Interventions to Address Moral Distress in Nurses and Other Healthcare Professionals: A Scoping Review and Evidence Gap Map

Abstract

Highlights What are the main findings? Interventions, intended to influence the moral-distress cluster on education and on ethics deliberation or consultation, are delivered predominantly to individuals and teams, and act around the moral event or downstream of it. Only one of 32 studies intervened preventively at the source of moral distress, and only five operated at the organisation or system level. What are the implications of the main findings? The empty regions of the evidence gap map identify where interventions have not yet been evaluated, rather than where they have been shown to fail. Future evaluations should be directed at the source of moral distress and at the organisational level, and should adopt validated measures and designs capable of controlling confounding. Abstract Background/Objectives: To map interventions intended to influence moral distress in nurses and other healthcare professionals by intervention modality, organisational level, and point of action in the moral-distress process, and to appraise the methodological quality of the underlying studies. Methods: Scoping review with an evidence gap map, reported in accordance with the PRISMA Extension for Scoping Reviews. PubMed, Ovid (MEDLINE, Embase, Cochrane CENTRAL and the Cochrane Database of Systematic Reviews), CINAHL and the Web of Science Core Collection were searched without language, date or publication-status restrictions (databases searched to 13 July 2026), supplemented by forward and backward citation searching. Records were screened, charted and coded independently by two reviewers (coding kappa 0.75 to 0.84 by dimension). Charting used best-fit framework synthesis, and methodological quality was appraised with the Mixed Methods Appraisal Tool 2018 at the item level. Findings were synthesised descriptively through frequency counts and cross-tabulation and displayed as an evidence gap map. Results: Thirty-two studies were included, most from the United States (20 of 32). Interventions clustered on education (13 of 32) and ethics deliberation or consultation (9 of 32), were delivered predominantly at the individual or team level (27 of 32), and acted around the moral event (24 of 32) or downstream of it (7 of 32); only one intervened at the source. A direct moral-distress measure was used in 24 of 32 studies, and the fourth, design-specific appraisal criterion was clearly met in only 2 of 32. Conclusions: The field acts around and after the moral event but rarely at its source or at the organisational level. Source-directed and organisational interventions and validated measurement, are the priorities for future research.