INTRODUCTION:

In normal courses clinical care is patient centered, with the ethical course of action aligned, as far as possible, with the preferences and value of the individual patient. A public health emergency, such as a surge of person seeking health care as wall as critically ill patient with Covid-19 or another severe respiratory illness, disrupts normal process for supporting ethically sound patient care. Ensuring the health of the population, especially in an Emergency, can Require Limitation on Individual Rights and Preferences. There is a basic tension between the patient centered approach of clinical care under normal condition and the public centered approach of clinical under emergency condition. Public health ethics guides us in balancing this tension between the needs of the individual and those of the group. The devasting pandemic Covid-19 that has stricken the worldwide population induced an unprecedented influx of sever ARDS patient dramatically exceeding ICU bed capacities in several areas of many countries.

Incidence:

The Covid-19 pandemic with 25,602,665 cases and 852,758 death worldwide (WHO dashboard as on 2 September 2020) with more than 4 million cases and 71642 deaths in India (as per Arogya setu app statistics) has highlighted many of the difficult ethical issues that health care professionals comfort in caring for patients and families. the decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. American nurse’s association (ANA) code of ethics for nurses with interpretive statements (2015) for nurses worldwide and INC code of ethics for nurses in India are the nursing professions nonnegotiable ethical practice standard.

Code of Ethics:

ANA provision 2 of the code and INC code 1 state that “the nurses primarily commitment is to the patient” and; ANA Provision 5 of the code states that the nurse owes the same duty to self as to others.

These equal obligations can conflict during pandemics when nursing must continually care for critical ill infectious patients, often under extreme circumstance including insufficient or inadequate resources and uncontained contagion. these multiple and even competing duties especially as they combine with civic and personal interests, place nurses many of whom have condition that make them more vulnerable to Covid-19 in a quandary.

The devasting pandemic covid 19 that has stricken the worldwide population induced an unprecedented influx of sever ARDS patient dramatically exceeding ICU bed capacities in several areas of many countries Nurses are required to balance their obligation of beneficence and duty to care for patient rights and responsibilities to address inadequacies with their health care system in way that are consistent with rights and duties to protect themselves and their loved ones.

Given the pratice environment of the Covid-19 pandemic:

The code of ethics for nurses with interpretive statements (2015) provides guidance for nurses in situations of crisis, such as responding to pandemics:

· During pandemics nurses must decide how much high-quality care they can provide to others while also taking care of themselves and their love ones.

· There may be times when a registered nurse must make a choice based on moral grounds in order to maintain professional integrity.

· Hospital, institutions, managers, administrator and health care providers need to understand employer and employee expectations during times of pandemic

· Organizational support for the registered nurse is a non-negotiable necessity.

· Effective communication between registered nurses and organizational management regarding a nurse’s ability to provide care to patient is essential and must be heard and valued at all organizational level.

· As front-line healthcare professional, nurses are key stakeholders in developing and implementation policies regarding standards of care during the Covid-19 pandemic

· Employers have the responsibility to create, maintain, and provide practice environments that help meet the medical needs of the community within a system that protects nurses and other employees or volunteers.

· In considering the nurse sing professions duty to society. INC code of ethic 2 and 3 and interpretive statement 8.4 of the ANA code of ethics for nurses with interpretive statements (2015) states “All actions and omissions risk unintended consequences with implications for human rights.”

· Thus, nurses must engage in discernment carefully assessing their intentions, reflectively weighing all possible options sand rationales and formulating a clear moral justification for their action.

· Only under extreme and exceptional condition, while conforming to international standards and engaging in an appropriate and transparent process of authorization, may nurses subordinate human rights concerns top other considerations

· Nurses must continue to advocate for systems and protocols that protect their ethical obligations as nurses, as well as ensure equity and fairness to all concerned in times of pandemics.

Ethical issues facing nurses and healthcare professionals specific to Covid-19:

· Protection of the public from harm-respects and educate about social distancing

· Proportionality-medications, PPE, equipment’s and beds must not be “hoarded” within the community

· Duty to provide care-balancing obligations to protect our own health and our families with that of our professional duties

· Equity-patients not expected to survive still need care

· Trust-communicate honestly and make decisions transparent, remember, nurses are the most trusted profession.

Develop a Plan to address these Ethical issues:

· Non maleficence: protect the public, respect, role model and educate about social distancing

· Justice: proportionality-avoid hording mentality develop creative solution to the concerns about the shortage of PPE

· Snorkel mask

· Call on painters, contractors, rail workers to donate particulate filtering masks

· Call on vets, dentists to donate N95 masks

· Consider sterilization using ethylene oxide (takes 12 hrs.)

· Consider decontamination with UV germicidal irradiation

· Wear surgical masks over N95 respirators to conserve but prevent droplet contamination

· Place infusion pumps outside room with extension cords to limit room entry

· Beneficence: Duty to provide care-balance professional duty with own health and family’s well -being cannot care for others if your don’ts take care of yourself physically emotionally and spiritually

· Consider staff at increased risk and limit their exposure

· Equity: call on palliative care teams to support those critically ill, especially those not expected to live

· We need a plan to care for those dying not just those we are trying to save

CONCLUSION:

A public health emergency, such as a surge of person seeking health care as wall as critically ill patient with Covid-19 or another severe respiratory illness, disrupts normal process for supporting ethically sound patient care. Ensuring the health of the population, especially in an emergency, can Require Limitation on individual rights and preferences.

REFRENCES:

1. Xavier Belsiyal C., Ethono psychology and its Application -Review.Research J. Humanities and social sciences. 2016; 7(4)

2. Deepa K Damodaran. Road to mental health: From Personality through Subjective well-being. Int. J. Adv. Nur. Management 2014; 2(1)

3. De Groot RJ, Baker SC, Baric R, Enjuanes L, Gorbalenya AE, Holmes KV, Perlman S, Poon L, Rottier PJ, Talbot PJ, Woo PC, Ziebuhr J (2011). "Family Coronaviridae". In AMQ King, E Lefkowitz, MJ Adams, EB Carstens (eds.). Ninth Report of the International Committee on Taxonomy of Viruses. Elsevier, Oxford. pp. 806-828. ISBN 978-0-12-384684-6.

4. International Committee on Taxonomy of Viruses (24 August 2010). "ICTV Master Species List 2009 – v10" (xls).

5. Li F, Li W, Farzan M, Harrison SC (September 2005). "Structure of SARS coronavirus spike receptor-binding domain complexed with receptor". Science. 309 (5742): 1864-1868. Bibcode: 2005Sci...309.1864L. doi:10.1126/science.1116480 PMID 16166518.

6. Geller C, Varbanov M, Duval RE (November 2012). "Huma coronaviruses: insights into environmental resistance and its influence on the development of new antiseptic strategies". Viruses. 4(11): 3044-3068. doi:10.3390/v4113044. PMC3509683. PMID 23202515.

Received on 29.03.2021 Modified on 18.04.2021

Int. J. Nur. Edu. and Research. 2021; 9(3):367-369.

DOI: 10.52711/2454-2660.2021.00085