Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand.
School of Communication, Journalism & Marketing, Massey University, Auckland, New Zealand.
J Clin Nurs. 2023 Sep;32(17-18):6611-6621. doi: 10.1111/jocn.16702. Epub 2023 Mar 27.
To explore the moral emotions that frontline nurses navigated in endeavouring to ensure a 'good death' for hospital patients and care home residents during the first wave of the COVID-19 pandemic.
Under normal circumstances, frontline staff are focused on clinical ethics, which foreground what is best for individuals and families. Public health crises such as a pandemic require staff to adapt rapidly to focus on what benefits communities, at times compromising individual well-being and autonomy. Visitor restrictions when people were dying provided vivid exemplars of this ethical shift and the moral emotions nurses encountered with the requirement to implement this change.
Twenty-nine interviews were conducted with nurses in direct clinical care roles. Data were analysed thematically informed by the theoretical concepts of a good death and moral emotions.
The data set highlighted that moral emotions such as sympathy, empathy, distress and guilt were integral to the decisions participants described in striving for a good palliative experience. Four themes were identified in the data analysis: nurses as gatekeepers; ethical tensions and rule bending; nurses as proxy family members; separation and sacrifice.
Participants reflected on morally compromising situations and highlighted agency through emotionally satisfying workarounds and collegial deliberations that enabled them to believe that they were party to painful but morally justifiable decisions.
Nurses are required to implement national policy changes that may disrupt notions of best practice and therefore be experienced as a moral wrong. In navigating the moral emotions accompanying this shift, nurses benefit from compassionate leadership and ethics education to support team cohesion enabling nurses to prevail.
Twenty-nine frontline registered nurses participated in the qualitative interviews that inform this study.
The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.
探讨一线护士在努力为医院患者和护理院居民实现“善终”时所经历的道德情感，这是在 COVID-19 大流行的第一波期间发生的情况。
在正常情况下，一线工作人员专注于临床伦理，强调对个人和家庭最有利的方面。像大流行这样的公共卫生危机要求工作人员迅速适应，将重点放在有利于社区的方面，有时会牺牲个人福祉和自主权。当人们临终时限制探视提供了这种伦理转变的生动例证，以及护士在实施这一变化时所遇到的道德情感。
对直接从事临床护理工作的 29 名护士进行了访谈。数据分析采用善终和道德情感的理论概念进行主题分析。
数据集突出表明，同情、同理心、痛苦和内疚等道德情感是参与者在努力实现良好姑息治疗体验时所描述的决策的重要组成部分。数据分析中确定了四个主题：护士作为把关人；伦理紧张和规则突破；护士作为代理家庭成员；分离和牺牲。
参与者反思了道德上有争议的情况，并通过情感上令人满意的权宜之计和同事审议强调了代理，这使他们相信自己参与了痛苦但在道德上合理的决策。
护士需要实施可能破坏最佳实践观念的国家政策变化，因此可能被视为道德错误。在应对伴随这种转变的道德情感时，护士受益于富有同情心的领导力和伦理教育，以支持团队凝聚力，使护士能够取得成功。
29 名一线注册护士参与了为这项研究提供信息的定性访谈。
该研究遵循了定性研究报告的统一标准清单。
