Aim: To identify factors underlying ethical conflict occurring during the current COVID-19 pandemic in the critical care setting. Background: During the first wave of the COVID-19 outbreak, Spanish and Italian intensive care units were overwhelmed by the demand for admissions. This fact revealed a crucial problem of shortage of health resources and rendered that decision-making was highly complex. Sources of evidence: Applying a nominal group technique this manuscript identifies a series of factors that may have played a role in the emergence of the ethical conflicts in critical care units during the COVID-19 pandemic, considering ethical principles and responsibilities included in the International Council of Nurses Code of Ethics. The five factors identified were the availability of resources; the protection of healthcare workers; the circumstances surrounding decision-making, end-of-life care, and communication. Discussion: The impact of COVID-19 on health care will be long-lasting and nurses are playing a central role in overcoming this crisis. Identifying these five factors and the conflicts that have arisen during the COVID-19 pandemic can help to guide future policies and research. Conclusions: Understanding these five factors and recognizing the conflicts, they may create can help to focus our efforts on minimizing the impact of the ethical consequences of a crisis of this magnitude and on developing new plans and guidelines for future pandemics. Implications for nursing practice and policy: Learning more about these factors can help nurses, other health professionals, and policymakers to focus their efforts on minimizing the impact of the ethical consequences of a crisis of this scale. This will enable changes in organizational policies, improvement in clinical competencies, and development of the scope of practice.

This article seeks to analyze the current state of scientific knowledge concerning critical thinking in nursing.The methodology used consisted of a scoping review of the main scientific databases using an applied search strategy. A total of 1518 studies published from January, 1999, to June, 2013, were identified, of which 90 met the inclusion criteria.The main conclusion drawn is that critical thinking in nursing is experiencing a growing interest both in the study of its concepts and its dimensions, as well as in the development of training strategies to further its development among both students and professionals.Furthermore, the analysis reveals that critical thinking has been investigated principally in the university setting independent of conceptual models, with a variety of instruments used for its measurement.We recommend the (i) investigation of critical thinking among working professionals,(ii) the designing of evaluative instruments linked to conceptual models, and (iii) the identification of strategies to promote critical thinking in the context of providing nursing care.

Background and Aim: A complex healthcare environment, with greater need for care based on the patient and evidence-based practice, are factors that have contributed to the increased need for critical thinking in professional competence. At the theoretical level, Alfaro-LeFevre (2016) put forward a model of critical thinking made up of four components. And although these explain the construct, instruments for their empirical measurement are lacking. The purpose of the study was to develop and validate the psychometric properties of an instrument, the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice), designed to evaluate the critical thinking abilities of nurses in the clinical setting.

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