Moral distress among nurses: an umbrella review of its prevalence, severity, causes, and consequences

Moral distress is a major ethical and psychological challenge in nursing practice that adversely affects nurses’ well-being, patient care quality, and healthcare organizations. This umbrella review aimed to synthesize and critically appraise evidence from existing systematic reviews regarding the prevalence, severity, causes, and consequences of moral distress primarily among nurses across diverse healthcare settings worldwide, with particular attention to regional and contextual variations.

This umbrella review was conducted according to the JBI methodology for umbrella reviews and reported in accordance with PRISMA 2020 guidelines. A comprehensive search was performed in PubMed, Scopus, Web of Science, and Google Scholar from inception until 10 March 2025. Systematic reviews and meta-analyses (with or without meta-analysis) published in English were included if they focused on moral distress among nurses or reported extractable nurse-relevant findings within mixed healthcare professional populations. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Due to considerable heterogeneity in populations, settings, and outcome measures, a narrative synthesis was undertaken.

Of 435 records identified, 19 systematic reviews published between 2009 and 2025 met the inclusion criteria. Reported moral distress scores varied across settings and instruments. Higher levels were consistently reported in intensive care, coronary care, and oncology units. Key contributing factors include younger age, female gender, poor teamwork, inadequate resources, and perceived futile or non-beneficial care. Major consequences comprise burnout, depression, reduced quality of nursing care, medication errors, and intention to leave the profession. Significant global and contextual variations were observed.

Moral distress remains a complex, multifaceted phenomenon influenced by individual, interpersonal, organizational, and systemic factors. Organizational and educational interventions may help mitigate its impact; however, further high-quality research is needed to strengthen the evidence base and inform effective strategies. This umbrella review synthesizes current evidence and highlights important implications for nursing practice, management, education, and future research.

Not applicable.