Moral injury and influencing factors among palliative care nurses : a cross-sectional study.

BACKGROUND

Moral injury has emerged as an important ethical and psychosocial concern in healthcare. Palliative care nurses frequently encounter ethically challenging situations and sustained emotional demands, yet evidence on the extent of moral injury and its associated factors remains limited.

METHODS

A cross-sectional, descriptive and correlational survey. Convenience sampling was used to recruit palliative care nurses working in palliative care services in Anhui and Jiangsu provinces, China, between December 2025 and February 2026. Participants completed a demographic/work-related questionnaire, the Moral Injury Symptom Scale–Health Professional (MISS-HP), and the Emotional Labor Scale. Data were analysed using t-tests/ANOVA, Pearson correlation, and stepwise multiple linear regression.

RESULTS

Of 361 nurses approached, 349 provided valid responses (96.7%). The mean MISS-HP total score was 48.96 ± 17.35, suggesting that moral injury scores among palliative care nurses were relatively elevated. In the multivariable model (adjusted R²=0.386), higher moral injury was associated with being male, being unmarried, having a higher education level, experiencing major ethical dilemmas more frequently in the past year, lower perceived support from leaders/colleagues, and higher emotional labour (all p < 0.05).

CONCLUSION

The findings suggest that moral injury symptoms among palliative care nurses were relatively elevated. Emotional labour was positively correlated with moral injury, indicating that nurses with higher emotional labour tended to report greater moral injury symptoms. In addition, demographic characteristics and work-related factors, including gender, marital status, educational attainment, frequency of major ethical dilemmas, and perceived organisational support, were significantly associated with moral injury. These findings highlight the importance of strengthening organisational support and developing strategies to manage emotional labour in order to mitigate moral injury and support nurses’ well-being.