Parental Dimensions of Moral Outrage in Pediatric Nursing: Challenges, Consequences, and Opportunities for Support

Background: Moral outrage in pediatric nursing arises when nurses confront ethical conflicts that undermine their professional integrity. Parental-related issues are a central source of such experiences, as nurses navigate between respecting caregivers' perspectives and ensuring safe, evidence-based care for children. While moral outrage often results in distress and reduced quality of care, it can also contribute to resilience and professional advocacy if adequately supported. Methods: This study adopted a mixed-methods design. In the qualitative phase, semi-structured interviews were conducted with pediatric nurses to capture experiences of moral outrage triggered by parental interactions. Data were analyzed thematically to identify recurring patterns. In the quantitative phase, a structured survey incorporating validated measures of moral distress, burnout, resilience, and professional quality of life was distributed to a broader sample. Statistical analyses, including descriptive and regression tests, were performed to examine associations between parental triggers, moral outrage, and professional outcomes. Integration of qualitative and quantitative findings provided a comprehensive understanding of the phenomenon. Results: Three key parental dimensions of moral outrage emerged. First, exclusion of parents from decision-making created ethical strain as nurses observed caregivers being marginalized. Second, persistence of misguided or unhealthy parental beliefs, such as rejecting medical advice, conflicted with nurses' professional values and placed children at risk. Third, confusion or disagreement among parents regarding treatment goals intensified moral tension and complicated care delivery. Quantitative findings confirmed significant associations between these parental triggers and negative outcomes including burnout, emotional exhaustion, and moral depletion. However, integration of both data sources revealed that moral outrage, when addressed through organizational support, ethics consultation, and resilience-building programs, could enhance professional commitment, strengthen altruistic motivation, and reinforce nurses' advocacy for vulnerable patients. Conclusion: Parental-related dynamics - including exclusion from decisions, harmful beliefs, and treatment-related confusion - are major contributors to moral outrage in pediatric nursing. Although prolonged exposure to these triggers leads to burnout and ethical disillusionment, a mixed-methods analysis demonstrates that with appropriate institutional support, moral outrage can be transformed into a constructive force for resilience and advocacy. These findings underscore the importance of integrating ethical support frameworks and communication strategies that address the unique parental dimensions of moral outrage, thereby protecting nurses' well-being, sustaining pediatric care quality, and supporting long-term workforce stability.