As frontline caregivers, nurses often find themselves at the crossroads of complex ethical decisions that can significantly impact patient outcomes and their own well-being. Identifying the areas of experienced moral dilemmas in the workplace and gaining insight into the prevalence of moral distress can lead to a healthier workplace environment. This study aims to examine the frequency, intensity and level of moral distress among nurses who work in a hospital, and to identify the variables associated with the level of moral distress. Cross-sectional study. One university hospital and six general hospitals. 654 of the 1095 nurses working on inpatient units filled out the questionnaire (response rate 60 %). The intensity and frequency of moral distress was assessed using the Moral Distress Scale-Revised (MDS-R). We also asked two additional questions about considering leaving their job, and if they could describe a distressing case and how moral distress was discussed. Multivariable regression analysis was conducted to identify the variables associated with the level of moral distress. The overall mean MDS-R score of the 654 included nurses was low at 36.4 (SD 26). Nurses reported to have frequent dilemmas regarding organizational aspects and aspects of end-of-life care. The multivariable analyses showed that higher levels of moral distress were experienced by registered nurses, nurses working on a medical ward, and nurses who had ever left or considered leaving their job, or considering leaving their job at the moment. Although nurses in our study experiences low levels of moral distress, they do experience moral dilemmas related to organizational topics and end of life care. We all need to pay attention to these dilemmas and how to discuss them in order to achieve a resilient nursing profession at a time of major nursing shortages. Caring for increasingly complex patients in a dynamic healthcare system is likely to continue to produce morally challenging scenarios.

中文翻译：

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护士的内心斗争，探索医院护士的道德困境：一项横断面研究


作为一线护理人员，护士经常发现自己处于复杂的道德决策的十字路口，这些决策可能会严重影响患者的治疗结果及其自身的福祉。识别工作场所中存在道德困境的领域并深入了解道德困扰的普遍程度可以带来更健康的工作环境。本研究旨在调查在医院工作的护士的道德困扰的频率、强度和水平，并确定与道德困扰水平相关的变量。横断面研究。 1所大学医院和6所综合医院。住院部 1095 名护士中有 654 名填写了调查问卷（答复率为 60%）。使用道德困扰量表修订版（MDS-R）评估道德困扰的强度和频率。我们还问了两个关于考虑离职的额外问题，以及他们是否可以描述一个令人痛苦的案例以及如何讨论道德困境。进行多变量回归分析以确定与道德困扰水平相关的变量。 654 名护士的总体平均 MDS-R 评分较低，为 36.4 (SD 26)。据报告，护士在组织方面和临终关怀方面经常遇到困境。多变量分析显示，注册护士、内科病房工作的护士以及曾经离职或考虑离职或目前正在考虑离职的护士所经历的道德困扰程度较高。尽管我们研究中的护士经历的道德困境水平较低，但他们确实经历了与组织主题和临终关怀相关的道德困境。 我们都需要关注这些困境以及如何讨论它们，以便在护士严重短缺的情况下实现有弹性的护理职业。在动态的医疗保健系统中照顾日益复杂的患者可能会继续产生道德上的挑战。