Combating COVID-19 Pandemic in Nepal: Ethical Challenges in an Outbreak

Nurses' experiences during the COVID-19 pandemic in Iran: a qualitative study

BACKGROUND

Nurses are at the forefront of patient care during infectious disease pandemics and they play a key role in treating and preventing the upward trend of the disease. Hence, it is crucial to consider their experiences in designing action plans to combat coronavirus disease 2019 (COVID-19). Since there is not enough data in this regard, the current study aimed to investigate the nurses' experiences in caring for patients with COVID-19 in Iran.

METHODS

In this descriptive qualitative study, a total of 20 nurses were selected by purposive sampling. Semi-structured interviews were conducted and analyzed using qualitative content analysis to collect data.

RESULTS

Data analysis revealed four main themes, including 'duality in the form of care,' 'confusion and ambiguity in care planning', 'workload', and 'social isolation in spite of positive image.'

CONCLUSION

Our findings indicated that the nurses experienced a range of paradoxes during the COVID-19 pandemic; these paradoxes included distraction from providing care due to focus on marginal factors in spite of empathy and cooperation in nurses, the presence of volunteer support staff despite the lack of equipment, lack of scientific information and the unreliability of online information, overload in the hospital due to insufficient facilities and equipment, and the physical avoidance of people in the community in spite of social support for nurses in the media. The results of this study can lead to a clear understanding for managers and healthcare policymakers in the country and aid them in taking optimal measures to support nurses and improve the quality of nursing care against COVID-19.

Implementing Public Health Strategies-The Need for Educational Initiatives: A Systematic Review

In the absence of a specific treatment or vaccines, public health strategies are the main measures to use in the initial stages of a pandemic to allow surveillance of infectious diseases. During the ongoing global pandemic of coronavirus disease 2019 (COVID-19), several countries initiated various public health strategies, such as contact tracing and quarantine. The present study aims to conduct a systematic literature review to identify the presence of educational initiatives that promote the implementation of public health strategies before public health emergencies, with a special focus on contact tracing applications. Using Science Direct, PubMed, Scopus, and Gothenburg University search engines, all published scientific articles were included, while conference, reports, and non-scientific papers were excluded. The outcomes of the reviewed studies indicate that the effective implementation of public health strategies depends on the peoples' willingness to participate and collaborate with local authorities. Several factors may influence such willingness, of which ethical, psychological, and practical factors seem to be the most important and frequently discussed. Moreover, individual willingness and readiness of a community may also vary based on the acquired level of knowledge about the incident and its cause and available management options. Educational initiatives, proper communication, and timely information at the community level were found to be the necessary steps to counteract misinformation and to promote a successful implementation of public health strategies and attenuate the effects of a pandemic. The systematic review conducted as a part of this study would benefit the relevant stakeholders and policy makers and assist with effective designing and implementation.

Ethical Challenges of Nurses in COVID-19 Pandemic: Integrative Review

Currently, nurses are in the middle of the battle against COVID-19. The pandemic situation has put these professionals against various ethical challenges. Therefore, this review aims to identify the main ethical challenges faced by nurses during COVID-19 pandemic. This integrative review was guided by the Preferred Reporting Items of Systematic Reviews and Meta-Analysis Protocols. All English version studies that reported ethical challenges of nurses during the COVID-19 pandemic, from November 9, 2019, to November 9, 2020, were eligible for the review. The electronic databases used were PubMed, Google Scholar, JURN, Cochrane Library E-Journals, MEDLINE, Academic Search Complete, CINAHL. Accordingly, 8 articles were included for further analysis and synthesis. The ethical challenges of nurses were categorized into three thematic areas: nurses' safety, role and moral distress, resource allocation, and client-nurse relationship. Thus, the lack of full protection of nurses across the health industry has raised ethical questions such as the extent of their duty, scarce resources, and the failure of personal protective equipment. In connection, a significant number of nurses were also facing moral distress because of prolonged pressure to maintain the resources needed to provide safe and high-quality nursing care. Furthermore, nurses were challenged to restrict many COVID-19 patients from having end-of-life communication with their families. Overall, nurses are still facing various ethical challenges across the globe. Therefore, it is important to mobilize resources and invest in nurses to bring long-lasting solutions.

Ethical dilemmas, perceived risk, and motivation among nurses during the COVID-19 pandemic

BACKGROUND

Positioned at the frontlines of the battle against COVID-19 disease, nurses are at increased risk of contraction, yet as they feel obligated to provide care, they also experience ethical pressure.

RESEARCH QUESTION AND OBJECTIVES

The study examined how Israeli nurses respond to ethical dilemmas and tension during the COVID-19 outbreak, and to what extent this is associated with their perceived risk and motivation to provide care?

RESEARCH DESIGN

The study implemented a descriptive correlative study using a 53-section online questionnaire, including 4 open-ended questions.

PARTICIPANTS AND RESEARCH CONTEXT

The questionnaire was complete by 231 registered and intern nurses after being posted on nurses' Facebook and WhatsApp groups, and through snowball sampling.

ETHICAL CONSIDERATIONS

The research was pre-approved by the ethics committee of the Faculty of Social Welfare and Health Sciences at the University of Haifa, Israel.

FINDINGS

In all, 68.8% of the respondents had received some form of training about COVID-19. Respondents positioned themselves at perceived high risk levels for contracting the virus. About one-third feared going to work because of potential contraction and due to feeling inadequately protected. While 40.9% were scared to care for COVID-19 patients, 74.7% did not believe they have the right to refuse to treat certain patients. When asked about defining an age limit for providing patients with scarce resources (such as ventilation machines) in cases of insufficient supplies, respondents stated that the maximum age in such scenarios should be 84 (standard deviation (SD = 19) - yet most respondents (81.4%) believed that every patient has the right to receive optimal treatment, regardless of their age and medical background.

DISCUSSION

Correlating with their strong commitment to care, nurses did not convey intention to leave the profession despite their stress, perceived risk, and feelings of insufficient support and protection at work. The nurses did not hold a utilitarian approach to resource allocation, thereby acknowledging the value of all people and their entitlement to care, regardless of optimal outcomes.

CONCLUSION

While experiencing significant personal risk and emotional burden, nurses conveyed strong dedication to providing care, and did not regret working in the nursing profession, yet they did seek a supportive climate for their needs and ethical concerns.