Moral Distress in Iranian Psychiatric Nurses: A Content Analysis

Abstract

Background: The complexities of the health care system have imposed complex ethical issues on nurses, resulting in moral distress in all categories of nurses with various specialties. Psychiatric nurses are also exposed to moral dilemmas because they care for vulnerable patients with delusions and suicidal ideation problems. Due to the different experiences of moral distress in different cultures, settings, and wards, we studied this phenomenon in Iranian psychiatric nurses. Objectives: We conducted this study to investigate the causes of moral distress in Iranian psychiatric nurses. Methods: This qualitative study was conducted based on a conventional content analysis on 12 psychiatric nurses selected by the purposive sampling method in 2020 in Shiraz, Iran, considering the maximum diversity. Data were collected through semi-structured interviews with participants for an average of 40 - 60 minutes per interview until data saturation. Results: We obtained causes of moral distress from 7 categories and 20 subcategories. The categories included “lack of professional competence”, “organizational culture”, “individual factors”, “environmental and organizational factors”, “management factors”, “weaknesses in professional and effective communication”, and “observation of moral dilemmas by nurses”. Conclusions: This study demonstrated various causes of moral distress that managers should consider by providing a safe environment and appropriate facilities for psychiatric nurses.

Intensity and frequency of moral distress in mental health nurses in Brazil

“…However, respecting the law of professional practice and ethical principles constitutes the basis of acting ethically that can minimize situations leading to the phenomenon. In this regard, the construction of practice based on ethical, technical, and legal precepts of the profession is an element that contributes to the visibility and empowerment of nurses in different work contexts ( 16 , 24 ) and is related to the factor “Safety and professional autonomy”.…”

“…Also associated with the factor, aspects such as inadequate treatment, omissive professional behavior ( 22 ) and other situations of social vulnerability of users represent generators of moral distress in nurses working in RAPS ( 9 , 22 ) . These situations contribute to the low adherence of users to the services, leading to therapeutic failures that gradually progress to more serious mental disorders and require complex interventions such as hospital admissions, thus generating a cycle of new conflicts ( 24 , 25 ) .…”

Intensidade e frequência de distresse moral em enfermeiros de saúde mental no Brasil

“…Entretanto, respeitar a lei do exercício profissional e os princípios éticos constitui a base do agir eticamente, que pode minimizar situações causadoras do fenômeno. Nesse sentido, a construção da prática apoiada em preceitos éticos, técnicos e legais da profissão é um elemento que contribui para a visibilidade e empoderamento do enfermeiro em diferentes contextos de trabalho (16,24) e está relacionado ao fator "Segurança e autonomia profissional".…”

“…Ainda associados ao fator, aspectos como tratamentos inadequados, comportamentos profissionais omissos (22) e outras situações de vulnerabilidade social dos usuários representam geradores de distresse moral nos enfermeiros que atuam na RAPS (9,22) . Estas situações contribuem para a baixa adesão dos Intensidade e frequência de distresse moral em enfermeiros de saúde mental no Brasil Rev Esc Enferm USP • 2023;57:e20230122 usuários aos serviços, provocando falhas terapêuticas que evoluem, paulatinamente, para quadros mais graves do transtorno mental e que necessitam de intervenções complexas como internação hospitalar gerando, assim, um ciclo de novos conflitos (24,25) .…”

“…Deste modo, para que se estruture um ambiente de trabalho menos estressante, são necessárias as estratégias de educação permanente em saúde que abordem a educação ética, o ensino problematizador e espaços de reflexão sobre a prática. Assim, os saberes emergentes deste processo contribuirão para refinar as competências ético-profissionais, estimulando enfermeiros a explorarem ações moralmente corretas (24,26) .…”