This research describes the empirical classification of stressors for gay men and lesbians. Volunteer respondents were recruited through a free local gay and lesbian newspaper, through gay and lesbian student organizations nationwide, through gay and lesbian bookstores nationwide, and at a gay festival in St. Louis. Nine hundred seventy-nine (979) participants completed a 70-item measure with stressors that had been identified in previous qualitative research. Participants were asked to indicate the degree to which they had experienced stress associated with a variety of experiences. Participants also completed a measure of dysphoria (CES-D), responded about their degree of openness regarding sexual orientation, and provided information about their relationship status and involvement with gay groups and activities. Using confirmatory factor analysis, a six-factor model was predicted to account for the data. One-factor, six-factor, and ten-factor models were tested. The ten-factor model yielded the best fit with the data and accounted for 63.5% of the variance. The factor structure remained stable when gay men were compared to lesbians, when those endorsing a predominantly gay versus exclusively gay orientation were compared, and when those in a relationship were compared to those who were not in a relationship. Increased gay stress was associated with more dysphoria. Implications of these findings are discussed and directions for future research are considered.

Inadequate staffing and perceived incompetent coworkers were the most distressing items. Almost 22% left a previous position because of moral distress and perceived the current climate to be less ethical compared with other participants. Findings may potentially impact nurse retention and recruitment and negatively affect the quality and safety of patient care. Interventions developed focus on the individual nurse, including ethics education and coping skills, intraprofessional/interprofessional approaches, and administrative/policy strategies.

Knowledge of sampling methods is essential to design quality research. Critical questions are provided to help researchers choose a sampling method. This article reviews probability and non-probability sampling methods, lists and defines specific sampling techniques, and provides pros and cons for consideration. In addition, issues related to sampling methods are described to highlight potential problems.

Moral distress remains a pervasive and, at times, contested concept in nursing and other health care disciplines. Ethical climate, the conditions and practices in which ethical situations are identified, discussed, and decided, has been shown to exacerbate or ameliorate perceptions of moral distress. The purpose of this mixed-methods study was to explore perceptions of moral distress, moral residue, and ethical climate among registered nurses working in an academic medical center. Two versions of the Moral Distress Scale in addition to the Hospital Ethical Climate Survey were used, and participants were invited to respond to 2 open-ended questions. Part I reported the findings among nurses working in adult acute and critical care units. Part II presents the results from nurses working in pediatric/neonatal units. Significant differences in findings between the 2 groups are discussed. Subsequent interventions developed are also presented.