Moral disengagement in critical care nurses: a conventional content analysis.

Background: Given the high-stakes environment of intensive care units, understanding how nurses navigate moral challenges and engage in ethical decision-making is critical for maintaining patient safety and care quality. One important process in this field is moral disengagement, which is growing in the nursing literature. However, there is a lack of foundational and qualitative studies addressing this issue. This study presents a qualitative content analysis aimed at exploring moral disengagement among nurses working in intensive care units.

Method: This qualitative study employed conventional content analysis from June to December 2024 in Tehran, Iran. Purposive sampling was used to recruit participants. Data were collected using in-depth, unstructured interviews at the beginning, followed by semi-structured interviews. Sampling continued until data saturation was reached, resulting in 30 interviews with 25 eligible intensive care unit nurses. The conventional qualitative content analysis approach developed by Graneheim and Lundman was employed.

Results: Three main categories with eight subcategories were identified from the initial 765 codes. The findings revealed three main categories: "cognitive justification of unethical behavior," "protective strategies for personal security," and "normalization of unconventional practices." These categories include subcategories such as "externalization of responsibility," "moral-cognitive justification," "positive reframing of the event," "preservation of job position and security," "psychological stabilization," "strategic violation of regulations for survival," "reduction of emotional and psychological pressure," and "protective framing of behavior."

Conclusion: This study reveals various aspects of moral disengagement among critical care nurses, which can pave the way for future studies to better understand the phenomenon, its related factors, and help with the development of preventive measures.