Nurses’ Lived Experiences of Moral Outrage With Co-Occurring Moral Distress: A Hermeneutic Phenomenological Study Publisher



Shahmari M ; Jafari M ; Nourani S ; Dashti S ; Nasrabadi A N
Source: Nursing Forum Published:2026

Abstract

Background: Nurses face significant ethical challenges that are crucial for providing quality care while maintaining ethical standards. Understanding their experiences of moral outrage is vital, particularly as moral distress frequently co-occurs in clinical practice. This study aimed to explore nurses’ lived experiences of moral outrage and its co-occurrence with moral distress. Methods: This qualitative study employed a hermeneutic phenomenological approach. Data were collected through semistructured interviews with 22 nurses from different clinical departments. Participants were selected through purposive sampling, and the data were analyzed following the hermeneutic method of Diekelmann et al., with Wilkinson’s (1987–88) framework applied as a supporting clarification tool to distinguish between moral outrage and moral distress where they co-occurred. Findings: One main theme “Bitter Experiences: In Search of Light in Darkness” and six subthemes (Bitter Sense of Helplessness, Storm at Sea, Deep Wounds, Narrow Cage, Fire in a Barren Garden, and Dark Tunnel) emerged. Nurses described profound helplessness and emotional suffering arising from systemic injustices and resource constraints. Moral distress was dominant in situations involving personal participation and constraint (e.g., understaffing), while moral outrage primarily arose from witnessing injustices and unethical behaviors. These two phenomena frequently co-occurred and were powerfully illustrated through metaphors of a storm at sea, deep wounds, narrow cage, fire in a barren garden, and dark tunnel. Conclusion: Nurses experience moral outrage intertwined with moral distress stemming from workplace pressures and systemic injustices. These phenomena may negatively affect nurses’ mental health and patient care quality. Organizational support and structural changes are essential to address both. Copyright © 2026 Mehraban Shahmari et al. Nursing Forum published by John Wiley & Sons Ltd.