Journal of Preventive Medicine

Introduction
On December 31, 2019, a new coronavirus (COVID-19) was emerged and spread rapidly around the world and negatively affected the public health and led to job loss, isolation, death. The results of a review study showed that the prevalence of anxiety during the COVID-19 pandemic in the general population is 19-27%. Mental health problems in nurses can negatively affect the quality of patient care. Moral distress can affect nurses’ mental health and work motivation. Some studies have identified moral distress as a potentially harmful factor in reducing work motivation, increasing job burnout, and the risk of psychological disorders. Moral distress is one of the challenges in the nursing profession and is known as a phenomenon that hinders the correct moral performance of people. This study was aims to determine the level of moral distress and general health status of nurses working in hospitals in Shushtar, Iran, during the COVID-19 pandemic.

Methods
This is a descriptive/correlational study. Participants were 120 nurses working in hospitals affiliated to Shushtar University of Medical Sciences and were in direct contact with COVID-19 patients in 2020. The data collection tools included a demographic form (surveying age, gender, marital status, work experience, employment status, type of work shift, average working hours per week), the 18-item moral distress scale - revised, and the 28-item general health questionnaire.

Results
Of 120 nurses, 97(80.8%) were female and the rest were male. It was found that 54(45%) nurses had a high level of moral distress. The general health level of 57 people (47%) was at a moderate level and the mean score was 48.08±17.13. In this study, nurses also reported symptoms of depression. There was no significant relationship between moral distress and general health (P=0.93) and demographic variables had no significant effect on the level of moral distress and general health.

Conclusion
The present study showed that during the COVID-19 pandemic, nurses in Shushtar experienced a high level of moral distress and their general health was at a moderate level. The moral distress of nurses has no significant relationship with their general health. Holding continuous educational courses can help improve general health, control stress and meet psychological needs in nurses, in addition to reducing their job pressure and moral distress, which can lead to better patient care. It is recommended to conduct more studies in this field.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Shushtar Faculty of Medical Sciences (Code: IR.SHOUSHTAR.REC.1399.028).

Funding
This article was financially supported by the Research Vice-Chancellor of Shushtar Faculty of Medical Sciences.

Authors' contributions
Conceptualization: Farzad Taban and Seyed Ali Mousavi; Statistical analysis: Saeideh Shojaei; Writing: Elham Abdolahi Shahvali; Project administration, review and editing: Akram Hemmatipour.

Conflicts of interest
The authors declared no conflict of interest.


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