Lethal ageism in the shadow of pandemic response tactics

Moral failure, moral prudence, and character challenges in residential care during the Covid-19 pandemic

In many high-income countries, an initial response to the severe impact of Covid-19 on residential care was to shield residents from outside contacts. As the pandemic progressed, these measures have been increasingly questioned, given their detrimental impact on residents' health and well-being and their dubious effectiveness. Many authorities have been hesitant in adapting visiting policies, often leaving nursing homes to act on their own safety and liability considerations. Against this backdrop, this article discusses the appropriateness of viewing the continuation of the practice of shielding as a moral failure. This is affirmed and specified in four dimensions: preventability of foreseeable harm, moral agency, moral character, and moral practice (in MacIntyre's sense). Moral character is discussed in the context of prudent versus proportionate choices. As to moral practice, it will be shown that the continued practice of shielding no longer met the requirements of an (inherently moral) practice, as external goods such as security thinking and structural deficiencies prevented the pursuit of internal goods focusing on residents' interests and welfare, which in many places has led to a loss of trust in these facilities. This specification of moral failure also allows a novel perspective on moral distress, which can be understood as the expression of the psychological impact of moral failure on moral agents. Conclusions are formulated about how pandemic events can be understood as character challenges for healthcare professionals within residential care, aimed at preserving the internal goods of residential care even under difficult circumstances, which is understood as a manifestation of moral resilience. Finally, the importance of moral and civic education of healthcare students is emphasized to facilitate students' early identification as trusted members of a profession and a caring society, in order to reduce experiences of moral failure or improve the way to deal with it effectively.

Intensive care unit nurses' knowledge and attitudes towards older adults with COVID-19: A cross-sectional survey

BACKGROUND

Older adults constitute the majority of patients admitted to COVID-19 intensive care units (ICUs). The knowledge and attitudes of ICU nurses towards older adults diagnosed with COVID-19 significantly impact the quality of treatment and nursing care they deliver.

OBJECTIVE

The objective of this study was to determine the ICU nurses' knowledge and attitudes towards older adults with COVID-19.

METHOD

This descriptive and cross-sectional study was conducted between February and October 2021. The sample consisted of 112 ICU nurses from a public hospital and three university hospitals. Demographic data were collected together with the Nurse COVID-19 Knowledge Level Assessment Form (NKLAF) and the Kogan's Attitudes Toward Old People Scale (KAOPS). The data were analysed using the independent-groups t-test, one-way analysis of variance, Mann-Whitney U Test (Z score), Kruskale-Wallis Variance Test, post hoc test, and Spearman's correlation analysis.

RESULTS

Intensive care nurses had a mean NKLAF score of 21.29 ± 2.63 (mean difference: 21.24). They had a mean KAOPS score of 129.37 ± 15.20 (mean difference: 129.32). There was no correlation between NKLAF and KAOPS scores (r = 0.163, p > 0.05). Female nurses had a significantly higher mean NKLAF score than their male counterparts (Z: -2.733, p = 0.006). The intensive care nurses with bachelor's degrees had a significantly higher mean KAOPS score than those with associate degrees (KW: 6.888, p = 0.032).

CONCLUSION

The results indicate that ICU nurses know enough about COVID-19 and have positive attitudes towards older adults diagnosed with it. Moreover, some descriptive characteristics affect the knowledge and attitudes of ICU nurses towards older adults. Therefore, nurses should consider these factors when planning interventions to enhance their care for older adults.

Are we there yet? A guide to achieving endemic status for COVID-19 and variants

AIM

To clarify factors that support a policy change from pandemic to endemic status and to examine options for non-medical responses to reduce COVID-19 transmission.

BACKGROUND

Critical factors to be considered in pandemic response decisions are not limited to medical options or public health orders, although these are important.

SOURCES OF EVIDENCE

All evidence drawn from publicly available sources is presented through the lens of the authors' nursing, management, education, policy and research experience.

DISCUSSION

As COVID-19 variants cause infections to surge nurses and other health practitioners, who are the de facto implementers of public and health policy, need to consider the evidence supporting a pandemic policy change to endemic status. Non-medical options for reducing transmission and variant mutations are needed to enable at-risk populations to avoid infection.

CONCLUSION

Public policy that shifts infection risks onto the general population requires close scrutiny of the evidence base for such decisions and warrants open debate and review. If people are to manage risks arising from policy decisions, they need access to non-medical virus detection options as well as access to effective medicines and treatment.

IMPLICATIONS FOR NURSING PRACTICE

Nurses have an extension to their advocacy role when policy changes about infectious disease status are declared. Evaluation of policy in terms of validity, equity and scientific basis is part of nursing's public responsibility. Policies that fail to reflect what is happening at the patient care level need to be questioned and modified where necessary. Only policies deemed 'good' policy by nurses should be implemented without challenge. Access to devices for environmental detection of the virus would enable real-time estimation of infection risks and inform individual decisions about the real risk of participating in work or other activities.

IMPLICATIONS FOR HEALTH AND SOCIAL POLICY

Policy decisions to transition from pandemic to endemic status must be evidence based. Clear messaging about risks and options assists policy implementation. Terminologies describing stages of infectious disease spread from 'outbreak, epidemic, endemic and pandemic' are not interchangeable, although they will expand and contract across the range in response to interventions such as public health safety measures (PHSM), quarantine, vaccinations, antivirals and fatalities that alter the case count in defined locations for those who avoid or survive an infection.