Relationship between critical thinking and moral distress in nurses: A cross-sectional study

Background: Nurses, as one of the key pillars of the healthcare system, constantly face complex ethical challenges that can impact the quality of care provided and their mental well-being. Enhancing critical thinking skills in this group may help them analyze ethical issues more effectively and make better decisions, ultimately reducing moral distress. Therefore, this study aimed to determine the relationship between critical thinking and moral distress in nurses. Methods: This cross-sectional study involved the selection of ۳۴۲ nurses from educational hospitals affiliated with Yasuj University of Medical Sciences in Iran in ۲۰۲۴, utilizing a systematic probability sampling method. Participants were required to have a minimum of one year of clinical experience and to be currently employed in hospital departments, ensuring a relevant background for the study. Data collection was conducted using the California Critical Thinking Skills Test – Form B and the modified ۱۸-item Hamric Moral Distress Scale. The findings were analyzed employing both descriptive and inferential statistical tests, including the Kolmogorov–Smirnov test for normality, Pearson correlation, and multiple linear regression, which were used to examine relationships between variables utilizing SPSS version ۲۷. Results: The mean age of participants was ۴۳.۳۳ ± ۱۰.۷ years; ۲۲۱ individuals (۶۴.۴۰%) were female, and ۱۲۷ persons (۳۷.۱۰%) had ۱ to ۵ years of work experience. Nurses had an average critical thinking score of ۲۱.۲۵ ± ۸.۶۴ and a moral distress score of ۱۱۶.۰۸ ± ۵۰.۸۲. A significant negative correlation was found between critical thinking and moral distress scores (r = -۰.۶۶, p = ۰.۰۰۱). A multiple regression model significantly predicted moral distress, explaining ۶۳% of its variance (R² = ۰.۶۲۸, F = ۲۹.۷۸۷, p = ۰.۰۰۱). Six predictors were significant. Overall critical thinking was the strongest negative predictor (β = -۰.۳۹۶, p = ۰.۰۰۱, ۹۰% CI [-۲.۶۵, -۱.۶۹]). The analysis, inference, and induction components were also significant negative predictors. In contrast, the deduction component (β = ۰.۱۹۷, p = ۰.۰۲۹, ۹۰% CI [۰.۲۴, ۴.۳۹]) and place of residence (β = ۰.۰۷۲, p = ۰.۰۳۷, ۹۰% CI [۱.۰۱, ۳۲.۶۰]) were positive predictors of moral distress. Conclusion: The findings suggest that as critical thinking skills improve, moral distress tends to decrease among nurses. Therefore, it is recommended to implement educational programs aimed at enhancing critical thinking skills in nursing practice, which could potentially alleviate feelings of moral distress.

کلیدواژه ها:

Critical thinking ، Moral distress ، Nursing ، Ethics ، Decision making