Experiences and perceptions of Turkish intensive care nurses providing care to Covid-19 patients: A qualitative study

Persistent Changes of Nurses' Practices and Working Conditions in High Acuity Settings in the Post-Pandemic Era: A Qualitative Meta-Aggregation

AIMS

To explore the persistent changes in working conditions and nursing practices in high acuity settings in the post COVID-19 pandemic era.

DESIGN

A qualitative systematic review using the meta-aggregation design of the Joanna Briggs Institute.

METHODS

After screening by two authors based on the inclusion and exclusion criteria, 36 studies were included. Quality was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were then extracted and synthesised. Confidence of findings was assessed using the ConQual approach.

DATA SOURCES

The electronic databases: MEDLINE, CINAHL, Embase, and Scopus were searched in November 2023. Additional searches were conducted using the preprint servers: medRxiv, Open Science Foundation, Social Science Research Network, and Journal of Medical Internet Research.

RESULTS

Synthesised findings of 'unfavourable working conditions and changed nursing practices' and 'health concerns caused by the nursing practices' with eight categories were identified. Significant findings included increased workloads; overwhelming use and insufficient supply of personal protective equipment; decreased communication between nurses and patients, families, and other healthcare workers; lack of knowledge of the disease; and adequate support from coworkers, but inadequate support from nurse managers and physicians.

CONCLUSION

This study synthesised existing knowledge and offered insight into the nursing practices and working conditions of high acuity nurses during the COVID-19 pandemic. Clinical nurses and managers need to actively take action on those modifiable aspects of their practices in a future similar crisis. This review did not identify any studies focusing on high acuity nurses' working conditions and practices in the post-pandemic era. This kind of research is urgently needed.

IMPACT

Nurse managers and policy makers can use the findings of this review to help construct better working conditions for their high-acuity nursing staff in a future similar crisis. Frontline high-acuity clinical staff may use the findings of this review to help better guide their nursing practices and mitigate negative effects of a future similar crisis on their practice and health.

REPORTING METHOD

The study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews: CRD42023473414.

Night-time sleep of intensive care patients: A qualitative study

BACKGROUND

The quality of the sleep in the intensive care unit (ICU) is generally poor. It is known that several factors contribute to this situation.

AIM

To describe the experiences of adult patients during night-time sleep in the ICU.

DESIGN

A qualitative study using a phenomenological approach was conducted from May to October 2021. Patients were intensive care patients (n = 10) who were treated for at least 24 h in tertiary ICUs.

METHODS

The data were obtained through semi-structured interviews based on an interview guide. A qualitative content analysis using an inductive approach was performed.

RESULTS

The analysis resulted in three main themes: (a) inadequate sleep at night; (b) factors negatively affecting night-time sleep; and (c) patient expectations for improved night-time sleep. Night-time sleep of patients treated in intensive care were determined to generally have inadequate and be interrupted. Patients associated the cause of this situation with the physical environment conditions in the ICU, loud noises made by health employees and emotional reactions. It was stated that some physical environment changes that can be made in ICUs and psychological support will positively affect sleep.

CONCLUSIONS

Intensive care patients may not have quality night-time sleep because of multifactorial reasons. Noise in the ICU is a significant factor preventing patients from sleeping. In addition to reorganization of the physical environment to ensure adequate sleep, there is a need for an integrated approach dealing with patients' feelings and concerns.

RELEVANCE TO CLINICAL PRACTICE

Each patient has their own unique sleep pattern. To ensure effective management of sleep problems, health professionals should organize care and physical conditions in line with guidelines and create patient-specific night-time sleep management programmes.

Nurses' Experiences of the Caring Role during the COVID-19 Pandemic: A Scoping Review of Qualitative Research

Aims

To synthesize the evidence on nurses' experiences of their caring role during the COVID-19 pandemic and identify emerging concepts that have affected nurses within the caring role in relation to (a) their professional lives and (b) their personal lives.

Background

The concept of caring is central to the science and art of nursing practice, and fulfilment of the caring role is fundamental to the profession. The COVID-19 pandemic imposed unprecedented change globally transforming the caring role of the nurse. The WHO highlights that a well-supported workforce is paramount to emergency preparedness; therefore, understanding the experiences of the nurse's caring role during the COVID-19 crisis is paramount to practice in future healthcare crises.

Methods

A scoping review. Data Sources. Studies published between January 2020 and November 2023 were identified from the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Coronavirus Database, PUBMED, PsycINFO, PsycArticles, Scopus, Web of Science, and SocINDEX. Reporting Method. The scoping review adhered to the Joanna Briggs Institute (JBI) Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) checklist.

Results

The search identified 1,347 studies, subsequent review of title and abstract, resulted in 117 full-text papers for further eligibility screening, with a total of 52 studies being included in the scoping review. Findings were grouped thematically using the Braun and Clarke (2006) approach. The five distinctive themes that emerged were (a) emotional turmoil, (b) erosion of care, (c) relationships and solidarity, (d) expansion of role, and (e) professional growth.

Conclusion

During the COVID-19 pandemic, there was an evolutionary shift in the caring role of the nurse, on a trajectory from emotional turmoil to professional growth. The process followed a theoretical framework of transformative learning that could support nurses' capability and preparedness in their caring role for future inevitable extreme events and crisis in healthcare. Implications for Nursing Management. Mapping current knowledge of the unprecedented COVID-19 crisis from a nurse's professional and personal perspective purposefully aims to highlight gaps for future research, education, and policy and is paramount to emergency preparedness and a well-supported workforce in future healthcare crisis.

The association of fear of COVID-19 on occupational stress in pediatric nurses: Examining the mediating role of psychological well-being

PURPOSE

This study investigated the associations of fear of COVID-19 with occupational stress and the mediating role of psychological well-being in pediatric nurses.

METHODS

This cross-sectional study was conducted between December 2021 and February 2022. The sample consisted of 464 pediatric nurses from public or university hospitals in Türkiye. Data were collected using a sociodemographic characteristics questionnaire, the Fear of COVID-19 Scale, the Occupational Stress Scale, and the Psychological Well-Being Scale. The data were analyzed using Pearson's correlation and regression analysis.

RESULTS

Participants' fear of COVID-19 was positively associated with their occupational stress (F = 17.263; p < 0.001) but negatively associated with their psychological well-being (F = 10.575; p = 0.001). Their psychological well-being was negatively associated with their occupational stress (F = 22.084; p < 0.001). Nurses fear of COVID-19 explained three and 2 % of their occupational stress and psychological well-being, respectively. Nurses' psychological well-being explained 4 % of their occupational stress. The results showed that participants' psychological well-being did not mediate between their fear of COVID-19 and occupational stress.

CONCLUSION

Pediatric nurses fear COVID-19 but have an above-mean level of occupational stress and psychological well-being. In conclusion, psychological well-being does not mediate between pediatric nurses' fear of COVID-19 and occupational stress.

PRACTICE IMPLICATIONS

The pandemic was a traumatic experience for pediatric nurses. Hospital administrators and nurse managers must monitor the psychosocial health of pediatric nurses and support them in times of crisis.

Attitudes and experiences related to the deaths of COVID-19 patients among nursing staff: A qualitative evidence synthesis

AIM

To identify and synthesize the experiences and attitudes of nursing staff regarding the deaths of COVID-19 patients.

REVIEW METHODS

A qualitative evidence synthesis was carried out, using Noblit and Hare's meta-ethnographic approach. The review protocol was listed in PROSPERO (CRD42022330928). Studies published from January 2020 to January 2022 that met the criteria were searched in PubMed, Web of Science, Scopus, CINAHL, CUIDEN and PsycInfo. A total of 12 articles were included.

RESULTS

Thirty-three metaphors emerged, which were grouped into three main themes: Determining factors of care, Feelings about death and Strategies for coping with death. Nurses reported the high emotional toll, the absence of family and the lack of staff, protocol and training as determining factors. Furthermore, staff had doubts about the quality of care that COVID-19 patients received. As coping strategies, nurses developed avoidance behaviours towards COVID-19 patients, selective memories, resilience, and/or leaving the profession.

CONCLUSIONS

The difficulty in providing adequate nursing care and the high number of deaths has increased anxiety and stress among nurses. These factors, alongside their lived experiences of seeing patients suffering, many dying alone without family members, have had psychological repercussions on nursing staff.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The results demonstrate a high emotional toll and doubts surrounding their caregiving role caused by the lack of professional training needed to face a pandemic. This research shows what has been learned for future pandemics and highlights basic components that could provide a foundation for coping interventions for healthcare professionals.

IMPACT

WHAT PROBLEM DID THE STUDY ADDRESS?: The challenges posed by COVID-19 patient deaths for nursing staff around the world and also by the pandemic circumstances in which those deaths occurred. WHAT WERE THE MAIN FINDINGS?: The high number of deceased patients who were isolated from family members, communication with family members and doubts surrounding care given during the pandemic have created feelings of fear, stress and anxiety, as well as obsessive thoughts that have changed nursing staff's perception of death due to COVID-19. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Results will be useful for preparing for future pandemics, and for policymakers and health staff in supporting healthcare professionals by creating programmes to help them cope with the emotional toll they have felt after dealing with death in such unprecedented circumstances.

REPORTING METHOD

The authors have adhered to the PRISMA guidelines and the eMERGe Reporting Guidance.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The lived experiences of critical care nurses during the COVID-19 pandemic. A qualitative systematic review

OBJECTIVES

To critically synthesis the qualitative literature to understand the experiences of critical care nurses during the COVID-19 pandemic.

RESEARCH METHODOLOGY

A meta-aggregation systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant online databases were searched using a wide range of keywords and subject headings. All qualitative studies were included to understand the lived experiences of critical care nurses in the intensive care unit during the COVID-19 pandemic. All studies were screened using a pre-eligibility screening criteria by three reviewers. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research was used to provide methodological appraisal. The JBI method of meta-aggregation was used to extract, synthesize, and categorise the data.

FINDINGS

17 publications met the inclusion criteria. 136 individual findings were extracted, which were synthesised into 18 categories and eight synthesised findings. The eight synthesised findings included,1) Working as a team to adapt to the challenges of the pandemic, 2) Striving to provide patient centred care, 3) Coping with frequent deaths in the intensive care unit, 4) Challenges of supporting patients family from a distance, 5) The psychological impact of caring for critically unwell patients with COVID-19, 6) Working through the challenges of the intensive care unit setting during the pandemic, 7) The challenges of wearing personal protective equipment while undertaking patient care, 8) The impact of working in the intensive care unit during the pandemic on life at home..

CONCLUSION

This qualitative systematic review has given new insight into the lived experiences of critical care nurses. There were significant psychological and physical impacts on critical care nurses working during the COVID-19 pandemic. Therefore, improving psychological support, maintaining adequate staffing levels/skill mix to ensure basic nursing care can be completed, and the attendance of leadership/management staff is essential to ensure the retention of critical care nurses and achieve optimal patient outcomes.

IMPLICATIONS FOR CLINICAL PRACTICE

This review has highlighted implications for staff retention (counselling, skills development, contingency staffing), the need for improved management/leadership strategies and human resource policies to support critical care nurses when hospitals are in crisis. Additionally, the presence and needs of the family members of critically unwell patients' needs to be prioritised in the intensive care unit.

Surviving Covid-19 Diagnosis Among Registered Nurses: Reactions, Consequences, and Coping Mechanisms

Background

To mitigate the spread of Covid-19, nurses infected with the virus were required to isolate themselves from their families and community. Isolated patients were reported to have experienced mental distress, posttraumatic stress disorder symptoms, and suicide. Though studies have reported the psychological impact of the Covid-19 pandemic, less is known about the lived experiences of nurses who survived Covid-19 infection in sub-Saharan Africa.

Methods

A descriptive phenomenological approach was used to study the lived experiences of registered nurses who survived Covid-19 disease. In-depth interviews were conducted among nurses diagnosed with Covid-19 from two hospitals in Kenya between March and May, 2021. Purposive and snowball sampling were used to recruit registered nurses. Data were analyzed using Giorgi's steps of analysis.

Results

The study included ten nurses between 29 and 45 years of age. Nurses' experiences encompassed three themes: diagnosis reaction, consequences, and coping. Reactions to the diagnosis included fear, anxiety, and sadness. The consequence of the diagnosis and isolation was stigma, isolation, and loneliness. Nurses coping mechanisms included acceptance, creating routines, support, and spirituality.

Conclusion

Our findings aid in understanding how nurses experienced Covid-19 infection as patients and will provide evidence-based content for supporting nurses in future pandemics. Moreover, as we acknowledge the heroic contribution of frontline healthcare workers during the Covid-19 pandemic, it is prudent to recognize the considerable occupational risk as they balance their duty to care, and the risk of infection to themselves and their families.

The causative factors of psychological distress and mental ill-health among ICU nurses during the pandemic

The coronavirus disease (COVID-19) pandemic had a global impact on health systems and health professionals. Nurses, particularly those working in intensive care units (ICUs), held a central critical role in the care of COVID-19 patients, facing numerous challenges in the delivery of care, leading to significant psychological and mental health issues. This article reports on findings from a qualitative narrative review of the literature related to psychological ill-being and mental health of ICU nurses' during the pandemic. Four key themes emerged: (1) isolation (2) workload (3) clinical preparedness and lack of protocols and (4) fear.

COVID-19 pandemic in the intensive care unit: Psychological implications and interventions, a systematic review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic produced changes in intensive care units (ICUs) in patient care and health organizations. The pandemic event increased patients' risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff; this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties.

AIM

To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff.

METHODS

We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles, upon which we commented.

RESULTS

Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories.

CONCLUSION

As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.

Impact of the COVID-19 Pandemic on Nurses Working in Intensive Care Units: A Scoping Review

BACKGROUND

The COVID-19 pandemic resulted in significant system strain, requiring rapid redeployment of nurses to intensive care units. Little is known about the impact of the COVID-19 pandemic and surge models on nurses.

OBJECTIVE

To identify the impact of the COVID-19 pandemic on nurses working in intensive care units.

METHODS

A scoping review was performed. Articles were excluded if they concerned nurses who were not caring for critically ill adult patients with COVID-19, did not describe impact on nurses, or solely examined workload or expansion of pediatric intensive care units.

RESULTS

This search identified 417 unique records, of which 55 met inclusion criteria (37 peer-reviewed and 18 grey literature sources). Within the peer-reviewed literature, 42.7% of participants were identified as intensive care unit nurses, 0.65% as redeployed nurses, and 72.4% as women. The predominant finding was the prevalence of negative psychological impacts on nurses, including stress, distress, anxiety, depression, fear, posttraumatic stress disorder, and burnout. Women and members of ethnic minority groups were at higher risk of experiencing negative consequences. Common qualitative themes included the presence of novel changes, negative impacts, and mitigators of harm during the pandemic.

CONCLUSIONS

Nurses working in intensive care units during the COVID-19 pandemic experienced adverse psychological outcomes, with unique stressors and challenges observed among both permanent intensive care unit and redeployed nurses. Further research is required to understand the impact of these outcomes over the full duration of the pandemic, among at-risk groups, and within the context of redeployment roles.

The Impact of a 3-Tiered Model of Nursing Redeployment During the COVID-19 Pandemic: A Cross-Sectional Study

Objective

The COVID-19 pandemic resulted in extreme system pressures, requiring redeployment of nurses to intensive care units (ICUs). We aimed to assess the impacts of a 3-tiered pandemic surge model on nurses working in ICUs during the COVID-19 pandemic.

Methodology

In this cross-sectional study, 931 nurses (464 ICU and 467 redeployed nurses) who worked within 4 adult ICUs in Western Canada during pandemic surge(s) were invited via email to participate in a survey. The survey explored the impact of redeployment, rapid ICU orientations, just-in-time training, and the 3-tiered model of nursing during pandemic surge. Burnout was measured utilizing the Copenhagen Burnout Inventory questionnaire.

Results

A total of 191 survey responses were retained (59 ICU nurses and 132 redeployed). Survey results are reported by tier, with outcomes varying based on team leadership, ICU, and redeployment nursing roles. Burnout in personal and workplace domains was present amongst all nursing tiers, while only team leadership roles experienced burnout in the patient domain. Overall, team leadership roles and permanent ICU nurses experienced the highest rates of burnout. Redeployed nurses reported numerous aids to success including support from colleagues, prior experience, and educational supports. Skill-based orientation, ongoing education, optimized scheduling, role clarity, and mitigators of psychological impacts were identified by respondents as potential facilitators of redeployment and surge models.

Conclusion

Nurses working within this tiered model experienced high degrees of burnout, with highest prevalence amongst team leads and ICU nurses. Optimization of support for and interventions aimed at improving well-being are important considerations going forward.

Critical Care Nursing in a Resource-Constrained Setting: A Qualitative Study of Critical Care Nurses' Experiences Caring for Patients on Mechanical Ventilation

Introduction

Managing a patient on mechanical ventilation is a vital aspect of clinical scope in intensive and critical care units. In addition, it is a highly technical, intricate, dynamic task requiring extensive knowledge and skills. Little is known about critical care nurses' experiences caring for patients on mechanical ventilation in contexts where resources are constrained, creating an empirical gap in the available body of knowledge.

Objective

This study explored critical care nurses' experiences caring for patients on mechanical ventilators at an intermediate hospital in northeastern Namibia.

Method

The study followed qualitative descriptive and explorative designs. The purposive sample included 13 critical care nurses who had cared for patients on mechanical ventilation for more than 6 months. Data were collected via individual unstructured interviews and analyzed using a reflexive thematic analysis approach.

Results

Four themes and eight subthemes emerged. Varied personal feelings, such as feeling proud, competent, exhausted, traumatized, overwhelmed, and concerns for patients' well-being were experienced by critical care nurses. Participants described learning from colleagues in the unit and expressed concerns about not having postbasic training in critical care nursing. Negative experiences included concerns about community members' misconceptions about critical care units and mechanical ventilators, and challenges with resources, personnel, and admission procedures.

Conclusion

Critical care nurses in resource-constrained settings have positive and negative experiences caring for patients on mechanical ventilators. The findings have implications for the development of support systems for critical care nurses, including induction programs, competence enhancement, psychological support, the development of guiding documents for admission, patient preparation and sensitization of community members. There is a need for this study to be replicated in other resource-constrained contexts where specialized critical care nurses are available.

Nurses' safety-related organisational challenges during the COVID-19 pandemic: A qualitative study

AIM

To explore nurses' perspectives on and experiences of safety-related organisational challenges during the coronavirus disease 2019 (COVID-19) outbreak by Iranian nurses.

BACKGROUND

In different clinical contexts, nurses face numerous organisational challenges threatening their safety because of the COVID-19 pandemic.

INTRODUCTION

Exploring nurses' perceptions towards safety-oriented organisational challenges might inform nurse managers, healthcare managers, educators and policymakers on the priorities that should be considered to increase organisations' readiness and safety.

METHODS

This qualitative descriptive study is reported according to the Consolidated Criteria for Reporting Qualitative Research guidelines. Through purposeful sampling, 19 participants were involved. The research data were collected from March to August 2021 by conducting semi-structured interviews that were analysed through the content analysis approach.

FINDINGS

Three organisation-related safety challenges experienced were related to (1) human resource, (2) educational and (3) workforce protection issues.

DISCUSSION

Nurses experienced several safety issues related to the complexity faced by the health care organisations during the pandemic, exacerbated by previous frailties of the nursing system.

CONCLUSION

The three challenges that emerged might be considered a priority in building pandemic plans, transforming the experiences of nurses as a source of learning for all, capitalising on their suggestions and rendering healthcare facilities ready to deal safely with future crises.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Adopting appropriate measures to decrease human resource issues and that related to education, and promoting workforce health protection, are both recommended to improve nurses' work environment and satisfy their safety needs.

Experiences of intensive care unit nurses working with COVID-19 patients: A systematic review and meta-synthesis of qualitative studies

Objectives

Intensive Care Unit (ICU) nurses are at the forefront of fighting and treating the Coronavirus 2019 (COVID-19) pandemic and are often directly exposed to this virus and at risk of disease, due to their direct care for infected patients. This study aims to synthesize the experiences of ICU nurses working with COVID-19 patients.

Methods

A systematic review and meta-synthesis of qualitative studies were undertaken. A systematic literature search in four databases, including Web of Sciences, Scopus, Embase, and PubMed (including Medline), was performed. Original qualitative studies and the qualitative section of mixed method studies, written in English, which focused on the experiences of only ICU nurses working with COVID-19 patients, were included.

Results

Seventeen qualitative studies and two mixed-method studies were included in the review. As a result of the inductive content analysis, six main categories were identified, as follows: "distance from holistic nursing," "psychosocial experiences," "efforts for self-protection and wellbeing," "organizational inefficiency," "job burnout," and "emerging new experiences in the workplace."

Conclusions

The findings from this study suggest that healthcare authorities and policymakers can facilitate the provision of high-quality patient care during the COVID-19 pandemic through appropriate planning to provide adequate support and training, prevent shortages of nursing staff and equipment, and provide adequate attention to the psychological needs and job satisfaction of ICU nurses.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256070, identifier: CRD42021256070.

Institutional Constraints as an Obstacle for Prioritizing Nursing Interventions During the COVID-19 Pandemic—Critical Care Nurses’ Experiences

Introduction

The demands of the pandemic such as staff shortages and limited resources combined with new guidelines regarding infection control may have required the prioritizing of nursing interventions.

Objectives

The aim of this study was to describe critical care nurses’ experiences of prioritizing nursing interventions for patients with COVID-19 in intensive care units (ICUs) during the pandemic.

Method

A qualitative descriptive study was gathered from open-ended questions included in a cross-sectional online questionnaire. Characteristics were presented using descriptive statistics, and open-ended questions were analyzed using qualitative content analysis with an inductive approach. The study was conducted in Sweden and focused on critical care nurses working in ICUs during spring 2021 and the second year of the COVID-19 pandemic.

Results

During the COVID-19 pandemic, 87% of the critical care nurses had provided orientations for new co-workers, and 52% had supervised intensive care nursing students. In all, 70 answered the question of whether they had prioritized nursing care differently during the pandemic; 86% reported that they had and 14% had not. The qualitative analysis resulted in one theme, Institutional constraints as an obstacle for nursing interventions, with three categories: Prioritizing lifesaving interventions, Performing nursing interventions less frequently, and Not able to provide the nursing care I wish to provide.

Conclusion

Institutional constraints as an obstacle for nursing interventions is the overall theme. It illustrates how critical care nurses have been forced to prioritize, thereby not being able to provide the nursing interventions they wanted to do provide, and it describes their feelings in this situation. The nurses need recovery and possibilities for reflection. The organization must also recover and not only return to how it was before the pandemic but also to learn from recent events and take actions to reduce the long-term effects on staffing.

Moral Distress Experienced by US Nurses on the Frontlines During the COVID-19 Pandemic: Implications for Nursing Policy and Practice

Introduction

The ongoing COVID-19 pandemic represents the largest contemporary challenge to the nursing workforce in the 21^st century given the high stress and prolonged strain it has created for both human and healthcare supply resources. Nurses on the frontlines providing patient care during COVID-19 have faced unrivaled psychological and physical demands. However, no known large-scale qualitative study has described the emotions experienced by nurses providing patient care during the first wave of the COVID-19 pandemic in the US. Objective: Therefore, the purpose of this study was to qualitatively describe the emotions experienced by US nurses during the initial COVID-19 pandemic response.

Methods

One hundred individual interviews were conducted with nurses across the United States from May to September of 2020 asking participants to describe how they felt taking care of COVID-19 patients. All interviews followed a semi-structured interview guide, were audio recorded, transcribed, verified, and coded by the research team.

Results

Participants narratives of the emotions they experienced providing patient care during COVID-19 unequivocally described (1) moral distress, and moral distress related (1.1) fear, (1.2) frustration, (1.3) powerlessness, and (1.4) guilt. In sum, the major emotional response of nurses across the US providing patient care during the pandemic was that of moral distress.

Conclusion

Investments in healthcare infrastructures that address moral distress in nurses may improve retention and reduce burnout in the US nursing workforce.