Caring for the Unvaccinated During a Pandemic: Connecting Swanson's Theory of Caring

Background and Purpose: Nurses frequently care for patients who make decisions against medical advice, a challenge that continues during and after the COVID-19 pandemic. This article explores U.S. nurses' experiences caring for unvaccinated COVID-19 patients and the resulting impacts using Swanson's Theory of Caring (STC). Methods: Data were gathered through an online survey collecting nurses' demographics, mental health screening data, and an open-ended question asking about a personal experience providing care to an unvaccinated COVID-19 patient. Researchers analyzed 128 responses using content analysis. STC served as the analytical framework. Results: Nurses' experiences were summarized into two main themes and four subthemes: (a) anger, frustration, fatigue, and resentment (24.2%) and (b) feeling a professional commitment to a nurse's duty (60.9%). Within the professional commitment theme, subthemes include the following: (a) patients can make an autonomous decision (15.6%); (b) feeling concerned for the patient (6.3%); (c) wanting to take action, educate, and vaccinate (29.7%); and (d) feeling moral conflict (9.3%). Results aligned with STC's five caring actions: knowing, doing for, being with, enabling, and maintaining belief. Implications for Practice: Nurses experienced emotional challenges caring for the unvaccinated during the pandemic resulting in psychological sequelae, including compassion fatigue and moral distress, in addition to positive outcomes of resilience and enhanced coping mechanisms. This study underscores the multifaceted nature of nurses' experiences and the emotional, ethical, and professional challenges they encountered when caring for unvaccinated COVID-19 patients. Nurse leaders should address these issues to enhance nurses' wellbeing and reduce compassion fatigue and dissatisfaction.