Moral Distress among Healthcare Workers in Paediatric Intensive Care Units in Sri Lanka: A Cross-Sectional Study

Background: When institutional or contextual limitations prevent healthcare professionals from acting in accordance with their ethical values, moral distress results. Due to difficult moral choices, emotional demands, and scarce resources, paediatric intensive care units (PICUs) are especially susceptible to moral distress. There is still a dearth of data from low- and middle-income nations like Sri Lanka.
Objectives: To find out how common moral distress is among healthcare professionals in PICUs in Sri Lanka and how it relates to their professional quality of life.
Methods: From April to October 2025, physicians, nurses, and physiotherapists with at least six months of PICU experience participated in a descriptive cross-sectional study. A self-administered questionnaire comprising sociodemographic and work-related variables, the Professional Quality of Life Scale (ProQOL-5), and the Moral Distress Scale–Revised (MDS-R) was used to gather data. SPSS version 24 was used to analyse the data, and p < 0.05 was chosen as the statistical significance level.
Results: A total of 306 healthcare professionals (mean age 39.99 ± 7.10 years), mostly nurses (80.1%) and women (91.1%), took part. Mild moral distress was indicated by the mean moral distress score of 21.44 ± 7.76. The majority of participants reported low levels of burnout (86%) and secondary traumatic stress (86%), as well as average compassion satisfaction (70%). Burnout, secondary traumatic stress, compassion satisfaction, and professional or demographic traits did not significantly correlate with moral distress. On the other hand, there was a significant correlation (p = 0.008) between increased secondary traumatic stress and longer weekly working hours. There were very few opportunities for structured debriefings (4.0%) and ethics training (2.6%).
Conclusion: Healthcare professionals in Sri Lankan PICUs have a generally positive professional quality of life despite experiencing mild moral distress. Employee well-being may be further improved by bolstering institutional support through workload management, debriefing procedures, and ethics education.