Moral distress in nurses of gastroenterological and proctological departments: psychological features and ways to overcome

Abstract

Aim. The study aimed to theoretically and empirically investigate the psychological characteristics of moral distress among nurses working in gastroenterology and proctology departments, and to develop practical recommendations for reducing its prevalence and preventing its negative effects on professional health and the quality of nursing practice. Materials and methods. The study was conducted in 2024–2025 at the Volyn and Zhytomyr Medical Institutes. The sample included 115 medical workers with more than one year of work experience. Standardized psychodiagnostic methods were used: the Social Adaptation and Reappraisal of Life Events Scale, developed by T. Holmes and R. Rahe, the Professional Quality of Life Scale (ProQOL, B. Stamm), and the Impact of Event Scale–Revised (IES-R, M. Horowitz et al.). Data collection involved questionnaires, surveys, and structured observation. Statistical processing was carried out using SPSS v.27 and Microsoft Excel (2019). Results. The findings demonstrated a significant prevalence of low and medium stress resilience. Over 90% of respondents showed average, threshold, or low resistance, indicating vulnerability to stress factors in the clinical environment, while only 1.7% reported high resilience. The Professional Quality of Life Scale revealed that nearly half of respondents experienced insufficient compassion satisfaction. Compassion fatigue was high in 39.1% of participants, and burnout symptoms were detected in 40.9%. Analysis of the Impact of Event Scale identified avoidance as the most frequent coping mechanism, reported by 25.2% of respondents. Intrusion, manifested through repetitive thoughts and sleep disturbances, was observed in 11.3%, while 7% demonstrated hyperarousal. Although avoidance provides temporary protection, it tends to cause long-term consequences, including emotional withdrawal, diminished empathy, and impaired communication with patients and colleagues. Overall, the study confirmed that moral distress is widespread and strongly correlated with emotional exhaustion and burnout. The coexistence of low stress resilience and high burnout levels forms a cycle of moral burden that deepens psychological vulnerability. These findings correspond to international studies, confirming that moral distress represents a universal challenge in healthcare systems across specialties. Conclusions. The research established the high prevalence of moral distress among nurses in gastroenterology and proctology units in Ukraine and demonstrated its close link with professional burnout and reduced resilience. The results emphasize the need for national strategies to support nursing personnel. Such strategies should integrate psychological support services, structured training in burnout prevention, and resilience-building interventions. These measures are particularly important within postgraduate education and institutional healthcare support systems. The obtained results can serve as a foundation for further applied research and the design of evidence-based interventions aimed at improving the psychological climate in hospital units. Future studies should assess the effectiveness of implemented programs and explore the long-term impact of moral distress on professional motivation, retention of nursing staff, and the quality of patient care. Addressing moral distress proactively can strengthen both the well-being of healthcare providers and the overall effectiveness of medical services.