Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Ann M. Mayo, RN, DNSc; Jane M. Georges, PhD, RN; Anita J. Hunter, PhD, RN, CPNP, FAAN


Critical Care Nurses, end of life care, moral distress, nursing, Psychological empowerment, quantitative


Background Critical care nurses care for many adults at end of life and it is known that these nurses can experience moral distress. Moral distress occurs when nurses are unable to perform what they believe is ethically correct. There has been speculation that psychological empowerment may ameliorate moral distress among critical care nurses. However, research has yet to examine the relationship between moral distress and psychological empowerment in the population of critical care nurses.

Objectives To describe the relationships between moral distress, psychological empowerment and select demographics in critical care nurses caring for patients at EOL.

Method Using a quantitative correlational survey design a sample of critical care nurses (n=277) was recruited using the American Association of Critical Care Nurses online Newsletter. Instruments included the Moral Distress Scale (MDS) for Intensity and Frequency each having the subscales of a) not in patient's best interest, b) individual responsibility, and c) deception and the Psychological Empowerment Instrument (PEI) with subscales of a) meaning, b) competence, c) self-determination, and d) impact.

Results MDS intensity mean score was high (m=5.34, SD=1.32) and positively correlated with age (r=.179, p=.011) and ELNEC critical care training (r=.185, p=.008). MDS frequency mean score was moderate (m=2.51, SD=0.87) and correlated with nurse collaboration in EOL patient care conferences (r=-.191, p=.007), with nurses reporting more collaboration experiencing moral distress less frequently. PEI scores (m=5.31, SD=1.00) were high and positively correlated with age (r =.139, p=.031), years of critical care experience (r=.165, p=.010), collaboration in EOLC conferences (r=.163, p=.012), EOLC education in the past year (r=.221, p=.001). Total PEI scores negatively correlated with moral distress frequency scores (r=-.194; p=.010). Multiple regression analysis indicated that for every 1-point increase on the PEI, moral distress frequency scores decreased by 0.222 points (p=<.01).

Conclusion This study contributes to the understanding of the relationship between moral distress and psychological empowerment in critical care nurses caring for patients in end of life. The significant negative correlation between psychological empowerment and moral distress frequency in this population of nurses is of particular interest and can serve as the first step in testing interventions to decrease moral distress.

Document Type

Dissertation: Open Access



Included in

Nursing Commons