Nurses are key players in the health care sector of a nation. They provide care and information to patients and occupy leadership positions in the health systems, hospitals, and other related organizations. However, being a nurse is not a walk in the park as the profession is flooded with challenges that require one to have full dedication and commitment. Among several challenges nurses face are workplace hazards related to the execution of their daily duties. The dangers are mostly associated with blood-borne pathogens. A study conducted by the University of Manchester indicates that in 12.2 million health workers, 5.6 million are at a high risk of getting blood-borne pathogens (Ramos et al., 2016). However, the outbreak of COVID 19 has made the work of health personnel more complicated due to its nature. COVID 19 has fatal health consequences and is easily transmitted to uninfected persons, thus presenting a delicate scenario to nurses handling the patients. This paper analyses the COVID-19 virus, how health centres are prepared to handle the epidemic, and the ethical dilemmas nurses face while executing their duties on patients and suspects.
Coronaviruses are defined as viruses of large families that cause the common cold, Middle East respiratory syndrome, and severe acute respiratory syndrome (SARS-CoV). The disease of coronavirus, commonly referred to as (COVID-19), was discovered in December 2019 in China. By the end of the same month, COVID-19 was already declared a public health emergency by the World Health Organization. Since then, the spread of COVID-19 has been so rapid, causing over 14,510 death cases across 190 countries as of March 23, 2020, leading to WHO declaring it a pandemic.
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Diseases associated with COVID-19 relate to the common cold, severe cases are Middle East Respiratory Syndrome (MERS-V), and Severe Acute Respiratory Syndrome (SAR-CoV). Researchers confirmed that the virus is zoo tonic-transferable between people and animals. Further statistics reveal that the SAR-CoV virus to humans is from the cat, while MERS-CoV comes from camels. The disease is associated with respiratory symptoms, cough, fever, and difficulty in breathing. In advanced cases, the disease can lead to pneumonia, kidney failure, severe acute respiratory syndrome, and death. However, there are prevention measures that help to minimize the spread of the disease. The methods rely on cleanliness, disinfection, and proper cooking methods to reduce the lifespan of the virus. Also, maximum avoidance of coming in contact with patients or people suspected to have the virus should be exercised to the latter (Zhao et al., 2020).
According to Zhao et al., 2020, health care facilities have incorporated measures to suppress and manage COVID-19. The standards aid in limiting exposure among other patients and health facility workers. First, persons entering the health facility are limited, and face to face triage have been given alternative ways. Patients with respiratory infections strictly follow hygiene and cough etiquette and restructuring of barriers at the reception to reduce conduct enforced. Also, patients with COVID-19 are isolated in their room and allocated a medical practitioner to provide care and medication. Visitors to the affected patients have been limited and thoroughly screened before entering the facility. In some situations, the visits are prohibited and substituted with video calls between victims and their people. Lastly, during the reception of patients, those having respiratory issues are given priority ( Wang et al., 2020).
In line with managing patients and suspects of COVID-19, nurses encounter various ethical dilemmas. The first ethical dilemma is the principle of beneficence. The principle requires people to be treated ethically by protecting them from harm and respecting their decisions as well as guaranteeing their well-being. The principle bases its reference on two rules which are; do not harm and maximize possible benefits. However, nurses face a dilemma of ensuring this principle to the patients due to the dangerous nature of the virus. In some health facilities, patients do not get the services due to incapacitated facilities to contain the victim. Furthermore, some cases have been reported where nurses run away from patients suspected to have the virus, which amounts to stigmatization and unethical conduct. As much as the nurses may appear unethical, it is worth noting that they face a critical dilemma since the rate of patient-nurse infections are high in this pandemic. To solve this, there is a creation of isolated rooms to patients of COVID-19, where they are enclosed with their doctor. Training and equipping nurses on how to handle the patients is also ongoing, though with limited time and resources (Zhao et al., 2020).
Furthermore, there is the principle of veracity presenting nurses with a further dilemma. The principle insists on honesty and truth and is more related to the principle of autonomy. There should be a trust relationship between the nurses and the patients, which allows patients to make their own rational decisions of best interest. According to Centres for Disease Control and Prevention (CDC), there is no cure for coronavirus, and treatment is based on other respiratory diseases and seasonal flu commonly referred to as supportive care. Nurses incur an ethical dilemma for delivering this bitter truth to patients keeping in mind the thousands of fatalities being experienced globally. The scenario can be overcome by creating awareness to the public on the overall information about the virus-like the cause, transmission, prevention, and management. The information will help the patients to have prior knowledge before even getting infected.
The third ethical principle is justice. According to handle, Arianto, Trisyani, and Emiliyawati (2018 ), the principle of justice states that there should be fairness and equity. Clients to be given equal opportunity to treatment and allocation of resources. In the concept of medicine, all the patients should be treated with fairness and equity from nurses. However, based on the strategies implemented to manage and contain COVID-19, nurses discriminate against patients and suspects of the virus. Unlike other clients, patients and suspects of COVID-19 are isolated in enclosed arrears with a medical professional. There is a firm restriction of access by visitors, relatives, and other family members wishing to view their progress (Zhao et al., 2020). The nurses fail to interact with corona patients freely the same way they do with other patients. Also, there is the installation of barriers in the reception to minimize the contact between staff members with the infected clients. Nurses implement all these procedures in an attempt to control the spread of the COVID-19 virus among them. The situation can be resolved by visitors being given the required information about the handling of persons with the COVID-19 infection. Furthermore, nurses should be trained enough and equipped with proper protective gear.
Besides, there is a principle of totality and integrity. This principle states that when the medical facility is making a decision, it must consider the good of the entire person, which incorporates psychological, physical, and spiritual factors (Wang, 2020). The founder of the principle, Thomas Aquinas, made it a widely used principle in Catholic healthcare establishments. Nurses face an ethical dilemma in a sense they fail to provide treatment for the patients and instead avoid them. Furthermore, the patients do not access the moral support and comfort from the nurses. To handle the case, health care managers should restructure their facilities with the necessary equipment for handling patients with the COVID-19 virus ( Zhao et al., 2020).
Lastly, other ethical dilemmas of nurses have been exhibited on the principle of autonomy, which views the right of an individual to self-determination. It is extracted from the society and requires that a person makes his or her own informed decision for the benefit of their community and not for the health facility (Arianto, Trisyani, & Emiliyawati, 2018). COVID-19 virus is easily transmitted from one person to another through coughing and sneezing from an infected person. Therefore, a patient's right of movement is denied for this case. Besides, the nurse will face the dilemma of denying patients any rational decisions concerning visits. This scenario can be solved by instituting video call between the patient and their family members or friends.
In conclusion, the COVID-9 virus is a dangerous disease that should not only be addressed by all stakeholders but also with each individual's concern. The global loss attributed to the virus starting from Asia to Europe, America, and Africa is worth the attention of the health facilities and governments to initiate costly and appropriate measure of counter-attacking the pandemic. Nurses' ethical dilemmas are part of their profession definition, but re-address of the issues can be well utilized by putting the strategies initiated in health facilities into practice. The practice will as well help resolve the pandemic and minimize mortality rates and adverse economic consequences.
Arianto, A. B., Trisyani, Y., & Emiliyawati, E. (2018). Ethical dilemmas of end of life care in the intensive care unit: A literature review. Jurnal Pendidikan Keperawatan Indonesia , 4 (2). doi:10.17509/jpki.v4i2.13637
Wang, S., Guo, L., Chen, L., Liu, W., Cao, Y., Zhang, J., & Feng, L. (2020). A case report of neonatal COVID-19 infection in China. Clinical Infectious Diseases . doi:10.1093/cid/ciaa225
Zhao, D., Yao, F., Wang, L., Zheng, L., Gao, Y., Ye, J., … Gao, R. (2020). A comparative study on the clinical features of COVID-19 pneumonia to other pneumonias. Clinical Infectious Diseases . doi:10.1093/cid/ciaa247