The general experience and moral distress of nurses in the sociocultural context of the intensive care unit and the COVID-19 pandemic: A focused ethnography

Background and purpose: Moral distress is defined by Morley et al. (2019, p. 3) as “a direct causal link between the experience of a moral event and psychological distress.” It can lead to psychological, physical, and organizational consequences. The COVID-19 pandemic exacerbated and created factors that may have contributed to moral distress in intensive care (ICU) nurses. The framework for this study is the typology of moral distress written by Morley, Sese et al. (2020). The purpose of this study is to understand the general experience and moral distress of nurses better, in the sociocultural context of the ICU and the COVID-19 pandemic. Method and procedures: A qualitative focused ethnography design was used. The data collection was carried out by observations with field notes, an observation grid, informal exchanges with general informants, semi-structured interviews with key informants, as well as a reflective journal. Data analysis was conducted with the constant comparison method. Results: Eight key informants between the ages of 26 and 50 participated in the interviews. Three main themes emerged: 1) the temporality of the pandemic, 2) factors influencing the general experience, and 3) moral distress. Discussion: The type of moral distress most experienced by participants was that of moral constraint, when informants felt that their patients were suffering or that there was therapeutic futility. The second most common type of distress was that of moral tension, as nurses felt they could not talk about their experiences with anyone. Conclusion: Moral distress is a common phenomenon amongst RNs, already known in the sociocultural context of the ICU. The circumstances of the pandemic only exacerbated and added to this moral distress. Recommendations were made to mitigate moral distress in times of crisis. Keywords: moral distress, registered nurses, intensive care unit, culture, focused ethnography