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Nurs Educ Perspect ; 43(1): 1-2, 2022.
Article in English | MEDLINE | ID: covidwho-1597032
Appl Nurs Res ; 62: 151508, 2021 12.
Article in English | MEDLINE | ID: covidwho-1458585


BACKGROUND: The ANA Code of Ethics for Nurses, regularly revised since 1896, may not provide guidance in an era of pandemic and sociopolitical unrest. PURPOSE: This study explored whether the Code of Ethics comprehensively address current nursing challenges. METHODS: 23 nurses participated in six Zoom focus groups to discuss whether provisions were applicable to their current practice. An iterative approach was used to review transcripts independently and then merge findings to identify ethical themes. FINDINGS: Provisions 4, 6, and 8 were most relevant. None of the provisions addressed the guilt secondary to isolating patients from support systems and not being "on the front lines" of COVID care. DISCUSSION: The co-occurring crises of COVID-19 and social unrest created an ethical crisis for many nurses. The Code of Ethics provided a useful guide for framing discussion and formulating strategies for change, but did not eliminate distress during a time of novel challenges.

COVID-19 , Ethics, Nursing , Codes of Ethics , Humans , Pandemics , SARS-CoV-2
Nurs Ethics ; 27(4): 924-934, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1453014


BACKGROUND: Fifteen years have passed since the outbreak of severe acute respiratory syndrome in Hong Kong. At that time, there were reports of heroic acts among professionals who cared for these patients, whose bravery and professionalism were highly praised. However, there are concerns about changes in new generation of nursing professionals. OBJECTIVE: We aimed to examine the attitude of nursing students, should they be faced with severe acute respiratory syndrome patients during their future work. RESEARCH DESIGN: A questionnaire survey was carried out to examine the attitude among final-year nursing students to three ethical areas, namely, duty of care, resource allocation, and collateral damage. ETHICAL CONSIDERATIONS: This study was carried out in accordance with the requirements and recommendations of the Central Research and Ethics Committee, School of Health Sciences at Caritas Institute of Higher Education. FINDINGS: Complete responses from 102 subjects were analyzed. The overwhelming majority (96.1%) did not agree to participate in the intubation of severe acute respiratory syndrome patients if protective measures, that is, N95 mask and gown, were not available. If there were insufficient N95 masks for all the medical, nursing, and allied health workers in the hospital (resource allocation), 37.3% felt that the distribution of N95 masks should be by casting lot, while the rest disagreed. When asked about collateral damage, more than three-quarters (77.5%) said that severe acute respiratory syndrome patients should be admitted to intensive care unit. There was sex difference in nursing students' attitude toward severe acute respiratory syndrome care during pregnancy and influence of age in understanding intensive care unit care for these patients. Interestingly, 94.1% felt that there should be a separate intensive care unit for severe acute respiratory syndrome patients. CONCLUSION: As infection control practice and isolation facilities improved over the years, relevant knowledge and nursing ethical issues related to infectious diseases should become part of nursing education and training programs, especially in preparation for outbreaks of infectious diseases or distress.

Attitude of Health Personnel , Disease Outbreaks , Ethics, Nursing , Severe Acute Respiratory Syndrome/epidemiology , Students, Nursing/psychology , Adult , Female , Health Care Rationing , Hong Kong , Humans , Intensive Care Units , Male , Patient Admission , Standard of Care , Surveys and Questionnaires
Nurs Sci Q ; 34(4): 356-358, 2021 10.
Article in English | MEDLINE | ID: covidwho-1440874


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.

Education, Nursing, Graduate , Ethics, Nursing , Mentoring , Humanism , Humans , Mentors , Morals
Rev. gaúch. enferm ; 42(spe): e20200172, 2021.
Article in English | LILACS (Americas) | ID: covidwho-1410822


ABSTRACT Objective: To reflect about the do-not-resuscitation order at COVID-19 in Brazil, under bioethical focus and medical and nursing professional ethics. Method: Reflection study based on the principlist bioethics of Beauchamps and Childress and in professional ethics, problematizing actions, and decisions of non-resuscitation in the pandemic. Results: It is important to consider the patient's clinic, appropriation of treatment goals for people with comorbidities, elderly people, with less chance of surviving to resuscitation, or less quality of life, with the palliative care team, to avoid dysthanasia, use of scarce resources and greater exposure of professionals to contamination. Conclusion: COVID-19 increased the vulnerabilities of professionals and patients, impacting professional decisions and conduct more widely than important values ​​such as the restriction of freedom. It propelled the population in general to rethink ethical and bioethical values ​​regarding life and death, interfering in decisions about them, supported by human dignity.

RESUMEN Objetivo: Reflexionar sobre el orden de no reanimación en COVID-19 en Brasil, bajo enfoque bioético y ética profesional médica y de enfermería. Método: Estudio de reflexión basado en la bioética principialista de Beauchamps y Childress y ética profesional, acciones problemáticas y decisiones de no reanimación en la pandemia. Resultados: Considerar la clínica del paciente, con un esquema apropiado de los objetivos del tratamiento, especialmente en los ancianos y las personas con comorbilidades y contar con el apoyo del equipo de cuidados paliativos, para evitar la distanasia, así como el mal uso de los recursos y la exposición de los profesionales a la contaminación. Conclusión: COVID-19 aumentó las vulnerabilidades de profesionales y pacientes, impactando decisiones profesionales y conductas más amplias que valores importantes como la restricción de la libertad, pero especialmente haciendo que la población en general reconsidere los valores éticos y bioéticos con respecto a la vida y la muerte, interferir en las decisiones sobre ellos apoyadas por la dignidad humana.

RESUMO Objetivo: Refletir sobre ordem de não reanimação na COVID-19 no Brasil, sob foco bioético e da ética profissional médica e de enfermagem. Método: Estudo de reflexão embasado na bioética principialista de Beauchamps e Childress e na ética profissional, problematizando ações e decisões de não reanimação na pandemia. Resultados: Importa considerar a clínica do paciente, apropriação das metas dos tratamentos de pessoas com comorbidades, idosas, com menores chances de sobreviver à reanimação, ou menor qualidade de vida, junto à equipe de cuidados paliativos, para evitar distanásia, uso dos recursos escassos e maior exposição dos profissionais à contaminação. Conclusão: A COVID-19 ampliou as vulnerabilidades de profissionais e pacientes, impactando nas decisões e condutas profissionais mais amplamente do que nos valores importantes como a restrição da liberdade. Impulsionou a população em geral a repensar valores éticos e bioéticos referentes à vida e à morte, interferindo nas decisões sobre elas, respaldas na dignidade humana.

Humans , Bioethics , Critical Care , Ethics, Nursing , Decision , COVID-19 , Palliative Care/ethics , Brazil , Cardiopulmonary Resuscitation/ethics , Ethics, Medical
Nurs Ethics ; 28(2): 147-148, 2021 03.
Article in English | MEDLINE | ID: covidwho-1145422

Ethics, Nursing , Humans , Nursing
Am J Nurs ; 120(10): 7, 2020 10.
Article in English | MEDLINE | ID: covidwho-940587


This presidential election may be the most important of modern times.

American Nurses' Association , Politics , Betacoronavirus , COVID-19 , Coronavirus Infections , Ethics, Nursing , Humans , Pandemics/legislation & jurisprudence , Pneumonia, Viral , SARS-CoV-2
Aquichan ; 20(4): e2041, Dic. 4, 2020.
Article in English | LILACS (Americas) | ID: covidwho-1134394


In times of a pandemic, this reflection conceives two enormous challenges for nursing in collective health. Politically, the challenge is to vindicate and recognize care as a creative and transformative action taken by individuals, families, and communities in territories to sustain life and mitigate human suffering through health promotion, disease prevention, and care. Ethically, the task is to clearly understand safe, supportive, and sustainable actions to strengthen equity and ethos of caring as a project-oriented to welfare, compassion, and the defense of the right to health.

Esta reflexión concibe dos grandes desafíos para la enfermería en el campo de la salud colectiva en tiempos de pandemia, por un lado, el desafío político por la reivindicación y el reconocimiento del cuidado como un acto creativo y transformador que se construye en los territorios con las personas, las familias y las comunidades a partir de acciones de promoción de la salud, prevención y atención de la enfermedad con el fin de mantener la vida y mitigar el sufrimiento humano; por otro lado, está el desafío ético para alcanzar una mayor comprensión de las acciones solidarias, seguras y sostenibles para fortalecer la equidad y el ethos que cuida como un proyecto orientado al bienestar, la compasión y la defensa del derecho a la salud.

Esta reflexão apresenta dois grandes desafios para a Enfermagem no campo da saúde coletiva em tempos de pandemia. Por um lado, o desafio político pela reivindicação e pelo reconhecimento do cuidado como um ato criador e transformador que é construído nos territórios com as pessoas, as famílias e as comunidades a partir de ações de promoção da saúde e de prevenção e atenção da doença a fim de manter a vida e amenizar o sofrimento humano. Por outro, está o desafio ético para atingir uma maior compreensão das ações solidárias, seguras e duradouras para fortalecer a equidade e o ethos que cuida como um projeto orientado ao bem-estar, à compaixão e à defesa do direito à saúde.

Public Policy , Health Equity , Social Vulnerability , Ethics, Nursing , Nursing Care
J Hosp Palliat Nurs ; 23(2): 114-119, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1072475


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.

COVID-19/nursing , Ethics, Nursing , Personal Protective Equipment/supply & distribution , COVID-19/epidemiology , COVID-19/prevention & control , Conflict, Psychological , Humans , Nurses/psychology , United States/epidemiology
Nurs Ethics ; 28(1): 82-90, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1039987


The conduct of nurse managers, and health service managers more widely, has been subject to scrutiny and critique because of high-profile organisational failures in healthcare. This raises concerns about the practice of nursing management and the use of codes of professional and managerial conduct. Some responses to such failures seem to assume that codes of conduct will ensure or at least increase the likelihood that ethical management will be practised. Codes of conduct are general principles and rules of normative standards, including ethical standards, and guides for action of agents in particular roles. Nurse managers seem to stride two roles. Contra some accounts of the roles of a professional (nurse) and that of a manager, it is claimed that there is no intrinsic incompatibility of the roles though there is always the possibility that it could become so and likewise for codes of conduct. Codes of conduct can be used to support nurse managers in making practical decisions via an 'outside in' approach with an emphasis on the use of principles and an 'inside out' approach with an emphasis on the agent's character. It is claimed that both approaches are necessary, especially as guides to ethical action. However, neither is sufficient for action because judgement and choice will always be required (principles always underdetermine action) as will a conducive environment that positively influences good judgement by being supportive of the basic principles and values of healthcare institutions. The response to the Covid-19 pandemic has created a unique set of circumstances in which the practical judgement, including ethical judgement, of nurse managers at all levels is being tested. However, the pandemic could be a turning point because staff and institutions (temporarily) freed from managerialism have demonstrated excellent practice supportive of ethical and other practical decision making. Organisations need to learn from this post pandemic.

COVID-19/nursing , Codes of Ethics , Leadership , Organizational Culture , Ethics, Nursing , Humans , Pandemics , SARS-CoV-2
J Contin Educ Nurs ; 52(1): 8-10, 2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-1000378


New nurse leaders may lack the foresight to understand ethical dilemmas encountered in their leadership practice. Two sets of ethical dilemmas faced by nurse leaders were identified as part of a leadership class: patient care and work environment, exacerbated by the COVID-19 pandemic. Professional development opportunities for new and evolving leaders should include robust opportunities to identify and resolve ethical dilemmas. [J Contin Educ Nurs. 2021;52(1):8-10.].

COVID-19/epidemiology , Ethics, Nursing , Leadership , Nurse's Role , Decision Making , Education, Nursing, Baccalaureate , Humans , Pandemics , SARS-CoV-2 , Workplace
Soins Gerontol ; 25(146): 21-22, 2020.
Article in French | MEDLINE | ID: covidwho-960117


Covid epidemic and containment have generated numerous ethical dilemmas. Autonomy is the most frequently jeopardized ethical principle. Continued commitment has run into specific funerary rules of deceased residents. Professional proficiency has been eroded by omnipresent feelings of fear and powerlessness, and by medicalized daily activity. Decontainment and after-crisis raise specific ethical questionnings.

Decision Making , Ethics, Nursing , Nursing Homes/ethics , COVID-19 , Ethics, Professional , Humans , Nursing Homes/organization & administration , Pandemics , SARS-CoV-2
Nurs Ethics ; 28(1): 9-22, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-807852


BACKGROUND: Positioned at the frontlines of the battle against COVID-19 disease, nurses are at increased risk of contraction, yet as they feel obligated to provide care, they also experience ethical pressure. RESEARCH QUESTION AND OBJECTIVES: The study examined how Israeli nurses respond to ethical dilemmas and tension during the COVID-19 outbreak, and to what extent this is associated with their perceived risk and motivation to provide care? RESEARCH DESIGN: The study implemented a descriptive correlative study using a 53-section online questionnaire, including 4 open-ended questions. PARTICIPANTS AND RESEARCH CONTEXT: The questionnaire was complete by 231 registered and intern nurses after being posted on nurses' Facebook and WhatsApp groups, and through snowball sampling. ETHICAL CONSIDERATIONS: The research was pre-approved by the ethics committee of the Faculty of Social Welfare and Health Sciences at the University of Haifa, Israel. FINDINGS: In all, 68.8% of the respondents had received some form of training about COVID-19. Respondents positioned themselves at perceived high risk levels for contracting the virus. About one-third feared going to work because of potential contraction and due to feeling inadequately protected. While 40.9% were scared to care for COVID-19 patients, 74.7% did not believe they have the right to refuse to treat certain patients. When asked about defining an age limit for providing patients with scarce resources (such as ventilation machines) in cases of insufficient supplies, respondents stated that the maximum age in such scenarios should be 84 (standard deviation (SD = 19) - yet most respondents (81.4%) believed that every patient has the right to receive optimal treatment, regardless of their age and medical background. DISCUSSION: Correlating with their strong commitment to care, nurses did not convey intention to leave the profession despite their stress, perceived risk, and feelings of insufficient support and protection at work. The nurses did not hold a utilitarian approach to resource allocation, thereby acknowledging the value of all people and their entitlement to care, regardless of optimal outcomes. CONCLUSION: While experiencing significant personal risk and emotional burden, nurses conveyed strong dedication to providing care, and did not regret working in the nursing profession, yet they did seek a supportive climate for their needs and ethical concerns.

Attitude of Health Personnel , COVID-19/nursing , Ethics, Nursing , Nursing Staff, Hospital/psychology , Adult , COVID-19/psychology , COVID-19/transmission , Female , Humans , Israel , Male , Motivation , Pandemics , Qualitative Research , Risk Assessment , SARS-CoV-2 , Surveys and Questionnaires
Nurs Outlook ; 68(6): 838-844, 2020.
Article in English | MEDLINE | ID: covidwho-739077


Registered nurses are an essential workforce group across the globe. They use their expertise and skill sets every day in clinical practice to protect, promote, and advocate on behalf of patients and families under their care. In this article we discuss the physical, emotional, and moral stresses that nurses are experiencing in their day-to-day practice settings created by the novel coronavirus. We consider the demands placed on nurses by unexpected patient surges within hospital environments and inadequate personal protective equipment and other critical resources, challenging nurses' ability to meet their professional and ethical obligations. We also share our thoughts on supporting nurses and others now, and ideas for needed healing for both individuals and organizations as we move forward. Finally, we argue for the need for substantive reform of institutional processes and systems that can deliver quality care in the future when faced with another devastating humanitarian and public health crises.

COVID-19/nursing , Nurses/psychology , Nursing Care/ethics , Nursing Care/psychology , Nursing Staff, Hospital/ethics , Nursing Staff, Hospital/psychology , Quality of Health Care/ethics , Adult , Coronavirus , Ethics, Nursing , Female , Humans , Male , Middle Aged , Occupational Stress , Pandemics , United States