From Distress to Congruence: A Qualitative Study of Emergency Department Nurses' Experiences of Moral Pleasure

This study aimed to explore the essential meaning, structural characteristics, and intrinsic significance of moral pleasure experienced by emergency department (ED) nurses during moral practice, thereby providing evidence for positive psychological interventions to support ethical well-being and informing the development of ethics-focused nursing programs.

A descriptive phenomenological approach guided by Husserl's philosophy was used.

Purposive sampling was employed to recruit 25 registered nurses from the ED of a tertiary Grade-A hospital in Southern China. All participants held a valid nursing licence and had ≥ 1 year of ED experience. Semi-structured face-to-face interviews were conducted from June to December 2024. Data were analysed using Colaizzi's seven-step phenomenological method.

Four core themes and eight sub-themes emerged: (1) Value affirmation in life-saving; (2) Inner moral congruence amid ethical dilemmas; (3) Emotional resonance in nurse-patient interactions; (4) Sense of belonging through team collaboration. Participants described moral pleasure as a meaningful positive moral experience that they perceived as counterbalancing moral distress, sustaining moral resilience, and reinforcing professional identity.

ED nurse leaders and educators may use these findings to design ethical-success debriefing, recognise moral courage, establish peer-support structures, integrate moral pleasure into ethics education, and cultivate supportive ethical climates.

Moral pleasure represents a distinct and positive moral experience through which ED nurses perceive ethical meaning and sustain professional commitment. These findings suggest that nursing leaders can cultivate such experiences by building supportive ethical climates, providing ethics training, and implementing peer-support programs. Further quantitative research is needed to test the potential buffering effects of moral pleasure on moral distress and burnout.

Patients and the public were not involved in the design, conduct, reporting, or dissemination plans of this research.