The struggle for good care: moral challenges during the COVID-19 lockdown of Dutch elderly care facilities

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  • 1 University of Humanistic Studies and Careyn Zuid-Hollandse Eilanden, , the Netherlands
  • | 2 University of Humanistic Studies, , the Netherlands
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The COVID-19 lockdown of Dutch long-term care facilities between March and May 2020 affected the quality of lives of residents and opposed professional and personal ethics of care. This article, based on 25 in-depth interviews with healthcare chaplains, gives insight into what moral challenges appeared for care professionals. Moral challenges were related to: ‘family ruptures’, ‘residents’ loneliness and despair’, ‘cold-hearted deaths’ and ‘response and responsibilities’. The findings illuminate the complexity of providing care during the lockdown and show variation in the impact of these ethical experiences, in which both moral distress and moral resilience occurred.

  • Arendt, H. (1972) Crisis of the Republic: Lying in Politics; Civil Disobedience; On Violence; Thoughts on Politics and Revolution, 1st edn, Boston, MA: Houghton Mifflin.

    • Search Google Scholar
    • Export Citation
  • Arendt, H. (2018) The Human Condition, 2nd edn, Chicago, IL: The University of Chicago Press.

  • Borges, L.M., Barnes, S.M., Farnsworth, J.K., Bahraini, N.H. and Brenner, L.A. (2020) A commentary on moral injury among health care providers during the COVID-19 pandemic, Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1): S138. doi: 10.1037/tra0000507

    • Search Google Scholar
    • Export Citation
  • Bouchoucha, S. and Bloomer, M.J. (2020) Family‐centred care during a pandemic: the hidden impact of restricting family visits, Nursing & Health Sciences, 23(1):46.

    • Search Google Scholar
    • Export Citation
  • Bruquetas Callejo, M.M. and Böcker, A. (2021) Governmental response to the COVID-19 pandemic in long-term care residences for older people. Preparedness, responses and challenges for the future, The Netherlands, Working Paper 11/2021, doi: 10.20350/digitalCSIC/13699.

    • Search Google Scholar
    • Export Citation
  • Burston, A.S. and Tuckett, A.G. (2013) Moral distress in nursing: contributing factors, outcomes and interventions, Nursing Ethics, 20(3): 31224. doi: 10.1177/0969733012462049

    • Search Google Scholar
    • Export Citation
  • Campbell, S.M., Ulrich, C.M. and Grady, C. (2016) A broader understanding of moral distress, The American Journal of Bioethics, 16(12): 29. doi: 10.1080/15265161.2016.1239782

    • Search Google Scholar
    • Export Citation
  • Carey, L.B., Hodgson, T.J., Krikheli, L., Soh, R.Y., Armour, A., Singh, T.K. and Impiombato, C.G. (2016) Moral injury, spiritual care and the role of chaplains: an exploratory scoping review of literature and resources, Journal of Religion and Health, 55(4): 121845. doi: 10.1007/s10943-016-0231-x

    • Search Google Scholar
    • Export Citation
  • Čartolovni, A., Stolt, M., Scott, P.A. and Suhonen, R. (2021) Moral injury in healthcare professionals: a scoping review and discussion, Nursing Ethics, 28(5): 590602.

    • Search Google Scholar
    • Export Citation
  • CBS (Centraal Bureau voor de Statistiek) (2020a) Aantal bewoners van verzorgings- en verpleeghuizen 2019 [Number of nursing home residents 2019], www.cbs.nl/nl-nl/maatwerk/2020/13/aantal-bewoners-van-verzorgings-en-verpleeghuizen-2019.

    • Search Google Scholar
    • Export Citation
  • CBS (2020b) Sterfte onder bewoners van institutionele huishoudens bijna verdubbeld [Deaths of institutional residents almost doubled], www.cbs.nl/nl-nl/nieuws/2020/16/sterfte-onder-bewoners-van-institutionele-huishoudens-bijna-verdubbeld.

    • Search Google Scholar
    • Export Citation
  • Coulter, A. and Richards, T. (2020) Care during COVID-19 must be humane and person centred, BMJ, 2020 September 8, 370: m3483.

  • Cousins, E., de Vries, K. and Dening, K.H. (2021) Ethical care during COVID-19 for care home residents with dementia, Nursing Ethics, 28(1): 4657. doi: 10.1177/0969733020976194

    • Search Google Scholar
    • Export Citation
  • Damen, A., Delaney, A. and Fitchett, G. (2018) Research priorities for healthcare chaplaincy: views of U.S. chaplains, Journal of Health Care Chaplaincy, 24(2): 5766. doi: 10.1080/08854726.2017.1399597

    • Search Google Scholar
    • Export Citation
  • DeBruin, D. and Leider, J.P. (2020) COVID-19: the shift from clinical to public health ethics, Journal of Public Health Management and Practice, 26(4): 3069. doi: 10.1097/PHH.0000000000001204

    • Search Google Scholar
    • Export Citation
  • European Network of Healthcare Chaplaincy (2017) Health care chaplaincy in the Netherlands, http://enhcc.eu/netherlands.htm.

  • Fine, M. and Tronto, J. (2020) Care goes viral: care theory and research confront the global COVID-19 pandemic, International Journal of Care and Caring, 4(3): 3019. doi: 10.1332/239788220X15924188322978

    • Search Google Scholar
    • Export Citation
  • Fourie, C. (2017) Who is experiencing what kind of moral distress? Distinctions for moving from a narrow to a broad definition of moral distress, AMA Journal of Ethics, 19(6): 57884. doi: 10.1001/journalofethics.2017.19.6.nlit1-1706

    • Search Google Scholar
    • Export Citation
  • Frampton, S., Agrawal, S. and Guastello, S. (2020) Guidelines for family presence policies during the covid-19 pandemic, JAMA Health Forum, 1(7): e200807.

    • Search Google Scholar
    • Export Citation
  • Gale, N.K., Heath, G., Cameron, E., Rashid, S. and Redwood, S. (2013) Using the framework method for the analysis of qualitative data in multi-disciplinary health research, BMC Medical Research Methodology, 13(1): 18. doi: 10.1186/1471-2288-13-1

    • Search Google Scholar
    • Export Citation
  • Gastmans, C. (2013) Dignity-enhancing nursing care: a foundational ethical framework, Nursing Ethics, 20(2): 1429. doi: 10.1177/0969733012473772

    • Search Google Scholar
    • Export Citation
  • Haidt, J. (2003) The moral emotions, in R.J. Davidson, K.R. Scherer and H.H. Goldsmith (eds), Handbook of Affective Sciences Oxford: Oxford University Press. pp 85270.

    • Search Google Scholar
    • Export Citation
  • Haker, H. (2009) Narrative ethics in health care chaplaincy, W. Moczynski, H. Haker and K. Bentele (eds) Medical Ethics in Health Care Chaplaincy. Essays, Berlin: LIT, pp 14373.

    • Search Google Scholar
    • Export Citation
  • Harrison, S. and Scarle, J. (2020) How are chaplaincy departments responding amidst the COVID-19 pandemic? A snapshot of UK responses to a questionnaire, Health and Social Care Chaplaincy, 8(2): 14353. doi: 10.1558/hscc.41624

    • Search Google Scholar
    • Export Citation
  • Hermsen, J. (2019) Het tij keren. Met Rosa Luxemburg en Hannah Arendt [Turn the Tide. with Rosa Luxemburg and Hannah Arendt], 1st edn, Amsterdam: Promotheus.

    • Search Google Scholar
    • Export Citation
  • Hossain, F. and Clatty, A. (2021) Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic, Nursing Ethics, 28(1): 2332. doi: 10.1177/0969733020961825

    • Search Google Scholar
    • Export Citation
  • Humanist Association (2020) Zorg manifest [Care manifesto], www.humanistischverbond.nl/zorgmanifest/.

  • Jameton, A. (1984) Nursing Practice: The Ethical Issues, Englewood Cliffs, NJ: Prentice-Hall.

  • Jameton, A. (1993) Dilemmas of moral distress: moral responsibility and nursing practice, AWHONN’s Clinical Issues in Perinatal and Women’s Health Nursing, 4(4): 542.

    • Search Google Scholar
    • Export Citation
  • Jia, Y., Chen, O., Xiao, Z., Xiao, J., Bian, J. and Jia, H. (2021) Nurses’ ethical challenges caring for people with COVID-19: a qualitative study, Nursing Ethics, 28(1): 3345. doi: 10.1177/0969733020944453

    • Search Google Scholar
    • Export Citation
  • Jones, K.F., Washington, J., Kearney, M. and Best, M.C. (2020) Responding to the ‘unknown assailant’: a qualitative exploration with Australian health and aged care chaplains on the impact of COVID-19, Journal of Health Care Chaplaincy 2020 December, 28: 115. doi: 10.1080/08854726.2020.1861536

    • Search Google Scholar
    • Export Citation
  • Kamerstukken (2020a) Lessen verpleeghuizen met het oog op een eventuele tweede golf [Nursing homes’ lessons for a possible second wave], Kamerstukken vergaderjaar 2019/2020, 25295, nr. 461, https://zoek.officielebekendmakingen.nl/kst-25295-461.html.

    • Search Google Scholar
    • Export Citation
  • Kamerstukken (2020b) Aanscherping bezoek verpleeghuizen i.v.m. COVID-19 [Restricting the number of visitors in nursing homes in the context of COVID-19], Kamerstukken vergaderjaar 2019/2020, 31765, nr. 491, https://zoek.officielebekendmakingen.nl/kst-31765-491.html.

    • Search Google Scholar
    • Export Citation
  • Kiers, B. (2020) Anne-Mei The: ‘Coronacrisis drukt kwaliteit van leven weg’ [Anne-Mei The: ‘Corona crisis pushes away the quality of life’], www.skipr.nl/nieuws/anne-mei-the-coronacrisis-drukt-kwaliteit-van-leven-weg/.

    • Search Google Scholar
    • Export Citation
  • Kruse, F., Remers, T. and Jeurissen, P. (2020) The impact of COVID-19 on long-term care in the Netherlands, Country Report, LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 24, Google Scholar, 2020 May 26, https://ltccovid.org/wp-content/uploads/2020/05/COVID19-Long-Term-Care-situation-in-the-Netherlands-25-May-2020-1.pdf

    • Search Google Scholar
    • Export Citation
  • Kumar, R. (2018) Research Methodology: A Step-by-Step Guide for Beginners, Sage.

  • Lachman, V.D. (2007) Moral courage: a virtue in need of development?, Medsurg Nursing, 16(2): 131, https://pubmed.ncbi.nlm.nih.gov/17547273/

    • Search Google Scholar
    • Export Citation
  • Lachman, V.D. (2016) Moral resilience: managing and preventing moral distress and moral residue, Medsurg Nursing, 25(2): 1215.

  • Leontjevas, R., Knippenberg, I.A., Smalbrugge, M., Plouvier, A.O., Teunisse, S., Bakker, C., Koopmans, R.T. and Gerritsen, D.L. (2020) Challenging behavior of nursing home residents during COVID-19 measures in the Netherlands, Aging & Mental Health, 25(7): 131419.

    • Search Google Scholar
    • Export Citation
  • Lyndes, K.A., Fitchett, G., Thomason, C.L., Berlinger, N. and Jacobs, M.R. (2008) Chaplains and quality improvement: can we make our case by improving our care?, Journal of Health Care Chaplaincy, 15(2): 6579. doi: 10.1080/08854720903113416

    • Search Google Scholar
    • Export Citation
  • Maguen, S. and Price, M.A. (2020) Moral injury in the wake of coronavirus: attending to the psychological impact of the pandemic, Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1): S131. doi: 10.1037/tra0000479

    • Search Google Scholar
    • Export Citation
  • McCarthy, J. and Gastmans, C. (2015) Moral distress: a review of the argument-based nursing ethics literature, Nursing Ethics, 22(1): 13152. doi: 10.1177/0969733014557139

    • Search Google Scholar
    • Export Citation
  • McCarthy, J. and Monteverde, S. (2018) The standard account of moral distress and why we should keep it, HEC Forum, 30(4): 31928. doi: 10.1007/s10730-018-9349-4

    • Search Google Scholar
    • Export Citation
  • Miljeteig, I., Forthun, I., Hufthammer, K.O., Engelund, I.E., Schanche, E., Schaufel, M. and Onarheim, K.H. (2021) Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway, Nursing Ethics, 28(1): 6681. doi: 10.1177/0969733020981748

    • Search Google Scholar
    • Export Citation
  • Morley, G., Bradbury-Jones, C. and Ives, J. (2020a) What is ‘moral distress’ in nursing? A feminist empirical bioethics study, Nursing Ethics, 27(5): 1297314. doi: 10.1177/0969733019874492

    • Search Google Scholar
    • Export Citation
  • Morley, G., Sese, D., Rajendram, P. and Horsburgh, C.C. (2020b) Addressing caregiver moral distress during the COVID-19 pandemic, Cleveland Clinic Journal of Medicine, 9 June. doi: 10.3949/ccjm.87a.ccc047.

    • Search Google Scholar
    • Export Citation
  • Muthert, H., Kraker-Zijlstra, d.A. and Holsappel, J. (2020) Geestelijke zorg in tijden van corona: verbinding op afstand [Chaplaincy in times of corona: connection at a distance], Tijdschrift Geestelijke Verzorging, 23(98): 249.

    • Search Google Scholar
    • Export Citation
  • Patton, M.Q. (2015) Qualitative Research and Evaluation Methods, Integrating Theory and Practice, 4th edn, Thousand Oaks, CA: Sage Publications Inc.

    • Search Google Scholar
    • Export Citation
  • Peter, E., Lunardi, V.L. and Macfarlane, A. (2004) Nursing resistance as ethical action: literature review, Journal of Advanced Nursing, 46(4): 40316. doi: 10.1111/j.1365-2648.2004.03008.x

    • Search Google Scholar
    • Export Citation
  • Rijksoverheid (2020) Eerste stap nieuwe bezoekregeling verpleeghuizen [First stage new visitors rules in nursing homes], www.rijksoverheid.nl/actueel/nieuws/2020/05/06/eerste-stap-nieuwe-bezoekregeling-verpleeghuizen.

    • Search Google Scholar
    • Export Citation
  • RTL nieuws (2020) Aantal coronadoden boven de 6000, bijna de helft overleed in verpleeghuis [Number of deaths from corona over 6,000, almost half of them died in nursing homes], www.rtlnieuws.nl/nieuws/artikel/5144186/corona-doden-sterfgevallen-overleden-verpleeghuis-ouderen.

    • Search Google Scholar
    • Export Citation
  • Rushton, C.H. (2016) Moral resilience: a capacity for navigating moral distress in critical care, AACN Advanced Critical Care, 27(1): 11119. doi: 10.4037/aacnacc2016275

    • Search Google Scholar
    • Export Citation
  • Rushton, C.H., Caldwell, M. and Kurtz, M. (2016) CE: moral distress: a catalyst in building moral resilience, The American Journal of Nursing, 116(7): 409. doi: 10.1097/01.NAJ.0000484933.40476.5b

    • Search Google Scholar
    • Export Citation
  • Rutte, M. and de Jonge, H. (dirs) (2020) Press conference, www.youtube.com/watch?v=Yqx0PlSnUFE.

  • Rutte, M., Grappenhuis, F. and van Rijn, M. (dirs) (2020) Integral press conference, www.youtube.com/watch?v=FEZlfShZdP4.

  • Schols, J., Poot, E.P., Nieuwenhuizen, N.M. and Achterberg, W.P. (2020) Dealing with COVID-19 in Dutch nursing homes, Journal of Nursing Home Research, 2020 6(July): 304.

    • Search Google Scholar
    • Export Citation
  • Shahriari, M., Mohammadi, E., Abbaszadeh, A. and Bahrami, M. (2013) Nursing ethical values and definitions: a literature review, Iranian Journal of Nursing and Midwifery Research, 18(1): 1.

    • Search Google Scholar
    • Export Citation
  • Sizoo, E.M., Monnier, A.A., Bloemen, M., Hertogh, C.M. and Smalbrugge, M. (2020) Dilemmas with restrictive visiting policies in Dutch nursing homes during the COVID-19 pandemic: a qualitative analysis of an open-ended questionnaire with elderly care physicians, Journal of the American Medical Directors Association, 21(12): 177481. doi: 10.1016/j.jamda.2020.10.024

    • Search Google Scholar
    • Export Citation
  • Stoeldraijer, L., Traag, T. and Harmsen, C. (2021) Oversterfte tijdens eerste golf corona-epidemie bijna dubbel zo hoog als tijdens griepepidemie [Excess mortality during the first wave of the corona epidemic almost half as high as during the flu epidemic], www.cbs.nl/nl-nl/longread/statistische-trends/2021/oversterfte-tijdens-eerste-golf-corona-epidemie-bijna-dubbel-zo-hoog-als-tijdens-griepepidemie.

    • Search Google Scholar
    • Export Citation
  • Szczerbińska, K. (2020) Could we have done better with COVID-19 in nursing homes?, European Geriatric Medicine, 11(4): 63943.

  • The, A.M. (2020) Anne-Mei The logeerde tijdens de coronacrisis twee maanden in het verpleeghuis, en was ooggetuige van een stille ramp [Anne-Mei The spent two months in a nursing home during the corona crisis and witnessed a silent disaster], Trouw, www.trouw.nl/zorg/anne-mei-the-logeerde-tijdens-de-coronacrisis-twee-maanden-in-het-verpleeghuis-en-was-ooggetuige-van-een-stille-ramp~b0564435/.

    • Search Google Scholar
    • Export Citation
  • Todd, A. (2012) Military Chaplaincy in Contention: Chaplains, Churches, and the Morality of Conflict, London: Routledge.

  • Turale, S., Meechamnan, C. and Kunaviktikul, W. (2020) Challenging times: ethics, nursing and the COVID‐19 pandemic, International Nursing Review, 67(2): 1647. doi: 10.1111/inr.12598

    • Search Google Scholar
    • Export Citation
  • Van der Roest, H.G., Prins, M., van der Velden, C., Steinmetz, S., Stolte, E., van Tilburg, T.G. and de Vries, D.H. (2020) The impact of COVID-19 measures on well-being of older long-term care facility residents in the Netherlands, Journal of the American Medical Directors Association, 21(11): 156970. doi: 10.1016/j.jamda.2020.09.007

    • Search Google Scholar
    • Export Citation
  • Verbeek, H., Gerritsen, D.L., Backhaus, R., de Boer, B.S., Koopmans, R.T. and Hamers, J.P. (2020) Allowing visitors back in the nursing home during the COVID-19 crisis: a Dutch national study into first experiences and impact on well-being, Journal of the American Medical Directors Association, 21(7): 9004. doi: 10.1016/j.jamda.2020.06.020

    • Search Google Scholar
    • Export Citation
  • VGVZ (Dutch Professional Association of Health Care Chaplains) (2015) Beroepsstandaard [Professional standard], https://vgvz.nl/over-de-vgvz/beroepsstandaard-gv-2015/.

    • Search Google Scholar
    • Export Citation
  • Walker, M.U. (1989) Moral understandings: alternative ‘epistemology’ for a feminist ethics, Hypatia, 4(2): 1528. doi: 10.1111/j.1527-2001.1989.tb00570.x

    • Search Google Scholar
    • Export Citation
  • Wallenburg, I., Helderman, J., Jeurissen, P. and Bal, R. (2021) Unmasking a health care system: the Dutch policy response to the COVID-19 crisis, Health Economics, Policy and Law, 5(March): 110. doi: 10.1017/S1744133121000128

    • Search Google Scholar
    • Export Citation
  • Wierstra, I.R., Jacobs, G. and Schuhmann, C. (2020) Present in times of crisis: the impact of COVID-19 on activities, visibility, and recognizability of chaplains in a healthcare organization in the Netherlands, Health and Social Care Chaplaincy, 8(2): 191205. doi: 10.1558/hscc.41833

    • Search Google Scholar
    • Export Citation
  • 1 University of Humanistic Studies and Careyn Zuid-Hollandse Eilanden, , the Netherlands
  • | 2 University of Humanistic Studies, , the Netherlands

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