Exploring the Phenomenon of Moral Distress Among Critical Care Nurses in Nigeria: A Hermeneutic Phenomenological Investigation

Background: Moral distress arises when nurses are unable to take actions they believe are ethically correct due to institutional, authority, or resource constraints. Despite its documented impact on nursing wellbeing and care quality, the phenomenon remains unexplored in Nigerian critical care contexts. Aim: This study explored the lived experience of moral distress among critical care nurses in Nigeria, drawing on sites in Lagos, Abuja, and Kano. Methods: A hermeneutic phenomenological design by van Manen was applied. Thirty-two purposively selected nurses with at least two years of ICU experience participated in conversational in-depth interviews. Data were interpreted through iterative hermeneutic reading cycles. Results: Five essential themes were identified: constrained advocacy in resource-depleted environments, witnessing futile care, complicity in inadequate pain management, silence as institutional survival, and resilience through moral community. Participants described a pervasive tension between professional duty and institutional limitation. Conclusion: Moral distress is a profound and structurally embedded experience in Nigerian critical care nursing. The study advocates for ethics committee establishment, nurse moral advocacy frameworks, resource allocation reform, and nurse psychological support programmes to mitigate its consequences. Keywords: moral distress, critical care nursing, hermeneutic phenomenology, Nigeria, nursing ethics.