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dekeyser ganz f. & berkovitz k. (2012) Surgical nurses’ perceptions of ethical dilemmas, moral distress and quality of care. Journal of Advanced Nursing68(7), 1516–1525. Abstract Aim. To describe surgical nurses’ perceived levels of ethical dilemmas, moral distress and perceived quality of care and the associations among them. Background. Nurses are committed to providing quality care. They can experience ethical dilemmas and moral distress while providing patient care. Little research has focused on the effect of moral distress or ethical dilemmas on perceived quality of care. Design. Descriptive, cross-sectional study. Method. After administration and institutional Research Ethics Committee approval, a researcher requested 119 surgical nurses working in two Israeli hospitals to fill out three questionnaires (personal background characteristics; Ethical Dilemmas in Nursing and Quality of Nursing Care). Data collection took place from August 2007 to January 2008. Results. Participant mean age was 39·7 years. The sample consisted mostly of women, Jewish and married staff nurses. The majority of nurses reported low to moderate levels of ethical dilemma frequency but intermediate levels of ethical dilemma intensity. Frequency of ethical dilemmas was negatively correlated with level of nursing skill, meeting patient’s needs and total quality of care. No important correlations were found between intensity of ethical dilemmas and quality of care. Conclusions. Levels of ethical dilemma frequency were higher than intensity. Nurses tended to be satisfied with their level of quality of care. Increased frequency of ethical dilemmas was associated with some aspects of perceived quality of care. Relevance to clinical practice. Quality of care is related to ethical dilemmas and moral distress among surgical nurses. Therefore, efforts should be made to decrease the frequency of these feelings to improve the quality of patient care.

brodsky-israeli m. & dekeyser ganz f. (2011) Risk factors associated with transfer anxiety among patients transferring from the intensive care unit to the ward. Journal of Advanced Nursing 67(3), 510–518. Abstract Aim. This paper is a report of an examination of the effect of risk factors on the development of transfer anxiety in patients being transferred from the intensive care unit to the ward. Background. Transfer of a patient from the intensive care unit to the ward could lead to transfer anxiety, a type of separation anxiety associated with transfer from a secure and familiar environment to an unfamiliar one. Previous studies have demonstrated associations between hospital anxiety and demographic, clinical and social factors. Method. Data were collected from 100 patients who were transferred from intensive care unit to the ward, using medical records and three self-report questionnaires (Hospital Anxiety and Depression Scale, Medical Outcomes Study-Social Support Scale, Health Care System Distrust Scale), completed within 72 hours of transfer, between 2005 and 2006. Spearman Rho correlations were used to determine relationships between variables. Findings. A statistically significant relationship was found between amount of social support (rs = −0·21, P = 0·04), length of intensive care unit hospitalization (rs = 0·21, P = 0·04) and gender (U = 907·0, P = 0·03) with transfer anxiety. No statistically significant relationships were found between transfer anxiety and other factors. Conclusion. Nurses should be especially aware of an increased risk for transfer anxiety among women, and those with lower social support and longer intensive care unit length of stay. We recommend that interventions, especially targeted to these populations, be developed to decrease its prevalence.

Aim. This paper reports a study to determine the perceptions of baccalaureate nursing students towards clinical specialties and what factors influenced these perceptions. Background. Previous studies have shown that nursing students enter their professional education with preconceived perceptions about the different clinical specialties in nursing. Some investigators have found that factors such as clinical experience influence these perceptions, but others have not. Cultural and social influences, especially among non-western cultures, have rarely been investigated. Methods. Israeli baccalaureate nursing students were surveyed in their first, third and fourth years of study during the years 1998–2004. They were asked to rank their preferences for clinical areas related to social need, social prestige, level of interest in the clinical area, job choice and what factors influenced their decisions related to job choice. Mean ranks and associations between class and calendar year cohorts were calculated. Results. Critical care was consistently ranked as the highest preference in all perception checklists, followed by emergency, maternity and paediatric nursing. Psychiatric, community and gerontological nursing were consistently found at the bottom of the list. High levels of association were found among students from different class cohorts and calendar years. Life experiences were ranked as the factor that most influenced career choice. Conclusion. Nursing students in Israel tend to perceive clinical areas in ways similar to other students around the world. These perceptions are strongly influenced by personal experiences and other personal contacts, most often not nursing instructors. Major changes in the local society seem for the most part to have little impact on these perceptions. Therefore there is a need for international nurse educators and recruiters to develop new, creative strategies to encourage nursing students to pursue careers in areas presently considered less popular.

The aim of this study was to determine levels of structural empowerment, moral distress, and the association between them among intensive care nurses.Structural empowerment is the ability to access sources of power. Moral distress is the painful feelings experienced when a person knows the right thing to do but cannot do so due to external constraints. Several studies suggest a theoretical relationship between these concepts.Cross-sectional, descriptive correlational study.Members of the Evidence Based Nursing Practice Committee of the Israeli Society for Cardiology and Critical Care Nurses recruited a convenience sample of intensive care nurses from their respective institutions and units. Nurses were asked to complete three questionnaires (demographic and work characteristics, Moral Distress Scale, and the Conditions of Work Effectiveness Questionnaire-II). Data were collected between May-September 2009.Intensive Care nurses had moderate levels of structural empowerment, low levels of moral distress frequency, and moderately high moral distress intensity. A weak correlation was found between moral distress frequency and structural empowerment. No other structural empowerment component was associated with moral distress. Work characteristics as opposed to demographic characteristics were more associated with the study variables.This study weakly supports the association between structural empowerment and moral distress. It also provides further evidence to the theory of structural empowerment as characterized in the critical care environment. Further studies are indicated to determine what other factors might be associated with moral distress.

To describe surgical nurses' perceived levels of ethical dilemmas, moral distress and perceived quality of care and the associations among them.Nurses are committed to providing quality care. They can experience ethical dilemmas and moral distress while providing patient care. Little research has focused on the effect of moral distress or ethical dilemmas on perceived quality of care.Descriptive, cross-sectional study.After administration and institutional Research Ethics Committee approval, a researcher requested 119 surgical nurses working in two Israeli hospitals to fill out three questionnaires (personal background characteristics; Ethical Dilemmas in Nursing and Quality of Nursing Care). Data collection took place from August 2007 to January 2008.Participant mean age was 39·7 years. The sample consisted mostly of women, Jewish and married staff nurses. The majority of nurses reported low to moderate levels of ethical dilemma frequency but intermediate levels of ethical dilemma intensity. Frequency of ethical dilemmas was negatively correlated with level of nursing skill, meeting patient's needs and total quality of care. No important correlations were found between intensity of ethical dilemmas and quality of care.Levels of ethical dilemma frequency were higher than intensity. Nurses tended to be satisfied with their level of quality of care. Increased frequency of ethical dilemmas was associated with some aspects of perceived quality of care.Quality of care is related to ethical dilemmas and moral distress among surgical nurses. Therefore, efforts should be made to decrease the frequency of these feelings to improve the quality of patient care.

This paper is a report of an examination of the effect of risk factors on the development of transfer anxiety in patients being transferred from the intensive care unit to the ward.Transfer of a patient from the intensive care unit to the ward could lead to transfer anxiety, a type of separation anxiety associated with transfer from a secure and familiar environment to an unfamiliar one. Previous studies have demonstrated associations between hospital anxiety and demographic, clinical and social factors.Data were collected from 100 patients who were transferred from intensive care unit to the ward, using medical records and three self-report questionnaires (Hospital Anxiety and Depression Scale, Medical Outcomes Study-Social Support Scale, Health Care System Distrust Scale), completed within 72 hours of transfer, between 2005 and 2006. Spearman Rho correlations were used to determine relationships between variables.A statistically significant relationship was found between amount of social support (r(s)=-0.21, P=0.04), length of intensive care unit hospitalization (r(s)=0.21, P=0.04) and gender (U=907.0, P=0.03) with transfer anxiety. No statistically significant relationships were found between transfer anxiety and other factors.Nurses should be especially aware of an increased risk for transfer anxiety among women, and those with lower social support and longer intensive care unit length of stay. We recommend that interventions, especially targeted to these populations, be developed to decrease its prevalence.