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Mediation

Critical Care Nurses in Saudi Arabia Face Ethical Dilemmas and Institutional Constraints

Strategic Insights

— 2 min read

A recent study published in BMC Nursing has highlighted the alarming rate of moral distress among critical care nurses (CCNs) in Saudi Arabia, stemming from a poor work environment and institutional constraints. According to the research conducted by the University of Hail, CCNs frequently encounter ethical dilemmas, leading to adverse psychological outcomes such as depression and increased turnover intentions. The study aimed to assess the mediating role of moral distress on the relationship between the work environment and depression among CCNs.

Key Takeaways:

  • Critical care nurses in Saudi Arabia experience high levels of moral distress, with a mean score of 104.24 ± 76.12 out of 150.
  • A significant weak negative correlation was found between the work environment and moral distress (r = -0.323, p < 0.05).
  • The study found that moral distress serves as a key mediator amplifying psychological harm, including depression among CCNs.
  • The work environment, as measured by the Practice Environment Scale of the Nursing Work Index (PES-NWI), had a mean score of 2.67 ± 0.46 out of 5.
  • Depression among CCNs was measured using the Patient Health Questionnaire (PHQ-9), with a mean score of 11.57 ± 5.72 out of 27.
  • The study's findings emphasize the need for systemic changes to enhance nurses' well-being and retention, particularly in high-intensity settings like critical care units.
  • Interventions targeting ethical climate improvement, mental health support, and educational advancement are urgently required to mitigate the effects of moral distress and depression among CCNs.

Statistics:

  • 230 critical care nurses participated in the study, recruited from four tertiary hospitals in Hail, Saudi Arabia.
  • The study had a cross-sectional design and used a cross-sectional survey with validated instruments to measure the work environment, moral distress, and depression.
  • Descriptive statistics, Pearson's correlation, and mediation analysis were used to analyze the data.
  • The mean score of the work environment was 2.67 ± 0.46 out of 5, indicating a relatively poor work environment.
  • The mean score of moral distress was 104.24 ± 76.12 out of 150, indicating high levels of moral distress among CCNs.
  • The mean score of depression was 11.57 ± 5.72 out of 27, indicating a moderate level of depression among CCNs.

Sources:

  • Habib Alrashedi et al., "The mediating effect of moral distress on the relationship between work environment and depression among critical care nurses." BMC Nursing, 2025, 24(1):1-9. (BMC Nursing - http://bmcnurs.biomedcentral.com).
  • The publisher for BMC Nursing is BMC.
  • A free version of this journal article is available at https://doi.org/10.1186/s12912-025-03873-5.

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