A qualitative study on emergency department nurses' experiences of coping with moral distress based on self-efficacy...

Grounded in Bandura's self-efficacy theory, this study aims to identify the key factors influencing how emergency department (ED) nurses cope with moral distress, providing an evidence base for targeted interventions to enhance their coping capacity and psychological well-being.

A qualitative descriptive design was adopted. Between November and December 2025, 17 ED nurses from a tertiary general hospital were recruited through purposive sampling with maximum variation. One-to-one semi-structured interviews were conducted and analyzed using thematic framework analysis. To enhance trustworthiness, the data were independently coded by two researchers, and peer debriefing and an audit trail were employed.

Four main themes and 10 subthemes emerged from the analysis. ED nurses' coping self-efficacy is influenced by both personal confidence and the social context surrounding ethical decision-making. Participants described recurrent tensions between institutional rules and humanitarian care, triage dilemmas arising from staff and equipment shortages, and defensive practice following complaints, disciplinary action, or workplace violence. Self-efficacy was further influenced by the availability of collegial discussion, senior guidance, and managerial recognition, as well as by a perceived lack of empathy among peers. Nurses also reported that disgust, emotional exhaustion, and value conflict undermined their willingness and confidence to sustain care, whereas indirect exposure to colleagues' traumatic experiences reinforced self-protective boundaries. The most frequently reported subtheme was value conflict and emotional exhaustion (76.5%), followed by conflict between institutional mandates and humanitarian care, and triage dilemmas under resource scarcity.

ED nurses' coping self-efficacy in the face of moral distress is socially situated and dynamically shaped by institutional constraints, resource scarcity, interpersonal interactions, emotional arousal, and exposure to traumatic clinical events. Interventions should move beyond individual-level coping training to address the organizational, relational, and ethical conditions of emergency care through context-sensitive support, mentorship, ethics training, and psychologically informed, team-based strategies.