Iranian nurses’ understanding of moral distress in pediatric wards

Abstract Background: As direct and continuous providers of patient services, nurses are more exposed tovarious types of psychological stress in the work environment compared to other members of the health system. Nurses working in pediatric wards are in contact with children, and their families are more exposed to moral distress.This study aimed to investigate Iranian nurses’ understanding of moral distress in pediatric wards. Methods: This qualitative study was conducted through inductive content analysis in 2023-2024. Data were collected through semi-structured and individual interviews and analyzed simultaneously and continuously using Graneheim and Lundman’s approach. Twelve participants among nurses with moral distress experiences were selected through purposive sampling from Babol and Tehran Universities of Medical Sciences. Results: The study findings include four main classes and eight subclasses: 1) moral distress related to colleagues (doctor and nurse colleagues), 2) moral distress related to parents (conflict with children’s rights and distrust in nurses), 3) moral distress related to organizational factors (lack of manpower and proper equipment), and 4) psychological tensions following moral distress (mental conflict and exhaustion). Conclusion: The findings demonstrate the need for mechanisms by managers and officials to hold educational programs and workshops to help reduce moral distress levels in nurses. To this end, it is necessary to identify the stressful conditions caused by nursing care in this ward and reduce nurses’ exposure to stress in moral dilemmas.