{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:03:01Z","timestamp":1790150581406,"version":"4.0.1"},"reference-count":33,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore moral distress and demoralization experienced by nurses in emergency departments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, nine databases (PubMed, Scopus, Embase, Web of Science, MEDLINE, ScienceDirect, CINAHL, PsycINFO, and ProQuest) were searched up to September 2025. Eligible studies were primary qualitative or mixed-methods research focusing on moral distress and\/or demoralization among ED nurses. Data were extracted, appraised using the CASP Qualitative Checklist, and synthesized through thematic and interpretive meta-synthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six high-quality qualitative studies (CASP scores: 8\u20139\/10) conducted in Spain, the United States, and T\u00fcrkiye were included. Five meta-themes and sixteen subthemes emerged: (1) Structural and organizational drivers\u2014including power imbalances, resource scarcity, and policy-imposed ethical barriers; (2) Ethical conflict at the bedside\u2014such as futile care, dehumanization, and unrelieved suffering; (3) Emotional consequences and moral residue\u2014manifesting as guilt, shame, and identity erosion; (4) Coping responses\u2014ranging from emotional numbing to peer solidarity and moral advocacy; and (5) Moral resilience and ethical sustenance\u2014fostered by experience, supportive leadership, and value alignment. Moral distress was conceptualized not as an individual weakness but as a systemic moral injury shaped by institutional constraints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Addressing moral distress requires organizational accountability, structured ethical reflection, and policies that protect nurses\u2019 moral agency.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09697330261483198","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:01:55Z","timestamp":1789966915000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Moral distress and demoralization experienced by nurses in emergency departments: A systematic review and meta-synthesis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9667-2345","authenticated-orcid":false,"given":"Jiaqi","family":"Wang","sequence":"first","affiliation":[{"name":"Taizhou Jiangyan Traditional Chinese Medicine Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9998-925X","authenticated-orcid":false,"given":"Xiao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Taizhou Jiangyan Traditional Chinese Medicine Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"issue":"1","key":"e_1_3_5_2_2","first-page":"9","article-title":"Nurses\u2019 knowledge and related factors towards professional ethics: a cross-sectional study","volume":"2","author":"Parvaresh Maryan M","year":"2023","unstructured":"Parvaresh Maryan M, Baghaee M, Kazemnejad Leyli E, et al. Nurses\u2019 knowledge and related factors towards professional ethics: a cross-sectional study. J Nurs Rep Clin Pract 2023; 2(1): 9\u201315. https:\/\/doi.org\/10.32598\/jnrcp.23.93","journal-title":"J Nurs Rep Clin Pract"},{"issue":"1","key":"e_1_3_5_3_2","first-page":"16","article-title":"Ethical issues of do not resuscitate in cancer patients: a narrative review from a nursing perspective","volume":"1","author":"Jafari H","year":"2023","unstructured":"Jafari H, Amjadi S, Javadian Kutenai H, et al. Ethical issues of do not resuscitate in cancer patients: a narrative review from a nursing perspective. 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