Ethical Challenges in Care for Nursing Home Residents During COVID-19: Insights From a Qualitative Study

During the early phase of the COVID-19 pandemic, nursing homes faced rapid changes in national guidelines and significant uncertainty in daily practice. Healthcare personnel and leaders were required to make immediate decisions regarding isolation and infection control, often involving complex ethical challenges. This study explores how nursing home staff and leaders experienced these challenges, particularly in relation to isolation practices, and interprets them through central ethical principles and values.

The study is based on qualitative data from one Norwegian nursing home that experienced confirmed COVID-19 infection early in the pandemic. Data were collected through one focus group interview with nursing staff, and individual interviews with two leaders and two physicians. Clarke and Braun's thematic analysis was used, and an ethical framework was applied in the interpretive phase.

The analysis identified three interconnected themes: Efforts in Making Isolation as Gentle as Possible-healthcare personnel aimed to protect residents from infection while maintaining familiarity, empathy, and emotional presence, reflecting values linked to virtue ethics. Balancing Safety and Relational Care-healthcare personnel faced moral tensions when trying to protect residents while preserving dignity and communication with relatives under strict restrictions. Challenges Related to Interpretation and Application of Isolation Guidelines-healthcare personnel navigated uncertainty in rapidly changing recommendations, highlighting ethical challenges related to autonomy, informed consent, proportionality, and quality of life.

The study demonstrates the complex interplay of ethical values when isolating nursing home residents during the early phase of the pandemic. Pandemic-related restrictions substantially limited autonomy and raised questions of proportionality, dignity, and informed consent. These findings highlight the need for ethical reflection and support to balance protection with humane care in future crises.