Exploring the Relationship Among Moral Distress, Coping, and the Practice Environment in Emergency Department Nurses

Abstract

Emergency department (ED) nurses practice in environments that are highly charged and unpredictable in nature and can precipitate conflict between the necessary prescribed actions and the individual's sense of what is morally the right thing to do. As a consequence of multiple moral dilemmas, ED staff nurses are at risk for experiencing distress and how they cope with these challenges may impact their practice. To examine moral distress in ED nurses and its relationship to coping in that specialty group. Using survey methods approach. One hundred ninety-eight ED nurses completed a moral distress, coping, and demographic collection instruments. Advanced statistical analysis was completed to look at relationships between the variables. Data analysis did show that moral distress is present in ED nurses (M = 80.19, SD = 53.27), and when separated into age groups, the greater the age, the less the experience of moral distress. A positive relationship between moral distress and some coping mechanisms and the ED environment was also noted. This study's findings suggest that ED nurses experience moral distress and could receive some benefit from utilization of appropriate coping skills. This study also suggests that the environment in which ED nurses practice has a significant impact on the experience of moral distress. Because health care is continuing to evolve, it is critical that issues such as moral distress and coping be studied in ED nurses to help eliminate human suffering.

Nurses’ experiences of unprofessional behaviors in the emergency department: A qualitative study

“…These findings have expanded our understanding of ED culture. The ED is noted to be a highly stressful, chaotic, and unpredictable workplace, further exacerbated by violence and aggression by patients and relatives (Angland et al, 2014;Tan, Lopez, & Cleary, 2015;Zavotsky & Chan, 2016). This organizational culture of the ED is compounded by long waiting times, overcrowding, scant resources, poor communication, and lack of teamwork (Angland et al, 2014;Di Somma et al, 2015;Enns & Sawatzky, 2016).…”

Moral distress and burnout in caring for older adults during medical school training

“…1a). Compared with third and fourth year students, second year students reported lower median (IQR) composite moral distress scores (8 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] versus 30 and 29 ) and a lower prevalence of burnout (28% versus 48 and 40%). While there was less moral distress and burnout among second year students who had overall less clinical experience, the Rotation experienced on which scenario most commonly experienced b Percentages do not add to 100% because the choices were not mutually exclusive association between moral distress score and burnout did not appear to vary by medical school year (p-forinteraction = 0.62, see Supplement Table 4).…”

“…Among nurses, resident physicians, and attending physicians, moral distress is associated with decreased professional quality-of-life and burnout [8][9][10][11][12][13][14][15][16][17][18][19][20], and burnout is associated with poor mental health and lower quality of patient care [21]. The association between moral distress and burnout has not yet been studied in medical students.…”

Nurses’ Moral Distress in the Emergency Department

“…In addition, nurses also have moral integrity which is the basis for nurses to act according to their professional roles. However, when ED nurses experience difficulties in determining actions according to their moral integrity because there are various obstacles, it will make ED nurses experience moral dilemmas related to their actions (White, 2016) The moral dilemma experienced will be a moral conflict when there is a difference between the nurse's decision and actions, so the condition will create moral distress for the nurse (White, 2016;Zavotsky & Chan, 2016). According to Corley (2002), moral distress occurs when the professional goals of a nurse are hindered.…”

“…The emergency department is an area that provides health care services with an everchanging number of patients, and critical conditions cannot be predicted (Robinson & Stinson, 2016). Other challenges that cannot be anticipated are patients are not in emergency conditions, overcrowding, short staffing, violence, nurses should have high analytical skills, and respond quickly to changing situations (Zavotsky & Chan, 2016;White, 201 ). RI Ministry of Health no.…”