018;25(1):6-19. [https://doi.org/10.1177/0969733016638146] [PMID]
49. Aydogmus C, Camgoz SM, Ergeneli A, Ekmekci OT. Perceptions of transformational leadership and job satisfaction: the roles of personality traits and psychological empowerment. Journal Of Management And Organization. 2018;24(1):81-107. [https://doi.org/10.1017/jmo.2016.59]
50. Aultman J. Moral courage through a collective voice. American Journal Of Bioethics. 2008;8(4):67-9. https://doi.org/10.1080/15265161.2019.1572821 [https://doi.org/10.1080/15265160802147140] [PMID]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.