Children's care: family centred but child focused.

Family-centred care is a widely used but loosely defined model of care often used in children's nursing. Although this allows for flexibility in its application, it also means that nurses can have very different ideas about its meaning. Recent decisions about the implementation of the COVID-19 vaccination programme for children under the age of 16 years in the UK and other countries have further confused this, as it has brought into question the relative position of children and their families in the decision-making process. Over time, the legislative and social positions of children have changed. Children are increasingly seen as being separate but related to their family, with an emphasis on their own human, legal, and ethical rights, including allowing children to choose the type of support they require for their care to reduce any undue stress. This article puts these into a current and contextual framework to better help nurses understand the historical as well as the contemporary reasons for the status of family-centred care today.

Nurses and COVID-19: Ethical Considerations in Pandemic Care

This book addresses the many ethical issues and extraordinary risks that nurses and others are facing during the COVID-19 pandemic, which creates physical, emotional, and economic burdens, affecting nurses' overall health and well-being. Nurses are essential front-line clinicians across all health care settings and in every nation. The COVID-19 pandemic caused by the novel SARs-CoV-2 virus has affected children, adults, and communities within and across all societies. Nurses, too, have contracted the virus and died from the disease. They have also seen their colleagues, family members, and friends hospitalized or in intensive care units struggling to survive. Nursing's professionalism and disciplinary resolve to care for patients and families amidst confusion, misinformation, and shifting guidelines has been called "heroic" by the public. How much risk should nurses be expected to accept during a pandemic? How do nurses help patients and families find comfort and dignity at the end-of-life? How do we help nurses who are suffering from moral distress and mental health concerns from what they have seen, been asked to do, or are unable to provide? And, how does society move forward from a pandemic that has challenged our basic ethical principles of justice and what is "fair, good and right" in caring for those who need care, including the most vulnerable and nurses themselves? This book addresses these and other ethical concerns that nurses are facing in their day-to-day clinical practice;experiences shared with patients, families, and colleagues. Although this book was written while the pandemic was still raging across the United States and globally, the events needed to be told as they were unfolding. This book helps us to learn from both the successes and failures that are affecting so many across the globe, including those on whom the public relies on to provide quality, compassionate, and expert care when they are sick: nurses. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

[Nursing ethics and the mandate of care-current limits using the example of inpatient care for the elderly]. / Pflegeethik und der Auftrag der Pflege ­ Gegenwärtige Grenzen am Beispiel der stationären Altenpflege.

The central guiding ethical principles of professional care are dignity, care, justice, and respect. The current framework conditions and circumstances in the care of the elderly mean that professional care ethics are no longer feasible in many cases. This leads not only to enormous (moral) burdens among the nursing staff, but also to a comprehensive degree to professional dissatisfaction and to leaving the profession. The term "Pflexit" (based on the German word "Pflege" = care) was first raised during the corona pandemic and has not faded. In order to ensure ethically justified and dignified care for the elderly that is also oriented towards human rights, as is conveyed politically in charters and rightly expected by people in need of care, rapid and comprehensive social and political intervention is required.In this context, dignity and respect are also a social mandate. Dignified professional care based on ethical values can only be implemented if nurses are shown this same respect. The clear warnings of a "nursing climate crisis" must finally be followed by action to stop the exodus from the profession. In this discussion paper, the importance of a professional care ethic is first explained. In a second step, the framework and current problems that oppose a comprehensive implementation of core values in nursing care for the elderly are highlighted. The focus here is on the effects of the precarious personnel situation.

COVID-19 as moral breakdown: Entangled ethical demands experienced by hospital-based nurses in the early onset of the pandemic.

2020 saw the rapid onset of a global pandemic caused by the SARS-CoV-2 virus. For healthcare systems worldwide, the pandemic called upon quick organization ensuring treatment and containment measures for the new virus disease. Nurses were seen as constituting a vital instrumental professional component in this study. Due to the pandemic's unpredictable and potentially dangerous nature, nurses have faced unprecedented risks and challenges. Based on interviews and free text comment from a survey, this study explores how ethical challenges related to "being a nurse" during the COVID-19 pandemic was experienced and understood by Danish hospital-based nurses. Departing from anthropologist Jarett Zigon's notion of moral breakdown, the study demonstrates how the rapid onset of the pandemic constitutes a moral breakdown raising ethical demands for nurses. Analytically we identify three different ethical demands experienced by the nurses. These ethical demands are Nursing and societal ethical demands, Nursing and personal ethical demands, and Nursing and conflicting ethical demands. These demands represent not only very different understandings of ethical demands but also different understandings of ethical acts that are seen as necessary to respond to these demands.

Legal Regulations and the Anticipation of Moral Distress of Prospective Nurses: A Comparison of Selected Undergraduate Nursing Education Programmes.

Moral distress is commonly experienced by nurses in all settings. This bears the risk of a reduced quality of care, burnout and withdrawal from the profession. One approach to the prevention and management of moral distress is ethical competence development in undergraduate nursing education. Profession-specific legal regulations function as a foundation for the decision on the educational content within these programmes. This theoretical article presents the extent to which legal regulations may open framework conditions that allow for the comprehensive preparation of prospective nurses to manage moral distress. The legal frameworks and the immediate responsibilities regarding their realisation in the context of undergraduate nursing education vary slightly for the three chosen examples of Switzerland, Austria and Germany. While an increased awareness of ethics' education is represented within the nursing laws, no definite presumption can be made regarding whether undergraduate nursing students will be taught the ethical competencies required to manage moral distress. It remains up to the curriculum design, the schools of nursing and instructors to create an environment that allows for the realisation of corresponding learning content. For the future, the establishment of professional nursing associations may help to emphasise acutely relevant topics, including moral distress, in undergraduate nursing education.

Nurses' duty to care during the COVID-19 pandemic: a cross-sectional survey.

BACKGROUND: Despite the increased demand for nurses worldwide, discussion of nurses' duty to care is lacking. This study aimed to examine nurses' duty to care during the coronavirus disease 2019 (COVID-19) pandemic and to identify the influencing factors. METHODS: This was a cross-sectional descriptive research study that used a structured online questionnaire. Registered Korean nurses answered a demographic questionnaire and the Nash Duty to Care Scale. RESULTS: Age and employment at tertiary hospitals increased nurses' duty to care. Male sex, a highly educated status, and employment at tertiary hospitals increased the perceived risk. Male sex and employment at tertiary or general hospitals increased confidence in the employer, while a high level of education and a longer total clinical career decreased the same. Age and a higher monthly wage increased perceived obligation. Age, lack of religious beliefs, and clinical experience of 3-7 years increased professional preparedness. CONCLUSION: Without enough nursing manpower, the disaster response system could prove to be inefficient. Considering that adequate nurse staffing is essential in disaster management, it is crucial to ensure that nurses have a will to provide care in the case of disaster. In the future, a more active discussion on nurses' duty to care and additional research on factors that may hinder and facilitate the same are needed.

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

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.

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.

Nursing ethics for prevention and control of major infectious disease outbreaks: Chinese expert consensus.

OBJECTIVES: Major infectious disease has become a serious threat to people's health worldwide. As the world's largest healthcare workforce and the core forces fighting against the epidemic, nurses are on the frontline of this battle. A number of ethical issues have given rise to numerous concerns that have largely affected nurses in different ways as they respond to the epidemic. In addition, excessive expectations from people can exert undue pressure, which can easily lead to burnout in nurses. METHODS: In this consensus, the expert panel method was used to develop and reach a consensus. The members involved in the formation of the consensus included an expert discussion panel and a consensus writing expert group, a methodologist, and four secretaries. After 16 rounds of online expert consultation and two rounds of expert panel meetings, the writing team analyzed and reviewed the 78 amendments suggested by the experts to develop a consensus on nursing ethics for prevention and control of major infectious disease outbreaks based on the ethical vision of life care. RESULTS: This expert consensus focuses on five essential domains: the responsibilities and rights of nurses, the nurse-patient relationship, the doctor-nurse relationship, and the relationship between society and nurses throughout the epidemic. CONCLUSIONS: We hope this consensus can help nurses better understand and respond to the ethical issues and challenges in public health emergencies, and raise reasonable public expectations of the roles and responsibilities of nurses in these situations.

Registered Nurses' Perceptions After a Patient with Ebola Virus Disease Is Admitted to Their Hospital.

Emerging diseases affect the nursing workforce, but little is known about the willingness of registered nurses (RNs) to work during outbreaks (eg, Ebola virus disease, COVID-19). The objective of our study was to examine the perceptions and attitudes of RNs in the United States regarding their duty to care and willingness to work after a patient infected with the Ebola virus was admitted to their hospital. We performed a quantitative, descriptive study using social media to recruit critical care RNs to complete an online survey. A total of 72 RNs completed the survey. While only 20 respondents reported providing direct care, more than half (n = 38) reported that family members asked them not to work with patients infected with the Ebola virus. A majority of respondents (n = 63) agreed that healthcare workers have a duty to help sick people despite high risks to themselves or their families; however, 59 agreed that family responsibilities would take priority. Respondents were less likely to work if their partners (n = 11) or children (n = 7) were ill but more likely to work if colleagues were infected (n = 48) or dying (n = 40). Shunning was experienced by 32 respondents, and 25 knew of others who were shunned. We observed several factors that affect RNs' willingness to provide care when patients are admitted, including moral conflict between their duty to treat sick people and their duty to protect their family. As part of infectious disease emergency planning, health policy managers should consider these complex factors, which may modulate effective patient care. While this study was limited to RNs in the United States during an Ebola virus disease outbreak, the results signal a need for similar research on other emerging infections such as COVID-19.

Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses' Relational Practice During the Coronavirus Pandemic.

Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses' moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.

Ethical Implications for Mentoring and the Discipline of Nursing.

The discipline of nursing is at a crossroads following the pandemic as scores of both budding and seasoned scholars and practitioners have left the discipline of nursing. Lower numbers of experienced nurses are entering into doctoral programs of nursing, especially PhD programs. A mentoring model is needed to guide and retain budding scholars of the discipline. The author of this article presents the humanbecoming mentorship model. It will be used to illustrate ethical straight-thinking implications for the future of the discipline of nursing.

Ethical challenges during the COVID-19 pandemic: Perspectives of nursing students.

BACKGROUND: The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students. OBJECTIVES: To explore the ethical dilemmas and ethical conflicts experienced by final-year nursing students who worked during the first outbreak of the COVID-19 pandemic in Spain. RESEARCH DESIGN: A qualitative exploratory study was conducted using purposive sampling. Semi-structured interviews were carried out using a question guide. Interviews took place via a private video chat room platform. A thematic, inductive analysis was performed of the information gathered. PARTICIPANTS AND RESEARCH CONTEXT: Eighteen nursing students were recruited from two universities of Madrid, aged between 18 and 65 years old, enrolled in the fourth year of nursing studies and who were hired under a relief contract for health professionals during the pandemic. ETHICAL CONSIDERATIONS: The present study was carried out in accordance with the Declaration of Helsinki, and the study was approved by the Local Ethics Committee of Universidad Rey Juan Carlos. RESULTS: Three specific themes emerged: (a) coping with patient triage, (b) difficulties in providing end-of-life care, and (c) coping with patient death. Nursing students participated in the process of patient selection for resource allocation and ICU bed occupancy. They were shown how to care for patients who were not admitted to the ICU, in their last moments and were faced with the difficulties of applying end-of-life care. Finally, the nursing students were confronted with the death of their patients, in overwhelming numbers and under adverse conditions. CONCLUSIONS: These findings can help shed light on the ethical dilemmas and ethical conflicts faced by novice nursing students, incorporated into the workforce during the COVID-19 pandemic. Moreover, it was described that students may normalize the death due to the exhaustion and overwhelmed routine.

Ethical Challenges of Nurses in COVID-19 Pandemic: Integrative Review.

Currently, nurses are in the middle of the battle against COVID-19. The pandemic situation has put these professionals against various ethical challenges. Therefore, this review aims to identify the main ethical challenges faced by nurses during COVID-19 pandemic. This integrative review was guided by the Preferred Reporting Items of Systematic Reviews and Meta-Analysis Protocols. All English version studies that reported ethical challenges of nurses during the COVID-19 pandemic, from November 9, 2019, to November 9, 2020, were eligible for the review. The electronic databases used were PubMed, Google Scholar, JURN, Cochrane Library E-Journals, MEDLINE, Academic Search Complete, CINAHL. Accordingly, 8 articles were included for further analysis and synthesis. The ethical challenges of nurses were categorized into three thematic areas: nurses' safety, role and moral distress, resource allocation, and client-nurse relationship. Thus, the lack of full protection of nurses across the health industry has raised ethical questions such as the extent of their duty, scarce resources, and the failure of personal protective equipment. In connection, a significant number of nurses were also facing moral distress because of prolonged pressure to maintain the resources needed to provide safe and high-quality nursing care. Furthermore, nurses were challenged to restrict many COVID-19 patients from having end-of-life communication with their families. Overall, nurses are still facing various ethical challenges across the globe. Therefore, it is important to mobilize resources and invest in nurses to bring long-lasting solutions.

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

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.

Challenging times: ethics, nursing and the COVID-19 pandemic.

Globally nurses and midwives are working hard to detect cases of COVID-19, to save lives or give comfort in the face of death, to educate themselves and the public about protective measures to stop the viral spread, while still caring for those not infected with the virus. In many countries nurses are working under virtual siege from this pandemic, with not enough resources or personal protective equipment, overwhelming numbers of patients, staff shortages, underprepared health systems and supply chain failures. Nurses and other health and emergency workers are suffering physical and emotional stress, and moral distress from conflicting professional values. They are faced with unpalatable and complex ethical issues in practice, with moral conflicts, high levels of acuity and patient deaths, and long working hours. A rising number of nurses are infected with SARS-CoV-2 or dying in the line of duty. Nurses need strong moral courage, stamina and resilience to work on the front lines of the pandemic, often while separated from their loved ones.