Experiences of moral distress in nursing students - A qualitative systematic review

Abstract

Objectives: The review aims to synthesize and consolidate the factors and situations in which student nurses experience moral distress during their clinical practice and its potential implications for patient care and outcomes.

Design: A qualitative systematic review.

Data sources: The articles were sourced from PubMed, Embase, CINAHL, Scopus, PsycInfo, Web of Science, ERIC (ProQuest), and ProQuest Dissertations and Theses Global Database between their inception dates to December 2022. Reference lists of included studies were also screened for additional studies.

Review methods: Published and unpublished primary studies of any qualitative research methods focused on student nurses' experiences of moral distress regardless of their education level were included in this review. Two reviewers independently screened titles and abstracts, assessed full-text articles for eligibility, extracted data, and appraised the quality of included studies. Sandelowski and Barroso's (2007) two-step meta-synthesis approach and Braun and Clarke's (2006) thematic analysis framework were used to analyze and interpret findings from included studies.

Results: Seven studies met the inclusion criteria and were included in the review. The meta-synthesis revealed an overarching theme, "Moral Distress and its Intertwined Roots". This was supported by the four main themes: 1) Inadequacy and lack of autonomy, 2) Unprofessionalism of healthcare professionals, 3) Differing cultural views and values of patients and their relatives, and 4) Healthcare needs versus resource constraints.

Conclusion: This review highlights the experiences of student nurses in situations of moral distress, including feelings of inadequacy and powerlessness when faced with ethical challenges, and the negative impact of resource constraints, unprofessional behavior, and cultural differences. Collaborative efforts between healthcare professionals and student nurses are needed to promote shared decision-making, prioritize ethical training, and provide culturally sensitive care to address these challenges and ultimately improve patient care.

Keywords: Experiences; Moral distress; Nursing students; Qualitative research; Systematic reviews.