Influencing factors of moral distress among dementia nursing staff: A systematic review

Purposes The aim of this study was to deeply explore and elucidate the factors that trigger moral distress in dementia nursing staff based on society ecosystems theory (SET), to provide a theoretical basis for alleviating the experience and severity of moral distress among dementia nursing staff. Methods This study was a mixed-methods systematic review that searched eight electronic databases, including PubMed, Web of Science, EMBASE, CINAHL, PsycINFO, EBSCO, Cochrane, and Scopus. And we searched the literature from 1984 until June 2025. Studies were selected based on predetermined inclusion and exclusion criteria, focusing on factors that contribute to moral distress in dementia nursing staff. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT), and data were analyzed and synthesized to extract relevant themes. Findings The study identified 21 studies that categorized factors contributing to moral distress as macro (nursing staff prevalent issues, dementia nursing staff specific issues), mezzo (relationships with others, caregiving conflicts), and micro (individual differences, conflicting values, psychological imbalances, or feelings of distress). Conclusions Moral distress among dementia nursing staff is driven by dementia symptoms, artificial nutritional issues, resource constraints, and caregiving conflicts. Synergistic interventions can be made at the micro, mezzo, and macro levels. However, systematic interventions for dementia nursing staff are currently inadequate, and effective and sustainable interventions need to be developed in clinical practice in the future.