A cross-sectional exploration of emergency department nurses’ moral distress, ethical climate and nursing practice environment

The relationships of ethical climate, physician–nurse collaboration and psychological empowerment with critical care nurses' ethical conflict in China: A structural equation model

“…The collaborative relationships can provide more opportunity for nurses to express their concerns and to demonstrate active behaviours in nursing practice, thus may reduce their feeling of ethical conflict (Kim et al, 2020; Ramathuba & Ndou, 2020). Our results showed that critical care nurses had a relatively low perception of psychological empowerment and physician–nurse collaboration, which was consistent with previous studies (Hou et al, 2021; Malak & Abu Safieh, 2022). This further suggested that interventions targeted at improving psychological empowerment and physician–nurse collaboration may benefit critical care nurses in managing ethical conflict.…”

“…Therefore, ethical conflict still needs to be tackled among critical care nurses. As hypothesized, ethical climate was an important factor influencing ethical conflict, which supported the previous studies related to moral distress (Altaker et al, 2018; Hou et al, 2021). A poor ethical climate may lead to an unsupported working environment and may expose nurses to numerous ethical challenges, especially when caring for patients with life‐threatening illnesses in the critical care setting.…”

“…Without active participation in decision‐making, nurses possibly become vulnerable to various ethical problems (Sabone et al, 2020). It is also worth mentioning that a negative ethical climate is a pivotal factor accounting for poor nurse–physician collaboration (Hou et al, 2021). Nurses' relationships with their co‐workers may be compromised in a stressful work environment, making nurses marginalized to express their voices and vulnerable to ethical issues (Usberg et al, 2021).…”

“…Olson (1995) first brought this concept into health care to describe the shared perceptions of the ethically right decision related to patient care and the conditions for ethical reflection. Research has shown that a positive ethical climate is associated with fewer nurses' experience of moral distress in various settings, such as paediatric oncology nursing (Ventovaara et al, 2021) and emergency department nursing (Hou et al, 2021). This can be explained by the impact of ethical climate on a working environment.…”

A study on the correlation between emotional intelligence and moral distress in oncology nurses

“…Correlation analysis showed that emotional intelligence was negatively correlated with the total moral distress score and each dimension, and regression results showed that age, and specialty work time, job title, and emotional intelligence together explained 42.6% of the variance in moral dilemma, similar to the results of related studies [21,22] , poor health care cooperation is a key factor in nurses' moral dilemma when facing disagreement about patients' treatment decisions, and mutual trust, respect, and open communication can promote effective communication between health care professionals, a deeper understanding of the decision-making opinions of people with different positions, and in-depth communication about patients' decision-making issues to strive for agreement and reduce the level of moral dilemmas.…”