Ethics and frontline nursing during COVID-19: A qualitative analysis

Area of Science:

• Nursing Ethics
• Pandemic Response
• Healthcare Morality

Background:

• Frontline nurses encountered profound ethical and moral challenges during the COVID-19 pandemic.
• A prior study identified six ethics subthemes: moral dilemmas, uncertainty, distress, injury, outrage, and courage.
• This analysis refined these concepts based on updated definitions.

Purpose of the Study:

• To analyze the ethical experiences of frontline U.S. nurses during the COVID-19 pandemic.
• To clarify conceptual characteristics and distinctions of ethical subthemes.
• To inform interventions for addressing ethical quandaries in nursing.

Main Methods:

• Qualitative content analysis using a directed methodology.
• Inclusion of 43 nurses from diverse U.S. academic medical centers and community hospitals.
• Ensured participant privacy and data confidentiality.

Main Results:

• Moral dilemmas frequently stemmed from balancing safety and patient care.
• Moral uncertainty arose from insufficient health information or evidence.
• Moral distress occurred when nurses were prevented from providing optimal care, particularly in end-of-life situations.
• Moral injury resulted from experiencing or witnessing wrongdoing, often involving authority figures.
• Nurses expressed moral outrage and demonstrated moral courage, sometimes by challenging policies to ensure compassionate care.

Conclusions:

• Conceptual clarity of ethical subthemes can guide nursing practice responses and interventions.
• Ethics education must incorporate pandemic and crisis-related moral dilemmas.
• Nurses require resources and time for healing after navigating complex ethical situations with limited ideal options.