The sources and effects of moral distress on nursing performance in emergency departments; a review of literature

Moral distress is a prevalent issue in healthcare settings, particularly among nurses in Emergency Departments (EDs), where ethical dilemmas frequently arise. This literature review aims to explore the sources and effects of moral distress on nursing performance, focusing on the unique challenges faced by ED nurses. A systematic literature review was conducted using multiple electronic databases, including PubMed, CINAHL, Scopus, and PsycINFO, to identify relevant studies published from 2010 to 2024. The search strategy included medical subject headings (MeSH) and free-text keywords related to moral distress in nursing. Inclusion criteria focused on studies that specifically addressed moral distress experienced by ED nurses and its impact on patient care and nurse well-being. Eleven studies met the inclusion criteria, revealing key sources of moral distress such as ethical dilemmas in decision-making, organizational constraints, conflicts with healthcare providers, and unrealistic patient expectations. The findings indicated that moral distress significantly affects job satisfaction, increases burnout, impairs clinical judgment, and compromises patient care. Coping strategies identified included organizational support programs, ethics training, peer support, and resilience-building practices. This review highlights the critical need for healthcare institutions to address moral distress among ED nurses through systemic changes and support mechanisms. By fostering a supportive environment and providing adequate resources, healthcare organizations can enhance nurse well-being and improve patient care outcomes.