Education and Ethics In Nursing ISSN: 2322-5300

Moral Distress among Nursing Students: A Silent Crisis in Clinical Education Settings

10.22034/ethic.2026.2086914.1229
Volume 15, Issue 2
June 2026
Education and Ethics In Nursing ISSN: 2322-5300

Document Type : Letter

Authors

Farangis Rajabi 1
Matin Hossein Fakhrabadi 2
Mobina Hossein Fakhrabadi 3

1 Master of Medical Education, Research Vice-Chancellor, Hasheminejad Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Master of Science Student, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3 Instructor, school of nursing and midwifery, North khorasan university of medical sciences, Bojnurd, Iran.

Abstract
Moral distress refers to a situation in which an individual recognizes the ethically appropriate action but is unable to perform it due to structural, organizational, or power constraints. Beyond clinical nurses, it has also been reported among nursing students: international studies describe moderate to high levels, while Iranian studies of nursing and other health-profession students report low to moderate levels. During clinical placements, students encounter situations that conflict with their professional values, such as witnessing unsafe care or disregard for patient dignity, yet owing to their low position in the clinical hierarchy and fear of consequences they often remain silent. Evidence links moral distress in nursing students to intention to leave the programme, depression and suicide risk. To address this, nursing education should integrate scenario-based ethics education, organize guided reflection sessions after clinical placements, empower clinical instructors to identify and manage moral distress, include ethical judgment and responsible reporting in assessment, and systematically monitor moral distress with validated instruments.

Keywords

Moral distress
Nursing students
Clinical education
Ethics education
Subjects
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