# Moral Challenges and Responsibilities in Caring for Relatives of Older Nursing Home Residents During the COVID-19 Pandemic in Sweden

## TL;DR

Nursing home nurses in Sweden faced moral challenges when caring for relatives of older residents during the pandemic, requiring reflection on professional ethics and values.

## Contribution

The study identifies four specific moral challenges and explores how nursing values can guide ethical decision-making in pandemic conditions.

## Key findings

- Nursing home nurses encountered moral dilemmas related to information sharing and visiting restrictions.
- Professional nursing values like empathy and advocacy were central to addressing these challenges.
- Conflicting values can lead to opposing ethical decisions, limiting the direct impact of moral principles on action.

## Abstract

Caring for relatives of older nursing home residents during COVID-19 was sometimes morally challenging for nursing home nurses. We identified four moral challenges: (1) providing versus withholding information, (2) respecting relatives’ wishes versus acting in accordance with professional standards, (3) acting in accordance with versus contrary to advance care plans, and (4) heeding versus ignoring visiting prohibitions. Care ethicist Margaret Urban Walker’s framework of moral responsibility together with values listed in the ICN code of ethics for nurses were used as points of departure for reflection on these moral challenges. Each challenge was described, and moral responsibilities were charted and discussed in terms of moral relationships between nursing home nurses and the relatives of older residents, nurses’ moral identity as a nurse, and nursing’s moral values as listed in the ICN code of ethics for nurses. Nursing home nurses’ moral responsibilities could be connected to many moral values of the nursing profession, such as empathy, responsiveness, caring, advocacy, equality, inclusivity, and compassion. However, these values have a limited effect on direct moral action, as different values can be addressed for opposite action alternatives.