Moral Distress, Self-Compassion, and Professional Quality of Life Among Icu Nurses: A Cross-Sectional Study in Northern Iran Publisher



Deylampasha M ; Jafari H ; Ahmadzadeh Zeidi M J ; Sharif Nia H ; Shafipour V
Source: BMC Nursing Published:2026

Abstract

Background and aim: ICU nurses are highly exposed to moral distress due to heavy workload and ethical challenges, which may lead to burnout and reduced quality of care. Self-compassion, as a positive psychological resource, can improve resilience and mental health, while professional quality of life plays a key role in nurses’ performance and commitment. This study aimed to investigate the relationship between Moral Distress, Self-Compassion, and Professional Quality of Life among ICU Nurses in Northern Iran. Materials & methods: This cross-sectional study involved 200 nurses working in intensive care units of four teaching hospitals in northern Iran. All eligible nurses were selected through a census method. Data were gathered using four tools: a demographic checklist, the Hamric Moral Distress Scale, the Stamm Professional Quality of Life Questionnaire, and the Neff Self-Compassion Scale. Data were analyzed in SPSS version 26 using descriptive statistics and inferential tests, including Pearson correlation, independent t-test, ANOVA, and multiple linear regression. Results: The mean age of the nurses was 37.36 ± 9.52 years, with most being female (80%) and married (66%). The means and standard deviation of moral distress, self-compassion, compassion satisfaction, burnout, and secondary traumatic stress were 88.70 (52.32), 81.74 (8.33), 33.27 (7.32), 27.93 (5.63), and 25.61 (6.62), respectively. Compassion satisfaction, burnout, and secondary traumatic stress were statistically correlated with moral distress (r = − 0.32, r = 0.38, r = 0.29; p < 0.01) and self-compassion (r = 0.32, r = − 0.29, r = − 0.36; p < 0.01). Moral distress predicted lower compassion satisfaction and higher burnout and secondary traumatic stress, whereas self-compassion showed opposite effects. The models explained 36–42% of the variance in professional quality of life (R² = 0.36–0.42). Conclusion: The findings indicate that moral distress is a significant predictor of poorer professional quality of life among ICU nurses, contributing to lower compassion satisfaction and higher burnout and secondary traumatic stress. In contrast, self-compassion acts as a protective factor that enhances compassion satisfaction and mitigates adverse psychological outcomes. Therefore, integrated strategies targeting both organizational stressors and individual psychological resources are essential to promote nurses’ well-being and improve the quality of care in critical care settings. Clinical trial number: not applicable. © The Author(s) 2026.