Ethical issues experienced by nurses during COVID-19 pandemic: Systematic review

BACKGROUND

Frontline nurses who care for patients with COVID-19 work in stressful environments, and many inevitably struggle with unanticipated ethical issues. Little is known about the unique, ethically sensitive issues that nurses faced when caring for patients with COVID-19.

AIM

To better understand how frontline nurses who care for patients with COVID-19 experience ethical issues towards others and themselves.

METHODS

Systematic review of qualitative evidence carried out according to the Preferred Reporting Items for Systematic reviews and Meta-analyses on ethical literature (PRISMA-Ethics). The electronic databases PubMed, Embase, Cinahl, Web of Science, Philosopher's Index, and Scopus were queried to identify candidate articles. Articles appearing from March 1, 2020 to December 31, 2022 were considered if they met the following inclusion criteria: (1) Published qualitative and mixed method studies and (2) ethical issues experienced by nurses caring for patients with COVID-19. We appraised the quality of included studies, and data analysis was guided by QUAGOL principles.

FINDINGS

Twenty-six studies meeting our inclusion criteria for how nurses experience ethical issues were characterised by two key themes: (1) the moral character of nurses as a willingness to respond to the vulnerability of human beings and (2) ethical issues nurses acted as barriers sometimes, impeding them from responding to requests of vulnerable human beings for dignified care.

CONCLUSION

Our review provides a deeper understanding of nurses' experiences of ethically sensitive issues, while also highlighting the critical need for adjustments to be made at organisational and societal levels. Ethical issues that emerged in situations where organisational and situational constraints impeded nurses' ethical responses to patients' appeals suggests that early practical support should be made available to resolve ethical issues recognised by nurses. Such support contributes to protecting and promoting not only the dignity of patients with COVID-19 but also of fellow humans in need during crisis.

Threats to professional dignity of Iranian clinical nurses: A qualitative study

AIM

Identifying threats to the nurses' professional dignity has an important role in maintaining and promoting their dignity. This study aimed to evaluate the perception of Iranian nurses' experiences of threats to their professional dignity in clinical settings.

DESIGN

A qualitative directed content analysis approach was used.

METHODS

The present qualitative study was conducted in Iran.Clinical nurses were selected using the purposive sampling method. Data were collected through in-depth semi-structured interviews with 15 clinical nurses from October 2020 to March 2021. The qualitative content analysis method was used to analyze the data.

RESULTS

Two main categories and 16 subcategories were extracted as follows: (1) professional factors (containing seven subcategories) and (2) organizational factors (containing nine subcategories).

CONCLUSIONS

To promote the professional dignity of nurses, it is recommended to identify the factors threatening their professional dignity and create healthy work environments for them.

Dignity encounters: the experiences of people with long-term illnesses and their close relatives within a primary healthcare setting

Aim:

To describe the experiences of dignity encounters from the perspective of people with long-term illness and their close relatives within a primary healthcare setting.

Background:

The importance of dignity as a concept in nursing care is well known, and in every healthcare encounter, the patient’s dignity has to be protected.

Methods:

A purposive sample of 10 people (5 couples) participated in this qualitative descripted study. One person in each of the couples had a long-term illness. Conjoint interviews were conducted and analyzed with an inductive qualitative content analysis.

Results:

The analysis resulted in three themes: i) Being supported by an encouraging contact; ii) Being listen to and understood; and iii) Being met with respect. Couples described being encountered with dignity as having accessibility to care in terms of being welcomed with their needs and receiving help. Accessibility promoted beneficial contact with healthcare personnel, who empowered the couples with guidance and support. Couples described a dignity encounter when healthcare personnel confirmed them as valuable and important persons. A dignity encounter was promoted their sense of feeling satisfied with the care they received and promoted safe care. Treated with dignity had a positive impact on the couples’ health and well-being and enhanced their sense of a good impression of the healthcare personnel within the primary health care.

Conclusions:

Healthcare personnel must regard and consider people with long-term illnesses and their close relatives’ experiences of dignity encounters to gain an understanding that enables them to support their needs and to know that the care is directed toward them.

The movement of virtue from ethos to action

In this paper, we explore the concept of virtue in nursing care. We particularly examine the description of 'virtue' offered by Aristotle, who considers it the mental constitution that forms the basis for laudable social behaviour. We then turn to Katie Eriksson's work on caritative caring ethics and draw parallels between the Aristotelian concept of virtue and being a good nurse. Eriksson suggests that embracing an ethos, a set of basic values, affects nurses' attitudes as well as the way they speak and take on their responsibility for the patient. We discuss these ideas in relation to a tentative ideal model of the movement from ethos to action to understand and address nurses' ethical thinking and acting. Here, we focus on the catalytic role of virtue as a means for realizing a deliberate, intentional acting with the best of the patient in mind. As an outcome of our analysis, we suggest that the movement of virtue from ethos to action is most usefully conceptualized as knowledge about facts, habits of the heart, deeds of the hand and the power of words. Implications for nursing leadership are suggested, including incorporating organizational values through the means of ethical conversations.

Gifts of wise women: A reflection on enduring ideas in nursing that transcend time

In this essay, I propose there are enduring ideas in the works of nurse theorists from the 1960s and 1970s that were valuable not only in the past, but in nursing today as well as in possibly shaping the future of nursing knowledge development. I identify these as gift ideas and draw on the work of Wiedenbach for the gift of dignity in nursing philosophy, and the gifts of dialogue from Orlando, behavioral systems from Johnson, context from Roy, self-care from Orem, and finally the gift of nursing science as emergent in understanding life processes from Rogers. Although the core of nursing knowledge may be elusive, the gift ideas mentioned in this essay provide some guideposts in articulating and developing that core in the present as well as in the future.

Factors of importance for developing a trustful patient-professional relationship when women undergo a pelvic examination

We examined gynecological teaching women's perception on what factors are important for developing a trustful patient-professional relationship when women undergo a pelvic examination. A qualitative research design was conducted with repeated focus group discussions. Our results show that healthcare professionals' communications skills can strengthen a trustful patient-professional relationship. Treating women with dignity could make them feel less vulnerable and make the relationship trustworthy based on respect. Thus, having the ability to identify factors important for a trustful relationship may support healthcare professional's ability to strengthen women's health issues. A trustful relationship might also affect quality of care.

Human dignity in religion-embedded cross-cultural nursing

BACKGROUND

Although human dignity is an unconditional value of every human being, it can be shattered by extrinsic factors. It is necessary to discover the authentic meaning of patients' dignity preservation from different religious perspectives to provide professional cross-cultural care in a diverse setting.

RESEARCH OBJECTIVE

This article identifies common experiences of Iranian Muslim and Armenian Christian patients regarding dignified care at the bedside.

RESEARCH DESIGN

This is a qualitative study of participants' experiences of dignified care elicited by individual in-depth semi-structured interviews.

PARTICIPANTS AND RESEARCH CONTEXT

A purposeful sample of 10 participants (five Iranian Muslims and five Iranian Armenians) from various private and governmental hospital settings was chosen.

ETHICAL CONSIDERATIONS

This study was approved by the ethics committee of Tehran University of Medical Sciences. All the participants were provided with information about the purpose and the nature of the study, the voluntary condition of their participation in this study, and the anonymous reporting of recorded interviews.

FINDINGS

The common experiences of Christian and Muslim patients regarding dignity preservation emerged as "exigency of respecting human nobility" and "providing person-centered care."

DISCUSSION AND CONCLUSION

It is essential to recognize the humanness and individuality of each patient to preserve and promote human dignity in diverse cross-cultural settings. The findings support and expand current understanding about the objective and subjective nature of dignity preservation in cross-cultural nursing.

'Like a prison without bars': dementia and experiences of dignity

The aim of this article is to investigate how life in Norwegian nursing homes may affect experiences of dignity among persons with dementia. The study had a qualitative design and used a phenomenological and hermeneutic approach. Participant observation in two nursing home units was combined with qualitative interviews with five residents living in these units. The study took place between March and December 2010. The residents feel that their freedom is restricted, and they describe feelings of homesickness. They also experience that they are not being seen and heard as individual autonomous persons. This lack of freedom, experiences of homesickness and feelings of not being confirmed and respected as individual autonomous persons may be a threat to their personal dignity. In order to protect and enforce the dignity of persons with dementia living in nursing home, we should confirm them as whole and as individual persons, and we should try to make the nursing homes less institutional and more home like.

Ethical issues in patient safety

The purpose of this article is to discuss the ethical issues impacting the phenomenon of patient safety and to present implications for nursing management. Previous knowledge of this perspective is fragmented. In this discussion, the main drivers are identified and formulated in ‘the ethical imperative’ of patient safety. Underlying values and principles are considered, with the aim of increasing their visibility for nurse managers’ decision-making. The contradictory nature of individual and utilitarian safety is identified as a challenge in nurse management practice, together with the context of shared responsibility and identification of future challenges. As a conclusion, nurse managers play a strategic role in patient safety. Their role is to incorporate ethical values of patient safety into decision-making at all levels in an organization, and also to encourage clinical nurses to consider values in the provision of care to patients. Patient safety that is sensitive to ethics provides sustainable practice where the humanity and dignity of all stakeholders are respected.

Nurses’ experiences of violation of their dignity

Dignity is a human right and a base for human health. This right must be observed in work environments as a moral obligation. This qualitative study aimed to understand nurses’ experiences of violation of their dignity at work and to explore its dimensions. The participants were 15 nurses working in two hospitals in Tehran. The data were collected through 26 unstructured interviews and analyzed using content analysis. The dimensions of violation were ‘irreverence’, including experiences of abuse and violence, humiliation, and being ignored; ‘coercion and violation of autonomy’, consisting of the control of relationships, lack of privacy, rigidness, and imposition; ‘ignoring professional and scientific ability’, indicating impossibilities in applying nurses’ knowledge; and ‘denying the value of nurse/care’, being the theme that verified the dominance of treatment/cure and lack of recognition of care value. Health systems should take the promotion of the nurses’ dignity into account through providing a dignified work environment.

Perceived ethical values by Iranian nurses

Nursing, a scientific and practical discipline, faces continuing challenges of finding new direction in order to decipher its core values and develop current ethical codes for nursing practice. In 2009–10, 28 nurses were purposely selected and interviewed using a semi-structured format in focus groups and individually. Thematic Content Analysis helped explore the perception of Iranian nurses on ethical values in patient care. Seven major themes emerged: respect for dignity, professional integrity, professional commitment, developing human relationships, justice, honesty, and promoting individuals and the nursing profession. Iranian nurses revealed a unique and culture-based set of ethical values. This study found that Iranian nurses place a greater emphasis on preserving the dignity of those accompanying the patient and in showing regard for patients' religious beliefs in a gender appropriate environment.

Human dignity: a cornerstone of doctoral education in nursing

Human dignity is foundational to nursing ethics in both the practice and educational arena. It is implicitly and explicitly woven throughout all ethical dialogue. This column offers insight into the ubiquitous nature of human dignity as it surfaced during a doctoral level ethics course. These examples are shared in light of the humanbecoming human dignity ethical tenets: reverence, awe, betrayal, and shame. The prevalence of dignity in ethical discussion serves as a reminder for nurses to carve out time for meaningful discussions regarding its importance to the nursing profession as a whole.

Common Metaphors in Nursing Ethics

Metaphors are literary comparisons that are used to create new meaning and insight for concepts, ideas, and situations found in a discipline. This author describes some common moral metaphors used in the discipline of nursing and specifically in situations of nursing ethics. New insights and questions for common usage are offered for the metaphors from a nursing theoretical perspective. Implications for nursing as a discipline are incorporated and discussion points for the future practice of nursing are illuminated.

Understanding the meaning of human dignity in Korea: a content analysis

This study aims to understand the meaning of human dignity among adults in Korea. A qualitative study design is utilized. Data were collected with non-structured questions in a sample of 74 Korean adults and analyzed with qualitative content analysis. There were 4 categories, 31 themes and 106 theme clusters classified. The four categories that emerged were: fullness of dignity; loss of dignity; reinforcement of dignity; and enfeeblement of dignity. The results of this study may contribute to healthcare professionals understanding of Korean adults human dignity.

Envisioning Human Dignity to Enhance Practice while Journeying with Rwandan Women

California Baptist University School of Nursing opened in September 2006 as the first baccalaureate nursing education program in Riverside, California. Under the direction of Dr. Constance Milton, the curriculum was cocreated using Parse's humanbecoming school of thought as a framework. In August 2008, nursing students traveled to Rwanda where they bore witness to the transformation after the 1994 genocide. Dimensions and processes of Parse's practice methodology—illuminating meaning by explicating what is with languaging, synchronizing rhythms while dwelling with ups and downs in the struggle of connecting-separating, and mobilizing transcendence as moving beyond with the not-yet while transforming— emerged in the students' journaling as lived all-at-once amid reverence that honored the dignity and worth of the Rwandan people.