Ethical issues experienced by nurses during COVID-19 pandemic: Systematic review

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Abstract

Background

Frontline nurses who care for patients with COVID-19 work in stressful environments, and many inevitably struggle with unanticipated ethical issues. Little is known about the unique, ethically sensitive issues that nurses faced when caring for patients with COVID-19.

Aim

To better understand how frontline nurses who care for patients with COVID-19 experience ethical issues towards others and themselves.

Methods

Systematic review of qualitative evidence carried out according to the Preferred Reporting Items for Systematic reviews and Meta-analyses on ethical literature (PRISMA-Ethics). The electronic databases PubMed, Embase, Cinahl, Web of Science, Philosopher's Index, and Scopus were queried to identify candidate articles. Articles appearing from March 1, 2020 to December 31, 2022 were considered if they met the following inclusion criteria: (1) Published qualitative and mixed method studies and (2) ethical issues experienced by nurses caring for patients with COVID-19. We appraised the quality of included studies, and data analysis was guided by QUAGOL principles.

Findings

Twenty-six studies meeting our inclusion criteria for how nurses experience ethical issues were characterised by two key themes: (1) the moral character of nurses as a willingness to respond to the vulnerability of human beings and (2) ethical issues nurses acted as barriers sometimes, impeding them from responding to requests of vulnerable human beings for dignified care.

Conclusion

Our review provides a deeper understanding of nurses’ experiences of ethically sensitive issues, while also highlighting the critical need for adjustments to be made at organisational and societal levels. Ethical issues that emerged in situations where organisational and situational constraints impeded nurses' ethical responses to patients’ appeals suggests that early practical support should be made available to resolve ethical issues recognised by nurses. Such support contributes to protecting and promoting not only the dignity of patients with COVID-19 but also of fellow humans in need during crisis.

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Most cited references 77

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Sheila Hawker, Sheila Payne, Christine Kerr … (2002)

The authors describe a method of systematically reviewing research from different paradigms. They draw on the methods adapted, developed, and designed during a study concerned with the delivery of care across professional boundaries. Informed by the established method of systematic review, the authors undertook the review in distinct stages. They describe the methods developed for each stage and outline the difficulties encountered, the solutions devised, and the appraisal tools developed. Although many of the problems encountered were related to the critical assessment of qualitative research, the authors argue that the method of systematic review can be adapted for use with different data andacross disciplines.

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The systematic review of evidence is the research method which underpins the traditional approach to evidence-based healthcare. There is currently no uniform methodology for conducting a systematic review of association (etiology). This study outlines and describes the Joanna Briggs Institute's approach and guidance for synthesizing evidence related to association with a predominant focus on etiology and contributes to the emerging field of systematic review methodologies. It should be noted that questions of association typically address etiological or prognostic issues.The systematic review of studies to answer questions of etiology follows the same basic principles of systematic review of other types of data. An a priori protocol must inform the conduct of the systematic review, comprehensive searching must be performed and critical appraisal of retrieved studies must be carried out.The overarching objective of systematic reviews of etiology is to identify and synthesize the best available evidence on the factors of interest that are associated with a particular disease or outcome. The traditional PICO (population, interventions, comparators and outcomes) format for systematic reviews of effects does not align with questions relating to etiology. A systematic review of etiology should include the following aspects: population, exposure of interest (independent variable) and outcome (dependent variable).Studies of etiology are predominantly explanatory or predictive. The objective of reviews of explanatory or predictive studies is to contribute to, and improve our understanding of, the relationship of health-related events or outcomes by examining the association between variables. When interpreting possible associations between variables based on observational study data, caution must be exercised due to the likely presence of confounding variables or moderators that may impact on the results.As with all systematic reviews, there are various approaches to present the results, including a narrative, graphical or tabular summary, or meta-analysis. When meta-analysis is not possible, a set of alternative methods for synthesizing research is available. On the basis of the research question and objectives, narrative, tabular and/or visual approaches can be used for data synthesis. There are some special considerations when conducting meta-analysis for questions related to risk and correlation. These include, but are not limited to, causal inference.Systematic review and meta-analysis of studies related to etiology is an emerging methodology in the field of evidence synthesis. These reviews can provide useful information for healthcare professionals and policymakers on the burden of disease. The standardized Joanna Briggs Institute approach offers a rigorous and transparent method to conduct reviews of etiology.

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QUAGOL: a guide for qualitative data analysis.

Bernadette Dierckx de Casterlé, Chris Gastmans, Els Bryon … (2012)

Data analysis is a complex and contested part of the qualitative research process, which has received limited theoretical attention. Researchers are often in need of useful instructions or guidelines on how to analyze the mass of qualitative data, but face the lack of clear guidance for using particular analytic methods. The aim of this paper is to propose and discuss the Qualitative Analysis Guide of Leuven (QUAGOL), a guide that was developed in order to be able to truly capture the rich insights of qualitative interview data. The article describes six major problems researchers are often struggling with during the process of qualitative data analysis. Consequently, the QUAGOL is proposed as a guide to facilitate the process of analysis. Challenges emerged and lessons learned from own extensive experiences with qualitative data analysis within the Grounded Theory Approach, as well as from those of other researchers (as described in the literature), were discussed and recommendations were presented. Strengths and pitfalls of the proposed method were discussed in detail. The Qualitative Analysis Guide of Leuven (QUAGOL) offers a comprehensive method to guide the process of qualitative data analysis. The process consists of two parts, each consisting of five stages. The method is systematic but not rigid. It is characterized by iterative processes of digging deeper, constantly moving between the various stages of the process. As such, it aims to stimulate the researcher's intuition and creativity as optimal as possible. The QUAGOL guide is a theory and practice-based guide that supports and facilitates the process of analysis of qualitative interview data. Although the method can facilitate the process of analysis, it cannot guarantee automatic quality. The skills of the researcher and the quality of the research team remain the most crucial components of a successful process of analysis. Additionally, the importance of constantly moving between the various stages throughout the research process cannot be overstated. Copyright Â© 2011 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Younjae Oh: (View ORCID Profile)

Journal

Title: Nursing Ethics

Abbreviated Title: Nurs Ethics

ISSN (Print): 0969-7330

ISSN (Electronic): 1477-0989

Publication date (Electronic): October 04 2023

Affiliations

[1 ]Hallym University

[2 ]KU Leuven

Article

DOI: 10.1177/09697330231200564

SO-VID: f77c5113-1c8c-44bd-9464-9f06b8c49aad

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http://journals.sagepub.com/page/policies/text-and-data-mining-license

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Ethical issues experienced by nurses during COVID-19 pandemic: Systematic review

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Novel Coronavirus Disease COVID-19

Most cited references 77

Appraising the evidence: reviewing disparate data systematically.

Conducting systematic reviews of association (etiology)

QUAGOL: a guide for qualitative data analysis.

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