Abstract
OBJECTIVE: Nurses frequently experienced moral distress during the COVID-19 pandemic. Moral distress can lead to negative mental health outcomes, such as depression and suicidal ideation, but the mechanisms underlying these relationships are not well understood. The current study examined whether guilt and shame resulting from morally distressing events mediate the relationships between moral distress and depression symptoms/suicidal ideation during the COVID-19 pandemic. METHODS: Registered nurses (N = 96) who directly cared for COVID-19 patients completed self-report assessments at two time points over 3 months between May and November 2021. RESULTS: Time 1 guilt (OR = 1.39, p = 0.03) mediated the relationship between Time 1 moral distress and Time 2 suicidal ideation, controlling for Time 1 suicidal ideation. By contrast, Time 1 shame was not a significant mediator (OR = 0.84, p = 0.40). Neither guilt (B = 0.03, p = 0.75) nor shame (B = -0.05, p = 0.59) at Time 1 mediated the relationship between Time 1 moral distress and Time 2 depression symptoms, controlling for Time 1 depression symptoms. However, there was a significant direct effect of Time 1 moral distress on Time 2 depression symptoms (B = 0.20, p = 0.03) in this model. CONCLUSIONS: Our findings suggest the importance of educating the nursing workforce on the psychological consequences of workplace moral distress. Intervening on feelings of guilt may reduce suicidal ideation in nurses endorsing moral distress.