The Association between Nurses’ Quality of Work Life and Moral Distress: A Cross-Sectional Study in Rasht, Iran

Abdolhosein E Sigaroudi; Negar Pourvakhshoori; Maedeh Shabani; Saman Maroufizadeh

doi:10.25159/2520-5293/17528

Authors

Abdolhosein E Sigaroudi Guilan University of Medical Sciences https://orcid.org/0000-0002-1394-3361
Negar Pourvakhshoori Guilan University of Medical Sciences https://orcid.org/0000-0002-4318-137X
Maedeh Shabani Guilan University of Medical Sciences https://orcid.org/0009-0008-1640-5092
Saman Maroufizadeh Guilan University of Medical Sciences https://orcid.org/0000-0001-5794-3876

DOI:

https://doi.org/10.25159/2520-5293/17528

Keywords:

quality of work life, nurse, moral distress, moral, occupational stress

Abstract

Nurses play a crucial role in delivering healthcare services, emphasising the need for healthcare managers to prioritise their well-being. The quality of work life (QWL) is a significant factor influencing the recruitment and retention of nurses. This study aimed to investigate the relationship between the QWL and moral distress among nurses working in educational-remedial hospitals in Rasht, Iran. This cross-sectional analytical study utilised multi-stage sampling to survey all nurses in educational-remedial hospitals in Rasht, excluding those in ICUs, and in administrative, educational and research roles. A structured questionnaire was employed as the primary data collection tool, with data analysis conducted using SPSS version 16. The study found that over 50% of nurses reported a QWL below the mean. Significant correlations were observed between the QWL and variables, such as age (r = 0.349, p < 0.001); work experience (r = 0.319, p < 0.001); marital status (p = 0.036); level of education (p = 0.023); work shifts (p < 0.001); employment status (p < 0.001); and work position (p = 0.014). Additionally, the nurses’ moral distress levels were generally low, with a notable negative correlation between the nurses’ total QWL score and total moral distress scores (r_S = –0.305, p < 0.001). The findings suggest that nurses experiencing moral distress due to executing unnecessary physician orders; ineffective team communication; and providing futile patient care are likely to face diminished QWL. Moreover, heightened moral distress levels can contribute to a decline in overall job satisfaction and well-being among nurses.

References

Abadi, F., F. Abadi, and E. Nouhi. 2019. “Survey Factors Affecting of Quality of Work Life in the Clinical Nurses.” Journal of Urmia Nursing and Midwifery Faculty 16 (11): 832–840.

Alzoubi, M. M., S. Al-Momani, K. Al-Mugheed, I. Owiedat, G. M. A. Shosha, A. A. S. Alabdullah, S. A. Alsenany, and S. M. F. Abdelaliem. 2024. “Assessment of the Quality of Nursing Work Life and Its Related Factors among Critical Care Nurses.” Frontiers in Public Health 12. https://doi.org/10.3389/fpubh.2024.1305686

Asadi, K., M. Niknami, M. Jafari Asl, and E. Kazemnezhad Leyli. 2019. “Relationship between the Dimensions of Quality of Work Life and General Health in Iranian Nurses.” Journal of Holistic Nursing and Midwifery 29 (1): 8–14. https://doi.org/10.29252/hnmj.29.1.266

Brooks, B. A. 2001. “Development of an Instrument to Measure Quality of Nurses’ Work Life.” PhD diss., University of Illinois at Chicago.

Brooks, B. A., and M. A. Anderson. 2005. “Defining Quality of Nursing Work Life.” Nursing Economics 23 (6): 319–326.

Corley, M. C., R. K. Elswick, M. Gorman, and T. Clor. 2008. “Development and Evaluation of a Moral Distress Scale.” Journal of Advanced Nursing 33 (2): 250–256. 10.1111/j.1365-2648.2001.01658.x

Dargahpour, M., P. Jalali, and M. Mohammadi. 2022. “The Relationship between Quality of Work Life and Job Satisfaction among Nurses in a Teaching Hospital in 2020.” Evidence Based Health Policy, Management and Economics 6 (3): 188–196. https://doi.org/10.18502/jebhpme.v6i3.10859

De Brasi, E. L., N. Giannetta, S. Ercolani, E. L. M. Gandini, D. Moranda, G. Villa, and D. F. Manara. 2021. “Nurses’ Moral Distress in End-of-Life Care: A Qualitative Study.” Nurings Ethics 28 (5): 614–627. https://doi.org/10.1177/0969733020964859

Ebramiabadi, E., M. Rahimzadeh, A. Omidi, F. Farahani, L. Malekyan, and F. Jalayer. 2020. “The Relationship between Moral Courage and Quality of Work Life among Nursing Staff in Bam Hospitals.” Journal of Advvanced Pharmacy Education and Research 10 (S1): 127–132.

Fotoohi, M., E. Jafar Jalal, and H. Haghani. 2021. “The Correlation of Safe Nursing Care with the Quality of Work Life of Nurses.” Iran Journal of Nursing 33 (128): 1–14. https://doi.org/10.52547/ijn.33.128.1

Habibzadeh, S., S. Masouleh, M. Chehrzad, and E. Kazemnejad Leili. 2020. “Moral Distress and Related Factors in Nurses Working in Intensive Care Units.” Journal of Holistic Nursing and Midwifery 30 (3): 166–173. https://doi.org/10.32598/jhnm.30.3.1092

Jameton, A. 1984. Nursing Practice: The Ethical Issues. Englewood Cliffs: Prentice-Hall.

Kaddourah, B., A. K. Abu-Shaheen, and M. Al-Tannir. 2018. “Quality of Nursing Work Life and Turnover Intention among Nurses of Tertiary Care Hospitals in Riyadh: A Cross-Sectional Survey.” BMC Nursing 17: 43. https://doi.org/10.1186/s12912-018-0312-0

Karimi, M., P. Bozorgzad, T. Najafi Ghezeljeh, H. Haghani, and B. Fallah. 2021. “The Productivity and Quality of Work Life in Emergency Nurses.” Iran Journal of Nursing 34 (130): 73–90. https://doi.org/10.52547/ijn.34.130.73

Kesti, R., O. Kanste, J. Konttila, and A. Oikarinen. 2023. “Quality of Working Life of Employees in Public Healthcare Organization in Finland: A Cross-Sectional Study.” Nursing Open 10 (9): 6455–6464. https://doi.org/10.1002/nop2.1896

Latimer, A. L., M. D. Otis, G. Mudd-Martin, and D. K. Moser. 2023. “Moral Distress during COVID-19: The Importance of Perceived Organizational Support for Hospital Nurses.” Journal of Health Psychology 28 (3): 279–292. https://doi.org/10.1177/13591053221111850

Lee, Y. W., Y. T. Dai, M. Y. Chang, Y. C. Chang, K. G. Yao, and M. C. Liu. 2017. “Quality of Work Life, Nurses’ Intention to Leave the Profession, and Nurses Leaving the Profession: A One-Year Prospective Survey.” Journal of Nursing Scholarship 49 (4): 438–444. https://doi.org/10.1111/jnu.12301

Mahdieh, O., and A. Shojaee. 2019. “Effectiveness of Ethical Values in Nurses’ Quality of Work Life with the Mediating Role of Professional Ethics.” Quarterly Journal of Nursing Management 8 (3): 1–9.

Malki, S., G. Hamouda, and O. Felemban. 2020. “Relationship between Perceived Organizational Support and Quality of Nurses’ Work Life at King Fahad Hospital-Saudi Arabia.” Innovative Journal of Medical and Health Science 10 (10): 1349–1360. https://doi.org/10.15520/ijmhs.v10i10.3136

Molazem, Z., L. Bagheri, and M. Najafi Kalyani. 2022. “Evaluation of the Moral Distress Intensity and Its Relationship with the Quality of Work Life among Nurses Working in Oncology Wards in Shiraz, Southwest of Iran.” Biomed Research International 7977039. https://doi.org/10.1155/2022/7977039

Mosalanezhad, L., S. Abiri, and N. Kalani. 2020. “Moral Distress Level in Nurses and Physicians Caring for Patients with COVID-19: A Cross-Sectional Descriptive Study in 2020.” Journal of Education and Ethics in Nursing 9 (3): 1–8. https://doi.org/10.52547/ethicnurs.9.3.4.1

Mosisa, G., M. Abadiga, A. Oluma, and B. Wakuma. 2022. “Quality of Work-Life and Associated Factors among Nurses Working in Wollega Zones Public Hospitals, West Ethiopia: A Cross-Sectional Study.” International Journal of Africa Nursing Sciences 17: 100466. https://doi.org/10.1016/j.ijans.2022.100466

Mozdeh, R., and E. Namani. 2021. “Relationship between Vitality and Sense of Psychosocial Coherence with Nurses’ Quality of Work Life: The Role Mediating of Self-Differentiation.” Journal of Sabzevar University of Medical Sciences 27 (6): 744–751.

Ogbuabor, D., N. Ghasi, and R. Eneh. 2022. “Nurses’ Perceptions of Quality of Work Life in Private Hospitals in Enugu, Nigeria: A Qualitative Study.” AIMS Public Health 9 (4): 718–733. https://doi.org/10.3934/publichealth.2022050

Oldenmenger, W. H., E. Berger, and A. Stoppelenburg. 2024. “The Inner Struggle of Nurses, Exploring Moral Distress among Hospital Nurses: A Cross-Sectional Study.” International Journal of Nursing Studies 158: 104864. https://doi.org/10.1016/j.ijnurstu.2024.104864

Rahmanian, A., T. Mirzaei, and S. Sabzevari. 2019. “The Relationship between Moral Development and Moral Distress in Bam.” Education and Ethics in Nursing 8 (3): 37–43. https://doi.org/10.52547/ethicnurs.8.3.4.37

Rahnama, N., S. Bakhtiarpour, S. Bavi, H. Jayrvand, and Z. Dasht Bozorgi. 2021. “Presentation a Model of Quality of Work Life Based on Job Stress and Optimism Mediated by Fatigue in Married Nurses in Ahvaz.” Journal of Health Promotion Management 10 (3): 96–108.

Sadeghinia, Z., S. Joekar, and Z. Zanjani. 2024. “The Structural Model of Anxiety Symptoms and Work-Life Areas in Nurses with the Mediating Role of Moral Distress and Emotion Regulation.” Nursing and Midwifery Studies 13 (2): 85–91. https://doi.org/10.48307/nms.2024.412495.1247

Sana, A., J. Moghri, V. Ghavani, and S. Tabatabaee. 2021. “The Relationship between Quality of Work Life and Turnover Intention among Nurses in the Public Hospitals in Herat, Afghanistan in 2019–2020.” Journal of Health Administration 24 (2): 33–44. https://doi.org/10.52547/jha.24.2.33

Shamsalinia, A, A. Mahmoudian, B. Sorori, M. Yoseframaki, and M. H. Vaziri. 2021. “Evaluation of Moral Distress and Its Related Factors in Nurses Working in Hospitals in Western Mazandaran.” Quarterly Journal of Caspian Health and Aging 6 (1): 20–28.

Soleimani, M. A., S. P. Sharif, A. Yaghoobzadeh, and B. Panarello. 2019. “Psychometric Evaluation of the Moral Distress Scale-Revised among Iranian Nurses.” Nursing Ethics 26 (4): 1226–1242. https://doi.org/10.1177/0969733016651129

Viselita, F., H. Handiyani, and H. Pujasari. 2019. “Quality Level of Nursing Work Life and Improvement Interventions: Systematic Review.” Enfermería Clínica 29: 223–228. https://doi.org/10.1016/j.enfcli.2019.06.001

Xie, W., L. Chen, F. Feng, C. T. C. Okoli, P. Tang, L. Zeng, M. Jin, Y. Zhang, and J. Wang. 2021. “The Prevalence of Compassion Satisfaction and Compassion Fatigue among Nurses: A Systematic Review and Meta-Analysis.” International Journal of Nursingg Studies 120: 103973. https://doi.org/10.1016/j.ijnurstu.2021.103973

Yarmohammadinejad, E., M. Seyedoshohadaee, P. Saberian, H. Haghani, and F. Khayeri. 2021. “The Correlation between Perceived Organizational Support and Quality of Work Life in the Operational Staff of Tehran Medical Emergency Center, 2019.” Iran Journal of Nursing 34 (130): 48–58. https://doi.org/10.52547/ijn.34.130.48