Moral Distress Among Critical Care Nurses in Imo State, Nigeria: Causes and Management Strategies

Abstract

Moral distress is a major source of concern to nurses in the critical care units who are unable to deliver the desired care to the patients due to various professional and environmental factors. Moral distress has several impacts on caregivers, including poor emotional well-being, job dissatisfaction, and low commitment, which in turn affect the quality of patient care. This study examined the prevalence, causes, effects, and possible strategies for dealing with moral distress among critical care nurses. The study adopted a descriptive cross-sectional design involving 210 nurses from purposively selected secondary and tertiary hospitals in Imo State. Nurses who met the eligibility criteria and were available during the study period were recruited using purposive sampling. Questionnaires were used to gather information regarding the level of distress, causal factors, effects of moral distress, and strategies for coping with moral distress. The data collected were analyzed and presented using percentages and frequencies. The analysis revealed that moral distress was prevalent among the participants, with 37.1% of the respondents experiencing moderate levels of distress, 31.4% severe distress, 20.95% extreme distress, and 10.5% mild distress. The major causes of moral distress identified in the study include high patient-nurse ratio (82.9%), heavy workload (80%), lack of ICU beds (77.1%), inadequate drugs and medications (74.8%), inadequate medical equipment (72.9%), and delay in treatment (71.9%). Other causes include lack of ventilators (70.5%), patients’ inability to pay for treatment (69.5%), inadequate diagnostic tests (69%), and lack of blood and blood products (66.2%). The study further revealed that moral distress causes major negative impacts on critical care nurses, including emotional exhaustion (76.7%), frustration (73.3%), reduced job satisfaction (67.6%), compassion fatigue (65.2%), demotivation (61.4%), and the intention to quit their jobs (45.7%). The most effective strategies for dealing with moral distress include recruiting more nurses (77.6%), acquiring more equipment and supplies (75.2%), collaborating and working closely with other health workers (71.9%), seeking assistance from colleagues (68.6%), supportive leadership (65.7%), and ethics education and training (60%). Moral distress is a major concern in critical care nursing practice, which negatively affects the well-being of caregivers and, in turn, impacts the quality of patient care delivered by these nurses. Lack of enough staff, poor working policies, and the unavailability of essential equipment and supplies contribute to the development of moral distress. Critical care nurses should advocate for more staffing and better working conditions, as well as effective mechanisms for dealing with moral distress to improve their well-being and the quality of patient care provided in the intensive care units.