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

Emergency Nursing and Staff Experiences With Visitation Restrictions During the Coronavirus Disease 2019 Pandemic: A Qualitative Descriptive Study

INTRODUCTION

At the onset of the coronavirus disease 2019 pandemic, visitors were prohibited in the emergency department, leaving patients bereft of their companionship and advocacy. However, little was known about the conflicts and distress of emergency department staff related to this policy. This study aimed to qualitatively explore emergency nursing and staff experiences regarding the no-visitor policy.

METHODS

A qualitative descriptive approach explored short answers to 1 open-ended question. Emergency nurses and assistive personnel (patient care technicians and emergency medical technicians/paramedics) were recruited from 11 participating emergency departments, using convenience sampling and a web-based survey. We followed the 6-step process of reflexive thematic analysis to identify patterns in the data and develop themes that describe the results.

RESULTS

Of 180 respondents, 69 (38%) answered our qualitative question. Participants were typically female (78.3%), White (82.6%), and mostly registered nurses (79.7%), with an average age of 39 years and an average of 10 years' ED experience. Participants offered complex, heartfelt responses, resulting in 3 themes: (1) exposure and risk, (2) experiencing patient and family reactions; and (3) policy enforcement challenges.

DISCUSSION

Although many respondents concluded that the policy was protective against pandemic risk, some saw it as ineffective. They believed exceptions must be made for imminent death. Participants felt that patients/visitors understood, but did not always like, restrictions. Adherence to policy left respondents conflicted, leading to inconsistent enforcement. Visitation policies for patients with infectious diseases must consider patient/visitor needs, moral distress of ED staff, and pragmatic enforcement strategies.

Experience of Student Nurse Anesthetists' Learning in the Operating Room During the COVID-19 Pandemic: A Qualitative Interview Study

PURPOSE

This study explores student nurse anesthetists' (SNAs) learning in the operating room during the coronavirus 2019 pandemic.

DESIGN

An explorative design with semistructured interviews was used.

METHODS

Thirteen former SNAs and 12 clinical supervisors (8 of whom were included in the final analysis) were recruited from 6 counties in Sweden. Participants were purposively recruited. Inclusion criterion for former SNAs was having completed the nurse anesthesia program in the fall of 2020 to spring 2022; and for nurse anesthetists, those who have experience in supervising SNAs. The interviews were analyzed with thematic analysis.

FINDINGS

The analysis identified one theme and five subthemes. The theme was that student learning was in focus despite an ongoing pandemic. Every learning situation contributed, and learning was triggered by the challenges. Both the SNAs and the supervisors exhibited resilience by accepting the situation and striving to do their absolute best in a nonoptimal learning environment. Over time, learning and supervision returned to normal.

CONCLUSIONS

During the pandemic, learning was ongoing despite stress, fear, and other challenging factors. Students' learning appears to have been prioritized. The study highlights that nurse anesthetists and SNAs were resilient, resourceful, and able to find new ways to keep learning going.

Reporting and managing ethical issues in intensive care using the critical incident reporting system

BACKGROUND

Intensive care nurses frequently encounter ethical issues with potentially severe consequences for nurses, patients, and next of kin. Therefore, ethical issues in intensive care units (ICU) should be recognized and managed.

RESEARCH OBJECTIVES

To analyze ethical issues reported by intensive care nurses and how reported issues were managed within the organization using register data from the HaiPro critical incident reporting system (CIRS), and to explore the suitability of this system for reporting and managing ethical issues.

RESEARCH DESIGN

This was a retrospective descriptive register study. CIRS reports on ethical issues in adult ICUs (n = 12) in one hospital district in Finland over 25 months (2019-2021) were analyzed through inductive content analysis and descriptive quantification. The CIRS's suitability for reporting and managing ethical issues was evaluated through a strengths, weaknesses, opportunities, and threats (SWOT) analysis.

ETHICAL CONSIDERATIONS

The study was approved by the University Ethics Committee, and permission to conduct the research was granted before data collection within the organization.

RESULTS

CIRS reports on ethical issues (n = 35) made by nurses were found in seven of the 12 ICUs. The CIRS managers of these units managed these reports. The ethical issues described by the nurses were divided into four main categories: nature, situational information, consequences, and contributing factors. Management of reported ethical issues was divided into three main categories: preventive actions proposed by nurses, proposals for actions by CIRS managers, and actions taken by CIRS managers.

CONCLUSIONS

Systematic register data broadly describe ethical issues and their management, indicating that the CIRS could be suitable for reporting and managing ethical issues, thereby enabling the monitoring and development of ethical quality at the unit and organizational levels.

Assessing Healthcare Integration: An Integrated Palliative Care System in Spain

Introduction

This study explored the Osona palliative care system, recognized internationally for its good results in managing the chronic patient. The literature notices a gap of models that evaluate integration in healthcare systems. This study assesses the degree of integration of the Osona palliative care system, as well it implements a model that evaluates integration.

Methods

This research used a qualitative methodology, involving a case study design with three study phases. The first phase involved reviewing primary sources, followed by conducting interviews. The final phase entailed comparing the findings with a theoretical model to analyse and validate the results.

Results

The study found the integrative elements that the Osona system includes such as: multidisciplinary teams, leadership and a palliative care system that is cost-efficient. It also found aspects to improve including collaboration, continuity of care, early patient identification and lack of funding.

Discussion

Our findings suggest that the Osona system has made significant progress toward integration, even though it continues the path of ongoing development in integrated care.

Conclusion

This research found that the Osona palliative care system includes many integrating aspects such as multidisciplinary teams, leadership and the system's cost-efficiency. Nevertheless, some aspects need changes such as continuity of care, collaboration, enhanced early patient identification and increase funding. Furthermore, this study provides an example of how to assess integration in a system.

Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS

AIM

To offer an overall picture of the research published regarding the different aspects of death and dying during the COVID-19 pandemic in journals covering the field of nursing in the Scopus database.

DESIGN

bibliometric analysis.

METHODS

The metadata obtained were exported from Scopus for subsequent analysis through Bibliometrix. Using the VOSviewer co-word analysis function, the conceptual and thematic structure of the publications was identified.

RESULTS

A total of 119 papers were retrieved, with the participation of 527 authors. The publications were found in 71 journals covering the nursing area. The main lines of research revolved around the keywords "palliative care" and "end-of-life care" in regard to the ethical, psychological, and organizational challenges faced by the health professionals who cared for these patients.

CONCLUSION

The results obtained offer a range of data and images that characterize the scientific production published on this topic, coming to the conclusion that, due to the multifaceted and multidisciplinary approach to the experience of death, care, and accompaniment in the dying process, bibliometric maps improve the comprehensive understanding of the semantic and conceptual structure of this field of research. This study was retrospectively registered with the OSF Registries on the 14 March 2024.

Conflict occurrence and preferred management styles among ICU nurses during the first wave of COVID-19 pandemic: A cross-sectional study in Saudi Arabia

BACKGROUND

Intensive care units (ICUs) have been overwhelmed by the increasing number of coronavirus disease 2019 (COVID-19) cases, causing psychological burdens, stress, and various types of conflict among nurses.

AIM

To examine the occurrence, type, and intensity of conflict and preferred management styles among ICU nurses during the COVID-19 pandemic.

STUDY DESIGN

This cross-sectional descriptive study was conducted in a government hospital in Saudi Arabia using a convenience sample of 95 nurses from three ICUs. Data were collected using an e-questionnaire comprising the Nursing Conflict Scale, Rahim Organizational Conflict Inventory-II, and sociodemographic variables.

RESULTS

Most participants reported exposure to moderately (64.2%) or highly (34.79%) intense conflict during the pandemic. The competitive (2.23 ± .472) and intragroup (2.23 ± .385) types of conflict were the most frequently reported. The preferred conflict management style was collaborating (21.85 ± 5.49), followed by accommodating (18.39 ± 4.03). Pearson's correlation analysis showed that age, years of experience, and education were significantly associated with conflict type and management style. Preparedness to care for suspected or confirmed COVID-19 cases was associated with interpersonal conflict (r = .20, p = .04).

CONCLUSIONS

The participants experienced moderate- to high-intensity conflict; however, they employed constructive rather than destructive management styles.

RELEVANCE TO CLINICAL PRACTICE

Nurse leaders, policymakers, and educators must initiate transformational intervention programmes to enhance and sustain nurses' competencies in constructive conflict management strategies. Interpersonal communication and crisis management training programmes should be formulated to raise nurses' awareness and enhance their competencies vis-à-vis taking a positive approach to overcoming various conflict types and levels, particularly during crises.

Explaining ethical challenges and practical solutions from a nursing managements' perspective: A phenomenological study

Introduction and Objective

Ethical practice is a vital aspect of nursing interventions. Complying with the ethical aspects of the intervention procedure in a stressful nursing environment is not easy and nurse managers always face ethical challenges which are in conflict with their personal values and norms. Identifying and solving these challenges improves the efficiency and effectiveness of nursing care activities. Therefore, this research was done to explain the ethical challenges of nurse managers and practical solutions from their perspective.

Material and Method

It is a qualitative study that was carried out based on the phenomenological method in 2022. The participants of this study were 20 nurse managers of Arak hospitals who were selected by purposive sampling until data saturation. The data were collected through semi-structured interviews for 30 to 90 minutes. Data collection was carried out with the participant's consent, using a digital recording device and verbatim transcription, and then it was analyzed using Van Manen's six-step hermeneutic phenomenological approach.

Findings

The results of this study could provide a clear picture of ethical challenges and their practical solutions from the nurse managers' perspective in the form of four themes of managerial ethical challenges which include challenges facing physicians, organizations, employees, managers, and three themes for practical solutions, including organizational solutions, interpersonal solutions, and educational solutions which were manifested.

Conclusion

Nurse managers are always faced with ethical challenges in their daily activities. To deal with these challenges, they must be familiar with the rules and principles of professional ethics, practical standards, and laws related to patients' rights. Ethical principles and awareness of the ethical decision-making process are useful and effective in having capable and ethical nurses who provide competent care. To deal with ethical challenges, it is suggested to consider self-care strategies and structural and specialized support in each center, which will ultimately lead to the improvement of service quality and the promotion of ethics in care-treatment environments.

Ethics and frontline nursing during COVID-19: A qualitative analysis

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.

Protective factors of ethical conflict during a pandemic-Quali-Ethics-COVID-19 research part 2: An international qualitative study

AIMS AND OBJECTIVES

To determine which factors can be considered protective of ethical conflicts in intensive care unit healthcare professionals during a pandemic.

BACKGROUND

The COVID-19 pandemic gave rise to new ethical concerns in relation to the management of public health and the limitations on personal freedom. Continued exposure to ethical conflict can have a range of psychological consequences.

DESIGN

A qualitative design based on phenomenological approach.

METHODS

A total of 38 nurses and physicians who were regular staff members of Barcelona and Milan's public tertiary university hospitals and working in intensive care units during the first wave of the COVID-19 pandemic. Semi-structured online in-depth interviews were conducted. A thematic analysis was performed by two independent researchers following the seven steps of Colaizzi's methods. We adhere COREQ guidelines.

RESULTS

One theme 'Protective factors of ethical conflict in sanitary crisis' and four subthemes emerged from the data: (1) knowledge of the infectious disease, (2) good communication environment, (3) psychological support and (4) keeping the same work team together.

CONCLUSIONS

Four elements can be considered protective factors of ethical conflict for healthcare professionals during a sanitary crisis. While some of these factors have already been described, the joint identification of this set of four factors as a single element is, in itself, novel. This should help in ensuring the right mechanisms are in place to face future pandemics and should serve to improve institutional organisation and guarantee safe and high-quality patient care in times of healthcare crisis.

RELEVANCE TO CLINICAL PRACTICE

Future strategies for the prevention of ethical conflict during sanitary crises, pandemics or other catastrophes need to consider a set of four factors as a single element. These factors are the knowledge of the infectious disease, a good communication environment, psychological support and keeping the same work team together into joint consideration.

Supporting ethical end-of-life care during pandemic: Palliative care team perspectives

BACKGROUND

Italy was the first European country to be involved with the COVID-19 pandemic. As a result, many healthcare professionals were deployed and suddenly faced end-of-life care management and its challenges.

AIMS

To understand the experiences of palliative care professionals deployed in supporting emergency and critical care staff during the COVID-19 first and second pandemic waves.

RESEARCH DESIGN

A qualitative descriptive design was adopted, and in-depth interviews were used to investigate and analyse participants' perceptions and points of view.

PARTICIPANTS AND RESEARCH CONTEXT

Twenty-four healthcare professionals (physicians, nurses, psychologists, physiotherapists, and spiritual support) from the most affected areas of Italy were recruited via the Italian society of palliative care and researchers' network.

ETHICAL CONSIDERATIONS

The University Institutional Board granted ethical approval. Participants gave written informed consent and agreed to be video-recorded.

FINDINGS

The overarching theme highlighted participants' experience supporting health professionals to negotiate ethical complexity in end-of-life care. Crucial topics that emerged within themes were: training emergency department professionals on ethical dimensions of palliative and end-of-life care, preserving dying patients' dignity and developing ethical competence in managing end-of-life care.

CONCLUSIONS

Our study showed palliative care teams' challenges in supporting health professionals' ethical awareness in emergencies. However, while they highlighted their concerns in dealing with the emergency staff's lack of ethical perspectives, they also reported the positive impact of an ethically-informed palliative care approach. Lastly, this study illuminates how palliative care professionals' clinical and ethical competence might have assisted a cultural change in caring for dying patients during COVID-19 and future emergencies.

Moral distress in psychiatric nurses in Covid-19 crisis

BACKGROUND

The COVID-19 pandemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient's lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in Iranian psychiatric nurses during the COVID-19 pandemic.

METHOD

This qualitative study with a conventional content analysis approach involved 12 nurses at the Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by semi-structured interviews, data analysis was performed based on the five steps of Graneheim and Lundman.

RESULTS

By continuous comparison and integration of data, 17 subcategories, 8 subcategories, and 3 categories were extracted from 252 initial codes. The causes of moral distress in psychiatric nurses during the COVID-19 pandemic were identified as emotional responses (Fear and Doubt), relational factors (Nurses' Relationship with Each Other, Nurse-physician Relationship, and Relationship whit Patients), and Institutional factors (Lack of Attention to Health Instructions, Failure to complete the treatment process for patients and Institutional Policies).

CONCLUSION

New dimensions of the causes of moral distress associated with the COVID- 19 pandemic are discovered in this study. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.

Austerity Measures and Underfunding of the Spanish Health System during the COVID-19 Pandemic-Perception of Healthcare Staff in Spain

Insufficient pandemic preparedness and underfunding of human and economic resources have conditioned the response to COVID-19 in Spain. This underfunding has continued since the austerity measures introduced during the 2008 financial crisis. This study aims to understand the perceptions of healthcare staff in Spain on the relationship between the funding of the health system and its capacity to respond to the COVID-19 pandemic. To this end, we carried out a thematic content analysis, based on 79 online semi-structured interviews with healthcare staff across the regions most affected by the COVID-19 first wave. Participants reported a lack of material resources, which had compromised the capacity of the health system before the pandemic. The lack of human resources was to be addressed by staff reorganisation, such as reinforcing hospital units to the detriment of primary health care. Staff shortages continued straining the COVID-19 response, even after material scarcities were later partially alleviated. Personnel shortages need to be adequately addressed in order to adequately respond to future health crises.

Intensive care nurses' lived experience of altruism and sacrifices during the Covid-19 pandemic: A phenomenological study

AIM

The aim of this study was to understand the lived experience of altruism and sacrifices among Swedish nurses working in intensive care units (ICU) during the COVID-19 pandemic.

DESIGN

This was a descriptive phenomenological study.

METHODS

The study was conducted between June 2020 and March 2021 and included 20 nurses who were directly involved in the ICU care of COVID-19 patients in Sweden during the pandemic. The text transcripts were analysed using Malterud's Systematic Text Condensation.

FINDINGS

The analysis revealed four themes. The work situation changed from 1 day to another-the nurses were brutally confronted with a new and highly demanding situation. Adapting to the chaotic situation-despite fear, anguish and exhaustion, the nurses adapted to the new premises. They shouldered the moral responsibility and responded to the needs of the patients and the health care system since they had the competence. Being confronted with ethical and moral challenges-the nurses were overwhelmed by feelings of helplessness and inadequacy because despite how hard they worked, they were still unable to provide care with dignity and of acceptable quality. The importance of supporting each other-collegiality was fundamental to the nurses' ability to cope with the situation.

CONCLUSIONS

Taken together, being exposed to a constantly changing situation, facing the anguish and misery of patients, families, and colleagues, and being confronted with a conflict between the moral obligation to provide care of high quality and the possibility to fulfil this commitment resulted in suffering among the nurses. Collegial back-up and a supportive culture within the caring team were important for the nurses' endurance.

IMPACT

The study contributes an understanding of nurses' lived experience of working during the COVID-19 pandemic and highlights the importance of protecting and preparing nurses and nursing organisation for potential future crises.

Mediating scarcity in pandemic times: an ethnographic study on the prevention and control of SARS-CoV-2 infections during the emergence of the corona crisis in the Netherlands

BACKGROUND

In this paper we explore how staff involved with infection prevention managed the emerging COVID-19 crisis in the context of scarcity of Personal Protective Equipment (PPE), focussing specifically on the (re)writing of guidelines. We conceptualize guidelines as 'mediating devices' as they translate between evidence and clinical practice, between management and the workplace, as well as the different values embedded in these domains. It is this mediation, we argue, that adds to the resilience of healthcare organizations. The setting for this research is an elite academic hospital in the Netherlands during the emergence of the COVID-19 pandemic.

METHODS

We conducted non-participative observations, semi-structured interviews, and document analysis during the emerging pandemic (March-July 2020). We observed meetings from the crisis team and the unit for infection prevention (210 hours), interviewed members of these teams (21 interviews) and analysed guidelines and flowcharts concerning infection prevention, as such collecting a unique and rich qualitative dataset. Analysis was done through thematic coding.

RESULTS

Our results show the writing and rewriting of guidelines as a fundamental characteristic of dealing with scarcity and adding to resilience. We found three main practices our research participants engage in while trying to manage the uncertain situations emerging from the scarcity of personal protection equipment. The first practice we observe is defining safety; dealing with different perspectives and experiences of what 'working safely' means. The second entails the anticipation of scarcity by which our participants aim to control the situation through monitoring, research and creating scenarios. The third practice we observe is finding new ways to use PPE that is available, by experimenting and tinkering with the material.

CONCLUSION

Infection prevention guidelines are crucial in managing the emerging crisis. We discuss how the writing of guidelines mediates between different settings, timeframes, and different worlds of quality. Through (re)writing there is a constant negotiation and discussion with the various actors about what works, and there is a continuous adaptive attitude. At the cost of a lot of work and struggle, this creates a resilient and inclusive work environment useful in a long-lasting crisis.

Moral Distress of Intensive Care Nurses: A Phenomenological Qualitative Study Two Years after the First Wave of the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has imposed great pressure on healthcare facilities, exposing healthcare professionals to various challenges that may result in the onset of moral distress, a condition of psychological distress caused by the inability to act as it would be most morally appropriate. The purpose of this research was to investigate the experience lived by nurses who worked in an intensive care unit during the COVID-19 pandemic.

METHODS

This is a phenomenological study using interpretative phenomenological analysis. Sixteen nurses who worked in the COVID-19 Intensive Care Unit of Northern Italian Hospitals from January to April 2022 were selected through purposive sampling. Data on experiences, thoughts, and symptoms were collected through semi-structured interviews with in-person and remote modalities.

RESULTS

Five themes and fourteen subthemes emerged from the study. The themes are: (1) pride, isolation, and fear; (2) teamwork and organisation; (3) moral/ethical aspect; (4) true heroes; and (5) dignity.

CONCLUSIONS

This study highlights the impact of the COVID-19 pandemic on intensive care unit nurses. It has emerged that the risk of moral distress is high among healthcare workers in the front line of the fight against the virus. This condition should be avoided and managed through early psychological interventions, sharing of experiences, and a good organization that supports decision-making and professional well-being.

Associations between psychosocial stressors at work and moral injury in frontline healthcare workers and leaders facing the COVID-19 pandemic in Quebec, Canada: A cross-sectional study

Healthcare workers (HCWs) on the frontline of the COVID-19 pandemic exhibit a high prevalence of depression and psychological distress. Moral injury (MI) can lead to such mental health problems. MI occurs when perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. Since the start of the pandemic, psychosocial stressors at work (PSWs) might have been exacerbated, which might in turn have led to an increased risk of MI in HCWs. However, research into the associations between PSWs and MI is lacking. Considering these stressors are frequent and most of them are modifiable occupational risk factors, they may constitute promising prevention targets. This study aims to evaluate the associations between a set of PSWs and MI in HCWs during the third wave of the COVID-19 pandemic in Quebec, Canada. Furthermore, our study aims to explore potential differences between urban and non-urban regions. The sample of this study consisted of 572 HCWs and leaders from the Quebec province. Prevalence ratios (PR) of MI and their 95% confidence intervals (CI) were modelled using robust Poisson regressions. Several covariates were considered, including age, sex, gender, socio-economic indicators, and lifestyle factors. Results indicated HCWs exposed to PSWs were 2.22-5.58 times more likely to experience MI. Low ethical culture had the strongest association (PR: 5.58, 95% CI: 1.34-23.27), followed by low reward (PR: 4.43, 95% CI: 2.14-9.16) and high emotional demands (PR: 4.32, 95% CI: 1.89-9.88). Identifying predictors of MI could contribute to the reduction of mental health problems and the implementation of targeted interventions in urban and non-urban areas.

Experiences and Needs of Patients, Caregivers and Nurses during the COVID-19 Pandemic: Study Protocol for a Mixed-Methods Multicentre Study

The COVID-19 pandemic is a major public health problem with millions of confirmed cases and deaths described. Nurses are among the health care professionals most involved at the front line, caring for those affected by COVID-19. Patients and families have been subjected to a high emotional burden of fear, anxiety, and uncertainty. The COVID-19 pandemic has had a significant impact on the approach to patients, the organisation of care, and communication with patients and their families, all requiring considerable adaptation on the part of nurses and health care professionals. The overall aim of this research was to find out the needs of patients with COVID-19, the nursing interventions provided and their outcomes, and to explore the experiences of the nurses, patients, and caregivers. A mixed method study will be performed with a convergent design. The study was divided into three phases. Quantitative methods involved nurses and patients affected by COVID-19 with a questionnaire. Qualitative methods involved nurses, patients, and caregivers with interviews and finally a quantitative analysis of the nursing documentation of the interviewed patients. We hope that this study will help us to understand and identify the main nursing and support needs expressed by patients and their families at different stages of their illness.

Modeling the Transmission Dynamics of COVID-19 Among Five High Burden African Countries

Background

Today, coronavirus disease-19 has left a permanent dark mark on the history of human beings. The ongoing global pandemic outbreak of COVID-19 has spread to 58 African countries, with over 6.07 million confirmed cases and over 151,412 deaths. The five high burden African countries are South Africa, Morocco, Tunisia, Ethiopia, and Libya, with case fatality rates (CFR) of nearly 0.15%, 0.042%, 0.22%, 0.006%, and 0.086%, respectively. This is why the research aims to adequately understand the transmission dynamics of the virus and its variants in five high-burden African countries.

Methods

Our study is a deterministic model, where the population is partitioned into five components on the epidemiological state of the individuals. We presented a year-structured susceptible, infected, mild severs, critical severe, and recover (SIMCR) compartmental model of COVID-19 disease transmission with incidence rate during the pandemic period.

Results

The number of susceptible individuals increased by 30,711,930 in South Africa, 5,919,837 in Morocco, 3,485,020 in Tunisia, 7,833,642 in Ethiopia, and 2,145,404 in Libya in the next 3 decades with compare to the unvaccinated population and the number of infected individuals decreased by 30,479,271 in South Africa, 19,809,751 in Morocco, 3,456,406 in Tunisia, 7,761,993 in Ethiopia, and 2,125,038 in Libya.

Conclusion

SIMCR model is used to describe the transmission of COVID-19 among five high-burden African countries. For the next 30 years, we will have around 86 million infected individuals and millions of death only in those five African countries. To reduce those problems, vaccination is the best and most effective mechanism. So vaccinating half of the populations in those countries helps to control and reduce the transmission rate of COVID-19 in Africa for the next 30 years. This leads to preventing 17,212,405 people from becoming infected and millions of deaths being reduced in those five high-burden African countries.

Moral Distress Scores of Nurses Working in Intensive Care Units for Adults Using Corley's Scale: A Systematic Review

BACKGROUND

No systematic review in the literature has analyzed the intensity and frequency of moral distress among ICU nurses. No study seems to have mapped the leading personal and professional characteristics associated with high levels of moral distress. This systematic review aimed to describe the intensity and frequency of moral distress experienced by nurses in ICUs, as assessed by Corley's instruments on moral distress (the Moral Distress Scale and the Moral Distress Scale-Revised). Additionally, this systematic review aimed to summarize the correlates of moral distress.

METHODS

A systematic search and review were performed using the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), the National Library of Medicine (MEDLINE/PubMed), and Psychological Abstracts Information Services (PsycINFO). The review methodology followed PRISMA guidelines. The quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale.

RESULTS

Findings showed a moderate level of moral distress among nurses working in ICUs. The findings of this systematic review confirm that there are a lot of triggers of moral distress related to patient-level factors, unit/team-level factors, or system-level causes. Beyond the triggers of moral distress, this systematic review showed some correlates of moral distress: those nurses working in ICUs with less work experience and those who are younger, female, and intend to leave their jobs have higher levels of moral distress. This systematic review's findings show a positive correlation between professional autonomy, empowerment, and moral distress scores. Additionally, nurses who feel supported by head nurses report lower moral distress scores.

CONCLUSIONS

This review could help better identify which professionals are at a higher risk of experiencing moral distress, allowing the early detection of those at risk of moral distress, and giving the organization some tools to implement preventive strategies.

A critical incident study of ICU nurses during the COVID-19 pandemic

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.

Conflict Sources and Management in the ICU Setting before and during COVID-19: A Scoping Review of the Literature

INTRODUCTION

Conflicts are an inherent part of work within any organisation. They can arise between members of an interdisciplinary team (or between teams representing different departments), between patients and team members/family members, and patients' families and team members. Various conflict situations among employees may occur, therefore it is very important to identify their causes and take preventive or targeted corrective measures. The aim of this study was to review the available literature concerning conflicts arising in ICUs-their types, methods of expression as well as their management and mitigation. In addition, we reviewed the available literature on the impact of the pandemic on the ICU environment caring for COVID-19 patients.

METHODS

The databases were searched. Single key words or their combinations using AND or OR operators were entered. Eventually, 15 articles were included in our review, which included two identical papers.

RESULTS

Conflicts occurred occasionally or rarely; researchers describing ethical conflicts demonstrated a moderate level of exposure to conflicts. The pandemic created many challenges and ethical dilemmas that are a source of ethical conflict.

CONCLUSIONS

As conflict by nature remains inevitable, adequate procedures in conflict management should be developed and the leadership of managing personnel should be reinforced, because team members frequently expect guidance from their supervisors. The importance of training in interpersonal communication and crisis situation management in healthcare should therefore be emphasised.

Managing the end of life in COVID patients. The role of palliative care in emergency departments during the pandemic

Managing COVID-19 patients has been an extremely difficult and dramatic task, especially for emergency departments during the strongest waves of the pandemic in Italy. Medical staff and health professionals were redeployed from their work setting to COVID units; many were overwhelmed by the deaths of so many patients in a very short time. This work aimed to explore palliative care health professionals' and physicians' perceptions of end-of-life care management in COVID units during the first two waves of the pandemic in Italy. Qualitative data was collected through 24 semi-structured in-depth interviews. The participants were palliative care medical and health professionals redeployed, or in a supporting role, COVID units from the most affected areas of northern and central Italy. The interview questions were focused on four thematic areas concerning different aspects of the role and responsibilities of the palliative care specialist (physician and healthcare professional). A brief presentation of the main sociological literature on end-of-life management in hospital contexts will be firstly presented and discussed to offer a theoretical frame. Subsequently, some of the most significant results that emerged from our research will be illustrated concerning the role played by palliative care professionals during the pandemic and the relevance of the palliative care approach in emergency contexts.

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

The aim is to describe the health and psychosocial risk factors of Spanish healthcare workers during the COVID-19 pandemic.

METHODS

A cross-sectional study by means of an online questionnaire (April-May 2020). The data comes from the database resulting from the COTS project "Working conditions, insecurity, and health in the context of the COVID-19 pandemic". The sample consisted of 1989 health care workers.

RESULTS

Women, young people (doctors and nurses) and the middle-aged (assistants) had poorer health and greater exposure to psychosocial risks. Geriatric assistants were the most-affected occupational group.

CONCLUSIONS

gender, occupation, and age are focuses of inequality in the exposure of health care workers to psychosocial risks.

Experiences and perceptions of Turkish intensive care nurses providing care to Covid-19 patients: A qualitative study

AIM

To describe the experiences of intensive care nurses who provided care to Covid-19 patients and their perceptions towards the disease and their work conditions during the pandemic.

INTRODUCTION

Identification of experiences and perceptions of intensive care nurses towards disease, care and their workplace conditions when providing care to Covid-19 patients will inform decision-makers about improvements that can be implemented.

BACKGROUND

The Covid-19 pandemic has led to increased strain and workplace-related health risks to intensive care nurses, but it has also provided a unique experience and opportunities for learning and development.

METHODS

A descriptive qualitative study was conducted with 10 intensive care unit nurses working in seven hospitals in Istanbul, Turkey. Snowball sampling method was used, and the data were collected by semistructured online interviews. A thematic analysis was performed. The Consolidated Criteria for Reporting Qualitative Research were followed.

FINDINGS

Five major themes were identified: 'death and fear of death', 'impact on family and social lives', 'nursing care of Covid-19 patients', 'changing perceptions of their own profession: empowerment and dissatisfaction', and 'experiences and perceptions of personal protective equipment and other control measures'.

DISCUSSION

Intensive care nurses experience an increased risk of infection and psychological burden, and they lack a sense of professional satisfaction. Improvements to working conditions are needed to support nurses caring for patients during the pandemic.

CONCLUSION

The pandemic increased the workload and responsibilities of intensive care nurses and led to increases in their work-related health risks and challenges with care. However, it also increased nurses' awareness about the importance of their professional roles.

IMPLICATIONS FOR NURSING PRACTICE AND POLICIES

There is a need to improve working conditions and develop nursing standards for the care of Covid-19 patients in intensive care units.

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

Background: During the Covid-19 pandemic, nurses experienced increased pressure. Consequently, ethical concerns and psychological distress emerged. This study aimed to assess nurses’ ethical conflict, resilience and psychological impact, and compare these variables between nurses who worked in Covid-19 wards and nurses who did not. Methods: Design—Multicentre online survey. Setting—Multi-site public hospital; all nursing staff were invited to participate. The survey included validated tools and a novel instrument to assess ethical conflict. Spearman’s rho coefficient was used to assess correlations between ethical conflict and psychological distress, logistic regressions to evaluate relationships between nurses’ characteristics and outcome variables, and the Mann–Whitney/t-test to compare groups. Results: 548 questionnaires out of 2039 were returned (275 = Covid-19; 273 = non-Covid-19). We found a low–moderate level of ethical conflict (median = 111.5 [76–152]), which emerged mostly for seeing patients dying alone. A moderate and significant positive correlation emerged between ethical conflict and psychological distress rs (546) = 0.453, p < 0.001. Nurses working in Covid-19-ICUs (OR = 7.18; 95%CI = 3.96–13.01; p < 0.001) and Covid-19 wards (OR = 5.85; 95%CI = 3.56–9.6; p < 0.001) showed higher ethical conflict. Resilience was a protective factor for ethical conflict. Conclusions: Ethical conflict was significantly linked to psychological distress, while a higher level of resilience was found to be a protective factor. These results can be informative for nursing management in future similar crises.

Psychological crisis and emergency intervention for frontline critical care workers during the COVID-19 pandemic

AIM

To explore the main feelings and coping strategies among frontline critical care workers during the first phase of the COVID-19 pandemic and to evaluate the level of satisfaction after a psychological crisis and emergency intervention.

BACKGROUND

The health crisis brought about by the COVID-19 pandemic has exposed critical care workers to an intense physical and emotional burden. Scientific research recommends psychological crisis and emergency interventions during the acute phase to help cope with the situation and prevent emotional side effects.

DESIGN

A multicentre descriptive study with mixed qualitative and quantitative data was developed.

METHODS

Healthcare and non-healthcare critical care workers from 16 hospitals were included. Psychological crisis assistance was given (for individuals and groups), both face-to-face and online, with 18 psychologists for two months. Content analysis from the psychologists' session reports after each intervention was performed (COREQ). Satisfaction with the intervention was assessed with an 'ad hoc' 21-item online survey.

RESULTS

A total of 553 interventions were carried out (361 individually and 192 in groups). Four themes were identified: 1-Imbalance between occupational demands and resources; 2-Acute stress responses; 3-Personal and professional consequences; and 4-Protection factors. The main protection factor identified was group cohesion and perceived social support. The mean general satisfaction with the intervention was high and 96.2% (n=252) of the participants would recommend it in future.

CONCLUSIONS

A psychological crisis and emergency intervention helped critical care workers during the COVID-19 pandemic to verbalise and integrate the situation, providing strategies to cope with the experience with a high level of satisfaction from the participants assisted.

RELEVANCE TO CLINICAL PRACTICE

During the COVID-19 pandemic, support groups guided by psychologists fostered reflection on aspects related to work, interaction with patients and relatives and social support from workmates that help them for coping with stress, share emotions and experiences and feel understood.

Lethal ageism in the shadow of pandemic response tactics

Aim

This paper examines aspects of pandemic policy responses to the COVID‐19 and SARS‐CoV‐2 variants and presents an integrated view of the consequences of response tactics at national and health service levels for older adults.

Background

Nurses are positioned at the intersection of health service and policy implementation; therefore, their influence on clinical protocols and health policy directions post pandemic is crucial to preventing further premature deaths in the 65+ years age group and others.

Sources of evidence

Perspectives presented here are based on a critical evaluation of the many published reports, comments, research and insights concerning the pandemic. That evidence, combined with my experience in various fields of study and professional service, enables me to envisage what some decisions and policies may mean for older people, nurses and societies worldwide.

Discussion

Established information on world population patterns and the location and health of national groups has been made less reliable by population shifts caused by years of geo‐political conflicts and now the impact of the pandemic. Added to this already chaotic context, the pandemic has further disrupted societies, health services and economies. Ageist responses by these systems have further disadvantaged older people and generated trust deficits that need to be resolved.

Conclusion

When the pandemic recedes, policy and management decisions taken by governments and hospital administrators will be a telling indicator of whether the established systematic ageism exposed during the pandemic will continue to compromise the health and longevity of older adults.

Implications for nursing, health and social policy

The ascendency of nursing influence within the health and social policy environment must be further strengthened to enable nurses to champion equity and fairness in the pandemic recovery effort.

Ethical challenges of nurses related COVID-19 pandemic in inpatient wards: An integrative review

Introduction

The COVID-19 pandemic is a social problem. Nurses face ethical challenges in providing care activities related to COVID-19.

Aim

Therefore, this study aimed to explore the ethical challenges of nurses in COVID-19 pandemic.

Method

This is an integrative review study conducted from 2007 to 2020. Databases of PubMed, Google Scholar, Scopus, Web of Science were searched. The results of the eligible studies (12 cases) were analyzed.

Results

A total of 228 articles satisfied the inclusion criteria, and 12 articles were selected for analysis. The study units showed that the ethical challenges of nurses in caring for patients with COVID-19 consisted of three areas, including nursing; patient and family; and treatment equipment and facilities.

Conclusion

Providing care for patients with COVID-19 pandemic has increased nurses' ethical challenges. Therefore, nurses need to pay more attention to not face psychological problems and premature burnout.