Nurses’ experiences of moral suffering: A qualitative interview study

Abstract

Background: Moral suffering is a growing concern in healthcare, especially in the nursing profession. It encompasses various forms, such as moral distress and moral injury, both of which impact nurses’ professional integrity and mental and physical health. Despite extensive research, there is still no consensus on their definitions, distinctions, or causes, which impedes effective interventions. However, given their overlapping characteristics and consequences, joint consideration could offer critical insights to refine existing concepts. Aim: To explore how nurses in clinical practice perceive moral suffering and analyze the essence of their experience of moral suffering. Research design: Data were collected through qualitative, semi-structured online interviews. The interview transcripts were analyzed using qualitative content analysis. Participants and research context: A total of 47 registered nurses from different clinical settings in German hospitals participated in the study. Ethical considerations: The study protocol was approved by the Institutional Review Board at University Medicine Greifswald. All participants provided written informed consent. Findings: The essence of moral suffering was determined in five main categories with corresponding subcategories: A trigger situation (1) in which a person in a specific moral disposition is present (2), whereupon they assess the situation as morally meaningful (3) and, accordingly, moral suffering is experienced in its three specific dimensions: (4) the characteristics (dynamic, context-dependence, temporality, fuzziness), dimensions of experience (rational and emotional integrity-related manifestation), and dimensions of action (handling, coping, prevention). This experience of moral suffering has consequences (5). Conclusions: This study illuminates the complex nature of moral suffering among nurses, revealing its multidimensional essence and the interplay between personal and professional factors. The results underscore the need for a systemic approach to address moral suffering in nursing, emphasizing the importance of ethical leadership and workplace health promotion, and fostering shared values within healthcare teams.