Moral Distress Experienced by Nurses Involved in End-of-Life Care in the Intensive Care Units of Academic Affiliated, Tertiary/Quaternary Specialist Public Hospital in the Johannesburg Region

Wednesday, 24 July 2013: 1:30 PM

Gayle Cartland Langley, PhD
Department of Nursing Education, University of the Witwatersrand, Johannesburg, South Africa

Learning Objective 1: Discuss the moral distress experienced by intensive care nurses in South African academic, urban public hospitals and compare this with their own practice context

Learning Objective 2: Describe how this distress is manifested physically, psychologically, professionally and socially and how it is managed


The purpose of this study was to elicit ICU nurses’ perspectives of the clinical situations in Johannesburg’s urban, academic public hospitals which evoke moral distress; the consequences thereof and means they employed to manage their distress. 

HREC no. M 10525.


A short survey /interview guide, derived from Corley, Elswick, Gorman and Clor’s extensively used and validated “Moral Distress Scale” (Corley et al, 2001),  requiring narrative descriptions and explanations was distributed to registered nurses  (N= 100, n=100) in trauma, general medical and surgical and cardio-thoracic ICUs in  tertiary, academic hospitals in Johannesburg.  Data were triangulated by augmenting the information recorded from focus group discussions. 


Experiences of the situations, many engendered by perceived morality of the treatment and decisions made, as well as participants’ reactions and subsequent actions are described.  The findings are compared with those described in the international literature.


South Africa’s health system is complex displaying diverse disease patterns: acute and infectious diseases, high maternal and child mortality, non-communicable diseases and violence and injuries often exacerbated by patients’ HIV status (McNeilly, 2011).  these contextual issues impact upon and influence nurses and nursing care in intensive care units.