On order and disorder during the COVID-19 pandemic.

In this paper, we analyse the conditions under which the COVID-19 pandemic will lead either to social order (adherence to measures put in place by authorities to control the pandemic) or to social disorder (resistance to such measures and the emergence of open conflict). Using examples from different countries (principally the United Kingdom, the United States, and France), we first isolate three factors which determine whether people accept or reject control measures. These are the historical context of state-public relations, the nature of leadership during the pandemic and procedural justice in the development and operation of these measures. Second, we analyse the way the crisis is policed and how forms of policing determine whether dissent will escalate into open conflict. We conclude by considering the prospects for order/disorder as the pandemic unfolds.

Can Ethics Consultation Services Evolve to Support the Moral Distress of Caregivers?

Ethics consultation services were first implemented in the 1970s to provide physicians, other care providers, and family members with expert advice to address difficult ethical dilemmas in care. As nurses are increasingly confronted with moral dilemmas related to patient preferences, needs, and choices that conflict with their personal beliefs, the need for professional support has never been greater. This need may signal a new role for ethics consultation services. [J Contin Educ Nurs. 2022;53(7):297-298.].

Costs of Employee Stewardship Behaviors for Employees in the Work-to-Family Penetration Context during the COVID-19 Pandemic.

Drawing on the work-home resources model, our aim in this study was to explore the negative effects of employee stewardship behavior on work-family conflict (WFC) through work-to-family border permeation (WFBP) for employees. A conditional process model linking employee stewardship behavior (ESB), family-supportive supervisor behavior (FBBS), work-to-family border permeation (WFBP), family support, and work-family conflict (WFC) was developed. Longitudinal data collected at two different time points from 323 employees of three internet companies in south China were examined. The results revealed that WFBP mediates the impact of ESB on WFC. Family-supportive supervisor behavior substantially weakens the relationship between ESB and WFBP and the indirect effect of WFBP. Similarly, family support undermines the relationship between WFBP and WFC and the indirect effect of WFBP. Employee-level stewardship and blurred work-family boundaries have been common phenomena in contemporary China, especially during the COVID-19 pandemic. This study is among the first to focus on the negative impacts of employee stewardship behaviors on the employee, especially on their family, from a Chinese context. These findings also increase our understanding of the effects of ESB and provide some new insights into how to mitigate WFC.

Patients' Views of Shared Decision-making and Decisional Conflict in Otolaryngologic Surgery During the COVID-19 Pandemic.

Importance: A patient's decision to undergo surgery may be fraught with uncertainty and decisional conflict. The unpredictable nature of the COVID-19 pandemic warrants further study into factors associated with patient decision-making. Objective: To assess decisional conflict and patient-specific concerns for people undergoing otolaryngologic surgery during the pandemic. Design, Setting, Participants: This prospective cross-sectional survey study was conducted via telephone from April 22 to August 31, 2020. English-speaking adults scheduled for surgery from a single academic surgical center were invited to participate. Individuals who were non-English speaking, lacked autonomous medical decision-making capacity, scheduled for emergent surgery, or had a communication disability were excluded. For race and ethnicity reporting, participants were classified dichotomously as White according to the Behavioral Risk Factor Surveillance System from the Centers for Disease Control and Prevention or non-White as a collective term including Black or African American, American Indian or Alaska Native, Asian, or Pacific Islander race and ethnicity. Exposures: The SURE Questionnaire (sure of myself, understand information, risks/benefits ratio, and encouragement) was used to screen for decisional conflict, with a total score greater than or equal to 3 indicating clinically significant decisional conflict. Participants were asked to share their specific concerns about having surgery. Main Outcome and Measures: Decisional conflict and patient demographic data were assessed via bivariate analyses, multivariable logistic regression and conjunctive consolidation. Patient-specific concerns were qualitatively analyzed for summative themes. Results: Of 444 patients screened for eligibility, 182 (40.9%) respondents participated. The median age was 60.5 years (interquartile range, 48-70 years). The racial and ethnic identity of the participants was classified as binary White (84% [153 of 182]) and non-White (16% [29 of 182]). The overall prevalence of decisional conflict was 19% (34 of 182). Decisional conflict was more prevalent among non-White than White participants (proportion difference 18.8%, 95% CI, 0.6%-37.0% and adjusted odds ratio 3.0; 95% CI, 1.2-7.4). Combining information from multiple variables through conjunctive consolidation, the group with the highest rate of decisional conflict was non-White patients with no college education receiving urgent surgery (odds ratio, 10.8; 95% CI, 2.6-45.0). Intraoperative and postoperative concerns were the most common themes expressed by participants. There was a clinically significant difference in the proportion of participants who screened positive for decisional conflict (30%) and expressed postoperative concerns than those who screened negative for decisional conflict (17%) (proportion difference, 13%; 95% CI, 1%-25%). Among patients reporting concerns about COVID-19, most screened positive for decisional conflict. Conclusions and Relevance: Results of this cross-sectional survey study suggest that the COVID-19 pandemic was associated with decisional conflict in patients undergoing otolaryngologic surgery. Consistent discussion of risks and benefits is essential. The role of race and ethnicity in decisional conflict warrants further study.

Senior BSN students' confidence, comfort, and perception of readiness for clinical practice: the impacts of COVID-19.

OBJECTIVES: The Coronavirus Disease 2019 (COVID-19) has impacted overall nursing education program requirements, classroom delivery of theory hours, as well as clinical and laboratory learning opportunities for students. The aims of this study were to explore the impacts of COVID 19 on the students' perceptions of readiness for practice and their preparation for the NCLEX exam and initial clinical practice. METHODS: A cross-sectional descriptive design was used to investigate the impact of COVID-19 on senior BSN students' preparation for NCLEX and future careers. The Casey-Fink Readiness for Practice Survey was used to investigate the perceptions of the BSN students' clinical confidence and readiness for practice. RESULTS: Students reported substantial impacts of COVID-19 on their clinical experiences, their ability to practice skills and procedures, their preparations for NCLEX exam, and their nursing career. The most significant confidence concerns noted from this study seemed to center on handling multiple patient assignments, calling the physician, responding to a change in patient condition, and treating a dying patient. CONCLUSIONS: Healthcare experts expect that the impact of COVID-19 may last until 2022. More research is needed to understand the impact of COVID-19 on nursing education and transition to nursing practice. While clinical confidence and readiness for practice are essential topics, more research is needed to investigate the psychological and physiological impacts of COVID-19 on nurses, nursing students, nursing preceptors, and faculty members.

Is There an Ethical Mandate to Practice Without Proper Personal Protective Equipment?

In the spring of 2020, a novel virus known as COVID-19 (coronavirus disease 2019) was introduced to the human population, and the world faced a global pandemic with far-reaching consequences. One of the most difficult challenges that nurses faced in the midst of the crisis was the lack of proper personal protective equipment (PPE). The lack of PPE left health care professionals with a complicated ethical dilemma: Is there an ethical duty to care for patients in the absence of proper PPE? This article seeks to help the individual nurse (a) understand the ethical dilemma and the tensions that it brings, (b) look to the literature for guidance, and (c) understand how individuals can apply these ethical principles. After careful analysis, the recommendation is for the individual nurse to make a thorough assessment of their personal situation. This will include consideration for their family, community, financial responsibilities, legal protections, organizational policies, and personal health risk. Finally, this article serves as a call to organizations and professional leaders to increase their support of frontline health care workers and provide the individual nurse with the information they need in order to make sound decisions.

Torn Between Caution and Compassion: a Dilemma for Clinicians from Black and Minority Ethnic Groups During the COVID-19 Pandemic.

The wide disparity in coronavirus disease (COVID-19)-related death rates based upon the ethnic origin is well established by now. The higher incidence of COVID-19 deaths amongst the healthcare staff belonging to black and minority ethnic (BAME) communities living in the United Kingdom has generated a great deal of concern and anxiety in clinicians. Public Health England (PHE) has outlined mitigation strategies after immense pressure from professional organisations and influential clinical leaders. Although seemingly well thought through, these measures fall short of addressing the professional, moral and emotional dilemma faced by the BAME clinicians who feel that they are being expected to choose between their duty towards their patients and the profession, and their responsibility to look after their own health.

Early Effects of the COVID-19 Pandemic on Relationship Satisfaction and Attributions.

How has the COVID-19 pandemic affected intimate relationships? The existing literature is mixed on the effect of major external stressors on couple relationships, and little is known about the early experience of crises. The current study used 654 individuals involved in a relationship who provided data immediately before the onset of the pandemic (December, 2019) and twice during the early stages of the pandemic (March and April, 2020). Results indicate that relationship satisfaction and causal attributions did not change over time, but responsibility attributions decreased on average. Changes in relationship outcomes were not moderated by demographic characteristics or negative repercussions of the pandemic. There were small moderation effects of relationship coping and conflict during the pandemic, revealing that satisfaction increased and maladaptive attributions decreased in couples with more positive functioning, and satisfaction decreased and maladaptive attributions increased in couples with lower functioning.

COVID-19, Moral Conflict, Distress, and Dying Alone.

COVID-19 has truly affected most of the world over the past many months, perhaps more than any other event in recent history. In the wake of this pandemic are patients, family members, and various types of care providers, all of whom share different levels of moral distress. Moral conflict occurs in disputes when individuals or groups have differences over, or are unable to translate to each other, deeply held beliefs, knowledge, and values. Such conflicts can seriously affect healthcare providers and cause distress during disastrous situations such as pandemics when medical and human resources are stretched to the point of exhaustion. In the current pandemic, most hospitals and healthcare institutions in the United States have not allowed visitors to come to the hospitals to see their family or loved ones, even when the patient is dying. The moral conflict and moral distress (being constrained from doing what you think is right) among care providers when they see their patients dying alone can be unbearable and lead to ongoing grief and sadness. This paper will explore the concepts of moral distress and conflict among hospital staff and how a system-wide provider wellness programme can make a difference in healing and health.

Balancing the duty to treat with the duty to family in the context of the COVID-19 pandemic.

Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers (HCWs) refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients. I argue that it is morally permissible for HCWs to abstain from work when their duty to treat is outweighed by the combined risks and burdens of that work. For HCWs who live with their families, the obligation to protect one's family from infection contributes significantly to those burdens. There are, however, a range of complicating factors including the strength of duty to treat which varies according to the HCW's role, the vulnerability of family members to the disease, the willingness of family members to risk infection and the resources available to the HCW to protect their family. In many cases, HCWs in 'frontline' roles with a weak duty to treat and families at home will be morally permitted to abstain from work given the risks posed by COVID-19; therefore, society should provide additional incentives to maintain sufficient staff in these roles.