Abstract
Nurse Practitioners (NPs) working in the intensive care environment experience clinical and operational anxiety, such as moral distress. Moral distress occurs when an individual knows the ethically correct action but cannot take it due to internal or external constraints or violation of their professional core values. Causal factors of moral distress in nursing include inadequate staffing, prolonged patient pain and suffering, ethical conflicts in end-of-life care, lack of transparency and false hope, disruptive or aggressive family, and ineffective leadership. Historically, nurses have experienced moral distress at higher levels than other healthcare professionals, especially those in intensive care units (ICU). Because nurses are beginning to understand moral distress experiences better, the problem of moral distress is becoming more recognizable, particularly in the ICU.
This phenomenological study aimed to describe the lived experience of moral distress in ICU NPs, specifically emphasizing its effect on their personal and professional lives. Research on moral distress has demonstrated that individuals who experience moral distress have an increased likelihood of leaving their current position, decreased job satisfaction, and experiencing professional burnout syndrome. The negative effects of moral distress may also affect the health and personal lives of individuals experiencing moral distress. These effects include gastrointestinal distress, headaches, body aches, fatigue, sadness, anger, irritability, spontaneous crying, and overreaction to situations that do not normally provoke such reactions. Without examining moral distress in the ICU NP population, it is unclear what impact this lack of knowledge may have on the safety of ICU patients, the ICU environment, and NPs themselves. Using purposive sampling, the researcher conducted individual interviews with ICU NPs to explore moral distress, identify themes derived from the gathered data, and offer thematic analyses.
The researcher interviewed 17 participants in one-on-one interviews. The results of the study found three theme clusters (Moral Distress Decision-Making Causes, Negative Effects of Moral Distress in ICU NPs, Positive Effects of Moral Distress in ICU NPs) containing a total of 11 themes (Responsibility and Burden, Hierarchical System Barrier, Patient’s Family as a Barrier, Medical Futility, Professional Impact and Obligation, Inadequacy Causing Uncertainty, Personal Impact, Moral Distress during COVID, Positive Outcomes, Patient Care Effect, Maintaining Integrity). The universal essence of these themes is, “Moral distress experienced by ICU NPs is unique because of the increased responsibility perceived in a provider role when making ethical or moral decisions that directly affect patient care as they navigate it through a hierarchical system where their decisions must reflect and answer to that of their collaborative attending physician.”
This research intends to catalyze thoughtful conversation regarding the concept of moral distress as experienced by nurse practitioners and to promote interventions to mitigate moral distress and its negative effects in this population. In addition, the study hopes to encourage further research in NPs of all specialties. Nurses and NPs can lead these efforts to examine what the concept of moral distress means to ICU NPs by expanding upon this research.
Notes
Reference list included in attached slide deck.
Sigma Membership
Iota Kappa
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Phenomenology
Research Approach
Qualitative Research
Keywords:
Morals, Psychological Distress, Critical Care -- Psychosocial Factors, Nurse Practitioners, Intensive Care Units, Acute Care Nurse Practitioners
Recommended Citation
Bocchese, Steven L., "Exploring Moral Distress in ICU Nurse Practitioners: A Descriptive Phenomenological Study" (2026). Creating Healthy Work Environments (CHWE). 67.
https://www.sigmarepository.org/chwe/2024/presentations_2024/67
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-02-20
Exploring Moral Distress in ICU Nurse Practitioners: A Descriptive Phenomenological Study
Washington, DC, USA
Nurse Practitioners (NPs) working in the intensive care environment experience clinical and operational anxiety, such as moral distress. Moral distress occurs when an individual knows the ethically correct action but cannot take it due to internal or external constraints or violation of their professional core values. Causal factors of moral distress in nursing include inadequate staffing, prolonged patient pain and suffering, ethical conflicts in end-of-life care, lack of transparency and false hope, disruptive or aggressive family, and ineffective leadership. Historically, nurses have experienced moral distress at higher levels than other healthcare professionals, especially those in intensive care units (ICU). Because nurses are beginning to understand moral distress experiences better, the problem of moral distress is becoming more recognizable, particularly in the ICU.
This phenomenological study aimed to describe the lived experience of moral distress in ICU NPs, specifically emphasizing its effect on their personal and professional lives. Research on moral distress has demonstrated that individuals who experience moral distress have an increased likelihood of leaving their current position, decreased job satisfaction, and experiencing professional burnout syndrome. The negative effects of moral distress may also affect the health and personal lives of individuals experiencing moral distress. These effects include gastrointestinal distress, headaches, body aches, fatigue, sadness, anger, irritability, spontaneous crying, and overreaction to situations that do not normally provoke such reactions. Without examining moral distress in the ICU NP population, it is unclear what impact this lack of knowledge may have on the safety of ICU patients, the ICU environment, and NPs themselves. Using purposive sampling, the researcher conducted individual interviews with ICU NPs to explore moral distress, identify themes derived from the gathered data, and offer thematic analyses.
The researcher interviewed 17 participants in one-on-one interviews. The results of the study found three theme clusters (Moral Distress Decision-Making Causes, Negative Effects of Moral Distress in ICU NPs, Positive Effects of Moral Distress in ICU NPs) containing a total of 11 themes (Responsibility and Burden, Hierarchical System Barrier, Patient’s Family as a Barrier, Medical Futility, Professional Impact and Obligation, Inadequacy Causing Uncertainty, Personal Impact, Moral Distress during COVID, Positive Outcomes, Patient Care Effect, Maintaining Integrity). The universal essence of these themes is, “Moral distress experienced by ICU NPs is unique because of the increased responsibility perceived in a provider role when making ethical or moral decisions that directly affect patient care as they navigate it through a hierarchical system where their decisions must reflect and answer to that of their collaborative attending physician.”
This research intends to catalyze thoughtful conversation regarding the concept of moral distress as experienced by nurse practitioners and to promote interventions to mitigate moral distress and its negative effects in this population. In addition, the study hopes to encourage further research in NPs of all specialties. Nurses and NPs can lead these efforts to examine what the concept of moral distress means to ICU NPs by expanding upon this research.
Description
Moral distress experienced by intensive care unit (ICU) nurse practitioners is unique to their role. This is the first study of its kind to explore the lived experience of moral distress exclusively in ICU nurse practitioners.