Challenging times: ethics, nursing and the COVID‐19 pandemic

Abstract

Globally nurses and midwives are working hard to detect cases of COVID‐19, to save lives or give comfort in the face of death, to educate themselves and the public about protective measures to stop the viral spread, while still caring for those not infected with the virus. In many countries nurses are working under virtual siege from this pandemic, with not enough resources or personal protective equipment, overwhelming numbers of patients, staff shortages, underprepared health systems and supply chain failures. Nurses and other health and emergency workers are suffering physical and emotional stress, and moral distress from conflicting professional values. They are faced with unpalatable and complex ethical issues in practice, with moral conflicts, high levels of acuity and patient deaths, and long working hours. A rising number of nurses are infected with SARS‐CoV‐2 or dying in the line of duty. Nurses need strong moral courage, stamina and resilience to work on the front lines of the pandemic, often while separated from their loved ones.

Major Stressors and Coping Strategies of Frontline Nursing Staff During the Outbreak of Coronavirus Disease 2020 (COVID-19) in Alabama

“…Individual characteristics may provide a moderating effect on the stress levels of nurse staff engaging with highly infectious patients with rapidly deteriorating health in many cases. 30 Further, age may also contribute to anxiety and stress levels perceived by nurse staff in completing tasks requiring high amounts of emotional fortitude such as screening phone calls from the anxious family members of patients infected with COVID-19. 30 This study’s findings provide further evidence that such job demand stressors related to frontline nurse staff may be tied to the ethical challenges found in taking care of infectious patients while also taking care of yourself or loved ones.…”

“… 30 Further, age may also contribute to anxiety and stress levels perceived by nurse staff in completing tasks requiring high amounts of emotional fortitude such as screening phone calls from the anxious family members of patients infected with COVID-19. 30 This study’s findings provide further evidence that such job demand stressors related to frontline nurse staff may be tied to the ethical challenges found in taking care of infectious patients while also taking care of yourself or loved ones. 31 , 32 Additionally, this study's findings provide contextual support for the moral injury and trauma sustained by frontline nurse staff who choose to continue treating patients infected with COVID-19 despite their feelings of fear and burnout.…”

“…29 Turale et al (2020) provides insights through the experience of one notable emergency room nurse, Melissa Farmer, reporting how nurses in their hospital working 60 hours a week with bruises on their noses from wearing face masks, being informed by physicians about the “difficult decisions that will be made in the coming weeks about whom to resuscitate” due to a lack of ventilators. 30 On top of all of this, nursing staff during this time must also screen phone calls from the anxious family members of patients infected with COVID-19 who are not allowed into the hospital to comfort their loved one due to the need to socially distance. 30 While both provisions are regarded as non-negotiable ethical standards within their communities, these obligations are found to cause additional job-related burdens on nurse staff during pandemics when nurses must work under extreme conditions to continually care for critically ill infected patients.…”

Reflections of COVID-19 on Dermatology Practice

“…Proudly, the nursing profession is inherently adaptable and rose to the challenge in part because of their varied skill set that includes flexibility, resourcefulness, critical thinking skills, and personal and professional sacrifice. This should not be a surprise to anyone, given that nurses have been at the historical center of the recognition, prevention, health promotion, education, and care and control of infectious diseases from before the days of Florence Nightingale ( Turale et al, 2020 ). However, there were challenges as nurses and nurse practitioners from specialty practice had legitimate concerns about their safety as well as their clinical decision making in areas outside their established knowledge and skill set.…”

Physical Restraint of Dementia Patients in Acute-Care Hospitals During the COVID-19 Pandemic: A Cohort Analysis in Japan

“…1 In acute care hospitals, especially those treating COVID-19 patients, the medical staff face di culties in providing routine care owing to patient triage, social distancing, and shortage of resources, such as nances, medical supplies, and manpower. [2][3][4] To manage the pandemic, the Japanese government announced hospital restrictions, including those pertaining to family visits, at the end of February 2020. These changes in hospital care systems could exacerbate progressive cognitive disfunction and worsen behavioral and psychological symptoms in dementia patients and consequently result in a higher distress to both patients and medical staff.…”