Surgical nurses' perceptions of ethical dilemmas, moral distress and quality of care

J Adv Nurs. 2012 Jul;68(7):1516-25. doi: 10.1111/j.1365-2648.2011.05897.x. Epub 2011 Dec 6.


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.

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Choice Behavior / ethics*
  • Conflict, Psychological*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Israel
  • Male
  • Middle Aged
  • Morals
  • Nursing Staff, Hospital / psychology*
  • Perioperative Nursing / ethics*
  • Perioperative Nursing / standards
  • Quality of Health Care / ethics*
  • Quality of Health Care / standards
  • Stress, Psychological / psychology
  • Surveys and Questionnaires*
  • Young Adult