Exploring pediatric nurses' experiences of moral outrage: A qualitative content analysis

This study aims to explore the experiences of Iranian pediatric nurses (PNs) regarding moral outrage (MO).

This research utilized qualitative content analysis through in-depth, semi-structured interviews with 14 pediatric nurses in a referral hospital from January to September 2023. Interviews were analyzed using Elo and Kyngäs's inductive approach (2008) and reported by COREQ guidelines. MAXQDA software was employed for effective data organization throughout the analysis process.

Data analysis identified the main category "the feeling of moral stagnation in child care" encompassing five generic categories: parent-related challenges, inefficient management, helplessness in professional roles, indifferent coworkers, and psychosocial negative outcomes. These categories included 15 subcategories, such as ignored parental needs, unhealthy beliefs, confusion about treatment, novice nurses' confrontations, nursing shortages, ethical inattention, patient rights violations, decision-making uncertainties, interprofessional separation, unsympathetic attitudes, lack of accountability, mental exhaustion, physical stress, internalized guilt, and job burnout.

As a whole, MO among PNs was investigated in this study, revealing significant challenges in their interactions with parents and the healthcare system. To enhance ethical standards and emotional resilience in PNs, addressing parent-related issues, management inefficiencies, and coworker indifference is crucial.

Clinicians must educate parents on treatments and coordinate psychiatric consultations. Nursing managers should supervise novice nurses and enhance ethical training. Joint meetings can improve ethical decision-making. Fostering empathy and accountability for errors is essential, while health authorities should implement strategies to mitigate MO among nurses.