Skip to main content

Research Repository

Advanced Search

Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy

Papathanassoglou, Elizabeth De; Karanikola, Maria N.K.; Albarran, John; Drigo, Elio; Giannakopoulou, Margarita; Kalafati, Maria; Mpouzika, Meropi; Tsiaousis, George Z.


Elizabeth De Papathanassoglou

Maria N.K. Karanikola

John Albarran

Elio Drigo

Margarita Giannakopoulou

Maria Kalafati

Meropi Mpouzika

George Z. Tsiaousis


Aim: To explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. Background: Poor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. Methods: A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. Results: The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P < 0.001); and (2) intention to resign (r = 0.244, P < 0.0001). The frequency of occurrence of moral distress was associated with the intention of nurses to resign (r = -0. 209, P < 0.0001). Conclusion: Moral distress seems to be associated with the intention to resign, whereas poor nurse-physician collaboration appears to be a pivotal factor accounting for nurses' moral distress. Implications for nursing management: Enhancement of nurse-physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession. © 2013 John Wiley & Sons Ltd.


Papathanassoglou, E. D., Karanikola, M. N., Albarran, J., Drigo, E., Giannakopoulou, M., Kalafati, M., …Tsiaousis, G. Z. (2014). Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy. Journal of Nursing Management, 22(4), 472-484.

Journal Article Type Article
Publication Date Jan 1, 2014
Journal Journal of Nursing Management
Print ISSN 0966-0429
Electronic ISSN 1365-263X
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 22
Issue 4
Pages 472-484
Keywords moral distress, intensive care, autonomy, intensive care nurses
Public URL
Publisher URL
Additional Information Additional Information : Article first published online: 14 MAR 2013