Ethical conflict during COVID‐19 pandemic: the case of Spanish and Italian intensive care units

Abstract

Aim: To identify factors underlying ethical conflict occurring during the current COVID-19 pandemic in the critical care setting. Background: During the first wave of the COVID-19 outbreak, Spanish and Italian intensive care units were overwhelmed by the demand for admissions. This fact revealed a crucial problem of shortage of health resources and rendered that decision-making was highly complex. Sources of evidence: Applying a nominal group technique this manuscript identifies a series of factors that may have played a role in the emergence of the ethical conflicts in critical care units during the COVID-19 pandemic, considering ethical principles and responsibilities included in the International Council of Nurses Code of Ethics. The five factors identified were the availability of resources; the protection of healthcare workers; the circumstances surrounding decision-making, end-of-life care, and communication. Discussion: The impact of COVID-19 on health care will be long-lasting and nurses are playing a central role in overcoming this crisis. Identifying these five factors and the conflicts that have arisen during the COVID-19 pandemic can help to guide future policies and research. Conclusions: Understanding these five factors and recognizing the conflicts, they may create can help to focus our efforts on minimizing the impact of the ethical consequences of a crisis of this magnitude and on developing new plans and guidelines for future pandemics. Implications for nursing practice and policy: Learning more about these factors can help nurses, other health professionals, and policymakers to focus their efforts on minimizing the impact of the ethical consequences of a crisis of this scale. This will enable changes in organizational policies, improvement in clinical competencies, and development of the scope of practice.

Health outcomes and psychosocial risk exposures among healthcare workers during the first wave of the COVID-19 outbreak

“…de 23 de abril de, 2008 , Dosil Santamaría et al, 2021 , Falcó‐Pegueroles et al, 2021 , Fernandes et al, 2021 , Nacional, 2020a , Nacional, 2020b , Plan Nacional de Drogas, 2019 .…”

Ethical Conflict and Its Psychological Correlates among Hospital Nurses in the Pandemic: A Cross-Sectional Study within Swiss COVID-19 and Non-COVID-19 Wards

“…Furthermore, this extremely challenging situation has required nurses to cope with complex clinical decisions, thus exposing them to frequent ethical conflicts [3][4][5][6][12][13][14][15][16][17]. Ethical conflict is defined as a problem that arises when the idea of "good" or "right" with regard to other people's welfare or best interests or self-interest is compromised [18].…”

“…Various authors have stated that, during the Covid-19 pandemic, the ethical conflicts experienced by nurses-which were more intense in the critical care units-stemmed from three main sources, namely: (i) the relationship with patients and their families, which required a total revision of communication techniques and schemes; (ii) the provision of several treatments; and (iii) the specific characteristics of the setting in which the clinical team was asked to work. With regard to the first source, the decision-making process clashed with issues such as the difficulty of ensuring adequate informed consent to the patients, a failure to respect confidentiality, and a lack of protection of the patients' interests [13][14][15][16][17]23]. With respect to the provision of treatments, the Covid-19 pandemic forced nurses to experience conflict when asked to administer treatments they perceived as overly aggressive, when pain management seemed to be lacking, or when it became necessary to limit the use of life support procedures, especially in relation to End-of-Life care [13][14][15][16][17]23].…”

“…With regard to the first source, the decision-making process clashed with issues such as the difficulty of ensuring adequate informed consent to the patients, a failure to respect confidentiality, and a lack of protection of the patients' interests [13][14][15][16][17]23]. With respect to the provision of treatments, the Covid-19 pandemic forced nurses to experience conflict when asked to administer treatments they perceived as overly aggressive, when pain management seemed to be lacking, or when it became necessary to limit the use of life support procedures, especially in relation to End-of-Life care [13][14][15][16][17]23]. Finally, in relation to workplace dynamics, ethical conflict frequently emerged when professionals working in extreme conditions were not fully involved in the decision-making process or when the work environment made it difficult to consider issues of a bioethical nature [13][14][15][16][17]23].…”

It Is Time to Balance the Risks With Notions of Good

“…Even now, there are still many limitations placed on family visits, resembling restrictive environments that have historically existed in many acute and critical care settings. 2 , 3 , 4 , 5 , 6 , 7 This article will discuss the benefits of family access to hospitalized patients and explore implications for perianesthesia areas moving forward.…”