Commentary: Moral distress experienced by neonatal intensive and paediatric care nurses in Northern Ghana: a qualitative study

Moral distress is a fundamental ethical issue facing the nursing profession (Barlem and Ramos, 2015). Since first characterised in the 1980s, moral distress has been reconceptualised, redefined and researched extensively in a variety of settings and countries within the field of nursing (Oh and Gastmans, 2015). The authors of this paper examined moral distress as experienced by nurses working in neonatal intensive care units (NICU) and paediatric wards in Northern Ghana. Although moral distress has been studied in paediatric care and NICU nurses, this study is unique in that it is conducted in a developing economy. From my perspective, the disparity of the resources and the circumstances in which nurses in Northern Ghana practise as described in this paper, versus that of developed economies, is remarkable. That, and the resiliency of the nurses who participated in the study.

In my research of moral distress and review of the literature of studies conducted in the United States and other Western countries, the causes of moral distress are thematically consistent. Lack of institutional support, staff shortages and issues with physicians and administration are frequently described (Oh and Gastmans, 2015). While this study identified themes consistent with those conducted in developed economies, it is significant that many of the specific morally distressing situations and challenges that the nurses in Northern Ghana encounter on a daily basis are vastly different. For instance, staff shortages and workload issues are commonly reported causes of moral distress in the United States and other Western countries (Oh and Gastmans, 2015). Nurse to patient ratios may vary but generally range from 1:1 up to 1:4 in the NICU (Rogowski et al., 2015). In this study, one participant reported that two staff are tasked with managing 50 patients, a number that would be unheard of in a developed economy. Further, while lack of resources and support may be a common thread in moral distress research, the gross insufficiency of means needed to effectively deliver essential nursing care is striking and dramatically impacted the incidence of moral distress in this study.

One noteworthy area of divergence in themes in the literature from developed economies compared to this study is the concern of futility of care, an issue that is often regarded as a primary cause of moral distress in developed economies (Oh and Gastmans, 2015). Nurses complain of having to do too much, use too much advanced technology, and save patients who should not be saved (Prentice et al., 2016). In this study, however, the opposite was true. Participants described often being unable to provide the care needed to keep their patients alive due to lack of basic supplies or medications, religious beliefs of the family or inability of the family to pay for care. Not surprisingly, this led to the experience of moral distress among the nurses interviewed.

This study offers a valuable contribution to the literature on moral distress, specifically as experienced by nurses in developing economies, as well as highlighting the profound challenges faced by the NICU and paediatric nurses in Northern Ghana. Given the circumstances in which they are tasked to practise nursing, including the deficiency of resources needed to deliver appropriate care and the inadequacy of institutional support and teamwork, it is less than surprising that the participants in this study described high levels of moral distress. It is hopeful that this study will be a catalyst for the development of measures to reduce the incidence of morally distressing situations and moral distress in the Northern Ghana region.

Biography

Brandi Showalter currently works at Cizik School of Nursing at UT Health Houston in Houston, Texas working with undergraduate nursing students and is developing a certificate program for Clinical Research Coordinators.