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Exploring the Relationship Among Moral Distress, Coping, and the Practice Environment in Emergency Department Nurses

Zavotsky, Kathleen Evanovich PhD, RN, CCRN, CEN, ACNS-BC; Chan, Garrett K. PhD, APRN, FAEN, FPCN, FNAP, FAAN

Advanced Emergency Nursing Journal: April/June 2016 - Volume 38 - Issue 2 - p 133–146
doi: 10.1097/TME.0000000000000100

Emergency department (ED) nurses practice in environments that are highly charged and unpredictable in nature and can precipitate conflict between the necessary prescribed actions and the individual's sense of what is morally the right thing to do. As a consequence of multiple moral dilemmas, ED staff nurses are at risk for experiencing distress and how they cope with these challenges may impact their practice. To examine moral distress in ED nurses and its relationship to coping in that specialty group. Using survey methods approach. One hundred ninety-eight ED nurses completed a moral distress, coping, and demographic collection instruments. Advanced statistical analysis was completed to look at relationships between the variables. Data analysis did show that moral distress is present in ED nurses (M = 80.19, SD = 53.27), and when separated into age groups, the greater the age, the less the experience of moral distress. A positive relationship between moral distress and some coping mechanisms and the ED environment was also noted. This study's findings suggest that ED nurses experience moral distress and could receive some benefit from utilization of appropriate coping skills. This study also suggests that the environment in which ED nurses practice has a significant impact on the experience of moral distress. Because health care is continuing to evolve, it is critical that issues such as moral distress and coping be studied in ED nurses to help eliminate human suffering.

The Center for Professional Development, Innovation and Research, Robert Wood Johnson University Hospital, New Brunswick, New Jersey (Dr Zavotsky) and Stanford Health Care, Stanford, California (Dr Chan).

Corresponding Author: Kathleen Evanovich Zavotsky, PhD, RN, CCRN, CEN, ACNS-BC, The Center for Professional Development, Innovation and Research, Robert Wood Johnson University Hospital, 1 Robert Wood Johnson Pl, New Brunswick, NJ 08903 (

Disclosure: The authors report no conflicts of interest.

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