Journal of Medical Ethics and History of Medicine 2018. 11(0):.

The relationship between futile care perception and moral distress among intensive care unit nurses
Hamid Asayesh, Mojtaba Mousavi, Mohammad Abdi, Mohammad Parvaresh Masoud, kurosh jodaki


Moral distress is among the various types of distress that involves nurses and can lead to multiple complications. It is therefore rather important to identify the factors related to moral distress. The purpose of this study was to examine the relationship between futile care perception and moral distress among intensive care unit (ICU) nurses. This cross-sectional study used a descriptive-correlation method and was conducted on 117 ICU nurses of Qom hospitals in 2016. Data were collected using a 17-item futile care perception questionnaire, and Jameton’s moral distress questionnaire containing 30 questions. Data analysis was performed using SPSS 16, descriptive statistics and univariate regression analysis. The results showed that the mean age of the participants was 34.99, and most (about 66.7%) were women. Univariate regression analysis indicated that when ICU nurses’ perception of futile care and work experience increased, their moral distress also increased significantly (P = 0.03 and P = 0.02, respectively). It can therefore be concluded that moral distress is associated with futile care and ICU work experience. It seems that some interventions are necessary in future to place nurses in clinical situations involving futile care, and thus reduce their level of moral distress.


Futile care; Moral distress; Intensive Care Unit

Full Text:



Rushton CH, Kaszniak AW, Halifax JS. A framework for understanding moral distress among palliative care clinicians. Journal of Palliative Medicine. 2013; 16(9):1074-9.

Ganske KM. Moral distress in academia. OJIN: The Online Journal of Issues in Nursing. (accessed on: 2015).

Gutierrez KM. Critical care nurses' perceptions of and responses to moral distress. Dimensions of Critical Care Nursing. 2005; 24(5):229-41.

Wiegand DL, Funk M. Consequences of clinical situations that cause critical care nurses to experience moral distress. Nursing Ethics. 2012; 19(4):479-87.

Rabiee S, Khatiban M, Cheraghi MA. Nurses distress in intensive care unit: a survey in teaching hospitals.Iranian Journal of Medical Ethics and History of Medicine. 2012; 5(2):58-69.

Attashzadeh SF, Ashktorab T, Yaghmaei F. The experience of moral distress in ICU nurses: A qualitativestudy. Daneshvar Medicine Journal. 2011; 19(95): 79-92. [in Persian]

Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a medical intensive care unit. American Journal of Critical Care. 2005; 14(6):523-30.

Maiden JM, editor A Quantitative and Qualitative Inquiry Into Moral Distress, Compassion Fatigue, and Medication Error in Critical Care Nurses. 20th International Nursing Research Congress Focusing on Evidence-Based Practice. (access on:2009).

Park H-A, Cameron ME, Han S-S, Ahn S-H, Oh H-S, Kim K-U. Korean nursing students’ ethical problems and ethical decision making. Nursing Ethics. 2003; 10(6):638-53.

Corley MC. Moral distress of critical care nurses. American Journal of Critical Care. 1995; 4(4):280-5.

Beckstrand RL, Kirchhoff KT. Providing end-of-life care to patients: critical care nurses’ perceived obstacles and supportive behaviors. American Journal of Critical Care. 2005; 14(5):395-403.

Yekefallah L, Ashktorab T, Manoochehri H, Alavi majd H. Futile care: why Intensive care nurses’ provide it? A phenomenologic study. Advances in Nursing & Midwifery. 2015; 24(87):1-14. [in Persian]

Palda VA, Bowman KW, McLean RF, Chapman MG. “Futile” care: Do we provide it? Why? Asemistructured, Canada-wide survey of intensive care unit doctors and nurses. Journal of critical care. 2005;20(3):207-13.

Heland M. Fruitful or futile: intensive care nurses' experiences and perceptions of medical futility.Australian Critical Care. 2006; 19(1):25-31.

Mobley MJ, Rady MY, Verheijde JL, Patel B, Larson JS. The relationship between moral distress and perception of futile care in the critical care unit. Intensive and Critical care nursing. 2007; 23(5):256-63.

Mohammadi S, Roshanzadeh M. Exploring the Perception of intensive care unit nurses of futile care.Education & Ethic in Nursing. 2015; 3(2):65-72. [in Persian]

Yekefalah L, Ashktorab T. Experiences of Critical Care Units Nurses about Futile Care a Qualitative Study.Preventive Care in Nursing & Midwifery Journal. 2015; 4(2):23-34. [in Persian]

Vaziri MH, Merghati-Khoei E, Tabatabaei S. Moral distress among Iranian nurses. Iranian journal of psychiatry. 2015; 10(1): 32-36.

Ghasemi E, Negarandeh R, Janani L. Moral distress in Iranian pediatric nurses. Nursing ethics. (accessed on: 2017).

Shorideh FA, Ashktorab T, Yaghmaei F. Iranian intensive care unit nurses’ moral distress: A content analysis. Nursing Ethics. 2012; 19(4):464-78.

Borhani F, Mohammadi S, Roshanzadeh M. Moral distress and perception of futile care in intensive care nurses. Journal of medical ethics and history of medicine. 2015; 8(2):1-7.

Meltzer LS, Huckabay LM. Critical care nurses’ perceptions of futile care and its effect on burnout.American journal of critical care. 2004; 13(3):202-8.

Motevallian SA, Alizadegan S, hossein Vaziri M, Khoiee EM, Goushegir SA, Ghoroubi J. Developing the moral distress scale in the population of Iranian nurses. Iranian Journal of Psychiatry. 2008; 3(2):55-8.

Karanikola MN, Albarran JW, Drigo E, Giannakopoulou M, Kalafati M, Mpouzika M, et al. Moral distress,autonomy and nurse–physician collaboration among intensive care unit nurses in Italy. Journal of nursingmanagement. 2014; 22(4):472-84

Lawrence LA. Work engagement, moral distress, education level, and critical reflective practice in intensive care nurses. Nursing Forum; 2011; 46(4):256-68.

Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. The Journal of clinical ethics. 2009; 20(4): 330-342.

Dodek PM, Wong H, Norena M, Ayas N, Reynolds SC, Keenan SP, et al. Moral distress in intensive careunit professionals is associated with profession, age, and years of experience. Journal of critical care. 2016;31(1):178-82.

Piers RD, Azoulay E, Ricou B, Ganz FD, Decruyenaere J, Max A, et al. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. Jama. 2011; 306(24):2694-703.

Ferrell BR, editor Understanding the moral distress of nurses witnessing medically futile care. Oncol NursForum; 2006:33(5):922-930.

Rostami S, Esmaeali R, Jafari H, Cherati JY. Perception of futile care and caring behaviors of nurses in intensive care units. Nursing Ethics. (accessed on: 2017).

Dunwoody DR. Nurses' level of moral distress and perception of futile care in the critical care environment [dissertation]. United States. D'Youville College; 2010.

Ebrahimi H, Kazemi A, Asghari Jafarabadi M, Azarm A. Moral distress in nurses working in educational hospitals of Northwest Medical Universities of Iran. Iranian Journal of Medical Ethics and History of Medicine. 2013; 6(4):80-8.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.