|Year : 2021 | Volume
| Issue : 1 | Page : 2-7
Qualitative study on the psychological experience of nursing officers caring COVID-19 patients
Nipin kalal1, Ashok kumar2, Raj Rani3, Navratan suthar4, Himanshu vyas2, Vikas choudhary5
1 Assistant Professor, College of Nursing, All India Institute of Medical Sciences, Jodhpur, India
2 Associate Professor, College of Nursing, All India Institute of Medical Sciences, Jodhpur, India
3 Professor, College of Nursing, All India Institute of Medical Sciences, Jodhpur, India
4 Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, India
5 Nursing Tutor, College of Nursing, All India Institute of Medical Sciences, Jodhpur, India
|Date of Submission||09-Oct-2020|
|Date of Decision||23-Nov-2020|
|Date of Acceptance||23-Mar-2021|
|Date of Web Publication||17-Jun-2021|
Mr. Nipin kalal
All India Institute of Medical Sciences, Jodhpur, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: Coronavirus spreads very rapidly and nursing staff is fighting like warrior. They are facing so many psychological issues. During the pandemic, positive and negative emotions of frontline nurses interlace and exist. Objectives: To explore the psychological experience of nursing officers caring coronavirus disease 2019 (COVID-19) patients. Materials and Methods: Phenomenological research approach was adopted. Twelve nursing officers were enrolled with nonprobability purposive sampling technique who provided care for COVID-19 patients. The interviews were conducted face-to-face and were analyzed by the Colaizzi's 7-step method. Results: The data were obtained from 12 nursing officers caring for patients with COVID-19. The mean age of the participants was 28 ± 1.87 years, with a mean work experience of 3.75 ± 1.05. Three themes were extracted from the detailed interview. First theme: the expression of negative emotions in the initial stage consisting of fear and anxiety regarding infection and family member, fatigue and discomfort related to high work intensity, and protective gear and anxiety regarding changing of ward and long duty hours. Second theme: the use of coping strategies and self-care styles consisting of communication with family members and friends and adjustment to the new era of life. Third theme: expressing positive emotions as adjusted with duty comprised of motivation and support from senior authority, feeling happy to be a part of humanity service, and satisfied with my duty and postduty quarantine facilities. Conclusions: The results of this study show that nursing officers caring COVID-19 patients are experiencing mental and emotional distress at initial stage of duty. As days passed participants used coping strategies and understand the new era of situation. Gradually, they expressed positive emotions and they were happy and satisfied with work.
Keywords: Coronavirus disease 2019, nursing staff, psychological experiences, qualitative study
|How to cite this article:|
kalal N, kumar A, Rani R, suthar N, vyas H, choudhary V. Qualitative study on the psychological experience of nursing officers caring COVID-19 patients. Indian J Psy Nsg 2021;18:2-7
|How to cite this URL:|
kalal N, kumar A, Rani R, suthar N, vyas H, choudhary V. Qualitative study on the psychological experience of nursing officers caring COVID-19 patients. Indian J Psy Nsg [serial online] 2021 [cited 2021 Nov 30];18:2-7. Available from: https://www.ijpn.in/text.asp?2021/18/1/2/318670
| Introduction|| |
Coronavirus disease 2019 (COVID-19) is rapidly spreading worldwide. As of September 30, 2020, there have been 33,502,430 confirmed cases worldwide with 1,004,421 deaths. 6,225,763 confirmed cases and 97,497 deaths have been reported in India.
In the pandemic of coronavirus disease, health-care workers have become the main force to fight with this virus. Their health and safety are most crucial aspect, not only for continuous and safe patient care, but also for the control of any cross infection and outbreak. However, many health-care providers involved in caring for patients during the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks were under extraordinary stress and discomfort. They were prone to get infection, having stigmatization, understaffing, and uncertainty, and comprehensive support was a high priority during the outbreaks and afterward.,
Liu et al. conducted a quantitative studies and found that frontline health-care providers involved in care of COVID-19 patients have greater risks of mental health problems, such as anxiety, depression, insomnia, and stress. Frontline nurses who had less infectious disease expertise had additional challenges and risk when they adjusted to an entirely new working environment in this stressful situation. To support them effectively and assess their mind, it is necessary to gain insights into their lived experience. While being quarantined at institute and home and not able to meet family members give much more stress and isolation so it is mandatory to counsel them and ask them to express their feeling.
Some studies have paid attention to the severity of psychological problems in the medical personnel and the urgency of providing psychological care.
In a study on the psychological experience of Ebola patients caregivers, 29% of respondents felt lonely and 45% gone under initial psychological counseling. On the contrary, some studies also revealed the positive experience and growth brought by the collective anti-epidemic efforts.,
Shen et al. have conducted a study on title psychological stress of intensive care unit (ICU) nurses in the time of COVID-19. They found that through the early assessment nurses experienced no adverse events during care of COVID patients. In the long-term, psychological changes in nurses needed a regular follow-up. Hence, it is endorsed to understand the psychological problems of ICU nurses who involved in care of COVID-19 patients and take necessary action to relieve the psychological pressure on these nurses.
Cui et al. conducted a cross-sectional survey study on the impact of COVID-19 on psychology of nurses working in the emergency. The author concluded that most of staff 281 (62.03%) had no any anxiety symptoms, 154 (34.00%) staff had mild anxiety level, 16 (3.53%) staff had moderate anxiety, and only 2 (0.44%) staff had severe anxiety. The author found that 229 (50.55%) participants were express positive respond to the stress, whereas 224 (49.45%) were more likely to respond negatively.
During the pandemic, nursing officers remain at the frontline of patient care, in hospitals and closely involved in assessment and monitoring. Hence, they are highly exposed to psychological distress and experience enormous physical stress. Therefore, the present study aimed to explore the psychological experiences of nursing officer caring for COVID-19 patients.
| Materials and Methods|| |
We have adopted the Colaizzi's phenomenological method to qualitatively explore the psychological experience of nursing officers caring COVID-19 patients. Colaizzi's phenomenological method focuses on the experience and feeling of the nursing officers. This scientific approach covenants the reliability of the collected experience of participants to cohere to scientific standards.
By using a nonprobability purposive sampling technique, we selected 12 nursing officers caring COVID-19 patients in the All India Institute of Medical Sciences, Jodhpur. The inclusion criteria included (1) nursing officers who provided care for confirmed COVID-19 patients and (2) those who are willing to participate in the study. We determined the number of required respondents by face-to-face interviewing nurses who met the inclusion criteria until the data were saturated and no new topics were generated.
We established the interview outline by relevant literature, seeking expert's opinions, and guidance for preinterview. The main interview questions posed to the participants and answer are recorded to conclude and analyzed it. The main interview questions posed to the participants are the following:
- What is your psychological feeling while taking care of patient with COVID-19?
- How was your 1st day of posting in COVID-19 ward?
- How were your experiences throughout posting in COVID-19 ward?
- What are the challenges you encounter while caring of COVID-19 patient.
- What was the coping strategies and self-care style used by you during posting in COVID-19 ward?
- Elaborate about facilities provided by institution in COVID-19 ward
- How do you feel now after working in COVID-19 ward?
We communicated the purpose and significance of the study with the participant in advance and scheduled the interview time as per their convenience. The interviewer possessed a Master of Science in Nursing with experience in qualitative interview and had working in hospital and actively involved in COVID care. Therefore, we were adroit to carry out this research unaided.
The one-to-one face interviews were conducted in a personal room in a quiet manner without any disturbance and interruptions. The interviews were recorded in audiotape and which were kept safe and confidential. The interviews took around 20–30 min per nursing officers. If any participant exhibited with emotional problems during the interview, adequate psychological intervention was provided to relief from emotional pain and to prevent secondary psychological harm. The participants were allowed to withdraw his consent at any time. The researchers remained neutral and not forcing to divert his answer in any direction. We established good relationships with the participants and actively listen his answer without clarification to promote the authenticity of the data and to avoid bias. For each participant, data have collected at one point of time.
On the day of interview, the recording was transcribed and analyzed by Colaizzi's phenomenological analysis method. The data were transcribed through verbatim, and the themes and subthemes will be extracted from the statements of study participants. The findings were confirmed from the study participants once the themes are extracted from the study. All researchers independently reviewed the interview materials, summarized and extracted meaningful statements, meaning and formulated the themes present. Conflicting and ambiguity in opinions on the contents of a theme were discussed and resolved by a research group composed of a master of nursing and a consultant form psychiatry department.
Ethical approval and informed consent
Ethical permission was obtained from the Institutional Ethical Committee (IEC) of AIIMS, Jodhpur, to carry out the study. The study protocol was approved by the IEC vide letter no. AIIMS/IEC/2020/3158 on dated 09/07/2020. Written informed consent form was obtained from all the participants.
| Results|| |
In the present study, we enrolled 12 nursing officers ranged from 25 to 31 years with an average age of 28 ± 1.87. Majority of the participants were male 9 (75%). Out of 12 studied participants, 8 (66.66) possessed a B.Sc. Nursing degree. On asking about the marital status, 7 (58.33%) were married and 5 (41.66%) responded were single. The working experience ranged from 3 to 6 years with an average of 3.75 ± 1.05. The participants had a mean number of working days in COVID ward were 19.58 ± 8.64 [Table 1].
We explored the psychological experience of nursing officer caring for COVID-19 patients. We extracted three themes that are summarized with exemplar quotes for each theme [Table 2].
Theme 1: Expression of negative emotions in the initial stage
All study participants expressed significant amount of negative emotions in beginning of COVID ward posting. As they came to know about their duty in COVID ward, they were anxiety and worried. All participants were tensed about duty and felt that it will a tough task to complete it. Most of nursing officers expressed concerns about their family members and fear about new infectious disease. All participants expressed that it is lengthy duty hours and it is very challenging to complete it with full personal protective equipment (PPE) kit. All have expressed that after doffing they feel such as body pain, headache, chest tightness, and giddiness. Few participants expressed concern regarding difficult to get articles and equipment's as it was new ward for them. Most of the participants expressed concern that without drinking water, eating food and urinating, after worn PPE was the toughest time in COVID duty. The nursing officers expressed concern regarding duty hours. Nursing officers said that if duty hours are reduced then the quality of care can be improved.
Theme 2: Use of coping strategies and self-care styles
All study participants are enough skilled to manage such crisis with by using coping strategies. All participants were knowing that once they will have to do duty in COVID area and they were mentally prepared for it. All participants were ventilating their emotions by using various techniques. Majority of nursing officers were using mobile to watch movie and comedy serial to divert mind. Half of nursing officers were practicing yoga and meditation to get relax from hectic schedule and long hour's duty. Most of nursing officers were generally spending most of time by talking with family members and friends and they feel motivated by doing this. Maximum number of nursing officers were adopted to new environment and understand they have to live with this virus, so all were looking positive to work in COVID ward.
Theme 3: Expressing positive emotions as adjusted with duty
Almost all participants were expressed negative emotions in the initial phase of duty. However, as the days passed and they exposed to area it's converted to positive emotions progressively. Majority of the study participants expressed that all senior authority are facilitated them in each phase of posting and resolved their problems if existed. Most of the study participants mentioned that they are very blessed to work for noble cause and they feel honored to become part of this. Many staffs are again ready to work in COVID area as now they are enough self-confident. All participants were glad with the facilities of institute such as food, quarantine facilities, duties, stay, and transport facility. All nursing officers were contended to receive appreciation certificate from institute and NGOs. It was motivating them to work and serve the COVID-positive patients.
| Discussion|| |
The present study revealed the experience of nursing officers and described their lived experiences of battling COVID-19 was a prime responsibility to alleviate patients' suffering and make them comfortable. In pandemic of this unknown disease and unpredictable risks, nursing staffs have a feared about infection and stress about their family member. As a need of country all the nursing worriers came forward to join this fight and handle critical situation by taking responsibilities, shown their dedication toward profession.
In the present study, most of participants had fear regarding their duties, having anxiety and stress about family, which was consisted with the study done by Kim.
In the present study, nursing officers caring for COVID-19 patients felt extreme physical fatigue, body pain, and discomfort caused by the long duty, hard work with full PPE which was resemble with the study on the outbreak of MERS-CoV.
In the current study, nursing officers faced many challenges during posting and they showed great strength and positive attitude by using coping strategies and self-style to relieve stress and make them comfortable in COVID duties. During the SARS and MERS epidemics, frontline health-care providers were fearful, anxious, and they have also used psychological measures and adopted new behavior style to cope up with new ear of life. (e.g., posttraumatic stress disorder).,
Our finding of the existence of positive emotions in our nursing officers such as happiness with all facilities and feeling proud to a part of this humanity, which gradually overcome with negative emotions, was in contrast to the results of the several studies that describe only the presence of a large amount of negative emotions during outbreak stress.,
In this study, nursing officers' were worried about family members, similar result was found with the study of Lee et al., especially those with elderly and children in the family.
In the current study, participants adopted relaxation therapy, music, meditation, watching comedy serials, and other ways to reduce stress, which was resembled with the study of nurses in the SARS wards that adopted multiple ways to cope up and over come with stress.
In the current study, sample size was less as we have used qualitative approach. We have involved only nursing officers in our study. Psychological experience of physician, senior nursing officers, and administrators can be explored. Due to high risk of infection focus group discussion was not done. Our study was limited to one institute. As a part of short-term study, only one time date was collected. To get more experience and explore their continue experience, data can be collected at multiple time.
| Conclusions|| |
This study revealed comprehensive and in depth psychological experience of nursing officers caring COVID-19 patients through a phenomenological approach. In details, interview was held and in details interaction was recorded. We found that during the pandemic nursing officers has mixed emotions and it covert to positive at the end of their duty. In the beginning phase of posting, they were having certain negative emotions but gradually it changed to positive. It is also revealed that they were happy to worked for nobel cause. Staff were using coping strategies which motivated them to work for patient and prepared mentally for new life. Nursing officers were happy with all kind of facilities which were available for them. This study not only helps them to express their feeling but also encouraged and make them prepared for next upcoming COVID duty.
We are thankful to ethical committee for approval for conducting the research study. We would like to thanks All India Institute of Medical Sciences, Jodhpur for providing library facility which was helpful in literature search and nursing officers who has participated in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chang D, Xu H, Rebaza A, Sharma L, Dela Cruz CS. Protecting health-care workers from subclinical coronavirus infection. Lancet Respir Med 2020;8:e13.
Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry 2018;87:123-7.
Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al
. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ 2003;168:1245-51.
Liu S, Yang L, Zhang C, Xiang YT, Liu Z, Hu S, et al
. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry 2020;7:e17-e18.
Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al
. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020;7:e14.
Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al
. Timely mental health care for the 2019 novel coronavirus outbreak is urgent lyneeded. Lancet Psychiatry 2020;7:228-9.
Smith MW, Smith PW, Kratochvil CJ, Schwedhelm S. The psychosocial challenges of caring for patients with Ebola virus disease. Health Secur 2017;15:104-9.
Honey M, Wang WY. New Zealand nurses percept ions of caring for patients with influenza A (H1N1). Nurs Crit Care 2013;18:63-9.
Liu H, Liehr P. Instructive messages from Chinese nurses' stories of caring for SARS patients. J Clin Nurs 2009;18:2880-7.
Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care 2020;24:200.
Cui S, Jiang Y, Shi Q, Zhang L, Kong D, Qian M, et al. Impact of COVID-19 on psychology of nurses working in the emergency and fever outpatient: A cross sectional survey. BMC Psychiatry 2020;1-19. [doi: 10.21203/rs.3.rs-20777/v1].
Kim Y. Nurses' experiences of care for patients with Middle East respiratory syndrome-coronavirus in South Korea. Am J Infect Control 2018;46:781-7.
Kang HS, Son YD, Chae SM, Corte C. Working experiences of nurses during the Middle East respiratory syndrome outbreak. Int J Nurs Pract 2018;24:e12664.
Lee SH, Juang YY, Su YJ, Lee HL, Lin YH, Chao CC. Facing SARS: Psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital. Gen Hosp Psychiatry 2005;27:352-8.
Main A, Zhou Q, Ma Y, Luecken LJ, Liu X. Relations of SARS-related stressors and coping to Chinese college students' psychological adjustment during the 2003 Beijing SARS epidemic. J Couns Psychol 2011;58:410-23.Assistant Professor, 1,4Associate Professor, 2Professor, 5Nursing Tutor, College of Nursing, 3Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences Jodhpur, India
[Table 1], [Table 2]