nurses during pandemic

Understanding the lived experience provides a unique lens through which to view nursing during a global pandemic, and it serves as a starting point to ensure future safeguards are in place to protect nurses well-being. Inclusion criteria were (1) age at least 21 years or older; (2) English-language fluency (both reading and writing); and (3) being an RN who has been actively working (full-time, part-time, or per diem) during the COVID-19 pandemic. Information about the pathophysiology, prevention, and treatment of, as well as recovery from, COVID-19 continues to emerge. /X13 11 0 R The authors dedicate this manuscript to all of the health care workers who have died while fighting COVID-19. They were especially empowered by the teamwork in which they and their fellow nurses engaged. /Annots [27 0 R 28 0 R] We also wrote an exhaustive statement that described the overall experience of being a nurse during the COVID-19 pandemic. As the name of this design suggests, we used each type of data to validate the other and to create solid foundations through which to answer the research question. Specific examples are helpful. Participants shared their experiences by typing their response in a free-text box (qualitative data). /Author (K Birch) /StructParents 0 8 0 obj /Kids [4 0 R 5 0 R 6 0 R] /X25 24 0 R ( Most nurses (n = 29) reported that patients with COVID-19 had died in their unit. Many discussed leaving their work clothes at the door and sanitizing their hands and the surfaces they come in contact with. We reviewed the literature about nurses experiences during COVID-19, searching PubMed, CINAHL, and Google Scholar. << ( J ( @$( z u PAP@ IAP@ /@?Z u PAP@ P P@ I@ P@ P@ P@ P@ TNN\RRZI zfdW8Yadu\VNHM %'nqJ2"Xf7$V*ANVATPP@ PYZB1 AP@ P@ P@ @ Pf P@ 1@ @ @ PK Finally, nurses mentioned the heaviness and the emotional toll of being in the room on a Zoom call with family saying their last goodbye to their [ventilated and] sedated loved ones. In the words of the nurses themselves, the patients are more than their disease and we are doing our best.. What we have found across our studies is that nurses are struggling, and without help from both the public and health care systems they may they leave nursing altogether. The safety sacrifices nurses have made for their organizations and patients has led to severe mental health consequences. It challenges the health care system and our society as we know it. /G12 8 0 R Providing nursing care in this time, when we have more questions than answers about appropriate PPE, the use of prone positioning, and medication regimensthe list could go oncreates a space of personal vulnerability for these nurses. /X26 25 0 R Scientifically rigorous studies of the use of self-care methods and restorative practices to prevent burnout, such as those in creative arts and others mentioned in recent studies of critical care nurses, are needed to instill a sense of fulfillment.30 Our field also needs more high-quality qualitative and mixed-methods research both conducted by and focusing on interprofessional teams. When hospital systems are overwhelmed with unvaccinated COVID-19 patients, there may be limited staff or resources to help those who need care for other medical emergencies. /ProcSets [/PDF /Text /ImageB /ImageC /ImageI] Overall, the nurses were struggling with some large losses: wedding plans put on hold or changed, graduation celebrations postponed or cancelled, family time interrupted, vacations cancelled, personal appointments put off. ( These nurses demonstrated high resiliency related to the theme of being proud to be a nurse. Despite all that was happening, they continued to take pride in being on the front lines, showing up each day to provide care during the pandemic. 2 0 obj Another nurse in our study had a similar experience: Our policies were changing so rapidly that oftentimes anesthesia would have a different understanding [of the policy], the doctors and residents would have a different understanding, and nursing would have gotten a different email always within like a half-hour. Search for other works by this author on: Susan Bartos is Assistant Professor, Egan School of Nursing and Health Studies, Fairfield University, Fairfield, Connecticut; and per diem Registered Nurse, Surgical ICU, Bridgeport Hospital, Bridgeport, Connecticut, which was converted to a COVID ICU during the pandemic. >> Overall, nurses have high rates of exposure to infectious diseases. ( /F6 13 0 R They spoke not only of the meals but also of the thank you signs that people within their communities would hold up or place in their yards, and of the ways other essential workers (eg, firefighters and police) thanked them for their work as nurses. /ProcSets [/PDF /Text /ImageB /ImageC /ImageI] These nurses showed up each day to care for their patients, asking, Whats the protocol today? /ExtGState << One sentiment clearly resounding from the shared experiences of each nurse was: I am proud to be a nurse. Time and time again they demonstrated teamwork to care for not only their patients but each other. A total of 43 nurses participated in the study. ( JFIF C It was not that these nurses did not want to do their jobs. These nurses openly expressed their fears of getting sick themselves, and of inadvertently spreading the virus to their children, parents, or partners. The first wave of coronavirus disease 2019 was a global event for which nurses had limited time to prepare before receiving an influx of high-acuity patients and navigating new plans of care. ( Overall, for this study, a high score would demonstrate a participants ability to be positive and to grow during this stressful COVID-19 outbreak, whereas a low score would demonstrate that a participant has not been able to cope well with the situation. The Year of the Nurse and the Midwife, however, was quickly overshadowed by the international invasion of the novel coronavirus disease 2019 (COVID-19). ( The nurses also worried that the sanitation process for N95 masks had not been tested and could potentially break down the mask material, thereby putting them at a higher risk of being exposed to COVID-19. During our review of the qualitative data, we noted that 22 of the participants responded to the open-ended research question with only a few words or sentences. A medical-surgical nurse working in a float pool at a community hospital offered that so little research [is available] on this virus and therefore so little information on how to treat it no [intravenous] fluids for most of these patients because of the pneumonia, no [bilevel positive airway pressure], no med[ication]s proven to be effectiveyou feel almost helpless.. Qualitative narratives give meaning to and explain the quantitative numbers. /Keywords (DAD4IoFLs8c,BACWqN75860) ( These restorative acts of self-care were what was getting these nurses through the difficulties of being on the front lines. Severe acute respiratory syndrome coronavirus 2 is the virus that causes COVID-19, which was first identified as a pneumonia-like illness in Wuhan, China, in December 2019. /F7 14 0 R A survey conducted by the American Association of Critical-Care Nurses of over 6,000 ICU nurses found that 66% of respondents were considering leaving nursing as a result of their care experiences during the pandemic. /Resources << /MediaBox [0.0 7.9200063 612.0 799.92] Uncertainty remains regarding whether 2020 was the introduction, the rise in action, the climax, or an epilogue in the story of nursing. They were emotionally shaken by having to bridge the gap for their patients, who were not allowed visitors and who were dying alone while their loved ones said goodbye through tablets and phones the nurses held. /Type /Catalog The mean score on the BRCS for the entire sample (n = 43 nurses) was 14.4 (SD, 2.3). After providing electronic informed consent, the participants completed a demographic form and then the 4-item BRCS (quantitative data).33 They were asked to provide a written narrative in response to the request, As an acute care nurse working during the COVID-19 pandemic, please describe your experience of caring for your patients and for yourself. Although they worried about becoming sick themselves, the predominant sentiment was clearly worry about spreading it [COVID-19] to their loved ones., This worry led to the new way to come home. In addition, nurses shared how they also were journaling, exercising, gathering virtually with friends, crafting, practicing mindfulness, and talking to their loved ones more often. << University of Arizona provides funding as a member of The Conversation US. A convergent mixed-methods design presents a complete picture. They also went out of their way to hold phones to patients ears and hold up electronic devices such as tablets so that family members could say their final goodbyes and wish their loved ones sweet dreams. In the words of 1 nurse, that shit matters, and I believe it makes a difference for patients. Nurses demonstrated that they will do almost anything for their patients, even risking their own lives. doi: https://doi.org/10.4037/aacnacc2021816. As one nurse described it, the worst part was reassuring them no but not being so sure yourself. Despite the high acuity of their patients, nurses made every attempt to support and encourage them whenever possible. >> >> /F5 12 0 R This is how one young nurse described their experience caring for COVID-19 patients without any safety guidance: There was a palpable tenseness being there nobody knew what was going on or what was expected. /BM /Normal << Nurses are trained to practice evidence-based health care, and when a method of care works, they will implement it for their patients. One ICU nurse working at a community hospital described her new normal: When I return home from work I have to remove all of my clothes in the garage and place them immediately on [the] sanitize cycle in the washing machine. The qualitative themes from this study reflect both uncertainty (Whats the protocol today?) and certainty (Proud to be a nurse). Even worse, some health care organizations gaslit nurses for being concerned for their own safety. As 1 nurse shared, during this pandemic, I feel the teamwork, and the empowerment of being a nurse. The nurses pride allowed them to power on during the pandemic; it propelled them forward. There was no real protocol yet. The negative emotions, frustration, anxiety, and stress they each expressed stemmed from the unknown and from both the constantly changing protocols related to patient care and the continual changes surrounding proper use and allocation of PPE. They were proud to be providing nursing care and appreciated the recognition of their work by local restaurants who donated food to their hospitals. >> >> The effects of COVID-19 have been felt in, and continue to ripple through, all areas of the world. Curating and archiving these pandemic experiences are important and necessary. ( To help you understand their experiences, here are the five key takeaways from our studies on what nursing has been like during the COVID-19 pandemic. One nurse in the sample identified as male; the other 42 identified as female. The nurses in our studies put the needs of their patients and society above their own. /Creator (Canva) /Resources << The hero narrative surrounding nurses could exacerbate burnout. << These nurses discussed countless ways they were coping with their emotions through self-care measures, which encompassed quiet prayer and mediation, exercise, crafts, virtual meetings with friends, time spent with loved ones, and a decision to further ones nursing education. Those are very draining, especially when were supposed to provide patient care and do a good job. But this can be a dangerous label with negative consequences. /X21 21 0 R For all of their frustrations, disappointments, heavy emotional burdens, and anxieties, each nurse pivoted from these emotions to sharing at least 1 example of what they personally had been doing to cope with their feelings. 7 0 obj ( Colaizzis phenomenological method was used for qualitative analysis. The 12 nurses whose comments represented this theme expressed strong emotions related to being a nurse at the front lines of the COVID-19 pandemic. A second notable strength is the mixed-methods design. Several worked in more than 1 type of unit. stream All 21 nurses had at least 1 experience or thought that contributed to this theme. ( These nurses resoundingly shared how proud they were to be a nurse on the front lines during this pandemic. Last, to this point, within their institutions nurses faced not only limited supplies of PPE but also shortages of body bags and morgue space. Jenna A. LoGiudice, Susan Bartos; Experiences of Nurses During the COVID-19 Pandemic: A Mixed-Methods Study. (J ( ( They noted that patients smiled less without their family members around. /Font << 3 0 obj Nurses have cared for patients despite working in hazardous work environments. It hurt to have the family calls explaining [that] their loved ones were failing and not allowing them to visit, even at death. Nurses working during the COVID-19 pandemic demonstrated medium resilience scores on the BRCS (mean score, 14.4). If anything, it just makes the environment more toxic and unbearable, definitely, and at one point, it will start affecting your mental health and your physical health, even your spiritual health.. Even when these nurses expressed that their hospitals had prepared well for the predicted surge of COVID-19-positive patients who would require high-acuity care, they still focused on every day being so unpredictable with protocols and policies constantly changing. Then, as they became thankful that the numbers of patients with COVID-19 began to drop, a new stressor arose when COVID-19-positive and -negative patients were allowed on the same floors and units. Are there people down there? (: The authors declare no conflicts of interest. ( /ca 1 This study aims to understand the lived experiences of nurses working in this environment during the pandemic and to measure their level of resilience. The looming threat of continued waves of infected patients hangs over the heads and the practice of both novice and expert RNs. /Type /Page >> In this study, nurses had the highest score (mean, 4.0 of 5.0) for the BRCS item, I believe I can grow in positive ways by dealing with difficult situations. Participants in other published studies also experienced professional growth.22 Although previous studies were conducted with international samples, similar themes about connections to family and to the profession resonated. /F7 14 0 R endobj Although this last point was resolved when hospitals moved to testing all patients regardless of their symptoms, it was stressful for these nurses and illustrates their anxiety. Overall, the total mean score indicates that most nurses in this study (n = 19) were medium resilient copers; 9 were high resilient copers and 15 were low resilient copers. According to the CDC, 92% of COVID-19 cases and hospitalizations, and 91% of COVID-19-related deaths, were among individuals who were not fully vaccinated between April and July 2021. Self-care activities included spending time with those in the same household or arranging virtual visits with friends (social); prayer or meditation (spiritual); exercise, walking, and yoga (physical); arts/crafts/creative endeavors, reading, and writing/journaling (intellectual); and listening to music (emotional). ( /MediaBox [0.0 7.9200063 612.0 799.92] Share all your thoughts, feelings, and perceptions until you have no more to say about the experience. The mean score for resilient coping was 15.38 for the 21 nurses included in the qualitative data analysis, indicating that overall they were also medium resilient copers; the breakdown was 7 high resilient copers, 10 medium resilient copers, and 4 low resilient copers. Many organizations instead require overtime and dont provide adequate resources, such as personal protective equipment or support personnel, for safe patient care. /Contents 29 0 R /F16 17 0 R They shared how lonely patients were and how, with no family around[, they as nurses] are the family and provide not only the medical needs but also the emotional and mental support to patients. (J Nurses were literally watching family members via an iPad pour their hearts out to [the] patients. In some instances, it would be the last time a patient would speak to their loved one, given how quickly the disease often progressed. [Over 115,000 readers rely on The Conversations newsletter to understand the world. Jessica Rainbow receives funding from the National Institute of Occupational Safety and Health, National Council of State Boards of Nursing Center for Regulatory Excellence, The University of Arizona College of Nursing, and HRSA.

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