Negative and positive psychological experience of frontline nurses in combatting COVID‐19: A qualitative study

Author(s): Xin Peng , MD ¹ , Yi Yang , Undergraduate ¹ , Ping Gao , Undergraduate ¹ , Yi Ren , Undergraduate ² , Deying Hu , PhD ³ ^, , Qin He , Undergraduate ⁴ ^,

Publication date (Electronic): 01 November 2021

Journal: Journal of Nursing Management

Publisher: John Wiley and Sons Inc.

Keywords: frontline nurses, novel corona virus pneumonia, psychological experience, qualitative research

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Abstract

Aims

To qualitatively explore potential experience among frontline nurses who had been fighting against the COVID‐19 infection since the outbreak.

Background

Disasters are often sudden and uncertain. Since the COVID‐19 outbreak in Wuhan city, local frontline nurses had been responsible for treatment of COVID‐19 for several months. Qualitative study was required to assess complex multi‐component psychological experiences among frontline nurses.

Methods

Twenty local frontline nurses were recruited from a designated hospital of COVID‐19 treatment. We conducted semi‐structured interview using phenomenological method. Descriptive phenomenological method was applied for thematic analysis.

Results

Twenty female frontline nurses (aged 24 to 43 years old) were interviewed. Two broader themes, negative and positive, were identified. Negative experience included refusal and helpless (refusal to work at frontline, shortage of confidence in working and helpless), fear and anxiety, excessive miss, and other health issues. Positive experience included improved interpersonal relationship, sublimation of personal faith and strength, changes in understanding meaning of life and new possibility.

Conclusion

Both positive and negative psychological response were observed, which can provide evidence based clues for making essential strategies and policy.

Implications for Nursing Management

Understand subjective experience of frontline nurses can establish evidence for development of effective psychological intervention. Nursing administrator should consider the nurses' psychological experience comprehensively to promote psychological growth and lower post‐traumatic psychological burden.

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Most cited references 43

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Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

A Tong, P SAINSBURY, J. Craig (2007)

Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.

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World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19)

Catrin Sohrabi, Zaid Alsafi, Niamh O'Neill … (2020)

An unprecedented outbreak of pneumonia of unknown aetiology in Wuhan City, Hubei province in China emerged in December 2019. A novel coronavirus was identified as the causative agent and was subsequently termed COVID-19 by the World Health Organization (WHO). Considered a relative of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), COVID-19 is caused by a betacoronavirus named SARS-CoV-2 that affects the lower respiratory tract and manifests as pneumonia in humans. Despite rigorous global containment and quarantine efforts, the incidence of COVID-19 continues to rise, with 90,870 laboratory-confirmed cases and over 3,000 deaths worldwide. In response to this global outbreak, we summarise the current state of knowledge surrounding COVID-19.

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Mental health care for medical staff in China during the COVID-19 outbreak

Qiongni Chen, Mining Liang, Yamin Li … (2020)

In December, 2019, an outbreak of a novel coronavirus pneumonia occurred in Wuhan (Hubei, China), and subsequently attracted worldwide attention. 1 By Feb 9, 2020, there were 37 294 confirmed and 28 942 suspected cases of 2019 coronavirus disease (COVID-19) in China. 2 Facing this large-scale infectious public health event, medical staff are under both physical and psychological pressure. 3 To better fight the COVID-19 outbreak, as the largest top-class tertiary hospital in Hunan Province, the Second Xiangya Hospital of Central South University undertakes a considerable part of the investigation of suspected patients. The hospital has set up a 24-h fever clinic, two mild suspected infection patient screening wards, and one severe suspected infection patient screening ward. In addition to the original medical staff at the infectious disease department, volunteer medical staff have been recruited from multiple other departments. The Second Xiangya Hospital—workplace of the chairman of the Psychological Rescue Branch of the Chinese Medical Rescue Association—and the Institute of Mental Health, the Medical Psychology Research Center of the Second Xiangya Hospital, and the Chinese Medical and Psychological Disease Clinical Medicine Research Center responded rapidly to the psychological pressures on staff. A detailed psychological intervention plan was developed, which mainly covered the following three areas: building a psychological intervention medical team, which provided online courses to guide medical staff to deal with common psychological problems; a psychological assistance hotline team, which provided guidance and supervision to solve psychological problems; and psychological interventions, which provided various group activities to release stress. However, the implementation of psychological intervention services encountered obstacles, as medical staff were reluctant to participate in the group or individual psychology interventions provided to them. Moreover, individual nurses showed excitability, irritability, unwillingness to rest, and signs of psychological distress, but refused any psychological help and stated that they did not have any problems. In a 30-min interview survey with 13 medical staff at The Second Xiangya Hospital, several reasons were discovered for this refusal of help. First, getting infected was not an immediate worry to staff—they did not worry about this once they began work. Second, they did not want their families to worry about them and were afraid of bringing the virus to their home. Third, staff did not know how to deal with patients when they were unwilling to be quarantined at the hospital or did not cooperate with medical measures because of panic or a lack of knowledge about the disease. Additionally, staff worried about the shortage of protective equipment and feelings of incapability when faced with critically ill patients. Many staff mentioned that they did not need a psychologist, but needed more rest without interruption and enough protective supplies. Finally, they suggested training on psychological skills to deal with patients' anxiety, panic, and other emotional problems and, if possible, for mental health staff to be on hand to directly help these patients. Accordingly, the measures of psychological intervention were adjusted. First, the hospital provided a place for rest where staff could temporarily isolate themselves from their family. The hospital also guaranteed food and daily living supplies, and helped staff to video record their routines in the hospital to share with their families and alleviate family members' concerns. Second, in addition to disease knowledge and protective measures, pre-job training was arranged to address identification of and responses to psychological problems in patients with COVID-19, and hospital security staff were available to be sent to help deal with uncooperative patients. Third, the hospital developed detailed rules on the use and management of protective equipment to reduce worry. Fourth, leisure activities and training on how to relax were properly arranged to help staff reduce stress. Finally, psychological counsellors regularly visited the rest area to listen to difficulties or stories encountered by staff at work, and provide support accordingly. More than 100 frontline medical staff can rest in the provided rest place, and most of them report feeling at home in this accomodation. Maintaining staff mental health is essential to better control infectious diseases, although the best approach to this during the epidemic season remains unclear.4, 5 The learning from these psychological interventions is expected to help the Chinese government and other parts of the world to better respond to future unexpected infectious disease outbreaks.

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Author and article information

Contributors

Xin Peng:

ORCID: https://orcid.org/0000-0002-8061-2335

Role: Deputy Chief Nurse

Yi Yang: Role: Registered Nurse

Ping Gao: Role: Registered Nurse

Yi Ren: Role: Chinese Registered Nurse

Deying Hu: Role: Chief Nursehudeying2006@126.com

Qin He: Role: Registered Nurseheqinzz@163.com

Journal

Journal ID (nlm-ta): J Nurs Manag

Journal ID (iso-abbrev): J Nurs Manag

Journal ID (doi): 10.1111/(ISSN)1365-2834

Journal ID (publisher-id): JONM

Title: Journal of Nursing Management

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0966-0429

ISSN (Electronic): 1365-2834

Publication date (Electronic): 01 November 2021

Publication date PMC-release: 01 November 2021

Electronic Location Identifier: 10.1111/jonm.13481

Affiliations

[ ¹ ] Cancer Center, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China

[ ² ] Department of the Wise Group Pathways Health Hamilton New Zealand

[ ³ ] Department of Nursing, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China

[ ⁴ ] Public Health Department, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China

Author notes

[*] [* ] Correspondence

Hu Deying, MD, Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277, Wuhan 430022, China.

Email: hudeying2006@ 123456126.com

He Qin, Undergraduate, Public Health Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277, Wuhan 430022, China.

Email: heqinzz@ 123456163.com

Author information

Xin Peng https://orcid.org/0000-0002-8061-2335

Article

Publisher ID: JONM13481

DOI: 10.1111/jonm.13481

PMC ID: 8646834

PubMed ID: 34626025

SO-VID: 65856963-4c7f-4c48-9d2a-33187821ca57

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date revision received : 16 September 2021

Date received : 20 June 2021

Date accepted : 24 September 2021

Page count

Figures: 0, Tables: 1, Pages: 9, Words: 7048

Funding

Funded by: Huazhong University of Science and Technology , doi 10.13039/501100003397;

Award ID: 2020kfyXGYJ001

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edited-state corrected-proof

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.9 mode:remove_FC converted:06.12.2021

Keywords: frontline nurses,novel corona virus pneumonia,psychological experience,qualitative research

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Keywords: frontline nurses, novel corona virus pneumonia, psychological experience, qualitative research

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Negative and positive psychological experience of frontline nurses in combatting COVID‐19: A qualitative study

Read this article at

Abstract

Aims

Background

Methods

Results

Conclusion

Implications for Nursing Management

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 43

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19)

Mental health care for medical staff in China during the COVID-19 outbreak

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Cited by 9

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