• Anna Falcó-Pegueroles, Esperanza Zuriguel-Pérez, Gemma Via-Clavero, Alejandro Bosch-Alcaraz, and Loris Bonetti.
• School of Nursing, Faculty of Medicine and Health Sciences. Quantitative Psychology Research Group (SGR 269), University of Barcelona, Barcelona, Spain.
• Int Nurs Rev. 2021 Jun 1; 68 (2): 181-188.

AimTo identify factors underlying ethical conflict occurring during the current COVID-19 pandemic in the critical care setting.BackgroundDuring the first wave of the COVID-19 outbreak, Spanish and Italian intensive care units were overwhelmed by the demand for admissions. This fact revealed a crucial problem of shortage of health resources and rendered that decision-making was highly complex.Sources Of EvidenceApplying a nominal group technique this manuscript identifies a series of factors that may have played a role in the emergence of the ethical conflicts in critical care units during the COVID-19 pandemic, considering ethical principles and responsibilities included in the International Council of Nurses Code of Ethics. The five factors identified were the availability of resources; the protection of healthcare workers; the circumstances surrounding decision-making, end-of-life care, and communication.DiscussionThe impact of COVID-19 on health care will be long-lasting and nurses are playing a central role in overcoming this crisis. Identifying these five factors and the conflicts that have arisen during the COVID-19 pandemic can help to guide future policies and research.ConclusionsUnderstanding these five factors and recognizing the conflicts, they may create can help to focus our efforts on minimizing the impact of the ethical consequences of a crisis of this magnitude and on developing new plans and guidelines for future pandemics.Implications For Nursing Practice And PolicyLearning more about these factors can help nurses, other health professionals, and policymakers to focus their efforts on minimizing the impact of the ethical consequences of a crisis of this scale. This will enable changes in organizational policies, improvement in clinical competencies, and development of the scope of practice.© 2020 International Council of Nurses.

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