Nursing perspectives on care delivery during the early stages of the covid-19 pandemic: A qualitative study

Abstract

Background Research examining RNs’ experiences during the COVID-19 pandemic is lacking, thus inhibiting efforts to optimize nursing care delivery and patient outcomes during the current pandemic and future public health emergencies. Objective To explore the experience of being a registered nurse caring for patients with COVID-19 at an urban academic medical center during the early stages of the pandemic Design Qualitative descriptive study, guided by Donabedian's Quality Framework for Evaluation of Healthcare Delivery which focuses on structures, processes, and outcomes of care delivery Setting Urban academic medical center in the northeast United States Participants Registered nurses cared for or caring for patients with COVID-19, age ≥18 years old, and English-speaking Methods Participants were recruited for individual in-person semi-structured interviews. Interviews occurred during March and April 2020 and were recorded and transcribed. Transcripts were analyzed by two researchers using emergent qualitative content analysis to identify themes. Results Twenty-one registered nurses participated in the study. Three themes emerged from the data, included one relevant to structures and two relevant to processes of care during the pandemic. Registered nurses perceived the clinical context as highly dynamic, but quickly adapted to pandemic-related care delivery. They felt a “sense of duty” to care for patients with COVID-19, despite being fearful of acquiring or spreading infection. Compared to clinical colleagues, registered nurses reported increased patient exposure and performed tasks previously assigned to other clinical team members. Conclusion Roles and nursing practice processes evolved to meet the demand for care despite challenges. Registered nurses require adequate protection for their frontline role which may consist of increased patient exposure compared to clinical colleagues, emotional support, and clear clinical guidance. A deeper understanding of how a public health emergency, such as the COVID-19 pandemic, affects nursing practice can guide future efforts to optimize healthcare structures, nursing care processes, and patient outcomes. Our study can inform strategies for providing registered nurses with adequate communication, protection, and resources during the COVID-19 pandemic and future similar public health emergencies.

Emotional Experience and Feelings during First COVID-19 Outbreak Perceived by Physical Therapists: A Qualitative Study in Madrid, Spain

“…The results of the current study had consistently shown that physical therapists also experienced similar emotions and feelings as other healthcare professionals, since fear was the most intense and long-lasting emotion in these professionals [ 14 , 28 , 36 ]. During the first COVID-19 outbreak, various types of fear have been identified [ 37 ]; (a) the fear of attendance at work (doctors and nurses avoid accepting patients in the hospital and staff avoid being back at the hospital), (b) fear of infection (concern about family and the virus), (c) fear of getting sick (themselves or their family), (d) fear of more COVID-19 waves, (e) fear of an increase in mortality (death of patients and colleagues, particularly medical colleagues’ death had a huge negative effect on health professionals). Ardebili et al [ 14 ] and Barello et al [ 28 ] showed that healthcare professionals who worked during the pandemic reported concerns regarding their fear of dying alone and being separated from their loved ones, fear of infecting their families, friends, or colleagues, and fear of stigmatization.…”

“…Previous studies have also reported that healthcare professionals did not receive professional psychological support from their workplace centers during the first months of the acute COVID-19 outbreak [ 36 , 37 , 38 ]. In Spain, Martínez-López et al reported that 90% of the healthcare professionals considered that psychological care should have been provided from their workplace centers [ 33 ].…”

Nurses’ barriers to caring for patients with COVID‐19: a qualitative systematic review

“…• Ambiguity of information about COVID-19 (He et al 2020;Sadati et al 2020) • Far less information about patients' diagnosis when coming to the ED, except checking patients' fever (Hou et al 2020) • Excessive and rich source of information, but most of them were rumours and unclear (Pei et al 2020;Sadati et al 2020;Schroeder et al 2020;Yin & Zeng, 2020) • Sudden outbreak of the virus, still under investigation of the virus, its medications; thus, strong need for knowledge about the novel virus (Sheng et al 2020;Yin & Zeng, 2020) Unpredictable tasks and challenging practices…”

“…• Hospital and healthcare system unprepared to care for COVID-19 patients (He et al 2020;Hou et al 2020;Pei et al 2020;Shen et al 2020) • Lack of protective facilities such as isolation units (Kackin et al 2020;Sadati et al 2020;Schroeder et al 2020;) • Limited equipment, such as PPE, for protecting healthcare practitioners (He et al 2020;Hou et al 2020;Sadati et al 2020) • Shortage of staff who care for infected patients (Kackin et al 2020;Zhang et al 2020) Concerns about family…”

Hospital Nursing Staff Perceptions of Resources Provided by Their Organizations During the COVID-19 Pandemic

“…In hospitals, nursing staff were on the frontline providing care in close physical proximity to patients with COVID-19 and had direct risk of being exposed to the virus (Sim, 2020). Nurses worked long hours under extremely dynamic conditions, had heavy workloads, and carried the fear of becoming infected and transmitting the virus to family and friends (Liu et al, 2020; Schroeder et al, 2020). Many have experienced a decline in psychological well-being, such as increased anxiety, depression, and post-traumatic stress (Giusti et al, 2020), that may interfere with the safe delivery of high-quality care.…”