Research Article
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Ethical Problems Encountered by Nurses Working in Family Health Centers during the COVID-19 Pandemic: A Qualitative Study

Year 2021, Volume: 4 Issue: S-1, 51 - 62, 31.10.2021
https://doi.org/10.26650/JARHS2021-982400

Abstract

Objective: This study aimed to determine the ethical issues experienced by nurses working in family health centers during the COVID-19 pandemic. Materials and Methods: This research was carried out as a qualitative study following a phenomenological pattern. The sample of the study consisted of eight nurses working in seven different family health centers in the European Region of Istanbul and who were added to the study using the snowball sampling method. Data were collected and recorded using the in-depth interview method on an online platform between June and July 2021. Data were collected in line with the interview form consisting of 12 questions. After transcription of the data, content analysis was performed using the MAXQDA 2020 program. Results: In the interview, it was found that there were nine codes and 44 subcodes. These codes were handled in three main categories: working conditions, service delivery and psychological process. Nurses in the working conditions category expressed their problems regarding physical space, personal protective equipment, and increased workload. In the service delivery category, they expressed the problems and difficulties they experienced under the codes of changes in the provision of services that are routinely applied, services that are interrupted/ postponed, services that cannot be performed and newly added services/tasks. In the category of psychological processes, they talked about the difficulties they experienced regarding their perceptions and motivations regarding the pandemic and the process. Conclusion: It was observed that the ethical problems experienced by the nurses working in the family health center during their practice were mostly related to the ethical principles of justice, beneficence, and non-maleficence. Negative aspects such as the lack of follow-up of chronic patients by the nurses, the disruption of routine services or the inability to perform them, and the increase in the workload with newly assigned tasks were frequently expressed.

References

  • 1. Özceylan G, Kolcu G, editörler. COVID-19’un birinci basamak sağlık hizmetlerine etkileri. İzmir: Meta Basım Matbaacılık Hizmetleri; 2020.
  • 2. Taş BG, Özceylan G, Öztürk GZ, Toprak D. Evaluation of job strain of family physicians in COVID-19 pandemic period- an example from Turkey. J Community Health 2021; 46(4): 777- 85.
  • 3. Gürçiner İM. Pandemi döneminde ailehekimlerinin rolü. (Alıntılanma tarihi: 29. 07. 2021): Available from: https://www.tuseb.gov.tr/ tuspe/uploads/genel/files/haberler/zirve2021_ sunumlar/MineGurciner-TUSPEZirve- Sunumu.pdf.
  • 4. Sezer BA, Erol S. Aile sağlığı merkezinde eleman değil hemşire olmak. Hemşirelikte Eğitim ve Araştırma Dergisi 2016; 13(3): 244-9.
  • 5. Örnek BN. COVID 19 pandemisi ve etik konular. Sağlık ve Toplum 2020; Özel sayı: 16-26.
  • 6. Aktura B. Aile hekimliği merkezlerinde pandemi yönetimi. The Journal of Turkish Family Physician 2020;11(1):45-7.
  • 7. Samancı VM. Birinci basamak sağlık hizmetleri ve pandemi süreci. Konuralp Medical Journal 2020;12(S1):391-3.
  • 8. Bagnasco A, Zanini M, Dasso N, Rossi S, Timmins F, Galanti MC et al. Dignity, privacy, respect and choice-A scoping review of measurement of these concepts within acute healthcare practice. J Clin Nurs 2020;29(11- 12):1832-57.
  • 9. Chang D, Xu H, Rebaza A, Sharma L, Dela Cruz CS. Protecting health-care workers from subclinical coronavirus infection. Lancet Respir Med 2020; 8(3): e13.
  • 10. Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care providers during the COVID-19 crisis in China: A qualitative study. Lancet Glob Health 2020;8(6):e790-e798.
  • 11. Gebreheat G, Teame H. Ethical challenges of nurses in COVID-19 pandemic: Integrative review. J Multidiscip Healthc 2021;14:1029-35.
  • 12. Kackin O, Ciydem E, Aci OS, Kutlu FY. Experiences and psychosocial problems of nurses caring for patients diagnosed with COVID-19 in Turkey: A qualitative study. Int J Soc Psychiatry 2021;67(2):158-67.
  • 13. Turale S, Meechamnan C, Kunaviktikul W. Challenging times: Ethics, nursing and the COVID-19 pandemic. Int Nurs Rev 2020;67(2):164-7.
  • 14. McKenna H. Covid-19: Ethical issues for nurses. Int J Nurs Stud 2020;110:103673. 15. Sabatello M, Burke TB, McDonald KE, Appelbaum PS. Disability, ethics, and health care in the COVID-19 pandemic. Am J Public Health 2020;110(10):1523-7.
  • 16. Morley G, Grady C, McCarthy J, Ulrich CM. Covid-19: Ethical challenges for nurses. Hastings Cent Rep 2020;50(3):35-9.
  • 17. Shah A, Aacharya RP. Combating COVID-19 pandemic in Nepal: Ethical challenges in an outbreak. JNMA J Nepal Med Assoc 2020;58(224):276-9.
  • 18. Isfeedvajani MS, Fares F, Moqaddam ZIS. Ethical Issues in COVID-19 Pandemic. Hosp Pract Res 2020;5(4):126-33.
  • 19. Levene LS, Seidu S, Greenhalgh T, Khunti K. Pandemic threatens primary care for long term conditions. BMJ 2020;371:m3793.
  • 20. Halk Sağlığı Uzmanları Derneği. Bulaşıcı Olmayan Hastalıklar Çalışma Grubu. (Alıntılama tarihi: 03.07.2021): Availablefrom: https://hasuder.org.tr/wp-content/uploads/ Bulasici-Olmayan-Hastaliklar-Calisma-Grubu. pdf.
  • 21. American Nurses Association. Nurses, Ethics and the response to the COVID–19 pandemic. (Alıntılama tarihi: 12.07.2021): Available from: https://www.nursingworld. org/~495c6c/globalassets/practiceandpolicy/ work-environment/health--safety/coronavirus/ nurses-ethics-and-the-response-to-the-covid- 19-pandemic.pdf.
  • 22. Zhu J, Stone T, Petrini M. The ethics of refusing to care for patients during the coronavirus pandemic: A Chinese perspective. Nurs Inq 2021;28(1):e12380.
  • 23. Kinsinger FS. Beneficence and the professional’s moral imperative. J Chiropr Humanit 2009;16(1):44-6.
  • 24. Cousins E, Vries K, Dening KH. Ethical care during COVID-19 for care home residents with dementia. Nurs Ethics 2021;28(1):46-57.
  • 25. World Health Organization.Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance. (Alıntılama tarihi: 13.04.2020): Available from: https://apps.who. int/iris/handle/10665/331446.
  • 26. Daştan GS, Boran P. Ebeveyn antropometrik ölçümlerinin çocuk baş çevresi üzerine etkisi. Çocuk Dergisi 2018;18(3):113-20.
  • 27. Iserson KV. Healthcare ethics during a pandemic. West J Emerg Med 2020;21(3):477-83.
  • 28. Firouzkouhi M, Alimohammadi N, Kako M, Abdollahimohammad A, Bagheri G, Nouraie M. Ethical challenges of nurses related COVID-19 pandemic in inpatient wards: An integrative review. Ethics Med Public Health 2021;18:100669.

Aile Sağlığı Merkezlerinde Çalışan Hemşirelerin COVID-19 Pandemisi Sürecinde Karşılaştıkları Etik Sorunlar: Bir Nitel Çalışma

Year 2021, Volume: 4 Issue: S-1, 51 - 62, 31.10.2021
https://doi.org/10.26650/JARHS2021-982400

Abstract

Amaç: Bu araştırmada aile sağlığı merkezlerinde çalışan hemşirelerin COVID-19 pandemisi sırasında karşılaştıkları etik sorunların belirlenmesi amaçlandı. Gereç ve Yöntem: Araştırma, fenomenolojik desenli bir nitel çalışma olarak gerçekleştirildi. Araştırmanın örneklemini İstanbul İli Avrupa Bölgesi’nde yer alan yedi farklı aile sağlığı merkezinde çalışan ve kartopu örnekleme yöntemi ile ulaşılan sekiz hemşire oluşturdu. Veriler, Haziran-Temmuz 2021 tarihleri arasında çevrimiçi bir platform kullanılarak derinlemesine görüşme yöntemiyle toplandı ve kaydedildi. Veriler 12 sorudan oluşan görüşme formu doğrultusunda toplandı. Verilerin deşifre edilmesinden sonra MAXQDA 2020 programı kullanılarak içerik analizi yapıldı. Bulgular: Görüşmeler sonucunda dokuz kod ve 44 alt kod elde edildi. Bu kodlar; çalışma koşulları, hizmet sunumu ve psikolojik süreçler ile ilgili etik sorunlar olmak üzere üç temel kategoride ele alındı. Çalışma koşulları ile ilgili etik sorunlar kategorisinde hemşireler; fiziksel alan, kişisel koruyucu ekipman ve artan iş yüküne ilişkin sorunlarını ifade ettiler. Hizmet sunumu ile ilgili etik sorunlar kategorisinde; rutinde uygulanan hizmetlerin sunumundaki değişimler, aksayan/ertelenen hizmetler, yapılamayan hizmetler ve yeni eklenen hizmetler/ görevler kodlarının altında yaşadıkları sorunları ve zorlukları ifade ettiler. Psikolojik süreçler ile ilgili etik sorunlar kategorisinde ise pandemiye ve sürece ilişkin algılarından ve motivasyonlarına ilişkin yaşadıkları zorluklardan bahsettiler. Sonuç: Çalışmanın bulguları ışığında aile sağlığı merkezinde çalışan hemşireler tarafından kronik hasta izlemlerinin yapılmaması, rutin hizmetlerin aksaması ya da gerçekleştirilememesi ve yeni verilen görevlerle iş yükünün artması gibi olumsuzluklar sıklıkla ifade edilmiş olup, uygulamaları sırasında yaşadıkları etik sorunların en fazla adalet, yararlı olma ve zarar vermeme etik ilkeleriyle ilgili olduğu saptandı.

References

  • 1. Özceylan G, Kolcu G, editörler. COVID-19’un birinci basamak sağlık hizmetlerine etkileri. İzmir: Meta Basım Matbaacılık Hizmetleri; 2020.
  • 2. Taş BG, Özceylan G, Öztürk GZ, Toprak D. Evaluation of job strain of family physicians in COVID-19 pandemic period- an example from Turkey. J Community Health 2021; 46(4): 777- 85.
  • 3. Gürçiner İM. Pandemi döneminde ailehekimlerinin rolü. (Alıntılanma tarihi: 29. 07. 2021): Available from: https://www.tuseb.gov.tr/ tuspe/uploads/genel/files/haberler/zirve2021_ sunumlar/MineGurciner-TUSPEZirve- Sunumu.pdf.
  • 4. Sezer BA, Erol S. Aile sağlığı merkezinde eleman değil hemşire olmak. Hemşirelikte Eğitim ve Araştırma Dergisi 2016; 13(3): 244-9.
  • 5. Örnek BN. COVID 19 pandemisi ve etik konular. Sağlık ve Toplum 2020; Özel sayı: 16-26.
  • 6. Aktura B. Aile hekimliği merkezlerinde pandemi yönetimi. The Journal of Turkish Family Physician 2020;11(1):45-7.
  • 7. Samancı VM. Birinci basamak sağlık hizmetleri ve pandemi süreci. Konuralp Medical Journal 2020;12(S1):391-3.
  • 8. Bagnasco A, Zanini M, Dasso N, Rossi S, Timmins F, Galanti MC et al. Dignity, privacy, respect and choice-A scoping review of measurement of these concepts within acute healthcare practice. J Clin Nurs 2020;29(11- 12):1832-57.
  • 9. Chang D, Xu H, Rebaza A, Sharma L, Dela Cruz CS. Protecting health-care workers from subclinical coronavirus infection. Lancet Respir Med 2020; 8(3): e13.
  • 10. Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care providers during the COVID-19 crisis in China: A qualitative study. Lancet Glob Health 2020;8(6):e790-e798.
  • 11. Gebreheat G, Teame H. Ethical challenges of nurses in COVID-19 pandemic: Integrative review. J Multidiscip Healthc 2021;14:1029-35.
  • 12. Kackin O, Ciydem E, Aci OS, Kutlu FY. Experiences and psychosocial problems of nurses caring for patients diagnosed with COVID-19 in Turkey: A qualitative study. Int J Soc Psychiatry 2021;67(2):158-67.
  • 13. Turale S, Meechamnan C, Kunaviktikul W. Challenging times: Ethics, nursing and the COVID-19 pandemic. Int Nurs Rev 2020;67(2):164-7.
  • 14. McKenna H. Covid-19: Ethical issues for nurses. Int J Nurs Stud 2020;110:103673. 15. Sabatello M, Burke TB, McDonald KE, Appelbaum PS. Disability, ethics, and health care in the COVID-19 pandemic. Am J Public Health 2020;110(10):1523-7.
  • 16. Morley G, Grady C, McCarthy J, Ulrich CM. Covid-19: Ethical challenges for nurses. Hastings Cent Rep 2020;50(3):35-9.
  • 17. Shah A, Aacharya RP. Combating COVID-19 pandemic in Nepal: Ethical challenges in an outbreak. JNMA J Nepal Med Assoc 2020;58(224):276-9.
  • 18. Isfeedvajani MS, Fares F, Moqaddam ZIS. Ethical Issues in COVID-19 Pandemic. Hosp Pract Res 2020;5(4):126-33.
  • 19. Levene LS, Seidu S, Greenhalgh T, Khunti K. Pandemic threatens primary care for long term conditions. BMJ 2020;371:m3793.
  • 20. Halk Sağlığı Uzmanları Derneği. Bulaşıcı Olmayan Hastalıklar Çalışma Grubu. (Alıntılama tarihi: 03.07.2021): Availablefrom: https://hasuder.org.tr/wp-content/uploads/ Bulasici-Olmayan-Hastaliklar-Calisma-Grubu. pdf.
  • 21. American Nurses Association. Nurses, Ethics and the response to the COVID–19 pandemic. (Alıntılama tarihi: 12.07.2021): Available from: https://www.nursingworld. org/~495c6c/globalassets/practiceandpolicy/ work-environment/health--safety/coronavirus/ nurses-ethics-and-the-response-to-the-covid- 19-pandemic.pdf.
  • 22. Zhu J, Stone T, Petrini M. The ethics of refusing to care for patients during the coronavirus pandemic: A Chinese perspective. Nurs Inq 2021;28(1):e12380.
  • 23. Kinsinger FS. Beneficence and the professional’s moral imperative. J Chiropr Humanit 2009;16(1):44-6.
  • 24. Cousins E, Vries K, Dening KH. Ethical care during COVID-19 for care home residents with dementia. Nurs Ethics 2021;28(1):46-57.
  • 25. World Health Organization.Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance. (Alıntılama tarihi: 13.04.2020): Available from: https://apps.who. int/iris/handle/10665/331446.
  • 26. Daştan GS, Boran P. Ebeveyn antropometrik ölçümlerinin çocuk baş çevresi üzerine etkisi. Çocuk Dergisi 2018;18(3):113-20.
  • 27. Iserson KV. Healthcare ethics during a pandemic. West J Emerg Med 2020;21(3):477-83.
  • 28. Firouzkouhi M, Alimohammadi N, Kako M, Abdollahimohammad A, Bagheri G, Nouraie M. Ethical challenges of nurses related COVID-19 pandemic in inpatient wards: An integrative review. Ethics Med Public Health 2021;18:100669.
There are 27 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Melek Esin 0000-0002-5476-9419

Ayşe Dost 0000-0002-4651-7254

Nursel Gülyenli 0000-0003-3592-3270

Publication Date October 31, 2021
Submission Date August 13, 2021
Published in Issue Year 2021 Volume: 4 Issue: S-1

Cite

MLA Esin, Melek et al. “Aile Sağlığı Merkezlerinde Çalışan Hemşirelerin COVID-19 Pandemisi Sürecinde Karşılaştıkları Etik Sorunlar: Bir Nitel Çalışma”. Sağlık Bilimlerinde İleri Araştırmalar Dergisi, vol. 4, no. S-1, 2021, pp. 51-62, doi:10.26650/JARHS2021-982400.