Prediction of moral blindness based on moral orientation and sensitivity among critical care nurses: a cross-sectional study in Iran

Failure to recognize and accurately assess an ethical situation, or the inability to make sound clinical judgments, results in a phenomenon known as moral blindness, in which nurses are unable to make appropriate ethical decisions. Identifying and applying predictive factors of moral blindness can provide a foundation for mitigating and managing its adverse effects in the demanding environment of critical care units, thereby promoting a safer and more ethical environment for both patients and nursing staff. Perdition of moral blindness based on moral orientation and moral sensitivity among critical care nurses in educational and medical centers. This research employed a cross-sectional correlational design. Sampling was conducted using the census method among 330 critical care nurses working in educational and medical centers in Ardabil, northwestern Iran, from December 2024 to April 2025. Finally, a total of 320 participants returned the questionnaire. Data were collected through a demographic questionnaire and instruments measuring moral blindness, moral sensitivity, and moral orientation. The collected data were analyzed using SPSS version 22. Descriptive and inferential statistics (i.e., t-test, ANOVA, Pearson correlation coefficient, and hierarchical regression analyses) were applied, with the significance level set at 0.05. The mean moral blindness score of critical care nurses was 28.52, with a standard deviation of 14.28. Several factors in the hierarchical regression predicted moral blindness among critical care nurses, including work experience (B = -0.582, p < 0.001), ability to communicate effectively (B=-0.133, p = 0.001), age (B=-0.126, p = 0.005), idealism (B=-0.143, p < 0.001), and relativism (B = 0.123, p = 0.004). Given that moral blindness can be partially predicted by different dimensions of moral sensitivity and moral orientation, we recommend designing educational models, clinical and management interventions, and ethical process improvements for stressful critical care environments. These initiatives should focus on strengthening moral sensitivity, communication skills, and idealism to effectively reduce moral blindness.