• Melissa Burton, Hollis Caswell, Courtney Porter, Sandra Mott, and Michele DeGrazia.
• Melissa Burton, RN, CCRN, is staff nurse II at the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, Boston, MA. Hollis Caswell, MS, RN, CCRN, is lecturer at Sandra R. Berman School of Nursing and Health Professions, Stevenson University, Owings Mills, MD. Courtney Porter, MPH, CPHQ, is program administrative manager III of Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, Boston, MA. Sandra Mott, PhD, CPN, RN-BC, is nurse scientist, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, Boston, MA. Michele DeGrazia, PhD, RN, NNP-BC, FAAN, is director of nursing research, Neonatal Intensive Care Unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor at the Department of Pediatrics, Harvard Medical School, Boston, MA.
• Dimens Crit Care Nurs. 2020 Mar 1; 39 (2): 101-109.

Background/IntroductionDespite a growing population of chronically and acute critically ill neonatal and pediatric patients, there were few published articles related to moral distress as experienced by nurses caring for these patients.Objectives/AimsThe aim of this study was to define moral distress based on the perceptions and experiences of neonatal and pediatric critical care nurses.MethodsA qualitative descriptive study using focus group methodology was undertaken. All nurses with 2 or more years of experience from the 4 neonatal and pediatric intensive care units in a large 404-bed urban pediatric hospital located in the northeast were invited to attend 1 of 15 audio-recorded focus groups lasting 60 to 90 minutes. Once data were transcribed, conventional content analysis was used to develop the definition and categories of moral distress.ResultsNurse participants defined moral distress as "patient care situations where there is a mismatch or incongruity between expected behaviors of the nurse and his/her personal values/beliefs in the neonatal/pediatric critical care setting." The 2 overarching categories that emerged from the data were patient-focused factors and nurse-focused factors.Discussion/ConclusionsUnderstanding how neonatal and pediatric critical care nurses define moral distress and what contributes to its development is foundational to developing targeted strategies for nursing support and education, with the goal of creating a culture of moral resiliency.

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