Investigating the Relationship between Moral Injury in Nurses with Ethical Climate in Critical Care Departments of Selected Hospitals of Tabriz University of Medical Sciences in 2022: A Cross-sectional Study

Intensive Care Units (ICUs) are considered as one of the most complex hospital units due to their high sensitivity and special conditions. Therefore, nurses in special care departments experience many challenges such as moral injury and conflict with management elements that can affect their performance and health. Moral injury is defined as guilt, social isolation and emotional numbness, which can affect the performance and physical and mental health of nurses. Therefore, the present study was conducted with the aim of investigating the relationship between moral injury in nurses and the ethical climate of critical care units.

The present study was a cross sectional research that was conducted in 2022 in the ICU and Critical Care Unit (CCU) departments of hospitals affiliated to Tabriz University of Medical Sciences. The study population included 266 nurses working in CCUs who were selected by simple random method. Research tools included demographic questionnaire, moral injury questionnaire and ethical climate.

According to the findings of the present study, the average score of the ethical climate of special care units in general was 77.31 ± 6.84 and the average score of moral injury among nurses was 40.67 ± 3.93, which indicates the favorable ethical climate of ICUs and severe moral injury in nurses working in these departments. Among the different dimensions of Ethical climate, the highest score was related to the instrumental dimension with an average of 22.65 ± 3.57 and the lowest score was related to the independent dimension with an average of9.11 ± 2.13. By using the Pearson's correlation coefficient, no significant relationship was observed between ethical climate and moral injury. However, moral injury had a significant and inverse relationship with the organization's ethical climate rules and regulations subscale (P = 0.24, r = -1.38) and had no statistically significant relationship with the other ethical climate subscales (P>0.05).

The findings showed that there is no significant relationship between the moral injury of nurses and the ethical climate of CCUs. Therefore, moral injury in nurses includes complex components and concepts that can be influenced by several factors. Also, the findings showed that the increase in organizational rules and regulations in CCUs will reduce the moral injury in nurses working in CCUs, so managers and trustees of medical systems should pay attention to this issue and take measures. Practices can reduce moral injury and also increase health and job satisfaction in nurses.