Besharaty Laya, Jackson Alun C, Rahmaty Zahra, Nia Mohammad Namazi, Bahramnezhad Fatemeh
Department of Emergency Nursing, Nursing and Midwifery Care Research Center, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
Centre on Behavioral Health, University of Hong Kong, Pokfulam, Hong Kong, China.
J Nurs Manag. 2025 Oct 31;2025:5230876. doi: 10.1155/jonm/5230876. eCollection 2025.
It is widely accepted that emergency department is an inherently high-stress environment where organizational bullying is prevalent, potentially leading to psychological harm and ethical complications. Moral distress occurs when nurses feel unable to adequately resolve ethical challenges, while moral disengagement involves mental processes that rationalize or excuse unethical actions, thereby diminishing personal responsibility.
This descriptive-analytical study was carried out in 2024 across public and private hospitals in Ilam Province, a border region in western Iran. Ilam Province has a total of 11 hospitals, consisting of 9 public hospitals and 2 private hospitals. The study population comprised 266 nurses working in emergency departments, with the entire group selected via census sampling. The research instruments included the Einarsen Organizational Bullying Questionnaire, the Hamric Moral Distress Scale, and Fida's Moral Disengagement in Nursing instrument. Data were analyzed using SPSS version 25, examining the complex relationships among organizational bullying, moral distress, and moral disengagement. Model 4 of the PROCESS macro was employed to assess mediation effects. Descriptive statistics were calculated for all variables, and data normality was assessed using skewness and kurtosis values. To further explore the associations among the key variables, Pearson correlation coefficients were computed.
The nurses' mean ratings for organizational bullying, moral distress, and moral disengagement were 42 ± 14.5, 22.2 ± 12.8, and 39 ± 10.9, respectively. Statistical research found a moderate link between organizational bullying and moral suffering (p = 0.0112, = 0.1865). Furthermore, a substantial and direct relationship was detected between moral discomfort and moral disengagement ( < 0.001, = 0.6470). A positive and moderate connection was discovered between organizational bullying and moral disengagement (=0.0006, = 0.2358).
The findings of this study show that organizational bullying is strongly linked to moral anguish among emergency department nurses. Furthermore, moral distress has a significant and direct association with moral disengagement, suggesting that it may weaken ethical awareness and increase the likelihood of unethical behavior in the workplace. Furthermore, the considerable positive link between organizational bullying and moral disengagement suggests that increasing bullying behaviors may exacerbate moral disengagement among nurses. These findings highlight the necessity of adopting organizational measures to minimize bullying in healthcare settings while also improving nurses' psychological and ethical well-being. It is recommended that hospital administrators and health system policymakers develop and implement educational and supportive programs aimed at mitigating organizational bullying, bolstering moral resilience, and promoting the overall professional well-being of nurses.
The findings indicate that organizational bullying significantly influences moral distress and moral disengagement among nurses, highlighting the need for targeted management strategies. Nursing leaders should implement strict antibullying policies, foster ethical decision-making through training programs, and provide psychological support systems to reduce moral distress. Additionally, mentoring younger and less experienced nurses, particularly those in public hospitals and emergency departments, can help mitigate disengagement. Creating a culture of accountability, promoting ethical leadership, and ensuring open communication will enhance job satisfaction and improve patient care outcomes.
人们普遍认为急诊科是一个本质上压力很大的环境，职场霸凌现象普遍存在，这可能会导致心理伤害和伦理问题。当护士感到无法充分解决伦理挑战时，就会出现道德困扰，而道德推脱则涉及使不道德行为合理化或为其辩解的心理过程，从而减轻个人责任。
这项描述性分析研究于2024年在伊朗西部边境地区伊拉姆省的公立和私立医院开展。伊拉姆省共有11家医院，其中包括9家公立医院和2家私立医院。研究对象包括266名在急诊科工作的护士，整个群体通过普查抽样选取。研究工具包括艾纳森职场霸凌问卷、哈姆里克道德困扰量表和菲达护理道德推脱量表。使用SPSS 25版软件对数据进行分析，研究职场霸凌、道德困扰和道德推脱之间的复杂关系。采用PROCESS宏程序的模型4来评估中介效应。计算所有变量的描述性统计量，并使用偏度和峰度值评估数据正态性。为了进一步探究关键变量之间的关联，计算了皮尔逊相关系数。
护士在职场霸凌、道德困扰和道德推脱方面的平均得分分别为42±14.5、22.2±12.8和39±10.9。统计研究发现职场霸凌与道德痛苦之间存在中度关联（p = 0.0112，r = 0.1865）。此外，发现道德不适与道德推脱之间存在显著的直接关系（p < 0.001，r = 0.6470）。发现职场霸凌与道德推脱之间存在正向中度关联（p = 0.0006，r = 0.2358）。
本研究结果表明，职场霸凌与急诊科护士的道德痛苦密切相关。此外，道德困扰与道德推脱之间存在显著的直接关联，这表明它可能会削弱伦理意识，增加工作场所不道德行为的可能性。此外，职场霸凌与道德推脱之间存在相当大的正向关联，这表明霸凌行为的增加可能会加剧护士的道德推脱。这些发现凸显了采取组织措施以尽量减少医疗环境中的霸凌行为，同时改善护士心理和伦理健康状况的必要性。建议医院管理人员和卫生系统政策制定者制定并实施教育和支持项目，以减轻职场霸凌，增强道德复原力，并促进护士的整体职业健康。
研究结果表明职场霸凌对护士的道德困扰和道德推脱有显著影响，凸显了制定针对性管理策略的必要性。护理领导者应实施严格的反霸凌政策，通过培训项目促进伦理决策，并提供心理支持系统以减少道德困扰。此外，指导年轻和经验不足的护士，特别是公立医院急诊科的护士，有助于减轻职业倦怠。营造问责文化，促进伦理领导，并确保开放沟通，将提高工作满意度并改善患者护理结果。
