COVID-19 and ethics in the ICU

Nelson, Sarah E.

doi:10.1186/s13054-020-03250-5

Cited by 11 publications

(6 citation statements)

References 8 publications

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“…This result was confirmed by other studies on previous pandemics [5], as well as in the Covid-19 pandemic [40]. Moreover, nurses who were directly involved in the care of patients with Covid-19 reported significant work-psychological stress and burnout [41,42].…”

Section: Discussionsupporting

confidence: 83%

“…Based on the findings of this survey, the importance of monitoring the psychological well-being of nurses in order to prevent burnout syndrome or professional abandonment also clearly emerges [35,40,41]. This is even more true because, at the time of writing, we are in the middle of a third wave that may lead to what has been recently defined as pandemic fatigue [43].…”

Section: Discussionmentioning

confidence: 87%

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Ethical Conflict and Its Psychological Correlates among Hospital Nurses in the Pandemic: A Cross-Sectional Study within Swiss COVID-19 and Non-COVID-19 Wards

Villa

Balice-Bourgois

Tolotti

et al. 2021

IJERPH

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Background: During the Covid-19 pandemic, nurses experienced increased pressure. Consequently, ethical concerns and psychological distress emerged. This study aimed to assess nurses’ ethical conflict, resilience and psychological impact, and compare these variables between nurses who worked in Covid-19 wards and nurses who did not. Methods: Design—Multicentre online survey. Setting—Multi-site public hospital; all nursing staff were invited to participate. The survey included validated tools and a novel instrument to assess ethical conflict. Spearman’s rho coefficient was used to assess correlations between ethical conflict and psychological distress, logistic regressions to evaluate relationships between nurses’ characteristics and outcome variables, and the Mann–Whitney/t-test to compare groups. Results: 548 questionnaires out of 2039 were returned (275 = Covid-19; 273 = non-Covid-19). We found a low–moderate level of ethical conflict (median = 111.5 [76–152]), which emerged mostly for seeing patients dying alone. A moderate and significant positive correlation emerged between ethical conflict and psychological distress rs (546) = 0.453, p < 0.001. Nurses working in Covid-19-ICUs (OR = 7.18; 95%CI = 3.96–13.01; p < 0.001) and Covid-19 wards (OR = 5.85; 95%CI = 3.56–9.6; p < 0.001) showed higher ethical conflict. Resilience was a protective factor for ethical conflict. Conclusions: Ethical conflict was significantly linked to psychological distress, while a higher level of resilience was found to be a protective factor. These results can be informative for nursing management in future similar crises.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 87%

Ethical Conflict and Its Psychological Correlates among Hospital Nurses in the Pandemic: A Cross-Sectional Study within Swiss COVID-19 and Non-COVID-19 Wards

Villa

Balice-Bourgois

Tolotti

et al. 2021

IJERPH

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“…6,7 Besides the usual flow of patients referring to the ed for varied complaints, emergency physicians, overwhelmed by a large flow of new patients, 8 had to rapidly determine the most appropriate destination (either hospital admission or quarantine home discharge) considering the relative lack of beds, [9][10][11] especially in the intensive and Semi-intensive care Units. [12][13][14] To accomplish this task, we proposed a clinical score, the novara-cOvid score, for rapid destination of cOvid patients at emergency department presentation. 15 This score was developed and adopted since the very first days of cOvid-19 pandemic in our University Hospital, to determine the intensity of care that should have been required by each cOvid patient.…”

Section: Discussionmentioning

confidence: 99%

Clinical stability and in-hospital mortality prediction in COVID-19 patients presenting to the Emergency Department

et al. 2021

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BacKGrOUnd: The novara-cOvid score was developed to help the emergency physician to decide which coronavirus disease (cOvid) patient required hospitalization at emergency department (ed) presentation and to which intensity of care. We aimed at evaluating its prognostic role. MeTHOdS: We retrospectively collected data of cOvid patients admitted to our ed between March 16 and april 22, 2020. The novara-cOvid score was systematically applied to all cOvid patients since its introduction in clinical practice and adopted to decide patients' destination. The ability of the novara-cOvid score to predict in-hospital clinical stability and in-hospital mortality were evaluated through multivariable logistic regression and cox regression hazard models, respectively. reSULTS: among the 480 cOvid patients admitted to the ed, 338 were hospitalized: the novara-cOvid score was 0-1 in 49.7%, 2 in 24.6%, 3 in 15.4% and 4-5 in 10.3% of patients. novara-cOvid score values of 3 and 4-5 were associated with lower clinical stability with adjusted odds ratios of 0.28 (0.13-0.59) and 0.03 (0.01-0.12), respectively. When inhospital mortality was evaluated, a significant difference emerged between scores of 0-1 and 2 vs. 3 and 4-5. in particular, the death adjusted hazard ratio for novara-cOvid scores of 3 and 4-5 were 2.6 (1.4-4.8) and 8.4 (4.7-15.2), respectively. cOncLUSiOnS: The novara-cOvid score reliably predicts in-hospital clinical instability and mortality of cOvid patients at ed presentation. This tool allows the emergency physician to detect patients at higher risk of clinical deterioration, suggesting a more aggressive therapeutic management from the beginning.

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“…These committees would be in charge of both the rationing decisions—with information from clinicians at the bedside—and the communication of these decisions to patients or surrogates. 11 , 12 , 13 , 14 However, thus far no systematic use of triage committees to make allocation decisions were put in place during the COVID-19 pandemic. 15 The triage committee structure alone does not prescribe the approach to decision making: the values and principles upon which the triage decisions are made must also be defined.…”

Section: Pre-covid-19 Approaches To Rationing Scarce Resourcesmentioning

confidence: 99%

“…These policies and recom mendations must consider and balance morally relevant competing demands and interests (eg, ECMO treatment, compared with invasive mechanical ventilation alone, requires higher staffing ratios, which might limit resources available for other patients). 13,14,37,38 Furthermore, triage committees could develop policies and recom mendations that help institutions address the racial and ethnic disparities that have been so notable in the COVID-19 pandemic and actively discourage biased decision making, whether explicit or implicit. 22 Triage committees, similar to clinical ethics committees, might set standards and guidelines based on the principles for rationing decisions we have discussed.…”

Section: Role Of Triage Committeesmentioning

confidence: 99%

Allocating scarce intensive care resources during the COVID-19 pandemic: practical challenges to theoretical frameworks

Supady

Curtis

Abrams

et al. 2021

The Lancet Respiratory Medicine

112

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The COVID-19 pandemic strained health-care systems throughout the world. For some, available medical resources could not meet the increased demand and rationing was ultimately required. Hospitals and governments often sought to establish triage committees to assist with allocation decisions. However, for institutions operating under crisis standards of care (during times when standards of care must be substantially lowered in the setting of crisis), relying on these committees for rationing decisions was impractical-circumstances were changing too rapidly, occurring in too many diverse locations within hospitals, and the available information for decision making was notably scarce. Furthermore, a utilitarian approach to decision making based on an analysis of outcomes is problematic due to uncertainty regarding outcomes of different therapeutic options. We propose that triage committees could be involved in providing policies and guidance for clinicians to help ensure equity in the application of rationing under crisis standards of care. An approach guided by egalitarian principles, integrated with utilitarian principles, can support physicians at the bedside when they must ration scarce resources.

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COVID-19 and ethics in the ICU

Cited by 11 publications

References 8 publications

Ethical Conflict and Its Psychological Correlates among Hospital Nurses in the Pandemic: A Cross-Sectional Study within Swiss COVID-19 and Non-COVID-19 Wards

Ethical Conflict and Its Psychological Correlates among Hospital Nurses in the Pandemic: A Cross-Sectional Study within Swiss COVID-19 and Non-COVID-19 Wards

Clinical stability and in-hospital mortality prediction in COVID-19 patients presenting to the Emergency Department

Allocating scarce intensive care resources during the COVID-19 pandemic: practical challenges to theoretical frameworks

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