A qualitative study of moral distress among rural nurses

BackgroundMoral distress challenges nurses in rural, underserved regions where systemic and cultural factors intersect, yet context-specific experiences in non-Western settings remain underexplored.AimTo explore the experiences and perceptions of moral distress among nurses working in rural, deprived areas of Southeast Iran.MethodsThis qualitative descriptive study involved semi-structured interviews with 28 nurses across various wards in three public hospitals. Data were analyzed using Braun and Clarke's thematic analysis framework.Ethical considerationsEthical approval was granted by the relevant university ethics committee (Code: IR.REC.1402.026). Written informed consent was obtained from all participating nurses, with guarantees of anonymity, confidentiality, and the right to withdraw without consequence.ResultsThree themes emerged: Emotional Burden of Distress (guilt, exhaustion); Ethical Conflicts in Practice (tensions between professional duties and cultural expectations, for example, communal family pressures); and Systemic Barriers to Care (understaffing, bureaucratic constraints).ConclusionGeographic isolation and cultural norms intensify nurses' ethical strain. Tailored peer support, virtual ethics training, and retention incentives can enhance nurse well-being and patient safety, offering insights for global nursing practice in resource-scarce regions.