Iranian Nurses' Experiences of Moral Distress in Paediatric Wards: A Qualitative Study

As direct and continuous providers of patient care, nurses are more susceptible to various forms of psychological stress within the healthcare environment compared to other healthcare professionals. Nurses in paediatric wards, who maintain constant contact with children and their families, are particularly vulnerable to moral distress. This study aimed to explore the perceptions and experiences of Iranian nurses regarding moral distress in paediatric settings.

This qualitative study employed inductive content analysis, conducted between 2023 and 2024. Data were collected through semi-structured individual interviews and analysed following Graneheim and Lundman's approach. Twelve participants experiencing moral distress were selected via purposive sampling from the Babol and Tehran Universities of Medical Sciences.

The findings identified four primary categories and eight subcategories: moral distress related to colleagues (doctors and nursing colleagues); moral distress related to parents (conflict with children's rights and distrust of nurses); moral distress related to organizational factors (understaffing and workload undermining holistic care and professional ethics; and inadequate equipment and resources compromising care and fostering dishonesty); and psychological tensions following moral distress (mental conflict involving the cognitive and emotional burden of moral compromise; and helplessness and despair in the face of systemic failure). Rather than representing isolated individual experiences, these findings illustrate that moral distress in paediatric nursing is deeply rooted in the structural and relational conditions of healthcare settings. The results highlight that repeated exposure to ethical conflicts can erode professional values, impede the delivery of holistic care, and intensify emotional suffering. Consequently, this study contributes to a deeper understanding of moral distress as a systemic phenomenon requiring organizational intervention rather than merely an individual coping response.

The findings underscore the necessity for healthcare managers and policymakers to implement systemic mechanisms, such as specialized educational programmes and workshops, to mitigate moral distress among nurses. Furthermore, identifying the inherent stressors in paediatric nursing and reducing nurses' exposure to moral dilemmas are essential steps toward safeguarding ethical practice and enhancing care quality. This study contributes by shifting the focus from merely describing moral distress as a set of themes toward understanding it as a critical indicator of organizational strain and ethical vulnerability in paediatric nursing.