Voice from the frontline and learning for the future: A qualitative descriptive study on wider perspectives of frontline nurses in India during the COVID 19 global pandemic

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Abstract

Objective

This study was conducted to explore frontline nurses’ experiences of the impact of COVID 19 pandemic and suggestions for improvement in the healthcare system, policy and practice in the future.

Method

A qualitative descriptive design was used. Frontline nurses who were involved in providing care to patients affected with COVID 19 in four designated COVID units from the Eastern, Southern and Western regions of India were interviewed during January to July 2021. Interviews were audio-recorded and transcribed manually by researchers from each region and thematically analysed.

Result

Twenty-six frontline nurses aged between 22 to 37 years with a range of 1–14 years of work experience following a Diploma or Bachelor's degree in Nursing and Midwifery and working in the COVID units of selected regions in India participated in the study. Three key themes emerged: ‘Physical, emotional and social health - an inevitable impact of the pandemic’ described effects of the pandemic on nurses' health and wellbeing; ‘Adapting to the uncertainties’ narrated how nurses accommodated to the uncertainties during the pandemic; and ‘An agenda for the future - suggestions for improvement’ emphasised on practical strategies for the future.

Conclusion

The inevitability of the pandemic had an influence at a personal, professional, and social level with learning for the future. The findings of this study have implications for healthcare system and facilities by enhancing resources, supportive environment for staffs to cope with the challenges imposed by the crisis and ongoing training to manage life threatening emergencies in the future.

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Most cited references 22

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Using thematic analysis in psychology

Virginia Braun, Victoria Clarke (2016)

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Whatever happened to qualitative description?

Margarete Sandelowski (2000)

The general view of descriptive research as a lower level form of inquiry has influenced some researchers conducting qualitative research to claim methods they are really not using and not to claim the method they are using: namely, qualitative description. Qualitative descriptive studies have as their goal a comprehensive summary of events in the everyday terms of those events. Researchers conducting qualitative descriptive studies stay close to their data and to the surface of words and events. Qualitative descriptive designs typically are an eclectic but reasonable combination of sampling, and data collection, analysis, and re-presentation techniques. Qualitative descriptive study is the method of choice when straight descriptions of phenomena are desired. Copyright 2000 John Wiley & Sons,

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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

Journal

Journal ID (nlm-ta): Clin Epidemiol Glob Health

Journal ID (iso-abbrev): Clin Epidemiol Glob Health

Title: Clinical Epidemiology and Global Health

Publisher: The Authors. Published by Elsevier B.V. on behalf of INDIACLEN.

ISSN (Print): 2452-0918

ISSN (Electronic): 2213-3984

Publication date PMC-release: 13 April 2023

Publication date (Electronic): 13 April 2023

Electronic Location Identifier: 101298

Affiliations

[a ]School of Nursing and Midwifery, Trinity College Dublin, Ireland

[b ]MTPG and RIHS, Pondicherry, India

[c ]College of Nursing Berhampur, Odisha, India

[d ]Seva Mandal Education Society's Smt. Sunanda Pravin Gambhirchand College of Nursing, Matunga, Mumbai, India

[e ]Ramachandra Institute of Higher Education and Research, Porur, Chennai, India

[f ]Department of Obstetrics, Indira Gandhi Medical College and Research Institute, Puducherry, India

Author notes

[∗ ]Corresponding author.

Article

Publisher Item ID: S2213-3984(23)00085-4 Publisher ID: 101298

DOI: 10.1016/j.cegh.2023.101298

PMC ID: 10101487

PubMed ID: 37073375

SO-VID: 6c3c26e9-6361-48e6-9477-f2b56ac332b0

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 17 September 2022

Date revision received : 22 March 2023

Date accepted : 10 April 2023

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Voice from the frontline and learning for the future: A qualitative descriptive study on wider perspectives of frontline nurses in India during the COVID 19 global pandemic

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Abstract

Objective

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Conclusion

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Novel Coronavirus Disease COVID-19

Most cited references 22

Using thematic analysis in psychology

Whatever happened to qualitative description?

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

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