COVID-19 and nurses' ethical issues: Comparisons between two European countries.

BACKGROUND: The global pandemic raised ethical issues for nurses about caring for all patients, not just those with COVID-19. Italy was the first European country to be seriously affected by the first wave, while Estonia's infection and death rates were among the lowest in Europe. Did this raise different ethical issues for nurses in these two countries as well? AIM: The aim was to describe and compare ethical issues between nurses working during the first wave of the COVID-19 pandemic in Estonia and Italy. RESEARCH DESIGN: A cross-sectional survey study with a self-administered questionnaire. The impact of COVID-19 emergency on nursing care questionnaire was used. PARTICIPANTS AND RESEARCH CONTEXT: Convenience sampling was used to recruit 1098 nurses working during the first wave of the pandemic in 2020: 162 from Estonia and 936 from Italy. ETHICAL CONSIDERATIONS: Research ethics approvals were obtained, and the nurses provided informed consent. RESULTS: The most frequent ethical issues for Estonian nurses were professional communication and ensuring access to care for patients without COVID-19, and for Italian nurses, the end-of-life care and the risk of them getting the virus and transmitting it to their loved ones. There were no statistically significant differences in the frequency of ethical issues between Estonian nurses working with patients with and without COVID-19. Italian nurses caring for COVID-19 patients faced statistically significantly more (both p < .001) issues around prioritising patients and end-of-life. Nurses working with patients without COVID-19 in Italy faced more issues about access to care (p < .001). CONCLUSIONS: Estonian and Italian nurses, working in different clinical contexts during the first wave of the pandemic, faced different ethical issues. Local contextual aspects need to be considered to support nurses' ethical decision-making in providing care during future crises and to ensure ethical care for patients.

Changes in nurses' work: A comparative study during the waves of COVID-19 pandemic.

AIM: The aim of this study is to describe and evaluate how nurses caring for COVID and non-COVID patients assess changes in their work and in nursing activities during the two waves of the COVID-19 pandemic. METHODS: Two cross-sectional surveys were conducted for Estonian nurses working during the first and second waves of the COVID-19 pandemic, using The impact of COVID-19 emergency on nursing care questionnaire. Based on convenience sampling, the data were collected among the members of professional organizations, unions and associations. Responses from the first (n = 162) and second wave (n = 284) were analysed using descriptive statistics, Fisher's exact test and McNemar's test. RESULTS: The COVID-19 pandemic changed the working context during both waves for nurses caring for COVID and non-COVID patients. Changes were considered to a greater extent during the second wave, when Estonia was severely affected, and by nurses caring for COVID patients. During the second wave, the number and complexity of patients increased, and nurses caring for COVID patients performed fundamental care, nursing techniques and symptom control significantly more frequently compared to nurses caring for non-COVID patients. CONCLUSION: Taking care of COVID patients is demanding, requiring nurses to perform more direct patient care. However, the pandemic also increased the frequency of activities not related with direct patient care.

Ethical conflicts in nursing: An interview study.

BACKGROUND: A growing body of evidence about nurses' ethical conflicts has been added to nursing science in recent decades, but no research has been done in Estonia. Ethical conflicts are a cultural and context sensitive phenomenon, so the historical, legal, social, economic and political backgrounds and position of nursing have had an impact on ethical conflict experiences. AIM: Describe nurses' experiences of ethical conflicts. METHOD: A qualitative, descriptive study was conducted among nurses (n = 21) in May-October 2018 in Estonia. The data were collected in the form of semi-structured individual interviews and analysed using the inductive content analysis method. ETHICAL CONSIDERATIONS: Due to the sensitive nature of the research topic, only individual interviews were carried out. FINDINGS: Nurses' ethical conflicts were related to situations that violated the rights, safety or well-being of the patient or relatives, caused them suffering, were against their will or threatened nurses' dignity and professionalism through a variety of practices, attitudes and relationships. The insufficiency of patient care and professional collaboration emerged as important sources of nurses' ethical conflicts and were connected to historical and societal factors. CONCLUSIONS: In order to achieve good quality of care, nurses need to have appropriate education and organisational support to carry out ethical daily care. More research is needed to understand the multidimensional cultural and contextual knowledge of ethics and nurses' ethical conflicts.