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.
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
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):4–6.
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.
Burston, A.S. and Tuckett, A.G. (2013) Moral distress in nursing: contributing factors, outcomes and interventions, Nursing Ethics, 20(3): 312–24. doi: 10.1177/0969733012462049
Campbell, S.M., Ulrich, C.M. and Grady, C. (2016) A broader understanding of moral distress, The American Journal of Bioethics, 16(12): 2–9. doi: 10.1080/15265161.2016.1239782
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): 1218–45. doi: 10.1007/s10943-016-0231-x
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): 590–602.
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.
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.
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): 46–57. doi: 10.1177/0969733020976194
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): 57–66. doi: 10.1080/08854726.2017.1399597
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): 306–9. doi: 10.1097/PHH.0000000000001204
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): 301–9. doi: 10.1332/239788220X15924188322978
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): 578–84. doi: 10.1001/journalofethics.2017.19.6.nlit1-1706
Frampton, S., Agrawal, S. and Guastello, S. (2020) Guidelines for family presence policies during the covid-19 pandemic, JAMA Health Forum, 1(7): e200807.
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): 1–8. doi: 10.1186/1471-2288-13-1
Gastmans, C. (2013) Dignity-enhancing nursing care: a foundational ethical framework, Nursing Ethics, 20(2): 142–9. doi: 10.1177/0969733012473772
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 852–70.
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 143–73.
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): 143–53. doi: 10.1558/hscc.41624
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.
Hossain, F. and Clatty, A. (2021) Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic, Nursing Ethics, 28(1): 23–32. doi: 10.1177/0969733020961825
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.
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): 33–45. doi: 10.1177/0969733020944453
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: 1–15. doi: 10.1080/08854726.2020.1861536
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.
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.
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/.
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
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/
Lachman, V.D. (2016) Moral resilience: managing and preventing moral distress and moral residue, Medsurg Nursing, 25(2): 121–5.
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): 1314–19.
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): 65–79. doi: 10.1080/08854720903113416
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
McCarthy, J. and Gastmans, C. (2015) Moral distress: a review of the argument-based nursing ethics literature, Nursing Ethics, 22(1): 131–52. doi: 10.1177/0969733014557139
McCarthy, J. and Monteverde, S. (2018) The standard account of moral distress and why we should keep it, HEC Forum, 30(4): 319–28. doi: 10.1007/s10730-018-9349-4
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): 66–81. doi: 10.1177/0969733020981748
Morley, G., Bradbury-Jones, C. and Ives, J. (2020a) What is ‘moral distress’ in nursing? A feminist empirical bioethics study, Nursing Ethics, 27(5): 1297–314. doi: 10.1177/0969733019874492
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.
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): 24–9.
Patton, M.Q. (2015) Qualitative Research and Evaluation Methods, Integrating Theory and Practice, 4th edn, Thousand Oaks, CA: Sage Publications Inc.
Peter, E., Lunardi, V.L. and Macfarlane, A. (2004) Nursing resistance as ethical action: literature review, Journal of Advanced Nursing, 46(4): 403–16. doi: 10.1111/j.1365-2648.2004.03008.x
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.
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.
Rushton, C.H. (2016) Moral resilience: a capacity for navigating moral distress in critical care, AACN Advanced Critical Care, 27(1): 111–19. doi: 10.4037/aacnacc2016275
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): 40–9. doi: 10.1097/01.NAJ.0000484933.40476.5b
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): 30–4.
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.
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): 1774–81. doi: 10.1016/j.jamda.2020.10.024
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.
Szczerbińska, K. (2020) Could we have done better with COVID-19 in nursing homes?, European Geriatric Medicine, 11(4): 639–43.
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/.
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): 164–7. doi: 10.1111/inr.12598
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): 1569–70. doi: 10.1016/j.jamda.2020.09.007
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): 900–4. doi: 10.1016/j.jamda.2020.06.020
VGVZ (Dutch Professional Association of Health Care Chaplains) (2015) Beroepsstandaard [Professional standard], https://vgvz.nl/over-de-vgvz/beroepsstandaard-gv-2015/.
Walker, M.U. (1989) Moral understandings: alternative ‘epistemology’ for a feminist ethics, Hypatia, 4(2): 15–28. doi: 10.1111/j.1527-2001.1989.tb00570.x
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): 1–10. doi: 10.1017/S1744133121000128
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): 191–205. doi: 10.1558/hscc.41833
May 2022 onwards | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 0 | 0 | 0 |
Full Text Views | 16 | 16 | 16 |
PDF Downloads | 4 | 4 | 4 |