Predictive Role of Moral Injury and Burnout in Professional Communication: A Cross-Sectional Study Among Operating Room Nurses.

AIM(S): This study examined the association of moral injury and burnout with professional communication among operating room (OR) nurses in Southern Iran.

BACKGROUND

Effective professional communication is essential for surgical teamwork and patient safety. However, limited context-specific evidence is available on how moral injury and burnout are jointly associated with the quality of professional communication among OR nurses. Addressing this gap may help inform strategies to improve staff well-being, team functioning, and patient safety in high-stakes perioperative settings.

METHODS

A cross-sectional analytical study was conducted between March and May 2025. A total of 307 OR nurses were recruited from six tertiary referral hospitals in Shiraz, Iran. Data were collected using a demographic questionnaire, the Moral Injury Symptom Scale-Healthcare Professionals (MISS-HP), the Operating Room Nurses' Burnout Questionnaire, and the Professional Communication Questionnaire for Operating Room Personnel. Data were analyzed using descriptive and inferential statistics.

RESULTS

Moral injury was significantly and positively correlated with burnout. In the multivariate regression model, moral injury was positively associated with professional communication, whereas burnout showed a negative association.

CONCLUSION

Moral injury and burnout were associated with professional communication among OR nurses. While burnout was negatively associated with communication, the unexpected positive adjusted association between moral injury and professional communication should be interpreted cautiously and may reflect ethically motivated communication, moral sensitivity, or professional advocacy rather than a beneficial effect of moral injury itself.

IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should consider integrated strategies to reduce burnout, support nurses facing morally challenging situations, and strengthen professional communication within surgical teams. Practical approaches may include workload monitoring, fair shift allocation, moral resilience training, ethics debriefing, supportive supervision, and team-based communication training. Such interventions may help promote nurses' psychological well-being while supporting safer and more effective communication in OR settings.