Nurses’ experiences of moral distress and how it affects daily work in surgical care—a qualitative study

Abstract

AimTo describe nurses’ and specialist nurses’ experiences of moral distress and how it affects daily work in surgical care.DesignA qualitative descriptive study design was used.MethodsA qualitative study with 12 interviews with nurses and specialist nurses working in surgical care. All interviews were conducted during October and November 2022 in two hospitals in southeastern Sweden. Data were analysed using conventional qualitative content analysis.FindingsThree categories and seven subcategories generated from the data analysis. The three categories generated from the analysis were Experiences that lead to moral distress, Perceived consequences of moral distress and Strategies in case of moral distress. The results show that a lack of personnel in combination with people with complex surgical needs is the main source of moral distress. Both high demands on nurses as individuals and the teamwork are factors that generate moral distress and can have severe consequences for the safety of patients, individual nurses and future care.ConclusionsThe results show that moral distress is a problem for today's nurses and specialist nurses in surgical care. Action is necessary to prevent nurses from leaving surgical care. Prioritizing tasks is perceived as challenging for the profession, and moral distress can pose a patient safety risk.ImpactSurgical care departments should design support structures for nurses, give nurses an authentic voice to express ethical concerns and allow them to practice surgical nursing in a way that does not violate their core professional values. Healthcare organizations should take this seriously and work strategically to make the nursing profession more attractive.Patient or Public ContributionThere was no patient or public contribution.

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies

“…Peers can be a second family, especially when working together for several years, and being separated from them because of re-location can be stressful. The feeling of isolation can also arise when the buffer provided by families and friends is missing, or they feel own relatives don’t understand the challenges they go through daily [e.g., 38 , 45 , 46 , 72 , 85 ].…”

“…Shortage of resources, like appropriate equipment or medications, and personal protection materials is described as a source of distress because it hinders the ability to care properly for patients whilst also protecting oneself. Shortages in human resourcing has an impact on individuals’ workload and therefore is an indirect cause of distress [e.g., 38 , 42 , 45 , 71 , 78 , 82 ].…”

“…Study sites were always indicated, North America and Europe, specifically England/UK were represented more than other regions. Studies were conducted across a number of different healthcare systems from the non-universal insurance system of the USA [ 40 – 42 , 44 , 48 , 57 , 62 , 63 , 69 , 76 , 78 , 85 , 87 ] to universal government-funded health system (single-payer) of Italy [ 43 , 64 , 65 , 67 , 86 ], UK [ 6 , 46 , 51 , 66 , 68 , 72 , 74 , 77 , 81 ], Sweden [ 45 ], Canada [ 47 , 49 , 52 , 54 – 56 , 61 , 70 , 71 , 73 , 75 , 79 , 82 , 84 ], Norway [ 58 – 60 ] and Australia [ 50 ], to the universal private health insurance system of Netherlands [ 39 ], and the universal public insurance system (social insurance) of Romania [ 53 ]. Although clear themes emerged that related to different healthcare systems and funding mechanisms for care (e.g., what is available to the individuals in that system based on resources and guidelines), overall, descriptions of events which could cause moral distress showed some consiste...…”

“…To cope, HSCW had to emotionally distance themselves from decisions and actions that did not align with their personal views and reported “feeling empty” because of a repeated inner trauma [ 58 ]. Linked to this, was the fear of retribution for speaking out in opposition to leadership decisions, which led to lower ranked staff conforming to practices they may not agree with [ 45 ]. In contrast, there was evidence that moral distress can increase resilience, which was mentioned in several papers (e.g.…”