Examination Date

2026

Degree

Dissertation

Degree Program

Nursing (PhD)

Examination Committee

Gloria Giarratano PhD, APRN, CNS, FAAN; Marie Adorno, PhD, APRN, CNS, RNC-MNN, CNE; Laura S. Bonanno, PhD, DNP, CRNA, F AANA, FAAN, CNE; Mary D. Ramos, PhD, RN, CNE, FAAN; Linda M. Ledet, DNS, APRN, PMHCNS-BC; Elizabeth G. Epstein, PhD, RN, HEC-C, FAAN

Abstract

Background: Moral distress occurs when nurses recognize the ethically appropriate action but are unable to act due to internal or external constraints. The sources of moral distress vary by clinical context and are shaped by individual and organizational factors. Maternity nurses may be particularly vulnerable because pregnancy and childbirth involve ethically complex, high-stakes decision-making that affects both patients in the maternal-fetal dyad.

Purpose: This phenomenological qualitative study aimed to describe and interpret the lived experiences of maternity nurses who encounter moral distress in inpatient antenatal and intrapartum settings. By focusing on practice situations that contribute to moral distress, this study sought to generate foundational knowledge to better understand its impact on nurses and patient care and to inform future mitigation strategies.

Study Method: A hermeneutical phenomenological approach was used to explore the lived experiences of 14 maternity nurses. Participants were recruited through purposive sampling from multiple regions across the United States using social media platforms. Individual interviews were conducted via Zoom, audio-recorded, transcribed verbatim, and analyzed using van Manen’s human science framework.

Results: Analysis revealed four primary themes (1) ethical and professional duty, (2) obstacles/hurdles in practice resulting in moral distress, (3) far-reaching consequences of moral distress, (4) addressing moral distress in meaningful ways. Sixteen subthemes, supported by rich participant narratives, provided deeper insight into how maternity nurses experience and interpret moral distress in their practice.

Conclusion: Maternity nurses caring for the maternal-fetal dyad experience unique ethical challenges and root causes of moral distress. Participants described a strong sense of ethical responsibility, particularly regarding advocacy, within a highly complex care environment. Consistent with existing literature, contributing factors include power imbalances, structural and system-level barriers, and staffing challenges as key contributing factors, alongside emotional, physical, and professional consequences. Despite these difficulties, nurses demonstrated resistance and perseverance and identified strategies to mitigate moral distress. Further research is needed to clarify how moral distress manifests in maternity care and to guide effective interventions.

Comments

The attached documents have been formatted to meet PDF/UA v1 - ISO 14289-1 2014 accessibility compliance standards. Please contact DigitalScholar@lsuhsc.edu if further assistance is needed.

Additional Files
Patterson signatures.pdf (202 kB)
Patterson signature page
Download

Share

COinS