Lived in experiences of nurses working with Covid-19 positive patient

INTRODUCTION

Novel Corona virus disease 2019 (COVID-19) is rapidly spreading worldwide.1 The COVID-19 outbreak was declared pandemic by the WHO on 11 March 2020.² As of April 22, 2020, there have been 24,71, 136 confirmed cases worldwide, with 1,69, 006 deaths.¹

As COVID-19 is a new disease, the medical system and culture of different countries varies in fighting against COVID-19. Currently, published studies have highlighted the disease prevalence, clinical characteristics, diagnosis and treatment. Some reports have paid attention to the severity of psychological problems in medical personnel.³

According to Preeti Sudan, Secretary of Govt of India, Doctors, nurses and health care professionals are at the forefront in the fight against COVID-19. Their efforts and spirit is being widely acclaimed at all levels. The skills and spirit of service amongst these professionals places them in a unique position to save people from this disease. It is utmost important that adequate measures must be taken by the concerned authorities are taken for ensuring their safety.⁴

A study on special attention to nurse’s protection during COVID-19 epidemic was conducted at Guangdong second provincial general hospital, China. During study period they have treated 35 confirmed and more than 260 suspected cases of COVID-19. The results revealed that while by providing adequate education to nurses on use of personal protective equipments (PPE), hand hygiene, ward disinfection, medical waste management, sterilisation of patient care devices, and management of occupational exposures as well as providing reasonable shift duty schedule, the hospital is able to maintain a zero nurse infection rate during COVID-19 epidemic pandemic. The study recommended that, as most of nurse’s working in direct contact with COVID-19 patients so they are vulnerable for infection. Hence there should be specific protocol in each hospital to reduce the risk of infection among nurses who are in direct contact with patients.⁵

Hence the present study was undertaken with an objective to explore the nurse’s lived-in experiences while taking care of COVID-19 positive patients.

Literature Review:

We searched PubMed, Science Direct, and Google Scholar for studies describing the Lived-in experiences of registered nurses caring for patients with coronavirus disease 2019 (COVID-19), using the search terms “COVID-19” or “novel coronavirus” and “lived-in experiences of nurses” or “experiences of registered nurses” or “nursing staff”. We found Several on perception of nurses, psychological experience of caregivers, stress relief strategies for staff nurses and psychological impact of covid-19 on health care providers generally and infection prevention for health-care providers. There were no research articles on lived-in experiences of nurses in the COVID-19 pandemic.

The COVID-19 pandemic is producing a huge health care burden with millions of cases and thousands of deaths. The coronavirus' high virulence and contagiousness and the frequent sudden onset of illness is overwhelming critical care and frontline healthcare staff. Frontline professionals are exposed to unprecedented levels of intensive existential threat requiring systematic, specialized psychological intervention and support. New psychological services need to be urgently implemented to manage the mental healthcare needs of frontline medical staff working with patients with COVID-19⁶.

A literature review on the psychological impact of a pandemic outbreak on medical staff revealed very scarce literature and also revealed short and long-term impact of such epidemics on the mental health of the medical teams such as depression, anxiety and post-trauma and further identified constituting risk factors for mental symptoms such as Direct exposure to affected patients, the risk of contagion, a subjectively negative perception of one's medical condition and being in isolation or quarantine. Review has concluded that, a sense of control, especially regarding the means of protection and controlling infection, altruistic acceptance of the work-related risks, social support, good team-spirit in the medical unit and support from superiors are all protective factors⁷ .

A Systematic Review and Meta-Analysis on Prevalence of Depression, Anxiety, and Insomnia Among Healthcare Workers During the COVID-19 Pandemic revealed pooled prevalence of anxiety-23·2%, depression-22·8%, insomnia-38·9% with gender and occupational differences with female Health Care Providers and nurses exhibiting higher rates of affective symptoms compared to male and medical staff respectively⁸ .

MATERIALS AND METHODS:

The Research design used for the study was Phenomenological research design. Ethical clearance was obtained from the Institutional ethics committee, through Institutional alumni whats app group, a text message was sent with an information on statement of the problem and objectives of the study with a request to share mail id of alumni or their friends who were registered nurses caring for COVID positive patients and willing to participate in the study. The participants were recruited by using purposive sampling technique. The questionnaire was sent to all received mail IDs. After a week of follow up around 15 nurses were responded with their consent to participate in the study. The mailed questionnaire has two sections. Section-A: had socio-demographic data which includes age, gender, professional qualification, years of experience and area of working. Section-B: consists of six open ended questions. Data was collected through self report from 15th May 2020 to 15th June 2020. Confidentiality was maintained by giving numbers to the participants

DATA ANALYSIS

Data analysis was done, by content verification while reading line by line and paragraph by paragraph, looking for significant statements and codes according to the topics addressed.

The researcher used three levels of coding. In level one coding, researcher examined the data line by line and making codes which were taken from the language of the subjects. In level two coding, comparing of coded data with other data and creation of categories were done. In level three coding, the categories that seem to cluster together were formed as themes. Then the documents were submitted to two assessors for validation. This action provided an opportunity to determine the reliability of the coding.

RESULTS

I. Socio-demographic data of nurses working with COVID patients

Socio-demographic data of nurses working with COVID positive patients are presented in table-1.

II. Lived in experiences of nurses caring for COVID positive patients

From the analysis, five themes were identified. They are anxiety and fear, call for duty, preparedness, adequacy of resources, and Patient response to treatment

1.Anxiety and fear

This theme is emerged from all study subjects. Almost all (100%) nurses reported that, they were anxious, nervous and fear at the first site of caring COVID19 positive patient because it is contagious disease and may show impact on self, family, friends and colleagues. Few (20%) nurses reported that, Hospital CMO and Director have taken extra care by making rounds in between shifts asking for welfare of the staff regarding anxiety and fear.

2. Call for duty

Majority (80%) of nurses reported that, COVID19 is a pandemic disease and once in a life time they get a chance to care this type of patients, so they felt that it’s a call for duty. Further they have also stated that, being in a noble profession, it is their pride to take care of patients. Remaining 20% of them mentioned that it’s their duty to care so they are caring.

3.Preparedness

Almost all (100%) nurses reported that they were adequately prepared with training on care of patient with COVID19 by the institution before postings them to the COVID ward /ICU and few(33%) of them stated that they have downloaded videos on stress relief from the YouTube and modified their lifestyle like eating habits, practicing Yoga, relaxation techniques and stress management. Some (13%) of them stated that they have followed strict universal precautions including clean shave and hair cut.

4.Adequate facility

Almost all (100%) nurses reported that their institution has provided them an adequate facility to care the COVID19 patients such as PPE and hand sanitizers. Few (40%) of them stated that, they were given prophylactic treatment before the postings and others said that, variety of PPE kits everyday made them confused. Some even stated that in the beginning, they have not received proper guidance regarding categorization of COVID positive or negative patients, which created them confusion in shifting or discharging them from the ward. Few of Indian nurses mentioned that, they were provided food and accommodation during quarantine and abroad nurses stated proper use of PPE, Hand hygiene and maintaining distance helped them with family without quarantine. Few have expressed that, after exposure to the patient, even though they felt that, they were having warning symptoms, hesitated to express because of expensive diagnostic measures and lack of administrative support.

5.Patient response to treatment

With regard to this theme, majority (80%) of nurses reported that patients were responding well for the treatment and recovered between 7 to 10 days. Few (20%) stated that, patients with comorbid diseases like diabetes, hypertension, heart diseases needed prolonged hospitalization with ventilator support but recovered with high quality patient care. Further they have also mentioned that, few patients responded well for both Hydroxychloroquine (HCQ) and antiviral drugs, well built patients recovered faster than older and co-morbid patients. In abroad, patients responded well with Remdesevir where as in India with HCQ.

DISCUSSION

From lived-in experiences of nurses, five themes were emerged such as Anxiety and fear, Call for duty, Preparedness, Adequate facility and patient response to treatment. With regard to anxiety and fear almost all nurses reported that, at the first site of caring COVID patients they were anxious, nervous and fearful.This was supported by the study conducted by NiuniuSun etal.3With regard to the theme on “call for duty”, majority felt that COVID disease is a pandemic and it affected whole nation and the world. Caring patients in such situation is a great experience (transcendence) or call for duty by the God. This was supported by the study conducted by Qian Liu etal.6With regard to“Preparedness”, almost all nurses expressed that they were prepared adequately (physically and psychologically) by the institution as well as themselves by adopting self-management strategies by adopting coping skills. With regard to adequate facility, almost all nurses expressed that they were provided with adequate PPE except face shield which they were disinfecting and using.With regard to patient response to treatment, nurses reported that with high quality care, patients recovered well, irrespective of age and risk factors. This was supported by the study conducted by Lishan etal.5

Recommendations:

From the above findings of the study, researchers made the following recommendations;

• The health care centres should immediately develop their own SOP based on WHO and NCDC guidelines related to use of personnel protective equipments (PPE), hand hygiene, ward disinfection, waste management, sterilization of patient care devices, screening and quarantine of exposed staff and nursing shift schedule.

• Regular orientation programme to the frontline health workers on use of PPE and infection control measures.

• Nursing shift schedule preferable 4 hrs duty.

• Regular counselling services to the frontline workers at the entry/exit level of COVID ward/ ICU in order to identify the vulnerable health workers and provide treatment with free of cost.

Conclusion

Nurses have showed professional dedication and acceptance of the need to place themselves at risk to care for COVID-19 positive patients. They adopted self-coping styles and altruistic acts to promote patients’ recovery.

Regular training programmes to promote preparedness and efficacy, adequate supplies and equipment and good team spirit are required to manage the crisis.

ACKNOWLEDGEMENTS

The writers expressed their gratitude and appreciation to the research experts and all the nurses who participated in this study.

UNDERTAKING BY AUTHORS

We, the undersigned, give an undertaking to the following effect with regard to our article entitled LIVED IN EXPERIENCES OF NURSES WORKING WITH COVID-19 POSITIVE PATIENT submitted for publication in the Journal of RGUHS Nursing sciences. The article mentioned above has not been published or submitted to or accepted for publication in any form, in any other journal. We declare that, we contributed significantly towards the research study i.e., conception, design and/or analysis and interpretation of data.

Dr. G.Vijayalakshmi Dr. Radha M.S.