# The relationship between moral distress and occupational burnout among ICU nurses: social support and psychological resilience as mediating variables

## TL;DR

This study explores how social support and psychological resilience affect the link between moral distress and burnout in ICU nurses.

## Contribution

The study identifies both independent and chain-mediated roles of social support and psychological resilience in moral distress-related burnout.

## Key findings

- Moral distress is strongly linked to occupational burnout, partially mediated by social support and psychological resilience.
- Social support alone mediates 42.82% of the effect of moral distress on burnout.
- Combined mediation of social support and psychological resilience accounts for 15.79% of the total effect.

## Abstract

ICU nurses are prone to occupational burnout due to high workloads and emotional exhaustion. Moral distress exacerbates this issue, though the precise mechanisms remain unclear.

This study aims to examine the mediating role of social support and psychological resilience in the relationship between moral distress and occupational burnout among ICU nurses.

A cross-sectional survey was conducted from October to November 2024 among 233 ICU nurses from intensive care units in multiple tertiary hospitals in China. The survey instruments included a general demographic questionnaire, MD-APPS, PSSS, CD-RISC, and MBI. Descriptive analysis and Pearson correlation analysis were performed using SPSS 27.0. Structural equation modeling was conducted using R 4.4.3 software.

Moral distress was negatively correlated with social support (r = −0.765, p < 0.05) and psychological resilience (r = −0.661, p < 0.05), and positively correlated with emotional exhaustion (r = 0.714), depersonalization (r = 0.737), and reduced personal accomplishment (r = 0.706, all p < 0.05). The structural equation model demonstrated good fit (χ2/df = 2.446, CFI = 0.972, TLI = 0.960, RMSEA = 0.079). Moral distress had a significant direct effect on occupational burnout (β = 0.380, p < 0.05). Social support independently mediated this relationship (β = 0.573, 95% CI: 0.320–0.827), accounting for 42.82% of the total effect. Psychological resilience independently mediated the relationship (β = 0.174, 95% CI: 0.013–0.335), accounting for 13.01% of the total effect. The chain mediating effect of social support and psychological resilience was significant (β = 0.211, 95% CI: 0.055–0.368), accounting for 15.79% of the total effect. The total indirect effect accounted for 71.62% of the total effect.

Social support and psychological resilience play both independent and chain-mediated roles in the relationship between moral distress and occupational burnout among ICU nurses. Healthcare managers should prioritize addressing moral distress and establishing comprehensive support systems to enhance social support and psychological resilience, thereby reducing occupational burnout.