Moral distress in psychiatric nurses in Covid-19 crisis

Abstract Background: The COVID-19 epidemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient’s lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in psychiatric nurses during the COVID-19 epidemic. Method: This qualitative study with a conventional content analysis approach involved 12 nurses at Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by unstructured interviews, data analysis was performed based on the five steps of Graneheim and Lundman. Results: From the data analysis, 252 initial codes were extracted, which were obtained by continuous comparison and integration of subcategories of 4 main categories including emotional responses, relational factors, Institutional factors, and management factors caused by Moral Distress in psychiatric nurses. Conclusion: new dimensions of the causes of moral distress associated with the COVID-19 pandemic are discovered. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.