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

Area of Science:

• Nursing Ethics
• Global Health
• Pandemic Response

Background:

• The COVID-19 pandemic presented unprecedented ethical dilemmas for nurses globally.
• Italy experienced a severe first wave, while Estonia maintained low infection rates, suggesting potential differences in nursing ethical issues.
• Nurses faced challenges in providing care to all patients, not exclusively those with COVID-19.

Purpose of the Study:

• To compare and describe the ethical issues encountered by nurses in Estonia and Italy during the initial phase of the COVID-19 pandemic.
• To identify country-specific ethical challenges faced by nurses in different pandemic contexts.

Main Methods:

• A cross-sectional survey was conducted using the "The impact of COVID-19 emergency on nursing care" questionnaire.
• 1098 nurses (162 from Estonia, 936 from Italy) participated, recruited via convenience sampling during the first wave of the pandemic in 2020.
• Informed consent was obtained, and research ethics approvals were secured prior to data collection.

Main Results:

• Estonian nurses most frequently reported issues with professional communication and ensuring access to care for non-COVID-19 patients.
• Italian nurses frequently encountered ethical issues related to end-of-life care and personal risk of infection.
• Italian nurses caring for COVID-19 patients reported significantly more issues with patient prioritization and end-of-life care compared to those caring for non-COVID-19 patients.

Conclusions:

• Nurses in Estonia and Italy experienced distinct ethical issues during the first COVID-19 wave due to differing clinical contexts.
• Local contextual factors significantly influence nurses' ethical decision-making during health crises.
• Addressing these context-specific ethical challenges is vital for supporting nurses and ensuring patient care during future pandemics.