"Should they be left to suffer and die or allowed a more peaceful passing?" : Nurses' experiences of work-related, moral and ethical stress during the COVID-19 pandemic

The study explores how structural, organizational, and social factors in Swedish healthcare influences nurses’ experiences of work-related stress during the COVID19 pandemic. It focuses on nurses’ perceptions of how working conditions affect their stress levels, particularly in relation to their professional and ethical autonomy. Key areas include the impact of the work environment, leadership, resource shortages, and ethical dilemmas. A qualitative interview method was used, involving eight nurses from various fields who worked during the pandemic’s peak between 2020 and 2022. Data was analyzed using thematic analysis. The theoretical framework is the demand-control-support model (1990), complemented by concepts of moral and ethical stress. Findings show that institutional constraints sometimes limit nurses’ moral agency, preventing them from delivering adequate care. However, strong social support from colleagues helped manage the emotional burden. High demands and poor working conditions had lasting effects on nurses’ well-being, though supportive leadership could help with the stress. Despite the challenges, nurses also experienced professional growth, gaining new skills and control over their work. The study concludes that stress was not solely negative but also included elements of positive stress and development. Theoretical insights expand the demand-control-support model by integrating moral and ethical stress for further understandings.