Moral Injury and Coping Mechanisms among Critical Care Nurses at The Nairobi Hospital, Nairobi County, Kenya

Abstract

Moral injury, defined as the psychological distress arising from actions or inactions that violate an individual's moral or ethical beliefs, has become an increasingly critical concern in healthcare, particularly among critical care nurses. These professionals often find themselves in ethically complex and emotionally demanding situations, where institutional constraints, resource limitations, and life-and-death decisions can result in lasting emotional and moral distress. This study aimed to examine the prevalence of moral injury and to explore the coping mechanisms employed by critical care nurses working at The Nairobi Hospital within Nairobi County, Kenya. A mixed-methods research design was employed to provide a comprehensive understanding of the phenomenon. The study targeted a population of 600 critical care nurses, from which a sample of 234 respondents was selected using simple random sampling. Quantitative data were collected using structured questionnaires and analyzed through the Statistical Package for the Social Sciences (SPSS Version 29.0). Descriptive and inferential statistics, including one-way ANOVA and Pearson correlation, were used to examine the relationships between levels of moral injury and coping strategies. Qualitative data was obtained through semi-structured interviews and open-ended survey questions, and analyzed thematically using NVivo software. The findings revealed that 76.6% of participants experienced moderate to high levels of moral injury, highlighting its widespread presence within critical care settings. Nurses predominantly utilized problem-focused and emotion-focused coping strategies, while avoidant coping was less frequently reported. A significant positive correlation was observed between emotion-focused coping and moral injury levels, indicating that while nurses attempt to regulate emotions, these strategies may not fully mitigate the psychological impact of moral distress. Qualitative insights reinforced these findings, with participants describing feelings of guilt, helplessness, emotional fatigue, and the internalization of moral conflict, often in the absence of adequate organizational support.This study underscores the urgent need for institutional interventions that foster ethical support systems, promote psychological resilience, and provide safe spaces for emotional and moral reflection. The insights generated are expected to contribute to both academic literature and practical policy-making, with the goal of enhancing the well-being of critical care nurses