The Effect of a Grand Rounds-Based Empowerment Program on Moral Distress Among Nurses in Intensive Care Units: A Quasi-Experimental Study
| Author | Alireza Salar | en |
| Author | Saeideh Varasteh | en |
| Author | Mehdi Rezvaniamin | en |
| Author | Zahra Pournamdar | en |
| Orcid | Alireza Salar [0000-0002-5280-0283] | en |
| Orcid | Saeideh Varasteh [0000-0002-2088-0178] | en |
| Orcid | Mehdi Rezvaniamin [0000-0003-4951-7767] | en |
| Orcid | Zahra Pournamdar [0000-0001-9859-0106] | en |
| Issued Date | 2026-06-30 | en |
| Abstract | Background: Moral distress is prevalent among intensive care unit (ICU) nurses and can adversely affect both their well-being and the quality of patient care. Objectives: To address the need for strategies to help nurses manage moral distress, this study examined the effect of a grand rounds-based empowerment program on moral distress among nurses working in ICUs. Methods: This quasi-experimental, two-group, pretest–posttest study was conducted from March 2024 to April 2025 in the ICUs of two teaching hospitals in Zahedan, Iran. To minimize contamination, the intervention and control groups were recruited from separate hospitals; the intervention hospital was selected using a simple random procedure (a die roll). Convenience sampling was used in each hospital, and 62 nurses were enrolled. The intervention group attended six face-to-face, group-based grand rounds sessions (two per week, 30 minutes each) at the ICU nursing station. Moral distress was assessed using the Moral Distress Scale-Revised (MDS-R) at baseline and at three follow-up time points (immediately, 2 weeks, and 1 month after the intervention). The control group received no educational intervention during the study period. Data were analyzed using SPSS version 25, with P < 0.05 considered statistically significant. Results: In the intervention group, mean moral distress decreased from 2.80 ± 1.92 at baseline to 2.28 ± 1.31 at 1 month. Between-group differences at each time point were not statistically significant (all P > 0.05), and the time-by-group interaction was not significant (P = 0.54). Within the intervention group, pairwise comparisons showed significant reductions from baseline to 1 month (P = 0.05) and from 2 weeks to 1 month (P = 0.03). The between-group mean differences (intervention minus control) were -0.07 (95% CI: -1.08 to 0.95) at baseline, -0.10 (95% CI: -1.09 to 0.90) immediately after the intervention, -0.19 (95% CI: -1.01 to 0.63) at 2 weeks, and -0.49 (95% CI: -1.30 to 0.32) at 1 month. Within the intervention group, the mean change from baseline to 1 month was -0.52 (95% CI: -1.03 to -0.01). Conclusions: Although no significant between-group differences or time-by-group interactions were observed, the gradual reduction in moral distress in the intervention group suggests a potential benefit of the grand rounds-based empowerment program. Given the multifactorial and context-dependent nature of moral distress, future randomized studies with larger samples and longer follow-up periods are needed to clarify these findings. | en |
| DOI | https://doi.org/10.5812/jnms-167650 | en |
| Keyword | Moral Distress | en |
| Keyword | Nurses | en |
| Keyword | Intensive Care Units | en |
| Keyword | In-service Training | en |
| Keyword | Empowerment | en |
| Publisher | Brieflands | en |
| Title | The Effect of a Grand Rounds-Based Empowerment Program on Moral Distress Among Nurses in Intensive Care Units: A Quasi-Experimental Study | en |
| Type | Research Article | en |
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