Moral distress and moral resilience in nurses during the COVID-19 pandemic: A narrative review

Abstract

COVID-19 has resulted in devastating economic, social, and psychological effects on a global scale due to its unstoppable and disastrous nature. There is a paucity of literature examining the interconnection between moral distress (MD) and resilience among nurses in the context of the pandemic. We have undertaken a narrative review of the available research on nurses' MD and resilience during the COVID-19 outbreak. A narrative review was performed through an extensive search in databases, such as PubMed, Web of Science, and Scopus, from December 1, 2020, to March 29, 2023. Keywords included "COVID-19", "2019-nCoV disease", "2019 novel coronavirus infection", "nurses", "moral distress", and "moral resilience". English-language published articles that matched the inclusion criteria were evaluated and included. Inclusion criteria included review and all descriptive studies evaluating MD and resilience in nurses during the COVID-19 pandemic. Gray literature and letters were excluded from the search results. The study results showed that nurses suffered from MD during the COVID-19 pandemic. Moral resilience is the opposite of MD, which can be reduced by using strategies such as developing the abilities of healthcare workers, strengthening honesty, and reducing their stress and anxiety. On the other hand, strengthening moral resilience by fostering self-regulation capacities, accountability and flexibility, recognizing the boundaries of honesty, and exercising conscientious objections can effectively promote their moral resilience. Considering the challenging conditions among healthcare professionals, especially nurses, in the era of COVID-19, this causes increased MD, which can cause mental and emotional risks for nurses. So, considering the relationship between MD and moral resilience (considered a protective factor) and the inverse relationship between them, it is suggested that by increasing moral resilience, we should reduce MD to survive the difficult period of COVID-19. Protect ourselves from moral and psychological problems and improve patient care quality by following the tips.