Influencing factors of moral distress among dementia nursing staff: A systematic review.

This systematic review investigates the factors contributing to moral distress among dementia nursing staff using society ecosystems theory (SET), which categorizes influences into macro, mezzo, and micro levels. The review synthesizes 21 studies from developed countries, identifying macro-level issues such as institutional constraints, resource shortages, and dementia-specific challenges (e.g., managing symptoms, artificial nutrition, and restraints); mezzo-level factors including interpersonal conflicts and caregiving disagreements; and micro-level factors like individual differences, value conflicts, and psychological distress. The findings highlight that moral distress in dementia care is a chronic, multifaceted phenomenon shaped by the disease's characteristics and systemic factors, underscoring the need for integrated interventions across individual, organizational, and policy domains. The study calls for development of targeted ethical support systems, standardized assessment tools, and improved resource allocation to alleviate moral distress in this specialized nursing population.