Background: As caring in times of pandemics becomes extremely stressful, the volume and intensity of nursing work witness significant increase. Ethical practices are therefore even more important for nurses and nurse leaders during this special period. Research aim: The aim was to explore the relationship between ethical nurse leaders and nurses’ task mastery and ostracism, and to examine the mediating role of relational identification in this relationship during pandemics. Research design: Based on social exchange theory, this study tests a theoretical (...) model proposing that ethical nurse leaders can increase nurses’ task mastery and reduce their ostracism by improving their relational identification with leaders during pandemics. Participants and research context: A multilevel and multi-wave field study using data from 172 nurses from 45 departments of two comprehensive hospitals was performed from April to August 2020 to test proposed hypotheses. Ethical considerations: We received formal approvals from the ethical committee of the hospital where we conducted this study before the data collection. Results: Ethical nurse leaders can indeed increase nurses’ task mastery and reduce their ostracism during the pandemic period; furthermore, nurses’ identification with their leaders mediates these relationships. We find that ethical leadership plays an even more important role in improving nurses’ task mastery and reducing their ostracism that may be facilitated by pandemics this special time. Nurses will become more identified with their leaders when they are treated by ethical ways. Discussion: The study tries to advance our understanding of the important role of ethical leadership in nurse management literature and provide useful suggestions for healthcare institutions, nurse leaders, and nurses during pandemics. Conclusion: Theoretical contributions and practical implications of our findings are discussed. Specifically, we suggest that healthcare institutions cultivate ethical nurse leaders to facilitate nurses’ relational identification, which in turn will positively influence work outcomes. (shrink)

BackgroundNurses working in the intensive care unit clung tenaciously to their job during the COVID-19 pandemic in spite of enduring stressed psychological and physical effects as a result of providing nursing care for the infected patients, which indicates that they possessed a high degree of professionalism and career calling. The aim of this study was to explain the associations between resilience, thriving at work, and ethical leadership influencing the calling of ICU nurses.MethodsFrom December 2020 to January 2021 during the COVID-19 (...) pandemic, a cross-sectional survey of 15 provinces in China was conducted using an online questionnaire. A total of 340 ICU nurses completed sufficient responses to be used in the study. Sociodemographic factors, job demographic factors, resilience, calling, thriving at work, and ethical leadership were assessed using the questionnaire. General linear modeling, hierarchical linear regression analysis, and generalized additive model were performed to examine all the considered research hypotheses.ResultsResilience was positively and significantly associated with calling. Moreover, thriving at work partially mediated the relationship between resilience and calling. The indirect effect of resilience on calling was 0.204, and the direct effect of resilience on calling through thriving at work was 0.215. The total effect of resilience on calling was 0.419. In addition, ethical leadership played a moderating role in the relationship between resilience and calling.ConclusionGreater resilience can positively predict increased calling among Chinese ICU nurses during the COVID-19 pandemic. Moreover, thriving at work is a mechanism that partly transmits the positive effects of resilience on calling. Overall, nurses possessing greater resilience tend to maintain thriving at work in the face of such adversity, further resulting in subsequently increased calling. Besides, findings suggest that there is stronger influence of resilience on calling among nurses working in an organization managed by an ethical leader. The current findings may offer two insights for nursing practitioners and policymakers in the postpandemic world. First, resilience training and intervention are necessary to foster nurses' sense of thriving at work in the nursing industry, further promoting career calling. Second, better training and effort on the development of ethical leadership for leaders in nursing practice are essential to encourage followers to engage in social learning of ethical behaviors and abiding by normatively appropriate conduct, further enacting prosocial values and expressing moral emotions. (shrink)

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: In modern healthcare, the role of solidarity, altruism and the natural response to moral challenges in life-threatening situations is still rather unexplored. The COVID-19 pandemic provided an opportunity to obtain a deeper understanding of nurses’ willingness to care for patients during crisis. Objective: To elucidate clinical expressions of ontological situational ethics through nurses’ willingness to work during a pandemic. Research design, participants and context: A qualitative study with an interpretive design was applied. Twenty nurses who worked in intensive care (...) unit at two Swedish hospitals during the first, second, and third waves of the COVID-19 pandemic were interviewed. The analysis was interpretative and applied a theoretical ethics perspective. Ethical considerations: The study was approved by the Swedish Ethical Review Authority and informed consent was obtained from all participants. Findings: From a philosophical perspective, the nurses expressed sovereign life expressions of mercy and compassion, which arose spontaneously in response to seeing vulnerable fellow humans. They referenced ‘‘the nurse inside me’’ and their choice of profession as motives to provide care. Ontological situational ethics in culture and norms were noted in the constructs of competence, responsibility, solidarity with colleagues and organization; and interest and learning were driving forces. Ethical demand was evident when nurses expressed ideas of meaningfulness in helping their fellow humans; but themes of ambiguity, exhaustion and unwillingness were also present. Conclusions: The nurses showed a high willingness to care for patients during a crisis. Responding to the ethical demand and to care for vulnerable human beings while risking their own health and lives could be interpreted as an inter-human vocation. These spontaneous altruistic actions saved the lives of many patients during the pandemic and need to be understood and supported. (shrink)

Background: In the ever-changing and complex healthcare environment, nurses encounter challenging situations that may involve a clash between their personal and professional values resulting in a profound impact on their practice. Nevertheless, there is a dearth of literature on how nurses develop their personal–professional values. Aim: The aim of this study was to understand how nurses develop their foundational values as the base for their value system. Research design: A constructivist grounded theory methodology was employed to collect multiple data sets, (...) including face-to-face focus group and individual interviews, along with anecdote and reflective stories. Participants and research context: Fifty-four nurses working across various nursing settings in Indonesia were recruited to participate. Ethical considerations: Ethics approval was obtained from the Monash University Human Ethics Committee, project approval number 1553. Findings: Foundational values acquisition was achieved through family upbringing, professional nurse education and organisational/institutional values reinforcement. These values are framed through three reference points: religious lens, humanity perspective and professionalism. This framing results in a unique combination of personal–professional values that comprise nurses’ values system. Values are transferred to other nurses either in a formal or informal way as part of one’s professional responsibility and customary social interaction via telling and sharing in person or through social media. Discussion: Values and ethics are inherently interweaved during nursing practice. Ethical and moral values are part of professional training, but other values are often buried in a hidden curriculum, and attained and activated through interactions during nurses’ training. Conclusion: Developing a value system is a complex undertaking that involves basic social processes of attaining, enacting and socialising values. These processes encompass several intertwined entities such as the sources of values, the pool of foundational values, value perspectives and framings, initial value structures, and methods of value transference. (shrink)

Background: Intensive care unit nurses are providing care to COVID-19 patients in a stressful environment. Understanding intensive care unit nurses’ sources of distress is important when planning interventions to support them. Purpose: To describe Canadian intensive care unit nurse experiences providing care to COVID-19 patients during the second wave of the pandemic. Design: Qualitative descriptive component within a larger mixed-methods study. Participants and research context: Participants were invited to write down their experiences of a critical incident, which distressed them when (...) providing nursing care. Thematic analysis was used to analyze the data. Ethical considerations: The study was approved by the ethics committee at the researchers’ university in eastern Canada. Results: A total of 111 critical incidents were written by 108 nurses. Four themes were found: (1) managing the pandemic, (2) witness to families’ grief, (3) our safety, and (4) futility of care. Many nurses’ stories also focused on the organizational preparedness of their institutions and concerns over their own safety. Discussion: Nurses experienced moral distress in relation to family and patient issues. Situations related to insufficient institutional support, patient, and family traumas, as well as safety issues have left nurses deeply distressed. Conclusion: Identifying situations that distress intensive care unit nurses can lead to targeted interventions mitigating their negative consequences by providing a safe work environment and improving nurses’ well-being. (shrink)

Background The COVID-19 pandemic has forced rapid and widespread change to standards of patient care and nursing practice, inevitably leading to unprecedented shifts in the moral conditions of nursing work. Less is known about how these challenges have affected nurses’ capacity to meet their ethical responsibilities and what has helped to sustain their efforts to continue to care. Research objectives 1) To explore nurses’ experiences of striving to fulfill their ethical responsibilities of care during the COVID-19 pandemic and 2) to (...) explore what has fostered nurses’ capacity to fulfill these responsibilities. Research Design A generic qualitative approach was used incorporating concepts coming from fundamental features of care. Participants Twenty-four Canadian Registered Nurses from a variety of practice settings were interviewed. Ethical Considerations After receiving ethics approval, signed informed consent was obtained before participants were interviewed. Findings Four themes were identified. 1) Challenges providing good care in response to sudden changes in practice. 2) Tensions in juggling the responsibility to prevent COVID-19 infections with other competing moral responsibilities. 3) Supports to foster nurses’ capacity to meet their caring responsibilities. 4) The preservation of nurses’ moral identity through expressions of gratitude and health improvement. Discussion Infection control measures and priorities set in response to the pandemic made at distant population and organizational levels impacted nurses who continued to try to meet the ideals of care in close proximity to patients and their families. Despite the challenges that nurses encountered, the care they received themselves enabled them to continue to care for others. Nurses benefited most from the moral communities they had with their colleagues and occasionally nurse leaders, especially when they were supported in a face-to-face manner. Conclusion: Moral community can only be sustained if nurses are afforded the working conditions that make it possible for them to support each other. (shrink)

Background: The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students. Objectives: To explore the ethical dilemmas and ethical conflicts experienced by final-year nursing students who worked during the first outbreak of the COVID-19 pandemic in Spain. Research design: A qualitative exploratory study was conducted using purposive sampling. Semi-structured interviews were carried out using a question guide. Interviews took place via a private video chat (...) room platform. A thematic, inductive analysis was performed of the information gathered. Participants and research context: Eighteen nursing students were recruited from two universities of Madrid, aged between 18 and 65 years old, enrolled in the fourth year of nursing studies and who were hired under a relief contract for health professionals during the pandemic. Ethical considerations: The present study was carried out in accordance with the Declaration of Helsinki, and the study was approved by the Local Ethics Committee of Universidad Rey Juan Carlos. Results: Three specific themes emerged: (a) coping with patient triage, (b) difficulties in providing end-of-life care, and (c) coping with patient death. Nursing students participated in the process of patient selection for resource allocation and ICU bed occupancy. They were shown how to care for patients who were not admitted to the ICU, in their last moments and were faced with the difficulties of applying end-of-life care. Finally, the nursing students were confronted with the death of their patients, in overwhelming numbers and under adverse conditions. Conclusions: These findings can help shed light on the ethical dilemmas and ethical conflicts faced by novice nursing students, incorporated into the workforce during the COVID-19 pandemic. Moreover, it was described that students may normalize the death due to the exhaustion and overwhelmed routine. (shrink)

Background Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses’ experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. Research aim To analyze frontline U.S. nurses’ experiences of ethics during the COVID-19 pandemic. Research design Qualitative analysis using a directed content (...) methodology. Participants and research context The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Ethical considerations Participant privacy and data confidentiality were addressed. Findings Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. Discussion This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. Conclusions Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available. (shrink)

Background: The coronavirus disease 2019 pandemic is impacting the delivery of healthcare worldwide, creating dilemmas related to the duty to care. Although understanding the ethical dilemmas about the duty to care among nurses is necessary to allow effective preparation, few studies have explored these concerns. Aim: This study aimed to identify the ethical dilemmas among clinical nurses in Spain and Chile. It primarily aimed to (1) identify nurses’ agreement with the duty to care despite high risks for themselves and/or their (...) families, (2) describe nurses’ well-being and (3) describe the associations between well-being and the duty to care. Research design: Cross-sectional self-reported anonymous data were collected between May and June 2020 via electronic survey distribution (snowball sampling). Ethical considerations: The Institutional Ethical Review Committees in both countries approved the study (CHUC_2020_33 and 27/2020). Findings: In total, 345 clinical nurses answered the primary question about the duty to care for the sick. Although in the total sample 77.4% agreed they have a duty to care for the sick, significant differences were found between the Spanish and Chilean samples. Overall, 53.6% of the nurses reported low levels of well-being; however, among those reporting low well-being, statistically significant differences were found between Spanish and Chilean nurses as 19.4% and 37.8%, respectively, disagreed with the statement regarding the duty to care. Discussion: Participants in both countries reported several ethical dilemmas, safety fears, consequent stress and low well-being. These results suggest that prompt actions are required to address nurses’ ethical concerns, as they might affect their willingness to work and psychological well-being. Conclusion: Our findings shed light on the ethical dilemmas nurses are facing related to the duty to care. Not only has the coronavirus disease 2019 pandemic given rise to ethical challenges, but it has also affected nurses’ well-being and willingness to work during a pandemic. (shrink)

Background: Although many studies have addressed COVID-19, the challenges faced by nurses in their workplace after recovering from this disease have not been investigated. As the backbone of the health system and at the forefront of the fight against COVID-19, nurses are exposed to serious risks of infection and even death. They may also face numerous challenges in their workplace after recovering from COVID-19. It is therefore ethically recommended that the problems of these nurses be solved to increase their job (...) satisfaction and encourage them to remain in their profession. Objectives: The present research was conducted to determine the workplace challenges faced by nurses who had recovered from COVID-19. Methods: This qualitative study was conducted using the interpretive phenomenological approach proposed by van Manen. The data collected through 17 in-depth semi-structured interviews with 14 eligible nurses at different occupational levels were analyzed using the six steps proposed by van Manen. These nurses had also recovered from COVID-19. Ethical considerations: This study was approved by the Ethics Committee of Urmia University of Medical Sciences (IR.UMSU.REC.1399.318). Findings: Four themes and 20 subthemes extracted from analyzing the data explained the challenges faced by the nurses after their return to work. The themes included declined ethical values (four subthemes), infected nurses, forgotten patients (three subthemes), gradually leaving the job (six subthemes), and corona phobia (seven subthemes). Conclusion: The present findings can be used to lay the foundations for adopting humanitarian policies in health organizations in terms of ethical care provision during future pandemics. (shrink)

Background: In the midst of the Covid-19 pandemic, healthcare workers increasingly encounter serious ethical issues that negatively affect their professionalism. Purpose: The study aims to examine the ethical sensitivity levels of physicians and nurses working in surgical units during the Covid-19 pandemic and the associating factors. Method: The sample of this cross-sectional online questionnaire–based study consists of 161 healthcare workers working at the surgical units in Turkish hospitals. The data were collected using the “Nurse Descriptive Information Form” developed by the (...) researchers and the “Ethical Sensitivity Questionnaire.” Ethical considerations: Approval was granted by the ethics committee. Verbal and written consent was received from the healthcare workers. Results: Ethical sensitivity in the dimension of conflict was found to be higher in healthcare workers who had ethical issues during the Covid-19 pandemic, who were married, who were nurses, who worked more than 45 h, and who had a work experience of 7–10 years (p < 0.05). Healthcare workers with a family member diagnosed with Covid-19 had high ethical sensitivity in the dimension of conflict (p = 0.008), while those who reported being fully competent and ready (p = 0.038) about Covid-19 were found to have low ethical sensitivity. Besides, those who experienced inadequate supplies (p = 0.045), long working hours (p = 0.038), and problems in asepsis–sterilization (p = 0.046) during the Covid-19 pandemic were found to have low sensitivity in the holistic approach dimension. Conclusion: The study revealed that ethical issues during the Covid-19 pandemic, sociodemographic characteristics, knowledge-skills about Covid-19, and the problems encountered in the work environment during the pandemic affect the ethical sensitivity of healthcare workers in the dimensions of conflict and holistic approach. Therefore, it is recommended that governments and all healthcare workers, and stakeholders in the health system in our country and other countries take action to promote ethical sensitivity in response to the rapidly increasing epidemic by considering the factors that adversely affect ethical sensitivity. (shrink)

Background Ethical reasoning and sensitivity are always important in public health, but it is especially important in the sensitive and complex area of public health emergency preparedness. Here, we explored the ethical challenges, and dilemmas encountered by frontline health workers amid the coronavirus disease-19 (COVID-19) pandemic in Ethiopia. Methods A nationwide survey was conducted amongst the frontline health workers from nineteen public hospitals. Health workers were invited to respond to a self-administered questionnaire. Data were weighted and analyzed using descriptive statistics. (...) Results Of the 285 frontline health workers to whom questionnaires were distributed, 217 of them gave their responses (response rate 76.1%). Respondents frequently reported encountering rationing dilemmas on health commodities directly used for the prevention and treatment of COVID-19. Most (83.9%) of the health workers agreed that they encountered ethical challenges very frequently or frequently. Almost all [215(99.1%)] claimed that the limitation of resources was directly used for the treatment and prevention of COVID-19. The frequency of difficulty in the provision of essential clinical services varied between 77% and 98.7% for different services. More than half of the study participants reported that they had encountered difficulty in the provision of clinical care on a daily or weekly basis. Regarding rationing strategies, isolating COVID-19 treatment units and limiting admission were the most frequent rationing strategies used by two-thirds of health workers on a daily or weekly basis. Conclusion Front-line health workers encountered numerous ethically challenging situations during COVID-19. More than half of health workers reported that they encountered ethical challenges in rationing the resources and delivery of different clinical services such as family planning services, maternal and childcare, immunization, and chronic care. With limited resources such as ventilators and hospital beds, healthcare providers have been faced with the difficult task of deciding who gets access to these resources and who doesn't. Overall, the COVID-19 pandemic has presented numerous ethical challenges for healthcare providers, highlighting the importance of ethical considerations in healthcare delivery. By being aware of these dilemmas and having policies in place to address them, healthcare providers can ensure that they are providing the best possible care to their patients while upholding ethical standards. (shrink)

Abstract2020 saw the rapid onset of a global pandemic caused by the SARS‐CoV‐2 virus. For healthcare systems worldwide, the pandemic called upon quick organization ensuring treatment and containment measures for the new virus disease. Nurses were seen as constituting a vital instrumental professional component in this study. Due to the pandemic's unpredictable and potentially dangerous nature, nurses have faced unprecedented risks and challenges. Based on interviews and free text comment from a survey, this study explores how ethical challenges related to (...) “being a nurse” during the COVID‐19 pandemic was experienced and understood by Danish hospital‐based nurses. Departing from anthropologist Jarett Zigon's notion of moral breakdown, the study demonstrates how the rapid onset of the pandemic constitutes a moral breakdown raising ethical demands for nurses. Analytically we identify three different ethical demands experienced by the nurses. These ethical demands are Nursing and societal ethical demands, Nursing and personal ethical demands, and Nursing and conflicting ethical demands. These demands represent not only very different understandings of ethical demands but also different understandings of ethical acts that are seen as necessary to respond to these demands. (shrink)

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. (shrink)

Background Duty to care is integral to nursing practice. Personal obligations that normally conflict with professional obligations are likely amplified during a public health emergency such as COVID-19. Organizations can facilitate a nurse’s ability to fulfill the duty to care without compromising on personal obligations. Research Aim The study aimed to explore the relationships among duty to care, perception of supportive environment, perceived stress, and COVID-19-specific anxieties in nurses working directly with COVID-19 patients. Research Design The study design was a (...) cross-sectional descriptive study using an online survey. It was conducted at an ANCC Magnet® designated 385-bed acute care teaching hospital located in a suburban area. Participants and Research Context Included in this study were 339 medical surgical nurses working directly with COVID-19 patients during the early phase of the pandemic. Ethical Considerations The study was reviewed by the institution’s clinical research committee and determined to be exempt. A survey invitation letter with a voluntary implied consent agreement was sent to participants with a description of the research study attached to the anonymous survey. Results Nurses with specific COVID-19-related anxieties were more likely to agree that it was ethical to abandon the workplace during a pandemic. Conclusions Organizations can and ought to mitigate the negative effects of COVID-19 on duty to care in future pandemics and healthcare emergencies by incorporating several recommendations derived from this study. (shrink)

Global shortages of healthcare workers, particularly nurses, have been exacerbated by the COVID-19 pandemic, putting significant pressure on healthcare systems worldwide. According to the International Council of Nurses (ICN), 13 million additional nurses are urgently needed to meet global demand. Nurses, who are the backbone of patient care, have faced unprecedented ethical dilemmas, particularly in intensive care units (ICUs), where resource allocation, such as ventilator management and triage decisions, often conflict with basic ethical principles. This study seeks to contribute to (...) the literature by examining the effect of the ethical dilemmas experienced by ICU nurses during COVID-19 pandemic on emotional exhaustion and turnover intention and testing whether emotional exhaustion has a mediating role on the relationship between ethical dilemma and turnover intention. The research model was tested with partial least square structural equation modeling (PLS–SEM) in the package program SmartPLS. The bias-corrected bootstrapping (resampling) method was applied to the sample of 189 nurses who work in the intensive care units in the hospitals in the East Black Sea Region of Türkiye. The research results indicated that ethical dilemma is positively associated with emotional exhaustion (β = 0.305, 95% CI [0.167–0.407]), and turnover intention (β = 0.156, 95% CI [0.146—0.423]). In addition, emotional exhaustion has a complementary partial mediation effect (B = 0.149, 95% CI [0.083–0.215]) between ethical dilemma and turnover intention among ICU nurses. (shrink)

Background Moral distress appears when a healthcare professional is not able to carry out actions in accordance with their professional ethical standards. The Moral Distress Scale-Revised is the most widely used to assess levels of moral distress, but it is not validated in Spanish. The aim of the study is to validate the Spanish version of the Moral Distress Scale – utilised within a sample of Spanish healthcare professionals treating COVID–19 patients. Methods The original (english) and the portuguese and french (...) versions of the scale were translated into spanish by native or bilingual researchers and reviewed by an academic expert in ethics and moral philosophy as well as by a clinical expert. Research design: Descriptive cross-sectional study carried out using a self-reporting online survey. The data was collected between June- November 2020. A total of 661 professionals responded to the survey (N = 2873). Participants: healthcare professionals with more than two weeks of experience treating COVID–19 patients at the end of their life and working in the public sector of the Balearic Islands Health Service (Spain). Analyses included descriptive statistics, competitive confirmatory factor analysis, evidence on criterion-related validity and estimates of reliability. The study was approved by the Research Ethics Committee at the University of Balearic Islands. Results An unidimensional model in which a general factor of moral distress explained by 11 items of the Spanish version of the MDS–R scale was an adequate representation of the data: χ 2 (44) = 113.492 (p 0.001); Comparative Fit Index = 0.965; Root Mean Square Error of Approximation = 0.079[0.062,0.097]; and Standarized Root Mean-Square = 0.037. Evidence of reliability was excellent: Cronbach’s alpha = 0.886 and McDonald’s omega = 0.910. Moral distress was related to discipline, with nurses having statistically significant higher levels than physicians. Additionally, moral distress successfully predicted professional quality of life, with higher levels of moral distress being related to poorer quality of life. Conclusions The Spanish version of Moral Distress Scale–Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by health professionals. This tool will be highly useful for managers and applicable to a variety of healthcare professionals and settings. (shrink)

Die vorliegende Interviewstudie untersucht ethische Herausforderungen des Pflegealltags in Einrichtungen der Langzeitpflege aus Sicht der Pflegepersonen während der Covid-19-Pandemie. Durch das explorative, wie auch deskriptive methodische Vorgehen liegen Interviewdaten vor, die vier Themenbereichen zugeordnet werden können, die eine komplexe und teilweise konfliktreiche Arbeits- und Lebenswirklichkeit der Langzeitpflege in der Pandemie aufzeigen. Zum einen werden von den Pflegepersonen die staatlich und institutionell getroffenen Schutzmaßnahmen sowie die daraus resultierenden Einschränkungen der persönlichen Freiheit der Bewohner:innen kritisch reflektiert und damit verbunden der Grad der (...) Selbstbestimmtheit der Bewohner:innen von Alten- und Pflegeheimen in der Pandemie hinterfragt. Zum anderen wird – gegeben der pandemiebedingten Maßnahmen – das pflegerische Handeln im Arbeits- und Lebensort Heim als herausfordernd und die Möglichkeiten pflegerischer Fürsorge als stark eingeschränkt beschrieben. Genannt werden hier als konkrete Herausforderungen veränderte pflegerische Prozesse und Pflegequalität, wie auch eine veränderte Beziehungsqualität zu den Bewohner:innen.Diese vier Themenbereiche können grundsätzlich den ethischen Prinzipien der Autonomie und Fürsorge zugeordnet werden und präsentieren eine inhaltlich relevante Konkretisierung der prinzipienorientierten ethischen Herausforderungen. In der Zusammenschau und Interpretation der Ergebnisse wird ersichtlich, dass die interviewten Pflegepersonen die Beachtung und Umsetzung des Autonomie-Prinzips im pflegerischen Alltag eng mit dem Fürsorgeprinzip und dem daraus resultierenden Wohltun für die Bewohner:innen verknüpfen.Unsere Ergebnisse verdeutlichen, dass der in den letzten Jahrzehnten erarbeitete Paradigmenwechsel in der Langzeitpflege durch die Covid-19-Pandemie geschwächt wurde. Zudem machen die berichteten moralischen Unsicherheiten und Konflikte klar, dass Pflegepersonen Unterstützung hinsichtlich der ethischen Reflexion ihres pflegerischen Handelns benötigen und eine nachhaltige Integration von Ethikberatung in Langzeitpflegeeinrichtungen einen möglichen Lösungsansatz darstellen kann. (shrink)

Definition of the problem This interview study investigated ethical issues in long-term care facilities from the perspective of caregivers during the coronavirus disease pandemic. Due to the explorative as well as descriptive methodological approach, interview data are available and can be assigned to four central topics, which reveal a complex and sometimes conflictual reality of work and life in long-term care during the pandemic. On the one hand, the protective measures taken by the state and the institutions, as well as (...) the resulting restrictions on the personal freedom of the residents are critically reflected and the degree of self-determination of the residents of nursing homes in the pandemic is questioned. On the other hand – given the pandemic-related measures – nursing activities in long-term care facilities as a place of work and life are described as challenging, especially regarding the changed nursing processes and quality of care, as well as due to the changed quality of relationships with the residents. Arguments These four topics can basically be assigned to the ethical principles of autonomy and care and present a relevant concretization of the principle-oriented ethical challenges in long-term care during the COVID-19 pandemic. In the synopsis and interpretation of the results, it becomes apparent that the interviewed caregivers closely link the observance and implementation of the autonomy principle in everyday nursing care with the principle of care and the resulting well-being of the residents. Conclusions Our results clearly show that the paradigm shift in long-term care, which has been developed over the last few decades, was weakened by the COVID-19 pandemic. In addition, the reported moral uncertainties and conflicts make it clear that caregivers need support regarding the ethical reflection of their nursing actions and that a sustainable integration of ethics counselling in long-term care facilities may be a possible approach to a solution. (shrink)

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)