title: "It's a Burden You Carry": Describing Moral Distress in Emergency Nursing.
abstract: BACKGROUND
  Moral distress in nursing has been studied in many settings, but there is a paucity of research on moral distress as it manifests in the emergency department. One study suggests a correlation between moral distress and aspects of burnout, and other researchers report that nurses have considered leaving their position or even their profession because of moral distress. Further exploration of these issues may provide insight into their effects on ED patient care and the emergency nursing profession. The purpose of this study was to explore the nature of moral distress as it is experienced and described by emergency nurses.
  
  
  METHODS
  A qualitative, exploratory design was employed using semi-structured focus groups for data collection. Using an iterative process, transcripts were analyzed for emerging themes by the research team. Six researchers analyzed the transcripts using a thematic analysis approach.
  
  
  RESULTS
  Themes from the data included dysfunctional practice arena, being overwhelmed, and adaptive/maladaptive coping. Participants described, overall, a profound feeling of not being able to provide patient care as they wanted to.
  
  
  CONCLUSIONS
  Causes of moral distress in emergency nurses are environment driven, not incident driven, as is described in other settings, and include a high-acuity, high-demand, technical environment with insufficient resources. Interventions should be targeted to improve environmental factors that contribute to the moral distress of emergency nurses. Future research should focus on the development and validation of an instrument to measure moral distress in this setting.
authors.affiliation: Des Plaines, IL; San Antonio, TX; Louisville, KY; New Brunswick, NJ. Electronic address: lwolf@ena.org.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Wolf
authors.affiliation: Des Plaines, IL; San Antonio, TX; Louisville, KY; New Brunswick, NJ.
authors.forename: Cydne
authors.initials: C
authors.lastname: Perhats
authors.affiliation: Des Plaines, IL; San Antonio, TX; Louisville, KY; New Brunswick, NJ.
authors.forename: Altair M
authors.initials: AM
authors.lastname: Delao
authors.affiliation: Des Plaines, IL; San Antonio, TX; Louisville, KY; New Brunswick, NJ.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Moon
authors.affiliation: Des Plaines, IL; San Antonio, TX; Louisville, KY; New Brunswick, NJ.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Clark
authors.affiliation: Des Plaines, IL; San Antonio, TX; Louisville, KY; New Brunswick, NJ.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Zavotsky
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000523:psychology*; D016529:Emergency Nursing; D017144:Focus Groups; D006801:Humans; D009014:Morals; D009741:Nursing Staff, Hospital / Q000523:psychology*; D036301:Qualitative Research; D013315:Stress, Psychological / Q000523:psychology*
keywords: Emergency department; Moral distress; Nursing; Qualitative