Background During disease outbreaks, nurses express concerns regarding the organizational and social support required to manage role conflicts. Objectives The study examined concerns, threats, and attitudes relating to care provision during the COVID-19 outbreak among nurses in Israel. Design A 53-item questionnaire was designed for this research, including four open-ended questions. The article used a qualitative research to analyze the responses to the open-ended questions and their association with responses to the close-ended ones. Participants and research context In all, 231 (...) registered nurses and fourth-year nursing students throughout the whole country. The questionnaire was delivered in nursing Facebook and WhatsApp groups and through snowball sampling. Ethical considerations The research was pre-approved by the Ethics Committee at the researchers’ university. Results Nurses mostly referred to personal risk, followed by dilemmas regarding care provision. On average, 38.6% of quotations stated that during the pandemic, nurses are not asked to perform unfair duties. Nurses discussed activities and requirements that impact their personal and familial safety, their relationship with employer, organization or the state, and their duty to providing care. Other than fear of contraction, respondents’ most frequent themes of concerns were related to work condition and patients’ interests, inter-collegiate relationships, and uncertainty and worries about the future. Respondents’ ethical dilemmas mostly referred to clinical questions, providing care without adequate equipment or managerial support, and in conditions of uncertainty and increased risk. Discussion Nurses raise important issues concerning their relationships with employers and family members, and significant insights regarding the pandemic and their revised responsibilities and definition of work. They raise serious concerns regarding their rights at work and their standing for them. Conclusions Health managers should find ways to enhance the ethical climate and institutional support to enable a better work-life balance in times of pandemic and support nurses’ working needs and labor rights. (shrink)

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. (shrink)

Background Ethical climate refers to the shared perception of ethical norms and sets the scope for what is ethical and acceptable behaviour within teams. Aim This paper sought to explore perceptions of ethical climate amongst healthcare workers as measured by the Ethical Climate Questionnaire (ECQ), the Hospital Ethical Climate Survey (HECS) and the Ethics Environment Questionnaire (EEQ). Methods A systematic review and meta-analysis was utilised. PSYCINFO, CINAHL, WEB OF SCIENCE, MEDLINE and EMBASE were searched, and papers were included if they (...) sampled healthcare workers and used the ECQ, HECS or EEQ. Ethical consideration Ethical approval was not required. Results The search returned 1020 results. After screening, 61 papers were included ( n = 43 HECS, n = 15 ECQ, n = 3 EEQ). The overall sample size was over 17,000. The pooled mean score for the HECS was 3.60. Mean scores of individual studies ranged from 2.97 to 4.5. For the HECS studies, meta-regression was carried out. No relationship was found between the country of the studies, the study setting (ICU v non-ICU settings) or the mean years of experience that the sample had. For the ECQ, sub-scales had mean scores ranging from 3.41 (instrumental) to 4.34 (law) and were all observed to have significant and substantial heterogeneity. Three studies utilised the EEQ so further analysis was not carried out. Conclusions The above results provide insight into the variability of scores as measured by the HECS, ECQ and EEQ. To some extent, this variability is not surprising with studies carried out across 21 countries and in a range of healthcare systems. Results also suggest that it may be that more local and context specific factors are more important when it comes to predicting ethical climate. (shrink)