The Weight of Responsibility: Understanding the Lived Experience of Moral Distress Among General Ward Nurses in Providing End-of-Life Care

Moral distress is a pervasive yet often overlooked challenge facing nurses providing end-of-life care, particularly in general ward settings designed primarily for curative and acute recovery rather than comfort and palliative support. This qualitative phenomenological study explored the lived experiences of eight (8) general ward nurses at a Level 2 hospital in San Jose Del Monte, Bulacan, focusing on their perception and navigation of the cumulative “ weight of responsibility” arising from ethical conflicts and systemic constraints. Grounded in Heideggerian hermeneutics, Jameton’s concept of moral distress, and Watson’s Theory of Human Caring, data were collected via semi-structured interviews and analyzed using phenomenology methods. Six (6) major themes emerged: the general ward as an environment of constant pressure; conflict between professional ideals and systemic limitations; moral distress as a tangible burden; eroded autonomy and struggles for advocacy; personal and professional impacts of cumulative distress; and resilience shaped by Filipino values, faith and purpose. Findings reveal moral distress stems primarily from institutional barriers - unfavorable staffing, resource scarcity, hierarchical decision-making- rather than lack of competence. Values such as malasakit both deepen nurse’s sense of duty and sustain their endurance. The study concludes individual coping is insufficient to address cumulative moral residue; meaningful change requires structural reform, shared decision-making and institutional support. Recommendations include policy adjustments, enhanced palliative and ethics training, and formal advocacy and wellness frameworks to uphold professional integrity and dignified end-of-life care.