Abstract

Moral distress is a significant psychological challenge among intensive care unit (ICU) nurses, often arising when they are unable to act according to their ethical values due to organizational or external constraints. This distress can negatively influence job satisfaction, which is a critical factor affecting nurse retention, performance, and quality of patient care. Self-awareness has been proposed as a key psychological factor that may mitigate the adverse effects of moral distress. Therefore, this literature review aimed to examine the mediating role of self-awareness in the relationship between moral distress and job satisfaction among ICU nurses.

A comprehensive search was conducted across PubMed, CINAHL, PsycINFO, and Google Scholar databases for studies published between 2019 and 2024. A total of 1,042 articles were initially identified, with 10 studies meeting the inclusion criteria after screening and full-text review. The findings indicate that moral distress is highly prevalent among ICU nurses and is associated with burnout, emotional exhaustion, and decreased job satisfaction. Job satisfaction, influenced by both intrinsic and extrinsic factors, plays a vital role in improving nurses’ well-being and reducing turnover intentions.

Importantly, self-awareness emerged as a significant mediating factor that helps nurses cope with ethically challenging situations by enhancing emotional regulation, resilience, and alignment between personal and professional values. Nurses with higher levels of self-awareness demonstrated lower levels of moral distress and higher job satisfaction. Interventions such as reflective practices and debriefing sessions were found to strengthen self-awareness and improve coping mechanisms.

In conclusion, self-awareness plays a crucial role in buffering the negative effects of moral distress on job satisfaction among ICU nurses. Promoting self-awareness through targeted interventions may enhance nurse well-being, improve job satisfaction, and ultimately contribute to better patient care outcomes and healthcare system sustainability.

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