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. 2025 May;32(3):900-912.
doi: 10.1177/09697330241268923. Epub 2024 Aug 23.

COVID-19 guidelines and media influenced ethical care in nursing homes

Caroline Wachtler  1 , Monica Bergqvist  1 , Pia Bastholm-Rahmner  1 , Lars L Gustafsson  1 , Katharina Schmidt-Mende  1
Affiliations

COVID-19 guidelines and media influenced ethical care in nursing homes

Caroline Wachtler et al. Nurs Ethics. 2025 May.

Abstract

BackgroundThe early phase of the COVID-19 pandemic affected nursing homes and their residents heavily. Guidelines on how to mitigate the virus's spread and ensuring safe healthcare delivery were continually evolving. Concurrently, nursing homes faced intense media scrutiny. This challenging environment severely impacted registered nurses and physicians employed within these facilities.AimTo understand the ethical challenges experienced by registered nurses and physicians working in nursing homes during the COVID-19 pandemic.Research designQualitative descriptive research using thematic analysis.Participants and research contextIndividual online interviews with four registered nurses and eight physicians clinically active at nursing homes in Sweden.Ethical considerationsThe study was approved by the Swedish Ethical Review Authority. All participants provided written consent.ResultsRegistered nurses and physicians working in nursing homes perceived ethical challenges stemming from early COVID-19 pandemic guidelines and media coverage. The main theme generated was 'Struggling to maintain professional and ethical standards under pressure' incorporating two subthemes: 'Guidelines developed without the profession put pressure on staff' and 'Media's biased reporting was perceived as unethical and undermined care'. Guidelines from the authorities were considered as developed without professional involvement. It made them difficult to adhere to without deviating from professional and ethical compasses. Media coverage adversely influenced relatives' perceptions, resulting in mistrust towards physicians' and registered nurses' in delivering optimal care for the residents.ConclusionsResilient care in nursing homes necessitates the collaborative development of guidelines involving registered nurses and physicians, particularly amidst crises. Moreover, it is vital to provide support to registered nurses navigating ethical dilemmas, especially during pandemics. Guidelines and principles for care during a crisis should be development with professional involvement, be transparent, and be available to the public, to promote neutral media coverage. Future research is crucial to enhance ethical standards and tackle challenges in this context.

Keywords: COVID-19; ethical challenges; guidelines; media; nursing homes; qualitative study.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Themes and subthemes outlining the challenges experienced by registered nurses and physicians in nursing homes due to guidelines and media attention.
Figure 2.
Figure 2.
Spectrum of physicians approaches to guidelines restricting physical visits.
See this image and copyright information in PMC

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