Intensity and Frequency of Moral Distress among Iranian Nurses: A Systematic Review and Meta-Analysis

Context: Moral distress is a common phenomenon in the nursing profession. This studywas aimed to determine the mean intensity and frequency of moral distress among Iranian Nurses. Evidence Acquisition: This systematic review and meta-analysis was based on PRISMA guideline and searching in National databases as SID, Magiran, Irandoc, Noormag, IranMedex, and Medlib as well as International databases as Madlib and Web of Sciences, Scopus, PubMed, Direct-Science, Cochrane, Embase, Springer, Online Library Wiley, Ebsco, CEBM, CINHAL, SAGE, and Google Scholar were published by 2016. Researched keywords were in Persian and their English equivalents in accordance with their Mesh: "Moral", "Morale", "Distress", "Iran", "Frequency", "intensity", "Ethics", "Nurse", and all possible combinations. The obtained documents were analyzed based on appropriate checklist through a random effects model by using Review Manager Software ver: 5.3.5. Results: According to 12 (3.08%) selected documents out of 389, 2655 Iranian nurses with a mean age of 32.3 15.265 years entered to meta-analysis. Mean intensity of moral distress was calculated 2.2329 [CI95%: 1.7651, 2.5230] out of 4, 2.9566 [CI95%: 2.4362, 3.4769] out of 5, and 3.4328 [C195%: 3.3200, 3.5455] out of 6. Furthermore, its frequency was calculated 1.9237 [C195%: 1.5533, 2.2941] out of 4, 3.0278 [CI95%: 2.4533, 3.6024] out of 5, and 2.6261 [CI95%: 2.5210, 2.7312] out of 6. Which the range of both has been reported in moderate to intense Conclusions: According to the results, the intensity and frequency of moral distress have been reported in the range of moderate to intense. Due to the most harmful effects of moral distress in nursing, management and prevention protocols of moral distress should be developed and done by nurses.