Appl Nurs Res. 2026 Apr;88:152065. doi: 10.1016/j.apnr.2026.152065. Epub 2026 Feb 5.
ABSTRACT
BACKGROUND: Moral distress is increasingly recognized as a critical challenge in critical care settings, where nurses frequently encounter ethically complex situations that can undermine their moral integrity. With the growing adoption of artificial intelligence (AI) in clinical decision-making, there is a need to understand whether AI integration may help mitigate the ethical burden experienced by nurses.
AIM: This study aims to examine the relationship between moral distress and moral integrity and investigate the mediating role of AI integration in this association.
METHODS: A cross-sectional correlation design was employed among 250 ICU nurses recruited from three private hospitals. Data was collected using three structured questionnaires. Descriptive statistics, Pearson correlations, multiple regression, and structural equation modeling (SEM) were used to examine direct and indirect effects.
RESULTS: Moral distress was negatively associated with both AI integration (r = -0.42, p < 0.01) and moral integrity (r = -0.56, p < 0.01), while AI integration demonstrated a positive association with moral integrity (r = 0.48, p < 0.01). The regression model explained 48% of the variance in moral integrity. SEM results indicated that AI integration partially mediated the association between moral distress and moral integrity (indirect β = -0.16, p < 0.001).
CONCLUSION: Moral distress significantly undermines nurses’ moral integrity, yet AI integration provides a partial protective effect by enhancing ethical clarity and decision support. While AI cannot fully offset the impact of chronic moral strain, it represents a promising tool to strengthen ethical practice in critical care environments.
PMID:41826035 | DOI:10.1016/j.apnr.2026.152065
