RESPONDER: A Qualitative Study of Ethical Issues Faced by Critical Care Nurses during the COVID-19 Pandemic.

AIMS: To identify and understand ethical challenges arising during COVID-19 in intensive care; nurses' perceptions of how they made 'good' decisions and provided 'good' care when faced with ethical challenges, and use of moral resilience.

BACKGROUND: Little is known about the ethical challenges that nurses faced during the COVID-19 pandemic and ways they responded. Design Qualitative, descriptive free-text surveys and semi-structured interviews, underpinned by appreciative inquiry.

METHODS: Nurses working in intensive care in one academic quaternary care center and three community hospitals in Midwest United States were invited to participate. In total, 49 participants completed free-text surveys and 7 participants completed interviews. Data were analyzed using content analysis.

RESULTS: Five themes captured ethical challenges: implementation of the visitation policy; patients dying alone; surrogate decision-making; diminished safety and quality of care; and imbalance and injustice between professionals. Four themes captured nurses' responses: personal strength and values, problem-solving, teamwork and peer support, and resources.

CONCLUSIONS: Ethical challenges were not novel but were amplified due to repeated occurrence and duration. Some nurses' demonstrated capacities for moral resilience, but none described drawing on all four capacities.

IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers would benefit from greater ethics training to support their nursing teams.