Vol. 2, Issue 2, Part A (2025)

Background: Mental health nurses working in high-risk psychiatric units frequently encounter ethically challenging situations, such as the use of coercive measures, conflicting care directives, and patient safety concerns. These challenges often lead to moral distress a psychological state arising when nurses know the ethically appropriate action but are constrained from acting upon it. Objective: This study aimed to assess the prevalence and intensity of moral distress among mental health nurses working in high-risk psychiatric units and to identify organizational and individual factors influencing its severity. Methods: A cross-sectional descriptive study was conducted among 180 registered mental health nurses employed in acute, forensic, and crisis psychiatric units. Data were collected using a structured demographic questionnaire and the Moral Distress Scale-Revised (MDS-R). Descriptive statistics were used to summarize participant characteristics, and inferential analyses (ANOVA and t-tests) were applied to examine group differences. Multiple regression was used to identify predictors of moral distress. Results: Forensic and crisis unit nurses demonstrated significantly higher moral distress scores compared to those in acute units. A right-skewed distribution indicated that a substantial subset of nurses experienced high levels of moral distress. Perceived organizational ethics support was inversely associated with moral distress levels, with nurses reporting stronger ethical support demonstrating significantly lower MDS-R scores. Experience showed a modest protective effect, suggesting that professional maturity contributes to ethical resilience. Conclusion: Moral distress is a prevalent and impactful issue in high-risk psychiatric units, shaped by organizational factors as much as individual experience. Strengthening ethics consultation services, reflective practice opportunities, and supportive leadership structures can help mitigate moral distress and its consequences. Implementing structured ethics support and promoting an ethical workplace culture are essential steps toward sustaining the mental health nursing workforce and improving patient care quality.