The Experience of Moral Distress from the Perspective of Emergency  Medicine Physicians and Nurses in the Emergency Department: A Qualitative Study

Leila  MasoudiYekta; Ehsan Hassanpour  Pazevar; Alireza  Parsapour; Ehsan Shamsi Gooshki; Mohammad  Jalili; Amirahmad  Shojaei

doi:10.18502/ijme.v18i3.18843

Leila MasoudiYekta PhD Student, Department of Medical Ethics, Research Center for Medical Ethics and History of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran.
Ehsan Hassanpour Pazevar General Medicine Student, Tehran University of Medical Sciences, Tehran, Iran.
Alireza Parsapour Assistant Professor, Research Center for Medical Ethics and History, Tehran University of Medical Sciences.
Ehsan Shamsi Gooshki Associate Professor, Medical Ethics and History or Medicine Research Center, Tehran University of Medical Sciences, Lecturer in Bioethics, Monash Bioethics Center, Monash University, Melbourne, Australia
Mohammad Jalili Professor, Department of Emergency Medicine, School of Medicine،Editor-in-Chief, Frontiers in Emergency Medicine (FEM)،Co-founder and Director, Health Professions' Education Research Center (HPERC)،Tehran University of Medical Sciences،Tehran, Iran
Amirahmad Shojaei Associate Professor, Medical Ethics and History or Medicine Research Center, Tehran University of Medical Sciences, Lecturer in Bioethics, Monash Bioethics Center, Monash University, Melbourne, Australia.

DOI: https://doi.org/10.18502/ijme.v18i3.18843

Keywords: Emergency Medicine, Physicians, Nurses, Moral Distress.

Abstract

Moral distress constitutes a significant challenge for healthcare professionals, arising when individuals find themselves unable to act in accordance with their personal and professional values due to both internal and external pressures. Healthcare professionals may face scenarios that prompt them to question the ethical acceptability of their decisions and treatment practices, often feeling powerless in the face of perceived unethical changes. This study sought to explore the experiences of moral distress encountered by emergency medicine physicians and nurses in the emergency department. This study was conducted using qualitative content analysis. Data were collected through semi-structured interviews with 25 healthcare providers selected via purposive sampling. Data analysis was conducted using MAXQDA 2018 software. The results indicated that the experiences of moral distress among emergency medicine physicians and nurses in the emergency department can be classified into four primary categories including those related to: 1. patient rights, 2. medical staff and colleagues, 3. management, and 4. professionals. Notably, factors such as overcrowding, inadequate staffing, discrepancies between salaries and workloads, and poor management of human and physical resources emerge as significant contributors to moral distress in the emergency department of Imam Khomeini Hospital. To improve patient care quality, it is essential to implement strategies that enhance triage processes, prioritize human resources, align resources with patient needs, monitor patient attendance, and develop a comprehensive protocol for staff.