Background:Emergency department nurses face numerous ethical challenges due to high workloads, resource shortages, and exposure to complex clinical situations, which may lead to moral distress and reduced quality of care. Moral awareness is an important factor in providing ethically sound care and may play a significant role in addressing ethical challenges. This study aimed to investigate the effect of Kitchener model-based education on moral awareness and moral distress among emergency department nurses.

Methods:This quasi-experimental study employed a pretest–posttest design with a two-month follow-up and was conducted in 2024–2025 among nurses working in the emergency departments of six hospitals in Bandar Abbas, Iran. Proportionate stratified sampling followed by simple random sampling was used. A total of 81 nurses were allocated to intervention and control groups. The educational intervention consisted of seven weekly sessions, each lasting 45–60 minutes, delivered over a four-month period using interactive lectures and scenario-based teaching grounded in the ethical concepts of Kitchener’s model. Data were collected using a demographic information questionnaire, the revised Moral Distress Scale for Nurses (MDS-R), and a moral awareness questionnaire. Both groups were assessed at three time points: before the intervention, immediately after the intervention, and two months later. Data were analyzed using descriptive statistics and mixed-design analysis of variance with repeated measures in SPSS version 26. Statistical significance was set at p < 0.05.

Results:A total of 81 nurses participated in the study, including 40 in the intervention group and 41 in the control group. The groups did not differ significantly in demographic characteristics (p > 0.05). Analysis of variance revealed significant effects of time, group, and the time-by-group interaction on both moral distress and moral awareness (p < 0.001). In the intervention group, moral distress decreased significantly at the two-month follow-up compared with both baseline and the immediate post-intervention assessment (p < 0.001), whereas the difference between baseline and the immediate post-intervention assessment was not statistically significant (p = 1.000). Moral awareness increased significantly immediately after the intervention and at the two-month follow-up compared with baseline (p < 0.001). However, moral awareness decreased significantly at the two-month follow-up compared with the immediate post-intervention assessment (p < 0.001). No significant association was observed between moral distress and moral awareness at any measurement time point in either the intervention or control group (p > 0.05).

Conclusion:Kitchener model-based ethics education may be effective in reducing moral distress and increasing moral awareness among emergency department nurses. By providing a structured framework for recognizing and analyzing ethical issues, this educational approach may enhance nurses’ ability to respond more thoughtfully to challenging ethical situations. Given the changes in moral awareness over time, ongoing education and booster sessions may help maintain and consolidate the effects of the intervention. Therefore, incorporating structured, model-based ethics education, such as Kitchener’s model, into nurses’ professional development programs may be beneficial.