Date of Award

10-13-2025

Degree Type

Thesis

Degree Name

MSc in Nursing

First Advisor

Dr Saleema Gulzar

Second Advisor

Dr. Qalab Abbas

Third Advisor

Ms. Karima Hirani

Department

School of Nursing and Midwifery, Pakistan

Abstract

Introduction: Neonatal and Pediatric Intensive Care Units (NICUs and PICUs) are specialised environments where critically ill infants and children receive life-sustaining treatment. These settings are inherently fraught with complex ethical dilemmas, arising from the vulnerability of the patient population, the intensity of medical interventions, and the often-uncertain prognoses. Thus, nurses, as the frontline caregivers who spend most time with patients and their families, are frequently at the center of these ethical challenges.
Objectives: This research explored nurses' perspectives regarding the ethical dilemmas they faced at a tertiary care facility. Including facilitators and barriers that affect the delivery of patient care.
Method: A qualitative study design was used. Data was collected through semi-structured interviews with a diverse sample of 12 nurses from various departments within a tertiary care facility. Participants were selected through purposive sampling methods to ensure a range of experiences and perspectives. All the interviews were conducted in person, audio-recorded and were analyzed into different themes.
Results: The research participants had a clear definition of ethical dilemmas. Barriers that nurses perceive ethical dilemmas as profound conflicts of values, characterised by uncertainty and emotional distress. These dilemmas are significantly compounded by families' struggles with medical literacy and overwhelming emotional burdens, which are further complicated by cultural and religious contexts. On the other hand, while the interdisciplinary team is seen as a vital resource, its effectiveness is often hampered by internal conflicts, poor communication, and hierarchical power structures. Furthermore, systemic issues, including a pervasive culture of aggressive intervention and severe resource limitations, create a challenging environment where ethical practice is constantly under strain. In response, the participants collectively advocated for a dual approach to improvement: strengthening individual nurses' skills through practical, communication-focused training, while simultaneously building a supportive organisational culture defined by ethically competent leadership, accessible resources, and a genuine commitment to staff well-being.
Conclusions: Currently, in Pakistan, research on ethical dilemmas faced by nurses is very limited. explore the strategies employed by nurses to navigate these dilemmas, potentially informing the development of targeted interventions or support mechanisms. Further, it should be included in the curriculum.

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Last Page

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