Moral Distress of Critical Care Nurses in Japan

BACKGROUND: Critical care nurse moral distress seriously affects the quality of care. Although there are quantitative studies in Japan, few have explored Japanese critical care nurses' (CCNs) experiences, necessitating a contextualized understanding. OBJECTIVE: To explore Japanese CCNs' descriptions of the causes of their moral distress. METHOD: A descriptive qualitative study using semistructured interviews was conducted on 10 CCNs working in intensive care units (ICUs) in Japan's Tokai region. Participants were recruited via purposive and snowball sampling. Inclusion criteria were at least 3 years of working in the ICU and 5 years' nursing experience. Data were analyzed using Tesch's eight-step content analysis. RESULTS: Five categories and 17 subcategories were identified as constraints preventing nurses from acting in accordance with their personal values and ethical standards: (1) difficulty in achieving common understanding between patients/family members in crisis and medical professionals; (2) insufficiencies in the therapy/treatment/care centered on patients and families; (3) physician attitudes that communicate superiority and higher status; (4) work environments that make expressing differences in values difficult; and (5) tension between one's professional and moral responsibilities. DISCUSSION: This study provides empirical evidence of situations where moral distress arises among Japanese CCNs in ICUs, emphasizing the influence of cultural norms (conformity and harmony). A cross-cutting theme of silence emerged, as nurses often chose not to voice concerns to maintain harmony, contributing to moral distress. These findings highlight the need for strategies supporting ethical dialogue and culturally sensitive interventions.