Good Death Disrupted: Nurses' Moral Emotions Navigating Clinical and Public Health Ethics During the First Wave of Covid-19 Pandemic
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Abstract
Aim To explore the moral emotions that frontline nurses navigated in endeavouring to ensure a ‘good death’ for hospital patients and care home residents during the first wave of the COVID-19 pandemic. Background Under normal circumstances, frontline staff are focused on clinical ethics, which foreground what is best for individuals and families. Public health crises such as a pandemic require staff to adapt rapidly to focus on what benefits communities, at times compromising individual well-being and autonomy. Visitor restrictions when people were dying provided vivid exemplars of this ethical shift and the moral emotions nurses encountered with the requirement to implement this change. Methods Twenty-nine interviews were conducted with nurses in direct clinical care roles. Data were analysed thematically informed by the theoretical concepts of a good death and moral emotions. Results The data set highlighted that moral emotions such as sympathy, empathy, distress and guilt were integral to the decisions participants described in striving for a good palliative experience. Four themes were identified in the data analysis: nurses as gatekeepers; ethical tensions and rule bending; nurses as proxy family members; separation and sacrifice. Conclusions Participants reflected on morally compromising situations and highlighted agency through emotionally satisfying workarounds and collegial deliberations that enabled them to believe that they were party to painful but morally justifiable decisions. Implications for the profession and patient care Nurses are required to implement national policy changes that may disrupt notions of best practice and therefore be experienced as a moral wrong. In navigating the moral emotions accompanying this shift, nurses benefit from compassionate leadership and ethics education to support team cohesion enabling nurses to prevail. Public contribution Twenty-nine frontline registered nurses participated in the qualitative interviews that inform this study. Reporting method The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.Description
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Journal of Clinical Nursing, ISSN: 0962-1067 (Print); 1365-2702 (Online), Wiley. doi: 10.1111/jocn.16702
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This is the Author's Accepted Manuscript (peer reviewed version) of an article which has been published in final form at http://dx.doi.org/10.1111/jocn.16702 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.