Background During a disaster, nurses face complex ethical challenges because of risky situations. It is necessary to identify trends and ethical issues of nurses in disasters to improve the quality of care and impact for nurses. Method This systematic review enrolled in the international registration with PROSPERO: CRD42022350765. We searched the following databases: PubMed, EBSCO MEDLINE, SCOPUS, ProQuest, ScienceDirect, and Sage Pub. The inclusion criteria were developed according to PICO and D; are Population (F): involving nurses; intervention/Exposure (I): disaster, Comparison (...) (C): none; outcome (O): ethical practice. And Design (D): qualitative, quantitative, and mixed methods. Years of publication were 2012–2022, with full text in English. The quality of study assessment used was The Joanna Briggs Institute (JBI) Critical Appraisal tool and Mixed Methods Appraisal Tool (MMAT) version 2018. Analysis used PICO synthesis. Results There were 15 studies reviewed from 2093 results, including cross-sectional (4/15, 26.6%), qualitative (9/15, 60%), and mixed methods (2/15, 13.3%) studies. The types of disasters were: COVID-19 (7/15, 46.6%), infectious (4/15, 26.6%), and all disaster events (4/15, 26.6%). The main themes were: (1) ethical issues in disasters have the potential to address ethical dilemmas, (2) factors applying nursing ethics to support ethical decision-making in disasters, (3) strategies for applying ethics and dealing with ethical issues in disasters, and (4) the impact of applying ethics in disasters. Conclusion Applying ethics nursing in a disaster is influenced by various factors. This framework for ethical nursing in disasters aims to help nurses, educational institutions, and policymakers develop schemes or scenarios to enhance responsible ethical decisions in disasters. (shrink)

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. (shrink)

Intensive care unit (ICU) nurses were at the forefront of patient care during the coronavirus (COVID‐19) pandemic. To date, no studies have explored what it meant to be a ‘good nurse’ in this unique and challenging context. As such, the aim of this study was to construct the meaning of the ‘good nurse’ in ICUs during a pandemic. Semi‐structured interviews were conducted with 25 ICU nurses from three ICUs in Kuwait, who had worked during the COVID‐19 pandemic. The data were (...) analysed using Charmaz's grounded theory methodology. The analysis showed that the good ICU nurse was defined by their sense of duty, which motivated compassionate and dedicated patient care. However, the nurses' attempts to demonstrate virtue also had negative consequences for them. Selflessness led to unsustainable self‐sacrifice, empathy led to emotional labour, and efforts to remain patient and respectful led to exhaustion as the nurses found themselves under increasing pressure. Attempts to remain mentally strong may have partially protected them from stress, but also deprived them of an outlet for authentic emotional expression and support. Ultimately, their efforts to preserve their quality of patient care despite the numerous challenges of the pandemic came at an increasing cost, and resulted in moral distress and impaired well‐being. (shrink)