To Örebro University

Background: Altruism has historically shaped the ethos of nursing. However, the COVID-19 pandemic reignited nurses' profound commitment to patient care, often at significant personal risk to own health and safety. This renewed dedication has prompted interest in whether altruism remains a vital component of nursing practice.

Objective: To clarify the meaning of professional altruism in nursing care.

Design: Catherine Norris's five-step concept clarification method was employed.

Methods: A systematic search was conducted in November 2024 across the CINAHL, PubMed, MEDLINE, and PsycINFO databases using the terms altruism, altruistic, and altruistic behavior/ behaviour in combination with nurses, nursing, and nursing care, resulting in the inclusion of 24 articles.

Results: Systemised descriptions of professional altruism yielded five categories: a willingness to act for others, a moral orientation, a motivational force, an unwavering professional expectation, and a valued, yet challenged and sometimes rejected phenomenon. Additionally, an operational definition of professional altruism in nursing care emerged: Professional altruism is a moral orientation toward fellow human beings in need of care, characterised by a willingness to prioritise the well-being of others over one's own needs. While balancing the expectations, challenges, and personal consequences involved, professional altruism remains a core aspect of nursing care, responsibility, and practice.

Conclusion: Professional altruism is a central aspect of nurses' professional identity and an essential element of nursing care. When acknowledged and supported, professional altruism can enhance both the quality of care and nurses' well-being.

Background: Many intensive care unit (ICU) nurses who were crucial to the frontline response during the COVID-19 pandemic left their employment during or after the pandemic. Studies exploring the experiences of these nurses are lacking. The aim of this study was to explore ICU nurses' course towards making the decision to resign from work in the ICU following the COVID-19 pandemic.

Method: Advertisements on social media and a snowball sampling-inspired method were used to recruit 11 nurses from hospitals around Sweden who worked in an ICU during the pandemic and who then left employment. The participants were interviewed individually via telephone, online or in-person. An interview guide with a few open-ended questions was used to capture the nurses' narratives. The data were analysed using a phenomenological hermeneutical method.

Results: The nurses were tangled in paradoxes, described as three themes: 'To give it all and yet feel insufficient', 'To experience togetherness and yet feel lonely' and 'To prioritise others and yet need to eventually prioritise oneself'. The decision to end their employment was ambivalent but necessary, made with relief and no regrets, but with sorrow. During this decision-making process, there may have been a window of opportunity during which nursing management or the health care service might have influenced the outcome.

Conclusion: The ICU nurses' decision to resign was influenced by a tangle of challenging paradoxes that entailed ambivalence. The course to the decision to resign was marked by hesitancy. While it is important to understand and support nurses' willingness to care for patients during a crisis and to acknowledge their suffering as it relates to their professional efforts, it is also essential to address their individual struggles and needs.

AIM: The aim of this study was to understand the lived experience of altruism and sacrifices among Swedish nurses working in intensive care units (ICU) during the COVID-19 pandemic.

DESIGN: This was a descriptive phenomenological study.

METHODS: The study was conducted between June 2020 and March 2021 and included 20 nurses who were directly involved in the ICU care of COVID-19 patients in Sweden during the pandemic. The text transcripts were analysed using Malterud's Systematic Text Condensation.

FINDINGS: The analysis revealed four themes. The work situation changed from 1 day to another-the nurses were brutally confronted with a new and highly demanding situation. Adapting to the chaotic situation-despite fear, anguish and exhaustion, the nurses adapted to the new premises. They shouldered the moral responsibility and responded to the needs of the patients and the health care system since they had the competence. Being confronted with ethical and moral challenges-the nurses were overwhelmed by feelings of helplessness and inadequacy because despite how hard they worked, they were still unable to provide care with dignity and of acceptable quality. The importance of supporting each other-collegiality was fundamental to the nurses' ability to cope with the situation.

CONCLUSIONS: Taken together, being exposed to a constantly changing situation, facing the anguish and misery of patients, families, and colleagues, and being confronted with a conflict between the moral obligation to provide care of high quality and the possibility to fulfil this commitment resulted in suffering among the nurses. Collegial back-up and a supportive culture within the caring team were important for the nurses' endurance.

IMPACT: The study contributes an understanding of nurses' lived experience of working during the COVID-19 pandemic and highlights the importance of protecting and preparing nurses and nursing organisation for potential future crises.

Background: In modern healthcare, the role of solidarity, altruism and the natural response to moral challenges in life-threatening situations is still rather unexplored. The COVID-19 pandemic provided an opportunity to obtain a deeper understanding of nurses' willingness to care for patients during crisis.

Objective: To elucidate clinical expressions of ontological situational ethics through nurses' willingness to work during a pandemic.

Research design, participants and context: A qualitative study with an interpretive design was applied. Twenty nurses who worked in intensive care unit at two Swedish hospitals during the first, second, and third waves of the COVID-19 pandemic were interviewed. The analysis was interpretative and applied a theoretical ethics perspective.

Ethical considerations: The study was approved by the Swedish Ethical Review Authority and informed consent was obtained from all participants.

Findings: From a philosophical perspective, the nurses expressed sovereign life expressions of mercy and compassion, which arose spontaneously in response to seeing vulnerable fellow humans. They referenced ''the nurse inside me'' and their choice of profession as motives to provide care. Ontological situational ethics in culture and norms were noted in the constructs of competence, responsibility, solidarity with colleagues and organization; and interest and learning were driving forces. Ethical demand was evident when nurses expressed ideas of meaningfulness in helping their fellow humans; but themes of ambiguity, exhaustion and unwillingness were also present.

Conclusions: The nurses showed a high willingness to care for patients during a crisis. Responding to the ethical demand and to care for vulnerable human beings while risking their own health and lives could be interpreted as an inter-human vocation. These spontaneous altruistic actions saved the lives of many patients during the pandemic and need to be understood and supported. 

Objectives: Patient participation is an established concept in public welfare. However, reports of the phe-nomenon of patient participation during intensive care from the patient’s point of view are scarce.Therefore, the aim of this study was to explore the meaning of patient participation in the intensive careunit from the patient’s perspective.

Research design: A qualitative design was used for the purpose of the study with a purposive convenientsample of nine adult patients with memories from their intensive care stay.

Method: Data was collected through individual interviews and analysed using a phenomenologicalhermeneutical method.

Findings: The results of our study show a variety of meanings and degrees of participation that continu-ously move on a sliding scale from acting as a captain to feelings of being on an isolated island. Patientparticipation varied due to individual cognitive abilities and individual preferences, and the caregiver’sattention altered between the body and the person through the continuum of care.

Conclusion: Patient participation during ICU care is more than participation in decision-making processesor direct patient care decisions. An understanding of the concept participation from the individual patientis necessary to support person centred care and the patient’s relatives play an important role in duringthe entire care process.

Background: For a long time, altruism was the basis for caring. Today, when society is more individualized, it is of interest to explore the meaning of altruism in nursing.

Methods: In all, 13 nurses from a Swedish acute care setting participated in two focus group interviews performed as Socratic dialogues. Data were analyzed using a phenomenological hermeneutical method.

Ethical considerations: Ethical issues were considered throughout the process according to established ethical principles. Informed consent was obtained from all participants, confidentiality regarding the data was guaranteed and quotations anonymized.

Findings: Altruism created a sense of ambivalence and ambiguity, described as a rise of sovereign expressions of life caused by "the other's" need, but also unwillingness to take unconditional responsibility for "the other."

Conclusion: Society's expectations of altruism and nurses' perception of their work as a salaried job collide in modern healthcare. Nurses are not willing to fully respond to the ethical demand of the patients. In case of a disaster, when nurses personal safety, life and health may be at risk, there might be reasons to question whether the healthcare organization would be able to fulfill its obligations of providing healthcare to an entire population.