MORAL DISTRESS AMONG EMERGENCY NURSES IN PALESTINIAN HOSPITALS IN THE NORTHERN WEST BANK: PREVALENCE, PREDICTORS, AND COPING STRATEGIES – A DESCRIPTIVE CROSS-SECTIONAL STUDY

Abstract

Background Moral distress is considered an important ethical and psychological issue for nurses, especially in situations characterized by heavy patient flow, such as the emergency room. Due to the lack of resources and political instability, situations arise in which nurses find themselves unable to act based on their ethical judgment. Objectives This study aimed to determine the level of moral distress among emergency nurses, identify its key predictors, explore coping strategies, and examine the relationships between these variables. Methodology The research design used was a descriptive cross-sectional quantitative research design. The study took place among emergency nurses working in both public and private hospitals located in the Northern West Bank, Palestine. A sample of 165 nurses participated in the study, selected through a convenient sampling technique. Data collection tools used in the study included the Measure of Moral Distress for Health Care Professional and Coping Orientation to Problems Experienced Inventory questionnaires. The data were in collection started in March,10th till April,30 and were analyzed using statistical software Statistical Package for the Social Sciences version 26.

Result The total number of emergency nurses included in the study was 165. Moral distress was common among the subjects, with an average frequency of 73.28 (SD = 7.65) and an average severity of 67.92 (SD = 8.19). About half of the respondents (47.3%) expressed the intention of quitting their current jobs due to moral distress. Total coping among the nurses was moderately high, with an average total COPE score of 65.25 (SD = 10.26), where problem-focused, emotion-focused, and avoidant coping scores were 2.37, 2.32, and 2.31, respectively. There were strong negative correlations between total coping and composite moral distress (r = -0.561, p < 0.001) as well as distress severity (r = -0.575, p < 0.001). Distress severity among female nurses was significantly higher than that among male nurses (p = 0.006). Distress and coping also varied significantly by age, education, years of experience, and professional position. Multiple linear regression results indicated that age, years of experience, professional position, and moral distress training predicted total moral distress, which explained 55.7% of variance (R² = 0.557, adjusted R² = 0.540; F(6,158) = 33.073, p < 0.001). Conclusion Moral distress represents an important and prevalent issue amongst emergency nurses in the Northern West Bank. There is a key organizational element involved in creating this distress, which highlights the need for organizational-level solutions. Improving ethical working conditions, improving resource management, and developing coping mechanisms must be considered if moral distress is to be minimized