Caught between care and conviction: Primary health care nurses’ moral distress during vaccine-hesitancy encounters in a culturally diverse context

BackgroundVaccine hesitancy can generate moral distress when nurses' duty to protect children conflicts with parental decision-making authority, family dignity, and longitudinal trust.Research question/aim/objectivesTo interpret how primary health care nurses experience and negotiate moral distress during vaccine-hesitancy encounters with families in culturally diverse Saudi primary care.Research designA qualitative Interpretive Description study informed by moral distress theory. In-person semi-structured interviews were analysed using reflexive thematic analysis.Participantsand research context: Twenty-two registered nurses from 20 primary health care centres in one southern Saudi health cluster participated. Purposive recruitment lacked a fixed sampling frame or approach log; therefore, a conventional response rate was not calculable.Ethical considerationsNajran University Research Ethics Committee approved the study, and the health cluster granted permission. Written informed consent, confidentiality, and voluntary participation were maintained.Findings/resultsParticipants' retrospective accounts generated four themes: constrained action despite knowing what responsible practice required; moral agency negotiated through family, faith, and gendered authority; cumulative moral residue; and organisational ethical responsibility. Family decision hierarchy was the most consistently described cultural constraint, while religious interpretation and gendered credibility shaped particular encounters.ConclusionsWithin this single-cluster sample, nurses' moral distress was interpreted as a relationally and organisationally mediated ethical burden shaped by family hierarchy, religious reasoning, gendered credibility, and limited organisational support. Participant-informed ethics case forums, shared escalation pathways, and team-based support warrant local piloting and evaluation as potential strategies to support nurses' moral voice while preserving respectful dialogue and longitudinal trust.