Nurses' Ethics in the Care of Patients During the COVID-19 Pandemic

Linking COVID-19 stress and Chinese nurses' life well-being: The influence of work-family conflict and work centrality

The COVID-19 pandemic has placed enormous stress on health workers, exposing them to high levels of work-family conflict (WFC), which in turn affects their life well-being（LWB). To date, whether WFC is involved in the association between COVID-19 stress and the well-being of life has not been investigated. The purpose of this paper was to explore the connection between COVID-19 stress and LWB in Chinese nurses and to analyse the mediating role of WFC and the moderating effect of work centrality. The link between COVID-19 stress and LWB was examined by performing multiple regression analysis, common method bias analysis, and confirmatory factor analysis on data for 227 nurses.COVID-19 stress exerted a remarkable direct impact on nurses' LWB, and WFC mediated the link between COVID-19 stress and nurses' LWB. Work centrality moderated the link between COVID-19 stress and nurses' WFC. COVID-19 stress decreases nurses' LWB and increases their WFC, which also decreases their LWB. For nurses with higher work centrality, the connection of COVID-19 stress to work-family conflict was stronger. Hospital managers should focus on nurses' work-family balance and pay particular attention to the work-family balance of work-centered nurses to avoid compromising their LWB.

Perceived risk of infection, ethical challenges and motivational factors among frontline nurses in Covid-19 pandemic: prerequisites and lessons for future pandemic

BACKGROUND

Infection risk was significant for front-line nurses during the Covid-19 outbreak. The pandemic presented several ethical difficulties and sapped nurses' drive to labor harder for longer periods. This study evaluates registered nurses' perceptions of Covid-19 infection risk, ethical dilemmas, and motivating factors.

MATERIALS AND METHODS

During March and April 2022, 400 registered nurses from a newly established tertiary care hospital participated in this cross-sectional exploratory survey. The risk assessment scale, motivation to work scale, and ethical dilemma scale were used to assess the perceived risk of infection, motivational factors and ethical challenges experienced by the nurses. Appropriate descriptive and inferential statistics were applied to compute the results.

RESULTS

76.4% of nurses feared working as a nurse put them at higher risk of infection. Besides the fear of contracting infection, nurses believed they were the source of infection to family members (70.8%) and people around (67.5%). 63.3% of nurses agree that they do not have the right to refuse treatment and every patient has the right to receive optimal care, regardless of age, gender, and medical conditions. Professional obligation to treat patients (72.3%) and sound professional knowledge and experience (83.5%) are important motivating factors to work during the pandemic. Multilinear regression analysis revealed that professional education (95% CI, 3.845 - 0.694, p = 0.005), Covid-19 positive status (95% CI,0.455-2.756, p = 0.006), and post-Covid-19 hospitalization (95% CI, 1.395-6.978, p = 0.003) and duration of hospitalization (95% CI, 0.754-0.058, p = 0.022) are independent predictors of higher perceived risk of infection among nurses.

CONCLUSIONS

During the pandemic, nurses were afraid to work and faced personal and family risks of contracting the virus. Despite these challenges, they still feel a strong sense of commitment and dedication to providing the best possible care. Nurse administrators need to create a supportive environment that follows ethical principles and meets the needs of nurses to boost their motivation and encourage them to continue working for longer periods.

Psychometric testing of the Indonesian version of the Nurses' Ethical Behavior in Protecting Patients' Rights (I-NEBPPR) scale

Background

Nurses routinely encounter ethical dilemmas with patients and healthcare professionals. Therefore, it is crucial for them to be conscious of ethical principles and apply them in their decision-making processes. However, no specific questionnaire is available to assess nurses' ethical conduct in Indonesia.

Objective

This study aimed to assess the psychometric properties of the Indonesian version of the Nurses' Ethical Behavior in Protecting Patients' Rights (I-NEBPPR) scale.

Methods

Following the World Health Organization's guidelines and utilizing the WHODAS 2.0 translation package, the NEBPPR was translated into Bahasa Indonesia and underwent a rigorous translation and adaptation process. Data were collected between October and November 2022 and included 283 Indonesian nurses as participants. Confirmatory factor analysis (CFA) was used to evaluate construct validity. Convergent validity, discriminant validity, and reliability were also performed for comprehensive evaluation. IBM SPSS statistics version 27.0 and AMOS 24.0 were used for statistical analysis.

Results

Five items were excluded from the original versions, forming five subscales that include a combined total of 23 items. The subscales are as follows: Factor 1 (Respect for right to information and decision), Factor 2 (Providing fair care), Factor 3 (Providing benefit-not harming), Factor 4 (Respect for patient values and choices), and Factor 5 (Attention to privacy). The I-NEBPPR model demonstrated robust construct validity with factor loadings ranging from 0.453 to 0.871. CFA showed satisfactory model fit indices (χ2/df = 1.554 (p <0.001), GFI = 0.906, CFI = 0.929, IFI = 0.930, RMSEA = 0.044). Reliability metrics were solid, with a Cronbach's alpha of 0.819 and composite reliability exceeding 0.6. Both convergent validity, as indicated by AVE, and discriminant validity, as confirmed by the Fornell-Larcker criterion, met established thresholds.

Conclusion

It is affirmed that the 23-item I-NEBPPR demonstrated strong psychometric properties, making it a valuable, practical, and time-efficient tool for nurse supervisors, nurse managers, and nurse leaders to assess nurses' clinically-based ethical behavior in their efforts to protect patient's rights.

Ethical issues experienced by nurses during COVID-19 pandemic: Systematic review

BACKGROUND

Frontline nurses who care for patients with COVID-19 work in stressful environments, and many inevitably struggle with unanticipated ethical issues. Little is known about the unique, ethically sensitive issues that nurses faced when caring for patients with COVID-19.

AIM

To better understand how frontline nurses who care for patients with COVID-19 experience ethical issues towards others and themselves.

METHODS

Systematic review of qualitative evidence carried out according to the Preferred Reporting Items for Systematic reviews and Meta-analyses on ethical literature (PRISMA-Ethics). The electronic databases PubMed, Embase, Cinahl, Web of Science, Philosopher's Index, and Scopus were queried to identify candidate articles. Articles appearing from March 1, 2020 to December 31, 2022 were considered if they met the following inclusion criteria: (1) Published qualitative and mixed method studies and (2) ethical issues experienced by nurses caring for patients with COVID-19. We appraised the quality of included studies, and data analysis was guided by QUAGOL principles.

FINDINGS

Twenty-six studies meeting our inclusion criteria for how nurses experience ethical issues were characterised by two key themes: (1) the moral character of nurses as a willingness to respond to the vulnerability of human beings and (2) ethical issues nurses acted as barriers sometimes, impeding them from responding to requests of vulnerable human beings for dignified care.

CONCLUSION

Our review provides a deeper understanding of nurses' experiences of ethically sensitive issues, while also highlighting the critical need for adjustments to be made at organisational and societal levels. Ethical issues that emerged in situations where organisational and situational constraints impeded nurses' ethical responses to patients' appeals suggests that early practical support should be made available to resolve ethical issues recognised by nurses. Such support contributes to protecting and promoting not only the dignity of patients with COVID-19 but also of fellow humans in need during crisis.

Addressing the second victim phenomenon in Israeli health care institutions

BACKGROUND

The 'second victim' phenomenon (SVP) refers to practitioners who experience a negative physical or emotional response, as well as a professional decline, after participating or witnessing an adverse event. Despite the Israeli Ministry of Health's implementation of specific protocols regarding the overall management of adverse events in health organizations over the past decade, there is limited knowledge regarding healthcare managers' perceptions of the 'second victim' occurrence.

METHODS

A phenomenological qualitative approach was used to identify an accurate view of policy. Fifteen senior risk manager/and policy makers were interviewed about their knowledge and perceptions of the 'second victim'. Topics addressed included reporting mechanisms of an adverse event, the degree of organizational awareness of 'second victim', and identifying components of possible intervention programs and challenges to implementing those programs.

RESULTS

Examining current procedures reveals that there is limited knowledge about uniform guidance for health care organizations on how to identify, treat, or prevent SVP among providers. The employee support programs that were offered were sporadic in nature and depended on the initiative of a direct manager or the risk manager.

CONCLUSIONS

Currently, there is little information or organizational discussion about the possible negative effects of AE on healthcare practitioners. To provide overall medical care that is safe and effective for patients, the health system must also provide a suitable response to the needs of the medical provider. This could be achieved by establishing a national policy for all healthcare organizations to follow, raising awareness of the possible occurrence of SVP, and creating a standard for the subsequent identification, treatment and future prevention for providers who may be suffering.

Structural Equation Modelling of Professional Values and Competency of Nurses During the COVID-19 Pandemic

Background

The COVID-19 pandemic is a global health crisis that affected nurses’ professional values and competence.

Aim

Our study examined the relationship between nurses’ professional values and competence in Saudi Arabia during the COVID-19 pandemic.

Methods

This study used a descriptive cross-sectional design with 748 nurses from Saudi Arabia. Two self-report instruments were used to collect data. Structural equation modelling was conducted to analyse the data.

Findings

The emerging model showed acceptable model fit indices. Two dimensions of nurse professional values significantly affected professional competence: professionalism and activism. Professionalism significantly affected the other four facets (e.g., caring, activism, trust, and justice) of nurse professional values. The dimension of caring had a strong, direct effect on activism. Justice had a moderate, direct impact on trust, while activism had a weak, direct impact on trust. Professionalism and caring had strong, indirect effects on professional competence by mediating the dimension of activism.

Discussion

The study’s findings highlight the need for strategies to evaluate and strengthen the various areas of professional values to foster professional competence among nurses. Moreover, nurse administrators should encourage nurses to participate in continuing nursing education programs or provide in-service educational training to promote professional values and competence.

Conclusion

This study provides a structural model of the interaction between nurses’ professional values and competence during the pandemic. Nurse administrators can leverage the presented model to develop policies and strategies to evaluate and strengthen nurses’ professional values and competence.

Experience of clinical nurses engaged in caring for patients with COVID-19: A qualitative systematic review and meta-synthesis

AIMS AND OBJECTIVE

This qualitative review summarises and synthesises the available evidence on subjective experiences of clinical nurses who cared for patients with COVID-19.

BACKGROUND

Nurses are first responders and play a vital role in emerging infectious disease epidemics such as the COVID-19 pandemic. In this context, they also face many difficulties and challenges related, for example to the imbalance between extensive demands and low control over work tasks.

DESIGN AND METHOD

A systematic review of qualitative studies and meta-synthesis focused on the experiences of clinical nurses caring for patients with COVID-19 during the pandemic was carried out.

RESULTS

A total of 279 findings were extracted, aggregated into 21 categories and combined into seven synthesised findings, namely (1) professional nursing practice during the pandemic, (2) support systems, (3) somatic sensations and psychological experiences, (4) difficulties and challenges, (5) coping strategies and behaviour, (6) impact on life, profession and values, and (7) needs and expectations for the future.

CONCLUSION

Nurses encountered considerable difficulties and challenges in caring for patients with COVID-19. Nurses caring for patients with COVID-19 need more support from organisations, families and society. It is essential to explore positive coping strategies suitable for working in different cultural backgrounds. Policymakers and decision-makers should pay attention to the experiences and voices of nurses.

RELEVANCE TO CLINICAL PRACTICE

It is critical for nurse managers to consider how to enhance the support system and help nurses develop adaptive coping strategies in response to COVID-19. Nurses' experiences and voices are valuable in improving health emergency response systems.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

Nurses' Experiences of Caring for Patients with COVID-19: A Qualitative Study

The purpose of this study was to explore nurses' experiences, abilities, and willingness to care for patients with Coronavirus Disease 2019 (COVID-19). A descriptive qualitative study was conducted among 12 nurses working with patients with COVID-19. Purposive sampling was used to recruit participants from two national hospitals in Jordan. Semi-structured interviews (45-90 minutes each) with open-ended questions were held via Zoom to collect data. Four major themes emerged from the data analysis. The first theme, uncertainty, consisted of two subthemes: new experience and lack of training. The second theme was related to social stigma by society and other staff members. The third theme of front-line fighters consisted of two subthemes: empowering the main health caregiver and community acknowledgment. The fourth theme was related to challenges and consisted of two subthemes: physical and psychological challenges. At the beginning of the outbreak of COVID-19, the nurses had experienced a lack of certainty, physical and psychological challenges, and social stigmatization, which had negatively affected their willingness and ability to fight the outbreak. However, the nurses reported growing professionally and psychologically with time and becoming more knowledgeable, skillful, powerful, and confident care providers during the pandemic. Being able to fulfill their responsibilities and being acknowledged by others gave the nurses a sense of achievement. Early education and training about COVID-19, clear infection control protocols and guidelines, psychological counseling, and adequate social support are essential steps for enhancing nurses' mental well-being and willingness and ability to fight COVID-19.

Nurses' professional values and competency in Saudi Arabia: A structural equation modelling approach

AIMS AND OBJECTIVES

To explore the relationship between Saudi nurses' professional values and competence.

BACKGROUND

Professionals are bound by ethical standards specific to their profession. Accordingly, the COVID-19 pandemic is the most significant event that has impacted nurses' professional values and competency.

DESIGN

A descriptive cross-sectional design adhering to STROBE guidelines.

METHODS

Clinical nurses from four tertiary government hospitals (n = 659) participated and completed two self-report instruments. Study variables were analysed using the structural equation modelling approach.

RESULTS

The emerging model displayed acceptable model fit indices. Professionalism and activism were two dimensions of nurse professional values that significantly impacted professional competency. Professionalism significantly impacted the four other aspects of nurse professional values: caring, activism, trust, and justice. Caring had a significant and direct impact on activism. Activism had a weak, direct effect on trust, whereas justice had a moderate, direct effect on trust. Through the mediation of the dimension of activism, both the dimensions of professionalism and caring had a strong, indirect impact on professional competency.

CONCLUSIONS

This research presents a structural model of the interrelationship between nurse professional values and competency. Nurse administrators can use the proposed model to develop approaches and policies for assessing, improving and evaluating professional values among nurses.

RELEVANCE FOR CLINICAL PRACTICE

Nursing professionals are committed to upholding their ethical and moral standards while performing their caregiver roles. Nurse administrators can implement activities and strategies to develop nurses' professional competence further, as professional values represent the ideal values expected of nurses providing patient care.

Relationship between Risk Perception of COVID-19 and Job Withdrawal among Chinese Nurses: The Effect of Work-Family Conflict and Job Autonomy

Aim

The aim of this study was to examine the mediating role of work–family conflict and the moderating role of job autonomy on the association between risk perception of COVID‐19 and job withdrawal among Chinese nurses during the initial disease outbreak.

Background

Nurses' job withdrawal can not only reduce the quality and efficiency of care but also give rise to turnover during the COVID‐19 pandemic. Thus, it is essential to clarify how and when the risk perception of COVID‐19 influences the job withdrawal behaviours of nurses and to provide guidelines for reducing nurses' job withdrawal.

Methods

A two‐wave study was conducted among 287 Chinese nurses from 11 COVID‐19‐designated hospitals during the initial outbreak of the disease from March through April 2020. Data on the risk perception of COVID‐19, job autonomy and work–family conflict were collected at time 1, and 1 month later, job withdrawal data were collected at time 2. Model 4 and Model 14 from SPSS macro PROCESS were used to test the mediating effect of work–family conflict and the moderating effect of job autonomy, respectively.

Results

Work–family conflict mediated 60.54% of the relationship between risk perception of COVID‐19 and job withdrawal. Job autonomy positively moderated the relation between work–family conflict and job withdrawal (β = 0.12, P < 0.01).

Conclusion

Risk perception of COVID‐19 influenced nurses' job withdrawal through work–family conflict. Job autonomy exaggerated the association between work–family conflict and job withdrawal.

Implications for Nursing Management

Managers should provide more supportive resources to help nurses cope with the risk of COVID‐19 to decrease work–family conflict and job withdrawal, and they should strengthen supervision over the work processes of nurses.

Using the Theory of Planned Behaviour to explain junior nurses’ and final‐year student nurses’ intention to care for COVID‐19 patients in China: a multisite cross‐sectional study

Aim

To explore junior nurses' and final‐year student nurses' intention to care for COVID‐19 patients amidst the Delta COVID‐19 variant outbreak in China using the theory of planned behaviour (TPB) as a framework.

Background

The COVID‐19 pandemic has intensified global nursing shortage. Junior nurses and final‐year student nurses represent the backbone of the future frontline nursing workforce. The TPB is a valid theoretical model for predicting nurses' caring behaviours.

Methods

A 47‐item self‐administered questionnaire was disseminated online to a convenience sample of 547 junior nurses and final‐year student nurses located in 13 regions across mainland China.

Results

Approximately 63.4% of the participants intended to care for COVID‐19 patients voluntarily and 65.6% by non‐voluntary assignment. The TPB model significantly predicted 45% of the variance in behavioural intention, subjective norms being the strongest predictor. Gender, vaccination status and ethical perceptions regarding frontline work significantly correlated with the intention to provide care.

Conclusions

Our findings highlight the importance of social, organisational and family support underpinning future junior nurses' professional commitment in times of public health crisis.

Implications for nursing management

Pandemic‐tailored workplace training programmes for nurses/student nurses that emphasize on self‐care and ethical issue discussions are warranted. Hospital managers should collaborate with community partners to offer additional family support for nurses in need.

Ethical dilemmas experienced by nurses while caring for patients during the Covid-19 pandemic: An integrative review of qualitative studies

Aim

This study aimed to identify ethical dilemmas faced by nurses while caring for patients during the COVID‐19 pandemic.

Background

Nurses express several concerns during disease outbreaks, some of which are related to ethical dilemmas.

Evaluation

It is an integrative review in which four databases were searched. Critical appraisal tools and PRISMA guidelines were used. Content analysis was performed to analyse the obtained data.

Key issues

A total of 14 studies were identified. The results are presented into four categories: concerns with beneficence–nonmaleficence; awareness of need for autonomy; challenges to justice; and coping with ethical dilemmas.

Conclusion

While caring for patients during the COVID‐19 pandemic, nurses often put their own health and that of their families at risk. The ethical dilemmas faced by nurses are mainly caused by the lack of Protective Personal Equipment (PPE), shortages of medical supplies and personnel and the uncertainties that permeate an environment threatened by a new and highly contagious disease such as COVID‐19.

Implications for nursing management

This review provides information that can inspire nurse managers working during the COVID‐19 pandemic to support and empower nurses to act in accordance with ethical principles, which is important in order for nurses to protect themselves while providing efficient and effective care.