Caring for Patients With Infectious Diseases: Nurses' Risk Perception, Moral Distress, Professional Ethos and Emotional Labor: A Mixed Methods Study

Aims: To examine the relationship between hospital nurses' self-perceived risk when caring for patients with infectious diseases and their moral distress, and how this relationship affects their emotional labour, while examining the moderating role of professional ethos. Design: Mixed methods research using quantitative and qualitative approaches. Methods: The research was conducted in a hospital in northern Israel among 139 nurses from 11 inpatient departments. Data were collected through structured self-administered questionnaires, including socio-demographic questions and measures examining risk perception, moral distress, professional ethos and emotional labor. Two open-ended questions were included for qualitative analysis. Results: A significant positive correlation was found between risk perception and moral distress. Nurses showed an intermediate level of risk perception, demonstrating a balanced awareness of occupational hazards while maintaining a high professional ethos and experiencing relatively low moral distress. Our analysis revealed that risk perception, along with experienced emotions and emotional gaps, were significant predictors of emotional labor. The qualitative findings revealed a wide spectrum of emotions among the nursing staff. Positive emotions included empathy, identification with patients, caring, compassion and tolerance, while negative emotions included anger, fear, frustration and helplessness. Participants described various coping strategies, both emotional and practical, including the use of protective equipment, adherence to hand hygiene, participation in workshops and conversations with colleagues for emotional processing of nursing experiences. Conclusion: The research raises awareness of the moral distress that nursing staff experience, not only during emergencies like a global pandemic but also in routine situations where they regularly care for patients with various infectious diseases. Significant organisational support and implementation of effective coping strategies are required to maintain nurses’ well-being. Reporting Method: The study adhered to the relevant EQUATOR guidelines and used the Good Reporting of a Mixed Method Study (GRAMM). Patient or Public Contribution: No Patient or Public Contribution. Impact: The research illuminates the unique challenges experienced by nursing staff in treating infectious diseases both in routine and emergency situations. The findings indicate the need for systemic support and the development of effective coping strategies. The research is relevant to all nursing staff in hospitals and healthcare system decision-makers.