Examining the effect of moral resilience on moral distress


Nursing Ethics, vol.30, no.7-8, pp.1156-1170, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 30 Issue: 7-8
  • Publication Date: 2023
  • Doi Number: 10.1177/09697330231177420
  • Journal Name: Nursing Ethics
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, Academic Search Premier, ASSIA, Abstracts in Social Gerontology, CINAHL, EBSCO Legal Collection, EBSCO Legal Source, EMBASE, MEDLINE, Philosopher's Index, Psycinfo, Public Affairs Index, DIALNET
  • Page Numbers: pp.1156-1170
  • Keywords: Ethics, moral distress, moral resilience, nursing, quantitative, Turkey
  • Hacettepe University Affiliated: Yes


Aims: The study aims to test the Turkish validity and reliability of the Rushton Moral Resilience Scale (RMRS) and examine the effect of moral resilience on moral distress. Background: Moral distress is a phenomenon that negatively affects health workers, health institutions, and the person receiving care. In order to eliminate or minimize the negative effects of moral distress, it is necessary to increase the moral resilience of nurses. Moral resilience involves developing systems that support a culture of ethical practice in healthcare and aim to increase an individual’s capacity to cope with moral challenges. Methods: A methodological and descriptive-predictive study design was adopted. Sociodemographic Information Form, Measure of Moral Distress – Healthcare Professionals (MMD-HP), and Rushton Moral Resilience Scale were used to collect data from the nurses. A total of 255 clinical nurses were recruited. Ethical considerations: Hacettepe University’s non-interventional ethics committee approved the study’s protocol and informed consent was obtained from the participants. Results: The original four-factor structure of the scale was tested with confirmatory factor analysis, and the index values were evaluated and found at an acceptable level. The Cronbach Alpha coefficient of the scale was found to be 0.826. Moral resilience predicted moral distress total, intensity, and frequency levels. A moderate and weak relationship was found in the negative between all sub-dimensions of moral distress and moral resilience. Conclusions: The Rushton Moral Resilience Scale Turkish version showed good psychometric properties. Moral resilience has a reducing effect on moral distress. Young nurses who have less experience are at risk because they have lower moral resilience levels, while nurses working in intensive care units are at risk because of their high moral distress levels. A healthy workplace can be created by developing specific approaches to improve moral resilience in reducing the impact of moral distress in the healthcare environment.