Moral Distress in the Neonatal Intensive Care Unit Experienced by Nurses Caring for Critically Ill Neonates: A Phenomenological Study

Aims: To elucidate the meaning of moral distress in nurses caring for critically ill neonates.

Design: Qualitative study using Husserl's descriptive phenomenology.

Methods: Between April and December 2022, unstructured interviews were conducted with 11 nurses with at least 3 years of neonatal intensive care unit experience in Japan. They were asked to recall experiences of moral distress and to speak freely about their thoughts and feelings at the time. The analysis followed Colaizzi's seven-step method.

Results: Three themes ('organisational constraints', 'regret' and 'unshared experiences') and seven subtheme clusters were extracted from the nurses' narratives of moral distress, which was the basis of trauma. Subtheme clusters included 'wavering beliefs', 'guilt associated with the death of a child', 'powerlessness at being unable to help one's family' and 'mismatch with the perceptions and feelings of the family'.

Conclusion: Nurses experience various morally distressing events, but these are processed only as personal problems and give rise to feelings of self-negation. Therefore, trauma can develop as a result of experiences related to decision-making and the child's best interests. There is a need to improve nurses' moral resilience and ensure their psychological safety to alleviate moral distress.

Implications for the profession: This study clarifies nurses' roles within the neonatal intensive care unit, potentially helping them to handle life-and-death issues and cope with feelings of moral distress.

Impact: This study elucidated the meanings of powerlessness underlying the moral distress experienced by neonatal intensive care unit nurses. These results will contribute to releasing suppressed feelings and thoughts and alleviating unavoidable moral distress in this setting.

Reporting method: This study was performed in accordance with the COREQ guidelines.

Patient or public contribution: Nurses with experience in neonatal intensive care unit nursing participated as interviewees. They also verified the credibility of survey results and ensured analytical rigour.