Moral Distress Among Healthcare Providers: An Umbrella Review

Background Moral distress among healthcare providers is a pervasive issue with significant implications for individual well-being, patient care, and organizational outcomes. This umbrella review synthesizes evidence from systematic reviews and meta-analyses to examine the prevalence, causes, consequences, and variations of moral distress worldwide, highlighting its impact on healthcare professionals and patient care. Methods Following JBI methodology and PRISMA guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar up to March 10, 2025, using keyword combinations such as "moral distress" AND "healthcare providers" AND "systematic review." Eligible studies included systematic reviews (with or without meta-analysis) and scoping reviews focusing on healthcare providers, published in English. Methodological quality was assessed using the JBI Critical Appraisal Checklist. Due to heterogeneity and the predominance of qualitative data, a narrative synthesis was conducted. Results From 435 identified articles, 21 systematic reviews published between 2009 and 2025 were included, covering nurses (predominantly), physicians, midwives, and other healthcare roles globally. Moral distress varied by country, with notable severity in Iran (e.g., mean intensity 2.23-3.43), Canada (mean 91.99 in Intensive care unit (ICU)), and the USA (mean 52.54 in ICU). ICU nurses (23.8% of studies) reported moderate to high distress, primarily due to futile care and staffing shortages, while oncology and emergency department nurses exhibited lower but significant distress levels. Identified causes included organizational factors, situational triggers, interpersonal conflicts, and individual factors. The COVID-19 pandemic intensified distress in critical care settings, despite an overall global decline (pooled mean = 2.55). Conclusions Moral distress is a multifaceted challenge influenced by role, setting, and systemic factors, with significant variation across countries and specialties. Targeted interventions, including organizational support and ethical training, are critical to mitigating its impact on healthcare providers and care quality. Future research should address gaps in non-nurse populations and standardize measurement approaches.