Ethical conflicts experienced by intensive care unit health professionals in a regional hospital, Limpopo province, South Africa

Challenges experienced by nurses in implementing Adolescent and Youth Friendly Services in clinics of the Limpopo province

Background

Effective implementation of Adolescent and Youth Friendly Services (AYFS) that are accessible, acceptable and effective for diverse youth population groups is significant to enhancing youth health. Because of various factors, improving youth health is a challenge in clinics in rural areas.

Aim

This study aims to explore and understand the challenges nurses experience while implementing AYFS programmes in Kganya local area clinics of the Capricorn district, Limpopo province, South Africa.

Setting

The study was conducted in the clinics of Kganya local area of Capricorn district, Limpopo province, South Africa.

Method

A qualitative, phenomenological, exploratory, descriptive design is employed in this study. Twelve nurses were selected using purposive sampling. Data were collected through semi-structured interviews with an interview guide. Notably, data were analysed using Tesch's open coding method.

Results

Two themes emerge from this study: 'Challenges experienced related to the implementation of Adolescent and Youth Friendly Services' and 'Suggestions to improve Adolescent and Youth Friendly Services'.

Conclusion

The results of this study confirm that nurses experience diverse challenges while implementing AYFS. Challenges include a lack of trained staff and material resources and the negative attitudes of adolescents, parents and community members.

Contributions

This study's findings might help identify the gaps in implementing the AYFS programmes. The findings may assist policymakers and the National Department of Health (NDoH) to monitor and review the effectiveness of the AYFS programme standards.

Clinical learning of nursing students during the COVID-19 pandemic in Limpopo province, South Africa

BACKGROUND

 The Nursing Education Programme was affected during the coronavirus disease 2019 (COVID-19) pandemic, resulting in nursing students being unable to participate in the clinical experiential learning required by the South African Nursing Council.

OBJECTIVES

 The study seeks to explore and describe nursing students' experiences of clinical experiential learning during the COVID-19 pandemic.

METHOD

 A qualitative, explorative and descriptive, research design was used in the study. A non-probability purposive sampling method was used, and 55 nursing students participated in the study. Data were collected through six focus group discussions, consisting of 8-12 nursing students in each group. Data were analysed following Tesch's open coding method.

RESULTS

 Three themes emerged from the study's findings: The impact of COVID-19 on the clinical experiential learning of nursing students, the effects of COVID-19 on the mental well-being of nursing students, and nursing students' experiences of support during the COVID-19 pandemic. Notably, 11 sub-themes emerged.

CONCLUSION

 The findings of this study reveal that the COVID-19 pandemic severely disrupted the Nursing Education Programme, highlighting the challenges of inadequate clinical hours, restricted clinical access and the significant psychological impact on students.Contribution: This study adds to the literature on students' experiences during clinical experiential learning in South Africa during the COVID-19 pandemic.

The experiences of ethical conflict among critical care professionals in China: A qualitative study

BACKGROUND

Ethical conflict is embedded in healthcare and is common in critical care setting. However, there is a paucity of research on the nature of ethical conflict in China. Ethical conflict has cultural and context sensitivity. Therefore, evidence is needed from different backgrounds to help discuss this issue across borders.

AIM

This study aimed to qualitatively identify the experience of ethical conflict in critical care professionals in China.

STUDY DESIGN

From December 2021 to February 2022, we performed semi-structured, face-to-face interviews with 21 critical care professionals from five intensive care units in a tertiary general hospital in China. A thematic analysis approach was used to analyse the data.

RESULTS

Five themes and 14 sub-themes emerged from the data. Critical care professionals probably felt unable to navigate uncertainty, torn by family issues, outraged by unprofessional behaviours of medical staff, being trapped in a socioeconomic dilemma when having experience of ethical conflict. In addition, they also perceived that they could turn struggle into growth.

CONCLUSIONS

The experience of ethical conflict in critical care professionals involved a mixture of feelings. This study builds a comprehensive understanding of how ethical conflict affected their perceptions of themselves and their profession and provides implications to develop effective coping strategies.

RELEVANCE TO CLINICAL PRACTICE

The identification of critical care professionals' experience of ethical conflict would help identify what might trigger the ethical issues and what would be the potential target to optimize in critical practice.

Exploration of clinical ethics consultation in Uganda: a case study of Uganda Cancer Institute

INTRODUCTION

Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESSs) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence about mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda.

METHODS

This phenomenological qualitative study utilized in-depth interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook.

RESULTS

The study revealed there was no formal committee or mechanism dedicated to resolving ethical dilemmas at the UCI. Instead, ethical dilemmas were addressed in six forums: individual consultations, tumor board meetings, morbidity and mortality meetings (MMMs), core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas.

CONCLUSION

The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.

Extending the concept of moral distress to parents of infants hospitalized in the NICU: a qualitative study in Greece

BACKGROUND

The hospitalization of infants in the neonatal intensive care unit (NICU) is an ethically challenging situation. A limited number of studies have extended the concept of moral distress to parents of infants hospitalized in the NICU. This topic requires further investigation.

METHODS

The present prospective qualitative study was conducted from February 2023 to May 2023. Data were collected through semistructured in-depth interviews, which were conducted in-person with fifteen parents of infants who were hospitalized in the NICU at the time of the interviews. Purposive sampling was used. The data were classified and analyzed using thematic analysis.

RESULTS

Three themes emerged from the data analysis performed for this empirical study. One intrapersonal dimension featuring two aspects (one dynamic and one static) and another interpersonal dimension focusing on parental moral distress emerged from the data analysis. Furthermore, seven subthemes emerged across these themes: (1) self-directed negative feelings were experienced by parents due to their inability to fulfill their caregiving/parental roles; (2) intense internal conflict was experienced by parents in response to a moral dilemma that was difficult, which was perceived as irresolvable; (3) objectively unjustified, self-directed negative feelings of guilt or failure were experienced by parents; (4) parents experienced moral distress due to the poor image of the ill infants; (5) inadequate information may predispose parents to experience moral distress (6) neonatologists' caring behaviors were unduly perceived by parents as paternalistic behaviors; (7) reasonable or justified institutional rules were unduly perceived by parents as constraint.

CONCLUSIONS

In general, the results of this study support the integrated definition of parental moral distress proposed by Mooney-Doyle and Ulrich. Furthermore, the present study introduces new information. The study distinguishes between the dynamic and static aspects of the intrapersonal dimension of the phenomenon of parental moral distress. Moreover, participants experienced moral distress because they unduly perceived certain situations as causing moral distress. In addition, inadequate information may predispose parents to experience moral distress. The findings of this study may contribute promote family-centered care in the NICU context.

Moral caring competency and moral distress among Ghanaian nurses in adult care settings: A descriptive-correlational study

Background

Nurses in adult care settings frequently encounter moral distress due to the daily ethical obligations they must fulfill. In contrast to other healthcare professionals, nurses often grapple with a heightened frequency of moral dilemmas, resulting in increased moral distress.

Objective

This study aimed to explore the levels and relationship between moral caring competency and moral distress among Ghanaian nurses in adult care settings.

Methods

This quantitative study utilized a descriptive-correlational design. A multistage sampling was used to select three public hospitals. Simple random sampling was used to recruit 231 nurses from the three public hospitals. Data were collected from June to July 2023 using validated questionnaires. The study utilized frequency and percentages, mean and standard deviation, and Spearman's Correlation.

Results

The nurses had a low level of moral caring competency (M = 2.18, SD = 0.340). The composite moral distress score was 227.31, indicating a high level of moral distress among the nurses. Furthermore, there was a moderate, negative significant relationship between moral caring competency and moral distress (rs = -.474, N = 231, p <0.001).

Conclusions

Nurses in public hospitals had limited personal cognitive, affective, and psychomotor abilities to address patient moral issues. The nurses also experience significant moral distress when delivering patient care. Furthermore, to decrease the level of moral distress, moral caring competency should be strengthened among nurses. Therefore, it is recommended that nurse administrators provide adequate organizational support and implement continuous moral training to improve nurses' moral caring competency and mitigate their moral distress. Healthcare policymakers are encouraged to develop or refine policies to navigate moral dilemmas and reduce moral distress among nurses. Future studies employing qualitative designs can explore the influence of culture on moral caring competency within the Ghanaian setting.

Newly qualified intensive care nurses' lived experiences of being a shift leader in a private healthcare institution in Gauteng, South Africa

Objective

Newly qualified intensive care nurses (NQICNs) are expected to execute the shift-leading role immediately after graduation. Critical reasoning, problem-solving, decision-making, and evidence-based clinical judgment are thus essential skills for intensive care nursing graduates. This study aimed to explore and describe NQICNs' lived experiences of being shift leaders.

Methods

This descriptive qualitative study was based on the data collected through semi-structured individual interviews. Five NQICNs in five hospitals from one region in Gauteng, South Africa, were interviewed between September and December 2019. NQICNs working as shift leaders for 10 to 12 months after intensive care training were eligible for inclusion in the study. Data were analyzed using the four steps suggested by Giorgi.

Results

The results revealed three themes and seven sub-themes. NQICNs suffered greatly intrapersonally (NQICNs reported intrapersonal suffering, manifesting as pre-shift anxiety, severe work stress, and post-shift exhaustion; NQICNs employed coping mechanisms and either fought, fled, or froze during conflict or crises; NQICNs lack of shift-leading experience did not match their heavy load of responsibilities and accountability); the NQICNs interpersonally matured and empowered themselves (NQICNs experienced support and challenges on an interpersonal level; NQICNs improved their interpersonal relationships and felt proud of and empowered by their professional growth); NQICNs highlighted various requirements to help them manage the high demands of leading shifts (others should fulfill certain needs to enable NQICNs to handle the shift-leading role; self-awareness as a need to enable NQICNs to embrace the shift-leading role).

Conclusion

A greater understanding of NQICNs and their unmet needs will enable nurse managers, educators, and nurses to better support NQICNs' evolution from novice to competent shift leaders.

Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study

BACKGROUND

Working as a neonatologist in a neonatal intensive care unit (NICU) is stressful and involves ethically challenging situations. These situations may cause neonatologists to experience high levels of moral distress, especially in the context of caring for extremely premature infants (EPIs). In Greece, moral distress among neonatologists working in NICUs remains understudied and warrants further exploration.

METHODS

This prospective qualitative study was conducted from March to August 2022. A combination of purposive and snowball sampling was used and data were collected by semi-structured interviews with twenty neonatologists. Data were classified and analyzed by thematic analysis approach.

RESULTS

A variety of distinct themes and subthemes emerged from the analysis of the interview data. Neonatologists face moral uncertainty. Furthermore, they prioritize their traditional (Hippocratic) role as healers. Importantly, neonatologists seek third-party support for their decisions to reduce their decision uncertainty. In addition, based on the analysis of the interview data, multiple predisposing factors that foster and facilitate neonatologists' moral distress emerged, as did multiple predisposing factors that are sometimes associated with neonatologists' constraint distress and sometimes associated with their uncertainty distress. The predisposing factors that foster and facilitate neonatologists' moral distress thus identified include the lack of previous experience on the part of neonatologists, the lack of clear and adequate clinical practice guidelines/recommendations/protocols, the scarcity of health care resources, the fact that in the context of neonatology, the infant's best interest and quality of life are difficult to identify, and the need to make decisions in a short time frame. NICU directors, neonatologists' colleagues working in the same NICU and parental wishes and attitudes were identified as predisposing factors that are sometimes associated with neonatologists' constraint distress and sometimes associated with their uncertainty distress. Ultimately, neonatologists become more resistant to moral distress over time.

CONCLUSIONS

We concluded that neonatologists' moral distress should be conceptualized in the broad sense of the term and is closely associated with multiple predisposing factors. Such distress is greatly affected by interpersonal relationships. A variety of distinct themes and subthemes were identified, which, for the most part, were consistent with the findings of previous research. However, we identified some nuances that are of practical importance. The results of this study may serve as a starting point for future research.

Attitudes of Caregivers of Children under Five Years Regarding Growth Monitoring and Promotion in Polokwane, Limpopo Province

Growth monitoring and promotion (GMP) is critical in tracking child growth to address widespread malnutrition and health status. Attitudes influence behaviour change, including attendance of GMP, and negative attitudes are linked to non-attendance. Moreover, negative attitudes correlate with low socioeconomic position. South Africa is characterized by inequality, which may lead to negative attitudes towards GMP among caregivers with a poor socioeconomic status. Hence, this study seeks to explore the attitudes of caregivers of children under five towards GMP. A qualitative exploratory study design was used. Caregivers of children under five were purposively sampled. Twenty-three participants were interviewed one-on-one, and the data were recorded using voice recorders and field notes. Tesch's eight steps and inductive, descriptive, and open coding techniques were used to analyse the data. Participants understood the significance of GMP and were confident their children would benefit from it; hence, they attended sessions out of love for their children. The inconsistent availability of GMP services and the behaviour of health workers affected participants' attitude. Despite these challenges, participants felt good about GMP. Caregivers' love for their children/grandchildren helped them overcome challenges experienced at the health facilities. Good feelings about GMP boosted caregivers' attitudes and aided in adherence. An intervention to address element impacting attitudes of caregivers is recommended.

Conflict Sources and Management in the ICU Setting before and during COVID-19: A Scoping Review of the Literature

Introduction. Conflicts are an inherent part of work within any organisation. They can arise between members of an interdisciplinary team (or between teams representing different departments), between patients and team members/family members, and patients’ families and team members. Various conflict situations among employees may occur, therefore it is very important to identify their causes and take preventive or targeted corrective measures. The aim of this study was to review the available literature concerning conflicts arising in ICUs—their types, methods of expression as well as their management and mitigation. In addition, we reviewed the available literature on the impact of the pandemic on the ICU environment caring for COVID-19 patients. Methods. The databases were searched. Single key words or their combinations using AND or OR operators were entered. Eventually, 15 articles were included in our review, which included two identical papers. Results. Conflicts occurred occasionally or rarely; researchers describing ethical conflicts demonstrated a moderate level of exposure to conflicts. The pandemic created many challenges and ethical dilemmas that are a source of ethical conflict. Conclusions. As conflict by nature remains inevitable, adequate procedures in conflict management should be developed and the leadership of managing personnel should be reinforced, because team members frequently expect guidance from their supervisors. The importance of training in interpersonal communication and crisis situation management in healthcare should therefore be emphasised.

COVID-19 in South Africa: outbreak despite interventions

The future dynamics of the Corona Virus Disease 2019 (COVID-19) outbreak in African countries is largely unclear. Simultaneously, required strengths of intervention measures are strongly debated because containing COVID-19 in favor of the weak health care system largely conflicts with socio-economic hardships. Here we analyze the impact of interventions on outbreak dynamics for South Africa, exhibiting the largest case numbers across sub-saharan Africa, before and after their national lockdown. Past data indicate strongly reduced but still supracritical growth after lockdown. Moreover, large-scale agent-based simulations given different future scenarios for the Nelson Mandela Bay Municipality with 1.14 million inhabitants, based on detailed activity and mobility survey data of about 10% of the population, similarly suggest that current containment may be insufficient to not overload local intensive care capacity. Yet, enduring, slightly stronger or more specific interventions, combined with sufficient compliance, may constitute a viable option for interventions for South Africa.