Health in Emergencies and Disasters Quarterly

en Moral Distress among Emergency Nurses in a Conflict‑Affected Setting: A Cross‑Sectional Study in Afghanistan اورژانس Emergency پژوهشي Research <div style="text-align: justify;">Background: Moral distress threatens the operational resilience and care continuity of emergency nurses, particularly in fragile health systems facing recurrent disasters and acute resource scarcity. Despite its direct relevance to workforce stability and surge capacity during crises, empirical evidence from conflict-affected, low-resource contexts such as Afghanistan is entirely lacking. This study aimed to assess the level of moral distress and its associated factors among emergency nurses working in hospitals in Afghanistan. Materials and Methods: This descriptive-analytical cross-sectional study was conducted among 313 nurses working in the EDs of four hospitals in Herat in 2024. Participants were selected using a quota sampling method. Data were collected using the Corley Moral Distress Questionnaire, which measures moral distress based on frequency and intensity of distressing situations across 21 items. Descriptive statistics and inferential tests (Mann-Whitney and Spearman correlation) were used to analyze the data. Results: The mean scores of moral distress in terms of frequency, intensity, and total score were 30.10 ± 14.47, 38.34 ± 15.93, and 64.03 ± 49.79, respectively. There was no statistically significant relationship between total moral distress score and demographic variables such as gender, marital status, age, work experience, or number of shifts per month (p > 0.05). Conclusion: Although the overall level of moral distress among emergency nurses in Herat hospitals was below average, this should not be interpreted as an absence of ethical conflict. Rather, it may reflect a process of desensitization—termed "normalization of moral poverty"—resulting from chronic exposure to systemic constraints in a resource‑limited, crisis‑affected setting. The lack of association with demographic variables suggests that moral distress is primarily a systemic issue, requiring organizational‑level interventions rather than individual‑focused approaches. To safeguard workforce well‑being and maintain functional surge capacity during disasters, health systems in similar fragile contexts should prioritize structural reforms, ongoing monitoring, and context‑specific support mechanisms. Future longitudinal and qualitative research is needed to deepen understanding of this phenomenon and inform evidence‑based policy development.</div> Moral distress, Nurses, Emergency departments, Herat, Afghanistan 0 0 http://hdq.uswr.ac.ir/browse.php?a_code=A-10-259-8&slc_lang=en&sid=1 Vahid Ghavami GhavamiV@mums.ac.ir No Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran. Somaya Vaghef somaya.waqef1993@gmail.com No Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran. Fatemeh Kokabi-Saghi KokabiSF@mums.ac.ir No Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran. Azadeh Tahernejad Tahernezhadazade@gmail.com No Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran. Hamidreza Shabanikiy ShabaniKiaHR@mums.ac.ir Yes Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.