Epidemics and the healthcare professional's duty to care: Students' attitudes about work requirements before and during Covid-19 (2017-2021)

CONTEXT

The Covid-19 pandemic has added a new chapter to discussions about the professional duty to care. To understand how Covid-19 may have changed medical students' ethical attitudes towards this duty, we analysed policies written before and during the pandemic by first-year students completing a yearly educational exercise focused on work requirement expectations for healthcare professionals during a hypothetical epidemic.

METHODS

Within a repeated cross-sectional design, consensus coding was performed on policies written over 5 years (2017-2021) using a codebook based on eight questions from the educational exercise for summative content analysis. Frequencies provided summative results and comparisons across years used Fisher's exact test.

RESULTS

We analysed 142 written policies from 2017 to 2021 representing 884 first-year students working in small groups. Students' commitment to the duty to care remained stable during the Covid-19 pandemic, but during the pandemic, students were more likely to support exceptions to the duty to care (e.g. for healthcare professionals with medical conditions or concern for household members' health) and more likely to expect institutions to provide safe working conditions. Ethical values supporting students' policies were largely consistent before and during the pandemic, the most common being beneficence, justice, duty to care, non-maleficence and utility.

CONCLUSIONS

Our results suggest that students' support for the duty to care remained strong during the Covid-19 pandemic. We also found that students supported exceptions to this duty to reflect the needs of healthcare professionals and their families and that they expected institutions to provide safe working conditions. These findings can help inform ethics education and future pandemic preparedness.

Original Research: Exploring U.S. Nurses' Perceived Duty to Care During the COVID-19 Pandemic

BACKGROUND

Duty to care is both an integral concept in health care and a fundamental nursing obligation. But nurses' perceptions of duty to care can be moderated by their experiences in the practice setting. Research examining nurses' perceptions of their duty to care during the COVID-19 pandemic could shed light on how the pandemic is affecting the nursing workforce.

PURPOSE

This study aimed to examine nurses' sense of duty to care during the early months of the pandemic, using the Nash Duty to Care Scale (NDCS), and to compare the high-scoring nurses with the low-scoring nurses.

METHODS

This quantitative study used a descriptive, cross-sectional design. It was conducted among licensed RNs enrolled at two accredited nursing programs in the Northeast region of the United States. Data were collected via a demographics questionnaire and the NDCS. A two-step cluster procedure was used to categorize participants into two groups: those with high perceived duty to care (HPDC) and those with low perceived duty to care (LPDC). Independent t tests were performed to compare NDCS results between the two groups.

RESULTS

Nearly two-thirds (61%) of the participants had total NDCS scores indicating an HPDC, while 39% had scores indicating an LPDC. Of the NDCS's four subscales, perceived obligation and perceived risk were the most important in separating participants into the low- and high-scoring groups.

CONCLUSIONS

This study adds to the literature about the components that affected nurses' perceived duty to care and willingness to report to work during the early months of the pandemic. Just as nurses have a duty to care, health care organizations have an obligation to provide a safe working environment so that nurses can fulfill that duty without sacrificing personal safety. The study findings may guide health care leaders, systems, and organizations regarding how to create safer work environments that support the nurse's duty to care during disasters.

An assessment of nurses' perceived and actual household emergency preparedness

Nurses' household preparedness is critical if they are to avoid role conflict and report for duty during an emergency. To date, the alignment between nurses' perceived and actual household preparedness remains under examined. Investigating one of these variables in isolation fails to consider that perceived and actual household preparedness must be high and aligned. If misaligned, vulnerabilities could surface during emergencies, like concerns about family safety, potentially impacting a nurse's commitment to duty during a crisis, or nurses may lack the actual preparedness to continue working long hours during an emergency. An online questionnaire was distributed to registered nurses in Ireland. The questionnaire was informed by a review of the literature and captured nurses' perceived and actual household preparedness, attitudes towards and exposure to a range of emergencies, and pertinent demographic characteristics. The results showed a relationship between how nurses view their household preparedness and their actual preparedness. Regression analyses indicate that while there is an overlap, the factors associated with how prepared nurses think they are and how prepared they are can differ. This means that strategies to boost actual preparedness may differ from those needed to boost perceived preparedness. This finding underscores the importance of psychosocial preparedness. Feeling prepared is crucial as it can influence how one responds in an emergency. Considering both the perceived and actual aspects of household preparedness can lead to a more effective response during emergencies.

Ethical-legal dilemmas of nursing practice in emergencies and disasters: a scoping review

OBJECTIVE

To map the ethical-legal dilemmas related to nursing practice in emergency and disaster situations.

METHOD

A scoping review developed in accordance with the JBI method, whose information sources were accessed in databases, in addition to gray literature. The selection was made by reading the titles, abstracts and descriptors, observing eligibility criteria, including two reviewers and a third in case of discrepancies. After reading, data extraction and content analysis of 17 selected studies were carried out.

RESULTS

Thirteen ethical-legal dilemmas were mapped related to professional/functional duty towards the family, lack of personal protective equipment and unsafe conditions at work, preparation and availability for action, skills, limits imposed by victims' religion, obligation to provide care.

CONCLUSION

Professionals, researchers and representatives of the category need to resolve demands that involve acting in emergencies and disasters, (re)cognizing the ethical-legal dilemma, and seeking (re)legal frameworks and observance of the fundamental/ethical principles that govern the profession, in the sense to support decision-making and the development of legally safe practices.

Use and impact of the ANA Code: a scoping review

Adherence to professional ethics in nursing is fundamental for high-quality ethical care. However, analysis of the use and impact of nurses' codes of ethics as a part of professional ethics is limited. To fill this gap in knowledge, the aim of our review was to describe the use and impact of the Code of Ethics for Nurses with Interpretive Statements published by the American Nurses Association as an example of one of the earliest and most extensive codes of ethics for nurses with their interpretative statements and constituting a strong basis for the International Council of Nurses' Code of Ethics for Nurses. We based our review on previous literature using a scoping review method. We included both non-scientific and scientific publications to provide an analysis of codes of ethics which can be utilized in development and revision of other nurses' codes of ethics. In the searches, we used CINAHL and PubMed databases limiting publications to texts with a connection to the Code of Ethics for Nurses published from January 2001 to November 2022 and written in English. Searches yielded 1739 references, from which 785 non-scientific and 71 scientific publications were included for analysis of the data. Although non-scientific and scientific publications addressed different number of categories, the results indicated that in the both groups the use and impact focused on professional ethics, nursing practice, and work environment and less on education, research, or social health issues. Nurses' ethical standards were not addressed in non-scientific publications, and clinical issues and leadership were not in focus in scientific publications. To increase evidence-based knowledge of the impact of codes of ethics additional research is needed. Good scientific conduct was followed.

Nurses' duty to care during the COVID-19 pandemic: a cross-sectional survey

Background

Despite the increased demand for nurses worldwide, discussion of nurses’ duty to care is lacking. This study aimed to examine nurses’ duty to care during the coronavirus disease 2019 (COVID-19) pandemic and to identify the influencing factors.

Methods

This was a cross-sectional descriptive research study that used a structured online questionnaire. Registered Korean nurses answered a demographic questionnaire and the Nash Duty to Care Scale.

Results

Age and employment at tertiary hospitals increased nurses’ duty to care. Male sex, a highly educated status, and employment at tertiary hospitals increased the perceived risk. Male sex and employment at tertiary or general hospitals increased confidence in the employer, while a high level of education and a longer total clinical career decreased the same. Age and a higher monthly wage increased perceived obligation. Age, lack of religious beliefs, and clinical experience of 3–7 years increased professional preparedness.

Conclusion

Without enough nursing manpower, the disaster response system could prove to be inefficient. Considering that adequate nurse staffing is essential in disaster management, it is crucial to ensure that nurses have a will to provide care in the case of disaster. In the future, a more active discussion on nurses’ duty to care and additional research on factors that may hinder and facilitate the same are needed.

Willingness to Work during Public Health Emergencies: A Systematic Literature Review

The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies.

Professional identity and supporting willingness of nurses during the COVID ‐19 epidemic in China

Aim

To investigate the professional identities and the willingness of nurses to respond to the call for support during the COVID‐19 epidemic.

Background

The COVID‐19 epidemic has resulted in nearly 300 million cases worldwide, causing more than five million deaths. However, the professional identities and the willingness of nurses to provide support during the COVID‐19 epidemic in China remain unclear.

Methods

A total of 1,505 eligible nurses from 120 hospitals during the COVID‐19 outbreak in China were included. Questionnaires were used to evaluate the willingness of these nurses to participate in epidemic control efforts. The Nurses' Professional Identity Scale was used to measure their sense of professional identity.

Results

About 90% of the nurses were willing to lend support in Hubei Province during the epidemic. The most common reason (93.84%) was found to be their beliefs as medical personnel in helping others in need. Nearly 10% of the nurses were unwilling to go to Hubei, primarily due to family reasons. The average total score of the Professional Identity Scale for all nurses reached a moderate to high level as indication of professional identity (116–125). Nurses who were willing to go to Hubei had a significantly higher total score than those who were not.

Conclusions

The professional identity of nurses in China improved during the epidemic, and those with higher professional identities were more likely to respond to calls for support during the epidemic.

Nursing ethics in an era of pandemic

Background

The ANA Code of Ethics for Nurses, regularly revised since 1896, may not provide guidance in an era of pandemic and sociopolitical unrest.

Purpose

This study explored whether the Code of Ethics comprehensively address current nursing challenges.

Methods

23 nurses participated in six Zoom focus groups to discuss whether provisions were applicable to their current practice. An iterative approach was used to review transcripts independently and then merge findings to identify ethical themes.

Findings

Provisions 4, 6, and 8 were most relevant. None of the provisions addressed the guilt secondary to isolating patients from support systems and not being “on the front lines” of COVID care.

Discussion

The co-occurring crises of COVID-19 and social unrest created an ethical crisis for many nurses. The Code of Ethics provided a useful guide for framing discussion and formulating strategies for change, but did not eliminate distress during a time of novel challenges.