United States nurses' experiences during the COVID‐19 pandemic: A grounded theory

Abstract

Objective The objective of this study was to explore nurses' experiences and perceptions at selected United States (U.S.) healthcare sites during the COVID‐19 pandemic. Background The COVID‐19 pandemic brought rapid changes to the healthcare community. While a few studies have examined the early pandemic experiences of nurses in China and Europe, nurses' experiences across the United States have remained relatively underexplored. Design A qualitative study design was used. Methods Using a constructivist grounded theory methodology and methods, we conducted eight focus groups across four hospital sites in the eastern, midwestern and western United States. Registered nurses with a minimum of six months' experience working in all clinical specialties were eligible. Forty‐three nurses participated. Data were analysed iteratively using the constant comparative method. The COREQ guidelines supported the work and reporting of this study. Results The nurses experiencing a pandemic (NEXPIC) grounded theory emerged positing associations between four interrelated themes: Challenges, Feelings, Coping and Ethics. Nurses reported Challenges associated with changes in the work environment, community and themselves. They expressed more negative than positive feelings. Nurses coped using self‐care techniques, and teamwork within the healthcare organisation. Moral dilemmas, moral uncertainty, moral distress, moral injury and moral outrage were ethical issues associated with nurses' Challenges during the pandemic. Moral courage was associated with positive Coping. Conclusions Awareness of frontline nurses' complex and interrelated needs may help healthcare organisations protect their human resources. This new theory provides preliminary theoretical support for future research and interventions to address the needs of frontline nurses. Relevance to clinical practice Nurses face added distress as frontline at‐risk caregivers. Interventions to promote nurses' ability to cope with personal and professional challenges from the pandemic and address ethical issues are needed to protect the nursing workforce. This study offers a new substantive theory that may be used to underpin future interventions.

What can general practice learn from primary care nurses’ and healthcare assistants’ experiences of the COVID-19 pandemic? A qualitative study

“…This study found that the COVID-19 pandemic has been a stressful period for nurses and HCAs in general practice, aligning with international accounts of primary care25 27 29 35–37 39 56–58 and nurses’ experiences in general 26 28 30–34 40 59–62. The necessity for meaningful and accessible short-term and long-term mental health support and continuous education and training are key recommendations in the literature 21–23 25 28 31 32 37 38 40 57 59.…”

“…Interviews were directed by a topic guide (box 1), ensuring important topics were covered while allowing exploration of novel ideas. The initial topic guide was based on the themes from existing literature 25–40. Clarity and focus of some questions were adjusted following a pilot interview with a practice nurse; the pilot interview was therefore not included in data analysis.…”

“…There is a substantial volume of international qualitative literature documenting nurses’ experiences of the pandemic. Most of these studies are set in hospitals 25 26 28–36. Fewer studies focus on primary care nurses who, with differing responsibilities during the pandemic and moving forward, possess different insights.…”

A Phenomenological Study of Nurses’ Experience in Caring for COVID-19 Patients

“…International researchers reported that nurses dealt with and attempted to overcome their challenges and feelings and emotional responses by coping during the pandemic. Nurses in the United States [ 17 ] and India [ 45 ] used teamwork and peer support, and used personal coping strategies, such as relationship development, play, exercise, meditation, and distractions.…”

“…Studies on the nursing experience of patients with COVID-19 are underway in countries in various trajectories of the COVID-19 pandemic, such as Spain [ 14 ], Italy [ 15 ], Canada [ 16 ], the United States [ 17 ], and China [ 18 ], and these previous studies are focused on the lived nursing experience itself or the ethical aspect. Experiences of nursing care reported so far are summarized as providing nursing care [ 14 , 15 , 16 ], psychosocial and emotional aspects [ 14 , 15 , 18 , 19 ], resource management [ 14 , 16 ], struggling on the frontline [ 19 , 20 ], personal growth [ 18 , 19 ] and adapting to changes [ 18 , 20 ].…”