Moral Distress and Associated Factors among Nurses Working in Public Hospitals in West Arsi Zone, Ethiopia, 2023

Background Moral distress is a psychological response experienced by nurses when they are prevented from acting according to their ethical beliefs due to internal or institutional constraints. Although moral distress is widely studied in high-income countries, limited evidence exists regarding its prevalence and associated factors in low-resource settings such as Ethiopia. Objective To assess the prevalence and associated factors of moral distress among nurses working in public hospitals of the West Arsi Zone, southeast Ethiopia, in 2023. Methods An institutional-based cross-sectional study was conducted from February 13 to March 2, 2023, among 349 nurses randomly selected from four public hospitals. Data were collected using a structured, self-administered questionnaire incorporating the Moral Distress Scale–Revised (MDS-R) and tools assessing personal and environmental factors. Data were analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with high levels of moral distress. Statistical significance was determined at p < 0.05 with 95% confidence intervals (CI). Results Of the 349 respondents (98.5% response rate), 73.1% reported high moral distress. Male nurses were less likely to report high distress compared to females [AOR = 0.46; 95% CI: 0.27, 0.91]. Nurses who were dissatisfied with their jobs had nearly eight times greater odds of experiencing high moral distress [AOR = 7.67; 95% CI: 3.08, 19.12]. Similarly, nurses working in unfavorable environments had significantly higher odds of moral distress [AOR = 4.07; 95% CI: 1.92, 8.65]. Conclusion Moral distress among nurses in West Arsi Zone public hospitals is alarmingly high. Key contributing factors include female gender, job dissatisfaction, and an unfavorable working environment. Interventions focusing on improving job satisfaction and working conditions are urgently recommended.