A network analysis of moral distress among clinical internship nursing students: A cross-sectional study

BackgroundMoral distress is a significant challenge faced by clinical internship nursing students. Most current studies investigate the impact of external factors on nursing students' moral distress. However, there is a lack of in-depth exploration of the interactions between various moral distress items.Research objectiveThis study aims to construct a network structure of moral distress among clinical internship nursing students, while exploring the touchpoints of moral sensitivity and moral resilience on moral distress, to identify potential targets for moral distress intervention.Research designA cross-sectional design utilized acceptable validity scales. Network analysis was conducted using R (Version 4.4.0). Regularized partial correlation was utilized to describe the associations between different nodes in the network. Central nodes were identified through centrality indices.Participants and research contextThe participants in this study are 372 nursing students undergoing clinical internships at a comprehensive teaching hospital in Changsha, China.Ethical considerationsThis study was approved by the hospital ethics committee (Review Number: Express 241098). Written informed consent was obtained from all participants.ResultsIn the moral distress network, the connections between MD3 "I provide life-sustaining treatment per the family's wishes" and MD4 "Despite only extending survival, I implement life-saving measures" are the strongest. MD18 "Decline in service quality due to poor team communication," MD19 "I ignore situations lacking adequate information for informed consent," and MD17 "I collaborate with colleagues unable to meet the patient's treatment needs" are the central nodes of the moral distress network. In the relational network, MD19 is a critical connection point linking moral distress with moral sensitivity and moral resilience.ConclusionFuture interventions for moral distress could focus on the strongly related and significant distress (MD3, MD4, MD18, MD19, MD20, and MD17) mentioned in this study, and develop scientific and targeted interventions to reduce clinical internship nursing students' moral distress.