Nurses' ethical challenges caring for people with COVID-19: A qualitative study

The Impact of Coronavirus Disease 2019 on Nursing Education: Evidence, Experience, and Lessons Learned

This article examines the multifaceted impact of the coronavirus disease 2019 pandemic on nursing education, with a focus on implications for critical care. Issues including the rapid transition to remote learning, stress and burnout, disengagement, challenges in clinical education, ethical dilemmas, and the influence of workforce dynamics on nursing education are discussed. The article explores challenges, opportunities, and the invaluable lessons learned from this unprecedented crisis. Understanding the evolving dynamics is essential for nursing education and practice, offering a pathway toward a more resilient and promising future for both individuals and the nursing profession as a whole.

Compassionate nursing in challenging contexts: The importance of judgments

BACKGROUND

Nurses' demonstration of compassion is an ethical and often regulatory expectation. While research has been conducted to examine the barriers and facilitators of compassion in nurses, little is known about how nurses develop and express compassion for patients who may be blamed for their health condition. Unvaccinated COVID-19 patients are an example of such patients.

RESEARCH QUESTIONS

How do nurses provide compassionate care for unvaccinated adults infected with COVID-19? How did the context of COVID-19 vaccination in Canada shape nurses' relationships with unvaccinated patients?

RESEARCH DESIGN

A generic qualitative approach using interviews to gather data was used. Martha Nussbaum's conceptualization of compassion and its cognitive requirements was employed to add depth to the analysis.

PARTICIPANTS AND RESEARCH CONTEXT

Seventeen Registered Nurses, from a range of practice settings, who had cared for unvaccinated patients with COVID-19 participated.

ETHICAL CONSIDERATIONS

Ethics approval was received, and signed informed consent was obtained. Participants who were the current students of the researchers were excluded.

FINDINGS

Three themes were identified:1) Encountering Extreme Workplace Impediments to Compassion.2) Managing Emotions to Provide "Nonjudgmental Care."3) Practicing Narrative Imagination.

DISCUSSION

The difficult working conditions during the pandemic impeded nurses' capacity to be compassionate. Yet, none judged their patients' suffering as trivial, and all provided necessary nursing care. Some initially blamed these patients for the severity of their illness and suppressed their emotions to provide what they called "nonjudgmental care." Upon reflection, participants recognized that these patients' life circumstances may have been barriers to vaccination which, in the end, facilitated the development of compassion.

CONCLUSION

This research has implications that go beyond that of caring for patients with COVID-19. The ideal of "nonjudgmental care" requires critical re-examination because judgments and emotions are required for compassion.

Ethical Dilemmas and Coping Experiences of Nurses Caring for Patients With Hematologic Cancer: A Phenomenological Study

The study aimed to evaluate the ethical dilemmas faced by nurses who provide care to patients with hematologic cancer and determine their coping mechanisms using a phenomenological approach. This qualitative study was conducted with 35 nurses employed in clinics specializing in hematologic cancer patient care, living in diverse regions of Turkey, using semistructured, in-depth interviews through the WhatsApp mobile application. The snowball sampling technique was utilized to identify participants, and interviews continued until data saturation was achieved. All interviews were recorded and subsequently transcribed. Data analysis was conducted using Colaizzi's phenomenological analysis method, with the study adhering to the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist for reporting. In the analysis of the data, 2 categories (ethical dilemma situations and coping experiences) and 6 subthemes (treatment, care, professional values and beliefs, emotions, struggling with emotional burdens, and psychosocial approach) emerged. According to the results, nurses responsible for hematologic cancer patients struggle with ethical dilemmas in healthcare delivery and face challenges in effectively addressing them, which could potentially impact the quality of healthcare provided by nurses.

Nurses' perceptions of involving family members in the care of mental health care users

BACKGROUND

 Family involvement in mental health care is a therapeutic intervention in the management of mental illness. The global concern in long-term mental health is that families find it difficult to accept mental illness when their loved ones are admitted to receive care, treatment and rehabilitation.

OBJECTIVES

 To describe nurses' perceptions of involving family members in the care of mental health care users in long-term institutions.

METHOD

 A quantitative descriptive design was used. The population comprised nurses working at three mental health institutions (MHIs). Probability simple random sampling was used to select 360 respondents. Data were collected using self-administered questionnaires.

RESULTS

 The findings revealed that most (86.9%) of the nurses acknowledged that challenges affect families' involvement in mental health care. A total of 91.4% of nurses complained that family members' involvement was insufficient and (80.6%) indicated that poor family contact affects the provision of quality mental health care. Therefore, the respondents believed that the families' involvement has an impact on the management of mental illness.

CONCLUSION

 Engaging family members in mental health care helps both health professionals and families to participate in patient-centred care and mental health care services. However, MHCUs benefit when their families are involved.Contribution: The study contributed to mental health nursing as its results can be used to measure the quality of health services improvements, by involving the family members during hospitalisation of their loved ones for mental health care.

Caring for children and families during the COVID-19 pandemic: innovations and changes experienced by nurses

OBJECTIVE

To understand the experience of nurses working in pediatric units in the face of innovations and changes in the process of caring for children and families during the COVID-19 pandemic. Also, the objective is to understand the typical experience of nurses in this care.

METHOD

Qualitative research, which involved the participation of 16 nurses from pediatric units of a public teaching hospital. The data were analyzed according to the theoretical-methodological framework of Alfred Schütz's social phenomenology.

RESULTS

The participants' reports generated the categories: the challenge of experiencing changes amid fear, the team's adaptation to innovations and changes caused by the COVID-19 pandemic and the expectation for care and the work process.

CONCLUSION

The understanding of the nurses' experience highlighted changes, team adaptations and expectations for the care of children and families, which, although permeated by learning, were experienced by ethical dilemmas and moral suffering for these professionals.

Experiences and attitudes of clinical and academic nurses about infection prevention and control nursing curriculum and duties - a qualitative study

BACKGROUND

Infectious diseases are becoming more widespread and re-emerging, causing psychological, social, economic, and health effects at both national and international levels. Specialist nurses can help prevent and control these infections. However, in Iran, there are currently no specialist infection prevention and control (IPC) nurses to manage and control infections. This study aims to explore clinical and academic nurses' attitudes toward IPC nursing curriculum and duties.

METHODS

The study used a qualitative content analysis approach. Thirty-six participants, including clinical and academic nurses, were selected using a purposeful sampling method. Data was collected through seven focused group discussions. The accuracy and validity of the research tools were measured using the Four-Dimension Criteria developed by Lincoln and Guba. Data analysis was conducted using directed content analysis.

RESULTS

The data analysis of the discussions held in the seven focus groups extracted 628 codes. Three themes were developed from the qualitative analysis: "Core characteristics of the curriculum", "Expected competencies and skills", and "Evaluation." These themes were derived from nine main categories and 25 subcategories.

CONCLUSIONS

Specialist IPC nurses can play important roles in various positions and environments. Therefore, educational policymakers in Iran should consider establishing IPC nursing courses. It is also recommended that policymakers and decision-makers in the nursing field of other less developed countries should prioritize this issue.

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.

The experiences of patients with COVID-19 and their relatives from receiving professional home care nursing: a qualitative content analysis

BACKGROUND

To overcome of patients with COVID-19 over the capacity of hospitals and mild to moderate severity of the disease in most cases, the World Health Organization and the Centers for Disease Control and Prevention in the United States, recommend home care for these patients. Receiving care at home will face challenges that can be context-based, especially in crises like the Coronavirus pandemic. The present study aimed to describe the experiences of patients with COVID-19 and their relatives from receiving professional home care nursing.

METHODS

This study was conducted using a qualitative content analysis method. Nine participants with COVID-19 who were receiving home care nursing in Semnan participated in this study. The purposive sampling method was used. Sampling continued until no new categories appeared, meaning the category's theoretical saturation. Deep and semi-structured interviews were used to collect data based on the research question. Data was analyzed using the conventional content analysis method using Graneheim and Lundman's approach.

RESULTS

After analyzing the interviews and comparing codes based on similarities and differences, three main themes, 11 categories, and 30 subcategories were identified. The main themes included "The value of home care" (personalization of care, being economical, providing intellectual security, and reducing the concern of family), "Comprehensive care" (professional commitment, empathy, mastery in care, and patronage), and "Care challenges" (cultural barriers, inadequate services, and lack of information about costs and conditions).

CONCLUSION

The patients with COVID-19 who received professional nursing care at home mentioned some challenges, such as the caregiver not being of the same sex as the patient, delay in receiving the service, the inadequacy of the centers, the limitation of the right to choose the care provider, and insufficient information about the cost of services received before receiving each care.

Nurses' Views on Caring for Lonely Patients During the Pandemic: A Qualitative Study

BACKGROUND

The implementation of safety measures in hospitals due to the COVID-19 pandemic, including family visitation restrictions, forced the family to be absent during the patient's hospitalization. Nurses were confronted with new roles and responsibilities, as caring for lonely patients was a new phenomenon that emerged during the pandemic.

PURPOSE

The purpose of this study was to explore the nurses' views on caring for lonely patients during the COVID-19 pandemic.

METHODS

A qualitative research method based on an inductive content analysis approach was used. Data collection was carried out using semi-structured interviews. The sample consisted of 11 nurses who worked in COVID-19 wards and units. Content analysis was used to analyze the interview data.

RESULTS

The analysis of the data revealed three main themes: 1) caring for the patient and the family; 2) extending conventional care; and 3) developing supportive mechanisms for better care. Caring for lonely patients brought about changes in patients's management and care and significantly affected communication patterns as well as nurses' roles and responsibilities. Providing care beyond limits, supporting care through the utilization of new technologies, and transforming organization and care were mentioned as areas of challenge for nursing practice.  Conclusions: Maintaining communication and supporting the family's involvement in patient care are considered to be equal to healing for the lonely patient. Reshaping working conditions and caring practices to meet the needs of the nurses, the patients, and their families during health crises may contribute positively to the provision of holistic care for patients and their families.

Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective

BACKGROUND

Intensive care unit (ICU) nurses working in South Korea report experiencing uncertainty about how to care for patients undergoing withdrawal of life-sustaining treatments (WLT). A lack of consensus on care guidelines for patients with WLT contributes to uncertainty, ambiguity, and confusion on how to act appropriately within current law and social and ethical norms. To date, little has been discussed or described about how ICU nurses construct meaning about their roles in caring for dying patients in the context of wider social issues about end-of-life care and how this meaning interacts with the ICU system structure and national law. We aimed to better understand how ICU nurses view themselves professionally and how their perceived roles are enabled and/or limited by the current healthcare system in South Korea and by social and ethical norms.

METHODS

This qualitative descriptive study was conducted using in-depth, semi-structured interviews and discourse analysis using Gee's Tools of Inquiry. Purposive sampling was used to recruit ICU nurses (n = 20) who could provide the most insightful information on caring for patients undergoing WLT in the ICU. The interviews were conducted between December 2021 and February 2022 in three university hospitals in South Korea.

RESULTS

We identified four categories of discourses: (1) both "left hanging" or feeling abandoned ICU nurses and patients undergoing WLT; (2) socially underdeveloped conversations about death and dying management; (3) attitudes of legal guardians and physicians toward the dying process of patients with WLT; and (4) provision of end-of-life care according to individual nurses' beliefs in their nursing values.

CONCLUSION

ICU nurses reported having feelings of ambiguity and confusion about their professional roles and identities in caring for dying patients undergoing WLT. This uncertainty may limit their positive contributions to a dignified dying process. We suggest that one way to move forward is for ICU administrators and physicians to respond more sensitively to ICU nurses' discourses. Additionally, social policy and healthcare system leaders should focus on issues that enable and limit the dignified end-of-life processes of patients undergoing WLT. Doing so may improve nurses' understanding of their professional roles and identities as caretakers for dying patients.

Rapid Critical Care Training for Nurses Deployed to Intensive Care Units During the COVID-19 Surge

BACKGROUND

During the first COVID-19 pandemic wave, non-intensive care unit (non-ICU) nurses were deployed to temporary ICUs to provide critical care for the patient surge. A rapid critical care training program was designed to prepare them to care for patients in either temporary or permanent ICUs.

OBJECTIVE

To evaluate the effectiveness of this training program in preparing non-ICU nurses to provide critical care for COVID-19 patients in temporary ICUs.

METHODS

A survey was used to evaluate the impact of rapid critical care training on nurses' critical care skills and compare the experiences of nurses deployed to temporary versus permanent ICUs. Data were analyzed with χ2 and Spearman ρ tests with α = .05.

RESULTS

Compared with nurses in other locations, nurses deployed to temporary ICUs were less likely to report improved capability in managing mechanical ventilation; infusions of sedative, vasoactive, and paralytic agents; and continuous renal replacement therapy. Nurses in temporary ICUs also reported being less prepared to care for critically ill patients (all P < .05).

CONCLUSIONS

The rapid training program provided basic critical care knowledge for nurses in temporary ICUs, but experiences differed significantly between those deployed to temporary versus permanent ICUs. Although participants believed they provided safe care, nurses with no critical care experience cannot be expected to learn comprehensive critical care from expedited instruction; more formal clinical support is needed for nurses in temporary ICUs. Rapid critical care training can meet emergency needs for nurses capable of providing critical care.

The nurses' perception of the factors influencing professional misconduct: A qualitative study

BACKGROUND

Professional misconduct undermines safe and quality care; however, little is known about its nature and influential factors.

AIM

This study aimed to explain the factors influencing professional misconduct in nurses.

RESEARCH DESIGN

This qualitative study was conducted using the conventional content analysis method.

PARTICIPANTS AND RESEARCH CONTEXT

Data were collected using semi-structured interviews with 19 nurses working in the hospital selected through a purposeful method and analyzed by Graneheim and Lundman approach.

ETHICAL CONSIDERATIONS

The ethics committee of Tehran University of Medical Sciences approved this study with the ethics code IR.TUMS.FNM.REC.1400.187. Informed consent was obtained from all participants. Participants were assured of confidentiality.

FINDINGS

Factors influencing professional misconduct by nurses were categorized into three main categories: human factors (nurses' professional characteristics, personal characteristics of nurses and patient/companion, patient's clinical condition), procedural factors (procedural conditions, possibility of proving misconduct), and organizational factors (recruitment process, conditions of resources, managing misconduct, bureaucracy, and ward characteristics).

CONCLUSION

This study assists in explaining the factors influencing professional misconduct by nurses. Therefore this study's results can help managers and planners develop interventions to prevent and correct factors that contribute to misconduct and strengthen factors that prevent misconduct in order to ensure quality and safe patient care.

Ethical Challenges to the Self-care of Nurses during the Covid-19 Pandemic

BACKGROUND

The emerging working conditions triggered by the COVID-19 pandemic have imposed numerous ethical challenges on the nurses, which, in turn, can negatively impact the nurses' physical and mental health, and thus their work performance through intensifying negative emotions and psychological pressures.

AIM

The purpose of this study was to highlight the nurses' perceptions of the ethical challenges that they faced regarding their self-care during the COVID-19 pandemic.

RESEARCH DESIGN

A qualitative, descriptive study with a content analysis approach.

PARTICIPANTS AND RESEARCH CONTEXT

The data were collected through semi-structured interviews with 19 nurses working in the COVID-19 wards of two university-affiliated hospitals. These nurses were selected using a purposive sampling method and the data were analyzed using a content analysis approach.

ETHICAL CONSIDERATIONS

The study was approved by the TUMS Research Council Ethics Committee under the code: IR.TUMS.VCR.REC.1399.594. In addition, it is based on the participants' informed consent and confidentiality.

FINDINGS

Two themes and five sub-themes were identified, including ethical conflicts (the conflict between self-care and comprehensive patient care, prioritization of life, and inadequate care) and inequalities (intra- and inter-professional inequalities).

CONCLUSION

The findings demonstrated that the nurses' care is a prerequisite for the patients' care. Considering that the ethical challenges faced by nurses are related to unacceptable working conditions, organizational support, and lack of access to facilities such as personal protective equipment, it seems essential to support nurses and provide adequate working conditions to provide patients with quality care.

Stretching oneself too thin and facing ethical challenges: Healthcare professionals' experiences during the COVID-19 pandemic

BACKGROUNDS

Most countries are facing increased pressure on healthcare resources. A better understanding of how healthcare providers respond to new demands is relevant for future pandemics and other crises.

OBJECTIVES

This study aimed to explore what nurses and doctors in Norway reported as their main ethical challenges during two periods of the COVID-19 pandemic: February 2021 and February 2022.

RESEARCH DESIGN

A longitudinal repeated cross-sectional study was conducted in the Western health region of Norway. The survey included an open-ended question about ethical challenges among doctors and nurses in hospital departments. Free-text comments were analysed using Systematic Text Condensation and also presented in a frequency table.

ETHICAL CONSIDERATIONS

Ethical approval was granted by the Regional Research Ethics Committee in Western Norway (131,421). All participants provided consent when participating in the study.

RESULTS

In 2021, 249 and in 2022, 163 healthcare professionals responded to the open-ended question. Nurses and doctors reported three main categories of ethical challenges related to the COVID-19 pandemic: (1) barriers that hindered them in acting as they ethically would have wanted to do; (2) priority-setting dilemmas linked to overtreatment, transfer of resources and ranking patient needs; and (3) workload expansion threatening work-life balance and employees' health. Category one comprised of resource barriers, regulatory barriers, system barriers, and personal barriers. Regulatory barriers, especially visitor restrictions for next-of-kin, were the most frequently reported in 2021. Resource barriers, related to the increased scarcity of qualified staff, were most frequently reported in 2022. Clinicians stretched themselves thin to avoid compromising on care, diagnostics, or treatment.

CONCLUSIONS

Developing clinicians' ability to handle and cope with limited healthcare resources is necessary. To foster resilience and sustainability, healthcare leaders, in collaboration with their staff, should ensure fair priority-setting and initiate reflections among doctors and nurses on what it implies to provide 'good enough' care.

Explaining ethical challenges and practical solutions from a nursing managements' perspective: A phenomenological study

Introduction and Objective

Ethical practice is a vital aspect of nursing interventions. Complying with the ethical aspects of the intervention procedure in a stressful nursing environment is not easy and nurse managers always face ethical challenges which are in conflict with their personal values and norms. Identifying and solving these challenges improves the efficiency and effectiveness of nursing care activities. Therefore, this research was done to explain the ethical challenges of nurse managers and practical solutions from their perspective.

Material and Method

It is a qualitative study that was carried out based on the phenomenological method in 2022. The participants of this study were 20 nurse managers of Arak hospitals who were selected by purposive sampling until data saturation. The data were collected through semi-structured interviews for 30 to 90 minutes. Data collection was carried out with the participant's consent, using a digital recording device and verbatim transcription, and then it was analyzed using Van Manen's six-step hermeneutic phenomenological approach.

Findings

The results of this study could provide a clear picture of ethical challenges and their practical solutions from the nurse managers' perspective in the form of four themes of managerial ethical challenges which include challenges facing physicians, organizations, employees, managers, and three themes for practical solutions, including organizational solutions, interpersonal solutions, and educational solutions which were manifested.

Conclusion

Nurse managers are always faced with ethical challenges in their daily activities. To deal with these challenges, they must be familiar with the rules and principles of professional ethics, practical standards, and laws related to patients' rights. Ethical principles and awareness of the ethical decision-making process are useful and effective in having capable and ethical nurses who provide competent care. To deal with ethical challenges, it is suggested to consider self-care strategies and structural and specialized support in each center, which will ultimately lead to the improvement of service quality and the promotion of ethics in care-treatment environments.

Nurses' coping strategies caring for patients during severe viral pandemics: A mixed-methods systematic review

BACKGROUND

Nurses play an essential role in responding to severe viral disease which bring considerable challenges to their personal and professional well-being. This subsequently can affect the delivery of care and healthcare systems' organisational capacity to respond. Understanding nurses' experiences of these challenges will help inform healthcare policies.

AIM

To explore the experiences and coping strategies of nurses caring for patients during severe viral disease pandemics.

DESIGN

A mixed-methods systematic review informed by the Joanna Briggs Institute (JBI) methodology.

METHODS

A mixed-methods systematic review. Five electronic databases Medline, CINAHL, PsychInfo, ASSIA and Scopus were searched on 4th April 2021. Results were reported in accordance with PRISMA. The findings were analysed and reported in the context of the Self-Regulatory Common-Sense Model.

RESULTS

In total, 71 peer-review primary research articles describing nurses' experiences of caring for patients during SARS, MERS, Swine flu H1N1, Avian influenza or SARS-CoV-2 / COVID-19 published in English from 2003 to 2021 were included. We found links between nurses' perception of the health threats, their emotional reactions, and coping strategies. Perceived health threats were influenced by organisational factors including frequent changes in clinical guidelines and workplace protocols, onerous workloads and working hours, unavailability of PPE, and lack of knowledge and training in pandemic management. These impacted nurses' physical, psychological and social well-being. Nurses also reported helpful and unhelpful coping strategies to manage the health threats.

CONCLUSIONS

It is vital for stakeholders, policymakers, government and healthcare institutions to recognise and monitor the wider impact on healthcare workers from health emergencies. In addition, support to develop and implement effective systems and individual mechanisms to offset the anticipated impact pre and post pandemics/epidemics is needed. Our findings can inform those strategies for similar future health emergencies.

RELEVANCE TO CLINICAL PRACTICE

Nurses are often the first point of contact in providing direct care to patients, hence they are at high risk of being infected. The findings from this review can help managers and policymakers in developing programmes to enhance resilience in the nursing workforce.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a literature review study.

Scarce resources, public health and professional care: the COVID-19 pandemic exacerbating bioethical conflicts - findings from global qualitative expert interviews

BACKGROUND

Since spring 2020, the SARS-CoV-2 virus has spread worldwide, causing dramatic global consequences in terms of medical, care, economic, cultural and bioethical dimensions. Although the resulting conflicts initially appeared to be quite similar in most countries, a closer look reveals a country-specific intensification and differentiation of issues. Our study focused on understanding and highlighting bioethical conflicts that were triggered, exposed or intensified by the COVID-19 pandemic in low and middle-income countries (LMICs) and high-income countries (HICs).

METHODS

We conducted qualitative interviews with 39 ethics experts from 34 countries (Argentina, Australia, Austria, Brazil, Canada, Colombia, Denmark, Ecuador, Ethiopia, France, Germany, India, Italy, Israel, Japan, Kyrgyzstan, Mexico, Nigeria, Oman, Pakistan, Paraguay, Poland, Romania, Russia, Singapore, South Korea, Spain, Sweden, South Africa, Tunisia, Türkiye, United-Kingdom, United States of America, Zambia) from November 2020 to March 2021. We analysed the interviews using qualitative content analysis.

RESULTS

The scale of the bioethical challenges between countries differed, as did coping strategies for meeting these challenges. Data analysis focused on: a) Resource scarcity in clinical contexts: Scarcity of medical resources led to the need to prioritize the care of some COVID-19 patients in clinical settings globally. Because this entails the postponement of treatment for other patients, the possibility of serious present or future harm to deprioritized patients was identified as a relevant issue. b) Health literacy: The pandemic demonstrated the significance of health literacy and its influence on the effective implementation of health measures. c) Inequality and vulnerable groups: The pandemic highlighted the context-sensitivity and intersectionality of the vulnerabilities of women and children in LMICs and the aged in HICs. d) Conflicts surrounding healthcare professionals: The COVID-19 outbreak underscored the tough working conditions for nurses and other health professionals, raising awareness of the need for reform.

CONCLUSION

The pandemic exposed pre-existing structural problems in LMICs and HICs. Without neglecting individual contextual factors in the observed countries, we created a mosaic of different voices of experts in bioethics across the globe, drawing attention to the need for international solidarity in the context of a global crisis.

A divided community: A descriptive qualitative study of the impact of the COVID-19 pandemic on nurses and their relationships

AIMS

To identify the personal and professional impact of the COVID-19 pandemic on clinical nurses with regard to personal and workplace safety, personal and professional relationships and perceptions of their team, organization and community, and to understand lessons learned to inform future responses to pandemics or global emergencies.

DESIGN

Qualitative, descriptive free-text surveys, informed by appreciative inquiry.

METHODS

Nurses working in adult COVID- and non-COVID cohort medical-surgical and intensive care units, outpatient cancer and general surgery centres were invited to participate. Data were collected between April and October 2021 and analysed using summative content analysis.

RESULTS

In total, 77 participants completed free-text surveys. Five themes were identified: (1) Constraints on nursing: barriers in communication and diminished patient safety and quality of care; (2) Navigating uncertainty: the emotional toll of the pandemic; (3) Team solidarity, renewed appreciation and reaffirming purpose in nursing work; (4) Enhanced trust versus feeling expendable; and (5) Increased isolation and polarization within communities. Nurses described a perceived negative impact on a number of their relationships, including with patients, employer and community. They described a huge emotional toll that included feelings of isolation and polarization. While some nurses described feeling supported by their team and employer, others described feeling expendable.

CONCLUSION

Nurses' responses provided insights into negative emotional experiences during the pandemic due to heightened uncertainty and fear, and also the importance of support received from peers, colleagues and their employer. Nurses experienced feelings of isolation and polarization within their communities. The varied responses reflect the importance of societal solidarity when faced with global emergencies, and the need for nurses to feel valued by their patients and employer.

IMPACT

Effective responses to public health emergencies require individuals and communities to work together to achieve collective goals. Efforts to retain nurses are critical during global emergencies.

PATIENT OR PUBLIC CONTRIBUTION

No patient and public involvement.

Moral distress experienced by care leaders' in older adult care: A qualitative study

BACKGROUND

Many healthcare professionals have left their professions recently because of increased moral distress, and the COVID-19 pandemic has had a further major impact on the ever-changing healthcare environment.

AIM

The purpose of the study was to examine care leaders' experiences of moral distress in their daily work in older adult care.

METHODOLOGY

A qualitative design was used. The data consisted of texts from interviews with care leaders (N = 8) in an older adult care context. Content analysis was used to analyse the data.

FINDINGS

Five themes emerged: (1) moral distress arises from a lack of time, (2) moral distress contributes to a sense of inadequacy but also a sense of responsibility, (3) moral distress arises from an imbalance in values, (4) increased knowledge and open discussion help reduce moral distress and (5) reflection, increased support and increased resources can reduce moral distress.

CONCLUSION

Moral distress is something that care leaders, according to this study, experience daily in an older adult care context and it is considered to have increased. Care leaders can experience moral distress from a lack of time; patient-related, relative-related or other ethically difficult situations or an imbalance between own values and an organisation's, other caregivers', patients' and/or patients' relatives values. Increased staffing resources, more knowledge (training and lectures) and time for reflection individually, in groups or with an outside expert could increase care leaders' insights into and ability to reduce moral distress. Although situations that are characterised by moral distress are burdensome, care leaders have the opportunity to learn from such situations through reflection and discussion and can develop strategies for future ethical challenges. Future research could focus on exploring caregivers' experiences of moral distress.

Ethical dilemmas faced by healthcare teachers during the COVID-19 pandemic

BACKGROUND

Previous studies have shown that the rapid transition to emergency remote teaching due to the COVID-19 pandemic was challenging for healthcare teachers in many ways. This sudden change made them face ethical dilemmas that challenged their values and ethical competence.

RESEARCH AIM

This study aimed to explore and gain a deeper understanding of the ethical dilemmas healthcare teachers faced during the COVID-19 pandemic.

RESEARCH DESIGN

This was an inductive qualitative study using a hermeneutic approach. Semi-structured interviews were conducted and analysed thematically.

PARTICIPANTS AND RESEARCH CONTEXT

Healthcare teachers (n = 20) from eight universities and universities of applied sciences in the Nordic and Baltic countries participated.

ETHICAL CONSIDERATIONS

This study was based on the research ethics of the Norwegian National Research Ethics Committee for Medicine and Health Sciences and approved by the Norwegian Agency for Shared Services in Education and Research.

FINDINGS

Healthcare teachers faced several ethical dilemmas due to restrictions during the COVID-19 pandemic. The analysis revealed three main themes: How should I deal with students' ill-being, and what can I as a teacher do?; What can I demand from myself and my students, what is good teaching?; How do I manage the heavy workload and everyone's needs, and who gets my time?

CONCLUSIONS

This study highlights the importance of healthcare teachers' continuous need for pedagogic and didactic education, especially considering new technology and ethical issues. During the pandemic, the ethical consequences of remote teaching became evident. Ethical values and ethical dilemmas should be addressed in healthcare education programmes at different levels, especially in teacher education programmes. In the coming years, remote teaching will grow. Therefore, we need more research on this issue from an ethical perspective on its possible consequences for students and healthcare teachers.

Through the eyes of nurses: a content analysis of nurses' experiences in caring for COVID-19 patients

BACKGROUND

In the current global climate, the nursing staff has placed a significant emphasis on developing effective self-protection strategies and implementing measures to prevent the transmission of infectious diseases, with a particular focus on the highly communicable COVID-19 virus. Ensuring the safety and well-being of both healthcare providers and patients has made it imperative to incorporate this aspect into healthcare provision.

OBJECTIVE

The study aimed to describe the experiences of nurses in providing care for patients infected with COVID-19.

METHODOLOGY

This qualitative content analysis study, following COREQ guidelines, involved 18 nurses who were taking care of COVID-19 patients at Shahid Mohamadi Hospital, a general hospital in Bandar Abbas, Hormozgan Province. The hospital is affiliated with Hormozgan University of Medical Sciences and the research was conducted in 2022.The sampling method was purposive, and unstructured interviews were used. Data collection continued until data saturation was achieved. Data analysis was performed continuously and concurrently through the collection of data using conventional content analysis methods.

FINDINGS

The qualitative analysis of the data revealed three main themes centered on challenges related to nurses' self-care, patient care, and the healthcare delivery system.

CONCLUSION

Overall, to address the challenges faced by healthcare providers caring for COVID-19 patients, their needs must be prioritized. This includes establishing a prepared healthcare system, implementing strategies to protect their well-being, and learning from their experiences for future disease outbreaks and disasters.

Bipolar Coping Strategies of Nurses in Facing the COVID-19 Pandemic: A Meta-synthesis Review

Nurses on the front line of facing the COVID-19 pandemic have applied many coping strategies to adapt to their experienced physical and psychosocial challenges. This review aimed to identify coping strategies of nurses in the face of Covid-19. In this meta-synthesis review, qualitative articles related to the coping strategies published in English in the Google Scholar, PubMed, Web of Science, ScienceDirect, and CINAHL databases were selected and analyzed. The review of selected articles showed nurses have used various coping strategies that can be categorized into one main theme, two themes, and ten sub-themes. The theme of efficient coping strategies includes the sub-themes of spiritual-religious coping, protective coping (protection of family members and colleagues), supportive coping by obtaining support from family, friends, colleagues, society, and government organizations, committed coping, positive mind coping, emotional coping, operational coping, and fun coping. The theme of inefficient coping strategies includes the sub-themes of avoidance and risky behaviors. The strategies lead to the synthesis of bipolar coping strategies of nurses during the COVID-19 pandemic. Therefore, healthcare policymakers should emphasize using efficient strategies and avoiding inefficient ones.

Caregiving experiences of nurses working in a newly established intensive care unit during the COVID-19 pandemic: A qualitative study

BACKGROUND

The coronavirus disease 2019 (COVID-19) has adversely affected intensive care nurses; for instance, they have fought against an unknown disease, and their workload has increased. In addition, the COVID-19 pandemic has led intensive care nurses to work in new settings and with new teams.

OBJECTIVE

The aim of this study was to explore and describe the caregiving experiences of nurses who were working in a new COVID-19 intensive care unit in Turkey and providing care for patients infected with SARS-CoV-2.

METHOD

In this descriptive qualitative study, semi-structured interviews were held from 22 July to 31 August 2020 and were recorded and analysed based on thematic analysis. The researchers followed the COREQ checklist in reporting the study.

FINDINGS

From interviews held with 11 nurses, four main themes (uncertainty and challenges in the 'danger zone', emotional and psychosocial changes, professional effects of the pandemic and being ready for a future pandemic) were derived from 11 sub-themes.

CONCLUSIONS

The new setting and the ever-changing team make caring for the COVID-19 patient even more difficult. A good organization, an experienced permanent team, a known setting and good working conditions are essential to be prepared for possible pandemics in the future.

Compassion Fatigue and Ethical Attitudes in Nursing Care in Intensive Care Nurses During the COVID-19 Pandemic: A Cross-sectional Study

BACKGROUND

Intensive care unit (ICU) nurses faced an increased risk of compassion fatigue and ethical concerns during the COVID-19 pandemic.

PURPOSE

To evaluate compassion fatigue of ICU nurses and their ethical attitudes in care during the COVID-19 pandemic and analyze contributing factors.

METHODS

An exploratory cross-sectional research design was used.

RESULTS

A total of 103 ICU nurses participated. The nurses' compassion fatigue and ethical attitude scores were high. Compassion fatigue was explained by the following variables: considering resigning, receiving support for ethical decisions, willingness to work in the ICU, duration of providing activities of daily living in a shift, and number of patients per nurse.

CONCLUSIONS

Compassion fatigue was high in nurses working in the ICU during COVID-19. The high level of ethical attitudes shows commitment to professional ethics and reflects the development of the nurses' professional identity. Implementation of interventions that help improve compassion fatigue among nurses is needed.

Resilience perspective on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis

OBJECTIVE

To identify, review and synthesise qualitative literature on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic.

DESIGN

Systematic review with meta-synthesis.

DATA SOURCES

Academic Search Elite, CINAHL, MEDLINE, PubMed, Science Direct and Scopus.

ELIGIBILITY CRITERIA

Qualitative or mixed-methods studies published between 2019 and 2021 investigating healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using a predesigned data extraction form that included details about publication (eg, authors, setting, participants, adaptations and outcomes). Data were analysed using thematic analysis.

RESULTS

Forty-seven studies were included. A range of adaptations crucial to maintaining healthcare delivery during the COVID-19 pandemic were found, including taking on new roles, conducting self and peer education and reorganising workspaces. Triggers for adaptations included unclear workflows, lack of guidelines, increased workload and transition to digital solutions. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies and healthcare services.

CONCLUSION

Healthcare professionals demonstrated significant adaptive capacity when faced with challenges imposed by the COVID-19 pandemic. Several adaptations were identified as beneficial for future organisational healthcare service changes, while others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations. Healthcare professionals' experiences working during the COVID-19 pandemic present a unique opportunity to learn how healthcare systems rapidly respond to changes, and how resilient healthcare services can be built globally.

Protective factors of ethical conflict during a pandemic-Quali-Ethics-COVID-19 research part 2: An international qualitative study

AIMS AND OBJECTIVES

To determine which factors can be considered protective of ethical conflicts in intensive care unit healthcare professionals during a pandemic.

BACKGROUND

The COVID-19 pandemic gave rise to new ethical concerns in relation to the management of public health and the limitations on personal freedom. Continued exposure to ethical conflict can have a range of psychological consequences.

DESIGN

A qualitative design based on phenomenological approach.

METHODS

A total of 38 nurses and physicians who were regular staff members of Barcelona and Milan's public tertiary university hospitals and working in intensive care units during the first wave of the COVID-19 pandemic. Semi-structured online in-depth interviews were conducted. A thematic analysis was performed by two independent researchers following the seven steps of Colaizzi's methods. We adhere COREQ guidelines.

RESULTS

One theme 'Protective factors of ethical conflict in sanitary crisis' and four subthemes emerged from the data: (1) knowledge of the infectious disease, (2) good communication environment, (3) psychological support and (4) keeping the same work team together.

CONCLUSIONS

Four elements can be considered protective factors of ethical conflict for healthcare professionals during a sanitary crisis. While some of these factors have already been described, the joint identification of this set of four factors as a single element is, in itself, novel. This should help in ensuring the right mechanisms are in place to face future pandemics and should serve to improve institutional organisation and guarantee safe and high-quality patient care in times of healthcare crisis.

RELEVANCE TO CLINICAL PRACTICE

Future strategies for the prevention of ethical conflict during sanitary crises, pandemics or other catastrophes need to consider a set of four factors as a single element. These factors are the knowledge of the infectious disease, a good communication environment, psychological support and keeping the same work team together into joint consideration.

The assessment of health system responsiveness from the viewpoints of COVID-19 patients

BACKGROUND

Pandemics such as Corona are currently major health concerns worldwide. Health system responsiveness to the medical and non-medical needs of patients during pandemics is essential. This study aimed to examine hospitals' responsiveness to Corona patients.

METHODS

This descriptive and analytical research had a cross-sectional design. The study population included Corona patients discharged from 17 public hospitals of Mashhad University of Medical Sciences, Iran, in the spring of 2021. WHO questionnaire for health system responsiveness was used to collect data. 413 patients participated in the study who were selected by random classified sampling. To analyze the data, descriptive statistics, including frequency, and deviation, and to examine the relationship between variables, Kruskal-Wallis and Mann-Whitney tests were used.

RESULTS

In this study, one-third participants were in the age range of 31 to 40 (32.6%). The ability of 277 (70.5%) participants to pay treatment costs was very low, and low. 380 (96.7%) of the respondents had basic health insurance and 101 (25.7%) had supplementary insurance. In general, respondents evaluated the responsiveness of hospitals as 75.6. The highest score was related to confidentiality, and the lowest to prompt attention. There was no significant relationship between the total response score with demographic information.

CONCLUSION

The responsiveness of studied hospitals to Corona patients was adequate. However, there was dissatisfaction with the lack of timely treatment and medication. Moreover, the most important dimension of responsiveness was dignity. Healthcare providers need to pay attention to different aspects of responsiveness and improving the quality of and access to health services during pandemics and disasters.

Influence of experience, tenure, and organisational preparedness on nurses' readiness in responding to disasters: An exploration during the COVID-19 pandemic

Background

The coronavirus 2019 (COVID-19) pandemic has placed unprecedented challenges on the nursing practice, particularly in Poland. Nurses, as crucial healthcare service providers, have faced organisational disruptions, altered working conditions, and heightened professional anxieties.

Methods

We undertook a comprehensive survey across all medical centres in Lublin, Poland in 2020 to understand nurses' attitudes towards their roles and working conditions during the pandemic. This involved 470 nurses completing a questionnaire which focused on four pivotal areas: readiness to be on call in a disaster situation (even when not formally asked); willingness to work overtime in a disaster without additional compensation, preparedness to undertake health risks by caring for individuals with infectious diseases or exposure to hazardous substances, and willingness to be transferred to other departments during a disaster.

Results

We found that excessive workload, fear of infection, and feelings of helplessness significantly influenced nurses' readiness to work overtime, particularly when unpaid. We also presented the ethical dilemmas that nurses encountered during the pandemic and how these dilemmas affected their decision-making processes. We further explored the impact of variables such as nurses' professional experience, tenure, and level of organisational preparedness on their readiness to respond to crisis situations.

Conclusions

Gaining an understanding of nurses' perspectives is key for formulating strategies to bolster their professional engagements and resilience during crises. Addressing these issues can help build a more robust and well-prepared healthcare system that can effectively navigate future crises.

Experience of Pediatric Nurses in Parent-Child Isolation Units of COVID-19 Designated Hospitals: A Qualitative Study

Background

The omicron pandemic in Shanghai has created unprecedented challenges for pediatric medical institutions, and the work of pediatric nurses has changed rapidly due to the introduction of parent-child treatment. This study aimed to explore the experiences of pediatric nurses in the parent-child isolation unit of COVID-19-designated hospitals and provide a basis for developing feasible interventions as the next step.

Methods

Using phenomenological research methods, 12 nurses working in the parent-child isolation unit of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine from April 1, 2022, to June 15, 2022, were selected by purposive sampling. Semi-structured interviews and data analysis were conducted using Colaizzi's 7-step analysis.

Results

Data analysis revealed three major themes and 11 subthemes. The main themes were "risk factors", "protection factors", and "resilience strategies". The sub-themes were "challenge of caring for both adults and children simultaneously", "lack of adult expertise leads to inadequate coping skills", "change in the care population increased communication difficulties", "physical and psychological distress", "social support", "social recognition", "awareness of responsibilities and roles", "team coming together", "hunger for knowledge", "health promotion", and "psychological adjustment strategies".

Conclusion

Hospital managers should optimize hospital management strategies, pay attention to multi-departmental and multidisciplinary team cooperation, reduce the burden on pediatric nurses, improve the work and rest environment, mobilize the hospital support system, and maintain nurse's physical and mental health, establish a warm parent-child isolation unit encourages nurses to listen to the patients' voices and adopt diversified communication methods, and strengthen the publicity of the nursing profession, improve social support and recognition, and enhance the sense of self-worth and mission.

Moral Breakdowns and Ethical Dilemmas of Perioperative Nurses during COVID-19: COREQ-Compliant Study

(1) Background: The COVID-19 pandemic has led to an increase in the complexity of caregiving, resulting in challenging situations for perioperative nurses. These situations have prompted nurses to assess their personal and professional lives. The aim of this study was to explore the experiences of perioperative nurses during the first wave of the COVID-19 pandemic, with a specific focus on analyzing moral breakdowns and ethical dilemmas triggered by this situation. (2) Methods: A qualitative design guided by a hermeneutical approach was employed. Semi-structured interviews were conducted with 24 perioperative nurses. The interviews were transcribed and thematically analysed following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. (3) Results: The findings revealed three main categories and ten subcategories. These categories included the context in which moral breakdowns emerged, the ethical dilemmas triggered by these breakdowns, and the consequences of facing these dilemmas. (4) Conclusions: During the first wave of COVID-19, perioperative nurses encountered moral and ethical challenges, referred to as moral breakdowns, in critical settings. These challenges presented significant obstacles and negatively impacted professional responsibility and well-being. Future studies should focus on identifying ethical dilemmas during critical periods and developing strategies to enhance collaboration among colleagues and provide comprehensive support.

Impressions of the Nursing Profession Among Nursing Students and New Graduates During the First Wave of COVID-19: A Qualitative Content Analysis

BACKGROUND

The COVID-19 pandemic has been a defining event for the next generation of the nursing workforce. Complex pandemic practice environments have raised concerns for the preparation and support of novice nurses, even as a multitude of nurses leave the profession.

PURPOSE

Researchers sought to examine nursing students' and new graduate nurses' impressions of the nursing profession in contrasting regions of New York State during the first wave of the COVID-19 pandemic.

METHODS

Inductive content analysis was performed on narrative text responses (n = 295) drawn from a larger multisite mixed-methods survey.

RESULTS

Five subconcepts were abstracted, leading to the main concept of shocked moral distress .

CONCLUSION

Nursing students and new graduate nurses have experienced high levels of moral distress but remain committed to the profession. Building moral resilience, fostering ethical decision making, and implementing protective policies can reduce the incidence of moral distress.

Supporting ethical end-of-life care during pandemic: Palliative care team perspectives

BACKGROUND

Italy was the first European country to be involved with the COVID-19 pandemic. As a result, many healthcare professionals were deployed and suddenly faced end-of-life care management and its challenges.

AIMS

To understand the experiences of palliative care professionals deployed in supporting emergency and critical care staff during the COVID-19 first and second pandemic waves.

RESEARCH DESIGN

A qualitative descriptive design was adopted, and in-depth interviews were used to investigate and analyse participants' perceptions and points of view.

PARTICIPANTS AND RESEARCH CONTEXT

Twenty-four healthcare professionals (physicians, nurses, psychologists, physiotherapists, and spiritual support) from the most affected areas of Italy were recruited via the Italian society of palliative care and researchers' network.

ETHICAL CONSIDERATIONS

The University Institutional Board granted ethical approval. Participants gave written informed consent and agreed to be video-recorded.

FINDINGS

The overarching theme highlighted participants' experience supporting health professionals to negotiate ethical complexity in end-of-life care. Crucial topics that emerged within themes were: training emergency department professionals on ethical dimensions of palliative and end-of-life care, preserving dying patients' dignity and developing ethical competence in managing end-of-life care.

CONCLUSIONS

Our study showed palliative care teams' challenges in supporting health professionals' ethical awareness in emergencies. However, while they highlighted their concerns in dealing with the emergency staff's lack of ethical perspectives, they also reported the positive impact of an ethically-informed palliative care approach. Lastly, this study illuminates how palliative care professionals' clinical and ethical competence might have assisted a cultural change in caring for dying patients during COVID-19 and future emergencies.

Experiences of nurses providing care for patients with COVID-19 in acute care settings in the early stages of the pandemic: A thematic meta-synthesis study

AIM

The aim of this work is to synthesize and interpret qualitative research examining the experiences of nurses providing care for patients with COVID-19 in acute care settings in the early stages of the pandemic in different countries.

BACKGROUND

The prevalence of disasters, including the pandemic, is increasing globally. It is important to understand nurses' experiences in depth to effectively manage extraordinary events that may occur in the future.

DESIGN

This is a thematic meta-synthesis study.

METHODS

Electronic databases, including CINAHL, MEDLINE, PubMed, Web of Science, OVID, and Scopus, were searched for publications from December 2019 to October 2020. The search was updated for publications to 30 May 2022. The thematic synthesis method was used to analyse and interpret the data.

FINDINGS

The experiences of the nurses giving care to patients with COVID-19 were grouped under four themes: (1) Difficulties encountered in the care of patients with COVID-19; (2) mixed emotions experienced in the care of patients with COVID-19; (3) coping strategies that nurses used in the management of the pandemic; (4) the benefits of the COVID-19 to nurses.

CONCLUSION

Nurses faced many difficulties and experienced mixed emotions while providing care for patients with coronavirus disease. Perceived social support was seen as the most important strategy for coping with these difficult situations. It is important to be aware of the difficulties and emotions experienced by nurses and support them during the COVID-19 pandemic for the management of future pandemics.

Structural Equation Modelling of Professional Values and Competency of Nurses During the COVID-19 Pandemic

Background

The COVID-19 pandemic is a global health crisis that affected nurses’ professional values and competence.

Aim

Our study examined the relationship between nurses’ professional values and competence in Saudi Arabia during the COVID-19 pandemic.

Methods

This study used a descriptive cross-sectional design with 748 nurses from Saudi Arabia. Two self-report instruments were used to collect data. Structural equation modelling was conducted to analyse the data.

Findings

The emerging model showed acceptable model fit indices. Two dimensions of nurse professional values significantly affected professional competence: professionalism and activism. Professionalism significantly affected the other four facets (e.g., caring, activism, trust, and justice) of nurse professional values. The dimension of caring had a strong, direct effect on activism. Justice had a moderate, direct impact on trust, while activism had a weak, direct impact on trust. Professionalism and caring had strong, indirect effects on professional competence by mediating the dimension of activism.

Discussion

The study’s findings highlight the need for strategies to evaluate and strengthen the various areas of professional values to foster professional competence among nurses. Moreover, nurse administrators should encourage nurses to participate in continuing nursing education programs or provide in-service educational training to promote professional values and competence.

Conclusion

This study provides a structural model of the interaction between nurses’ professional values and competence during the pandemic. Nurse administrators can leverage the presented model to develop policies and strategies to evaluate and strengthen nurses’ professional values and competence.

The Psychological and Professional Burden Experienced by Nurses Who Worked in COVID-19 Clinics during the Pandemic: A Content Analysis

INTRODUCTION

Since the beginning of the pandemic, nurses have played a key role in providing care for COVID-19 patients. Infection risk and fear, use of personal protective equipment, and social isolation were related to high levels of stress and extreme psychological drain among front-line healthcare providers.

AIM

The aim of this study was to explore how front-line nurses experienced psychological and professional burdens during the coronavirus outbreak.

MATERIAL AND METHODS

The study used a qualitative research design. Semi-structured interviews were applied as the method of data collection. Ten nurses from COVID-19 wards and units of two general public hospitals participated in the study. A content analysis approach was employed to analyze the data.

RESULTS

Data analysis revealed two main categories, namely: (A) front-line experience "From fear to empowerment", and (B) caring and management "From powerlessness to adaptation". Eight sub-categories were developed and included within the corresponding main categories. The study's findings demonstrated that the pandemic caused significant psychological and professional strain on front-line nurses, with feelings of fear, anxiety, and uncertainty predominating. Nonetheless, the process of adaptation and adjustment brought about sentiments of self-actualization and empowerment.

CONCLUSIONS

A thorough understanding of the psychological and professional burden experienced by the front-line nurses is crucial to ensure that nurses receive appropriate support and that quality care is sustained under highly demanding healthcare conditions.

Nurses' Perceptions of Ethical Conflicts When Caring for Patients with COVID-19

The COVID-19 pandemic has caused ethical challenges and dilemmas in care decisions colliding with nurses' ethical values. This study sought to understand the perceptions and ethical conflicts faced by nurses working on the frontline during the first and second waves of the COVID-19 pandemic and the main coping strategies. A qualitative phenomenological study was carried out following Giorgi's descriptive phenomenological approach. Data were collected through semi-structured interviews until data saturation. The theoretical sample included 14 nurses from inpatient and intensive care units during the first and second waves of the pandemic. An interview script was used to guide the interviews. Data were analyzed following Giorgi's phenomenological method using Atlas-Ti software. Two themes were identified: (1) ethical conflicts on a personal and professional level; and (2) coping strategies (active and autonomous learning, peer support and teamwork, catharsis, focusing on care, accepting the pandemic as just another work situation, forgetting the bad situations, valuing the positive reinforcement, and humanizing the situation). The strong professional commitment, teamwork, humanization of care, and continuous education have helped nurses to deal with ethical conflicts. It is necessary to address ethical conflicts and provide psychological and emotional support for nurses who have experienced personal and professional ethical conflicts during COVID-19.

End of life care during the COVID-19 pandemic: A qualitative study on the perspectives of nurses and nurse assistants

AIM

To explore nurses' and nurse assistants' experiences of providing end-of-life care during the COVID-19 pandemic in Austria, Germany and Northern Italy.

DESIGN

A qualitative explorative interview study.

METHOD

Data were collected between August and December 2020 and analysed using content analysis. Healthcare professionals (nurses (n = 30), nurse coordinators (n = 6) and nurse assistants (n = 5)) from hospitals (n = 32) and long-term care facilities (n = 9) in Austria, Germany and Northern Italy were interviewed for this study.

RESULTS

Five main categories were identified as follows: (i) end-of-life care involves love and duty, (ii) last wishes and dignity of the patient, (iii) communication with the family, (iv) organizational and religious aspects and (v) personal emotions. Results indicate that more training and guidelines are needed to prepare nurses and nurse assistants for end-of-life care during pandemics.

PUBLIC CONTRIBUTION

This research can help prepare nurses and nurse assistants for end-of-life care in pandemics and will be of value for improving the institutional and government health policies. Furthermore, it can be of value in preparing training for healthcare professionals patient-relatives.

Understanding lived experiences of nurse managers about managerial ethics

INTRODUCTION

Expressions of Managerial ethics as a clinical phenomenon in Nursing Ethics as expressed by nurse managers were investigated. A coherence could be detected between the concepts and phenomena of Managerial ethics and nurse managers as a context.

BACKGROUND

Managerial ethics as a new approach has emerged in the perspective and by prioritizing ethics in the organization has provided the basis for creating and promoting individual and organizational effectiveness. Managers' and staff's adherence to professional ethics helps hospitals to achieve their intended goals.

AIM

The present study aimed to explain nurse managers' experience of managerial ethics.

RESEARCH DESIGN

This qualitative study was conducted based on a phenomenological design in 2022.

PARTICIPANTS AND RESEARCH CONTEXT

The participants included 20 nurse managers working in hospitals in Arak, Iran. They were selected by the purposive sampling method which continued until data saturation. Data were collected through semi-structured individual interviews (30-90 min); subsequently, the obtained results were analyzed using the Van Manen six-step approach.

ETHICAL CONSIDERATIONS

The confidentiality and the right of participants to take part or withdraw from the study were observed during this research.

RESULTS

The results of the present study were able to demonstrate nurse managers' lived experience of managerial ethics in the form of five themes of professional ethics, people-oriented management, professional empowerment, excellencism, and patient-centered care.

CONCLUSIONS

As evidenced by the obtained results, nurse managers held a positive view of managerial ethics. They were striving to strongly adhere to ethical principles in nursing management since they contribute greatly to the improved quality of nursing services in care and health settings. Therefore, appropriate policy-making and planning for managerial ethics training are indispensable for all nurses and nursing students.

Clinical nurse adherence to professional ethics: A grounded theory

BACKGROUND

Professional ethics is the regulation and discipline of nurses' daily nursing work. Nurses often encounter various ethical challenges and problems in their clinical work, but there are few studies on nurses' adherence to professional ethics.

RESEARCH AIM

An analysis of nursing adherence to nursing ethics from the perspective of clinical nurses in the Chinese public health system.

RESEARCH DESIGN

This study adopts the grounded theory approach proposed by Strauss and Corbin.

PARTICIPANTS AND RESEARCH CONTEXT

Between July 2021 and January 2022, Clinical nurses were recruited for online video interviews using purposive and theoretical sampling methods in seven hospitals in Beijing, Tianjin, Shanxi, Henan, Guangdong, and Fujian, China. Data analysis was conducted using Strauss and Corbin's coding approach.

ETHICAL CONSIDERATIONS

This study was approved by the Ethics Committee of Sanming First Hospital (MingYiLun 71/2021).

FINDINGS

A total of 27 participants were included. A theoretical model of nursing staff adherence to professional ethics was constructed. The main core was adherence to professional ethics and the other cores were (1) causal conditions: professional ethics code, individual conscience; (2) intervening conditions: personal growth, social support system, matching career compensation, prediction of adverse consequences; (3) action strategies: sticking to professional values, self-regulation, flexible response, post-event improvement; and (4) outcomes: self-harmony, reduced medical disputes.

CONCLUSIONS

This study provides an interpretive understanding of why clinical nurses adhere to professional ethics in China and describes the challenges and issues posed by nurses' use of strategies to cope with ethical adversity. The findings can be used to develop future complex studies.

Moral distress in psychiatric nurses in Covid-19 crisis

BACKGROUND

The COVID-19 pandemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient's lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in Iranian psychiatric nurses during the COVID-19 pandemic.

METHOD

This qualitative study with a conventional content analysis approach involved 12 nurses at the Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by semi-structured interviews, data analysis was performed based on the five steps of Graneheim and Lundman.

RESULTS

By continuous comparison and integration of data, 17 subcategories, 8 subcategories, and 3 categories were extracted from 252 initial codes. The causes of moral distress in psychiatric nurses during the COVID-19 pandemic were identified as emotional responses (Fear and Doubt), relational factors (Nurses' Relationship with Each Other, Nurse-physician Relationship, and Relationship whit Patients), and Institutional factors (Lack of Attention to Health Instructions, Failure to complete the treatment process for patients and Institutional Policies).

CONCLUSION

New dimensions of the causes of moral distress associated with the COVID- 19 pandemic are discovered in this study. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.

Nurses' ethical challenges when providing care in nursing homes during the COVID-19 pandemic

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses' ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses' own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner.

Ethical challenges faced by healthcare workers in pediatric oncology care during the COVID-19 pandemic in Australia

OBJECTIVE

This qualitative study examined ethical challenges reported by healthcare professionals (HCPs) working in a large Australian pediatric oncology center during a period of strict COVID-19 restrictions.

METHODS

We conducted semi-structured interviews with 21 HCPs who provided pediatric cancer care during the pandemic in 2020, during strict lockdown periods. Interviews examined the difficulties they faced, as well as their own ethical evaluation of the impact of COVID-19 policies on oncology care. Data were analyzed using inductive content analysis and thematic analysis.

RESULTS

HCPs faced several challenges, primarily originating from hospital restrictions, which led to changes in usual clinical practices. These challenges included delivering care with personal protective equipment (PPE), the impact of a one-parent visitation policy, changes in psychosocial and allied health services, and COVID-19 swabbing policies. Overall, there was consensus from participants that hospital restrictions were justified and, while difficult, HCPs simply had to provide the best care possible given the circumstances. However, participants described decreased capacity to deliver holistic patient care and, in some instances, a tendency to avoid ethical reflection. Lastly, there was a consistent theme of shame and sense of responsibility underlying some participants' anxiety around inadvertently transmitting COVID-19 to immunocompromised patients.

CONCLUSION

Our findings show that many staff felt unease at the disruptions in patient care due to COVID-19 restrictions. Some HCPs indicated a degree of moral distress, with a possibility of moral injury among some HCPs. A focus on ethical recovery could assist in preventing any ongoing difficulties among HCPs because of their experiences.

Explanation of factors forming missed nursing care during the COVID-19 pandemic: A qualitative study

Background

Providing nursing care to patients with COVID-19 has put additional pressure on nurses, making it challenging to meet several care requirements. This situation has caused parts of nursing care to be missed, potentially reducing the quality of nursing care and threatening patient safety. Therefore, the present study aimed at explaining the factors forming missed nursing care during the COVID-19 pandemic from the perspective of nurses.

Methods

This qualitative study was conducted using a conventional content analysis approach in Iran, 2020-2021. Data were collected from in-depth, semi-structured interviews with 14 nurses based on purposive sampling. Data analysis was performed simultaneously with data collection. Graneheim and Lundman's approach was used for data analysis, and MAXQDA software was used for data management. After transcribing the recorded interviews, to achieve the accuracy and validity of the study, the criteria proposed by Lincoln and Guba were considered and used.

Results

A total of 14 nurses with a mean age and standard deviation of 31.85 ± 4.95 and working in the COVID-19 wards participated in the study. The acquired data were categorized into four main categories: care-related factors, disease-related factors, patient-related factors, and organization-related factors. The category "care-related factors" comprised uncertainty in care, PPE-related limitations, attrition from care, and futile care. The category "disease-related factors" consisted of the extension of symptoms, unpredictable peaks of the disease, and restriction on the presence of patients' companions. The category "patient-related factors" included comorbidities, elderly patients, and deterioration of infected patients. Ultimately, the category "organization-related factors" consisted of restrictions on equipment supply, lack of human resources, weaknesses in teamwork, and an unsupportive work environment.

Conclusion

The results of this study showed that several reasons including factors related to care, patient, disease, and organization cause missed nursing care. By modifying the related affecting factors and considering the effective mechanisms to minimize missed nursing care, it is possible to provide better services.

Ethical challenges faced by nurses during the COVID-19 pandemic: a scoping review protocol

OBJECTIVE

The aim of this scoping review is to describe the literature reporting on ethical challenges faced by nurses during the COVID-19 pandemic, including the contextual characteristics of ethical challenges, and strategies to address reported challenges.

INTRODUCTION

The COVID-19 pandemic presented many ethical challenges to nurses, ranging from allocating scarce resources, to balancing a duty of care with self-preservation and implementing visitation restrictions. Internationally, there has been a range of reported issues, but few studies describe strategies to overcome these challenges.

INCLUSION CRITERIA

Studies that report on ethical challenges faced by nurses while caring for patients during the COVID-19 pandemic will be included. Studies that report on strategies to address these challenges will also be considered for inclusion.

METHODS

This scoping review will be conducted in accordance with methods outlined by JBI and reported on using PRISMA-ScR guidance. The following databases will be searched for eligible studies from November 2019 to present day: PubMed, CINAHL, Ovid, PsycINFO, the Cochrane Library, and Scopus. No language restrictions will be applied. Studies will be reviewed for inclusion by 2 independent reviewers and a data extraction form developed specifically for this review will be used to extract data relevant to the review questions. Results will be analyzed and presented according to the concepts of interest, using tables, figures, images, and supporting narrative synthesis.

Predictors of job burnout among Chinese nurses: a systematic review based on big data analysis

Job burnout is an occupational hazard induced by prolonged exposure to excessive work-related stress -a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity. Knowledge jobs involve many health-promoting features, but stress and burnout may be caused by the rapid increase in the knowledge intensity of work, new job demands, and emerging new professional subcultures emphasizing the excessive commitment to work. Although there are studies on job burnout and predictors among nurses worldwide, evidence specific to Chinese nurses is lacking. The purpose of this review is to synthesize current research on predictors related to burnout affecting Chinese nurses. We searched the Chinese databases including National Knowledge Infrastructure (CNKI), WanFang, China Science and Technology Journal Database, and Chinese Biological Medical Database (CBM); and international databases including Cochrane Library, PubMed, EMBASE, and Web of Science published up to 30th August 2022. The 125 studies identified assessed a range of predictors of job burnout. The results showed good working relationships and internally controlled individuals were found to be predictive of job burnout. Moreover, numerous predictors produced contradictory data. There are still challenges with how to systematically operationalize such a complicated phenomenon to effectively prevent or reduce job burnout.

[Investigation of medical humanistic practice ability of nurses and factors affecting their practices: a questionnaire-based analysis of 1196 cases in a general hospital in Hunan Province]

OBJECTIVE

To investigate humanistic practice ability of nurses in a general hospital in Hunan Province and analyze the factors affecting their practices to provide evidence for interventions to improve humanistic practice ability of the nurses.

METHODS

A total of 1196 nurses were surveyed using a self-designed questionnaire and a nurse humanistic practice ability assessment scale questionnaire for assessment of their abilities for humanistic care practice, psychological adjustment, interpersonal communication, self-management, ethics and legal practice. Univariate and multivariate analyses were performed for analysis of the factors affecting the practice abilities of the nurses.

RESULTS

The total score of humanistic practice ability of the 1196 nurses was 105.69±16.45 (the full score of the scale was 130), and the scores of humanistic care practice ability, psychological adjustment ability, interpersonal communication ability, self-management ability, ethics and legal practice ability were 40.95±6.46, 16.41±2.66, 16.41±2.66, 11.32±2.05 and 12.43±2.00, respectively. Univariate analysis and multiple linear regression analysis showed that gender (P=0.033), age (P < 0.001), department (P=0.015), working years (P < 0.001), professional title (P < 0.001), first academic degree (P < 0.001), highest academic degree (P < 0.001), family location (P=0.010), marital status (P=0.023), number of patients to care for (P=0.022), number of children (P=0.001), previous humanities related training (P < 0.001), training times (P < 0.001), and care received from family members (P < 0.001) and colleagues (P < 0.001) were all the factors affecting humanistic practice ability of the nurses. Among these factors, age, working in department of obstetrics and gynecology and emergency department, professional title, humanities training, and care from family and colleagues explained 20.7% of the variance.

CONCLUSION

The humanistic practice ability of nurses in this general hospital is above the average level, but their self-management ability needs to be improved. Intervention measures should be implemented to improve the nurses' humanistic practice ability including more attentions to the key groups and departments, strengthening the training of humanistic practice ability, and improving the promotion assessment system.

Experience of clinical nurses engaged in caring for patients with COVID-19: A qualitative systematic review and meta-synthesis

AIMS AND OBJECTIVE

This qualitative review summarises and synthesises the available evidence on subjective experiences of clinical nurses who cared for patients with COVID-19.

BACKGROUND

Nurses are first responders and play a vital role in emerging infectious disease epidemics such as the COVID-19 pandemic. In this context, they also face many difficulties and challenges related, for example to the imbalance between extensive demands and low control over work tasks.

DESIGN AND METHOD

A systematic review of qualitative studies and meta-synthesis focused on the experiences of clinical nurses caring for patients with COVID-19 during the pandemic was carried out.

RESULTS

A total of 279 findings were extracted, aggregated into 21 categories and combined into seven synthesised findings, namely (1) professional nursing practice during the pandemic, (2) support systems, (3) somatic sensations and psychological experiences, (4) difficulties and challenges, (5) coping strategies and behaviour, (6) impact on life, profession and values, and (7) needs and expectations for the future.

CONCLUSION

Nurses encountered considerable difficulties and challenges in caring for patients with COVID-19. Nurses caring for patients with COVID-19 need more support from organisations, families and society. It is essential to explore positive coping strategies suitable for working in different cultural backgrounds. Policymakers and decision-makers should pay attention to the experiences and voices of nurses.

RELEVANCE TO CLINICAL PRACTICE

It is critical for nurse managers to consider how to enhance the support system and help nurses develop adaptive coping strategies in response to COVID-19. Nurses' experiences and voices are valuable in improving health emergency response systems.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

Experience in the development of nurses' personal resilience: A meta‐synthesis

AIM

Nurses play roles in hospitals, families, society and other aspects and often face stress sources, such as heavy workload, doctor-patient conflict and medical accidents. Resilience can help the nurses to avoid or reduce various adverse consequences caused by stress sources; however, this phenomenon remains ill-defined and under-researched. The aim of this review was to summarize the experiences of development of nurses' resilience and explore the reasons for the formation of resilience by examining the findings of the existing qualitative studies.

DESIGN

The review is a systematic review and meta-synthesis of qualitative studies.

DATA SOURCES

PubMed, Cochrane Library, CINAHL, Web of Science, Embase, and Ovid and Chinese databases include the following: Chinese National Knowledge Infrastructure (CNKI), Wanfang Database (CECDB), VIP Database and China Biomedical Database (CBM).

REVIEW METHODS

Relevant publications were identified by systematic searches across 11 databases in June 2021. All qualitative and mixed-method studies in English and Chinese that explored the experiences of development of nurses' resilience were included. The qualitative meta-synthesis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two independent reviewers selected the studies and assessed the quality of each study. Meta-synthesis was performed to integrate the results.

RESULTS

A total of nine studies revealed 10 sub-themes and three descriptive themes: being psychologically strong, physical positive coping and adoption of external support.

CONCLUSION

Several factors contributed to the development of nurses' resilience, and various supporting strategies in the nursing management and education are helpful to their adaption ability. However, it is necessary to focus on the cultivation of nurses' resilience to improve the quality of clinical nursing. Leaders or organizations are required to establish and sustain multifaceted strategies to improve nurse' resilience through scientific resilience training programmes and improved organizational support.