Exploring the experiences of nurses’ moral distress in long-term care of older adults: a phenomenological study

Abstract

Background 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. This study aimed to explore the experiences of nurses’ moral distress in the long-term care of older adults via a phenomenological study. Methods A 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. Results Five 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. Conclusions This 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.

Prevalence, Predictors, and Experience of Moral Suffering in Nursing and Care Home Staff during the COVID-19 Pandemic: A Mixed-Methods Systematic Review

“…The quantitative findings demonstrating the impact of factors such as workload and resource inadequacy on the emotional experience of N&CH workers are consistent with the qualitative findings of the studies included [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. The qualitative data collected highlighted the major themes of resource deficits, role challenges, communication and leadership difficulties, and emotional and psychological consequences.…”

“…The selected studies included in this review indicate a notable occurrence of MI and/or MD in N&CH staff during the COVID-19 pandemic which was inferred through the N&CH staff responses to surveys and interviews [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Unfortunately, a reliable and accurate prevalence of MI was not estimated in the studies; however, Brady et al [ 28 ] found that mean MIES scores reported by N&CH staff to be significantly higher than the levels other studies had found.…”

“…They also found a significant association between PMIEs experienced and physical and psychological impact [ 21 ]. Qualitative and mixed-methods research studies exploring MI in hospital staff have reported common major themes of organizational and infrastructural issues; advocating difficulties for the care of patients; and care burden, where HCPs expressed their distrust of leadership and feelings of non-support [ 20 , 22 ].…”

Perceptions and Experiences of Nurses When Confronted With Expressing a Conscientious Objection Towards End-of-Life Care in Greece

“…More precisely, Prompahakul states, 'The most commonly cited clinical causes of moral distress were providing futile care for end-of-life patients [44]. In a similar vein, Nikbakht et al identi ed causes of nurses' moral distress related to 'respectful end of life care' and 'futile care' [45].…”

Mitigating Moral Distress in Leaders of Healthcare Organizations: A Scoping Review

“…Some have been developed to directly address moral distress (Beumer, 2008; Hamric & Epstein, 2017), whereas others have attempted to address moral distress through its antecedents and indirect contributing factors (e.g., enhancing moral empowerment [Abbasi et al, 2019] and implementing organizational policy changes [Bosshardt et al, 2018]). Antecedents of moral distress among clinicians broadly occur at the level of the individual (e.g., sense of powerlessness), the clinical interaction, or the external environment (e.g., staffing constraints; Deschenes et al, 2020; Nasrabadi et al, 2021). Interventions intended to address moral distress most frequently focus on individuals, although an increasing number of interventions aim to improve environmental factors such as leadership (Shanafelt et al, 2021).…”