Number

Moral distress frequency

Moral distress intensity

Mean ( $\overline{X}$ ± s)

rank

Mean ( $\overline{X}$ ± s)

rank

1

Inability to provide optimal care to patients due to health care policies or pressure from patients to reduce the cost of treatment.

1.29 ±  0.99

7

1.38 ±  0.96

6

2

Witness medical staff offering “false hope” to patients

0.71 ±  0.85

17

0.80 ±  0.90

19

3

Even though I don’t think that is in the best interest of the patient, I still provide life support treatment to the patient in accordance with the family’s wishes.

1.74 ±  1.07

2

1.63 ±  0.93

3

4

I administer life-saving treatments to patients even when I know the outcome will only prolong their lives.

2.43 ±  1.11

1

1.99 ±  1.05

1

5

Comply with the family’s request to not discuss death with the terminally ill patient when they ask about it.

1.31 ±  1.09

5

1.35 ±  1.05

7

6

Follow doctor’s orders for tests or treatments that I consider unnecessary for the patient.

1.20 ±  0.99

9

1.26 ±  1.00

10

7

When no one makes a decision to discontinue treatment, treatment is continued for patients who are hopelessly dependent on ventilators to keep them alive.

1.67 ±  1.19

3

1.55 ±  1.11

4

8

When I discover that a physician or nursing colleague has made a medical error and not reported it, I let it go.

0.65 ± 0.85

20

0.83 ±  1.03

18

9

Assist physicians who I believe are not competent to do their job.

1.30 ±  1.03

6

1.41 ±  1.08

5

10

Was assigned to care for patients I felt I could not care for.

0.90 ±  0.88

14

1.02 ± 1.01

15

11

Witness doctors performing painful procedures on patients simply to improve their skills.

0.71 ±  0.88

16

1.82 ±  1.01

2

12

Providing patients with care that does not relieve pain because physicians fear that increasing the dose of analgesics will cause the patient to die.

0.78 ±  0.90

15

0.85 ±  0.96

16

13

Follow the physician’s request to not talk to the patient or family about their prognosis.

1.13 ±  1.01

10

1.08 ±  0.96

14

14

Increasing the dose of paroxysmal hypnotics in comatose patients, even though I think it may hasten the patient’s death.

0.53 ±  0.82

21

0.72 ±  1.01

21

15

Comply with requests from involved health care professionals or leaders to ignore ethical issues identified.

0.57 ±  0.82

22

0.70 ±  0.96

22

16

Although I did not agree with the family’s decision, I complied with the family’s wishes for the patient’s care to avoid medical disputes.

1.23 ±  0.99

8

1.34 ±  1.03

9

17

Work with colleagues who are unable to meet the treatment needs of their patients.

1.08 ±  0.91

11

1.22 ±  1.03

11

18

Witnessed a decline in the quality of medical care due to poor communication among colleagues.

1.08 ±  0.86

12

1.20 ±  0.98

12

19

I turned a blind eye to the failure to provide adequate information in securing informed consent from patients.

0.68 ±  0.83

19

0.80 ±  0.92

20

20

Witness the suffering of patients due to interruptions in the continuity of care by medical staff.

0.71 ±  0.81

18

0.84 ±  0.96

17

21

Work with colleagues who I believe are not up to par professionally.

1.02 ±  0.88

13

1.19 ±  1.03

13

22

Comply with family requests to conceal medical conditions from terminally ill or cancer patients.

1.54 ±  1.11

4

1.35 ±  1.04

8

All items

1.01 ±   0.53

1.19 ±  0.61