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he concept of moral distress was first introduced by Jameton in 1983 (1). This concept states that nurses make decisions based on four principles: a) Competence is the duty of nurses; B) Nurses should not use their position to exploit patients; C) Patient recovery is a primary concern of nurses; and D) Nurses should be loyal to one another (1). However, the profitability approach dominant in health-care settings is increasingly putting great pressure on nurses in order to reduce hospital costs, hence causing problems such as moral distress among nurses (2). In fact, moral distress is defined as discomfort or disturbance of one’s mental peace, occurring as a result of failure to take appropriate moral actions despite their recognition (2-4). Health promotion, disease prevention, and respect for client rights are important goals in the nursing profession. Lack of fulfillment of these objectives can lead to moral distress, which is in fact a common phenomenon in the nursing profession (3). As a huge group of caregivers, nurses are constantly faced with ethical issues that can play a significant role in their quality of care (5). Therefore, moral distress can have different effects on nurses, patients, and the health system and can result in significant consequences (6). It has been shown in various studies that moral distress in a nurse can lead to job withdrawal, stress, burnout, job dissatisfaction, poor quality of work, incidence of physical symptoms such as headache and nightmare, reduced nursing confidence, and even prolonged patient hospitalization (5-8). Several contributors to moral distress have been enumerated in studies conducted in T Abstract

Moral Distress in Nursing and Its Contributors in the Context of Iran