Research“It’s a Burden You Carry”: Describing Moral Distress in Emergency Nursing
Section snippets
Methods
The study methodology was a qualitative, exploratory design consisting of semi-structured focus groups for data collection. Prior to the recruitment of study participants, this study was reviewed by Chesapeake Institutional Review Board (IRB; Columbia, MD) and determined to be exempt from IRB oversight. Participants were provided with a written description of the study at the time of online enrollment and again at the start of each focus group session. Prior to conducting the focus groups,
Results
Seventeen nurses participated in 2 focus groups held at the ENA 2014 Annual Conference. They had a mean of 24 ± 13 years of experience in nursing and 19 ± 11 years of experience as an emergency nurse. The majority (89.2%) held bachelors or masters degrees. The focus group participants were predominately female (94%) and mainly worked as staff nurses (58.8%) in general emergency departments (94%), in urban areas (47.1%), with fewer than 40,000 annual ED patient visits (52.9%). Geographic areas
Discussion
The concept of moral distress has been described among various nursing specialties, but there is a gap in research that describes this phenomenon specifically in the emergency care setting. We conducted this exploratory, descriptive study to contribute to the limited research on manifestations of moral distress or discordance among emergency nurses.
It is important to distinguish “moral discordance” or “moral distress” from other phenomena that reflect frustration but do not contain moral
Limitations
Because this exploratory study consisted of focus group participants who were a self-selecting sample of emergency nurses reporting personal experiences with the phenomenon of moral distress, transferability of the findings may be limited. Our sample was biased toward higher educational levels (89% were prepared at the baccalaureate or master’s level), which may have an effect on the understanding of moral decision making. Although this sample was otherwise demographically and geographically
Implications for Emergency Nursing
Focus group participants expressed a common desire to provide high-quality, compassionate care to their patients but also described dysfunctional and challenging aspects of the care environment that contribute to feelings of moral distress by impeding their ability to provide safe, effective patient care. The implications for emergency nurses as individuals, as well as for the profession, are significant and demand attention from ED and hospital administrators, but also from staff. While
Conclusion
Emergency nurses in this sample described a primary source of moral distress arising from conflicts between administrators’ and nurses’ expectations of the nursing role. In this high-acuity, high-demand, technical environment with insufficient resources (eg, time, staffing, technology, and administrative support), nurses felt continually challenged to provide safe, effective patient care. Successful interventions will most likely need to be targeted at the work environment and systemic
Acknowledgments
We thank the Institute for Emergency Nursing Research Advisory Council and Leslie Gates for their assistance with this study.
Lisa A. Wolf, Member, Pioneer Valley Chapter, is Director, Institute for Emergency Nursing Research, Emergency Nurses Association, Des Plaines, IL.
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Lisa A. Wolf, Member, Pioneer Valley Chapter, is Director, Institute for Emergency Nursing Research, Emergency Nurses Association, Des Plaines, IL.
Cydne Perhats is Senior Associate, Institute for Emergency Nursing Research, Emergency Nurses Association, Des Plaines, IL.
Altair M. Delao is Senior Associate, Institute for Emergency Nursing Research, Emergency Nurses Association, Des Plaines, IL.
Michael D. Moon, Member, San Antonio Chapter, is Associate Professor, University of the Incarnate Word, San Antonio, TX.
Paul R. Clark, Member, Kentuckiana Chapter, is Assistant Professor, University of Louisville School of Nursing, Louisville, KY, and System Educator, Norton Healthcare Institute for Nursing, Louisville, KY.
Kathleen E. Zavotsky, Member, West Central New Jersey Chapter, is Director, Nursing Research, Advanced Practice and Education, Robert Wood Johnson University Hospital, New Brunswick, NJ.
Earn Up to 9.0 CE Hours. See page 94.