It's a burden you carry: describing moral distress in emergency settings

Purpose:
The purpose of this study was to explore the nature of moral distress as it is experienced and described by emergency nurses.

Background/Significance:
Moral distress in nursing has been studied in many settings, but there is a paucity of research on moral distress as it manifests in the emergency department (ED). One study suggests a correlation between moral distress and aspects of burnout, and other researchers report that nurses have considered leaving their position or even their profession due to moral distress. The purpose of this study was to explore the nature of moral distress as it is experienced and described by emergency nurses.

Methods:
A qualitative, exploratory design using semi-structured focus groups for data collection. A convenience sample of 17 emergency nurses was recruited, and focus group discussions were audiotaped and transcribed in their entirety. Using an iterative process, transcripts were analyzed for emerging themes by the research team; a total of six researchers analyzed the transcripts using constant comparison and a thematic analysis approach. Findings were sent to all participants for member checking; return comments indicated themes were captured appropriately, and that data saturation was reached.

Results:
Themes from the data included dysfunctional practice arena, being overwhelmed, and adaptive/maladaptive coping. Participants described, overall, a profound feeling of not being able to provide patient care as they wanted to. Causes of moral distress in emergency nurses are environment-driven, not incident driven, as is described in other settings, and include a high-acuity, high-demand, technical environment with insufficient resources. Interventions should be targeted to improve environmental factors that contribute to emergency nurses' moral distress.

Conclusions and Implications for Practice:
Moral distress manifests differently in nurses practicing in emergency settings, and suggests a different etiology. Future research should focus on development and validation of an instrument to measure moral distress in this setting, as well as interventions that address systemic dysfunction.