A qualitative study of school nurses' moral distress related to COVID-19

Abstract

Objective: To understand school nurses' perceptions and experiences of moral distress related to COVID-19 case management in the school systems.

Design: A descriptive qualitative study guided by Braun and Clarke's reflexive thematic analysis.

Sample: Twelve school nurses practicing in Colorado from December 2021 to January 2022.

Measurements: Semi-structured interviews about school nurses' experiences of COVID-19. Investigators utilized an iterative reflexive thematic analysis process engaging the participants' and researchers' subjective experiences.

Results: Four themes were created: (1) keeping kids and the community safe, (2) caught in the middle of the "tug of war" between health and politics, (3) distress amid an ocean of COVID-19 uncertainty, and (4) visibility as a bright spot shining through the COVID-19 cloud.

Conclusions: Two research questions examined school nurses' experiences of moral distress and their role and scope of practice that affected their relationships in the educational and public health systems. The results of this study confirm the important role of school nurses and interprofessional case management in school environments in the fight against infectious diseases and pandemics. Building stronger relationships between school nurses and public health is imperative for future collaborative and cohesive public health responses to pandemics.

Keywords: COVID-19; case management; moral distress; public health nursing; reflexive thematic analysis; school nurses.