The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, OH, USA; Center for Bioethics and Medical Humanities, The Ohio State University, Columbus, OH, USA.
College of Nursing, The Ohio State University, Columbus, OH, USA.
Nurs Ethics. 2023 Sep;30(6):803-821. doi: 10.1177/09697330221143150. Epub 2023 Mar 27.
Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts.
To analyze frontline U.S. nurses' experiences of ethics during the COVID-19 pandemic.
Qualitative analysis using a directed content methodology.
The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States.
Participant privacy and data confidentiality were addressed.
Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients.
This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice.
Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available.
在 COVID-19 大流行期间，护士经历了强烈的伦理道德挑战。我们 2020 年对一线护士在 COVID-19 大流行期间经历的定性研究发现，伦理是一个贯穿始终的主题，有六个子主题：道德困境、道德不确定性、道德困境、道德伤害、道德愤怒和道德勇气。我们根据对伦理概念的细化定义重新分析了与伦理相关的研究结果。
分析美国一线护士在 COVID-19 大流行期间的伦理体验。
使用定向内容分析法进行定性分析。
该研究包括来自美国东北部、大西洋中部、中西部和西部三个主要大都市学术医疗中心和一家社区医院的 43 名护士。
解决了参与者的隐私和数据保密问题。
道德困境出现在许多情况下，最常与平衡安全和患者护理有关。道德不确定性通常源于缺乏有关选项的健康信息或证据。当护士知道该做什么，但被阻止这样做时，就会出现道德困境，包括临终问题。道德伤害（伴随着痛苦、羞耻或内疚）发生在做错事、看到或经历不道德行为后，通常涉及权威人物。护士对医疗保健内外的事件和人表示道德愤怒。尽管面临困难的伦理情况，但一些护士表现出了道德勇气，有时是通过抵制他们认为会阻碍富有同情心的护理的政策，以对患者最有利的方式为指导。
本研究对与伦理相关的子主题进行了内容分析，揭示了概念特征，并澄清了与相应范例的区别。概念的清晰度可能会为解决护理实践中的伦理难题提供应对措施和干预措施。
护理伦理教育必须解决大流行、灾难和其他危机中的道德困境。当没有理想的选择时，护士需要时间和资源来从尽力提供最佳护理中恢复过来。
