Iranian intensive care unit nurses' moral distress: a content analysis

Area of Science:

• Nursing
• Medical Ethics
• Qualitative Research

Background:

• Moral distress is well-documented in Western countries.
• Cultural and educational variations may influence how Iranian nurses experience moral distress.
• This is the first study to investigate moral distress among nurses in Iran.

Purpose of the Study:

• To identify and describe the types of moral distress experienced by clinical nurses and nurse educators in Iran.
• To explore the unique manifestations of moral distress in the Iranian intensive care unit (ICU) setting.

Main Methods:

• Qualitative research methodology.
• Semistructured and in-depth interviews conducted with 31 participants (28 nurses, 3 nurse educators).
• Participants were purposively sampled from 12 cities across Iran.

Main Results:

• Content analysis revealed four major themes of moral distress: institutional barriers, communication problems, futile actions/malpractice/errors, and inappropriate responsibilities/resources/competencies.
• The identified themes indicate that moral distress experienced by Iranian ICU nurses differs from previous international findings.
• Specific examples include systemic constraints, difficulties in patient communication, witnessing errors, and role-related challenges.

Conclusions:

• Moral distress among Iranian ICU nurses is shaped by distinct cultural and systemic factors.
• Nursing leaders must address these identified issues to mitigate moral distress.
• Further research is needed to develop culturally relevant interventions to support nurses.