Tehran University of Medical Sciences Journal of Medical Ethics and History of Medicine 2008-0387 18 0 2025 06 07 1516 1516 Zahra Asadi Researcher, Ms. Student, Critical Care Nursing Department, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Alun Jackson Professor, Centre on Behavioral Health, University of Hong Kong, Pokfulam, Hong Kong, SAR China. Azam Jahangirimehr Researcher, School of Medical Sciences, Shoushtar Faculty of Medical Sciences, Ahvaz, Iran. Fatemeh Bahramnezhad Associate Professor, Department of ICU Nursing, School of Nursing & Midwifery,Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2025 02 12 2025 06 07 This cross-sectional study, conducted in 2023 on 386 ICU nurses from hospitals affiliated with Tehran University of Medical Sciences, investigated the relationships between moral resilience, moral distress, and second victim syndrome. Participants were selected through simple random sampling, and data were collected using Rushton’s Moral Resilience Scale, Hamric’s Moral Distress Questionnaire, and Burlison’s Second Victim Scale. Analysis was performed using descriptive statistics and Pearson’s correlation in SPSS v24. The results showed a significant positive correlation between second victim syndrome and moral distress, indicating that increased second victim experiences were associated with higher moral distress. There was also a significant negative correlation between moral resilience and second victim syndrome, confirmed by regression and structural equation modeling. However, no significant correlation was found between moral resilience and moral distress. Overall, the study highlights that second victim syndrome contributes to moral distress, while moral resilience acts as a protective factor. It is recommended that targeted interventions – such as resilience training, peer support groups, professional debriefing, and organizational mental health.initiatives -be implemented to mitigate these psychological challenges in high-stress ICU environments. https://jmehm.tums.ac.ir/index.php/jmehm/article/view/1516 https://jmehm.tums.ac.ir/index.php/jmehm/article/download/1516/465