Why it is important to pay more attention to moral sensitivity in intensive care units during the COVID-19 pandemic

Dear Editor, Intensive care admissions have increased dramatically during the COVID-19 pandemic, which in turn increased nurses’ responsibilities and care burden. Although nursing always involves ethical decision-making, the difficult conditions imposed by the pandemic have forced them to face such situations more frequently. As a result, more emphasis on the principle of moral sensitivity has become even more essential in nursing care[1]. Moral sensitivity is a key element of ethical action and establishes a person’s potential in ethical decision-making that fosters a nurse–patient relationship based on trust and awareness of the patient’s individual needs[2]. One of the most important characteristics of the nursing profession is moral sensitivity, which is an important resource for handling ethical dilemmas and is crucial for assuring professional development, making wise decisions, and carrying out one’s responsibilities. Morally sensitive nurses can better support patients, and enhance patient safety. More morally sensitive nurses have been found to be committed to moral standards[3]. Ethical principles and moral sensitivities of nurses are essential in decision-making. More moral distress motivates them to increase their enthusiasm for solving ethical issues. Regardless of factors such as institutional culture, and workplace conditions, nurses with more moral sensitivity overcome ethical concerns more successfully[4]. Intensive care units are one of the settings where ethical problems come up most frequently. The most frequent issues involve dishonesty, discontinuing treatment, invasions of privacy, contempt for autonomy, decisions regarding the quality of treatment and end-of-life care, insufficient communication, professional conflicts, and failing to inform families. Health care managers and professionals have numerous difficulties in ethical concerns such as selecting prioritized patients, triage uncertainty, and shortages of ICU beds, healthcare workers, and necessary equipment and supplies during the COVID-19 pandemic[5]. The demand for healthcare services is more than ever before, because of insufficient nurses, and the resultant increased overtime hours, are some of the contributing factors to the rising workload. It appears that a critical care nurse’s workload is related to poor nursing care, patient dissatisfaction, and the amount of time that nursing staff devotes to their difficult tasks[6]. Therefore, early identification and settlement of potential ethical problems, both during the epidemic and beyond, may be made possible by recognizing the moral sensitivity of intensive care nurses. In addition, the development of morals will increase job satisfaction, decrease physical and mental problems, reduce feelings of helplessness, burnout, and disappointment, and improve the quality of nursing care[7]. Nurses need to be aware of the implications of the moral decisions they make. In nursing, moral sensitivity provides a nurse-patient relationship built on trust to address specific needs, which enables or restricts the patient’s autonomy to protect them during their vulnerable states. A lack of moral sensitivity may make nurses unable to recognize when a situation is morally right or wrong. In this regard, moral sensitivity can be a crucial component of providing care and recognizing the dignity of the patients, especially when said they have the autonomy to reject unnecessary therapeutic interventions that do not characterize a dignified life[8]. Conclusions COVID-19 dramatically lengthens the number of time nurses spends with patients in the intensive care unit. As a result, more ICU nurses are required to handle effectively new waves of COVID-19. It is an important finding that nurses uphold ethical standards in the most trying circumstances and improve their moral awareness in clinical settings. Moral sensitivity may empower nurses to act bravely, and lessen their moral distress. It is important to improve education by changing the course content and teaching methodology to help nurses strengthen their moral sensitivity.