The ASSISTANCE STUDY: Moral distress and psychological wellbeing of nurses during the COVID-19 pandemic

Watts, Tessa ORCID: https://orcid.org/0000-0002-1201-5192, Sydor, Anna, Bundy, Edna ORCID: https://orcid.org/0000-0002-5981-3984, Pickles, Timothy ORCID: https://orcid.org/0000-0001-7743-0234, Pattinson, Rachael ORCID: https://orcid.org/0000-0002-3145-3710, Hewitt, Rachael, Temeng, Eunice and Kyle, Richard 2023. The ASSISTANCE STUDY: Moral distress and psychological wellbeing of nurses during the COVID-19 pandemic. Presented at: Royal College of Nursing International Nursing Research Conference, Manchester University, 6-8 September 2023.

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Abstract

Abstract Background: Moral distress is the psychological distress felt when confronted with adverse situations that undermine personal and professional values and integrity. Responding to the COVID-19 pandemic potentially magnified moral distress among nurses. However, few studies have explored moral distress prevalence and its association with psychological wellbeing in the nursing workforce during the COVID-19 pandemic. Aim: Toassesstheprevalenceofmoraldistressandassociationswithpsychologicalwellbeinginregisteredand student nurses during the COVID-19 pandemic. Methods: Cross-sectional anonymous online survey of registered and student nurses in Wales, recruited through social media between November 2021 and April 2022. The survey comprised the Measure of Moral Distress for Health Professionals [1] (MMD-HP), Patient Health Questionnaire, General Anxiety Disorder Ques tionnaire and the International Trauma Questionnaire, socio-demographic questions, and free text comments. Linear regression assessed associations between moral distress and psychological wellbeing measures. Frame work analysis was used for qualitative comments. Results: All participants (n=278) experienced moral distress. The average MMD-HP score was 99.48 (SD 85.89). Seventy-two percent experienced mild to moderatedepression, 70%mildtomoderateanxiety, and20%metthe post-traumatic stress disorder criteria. High moral distress scores were associated with redeployment, two-six years of nursing experience, directly exposed to people with COVID-19, and intention to leave the workforce. Depression scores were significantly associated with levels of moral distress. Qualitative analysis identified five themes: interplay between trauma experienced at home and work; unhealthy coping strategies; feeling unprepared and unsupported; planned changes to roles or careers; and renewed commitment to the nursing profession. Discussion and conclusions: Appropriate interventions are needed to support the psychological wellbeing of the nursing workforce in COVID-19 recovery. Trauma-informed approaches that recognise the interplay between pandemic experiences at home and work are especially needed to help prepare nurses and nursing students for future crises and prevent premature workforce exit.

Item Type:	Conference or Workshop Item - unpublished
Status:	Unpublished
Schools:	Schools > Dentistry Schools > Healthcare Sciences
Funders:	Burdett Trust for Nursing
Projects:	ASSISTANCE
Last Modified:	16 Sep 2026 15:58
URI:	https://orca.cardiff.ac.uk/id/eprint/163145

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