Navigating the Dangerous Terrain of Moral Distress: Understanding Response Patterns in the NICU

Moral distress is a well-recognized and ubiquitous aspect of health care professional practice in the neonatal intensive care unit (NICU) context. We used interpretive description methodology to guide a critical exploration of the dynamics of moral distress experience as reflected in the accounts of 28 health care professionals working in this setting. We learned about the kinds of clinical scenarios which triggered distressing experiences, and that the organizational and relational context of clinical work constituted a complex and dynamic working environment that profoundly affected both the individual and the collective experiences with moral distress in these situations. These findings shed light on possibilities for supporting NICU practitioners and developing the collaborative team cultures that may reduce the risk of unresolved effects of moral distress to the benefit of patients as well as the professionals who care for them.