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Vol. 46. Issue 7.
Pages 383-391 (July 2022)
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Vol. 46. Issue 7.
Pages 383-391 (July 2022)
Original article
Moral distress among healthcare professionals working in intensive care units in Spain
Desasosiego moral entre los profesionales sanitarios que trabajan en unidades de cuidados intensivos en España
E. Rodriguez-Ruiza,b,c,
Corresponding author

Corresponding author.
, M. Campelo-Izquierdod, P.B. Veirasd, M.M. Rodríguezd, A. Estany-Gestale, A.B. Hortase, M.S. Rodríguez-Calvof, A. Rodríguez-Núñezb,c,g
a Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
b Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
c CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
d Division of Nursing, Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
e Epidemiology and Clinical Research Unit, Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
f Institute of Forensic Sciences, University of Santiago de Compostela, Spain
g Paediatric Intensive Care Unit, Department of Pediatrics, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
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To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs).


Cross-sectional, prospective study.


ICUs in Spain.


HCPs currently working in Spanish ICUs.


A 55-item questionnaire was electronically distributed.

Main variables

The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS).


In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40–135) than for nurses (61, IQR 35–133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46–163 vs. 61, IQR 32–117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=−0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD.


In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.

Critical care
Intensive care units
Critical care nursing
Moral distress
Ethical climate

Evaluar el desasosiego moral (DM) entre los profesionales sanitarios que trabajan en UCI en España.


Estudio prospectivo transversal.


UCI en España.


Profesionales sanitarios que actualmente trabajan en UCI españolas.


Se distribuyó electrónicamente un cuestionario de 55 ítems.

Variables principales

El cuestionario incluía características sociodemográficas y laborales, la versión en español de la Medida de desasosiego moral para profesionales sanitarios (MMD-HP-SPA) y la Encuesta de clima ético hospitalario (HECS).


En total 1.065 profesionales sanitarios de cuidados intensivos completaron el cuestionario. Tres de 4 hipótesis de validez fueron apoyadas. El DM fue significativamente mayor entre los médicos (80, IQR 40-135) que entre las enfermeras (61, IQR 35-133, p=0,026). El DM fue significativamente más alto para aquellos médicos que estaban considerando dejar su puesto de trabajo (78, IQR 46-163 vs. 61, IQR 32-117; p<0,001). El MMD-HP-SPA se correlacionó inversamente con el HECS (r=–0,277, p<0,001). Un análisis factorial exploratorio reveló una estructura de 4 factores, evidenciando los niveles de paciente, equipo y sistema del DM.


En este estudio los intensivistas refirieron niveles de DM más altos que las enfermeras. Se deben implementar estrategias para mejorar el clima ético en las UCI y corregir otros factores relacionados con el fin de mitigar el DM en lo que atañe al paciente, al equipo y al sistema. Ambos grupos de profesionales manifestaron una intención relevante de abandonar su puesto de trabajo debido al DM. Se necesitan más estudios para determinar en qué medida el DM influye sobre su deseo de abandonar su puesto de trabajo.

Palabras clave:
Cuidados intensivos
Unidad de cuidados intensivos
Enfermería de cuidados intensivos
Desasosiego moral
Clima ético


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