A cross-sectional exploration of emergency department nurses' moral distress, ethical climate and nursing practice...

Moral distress is a common phenomenon among nurses that leads to physical and emotional problems and affects job retention, job satisfaction, and quality of care.

To explore relationships between moral distress, ethical climate, and nursing practice environment among a sample of ED nurses and determined significant predictors of moral distress in organizational environments.

A cross-sectional descriptive and correlational survey was performed on 237 nurses in emergency departments (EDs) from five hospitals in Taiyuan, mainland China.

Statistically significant negative and moderate correlations were found between the level of moral distress and ethical climate for the overall evaluation and 10 subscale scores and the overall evaluation of the nursing practice environment. The nurse-physician collaboration, ethical climate, and monthly income were statistically significant predictors of the level of moral distress (change in R² = 17.9%, 5.5%, and 5.6%, respectively).

Perceptions of a more positive ethical climate and healthier nursing practice environment resulted in lower moral distress levels experienced by ED nurses. Poor nurse-physician collaboration is a pivotal factor accounting for ED nurses' moral distress.