Changing nursing practice in response to musculoskeletal l pain and injury in the emergency nursing profession: What are we missing?



      Musculoskeletal disorders in emergency nurses result in physical, psychological and financial strain. Contributing factors include: environmental, organisational, patient-related, medical emergencies, nurse’s knowledge and health status. Stress and moral distress impact on nurses changing manual handling practices.


      Part of a cross-sectional survey of Australian emergency nurses, this study used content analysis to identify occurrence of change to practice and enablers to reporting injury. Secondary interpretive analysis using moral distress theory informed an alternative understanding of why nurses may not change their practice in response to injury.


      Most respondents made practice changes and reported pain/injury; 23% did not change, and 45.7% did not report. Respondents considered change impossible due to high demands and lack of resources; a position where nurses may have felt pressured to carry out unsafe manual handling practices. When conflicted between reporting a perceived insignificant injury, with feelings of guilt, nurses can feel devalued. Moral distress can occur when nurses and managers are conflicted between providing care and caring for self.


      A culture of trust, respect and open communication decreases stress/moral distress, enables safer manual handling and reporting of pain/injury. Moral distress is an invisible workplace challenge that needs to be met for staff wellbeing.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Australasian Emergency Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Safe Work Australia
        Australian workers’ compensation statistics 2017-18.
        • Pompeii L.A.
        • Lipscomb H.J.
        • Schoenfisch A.L.
        • Dement J.M.
        Musculoskeletal injuries resulting from patient handling tasks among hospital workers.
        Am J Ind Med. 2009; 52: 571-578
        • Whitby L.
        Preventing injury when moving patients in an emergency.
        in: Ergonomics Australia - HFESA 2011 Conference Edition. 2011 (11:1-4)
        • Jones D.W.
        Development of a bariatric patient readiness assessment tool for the emergency department.
        Adv Emerg Nurs J. 2012; 34: 238-249
        • Safe Work Australia
        Hazardous manual tasks: code of practice.
        Safe Work Australia, Canberra2018 (Report No.: ISBN 978-0-642-33307-0 (PDF); ISBN 978-0-642-33308-7 (DOCX))
        • ANMF
        Safe patient handling.
        Australian Nursing and Midwifery Federation, Melbourne, Victoria2018
        • Perhats C.
        • Keough V.
        • Fogarty J.
        • Hughes N.L.
        • Kappelman C.J.
        • Scott M.
        • et al.
        Non–violence-related workplace injuries among emergency nurses in the United States: implications for improving safe practice, safe care.
        JEN: J Emergency Nurs. 2012; 38: 541-548
        • Osborne A.
        • Connell C.
        • Morphet J.
        Investigating emergency nurses’ attitudes, perceptions and experiences with patient handling in the emergency department.
        Australas Emerg Care. 2021; 24: 49-54
        • Adriaenssens J.
        • De Gucht V.
        • Van Der Doef M.
        • Maes S.
        Exploring the burden of emergency care: predictors of stress-health outcomes in emergency nurses.
        J Adv Nurs. 2011; 67: 1317-1328
        • Blom T.
        • Viljoen R.
        Human reaction to change: the reality and impact of stress.
        in: 21st International Academy of Management and Business 2016 Conference; 18 – 20 May, University of Quebec at Montreal (UQAM)2016
        • Corley M.C.
        Nurse moral distress: a proposed theory and research agenda.
        Nurs Ethics. 2002; 9: 636-650
        • Jameton A.
        Nursing practice: the ethical issues.
        Prentice-Hall, Englewood Cliffs, NJ1984
        • Pendry P.S.
        Moral distress: recognizing it to retain nurses.
        Nurs Econo. 2007; 25: 217-221
        • Clark P.
        • Crawford T.N.
        • Hulse B.
        • Polivka B.J.
        Resilience, moral distress, and workplace engagement in emergency department nurses.
        West J Nurs Res. 2020; (193945920956970)
        • Robinson R.
        • Stinson C.K.
        Moral distress: a qualitative study of emergency nurses.
        Dimens Crit Care Nurs: DCCN. 2016; 35: 235-240
      1. NVIVO qualitative data analysis software. 11 Pro [Internet]. QSR International Pty Ltd., 2015
        • Vaismoradi M.
        • Turunen H.
        • Bondas T.
        Content analysis and thematic analysis: implications for conducting a qualitative descriptive study.
        Nurs Health Sci. 2013; 15: 398-405
        • Epstein E.G.
        • Whitehead P.B.
        • Prompahakul C.
        • Thacker L.R.
        • Hamric A.B.
        Enhancing understanding of moral distress: the measure of moral distress for health care professionals.
        AJOB Empir Bioeth. 2019; 10: 113-124
        • Crane M.F.
        • Searle B.J.
        • Kangas M.
        • Nwiran Y.
        How resilience is strengthened by exposure to stressors: the systematic self-reflection model of resilience strengthening.
        Anxiety Stress Coping. 2019; 32: 1-17
        • Hiler C.A.
        • Hickman Jr., R.L.
        • Reimer A.P.
        • Wilson K.
        Predictors of moral distress in a US sample of critical care nurses.
        Am J Crit Care. 2018; 27: 59-66
        • Rothman K.J.
        • Gallacher J.E.
        • Hatch E.E.
        Why representativeness should be avoided.
        Int J Epidemiol. 2013; 42: 1012-1014
        • Arnold T.C.
        Moral distress in emergency and critical care nurses: a metaethnography.
        Nurs Ethics. 2020; (969733020935952)