Nurs Crit Care. 2025 Nov;30(6):e70233. Revista: 10.1111/nicc.70233.

BACKGROUND: Emergency nurses are frequently placed in ethically complex, high-pressure situations when caring for older adults. In Saudi Arabia, these challenges are further shaped by cultural norms, hierarchical clinical structures and Islamic spiritual values. While international literature highlights the emotional and ethical tensions in emergency decision-making, little is known about how nurses in Middle Eastern contexts navigate these dilemmas in real time.

AIM: To explore the lived experiences of emergency nurses as they navigate critical decision-making processes in the care of older adults, with a focus on emotional burden, interdisciplinary negotiation and cultural-religious frameworks.

STUDY DESIGN: This qualitative phenomenological study employed in-depth semi-structured interviews with 14 emergency nurses working in Saudi Arabian hospitals. Data were analysed thematically using Braun and Clarke’s six-phase framework. The study adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines to ensure transparency and rigour.

RESULTS: Three interrelated themes emerged: (1) Burden of Rapid Decisions, describing nurses’ emotional paralysis, fear of error and isolation during high-stakes moments; (2) Collaborative Negotiation, capturing the team-based, family-inclusive and often hierarchical dynamics of decision-making and (3) Cultural-Religious Navigation, illustrating how faith-based ethics, spiritual coping practices and culturally sensitive communication informed and supported nurses’ actions under pressure.

CONCLUSIONS: Emergency nurses’ decision-making in the care of older adults in Saudi Arabia is shaped by a unique interplay of clinical urgency, interdisciplinary dynamics and culturally embedded spiritual values. Rather than relying solely on clinical protocols, nurses integrate moral reasoning, familial collaboration and Islamic belief systems to arrive at ethically congruent decisions.

RELEVANCE TO CLINICAL PRACTICE: To enhance care quality and ethical alignment, emergency departments should adopt culturally responsive frameworks that include interdisciplinary dialogue, family engagement and support for spiritual expression. Training nurses in value-sensitive communication and integrating Islamic principles-such as tawakkul-into care protocols can help reduce moral distress and foster trust among families and providers alike.

PubMed:41276467 | Revista:10.1111/nicc.70233