An Exploratory Descriptive Study of Critical Care Nurses' Perspectives on Moral Distress in Diverse Healthcare Settings: The Causes, the Psychological Impact, and the Coping Strategies

Background Moral distress is a significant issue among critical care nurses who frequently encounter ethically complex situations that contradict their moral and professional values. In Pakistan, research on this phenomenon remains limited particularly regarding how nurses in different healthcare setting perceive and manage moral distress. Objective This study aimed to explore perspective of critical care nurses on the causes, psychological impact of moral distress and the strategy they use to deal with moral distress in diverse healthcare settings. Methods An exploratory descriptive qualitative design was used to evaluate the phenomenon, data was gathered through in-depth interviews with critical care nurses working in public sector tertiary care setting in Peshawar Pakistan. A purposive sampling technique was used to select participants with at least one year experience of working in an Intensive Care Unit. A total of 35 nurses volunteered to participate in the study. Among these 15 were interviewed based on their eligibility and availability. The data was transcribed and then analysed using a thematic analysis framework to identify themes and patterns. Result Three themes were extracted Theme One: ‘The Genesis of Moral Distress - A Conflict Between Ethics and Reality’, theme two: ‘the Pervasive Impact, the Psychological and Professional toll’ and theme three: ‘Navigating the Aftermath: Coping in a Constrained Environment’. Findings suggest that moral distress arises from factors such as inadequate staffing, the hierarchical system in Pakistan which gives dominance to physician over nurses, systemic and resources constraint, The cohort verbalizes the consequences of moral distress includes anxiety, emotional breakdown and reduced job satisfaction lead to burnout. Coping mechanism included avoidance and detachment, peer and family support and spiritual healing, there was a lack of organizational support for coping with moral distress, participants urged for a structure and formal support from organization to mitigate moral distress. Conclusion The study underscores urgent need for organizational support, ethical education and supportive leadership to address moral distress among critical care nurses which directly affect patients care.