title: Everyday ethics: ethical issues and stress in nursing practice.
abstract: OBJECTIVE
  This paper is a report of a study of the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice.
  
  
  BACKGROUND
  Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care.
  
  
  METHODS
  A self-administered survey was sent in 2004 to 1000 nurses in four states in four different census regions of the United States of America. The adjusted response rate was 52%. Data were analysed using descriptive statistics, cross-tabulations and Pearson correlations.
  
  
  RESULTS
  A total of 422 questionnaires were used in the analysis. The five most frequently occurring and most stressful ethical and patient care issues were protecting patients' rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making. Other common occurrences were unethical practices of healthcare professionals; breaches of patient confidentiality or right to privacy; and end-of-life decision-making. Younger nurses and those with fewer years of experience encountered ethical issues more frequently and reported higher levels of stress. Nurses from different regions also experienced specific types of ethical problems more commonly.
  
  
  CONCLUSIONS
  Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed.
authors.affiliation: Center for Bioethics, Department of Medical Ethics, and Leonard Davis Institute of Health Economics, New Courtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. culrich@nursing.upenn.edu
authors.forename: Connie M
authors.initials: CM
authors.lastname: Ulrich
authors.forename: Carol
authors.initials: C
authors.lastname: Taylor
authors.forename: Karen
authors.initials: K
authors.lastname: Soeken
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Donnell
authors.forename: Adrienne
authors.initials: A
authors.lastname: Farrar
authors.forename: Marion
authors.initials: M
authors.lastname: Danis
authors.forename: Christine
authors.initials: C
authors.lastname: Grady
mesh_terms: D016223:Advance Directives / Q000941:ethics; D000367:Age Factors; D026688:Bioethical Issues; D002055:Burnout, Professional / Q000453:epidemiology* / Q000523:psychology; D002983:Clinical Competence; D016265:Conflict of Interest; D003430:Cross-Sectional Studies; D003657:Decision Making / Q000941:ethics; D004993:Ethics, Nursing; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D015399:Nursing Research; D009740:Nursing Staff / Q000523:psychology / Q000600:supply & distribution; D028701:Patient Rights / Q000941:ethics*; D010561:Personnel Staffing and Scheduling / Q000941:ethics; D010563:Personnel Turnover; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics; D014481:United States / Q000453:epidemiology