https://orcid.org/0000-0001-9293-4932
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Abstract
Objective
To investigate the experiences of healthcare staff in nursing homes during the COVID-19 pandemic.
Design
Individual interviews. Latent qualitative content analysis.
Setting
Ten nursing homes in Sweden.
Subjects
Physicians, nurses and nurse assistants working in Swedish nursing homes.
Main outcome measures
Participants’ experiences of working in nursing homes during the COVID-19 pandemic.
Results
Four manifest categories were found, namely: Balancing restrictions and allocation of scarce resources with care needs; Prioritizing and acting against moral values in advance care planning; Distrust in cooperation and Leadership and staff turnover – a factor for moral distress. The latent theme Experiences of handling ethical challenges caused by the COVID-19 pandemic gave a deeper meaning to the categories.
Conclusion
During the pandemic, nursing home staff encountered ethical challenges that caused moral distress. Moral distress stemmed from not being given adequate conditions to perform their work properly, and thus not being able to give the residents adequate care. Another aspect of moral distress originated from feeling forced to act against their moral values when a course of action was considered to cause discomfort or harm to a resident. Alerting employers and policymakers to the harm and inequality experienced by staff and the difficulty in delivering appropriate care is essential. Making proposals for improvements and developing guidelines together with staff to recognize their role and to develop better guidance for good care is vital in order to support and sustain the nursing home workforce.
KEY POINTS
The COVID-19 pandemic has affected both patients and staff in nursing homes, in Sweden and worldwide.
Our study highlights that during the COVID-19 pandemic, nursing home staff encountered several ethical challenges which caused moral distress.
Moral distress stemmed from not being given adequate conditions to perform their work, thus not giving the residents appropriate care.
Moral distress could also originate from nursing home staff’s feeling of being forced to act against their moral values.
Acknowledgements
We would like to thank the nurses, nurse assistants and physicians who participated in this study. We also thank Linköping University, Region Östergötland, Primary Health Care Centre in Region Östergötland, and the Medical Research Council of Southeast Sweden (Dnr. FORSS-976829).
Disclosure statement
No potential conflict of interest was reported by the author(s).