Moral Distress: A Qualitative Study of Emergency Nurses

Although many nursing studies have focused on moral distress, very few have looked at moral distress and emergency nurses despite the fact that this group works in stressful, fast-paced environments that often involve situations that can lead to moral distress.

The goals of this qualitative study are to determine how emergency nurses define moral distress, describe the experiences of moral distress by emergency nurses and its impact, and identify possible strategies to combat moral distress.

This study used a phenomenological qualitative design. A convenience sample was used and included 8 registered nurses from 3 different emergency departments in a midsized urban county in the South Central United States. A structured open-ended interview technique was used.

Four major themes were identified: (1) there was no face of the family, (2) asking God for forgiveness, (3) flipping the switch, and (4) it changes who we are.

Nurses in this study all reported experiencing moral distress. Sources of moral distress identified included patient advocacy issues, professional behavior of other health care professionals, internal conflicts with what they perceived to be the right thing to do and that which was asked of them, and guilt over their own feelings about patient care. These nurses described effective and ineffective coping mechanisms.