Moral Distress among Palliative Care Nurses; Exploring Causes and Coping Strategies : a descriptive literature review

Abstract

This research was conducted to investigate moral distress among registered nurses working in palliative and end-of-life care settings, and to recognize the coping strategies that help nurses' well-being and professional practice, thus ensuring the sustainability of palliative nursing.

The study was conducted through a descriptive literature review. A systematic search was done in CINAHL and PubMed databases using keywords and Boolean operator arranged following the PICO framework. Criteria included peer-reviewed nursing research published in English between 2020-2025, and in the area of palliative care settings. Upon reviewing titles, abstracts, and full text, 12 studies were selected for inclusion. The data was sorted using inductive content analysis to pull out themes in the events of moral distress and coping strategies among nurses.

The study results indicate moral distress generally takes place when nurses, due to various institutional factors, are unable to act according to their professional values such as ethical conflicts, high workloads, communication problems with families, and interdisciplinary teams. Nurses spoke of feeling such emotions as guilt, frustration, and failure. In addition, the results showed that the nurses' coping strategies consisted of peer support, self-reflection, ethical consultation, and collaborative communication.

The results indicate that avoiding moral distress needs support not only from the individual but also from the institution. Enhancing ethical debate, increasing teamwork among colleagues, and establishing formal support systems will help nurses to stay healthy and thus ensure the continued high standard of palliative care.