Abstract
Background: The effect of moral distress among healthcare providers is significant on disease morbidity, especially within the intensive care unit (ICU). In this systematic review and meta-analysis, we aimed to gather all evidence regarding moral distress frequency and severity/intensity among ICU health care providers.
Methods: We conducted a systematic search to gather all relevant studies from six databases, followed by a manual search of references. Fourteen studies consisting of 5905 participants were included in the final moral distress scale analyses.
Results: Overall, there was moderate moral distress severity/intensity among all participants (Mean = 27.79; 95% confidence interval (CI) = 7.40-64.18). On further stratification of the results according to countries, Canada (Mean = 91.99; 95% CI = 80.10-105.65) and USA (Mean = 52.54; 95% CI = 44.78-61.64) showed the highest distress scores, followed by Iran (Mean = 21.20; 95% CI = 7.21-62.30) and Italy (Mean = 3.42; 95% CI = 3.15-3.72). Studies conducted in high income-earning countries reported more severity/intensity (Mean = 22.65; 95% CI = 6.58-78.02) compared to those in the upper-middle income-earning ones (Mean = 18.89; 95% CI = 2.80-127.34). There was significant heterogeneity among the included studies, which could not be explained by the difference in scales, country of the participants, or the female proportion. Moreover, there was a moderate frequency of moral distress (Mean = 46.83; 95% CI = 8.34-262.87), which was found to be much higher (Mean = 87.94; 95% CI = 83.55-92.57), in performing analysis.
Conclusion: Moral distress is a major problem in the ICU setting, in terms of both severity/intensity and frequency. Future large-scale studies are required, through a unified framework, to develop appropriate interventions to address ICU-related moral distress.