Contributing and protecting factors to moral distress : A qualitative study amongst nurses meeting patients with HIV/AIDS in primary healthcare in Swaziland

Abstract: Background: Swaziland, a country in Sub-Saharan Africa, with an HIV prevalence of 26 % amongst 15-49 year olds. The nurses work conditions are heavily affected by the high prevalence of HIV/AIDS and of the increasing workload. Moral distress can have implications on the nurse’s social, physical, emotional and psychological wellbeing and can also serve as a wake-up call in morally questionable situations. Aim: To describe moral distress among nurses working with people living with HIV/AIDS in Swaziland. Method: A qualitative semi-structured interview study was carried out at two health clinics in Swaziland. Five nurses who in their daily work interact with patients living with HIV/AIDS were interviewed. Data was analysed using content analysis with an inductive approach as presented by Elo and Kyngäs. Results: The results were divided into two main themes of contributing and protecting factors. Contributing factors were: strain of heavy workload and shortages, powerless over ones work situation, guilt over not doing enough, expectations on being the perfect nurse and work not being recognised. Protecting factors were: providing beneficial care brings meaning and having a supportive and appreciative work environment. Discussions: The results of the study are reviewed in the light of the lifeworld perspective theory. Nurses’ sense of identity is discussed as well as experiences of high expectations, powerlessness and protecting factors such as meaningfulness and peer support.