Moral distress in nursing has been studied in many settings, but there is a paucity of research on moral distress as it manifests in the emergency department. One study suggests a correlation between moral distress and aspects of burnout, and other researchers report that nurses have considered leaving their position or even their profession because of moral distress. Further exploration of these issues may provide insight into their effects on ED patient care and the emergency nursing profession. The purpose of this study was to explore the nature of moral distress as it is experienced and described by emergency nurses.
A qualitative, exploratory design was employed using semi-structured focus groups for data collection. Using an iterative process, transcripts were analyzed for emerging themes by the research team. Six researchers analyzed the transcripts using a thematic analysis approach.
Themes from the data included dysfunctional practice arena, being overwhelmed, and adaptive/maladaptive coping. Participants described, overall, a profound feeling of not being able to provide patient care as they wanted to.
Causes of moral distress in emergency nurses are environment driven, not incident driven, as is described in other settings, and include a high-acuity, high-demand, technical environment with insufficient resources. Interventions should be targeted to improve environmental factors that contribute to the moral distress of emergency nurses. Future research should focus on the development and validation of an instrument to measure moral distress in this setting.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Nursing
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Nursing Practice: The Ethical Issues.Prentice-Hall, Englewood Cliffs, NJ1984
- Development and evaluation of a moral distress scale.J Adv Nurs. 2001; 33: 250-256
- ‘Moral distress’—time to abandon a flawed nursing construct?.Nurs Ethics. 2015; 22: 5-14
- How professional nurses working in hospital environments experience moral distress: a systematic review.Crit Care Nurs Clin North Am. 2012; 24: 91-100
- To what extent do nurses and physicians working within the emergency department experience burnout: a review of the literature.Australas Emerg Nurs J. 2006; 9: 57-64
- Nurses’ moral sensitivity and hospital ethical climate: a literature review.Nurs Ethics. 2008; 15: 304-321
- Moral distress of staff nurses in a medical intensive care unit.Am J Crit Care. 2005; 14: 523-530
- Moral distress in emergency nurses.J Emerg Nurs. 2013; 39: 547-552
- Emergency Medical Treatment and Labor Act (EMTALA).Updated March 26, 2012. Accessed August 14, 2015)
- Moral distress: a living nightmare.J Emerg Nurs. 2010; 36: 253-255
- Moral distress among nurses.J Emerg Nurs. 2014; 40: 4
- Crabtree BF Miller WL Doing Qualitative Research. 2nd ed. Sage, Thousand Oaks, CA1999
- The Discovery of Grounded Theory: Strategies for Qualitative Research.Aldine De Gruyter, New York, NY1967
- An integrated, ethically driven environmental model of clinical decision making in emergency settings.Int J Nurs Knowl. 2013; 24: 49-53
- Dilemmas of moral distress: moral responsibility and nursing practice.AWHONNS Clin Issues Perinat Womens Health Nurs. 1993; 4: 542-551
- Development and testing of an instrument to measure moral distress in healthcare professionals.AJOB Prim Res. 2012; 3: 1-9
- Frequent emergency department utilization and behavioral health diagnoses.Nurs Res. 2015; 64: 3-12
- US emergency nurses’ perceptions of challenges and facilitators in the management of behavioural health patients in the emergency department: a mixed-methods study.Australas Emerg Nurs J. 2015; 18: 138-148
- Moral residue.in: Rubin SB Zoloth L Margin of Error: The Ethics of Mistakes in the Practice of Medicine. University Publishing Group, Hagerstown, MD2000
- Working in an overcrowded accident and emergency department: nurses’ narratives.Aust J Adv Nurs. 2007; 25: 21-27
- Moral distress, moral residue, and the crescendo effect.J Clin Ethics. 2009; 20: 330-342
- Moral distress: recognizing it to retain nurses.Nurs Econ. 2007; 25: 217-221
- Preventing ethics conflicts and improving health care quality through system redesign.Qual Saf Health Care. 2010; 19: 526-530
- Understanding and addressing moral distress.Online J Iss Nurs. 2010; 15 (http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Courage-and-Distress/Understanding-Moral-Distress.html. Accessed August 14, 2015)
- Nietzsche for nurses: caring for the Übermensch.Nurs Philos. 2000; 1: 147-157
Lisa A. Wolf, Member, Pioneer Valley Chapter, is Director, Institute for Emergency Nursing Research, Emergency Nurses Association, Des Plaines, IL.
Cydne Perhats is Senior Associate, Institute for Emergency Nursing Research, Emergency Nurses Association, Des Plaines, IL.
Altair M. Delao is Senior Associate, Institute for Emergency Nursing Research, Emergency Nurses Association, Des Plaines, IL.
Michael D. Moon, Member, San Antonio Chapter, is Associate Professor, University of the Incarnate Word, San Antonio, TX.
Paul R. Clark, Member, Kentuckiana Chapter, is Assistant Professor, University of Louisville School of Nursing, Louisville, KY, and System Educator, Norton Healthcare Institute for Nursing, Louisville, KY.
Kathleen E. Zavotsky, Member, West Central New Jersey Chapter, is Director, Nursing Research, Advanced Practice and Education, Robert Wood Johnson University Hospital, New Brunswick, NJ.
Published online: September 27, 2015
Earn Up to 9.0 CE Hours. See page 94.
© 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Comment on “It’s a Burden You Carry”: Describing Moral Distress in Emergency NursingJournal of Emergency NursingVol. 42Issue 3