Nurses working in EDs face a certain level of moral distress that is different from other specialties, a recent Emergency Nurses Association study found.
The study, published online in the September issue of the Journal of Emergency Nursing, found that moral distress in emergency nurses stems more from the ED environment, rather than specific incidence. Researchers looked at 1,896 nurses using both survey data and focus group data.
Although nurses are able to provide end-of-life care in an emergency atmosphere, challenges exist to providing quality care, including lack of space, time and staff, according to the study. Study participants also noted the mismatch between the goals of emergency care and those of end-of-life care.
Caring for the dying also takes an emotional toll, the study said, particularly in environments where appropriate resources are lacking. “Emergency nursing is life-saving nursing and requires an environment where nurses can act in the best interest of their patients with more consideration of time constraint challenges,” Matthew F. Powers, MS, BSN, RN, MICP, CEN, president of the Emergency Nurses Association, said in an ENA news release. “This study is an excellent beginning to understand the distinct causes of moral distress in emergency nurses and how to address it.”
People experience moral distress when they are prevented from taking an action they believe is right, according to the ENA release. Unlike nurses in other care settings, ED nurses often do not have typical patients or days, leaving them with less time to build relationships with patients. Nurse-patient interaction in the ED is measured in minutes or hours, not days like in other settings, the news release said.
Among the environmental factors researchers discovered that resulted in limited interaction with patients were inadequate or unsafe staffing and a focus on time-based metrics. Patients with addictions or behavioral disorders who are frequent users of the ED also had an impact on the environment, according to the news release. These factors could result in moral distress from nurses being concerned about being able to provide sufficient care to patients.
ENA experts view the study as a call to acknowledge moral distress among ED nurses and come up with better ways of measuring moral distress in the ED. They also recommend developing strategies to address moral distress in ED nurses. “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,” Lisa A. Wolf, PhD, RN, CEN, FAEN, and coauthors wrote. “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. ”
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