[Exploring moral distress among clinical nurses]

Moral distress in nursing practice is described as a suffering situation that arises when the nurse is unable to act her/his ethical choices, when institutional constraints interfere with acting in the way she/he believes to be right. The aim is to describe nursing practice situations causing moral distress resulting from the recognition of the ethical appropriate actions combined with the impossibility to pursue it; to describe how nurses manage moral distress situations and the strategies to cope with them. A focus group was conducted in three wards of a large teaching-hospital in the north of Italy. In another ward the nurses were asked to write a moral distress experience. A total of 40 nurses were involved and 50 experiences collected. The experiences' analysis has shown 5 source areas of moral distress: 1) clinical decision; 2) nursing competences; 3) nurse-physician collaboration; 4) organization of care; 5) safe care. For each area the most frequent themes were highlighted.Areas of clinical decision, nursing competences, nurse-physician collaboration involve nurse leaders in identification and implementation of strategies for managing moral distress.