Abstract
Introduction: Moral distress occurs when nurses are unable to act according to their ethical values due to institutional or resource-related constraints. While it is well studied in Western settings, little is known about moral distress among nurses in Sub-Saharan Africa. This review synthesises and quantifies the prevalence and mean score of moral distress among nurses in Sub-Saharan Africa.
Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, African Journals Online, and Google Scholar from January 2005 to May 2025. Eligible studies reported quantitative measures of moral distress among nurses in Sub-Saharan Africa. Study quality was appraised using the Joanna Briggs Institute checklists. Random-effects meta-analysis was used to pool mean scores, with subgroup and meta-regression analyses to explore heterogeneity. Publication bias was assessed using funnel plots, Egger’s test, and trim-and-fill.
Results: Seven studies with a total of 1,704 nurses were included (Ethiopia, Ghana, South Africa). The pooled mean score of moral distress, standardised to a 1–10 scale, was 2.46 (95% CI: 2.33–2.58). Subgroup analyses revealed higher moral distress among Ethiopian nurses compared to Ghanaian and South African nurses, and among those working in ICU, surgical, and medical units compared with operating theatre nurses. Significant heterogeneity was present (I² = 100%).
Conclusion: This review provides the first region-specific evidence on moral distress among nurses in Sub-Saharan Africa. Findings highlight low but heterogeneous levels of distress. Enhancing organizational ethics, fostering supportive leadership, and implementing context-specific interventions could alleviate moral distress and improve the well-being of nurses.