Identification of risk factors for moral distress in nurses: basis for the development of a new assessment tool

Rafaela Schaefer*, Elma Lourdes Campos Pavone Zoboli, Margarida Vieira

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

26 Citations (Scopus)


This article proposes to identify risk factors for moral distress from the literature, validate them through expert analysis and provide the basis for a new tool to assess the risk of moral distress among nurses. Moral distress is related to the psychological, emotional and physiological aspects of nursing. It arises from constraints caused by various circumstances and can lead to significant negative consequences. A scoping review and validation through expert analysis were used. The research question guiding this study was as follows: What is known about risk factors for moral distress in nursing? The research was conducted using multiple sources including electronic databases and lists of references from relevant literature. The final sample consisted of 38 studies. A validation analysis was conducted by experts during December 2014 and June 2015. To exclude a risk factor item, at least 80% of the experts had to agree with the exclusion. In total, 53 risk factors for moral distress were identified, reviewed by the experts and grouped to form a new instrument that may help to identify risk for moral distress and to address its consequences.

Original languageEnglish
Pages (from-to)346-357
Number of pages12
JournalNursing Inquiry
Issue number4
Publication statusPublished - 1 Dec 2016


  • Ethics
  • Instrument development
  • Moral distress
  • Nursing practice
  • Risk factor
  • Scoping review


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