Decide Now! A Qualitative Study on Intensive Care Nurses' Moral Distress During Advanced Cardiopulmonary Life Support
Nursing in Critical Care, vol.31, no.4, 2026 (SCI-Expanded, SSCI, Scopus)
- Publication Type: Article / Article
- Volume: 31 Issue: 4
- Publication Date: 2026
- Doi Number: 10.1111/nicc.70536
- Journal Name: Nursing in Critical Care
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Keywords: advanced cardiopulmonary life support, intensive care nurses, moral distress, qualitative study
- Kütahya Health Sciences University Affiliated: Yes
Abstract
Background: Intensive care nurses sensitive to the physical and emotional needs of their patients who are vulnerable during advanced cardiopulmonary life support may experience moral distress when they cannot act in situations they consider morally and ethically correct. Aim: This study aimed to determine the moral distress experienced by intensive care nurses during advanced cardiopulmonary life support and the contextual factors leading to this distress. Study Design: A qualitative, descriptive study using semi-structured interviews was conducted. This study was conducted with 21 nurses who had worked in an adult intensive care unit for at least 1 year and had experience attending advanced cardiopulmonary life support. Data were collected between November and December 2023. Data were evaluated using the content analysis method. Consolidated Criteria for Reporting Qualitative was used for reporting this study. Findings: The following three themes and eight sub-themes were identified: (i) decisions in resuscitation, (ii) disorganization within the organization and (iii) person-centred care. Conclusions: Intensive care nurses sensitive to their patient's physical and emotional needs often experience moral distress for many reasons during the advanced cardiopulmonary life support process. Intensive care nurses experience moral distress during advanced cardiopulmonary life support due to lack of knowledge, legal obligations, organizational problems, inadequate teamwork and equipment and inadequacies in person-centred care. Relevance to Clinical Practice: Intensive care nurses frequently experience moral distress due to the nature of intensive care. However, information on the moral stress they experience during one of the most critical moments, the Advanced Cardiopulmonary Life Support (ACLS), is limited. In order to decrease the moral distress of nurses, regular training should be planned in which case studies are discussed and supported by ACLS simulations. Furthermore, a healthy working environment where intensive care nurses can comfortably share and resolve the moral distress that they experience during ACLS.