The Meaning of Moral Distress among South Korean ICU Nurses in General Hospitals

Purpose/Aims: The aim of this research was to understand the meaning and experience of moral distress among Intensive Care Unit (ICU) nurses from their own perspectives and in light of their socio-cultural context. The main questions of this research were, In which socio-cultural context do ICU nurses experience moral distress? and What is the meaning of their moral distress?

 Rationale/Conceptual Basis/Background: As professionals, nurses experience high levels of stress and emotional disturbance related to their moral responsibilities. This stress does not arise from insufficient knowledge and education on ethical issues, but much more from performing duties related to patient care. In South Korea, even if patient is at the end of life, discussion of death is taboo, and the South Korean healthcare environment is family-centered. Doctors primarily make clinical decisions about medical treatment for dying patients. Previous studies show that South Korean nurses experience a great deal of moral distress but lack taking any behavioral approaches to find and solve the problems related to end-of-life care. We sought to articulate South Korean nurses’ moral distress within their socio-cultural context and systematically analyze how nurses feel, think, and respond are greatly needed. Moral distress of ICU nurses is most severe when caring for patients receiving aggressive life-sustaining treatment even with an uncertain or unstated prognosis.

 Methods: This study analyzed through qualitative content analysis data collected by in‐depth interviews of 29 ICU nurses in 6 groups, including 2 groups of new nurses, 2 groups of experienced nurses, and 2 groups of head nurses. Data collection and analysis were conducted simultaneously. For data analysis, all of the group interviews were recorded and transcribed. A critical ethnography strategy was to used to analyze the data.

 Results: This study found practicing as a nurse with limitations to be a major source of moral distress experienced by ICU nurses in South Korea. According to the findings of this study, ICU nurses accepted nursing roles while having experiences of moral distress throughout their clinical experiences. Themes that emerged were feeling limitation as a nurse (for new nurses), expressing limitation as a nurse (for experienced nurses), and acting on the limitation as a nurse for head nurses. In addition, 6 descriptive categories were derived from the qualitative content analysis: personal characteristics, clinical situation, relation, perception, behavior, and outcomes.

 Implications: ICU nurses in South Korea are experiencing considerable moral conflicts around their patients' best interest between their clinical experience and cultural taboos. Therefore, it would be beneficial to develop systematic customized empowerment, support, and ethical education programs grounded in nurses’ clinical experience.