From the Guidelines
Moral distress in emergency department nursing is exemplified when a nurse is forced to provide life-sustaining treatments that merely prolong dying, contrary to the patient's goals of care, as seen in cases where aggressive interventions are continued on a terminally ill patient despite the nurse's professional judgment that palliative care would be more appropriate. This situation is strongly associated with moral distress and intention to leave the job, particularly among nurses, as highlighted in a 2024 study by the European Society of Intensive Care Medicine 1. The study emphasizes that providing life-sustaining treatments (LSTs) that are not consistent with patients' goals of care can lead to moral distress, which may result in depression, PTSD symptoms, burnout, and the loss of highly skilled healthcare professionals.
Some key factors that contribute to moral distress in ED nursing include:
- Institutional barriers that prevent nurses from acting in accordance with their professional judgment and values
- Conflicts between respecting family wishes, following physician orders, and the nurse's duty to prevent harm
- Overcrowded EDs where nurses must manage multiple critical patients, exacerbating the psychological strain of moral distress
- The lack of a structured strategy for decision-making in end-of-life care, which can lead to uncertainty and moral distress among healthcare professionals, as noted in the 2024 study 1.
The consequences of moral distress can be severe, including:
- Burnout and compassion fatigue
- Loss of professional respect and trust among team members
- Depression and PTSD symptoms
- Intention to leave the job, particularly among nurses, which can lead to a loss of highly skilled healthcare professionals, as highlighted in the study 1.
From the Research
Definition and Examples of Moral Distress
Moral distress in emergency department (ED) nursing refers to the emotional and psychological distress experienced by nurses when they are unable to provide care that aligns with their personal and professional values [(2,3,4,5,6)]. This can occur in situations where nurses are forced to provide treatments that they believe are futile or not in the best interest of the patient.
Causes of Moral Distress in ED Nursing
Some common causes of moral distress in ED nursing include:
- Providing treatments that are not expected to benefit the patient [(4,5)]
- Following family wishes to continue life support when it is deemed futile 5
- Dealing with the competency of healthcare providers [(4,5)]
- Experiencing professional role conflict and feeling powerless to advocate for patients [(2,6)]
Effects of Moral Distress on ED Nurses
Moral distress can have significant effects on ED nurses, including:
- Burnout and compassion fatigue [(3,5)]
- Attrition and consideration of leaving the profession [(2,3,4,5)]
- Moral numbing and decreased ability to provide empathetic care 3
- Decreased job satisfaction and increased stress [(4,6)]