Abstract
This study investigated the prevalence and intensity of moral distress among family health workers in Istanbul during the COVID-19 pandemic, as well as its association with the perceived ethical climate within family health centers. This descriptive, cross-sectional study was conducted in Istanbul between November 2021 and June 2022. Using Turkish versions of the "Measure of Moral Distress for Healthcare Professionals" and "Hospital Ethical Climate Survey-Shortened" scales, data were collected from three districts with the highest and three with the lowest mortality rates due to infectious diseases (n = 135 each). Mortality rates were based on deaths from infectious diseases, largely reflecting COVID-19-related mortality. The sample included 270 healthcare workers (77.4% women, mean age 39.92 ± 9.19 years; 44.9% family physicians, 26.6% midwives, 25.5% nurses). Participants in high-mortality districts reported significantly higher moral distress (p < 0.05). Family physicians exhibited greater moral distress and a poorer perception of the ethical climate compared with other staff (p < 0.05). Additionally, those experiencing the highest moral distress reported the lowest ethical climate scores. The results underscore the need for interventions to prevent moral distress, particularly among family physicians, during extraordinary situations. Ethical guidelines for primary care in such contexts are anticipated to enhance healthcare worker well-being and improve patient care quality.