Moral distress in emergency nurses: a qualitative systematic review and meta-synthesis protocol

Moral distress is a significant challenge in contemporary nursing practice, posing a substantial threat to nurses' well-being and patient safety. Nurses in the emergency department are considered a high-risk group for experiencing this distress due to their unique working environment. Although numerous qualitative studies have explored this issue, a systematic synthesis of this fragmented evidence is notably absent. This qualitative meta-synthesis aims to integrate existing evidence to construct a comprehensive conceptual framework of the experiences, processes and coping mechanisms related to moral distress among emergency nurses.

This study will be a qualitative systematic review and meta-synthesis, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and the Joanna Briggs Institute (JBI) methodology. A systematic search will be conducted in international and Chinese databases, including PubMed, CINAHL, Embase, CNKI, etc. All peer-reviewed qualitative studies exploring the first-person experiences of emergency nurses will be included. Two independent reviewers will perform study selection, data extraction and methodological quality appraisal using the JBI Critical Appraisal Checklist for Qualitative Research. Data synthesis will employ a theory-integrated meta-aggregation approach, systematically mapping findings onto the Stress, Appraisal, and Coping Theory to construct a nuanced conceptual framework that explains the dynamic process of moral distress. Confidence in the synthesised findings will be assessed using the ConQual approach.

As this study is a secondary analysis of published data, ethical approval is not required. The findings will be disseminated through publication in a peer-reviewed journal and presentations at academic conferences.

CRD420251041396.