Abstract
BackgroundMoral distress is a poorly defined and frequently misunderstood phenomenon, and little is known about its triggering factors during ICU end-of-life decisions for nurses in Iran. This study aimed to explore the experiences of nurses’ moral distress in the long-term care of older adults via a phenomenological study.MethodsA qualitative, phenomenological study was conducted with 9 participants using in-depth semi-structured interviews. The purpose was to gain insight into the lived experiences and perceptions of moral distress among ICU nurses in hospitals affiliated with Tehran University of Medical Sciences during their long-term care of older adults.ResultsFive major themes are identified from the interviews: advocating, defense mechanisms, burden of care, relationships, and organizational issues. In addition, several subthemes emerged including respectful end of life care, symptom management, coping, spirituality, futile care, emotional work, powerlessness, relationships between patients and families, relationships with healthcare teams, relationships with institutions, inadequate staffing, inadequate training, preparedness, education/mentoring, workload, and support.ConclusionsThis qualitative study contributes to the limited knowledge and understanding of the challenges nurses face in the ICU. It also offers possible implications for implementing supportive interventions.
Highlights
Moral distress is a poorly defined and frequently misunderstood phenomenon, and little is known about its triggering factors during intensive care unit (ICU) end-of-life decisions for nurses in Iran
In circumstances where patients are treated in the ICU for an extended period, moral distress can be a common experience among healthcare professionals
In addition to quantitative exploration, further qualitative analyses are needed to gain a deeper understanding of moral distress from the perspective of ICU staff, which can guide policymakers to generate a comprehensive perspective in understanding moral distress and formulate reliable strategies
Summary
Moral distress is a poorly defined and frequently misunderstood phenomenon, and little is known about its triggering factors during ICU end-of-life decisions for nurses in Iran. Nurses make decisions based on their moral beliefs during the different stages of a patients’ life cycle [2] These decisions can be influenced by the unique situation or context a patient is in, a patient’s family or the perspectives of other physicians and nurses [3, 4]. Jameton [6] defined moral distress as a psychological discomfort that occurs when a person is unable to complete what they believe to be an ethically responsible action due to internal or external factors. Based on this definition, nurses may have professional work requirements that conflict with their personal morals and beliefs [5]
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