Association Between Organizational Bullying, Moral Distress, and Disengagement Among Emergency Department Nurses in Ilam Hospitals: A Cross Sectional Study
Bibliographic record
Abstract
Background: 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. Methods: 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. Results: = 0.2358). Conclusion: 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. Implications for Nursing Management: 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".