Moral distress experiences of nurses who working in the psychiatric inpatient clinic: A qualitative study

In this study, it was aimed to examine the moral distress experiences of nurses working in inpatient psychiatry services in Turkey. Phenomenological qualitative research design was used in the study. The population of the study consisted of nurses who have been working in psychiatric hospitals and psychiatric clinics in Turkey for at least six months. The sample consisted of 16 psychiatric nurses who were reached by snowball method, met the inclusion criteria and accepted the study. The 'Descriptive Data Form' prepared by the researchers and the 'Semi-structured interview form' regarding moral distress were used for data collection. The data were collected by the researcher using in-depth interview method by taking audio and video recordings after obtaining consent from the interviewees. The interviews lasted an average of 53 minutes. The interviews were terminated in the sixteenth participant due to data saturation. Immediately after the interviews with the participants were completed, the interview data were transcribed over the audio recording, analyzed with phenomenological descriptive analysis, and the data were grouped into themes and sub-themes in three contexts. In the study, 6 main themes (Inability to Provide Desired Care, Witnessing Ethical Violation, Team Conflict, Decision Conflict, Institutional Causes, Systemic Causes) and 24 sub-themes in the context of "causes of moral distress", 3 main themes (Emotional Consequences, Physical Consequences, Professional Consequences) and 14 sub-themes, and 5 main themes (Support from the Team, Emotional Coping, Problem-Oriented Coping, Effort to Act in accordance with Values) and 8 sub-themes were identified in the context of "coping with moral distress". Nurses stated that the most important factors that caused them to experience moral distress were increased workload due to inadequate staffing and insufficient resources allocated to psychiatric services. As a result of the moral distress they experienced, they stated that they experienced sadness, helplessness, feelings of worthlessness, physical and mental fatigue, and that they wanted to leave the psychiatric clinic and experienced burnout. They stated that they coped with moral distress in a problem-oriented and emotion-oriented manner. It was recommended that awareness should be raised in the field regarding the moral distress experiences of psychiatric nurses and quantitative studies should be conducted on the frequency and levels of MD.