Articles

Moral distress experienced by intensive care nurses

Gayle Cartland Langley, Leah Kisorio, Shelley Schmollgruber

Abstract


Background. Moral distress is experienced when nurses experience conflict while making an ethical decision. This is magnified when the decisions are about withholding or withdrawing life-sustaining treatment.

Objective. To explore and describe nurses’ experiences of situations that involve end-of-life care and evoke moral distress in the intensive care units (ICUs) of two public tertiary-level hospitals in South Africa (SA), the personal consequences of these situations and the means employed to manage their distress. 

Methods. An exploratory, descriptive design was used. A short survey/interview guide was administered to registered and enrolled nurses (N=100) employed in the ICUs from two academic-affiliated, specialist public hospitals. 

Results. A total of 65 completed surveys were collected. Of these, 32 responses were judged not to be describing moral distress while 33 clearly described moral distress and were included and analysed by means of initial content analysis. The findings were presented in five major categories: (i) collegial incompetence or inexperience; (ii) resource constraints; (iii) end-of-life issues; (iv) lack of consultation, communication and negotiation; and (v) support. 

Conclusion. The study found that nurses experienced considerable moral distress. This is compounded in an environment where gender, professional and social status inhibit the nurses’ assertiveness, ‘voice’ and influence in the healthcare system. Parallels can be drawn between the microcosm of the ICU and the macrocosm of the SA social and ethical character.


Authors' affiliations

Gayle Cartland Langley, Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg

Leah Kisorio, Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg

Shelley Schmollgruber, Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg

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Keywords

Moral distress; end-of-life care; critical care nurse

Cite this article

Southern African Journal of Critical Care 2015;31(2):36-41. DOI:10.7196/SAJCC.2015.v31i2.235

Article History

Date submitted: 2015-05-12
Date published: 2015-11-04

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