Ethical Dilemmas and Moral Distress in Health Emergencies: The Case of the COVID-19 Pandemic in Spanish Nurses-A Qualitative Study.

BACKGROUND: The COVID-19 pandemic created unprecedented ethical challenges for nurses, often culminating in moral distress. AIM: The aim of this study was to explore the experiences of Spanish nurses in relation to moral distress and ethical conflicts experienced during the COVID-19 pandemic. DESIGN: Qualitative phenomenological study. METHODS: Nurses who had tended COVID-19 patients were given a semi-structured interview via the Zoom application. Thematic analysis was carried out, identifying units of meaning and assigning codes that were grouped into the different categories using Open Code software. RESULTS: Seventeen nurses participated and four categories emerged: (i) Difficulties in the general management of the pandemic on the institutional level, (ii) Limitation of patients' rights in a pandemic situation, (iii) Influence on the humanization of healthcare, (iv) Impact on professionals and on the profession. CONCLUSION: Restrictions on patients' and families' rights during the pandemic generated ethical conflicts for healthcare professionals. In addition, the scarcity of both human and material resources, together with limited access to information, intensified value conflicts in clinical practice. IMPACT: This project provides evidence on ethical conflicts experienced by nurses during the pandemic, both in the quality of care and professionals' well-being. Findings will contribute to and have an impact on future action protocols and public policies aimed at better managing ethical challenges in health emergency situations.