{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T12:41:05Z","timestamp":1792845665618,"version":"4.5.0"},"reference-count":46,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Use of physical restraints in intensive care units (ICUs) creates ethical challenges for nurses and often causes moral distress as they balance patient safety with autonomy and dignity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research aim<\/jats:title>\n                    <jats:p>To explore Iranian ICU nurses\u2019 experiences of moral distress related to decisions about PR use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design<\/jats:title>\n                    <jats:p>An exploratory qualitative approach was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and research context<\/jats:title>\n                    <jats:p>Twenty Persian-speaking ICU nurses with at least two years\u2019 clinical experience were purposively recruited from hospitals affiliated with Shahid Beheshti University of Medical Sciences between September 10 and November 14, 2025. In-depth semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed using Elo and Kyng\u00e4s\u2019s three-phase content analysis. Trustworthiness was ensured via Lincoln and Guba\u2019s criteria of credibility, dependability, confirmability, and transferability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethical considerations<\/jats:title>\n                    <jats:p>Approved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences (IR.SBMU.RETECH.REC.1404.397). Written informed consent and reconfirmed verbal consent were obtained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Analysis generated 323 initial codes; 201 remained after refinement. Two principal categories emerged: (1) Moral suffering in clinical decision-making\u2014ethical conflicts, negative emotions, consequences for the patient, and for nurses; and (2) Adaptation and efforts to reduce moral distress\u2014contextual factors, coping strategies, and suggestions for reducing moral distress. Participants described emotional exhaustion, guilt, reduced motivation, and compromised quality of care. Key contributing factors included staff shortages, workload pressure, and unilateral physician orders. Coping strategies comprised peer support, temporary distancing from the situation, and spiritual or self-soothing practices. Suggestions for reducing moral distress emphasized education on restraint alternatives, clear clinical guidelines, and strengthened interprofessional decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Moral distress related to PR use among ICU nurses stems from tensions between patient safety and dignity and is shaped by organizational and contextual factors. While nurses described individual strategies to cope, organizational support, clearer guidance, and collaborative decision-making may reduce ethical burden. Further research should examine applicability in other clinical and cultural contexts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09697330261428625","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T13:22:48Z","timestamp":1773235368000},"page":"1363-1383","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["ICU nurses\u2019 moral distress in decisions to implement physical restraints"],"prefix":"10.1177","volume":"33","author":[{"given":"Sogand","family":"Sarmadi","sequence":"first","affiliation":[{"name":"Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0014-7104","authenticated-orcid":false,"given":"Akbar","family":"Zare-Kaseb","sequence":"additional","affiliation":[{"name":"Shahid Beheshti University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neda","family":"Sanaie","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fariba","family":"Borhani","sequence":"additional","affiliation":[{"name":"Shahid Beheshti University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14435"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S455910"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16528"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2020.103856"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-024-02739-6"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.25259\/IJPC_227_2023"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.17041"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2025.101210"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.5005\/jp-journals-10071-24103"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1606359"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jointm.2023.11.005"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202006-738OC"},{"issue":"5","key":"e_1_3_6_14_2","doi-asserted-by":"crossref","first-page":"372","DOI":"10.5005\/jp-journals-10071-24458","article-title":"Factors affecting the use of physical restraints by nurses for patients in intensive care units","volume":"27","author":"Shakeri B","year":"2023","unstructured":"Shakeri B, Vatandost S, Nouri B, et al. 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