RESPONDER: A qualitative study of ethical issues faced by critical care nurses during the COVID‐19 pandemic

Abstract

Aims To identify and understand ethical challenges arising during COVID‐19 in intensive care and nurses' perceptions of how they made “good” decisions and provided “good” care when faced with ethical challenges and use of moral resilience. Background Little is known about the ethical challenges that nurses faced during the COVID‐19 pandemic and ways they responded. Design Qualitative, descriptive free‐text surveys and semi‐structured interviews, underpinned by appreciative inquiry. Methods Nurses working in intensive care in one academic quaternary care centre and three community hospitals in Midwest United States were invited to participate. In total, 49 participants completed free‐text surveys, and seven participants completed interviews. Data were analysed using content analysis. Results Five themes captured ethical challenges: implementation of the visitation policy; patients dying alone; surrogate decision‐making; diminished safety and quality of care; and imbalance and injustice between professionals. Four themes captured nurses' responses: personal strength and values, problem‐solving, teamwork and peer support and resources. Conclusions Ethical challenges were not novel but were amplified due to repeated occurrence and duration. Some nurses' demonstrated capacities for moral resilience, but none described drawing on all four capacities. Implications for Nursing Management Nurse managers would benefit from greater ethics training to support their nursing teams.

A multi-country mixed-method study identifying the association between perceived ethical work climate and problems among critical care nurses

“…Prior studies concluded that ICU nurses commonly face some ethical problems while caring for patients with infectious diseases [ 13 , 29 , 30 ], similar to the findings of the current study. While the statements used in the questionnaire did not cover all ethical problems encountered in ICUs, the qualitative component of the study provided additional insight into other ethical issues and conflicts.…”

A divided community: A descriptive qualitative study of the impact of the COVID‐19 pandemic on nurses and their relationships

“…We conducted a two-part study to understand nurses' personal and professional experiences during COVID-19 and the perceived impact on their relationships at home (with loved ones and community) and at work (with patients, colleagues, team, organization and community). In part one, we identified the ethical challenges nurses in intensive care units (ICU) encountered, how they sought to overcome these challenges and whether they drew upon capacities associated with 'moral resilience' (Morley et al, 2022). We learned that nurses found it difficult to disentangle their own values from their patient's values and often drew upon their own personal beliefs when responding to ethical challenges.…”

“…Nurses reported feeling overwhelmed because they were required to take on additional roles and responsibilities due to isolation precautions, high levels of sickness and staffing issues (Smeltzer et al, 2022). Feelings of imbalance and injustice between professionals led to a negative impact on some nurses’ working relationships (Jia et al, 2021; Morley et al, 2022). In particular, nurses reported challenges with physicians who were reluctant to enter patient rooms (Copel et al, 2022; Kelley et al, 2022).…”

Self-Deception in Clinical Nursing Practice: A Concept Analysis

“…Past research has also examined how nurses may draw upon moral resilience, which refers to an individual’s ability to maintain or restore their moral integrity in the face of moral ambiguity, uncertainty, distress, or adversity ( Young & Rushton, 2017 ), to overcome these challenges. Morley et al (2022) found that some nurses faced various ethical challenges regarding patients dying alone, surrogate decision-making, imbalance (of power), and injustice between professionals and were able to provide “good” care by drawing upon their strength and ethical values. However, in exploring nurses’ experiences of speaking up about concerns during the pandemic, Abrams et al (2023) highlighted that nurses felt they had no agency or choice.…”