Individual professional perceptions and practices, as well as organizational characteristics, affect the sustainability of evidence-based fall prevention practices. While all team members recognized patient falls as a significant quality and safety issue, most believed that direct care nurses hold primary responsibility for leading fall prevention efforts. The data support the importance of effective interprofessional team communication and organizational practices in sustaining an evidence-based fall prevention program across inpatient units. Furthermore, the data call into question the wisdom in labeling quality indicators as "nursing sensitive"; the evidence indicates that a team approach is best.

Moral distress is a negative emotional and somatic response to external constraints on moral action. The constraints are typically identified as a component of the work environment, called the ethical climate. Moral distress is identified as a primary reason for job attrition by up to one-quarter of registered nurses who leave their jobs. One strategy suggested to staff nurses who experience moral distress is to consult their Nurse Manager (NM). However, the moral distress of NMs who are employed in acute care hospitals is poorly understood. The purpose of this qualitative study was to examine NMs' perceptions of the external constraints on moral agency, specifically the hospital ethical climate, which leads to their experience of moral distress and to analyze how attributes of the ethical climate facilitated or impeded their resolution of moral distress. Semi-structured, audio-recorded telephone interviews were conducted with 17 NMs from across the United States. An interpretive description design using an iterative process between data collection and data analysis was used. Data were analyzed through descriptive coding and thematic analysis. The participants in this study were 15 women and 2 men with a mean age of 46.4 years. The mean length of time in their current positions was slightly less than 5 years. Of the 17 hospitals represented, 6 were affiliated with a university and 4 had a religious affiliation. Fifteen of 17 NMs described situations in which the implicit and explicit values of the hospital were incongruent with their personal moral values and professional ethics. Common themes describing factors contributing to moral distress were administrative policies, negative communication patterns and relationships with physicians, issues related to staff nurses, issues related to patients and families, and multiple competing job obligations. Respondents described strategies to navigate through their moral distress. The strategies included taking a positive perspective, seeking the advice of NM colleagues, reliance on a positive relationship with a supervisor, and Summary of Models of Moral Distress .

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Licensed registered nurses are trusted by society and the health care system to be competently skilled and to practice with ethical integrity. Nurses are expected not only to execute professional responsibilities and tasks within their scope of practice but also to root that practice in the art and science of nursing that is tethered by the Code of Ethics. As a guiding attribute of the profession, the American Nurses Association Code of Ethics is a dynamic document that reflects professional core values. The purpose of this article is to provide a foundational discussion of nursing's ethical norms by presenting information that will help a nurse to understand the language and concepts in the Code of Ethics. Foundational information includes the construction of the Code, including sociological and historical influences; explanations of terminology used in the Code; an analysis of the Code; and how to use the Code in the course of daily work.

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