Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Nursing Research, The Royal Children's Hospital, Parkville, Victoria, Australia.
Pediatr Blood Cancer. 2023 Feb;70(2):e30114. doi: 10.1002/pbc.30114. Epub 2022 Nov 30.
This qualitative study examined ethical challenges reported by healthcare professionals (HCPs) working in a large Australian pediatric oncology center during a period of strict COVID-19 restrictions.
We conducted semi-structured interviews with 21 HCPs who provided pediatric cancer care during the pandemic in 2020, during strict lockdown periods. Interviews examined the difficulties they faced, as well as their own ethical evaluation of the impact of COVID-19 policies on oncology care. Data were analyzed using inductive content analysis and thematic analysis.
HCPs faced several challenges, primarily originating from hospital restrictions, which led to changes in usual clinical practices. These challenges included delivering care with personal protective equipment (PPE), the impact of a one-parent visitation policy, changes in psychosocial and allied health services, and COVID-19 swabbing policies. Overall, there was consensus from participants that hospital restrictions were justified and, while difficult, HCPs simply had to provide the best care possible given the circumstances. However, participants described decreased capacity to deliver holistic patient care and, in some instances, a tendency to avoid ethical reflection. Lastly, there was a consistent theme of shame and sense of responsibility underlying some participants' anxiety around inadvertently transmitting COVID-19 to immunocompromised patients.
Our findings show that many staff felt unease at the disruptions in patient care due to COVID-19 restrictions. Some HCPs indicated a degree of moral distress, with a possibility of moral injury among some HCPs. A focus on ethical recovery could assist in preventing any ongoing difficulties among HCPs because of their experiences.
本定性研究考察了在严格的 COVID-19 限制期间，在澳大利亚一家大型儿科肿瘤中心工作的医疗保健专业人员（HCP）报告的伦理挑战。
我们对 21 名在 2020 年大流行期间严格封锁期间提供儿科癌症护理的 HCP 进行了半结构化访谈，访谈内容包括他们所面临的困难，以及他们自己对 COVID-19 政策对肿瘤学护理影响的伦理评估。使用归纳内容分析和主题分析对数据进行分析。
HCP 面临着一些挑战，主要源于医院的限制，这些限制导致了通常的临床实践发生变化。这些挑战包括在个人防护设备（PPE）下提供护理、单亲探视政策的影响、心理社会和联合健康服务的变化以及 COVID-19 拭子检测政策。总体而言，参与者一致认为医院的限制是合理的，虽然困难，但 HCP 必须在这种情况下尽最大努力提供最佳护理。然而，参与者描述了提供整体患者护理的能力下降，并且在某些情况下，避免伦理反思的倾向。最后，一些参与者在无意中将 COVID-19 传播给免疫功能低下的患者时，存在一种持续的羞耻感和责任感的主题。
我们的研究结果表明，许多员工对由于 COVID-19 限制而导致的患者护理中断感到不安。一些 HCP 表示存在一定程度的道德困境，一些 HCP 存在道德伤害的可能性。关注道德恢复可以帮助防止 HCP 因自身经历而继续面临任何困难。
