Ethical Challenges and Moral Distress Among ICU Nurses During the COVID-19 Pandemic: Contributing Factors, Consequences, and Coping Strategies

Abstract

Background: The COVID-19 pandemic has significantly heightened the prevalence of moral distress among intensive care unit (ICU) nurses. Moral distress occurs when nurses face ethical conflicts but are unable to act in alignment with their professional or personal values due to external constraints. These situations, such as resource scarcity, ethical dilemmas, and emotional fatigue, have deeply impacted nurses' psychological health, professional performance, and the quality of patient care. Despite its widespread occurrence, there is limited research on the specific drivers, consequences, and mitigation strategies for moral distress in pandemic ICU settings.

Aim: This paper aims to examine the experiences of ICU nurses with moral distress during the COVID-19 pandemic, focusing on contributing factors, the broader impacts on healthcare delivery, and the effectiveness of coping mechanisms and institutional responses.

Methods: A mixed-methods design was used to analyze moral distress, synthesizing data from qualitative interviews, large-scale surveys, and peer-reviewed literature. Data were extracted from nursing-focused journals and healthcare databases, with thematic coding employed to identify recurring patterns across sources.

Results: Ethical challenges, such as end-of-life decisions, resource rationing, and care prioritization, were identified as primary contributors to moral distress. Systemic issues, including staff shortages, lack of institutional support, and prolonged emotional strain, compounded its severity. Nurses employed coping strategies such as mindfulness, peer support, and team-based decision-making, but their efficacy was often limited by systemic barriers. Findings underscore the importance of organizational support and policy reforms in mitigating moral distress.

Conclusion: Moral distress among ICU nurses is a pervasive issue requiring urgent, multi-level interventions. Addressing moral distress through targeted support and systemic change is essential for ensuring nurse well-being, healthcare sustainability, and quality patient outcomes.