No abstract

Aims To identify and understand ethical challenges arising during COVID‐19 in intensive care and nurses' perceptions of how they made “good” decisions and provided “good” care when faced with ethical challenges and use of moral resilience. Background Little is known about the ethical challenges that nurses faced during the COVID‐19 pandemic and ways they responded. Design Qualitative, descriptive free‐text surveys and semi‐structured interviews, underpinned by appreciative inquiry. Methods Nurses working in intensive care in one academic quaternary care centre and three community hospitals in Midwest United States were invited to participate. In total, 49 participants completed free‐text surveys, and seven participants completed interviews. Data were analysed using content analysis. Results Five themes captured ethical challenges: implementation of the visitation policy; patients dying alone; surrogate decision‐making; diminished safety and quality of care; and imbalance and injustice between professionals. Four themes captured nurses' responses: personal strength and values, problem‐solving, teamwork and peer support and resources. Conclusions Ethical challenges were not novel but were amplified due to repeated occurrence and duration. Some nurses' demonstrated capacities for moral resilience, but none described drawing on all four capacities. Implications for Nursing Management Nurse managers would benefit from greater ethics training to support their nursing teams.

AimsTo identify the personal and professional impact of the COVID‐19 pandemic on clinical nurses with regard to personal and workplace safety, personal and professional relationships and perceptions of their team, organization and community, and to understand lessons learned to inform future responses to pandemics or global emergencies.DesignQualitative, descriptive free‐text surveys, informed by appreciative inquiry.MethodsNurses working in adult COVID‐ and non‐COVID cohort medical‐surgical and intensive care units, outpatient cancer and general surgery centres were invited to participate. Data were collected between April and October 2021 and analysed using summative content analysis.ResultsIn total, 77 participants completed free‐text surveys. Five themes were identified: (1) Constraints on nursing: barriers in communication and diminished patient safety and quality of care; (2) Navigating uncertainty: the emotional toll of the pandemic; (3) Team solidarity, renewed appreciation and reaffirming purpose in nursing work; (4) Enhanced trust versus feeling expendable; and (5) Increased isolation and polarization within communities. Nurses described a perceived negative impact on a number of their relationships, including with patients, employer and community. They described a huge emotional toll that included feelings of isolation and polarization. While some nurses described feeling supported by their team and employer, others described feeling expendable.ConclusionNurses’ responses provided insights into negative emotional experiences during the pandemic due to heightened uncertainty and fear, and also the importance of support received from peers, colleagues and their employer. Nurses experienced feelings of isolation and polarization within their communities. The varied responses reflect the importance of societal solidarity when faced with global emergencies, and the need for nurses to feel valued by their patients and employer.ImpactEffective responses to public health emergencies require individuals and communities to work together to achieve collective goals. Efforts to retain nurses are critical during global emergencies.Patient or Public ContributionNo patient and public involvement.

No abstract