Exploring the experiences of nurses’ moral distress in long-term care of older adults: a phenomenological study

Alireza Nikbakht Nasrabadi, Ahmad Hasyim Wibisono, Kelly-Ann Allen, Ameneh Yaghoobzadeh, Yee Bit-Lian

Research output: Contribution to journalArticleResearchpeer-review


Background: Moral distress is a poorly defined and frequently misunderstood phenomenon, and little is known about its triggering factors during ICU end-of-life decisions for nurses in Iran. This study aimed to explore the experiences of nurses’ moral distress in the long-term care of older adults via a phenomenological study. Methods: A qualitative, phenomenological study was conducted with 9 participants using in-depth semi-structured interviews. The purpose was to gain insight into the lived experiences and perceptions of moral distress among ICU nurses in hospitals affiliated with Tehran University of Medical Sciences during their long-term care of older adults. Results: Five major themes are identified from the interviews: advocating, defense mechanisms, burden of care, relationships, and organizational issues. In addition, several subthemes emerged including respectful end of life care, symptom management, coping, spirituality, futile care, emotional work, powerlessness, relationships between patients and families, relationships with healthcare teams, relationships with institutions, inadequate staffing, inadequate training, preparedness, education/mentoring, workload, and support. Conclusions: This qualitative study contributes to the limited knowledge and understanding of the challenges nurses face in the ICU. It also offers possible implications for implementing supportive interventions.

Original languageEnglish
Article number156
Number of pages10
JournalBMC Nursing
Issue number1
Publication statusPublished - Dec 2021


  • Aging
  • Critical care
  • Intensive care
  • Moral distress
  • Nursing
  • Older adult
  • Qualitative research

Cite this