Nurse's experience in giving nursing care to Covid-19 patients

Abstract

Objective

The objective was to describe Nurse's experience in giving nursing care to covid-19 patients.

Method

Phenomenology design was used in this study. Participants in this study were nurses who provided nursing care for COVID-19 patients. Participant data were obtained from the nursing office and contacted via cell phone to become participants. After data saturation the researcher found six nurses as participants. In-depth interviews were conducted from July to August 2020 to explore the experiences of nurses giving nursing care to Covid-19 patients. Data was analyzed using the Colaizzi method.

Result

We found five themes of nurses giving nursing care to Covid-19 patients. The themes include the Motivation of nurses to provide nursing care during the COVID-19 pandemic, the nurse emotional response, the patient emotional response, the problems faced by COVID-19 nurses, and the expectations of the nurses.

Conclusion

Nurses need support while giving nursing care to Covid-19 patients to break Covid-19 transmission.

Introduction

Starting from the phase when the Global Pandemic COVID-19 outbreak entered Indonesia, Nurse is a profession that must carry out its professional obligations to be at the front line of tackling this virus in nursing care. When most workers do work at home, one of the health workers who still have to work and continue to serve is a nurse.

The nursing profession during the COVID-19 pandemic was challenged to provide professional nursing care with the risk of contracting and even becoming victims of COVID-19. The duty of a nurse in the COVID-19 pandemic is to meet the basic needs of patients and provide education so that patients can take preventive measures in the event of a similar case. Although the chain of transmission has not been broken, nurses must continue to carry out their duties by providing nursing care for infected patients. During a pandemic, nurses together with their peers need to decide how much care they can give to others in addition to caring for themselves.¹

Nurses at hospitals who treat COVID-19 patients are faced with two choices, namely continuing to work by upholding professionalism or prioritizing personal and family safety. Nurses have a very important role in providing promotive, preventive, and nursing care services in the COVID-19 pandemic. Nurses who are currently involved in the care of COVID-19 patients in all hospitals around the world have sacrificed personal and family interests. Nurses have sacrificed safety and face the threat of contracting a virus that could end in death. The purpose of this study is to describe Nurse's experience in giving nursing care to covid-19 patients.

Methods

This research uses a qualitative study with a phenomenology design. This design was chosen so that participants’ experiences could be explored more clearly so that the description of the nurses experience during giving nursing care to Covid-19 patients could be clearly illustrated. This method is very appropriate to be used to explore the phenomenon of nurse's experience because each nurses has his own experience in giving nursing care. The study was conducted in the regional hospital in Padangsidimpuan city. Because the hospital became referral hospital for Covid-19 patients from several surrounding places of South Tapanuli Area. The study began in June September 2020, data collection was conducted in July to August 2020. The number of participants in this study was 6 participants. Participants were taken using purposive sampling with inclusion criteria: willing to be a participant, become covid-19 nurse and giving nursing care to Covid-19 patients. Participants in this study have agreed to provide information and have been kept confidential by the researcher by not including the participant's name

Data collection used in-depth interviews conducted by researchers with a duration of 50–60 min by telephone to record interviews. The interview was carried out several times to obtain data saturation. Data collection tools in this study were demographic data questionnaires, interview guidelines, and mobile phones. The interview guide consisted of 5 open-ended questions such as motivation to become a Covid-19 nurse, nurse emotional response, problems faced by nurses when providing nursing care, benefits of being a nurse during the Covid-19 pandemic, and nurse expectation.

Qualitative data analysis using the Colaizzi model with 7 stages ranging from reading all the contents of the interview, identifying significant statements, formulating meaning, clustering themes; developing an exhaustive description, producing the fundamental structure, and seeking verification of the fundamental structure.² Ethical approval was approved by the Universitas Prima Indonesia Health Research Ethics Commission (064/KEPK/UNPRI/III/2021). The limitation in this research is that triangulation of sources, methods and theories is not done.

Results

The characteristics of participants

The number of respondents in this study were 6 nurses. 4 female nurses, and 2 male nurses. Age between 33 and 38 years old 4 nurses, and age between 25 and 32 years old 2 nurses.

There were 5 themes emerged from this study, namely:

(1) Motivation of nurses to Provide Nursing care in the COVID-19 pandemic, (2) nurse emotional response, (3) patient emotional response, (4) Problems faced by nurses, (5) The expectations of the nurse.

Theme 1. Motivation of nurses to Provide Nursing care in the COVID-19 pandemic

Nurses explained that their motivation to provide nursing care in the COVID-19 pandemic was because it was an obligation for nurses to provide nursing care to patients regardless of their condition. And also nurses can get experience how to care the patient with Covid-19.

“yes, nurses still have to provide nursing care, it is our duty to provide nursing care, and we also know about COVID-19, and also we can have experience giving nursing care to the COVID-19 patients” (P2)

Theme 2. Nurse Emotional Response

Providing nursing care in the COVID-19 pandemic was still carried out by nurses. There was a feeling of pleasure and it became a challenge to be able to provide nursing care to patients. However, there were nurses who also felt afraid of being infected with COVID-19 and felt uncomfortable with the stigma from the community towards nurses who provide services during the COVID-19 pandemic.

“i am happy giving care to patients, even though there is a fear of contracting them from patients” (P5)

“afraid of being infected with covid-19 from patients, anxious and stressed also taking care of covid-19 patients” (P4)

“people are afraid to see uss, they think the nurses will transmit COVID-19 to others” (P3)

Theme 3. Patient Emotional Response

The majority of COVID-19 patients felt anxious and sad such as the patient crying, being anxious and feeling sad. But some patients felt happy because they were cared for by the nurse, considered by their family and got support and motivation from nurses.

“Patients sometimes cry because they feel sad about their illness, so they feel stressed when they are treated “(P4)

“There are also those who refuse to be treated, but over time they also want to be treated” (P5)

“Some of them feel happy because they are not alone in the isolation room, they treated us like their family” (P3)

“We give them attention and motivation so they feel like we are their family and also they feel like they are in their home” (P5)

Theme 4. Problems faced by nurses

There are many problems that should be handled by nurses while caring for the patient, such as personal protective equipment, difficulty meeting basic needs and the impact of wearing hazmat suits.

“when you wear hazmat clothes, sometimes it's hard to breathe, sweat is pouring out and your clothes get wet” (P4)

“Wearing hazmat clothes, you can’t eat and drink, sometimes you want to pee, you have to hold it until you finish the task, the clothes are only disposable.” (P6)

Theme 5. The expectations of nurses

Nurses hope that the community does not stigmatize patients and nurses who work in health services and also the community must comply with the health protocols set by the government. Hospitals and the government should give rewards to nurses who treat COVID-19 patients.

“I hope that society does not stigmatize patients and nurses who work in nursing care” (P2)

“It is my hope that the public will comply with the health protocol recommended by the government, so that they can prevent the transmission of COVID-19” (P1)

Discussion

The study found that the obligation of nurses to provide nursing care to patients was a motivation to treat Covid-19 patients. Nurses did not regret choosing nursing as a profession. They had the motivation to treat COVID-19 patients and were obliged to help people who need care.³ Nurses also gained experience in providing nursing care to Covid-19 patients.⁴

Negative emotions such as the feeling of fear of contracting COVID-19 from patients are experienced by nurses when providing nursing care during the COVID-19 pandemic. Health workers experience fear, especially at the increased risk of exposure, infection and the possibility of infecting their loved ones also becomes a burden.⁵ Many health workers have had to isolate themselves from their family and closest people even though they don’t have COVID-19. The study found that nurses who worked in providing nursing care to patients during the COVID-19 pandemic were stigmatized by society. People were afraid of getting infected from nurses who treat patients infected with COVID-19.⁶

The study found that nurses were happy to be able to provide nursing care to COVID-19 patients. Nurses have positive emotions such as happiness, which simultaneously or gradually appear with negative emotions during an outbreak.⁷ Support from hospitals and patients makes nurses enthusiastic and responsible for treating COVID-19 patients. Mutual respect, teamwork, family and team support bring happiness. The hospital had a reward and welfare system to support and motivate nurses. Coworkers’ encouragement also brings happiness to nurses and other forms of social support are important for nurses’ feelings of appreciation.⁷

The study found that patients were happy while receiving treatment in the isolation room. Nurses provide support and motivation to patients so they are not stressed during treatment and treat patients like family. With the motivation and support of nurses will have a positive impact on the patient so that the patient is not sad about his situation. The feeling of pleasure will create a good relationship between nurses and patients, so that patients will be cooperative when receiving nursing care. Before patients go home, COVID-19 nurses also always provide health education related to preventing COVID-19 transmission.

Negative responses are also felt by patients, sometimes cry and always look sad and do not accept the disease they are suffering from. In fact, sometimes patients refuse to be given nursing care by nurses even though nurses always provide support to patients so that patients are willing to accept the reality of their illness.

The stress experienced by patients is caused by various things, such as patients thinking that COVID-19 is a deadly disease so that patients always feel sad, especially when patients are treated in isolation rooms without any accompanying family. The existence of stigma has also exacerbated the stress level of Covid-19 patients and this is also experienced by patients who have been treated in the COVID-19 isolation room.

Nurses who wear Personal Protective Equipment (PPE) such as wearing hazmat suits when providing nursing care feel uncomfortable, such as difficulty breathing, experiencing excessive sweating and always feeling thirsty. When the nurse is wearing the hazmat suit the nurse cannot open the PPE before completing her task. So that the basic needs of nurses sometimes cannot be met while wearing hazmat suits. As stated by one of the nurses who worked at the hospital, wearing hazmat suits felt hot and sweaty and had difficulty breathing caused by the long use of hazmat.⁸

The problem faced by nurses in providing nursing care was that patients and families do not comply with health protocols. This finding is in line with other studies which state that the public does not comply with the government's appeal about the dangers of COVID-19 and the public considers that COVID-19 was just an ordinary virus.⁹ Lack of awareness from the community itself regarding the importance of using personal protective equipment for the prevention of COVID-19. The government's Covid-19 task force unit is increasingly aggressive in breaking the chain of transmission of COVID-19, so that people are aware of following health protocols.

The study found that being a COVID-19 nurse, all nurses felt like family, because while providing nursing care, nurses had to stay in the hospital, thus making fellow COVID-19 nurses closer and feeling like they had a new family. In addition, nurses also feel very excited to provide nursing care to patients and a sense of empathy for patients is increasing.

After giving nursing care to COVID-19 patients, nurses hope that the public will comply with the health protocols set by the government so that the incidence of COVID-19 does not increase. In addition, the nurse also hopes that society will eliminate the stigma against patients and nurses, so that patients and nurses can live their lives as usual without discrimination from the community. Because with the COVID-19 pandemic, nurses’ anxiety and depression levels have increased.¹⁰ The nurses hope that there will be incentives provided by hospitals and local governments for their duties to provide nursing care during the COVID-19 pandemic

The conclusions in this study provide evidence of how nurses experience while providing nursing care to patients infected with COVID-19. Nurses experience significant personal risk and emotional burden and nurses present a strong dedication to continuing to care for sick patients and do not regret working as nurses. However, nurses need support from various parties so that they can have strong motivation while providing nursing care to help break the chain of transmission of COVID-19.

Conflict of interest

The authors declare no conflict of interest.

Acknowledgments

The authors would like to thank the University of Aufa Royhan Padangsidimpuan for helping researchers to fund this research.