Ethical conflict experienced as a critical care nurse during the COVID-19 pandemic: a systematic review

Abstract

Background The COVID-19 pandemic had a devastating effect on healthcare workers and healthcare systems at large. The first case of COVID-19 in the Kingdom of Saudi Arabia was reported on 2 March 2020 and, by 15 July 2021, the Ministry of Health had reported 8020 fatalities from the contagion. The COVID-19 pandemic laid bare the unpreparedness of healthcare systems across the world, and further led to a substantial shift in occupational risks and various stressors pertaining to critical care nursing.

Objectives A PEO framework was used to develop the research question to investigate the ethical conflicts that intensive care nurses experienced during the COVID-19 pandemic, and their impact on nurses’ psychological wellbeing and job satisfaction. The study aimed to identify and describe common ethical conflicts faced by critical care nurses during the pandemic, their psychological impacts, and offer recommendations for healthcare and relevant policymakers.

Search Strategy The study adopted a qualitative approach, and a systematic literature review was conducted on existing studies. An induction approach was used in respect to the sample size of the selected studies. A systematic search was conducted across three electronic databases including CINAHL Plus, PubMed, and MEDLINE ALL. Studies conducted prior to COVID-19, those conducted on healthcare providers other than intensive care nurses, and sources published in languages other than English were exempted from the study.

Results The search produced 738 articles which were further evaluated against the inclusion and exclusion criteria. A total of 12 studies matched the inclusion criteria and met the CASP threshold for quality appraisal. Upon synthesis, changes in practice or work situations (n=7), lack of knowledge (n=3), an organisation’s inefficiency in supporting nurses (n=6), psychological wellbeing (n=7), and job satisfaction (n=4) were the main themes identified encapsulating ethical issues.

Conclusion Nurses had to work under unfamiliar conditions typified by a high workload, prolonged use of PPE, and an increased demand for care in ICUs, hence the potentiality for ethical conflicts. Amid the construction of new ICU centres and an increasing workload, nurses had to deal with novel experiences such as adapting to collaboration with new workers, the role of constantly acting as a supporter, and complexities linked to working with non-healthcare professionals. A failure to highlight these complexities may cause critical care nurses to perceive them as routine. Increased isolation also had emotional ramifications which could affect job satisfaction levels among ICU nurses. Involvement in practice during COVID-19 led to depression, psychological distress, insomnia, and anxiety. The study also established that discrimination over the distribution of PPE, fatigue, and burnout had a profound effect on nurses’ job satisfaction levels. There is a need for interventions tailored towards increasing organisational support, improving nurses’ wellbeing, and building capacity. Organisations should also include nurses in the decision-making process, and consider both extrinsic and intrinsic factors of motivation to enhance job satisfaction levels.