The Ethical Dilemmas Faced by Senior Nurses in the COVID-19 ICU: A Phenomenological Study

Abstract

Working with hi-tech life-supporting machines in the midst of rapid changes in regulations and settings has raised dilemmas among senior nurses who must inevitably work with fresh-graduate nurses during the COVID-19 pandemic. Staffing limitations in nursing, in terms of both quality and quantity, where the nurses must be dressed in hot personal protective equipment suits, have added a conflict in the intensive care unit. This research sought to reveal the reality in the ICU setting during COVID-19 based on nurses’ narratives of their experiences and feelings working in the COVID-19 ICU. This research was conducted in the COVID-19 ICU of one of the public hospitals in Riau Province. The purposive sampling technique was used to choose intensive care unit nurses. In-depth recorded phone interviews were performed from June to July 2022. The total number of participants joining this research until the researcher reached a data saturation point was five. This research used Colaizzi’s phenomenological method to uncover the meanings behind patients’ stories. The majority of participants were female, and there was only one male nurse. Sixty percent of the nurses had Bachelor’s degrees, and the remaining 40% had nursing diploma degrees. Four participants (80%) were government employees, and one (20%) was a freelance daily worker. The participants had been working for eight years on average. Five themes emerged: 1) work motivation, 2) COVID-19 protocol, 3) the competencies of nursing volunteers, 4) family roles, and 5) professional ethical dilemmas.


Keywords: ethics, dilemma, nurses, COVID-19, intensive care unit

References
[1] Bialek S, Boundy E, Bowen V, Chow N, Cohn A, Dowling N, et al. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343–346.

[2] Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA - J Am Med Assoc. 2020;323(21):2133–2134.

[3] Al Thobaity A, Alshammari F. Nurses on the frontline against the COVID-19 pandemic: An integrative review. Dubai Med J. 2020;3(3):87–92.

[4] Plunkett D, Greene JD. Overlooked evidence and a misunderstanding of what trolley dilemmas do best: Commentary on Bostyn, Sevenhant, and Roets (2018). Psychol Sci. 2019;30(9):1389-1391.

[5] Gangopadhyay P, Chawla M, Dal Monte O, Chang SW. Prefrontal–amygdala circuits in social decision-making. Nat Neurosci. 2021;24(1):5–18.

[6] Fowler M. Why the history of nursing ethics matters. Nurs Ethics. 2017;24(3):292– 304.

[7] Adams LM, Melius J. Prepared to respond? Exploring personal disaster preparedness and nursing staff response to disasters. Disaster Med Public Health Prep. 2021;15(5):557-562.

[8] Jia Y, Chen O, Xiao Z, Xiao J, Bian J, Jia H. Nurses’ ethical challenges caring for people with COVID-19: A qualitative study. Nurs Ethics. 2021;28(1):33–45.

[9] Turale S, Meechamnan C, Kunaviktikul W. Challenging times: Ethics, nursing and the COVID-19 pandemic. Vol. 67, International Nursing Review; 2020. p. 164–7.

[10] Polit DF, Beck CT. Nursing research: Principles and methods. Lippincott Williams & Wilkins; 2004.

[11] Jelagat Chumba R, Muindi F, Njihia J. Effect of reward on nurse job performance in Kenyan National Referral Hospitals. J Hum Resour Leadersh. 2018;4(2):77–92.

[12] Harisah H. Kebijakan Pemberian Insentif Pada Tenaga Medis Virus Corona Covid-19 Pendekatan Maslahah. SALAM J Sos dan Budaya Syar-i. 2020;46(7):519-528.

[13] Rafieepour A, Masoumi G, Dehghani A, Gh M. Research paper: Health responses during the COVID-19 pandemic: An international strategy and experience analysis. 2021;6(3):147–160.

[14] Home SPM, Asche SE, Morton S, Solberg LI. Support and strategies for change among small patient-centered medical home practices. 2013;6–13.

[15] Bogossian F, McKenna L, Levett-Jones T. Mobilising the nursing student workforce in COVID-19: The value proposition. Collegian. 2020;27(2):147–149.

[16] Roca J, Canet-Vélez O, Cemeli T, Lavedán A, Masot O, Botigué T. Experiences, emotional responses, and coping skills of nursing students as auxiliary health workers during the peak COVID-19 pandemic: A qualitative study. Int J Ment Health Nurs. 2021;30(5):1080–1092.

[17] Gold R, Evans M. Why did covid overwhelm hospitals? A yearslong drive for efficiency. Wall Str J [Internet]. 2020; Available from: https://www.wsj.com/articles/hospitals-for-years-banked-on-lean-staffing-thepandemic- overwhelmed-them-11600351907