Moral Distress, Power Asymmetry, and Communication Breakdown in Critical Care: A Critical Ethnography of Nurse–Family Interactions at Yaounde Central Hospital, Cameroon

This research aimed at studying nurse-family communication in the Internal Medicine Unit of Yaounde Central Hospital in Cameroon and how these encounters are affected by healthcare providers' power dynamics, communication breakages, and moral distress. A critical ethnography for this research obtained data through semi-structured interviews and other forms of communication with nurses, as well as those involved with patients in the department including families/caregivers. Thematic data analysis was conducted based on the power and practice relations framework. Three major and interrelated themes were identified. 1) Fragmented Communication Pathways: Small and sporadic communication channels for exchanging information between health workers and the patient's family members; 2) Unequal Power Relations in Communication: A situation where the doctor's supremacy tends to dominate both nurses and family members, resulting in the disenfranchisement of these two groups; 3) Perpetual Moral Distress: Continuously being in a state of ethical discomfort which is, for the most part, due to the inadequacies of the healthcare system. According to the investigation, insufficient communication, unbalanced power relations, and moral distress are different yet interconnected phenomena in this situation. Hospital authorities should tackle these problems through system-wide changes, setting up structured communication pathways and fostering an environment that promotes communication. Through this research, moral distress as a concept is advanced by redefining it as the interaction pattern of behaviors in intricate relationships within the healthcare system where power disparities and communication failures as the underlying condition are particularly context-specific for resource-constrained Critical Care settings. It aims to influence policy and nursing practice through identifying the necessity for fair decision-making, communicative framework development concerning case situations, and welfare that is provided by structures such as ethical competence that enhances nurse advocacy/care partner roles in patient- and family-centered care.