A qualitative approach to the ethical challenges of Iranian nurses during the COVID-19 pandemic

Document Type : Original Article


1 Assistant Professor, Department of Management, Yazd University, Yazd, Iran

2 Ph.D. Student in Business Administration, School of Accounting and Management, Yazd University, Yazd, Iran

3 Master Graduate in Business Administration, School of Accounting and Management, Yazd University, Yazd, Iran


Background: Nurses have vital roles during the COVID-19 pandemic but may face ethical dilemmas due to exposure to new illnesses and a lack of experience.
Aims: This study aimed to qualitatively investigate the ethical challenges faced by Iranian nurses during the COVID-19 pandemic.
Methods: This qualitative study involved conducting semi-structured individual interviews with 15 nurses working in COVID-19 wards at a hospital in Yazd, Iran, from February 2020 to April 2021. The data analysis was conducted using thematic analysis techniques.
Results: During the analysis, the researchers generated five themes: ethical principles, ethical decision-making, educational challenges, communication challenges, and workplace challenges.
Conclusion: The findings of this study demonstrate that frontline nurses in COVID-19 wards experienced their work as challenging and uncertain at the beginning of the COVID-19 outbreak. It seems that training programs in advance could help reduce this uncertainty.


Main Subjects

  1. Rajabipoor Meybodi A, Mohammadi M. Identifying the components of spirituality affecting the resilience of nurses. J Nurs Manag. 2021;29(5):982-8. doi:10.1111/jonm.13235 PMid:33306237
  2. Smith DJ, Hakim AJ, Leung GM, Xu W, Schluter WW, Novak RT, et al. COVID-19 Mortality and Vaccine Coverage-Hong Kong Special Administrative Region, China, January 6, 2022-March 21, 2022. Morbidity Mortality Weekly Report. 2022;71 (15):545. doi:10.15585/mmwr.mm7115e1 PMid:35421076 PMCid:PMC9020860
  3. Zhang SX, Chen J, Afshar Jahanshahi A, Alvarez-Risco A, Dai H, Li J, et al. Succumbing to the COVID-19 pandemic-healthcare workers not satisfied and intend to leave their jobs. Int J Men Health Addict. 2022;20(2):956-65. doi:10.1007/s11469-020-00418-6 PMid:33437225 PMCid:PMC7790354
  4. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open. 2020;3(3): e203976. doi:10.1001/jamanetworkopen.2020.3976 PMid:32202646 PMCid:PMC7090843
  5. Galindo RJ, Aleppo G, Klonoff DC, Spanakis EK, Agarwal S, Vellanki P, et al. Implement continuous glucose monitoring in the hospital: emergent considerations for remote glucose monitoring during the COVID-19 pandemic. J Diabetes Sci Technol. 2020;14(4). doi:10.1177/1932296820932903 PMid:32536205 PMCid:PMC7673156
  6. Weaver K. Ethical Sensitivity: State of Knowledge and Needs for Further Research. Nurs Ethics. 2007;14(2):141-55. doi:10.1177/0969733007073694 PMid:17425144
  7. Larkin ME, Beardslee B, Cagliero E, Griffith CA, Milaszewski K, Mugford MT, et al. Ethical challenges experienced by clinical research nurses: A qualitative study. Nurs Ethics. 2017;26 (1): 172-84. doi:10.1177/0969733017693441 PMid:29281934
  8. Bahadori Jahromi R, Alizadeh M. A study on ethical challenges of mining engineering. Res Quarterly Islamic Ethics. 2018;11 (39).
  9. Heydari A, Meshkin Yazd A. Ethical challenges in the nursing profession. J Clin Nurs Midwifery. 2020;7(1).
  10. Clarke V, Braun V. Teaching thematic analysis: Overcoming challenges and developing effective learning strategies. The Psychologist. 2013;26(2).
  11. Azadian M. Nursing students' perception of professional challenges: A qualitative study. J Med Educ Dev. 2015;10(1).
  12. Birkholz L, Kutschar P, Kundt FS, Beil-Hildebrand M. Ethical decision-making confidence scale for nurse leaders: Psychometric evaluation. Nurs Ethics. 2022.
    doi:10.1177/09697330211065847 PMid:35230887
  13. Ahmed EA. Effect of head nurses workplace civility educational program on nurses professional values and awareness of legal and ethical issues. Int Egypt J Nurs Sci Res. 2022;2(2):336-52.doi:10.21608/ejnsr.2022.212476
  14. Al-Zahrani JM, Aldiab A, Aldossari KK, Al-Ghamdi S, Batais MA, Javad S, et al. Prevalence of prediabetes, diabetes and its predictors among females in Alkharj, Saudi Arabia: a cross-sectional study. Ann Glob Health. 2019;85(1). doi:10.5334/aogh.2467 PMid:31348623 PMCid:PMC6659578
  15. Catania G, Zanini M, Hayter M, Timmins F, Dasso N, Ottonello G, et al. Lessons from Italian front‐line nurses' experiences during the COVID‐19 pandemic: A qualitative descriptive study. J Nurs Manag. 2021;29 (3):404-11. doi:10.1111/jonm.13194 PMid:33107657
  16. Shaw HK, Degazon C. Integrating the core professional values of nursing: a profession, not just a career. J Cult Divers. 2008;15(1).
  17. Sabone M, Mazonde P, Cainelli F, Maitshoko M, Joseph R, Shayo J, et al. Everyday ethical challenges of nurse-physician collaboration. Nurs Ethics. 2019;27(1):206-20. doi:10.1177/0969733019840753 PMid:31014168