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bioethics, culture, end-of-life issues, ethics, moral distress, nurses, nursing



  1. Bressler, Toby PhD, RN, OCN
  2. Hanna, Debra R. PhD, RN, ACNS-BC
  3. Smith, Elizabeth MS, RN, PMHCNS-BC, CHPN


The aim of this study was to explore nurses' experiences working on a chronic ventilator-dependent unit with a predominance of elderly Orthodox Jewish patients at the end of life. Little is known about how cultural complexity creates differences between nurses' and family's expectations for patient care at the end of life. A qualitative study of 27 nurses was conducted using focus groups. Early interviews led to the expansion of the original question to include exploring nurses' moral distress. Content analysis revealed 3 categories of themes, one of which is highlighted in this article. The main finding was an incongruence of perspectives, described as depth-of-field dissimilarity, in which the focus and depth of perspective depend on the person doing the looking. This study suggests that depth-of-field dissimilarity can be used to develop educational strategies, clinical interventions, and research to address moral distress and cultural complexity.