Nurses' Experiences and Ethical Dilemmas in the COVID-19 Pandemic: A Phenomenological Study

Yıl 2024, Cilt: 6 Sayı: 2, 225 - 238, 25.08.2024

Gülcan Eyüboğlu , Arnel Böke Kılıçlı , Zehra Göçmen Baykara , Firuze Çevık Aydın

Öz

This study aimed to explore the nurses' experiences and ethical dilemmas during the early stages of the COVID-19 (Novel Coronavirus Disease) pandemic in Türkiye. Nineteen nurses from seven different provinces in Türkiye were recruited using purposive and snowball sampling. We conducted qualitative research with an interpretative phenomenological design, collecting data through semi-structured, in-depth videoconference interviews from June to September 2020. Three themes emerged concerning experiences: "a range of emotions," "factors affecting nursing services," and "a change in the perspective of nurses." Three themes also emerged regarding ethical dilemmas: "Is the priority to benefit or not harm?", "Is the priority not to harm or justice?", and "Is the priority to benefit, not harm, or respect autonomy?" During this period, nurses experienced intense negative emotions such as fear, anxiety, and sadness. Solidarity, team collaboration, and management support facilitated nursing care. As reported by nurses, challenges in nursing care were attributed to the use of personal protective equipment, limited resources, and physical inadequacies. Nurses frequently faced ethical dilemmas involving the prioritization of benefiting patients, avoiding harm, upholding justice, and respecting patient autonomy while caring for individuals infected with COVID-19.

Anahtar Kelimeler

COVID-19, Experience, Ethical Dilemma, Nursing, Türkiye.

COVID-19 Pandemisinde Hemşirelerin Deneyimleri ve Etik İkilemler: Fenomenolojik Bir Çalışma

Öz

Bu çalışmanın amacı, Türkiye'de COVID-19 (Yeni Koronavirüs Hastalığı) pandemisinin erken döneminde hemşirelerin yaşadıkları deneyimleri ve etik ikilemleri ortaya çıkarmaktır. Türkiye'nin yedi farklı ilinde bulunan hemşireler (n=19) amaçlı ve kartopu örnekleme yöntemi kullanılarak seçilmiştir. Bu çalışmada, yorumlayıcı fenomenolojik tasarımlı nitel araştırma yürütülmüştür. Veriler, Haziran-Eylül 2020 tarihleri arasında yarı yapılandırılmış, derinlemesine video konferans görüşmeleri yoluyla toplanmıştır. Deneyimlerle ilgili üç tema ortaya çıkmıştır: "bir dizi duygu", "hemşirelik hizmetlerini etkileyen faktörler" ve "hemşirelerin bakış açısında değişiklik". Etik ikilemlerle ilgili üç tema ortaya çıkmıştır: "Öncelik yarar sağlamak mı yoksa zarar vermemek mi", "öncelik zarar vermemek mi yoksa adalet mi" ve "öncelik yarar sağlama- zarar vermeme mi yoksa özerkliğe saygı duymak mı". Pandemi sürecinde hemşireler korku, kaygı ve üzüntü gibi olumsuz duyguları yoğun olarak hissettiklerini belirtmişlerdir. Dayanışma, ekip iş birliği ve yönetim desteği hemşirelik bakımını kolaylaştıran faktörler olarak ifade edilmiştir. Hemşirelerin ifadelerine göre, kişisel koruyucu ekipman kullanımı, sınırlı kaynaklar ve fiziksel yetersizlikler hemşirelik bakımını zorlaştırmıştır. Hemşireler, COVID-19 ile enfekte olmuş bireylere bakım verirken yarar sağlama, zarar vermeme, adalet ve özerkliğe saygı etik ikilemleri ile karşılaştıklarını belirtmişlerdir.

Anahtar Kelimeler

COVID-19, Deneyim, Etik İkilem, Hemşirelik, Türkiye.

Kaynakça

• Akkuş, Y., Karacan, Y., Güney, R., & Kurt, B. (2022). Experiences of nurses working with COVID‐19 patients: A qualitative study. J Clin Nurs, 31(9-10), 1243-1257. https://doi.org/10.1111/jocn.15979
• Baykara, Z.G., & Eyuboglu, G. (2020). COVID-19 Pandemisinde hemşirelik bakımı. Gazi Health Sciences J, special issue, 9-17. https://dergipark.org.tr/en/pub/gsbdergi/issue/56673/790250 Cacchione, P. Z. (2021). COVID and the Year of the Nurse and Nurse Midwife. Clin Nurs Res, 30(6), 723-723. https://doi.org/10.1177/10547738211028414
• Creswell J.W., & Poth C.N. (2016). Qualitative inquiry and research design: Choosing among five approaches. United States of America: Sage Publications.
• Demir, G., & Şahin, S. (2022). Experiences of nurses providing care to patients with COVID‐19 in intensive care units: A qualitative study. Nurs Forum, 1-8. https://doi.org/10.1111/nuf.12716
• Gebreheat, G., & Teame, H. (2021). Ethical challenges of nurses in COVID-19 pandemic: integrative review. Journal of Multidisciplinary Healthcare, 14, 1029-1035. https://doi.org/10.2147/JMDH.S308758
• Gunawan, J., Aungsuroch, Y., Marzilli, C., Fisher, M. L., & Sukarna, A. (2021). A phenomenological study of the lived experience of nurses in the battle of COVID-19. Nurs Outlook, 69(4), 652-659. https://doi.org/10.1016/j.outlook.2021.01.020
• Liu, Q., Luo, D., Haase, J. E., Guo, Q., Wang, X. Q., Liu, S., ... & Yang, B. X. (2020). The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. The Lancet Glob Health, 8(6), e790-e798. https://doi.org/10.1016/S2214-109X(20)30204-7
• Merriam, S.B. & Tisdell, E.J. (2013). Qualitative Research: A Guide to Design and Implementation. United States of America:John & Wiley Sons.
• Miljeteig, I., Forthun, I., Hufthammer, K. O., Engelund, I. E., Schanche, E., Schaufel, M., & Onarheim, K. H. (2021). Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway. Nurs Ethics, 28(1), 66-81. https://doi.org/10.1177/0969733020981748
• Moustakas C. (1994). Phenomenological research methods. London: Sage publications. Newham, R., & Hewison, A. (2021). Covid-19, ethical nursing management and codes of conduct: An analysis. Nurs Ethics, 28(1), 82-90. https://doi.org/10.1177/0969733020988316
• Rezaee, N., Mardani-Hamooleh, M., & Seraji, M. (2020). Nurses' perception of ethical challenges in caring for patients with COVID-19: a qualitative analysis. J Med Ethics Hist Med, 13 (23),1-13. https://doi.org/10.18502/jmehm.v13i23.4954
• Robert, R., Kentish-Barnes, N., Boyer, A., Laurent, A., Azoulay, E., & Reignier, J. (2020). Ethical dilemmas due to the Covid-19 pandemic. Ann Intensive Care, 10(1), 1-9. https://doi.org/10.1186/s13613-020-00702-7
• Şahin, C. U., Aydın, M., Usta, A., & Sakın, M. (2021). Experiences and Psychosocial Difficulties of Frontline Health Care Workers Struggling With COVID-19 in Türkiye: A Qualitative Study. Florence Nightingale Journal of Nursing, 30(1), 74. https://doi.org/10.5152/fnjn.2022.21053
• Sezgin, D., Dost, A., & Esin, M. N. (2021). Experiences and perceptions of Turkish intensive care nurses providing care to Covid‐19 patients: A qualitative study. Int Nurs Rev, 1-13. https://doi.org/10.1111/inr.12740
• Silverman, H. J., Kheirbek, R. E., Moscou-Jackson, G., & Day, J. (2021). Moral distress in nurses caring for patients with Covid-19. Nurs Ethics, 28(7-8), 1137-1164. https://doi.org/10.1177/09697330211003217
• Sperling, D. (2021a). Nurses’ challenges, concerns and unfair requirements during the COVID-19 outbreak. Nurs Ethics, 28(7-8),1096–1110. https://doi.org/10.1177/09697330211005175
• Sperling, D. (2021b). Ethical dilemmas, perceived risk, and motivation among nurses during the COVID-19 pandemic. Nurs Ethics, 28(1), 9-22. https://doi.org/10.1177/0969733020956376
• The Ministry of Health of Türkiye. (2020). COVID-19 Weekly Situation Report 19/10/2020–25/10/2020 Türkiye https://l24.im/m5hvZ
• Wang, H., Liu, Y., Hu, K., Zhang, M., Du, M., Huang, H., & Yue, X. (2020). Healthcare workers’ stress when caring for COVID-19 patients: An altruistic perspective. Nurs Ethics, 27(7), 1490-1500. https://doi.org/10.1177/0969733020934146
• World Health Organization. (2019). Coronavirus disease (COVID-19) pandemic. https://l24.im/q6zU