Volume 32, Issue 4 (Winter 2026)                   Journal of Translational Medical Research. 2026, 32(4): 326-337 | Back to browse issues page

Research code: 6711
Ethics code: IR.BUMS.REC.1403.347


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Hajizadeh E, Negahban A, Eslamialiabadi H. Analyzing the concept of moral distress in emergency medical technicians: A qualitative study. Journal of Translational Medical Research. 2026; 32 (4) :326-337
URL: http://journal.bums.ac.ir/article-1-3565-en.html
1- Department of Nursing, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
2- Department of Health Information Technology, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran & Hazrat Rasool Hospital of Ferdows, Birjand University of Medical Sciences, Birjand, Iran
3- Department of Nursing, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran & Office of the Vice Chancellor for Education, Chamran Hospital of Ferdows, Birjand University of Medical Sciences, Birjand, Iran , h.eslami1300@gmail.com
Abstract:   (149 Views)
Background and Objective: Moral distress is a complex concept that requires further clarification in emergency medical services. The present study aimed to explore the different aspects of moral distress.
Materials and Methods: The present study was qualitative and employed the Walker and Avant conceptual analysis approach. The research period was from January 2004 to June 2005. The databases of Web of Science, PubMed, Embase, Scopus, and Google Scholar were searched. The search was conducted using keywords "moral distress," "ethical doubts," "ethical concerns," "emergency medical services," and "prehospital emergency." After analyzing the data, the defining characteristics, prerequisites, and consequences of the concept were identified.
Results: The search process identified a total of 1,521 articles. After removing duplicates, unrelated studies, and screening the full texts, 25 articles were ultimately included in the final analysis. The findings showed that the defining characteristics of moral distress included “occurrence in complex clinical settings,” “encountering an ethical dilemma in informed consent,” “discomfort due to weakening professional dignity,” and “awareness of weak ethical foundations.” Its consequences included “job dissatisfaction,” “emotional isolation from patients,” “burnout,” “decreased quality of care,” and “job abandonment”.
Conclusion: In this study, moral distress is defined as “a distressing mental state that manifests itself in complex and unpredictable clinical situations, the informed consent process, perception of professional dignity, and weakened ethical foundations in emergency medical technicians.” These characteristics can be developed and tested in future qualitative and quantitative studies to refine further and deepen the understanding of this concept.
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Type of Study: Original Article | Subject: Nursing- Qualitative Study
Received: 2025/11/24 | Accepted: 2025/12/27 | ePublished ahead of print: 2026/02/15 | ePublished: 2026/02/20

References
1. Butts JB. Adult health nursing ethics. Nursing ethics: across the curriculum and into practice Sudbury: Jones and Bartlett. 2005:53-68. URL: https://books.google.com/books/about/Nursing_Ethics.html?id=9R_ET0JLvEwC
2. Vryonides S, Papastavrou E, Charalambous A, Andreou P, Merkouris A. The ethical dimension of nursing care rationing: A thematic synthesis of qualitative studies. Nurs Ethics. 2015;22(8):881-900. DOI: 10.1177/0969733014551377 [DOI:10.1177/0969733014551377] [PMID]
3. Xhemajli H. The Role of Ethics and Morality in Law: Similarities and Differences. Ohio Northern University Law Review. 2021;48(1):3. URL: https://digitalcommons.onu.edu/onu_law_review/vol48/iss1/3
4. Jameton A. Nursing practice: The ethical issues. 1984.
5. Sandman L, Nordmark A. Ethical conflicts in prehospital emergency care. Nurs Ethics. 2006;13(6):592-607. DOI: 10.1177/0969733006069694 [DOI:10.1177/0969733006069694] [PMID]
6. Essex B, Scott LB. Chronic stress andassociated coping strategies among volunteer Prehosp Emerg Care. 2008;12(1):69-75. DOI: 10.1080/10903120701707955 [DOI:10.1080/10903120701707955] [PMID]
7. Petzäll K, Tällberg J, Lundin T, Suserud B-O. Threats and violence in the Swedish pre-hospital emergency care.Int Emerg Nurs. 2011;19(1):5-11. DOI: 10.1016/j.ienj.2010.01.004 [DOI:10.1016/j.ienj.2010.01.004] [PMID]
8. Cheraghi F, Yousefzadeh Chosari MR, Beyrami Jam M, Afshari A. Emergency medical technicians' ethical challenges in the Prehospital emergency services: a review article. Health in Emergencies and Disasters Quarterly. 2019; 5(1): 5-12. URL: URL: http://hdq.uswr.ac.ir/article-1-222-en.html [DOI:10.32598/hdq.5.1.151.2]
9. Hamric AB. Empirical research on moral distress: issues, challenges, and opportunities. HEC forum. 2012: Mar;24(1):39-49. DOI: 10.1007/s10730-012-9177-x [DOI:10.1007/s10730-012-9177-x] [PMID]
10. McCarthy J, Deady R. Moral distress reconsidered. Nurs Ethics. 2008;15(2):254-62. DOI: 10.1177/0969733007086023 [DOI:10.1177/0969733007086023] [PMID]
11. Jafari M, Khankeh H, Ebadi A, Maddah SSB, Hosseini M. Moral Distress in Pre-Hospital Emergency technicians: a cross-sectional study in Iran. Health in Emergencies and Disasters Quarterly. 2023;8(4):323-8. URL: http://hdq.uswr.ac.ir/article-1-463-en.html [DOI:10.32598/hdq.8.4.467.1]
12. Torabi M, Borhani F, Abbaszadeh A, Oshvandi Kh, Khazaie S, Masoumi H. Investigating the Relationship Between Moral Distress and Ethical Climate Among Emergency Medical Services Personnel. Health in Emergencies and Disasters Quarterly. 2024; 9(3):211-20. URL: http://hdq.uswr.ac.ir/article-1-562-en.html 10.32598/hdq.9.3.569.1 [DOI:10.32598/hdq.9.3.569.1]
13. Huniche L, Milling L, Wittrock D, Mikkelsen S, Bruun H. Preventing burnout from moral distress amongst prehospital emergency personnel: action research to develop and test organizationally targeted clinical ethics support. Sci Rep. 2024 ;14(1):31956. DOI: 10.1038/s41598-024-83507-z [DOI:10.1038/s41598-024-83507-z] [PMID] []
14. Walker LO, Avant KC. Strategies for theory construction in nursing. Vol. 4. Upper Saddle River, NJ; Pearson Prentice Hall; 2005. LCCN 2017058144| ISBN 9780134754079| ISBN 0134754077 .
15. DICTIONARY, Merriam-Webster. Merriam-webster. On-line at http://www. mw. com/home. htm, 2002, 8.2: 23. On-line at http://www. mw. com/home. htm, 2002‌.
16. Ambarwati R, Mandasari B. The influence of online Cambridge dictionary toward students' pronunciation and vocabulary mastery. Journal of English Language Teaching and Learning. 2020;1(2):50-5. DOI:10.33365/jeltl.v1i2.605 [DOI:10.33365/jeltl.v1i2.605]
17. Collinson P. Oxford Dictionary of National Biography: Oxford University Press; 2004.
18. Malekzadeh A, Gheibi A, Mohades A. PREDICT: persian reverse dictionary. arXiv preprint arXiv:210500309. 2021. [DOI:10.48550/arXiv.2105.00309]
19. Viele CM. Moral distress in emergency medical services: Johns Hopkins University; 2018: 1-38 URI: http://jhir.library.jhu.edu/handle/1774.2/59227
20. Rushton CH, Batcheller J, Schroeder K, Donohue P. Burnout and resilience among nurses practicing in high-intensity settings. Am J Crit Care. 2015;24(5):412-20. DOI: 10.4037/ajcc2015291 [DOI:10.4037/ajcc2015291] [PMID]
21. Austin CL, Saylor R, Finley PJ. Moral distress in physicians and nurses: Impact on professional quality of life and turnover. Psychol Trauma. 2017;9(4):399-406. DOI: 10.1037/tra0000201 [DOI:10.1037/tra0000201] [PMID]
22. Oh Y, Gastmans C. Moral distress experienced by nurses: a quantitative literature review. Nurs Ethics. 2015;22(1):15-31. DOI: 10.1177/0969733013502803 [DOI:10.1177/0969733013502803] [PMID]
23. Jafari M, Ebadi A, Khankeh HR, Maddah SSB, Hosseini M. Development and validation of moral distress scale in pre-hospital emergency service providers. International Journal of Emergency Services. 2022;11(2):263-76. DOI:10.1108/ijes-05-2021-0028 [DOI:10.1108/IJES-05-2021-0028]
24. Froutan R, Khankeh HR, Fallahi M, Ahmadi F, Norouzi K. Pre-hospital burn mission as a unique experience: a qualitative study. Burns. 2014;40(8):1805-12. DOI: 10.1016/j.burns.2014.04.010 [DOI:10.1016/j.burns.2014.04.010] [PMID]
25. Erbay H. Some ethical issues in prehospital emergency medicine. Turk J Emerg Med. 2014;14(4):193-8. DOI: 10.5505/1304.7361.2014.32656 [DOI:10.5505/1304.7361.2014.32656] [PMID] []
26. Torabi M, Borhani F, Abbaszadeh A, Atashzadeh-Shoorideh F. Barriers to ethical decision-making for pre-hospital care professionals. Nurs Ethics. 2020;27(2):407-18. DOI: 10.1177/0969733019848044 [DOI:10.1177/0969733019848044] [PMID]
27. Satkoske V, Kappel D. Emergency medical personnel face unique ethical challenges. Journal of Emergency Medical Services. 2014;39(11). URL: https://www.jems.com/ems-management/emergency-medical-personnel-face-unique/
28. Alinia S, Khankeh H, Maddah SSB, Negarandeh R. Barriers of pre-hospital services in road traffic injuries in Tehran: the viewpoint of service providers. Int J Community Based Nurs Midwifery. 2015;3(4):272-82. URL: https://pubmed.ncbi.nlm.nih.gov/26448954/
29. Colwell CB. Refusal in the Field. When can an uncooperative patient refuse care and transport? JEMS: a journal of emergency medical services. 2016;41(8):45-7. URL: https://pubmed.ncbi.nlm.nih.gov/29172333/
30. Adams JG, Arnold R, Siminoff L, Wolfson AB. Ethical conflicts in the prehospital setting. Ann Emerg Med. 1992;21(10):1259-65. DOI: 10.1016/s0196-0644(05)81759-7 [DOI:10.1016/S0196-0644(05)81759-7] [PMID]
31. Sherbino J, Guru V, Verbeek PR, Morrison LJ. Prehospital emergency medical services' ethical dilemma with do-not-resuscitate orders. Canadian Journal of Emergency Medicine. 2000;2(4):246-51. DOI:10.1017/S1481803500007272 [DOI:10.1017/S1481803500007272] [PMID]
32. Fernandez-Parsons R, Rodriguez L, Goyal D. Moral distress in emergency nurses. J Emerg Nurs. 2013;39(6):547-52. DOI: 10.1016/j.jen.2012.12.009 [DOI:10.1016/j.jen.2012.12.009] [PMID]
33. Pauly B, Varcoe C, Storch J, Newton L. Registered nurses' perceptions of moral distress and ethical climate. Nurs Ethics. 2009;16(5):561-73. DOI: 10.1177/0969733009106649 [DOI:10.1177/0969733009106649] [PMID]
34. Klugman CM. Why EMS needs its own ethics: What's good for other areas of healthcare may not be good for you. EMS World. 2007 Oct;36(10):114-122. https://www.emsworld.com/article/10321601/why-ems-needs-its-own-ethics

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