>> Overall, nurses have high rates of exposure to infectious diseases. >> Conversely, only 8% of COVID-19 cases and 9% of deaths were among fully vaccinated individuals. /MediaBox [0.0 7.9200063 612.0 799.92] All 21 nurses had at least 1 experience or thought that contributed to this theme. ( /Resources << Of the nurses in the sample, 14 reported that they were not aware of any COVID-19-related deaths on their unit. endobj Several worked in more than 1 type of unit. endobj But this can be a dangerous label with negative consequences. All 39 of those nurses continued to practice in their same state during the pandemic. /F6 13 0 R /F7 14 0 R 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. More than half of the RNs (n = 23) reported a bachelors degree as their highest level of education. The medications, treatment plans, and therapies were completely different for each. A convergent mixed-methods design presents a complete picture. Nurses were clear that their stress, frustration, and feelings of anger were all related to not having evidence-based practice recommendations for caring for patients with COVID-19. Most of them (n = 36) responded in May, meaning that these data were collected at the time when most regions in the United States had just passed the peak of COVID-19 cases within their hospitals and medical centers. 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. In the context of these rapid changes and the promotion of practices that were once unheard of, nurses face the potential for not only physical but also psychological distress. (J %PDF-1.4 There were definitely enough people to be sending emails and to be giving updates, but they were so unsure as well that they just kind of opted for radio silence, which was really frustrating and made the whole situation more challenging. It has truly been a team sport. Teamwork, and the bonds made, were an essential thread woven into this theme: We will never be the same after all this, but the bond we made as [front-line heroes] will never be broken [heart emoji], unless you were in it you will never understand fully., The sentiments representing this theme, from 12 nurses, are best summarized by an emergency department nurse at a university hospital: I purchased a Polaroid camera and I am journaling and taping in pictures of our lives during COVID-19. Twenty-three were married, 10 were in a committed relationship, 5 were divorced, 4 were single, and 1 was widowed. They noted that patients smiled less without their family members around. The hero narrative surrounding nurses could exacerbate burnout. endobj ( A second notable strength is the mixed-methods design. The main strength of this study is that we collected data immediately after the peak of COVID-19 cases in spring 2020; most participants responded to the survey in May 2020. The final sample comprised 43 RNs (42 from the United States, with 1 from Puerto Rico; and 1 from Ontario, Canada). 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.. /ProcSets [/PDF /Text /ImageB /ImageC /ImageI] Some patients with COVID-19 even asked nurses if they were going to die. 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. It was very, very stressful.. ( 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 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. /Annots [27 0 R 28 0 R] This ultimately could result in nurses leaving the profession because of burnout. Sign up today.]. /X20 20 0 R 5 0 obj You dont need to wear N95s all the time.. 8 0 obj /Contents 19 0 R /Length 327872 /Type /Page One young inpatient nurse, for example, described frustrations with lack of communication from management: They just werent telling us much of anything. A nurse working in an emergency department at a community hospital expressed it in this way: It feels as though everything is weighing heavy on me. 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. $@ 1 0 obj In the subsequent waves of the pandemic, follow-up studies would be beneficial to allow further understanding of the level of resiliency and the experiences of nurses working through this unprecedented time. /G3 7 0 R We are nurses and nurse scientists who study nurse well-being during the COVID-19 pandemic. (J ( Nurses care for patients regardless of vaccination status. /BitsPerComponent 8 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. >> /Count 3 We reviewed the literature about nurses experiences during COVID-19, searching PubMed, CINAHL, and Google Scholar. These nurses showed up each day to care for their patients, asking, Whats the protocol today? /Creator (Canva) I hope my future children will look back one day and be proud that I was a nurse on the front lines of COVID-19., The final result of our qualitative analysis was the essence of the experience of being a nurse during the COVID-19 pandemic. ( ( 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. JFIF C ( To the best of our knowledge, in the United States, only media publications exist about nurses experiences caring for patients with COVID-19, and no research publications from within the United States were available when we were writing this review. Having participants openly discuss their experiences is important: each individual has his experienced things, that is, if we understand by this what in particular is valid for him, what is seen by him,34(p164) we come to understand the essence of an experience. When they were giving us information, a lot of it was, you guys are overreacting. /BleedBox [0.0 7.9200063 612.0 799.92] (: 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. They also discussed the difficulties of COVID-19 testing, with the potential for false negatives, a lack of clarity regarding antibody testing, and the stress of potentially caring for asymptomatic patients with COVID-19. We also relied on snowball sampling and word of mouth to recruit a diverse sample of nurses with varying characteristics (age, practice experience, and geographic location). They worried that when reusing PPE, especially gowns, they would contaminate themselves while putting it back on. The authors declare no conflicts of interest. The World Health Organization declared a public health emergency in January of 2020, and in March 2020 the United States declared a national emergency.2 Areas of Europe and the United States became epicenters of the disease. The COVID-19 pandemic has challenged and continues to challenge us as humans and as health care providers. /BM /Normal As the pandemic continues to overwhelm hospitals and communities across the U.S., its effects on nurses need to be carefully considered. In this study, we used narratives from nurses caring for patients with COVID-19 and their scores from the BRCS to form a robust picture of their experience and how these caregivers have been coping during the pandemic. Quinn FD, ed, Prone ventilation for adult patients with acute respiratory distress syndrome, Guidance and patient instructions for proning and repositioning of awake, non-intubated COVID-19 patients, Prone positioning of nonintubated patients with COVID-19, Family visitation in the adult intensive care unit, Critical care nurse work environments 2018: findings and implications, Effects of work environment on patient and nurse outcomes, Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff, Critical supply shortages the need for ventilators and personal protective equipment during the Covid-19 pandemic, Moral distress in critical care nursing: the state of the science, American Association of Critical-Care Nurses, Moral distress in nursing: what you need to know, Psychological resilience and secondary traumatic stress in nurses working with terminally ill patientsthe mediating role of job burnout, Well-being playbooka guide for hospital and health system leaders, Peer support for nurses as second victims: resilience, burnout, and job satisfaction, The experiences of healthcare providers during the COVID-19 crisis in China: a qualitative study, A qualitative study on the psychological experience of caregivers of COVID-19 patients, Exploring the relationship between resilience and grit among nursing students: a correlational research study, A comparison of nurse shift workers and non-shift workers psychological functioning and resilience, Conceptualising moral resilience for nursing practice, Promoting well-being and resilience in critical care nursing, Personal and work-related factors associated with nurse resilience: a systematic review, Systems to address burnout and support well-being: implications for intensive care unit nurses, Positive emotion skills intervention to address burnout in critical care nurses, Creative arts therapy as a potential intervention to prevent burnout and build resilience in health care professionals, The development and psychometric evaluation of the Brief Resilient Coping Scale, Designing and Conducting Mixed Methods Research, Mixed methods: integrating quantitative and qualitative data collection and analysis while studying patient-Centered medical home models, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Crisis of European Sciences and Transcendental Phenomenology: An Introduction to Phenomenological Philosophy, Psychological research as the phenomenologist views it, Existential-Phenomenological Alternatives for Psychology, Resilience and thriving: issues, models, and linkages, Letter from Florence Nightingale to Miss H. Bonham Carter, 1861, 2021 American Association of Critical-Care Nurses, This site uses cookies. Those who have been serving throughout this pandemic have been forced into an unrecognizable shapea shape from which many may not be able to spring back. The concept of resilience has been elevated from resuming a previous shape to growing and thriving, with ones experience translating into new meaning.37 Thriving is about rising above resilience. But the public and health care organizations can step up to help nurses now by increasing access to mental health support and providing adequate resources, safe working conditions and organizational transparency during times of immense change. In the year of Florence Nightingales 200th birthday, nurses continue to embody her spirit. Juxtaposition of the data allows for a more complete picture. Some chose activities such as watching television, going to the spa, or attending formal therapy as a method of restoration; these would be categorized as other (Table 1). For this study we followed the method of descriptive phenomenology described by Husserl.34 Descriptive phenomenology allows participants to openly describe the essence of an experience and allows the researcher(s) to examine the phenomena as the participants experience them. These 22 brief responses did not contain any experiences or examples; therefore, we were unable to include them in the qualitative portion of this study. Most (n = 34) self-identified as White (non-Hispanic), 5 as Asian, 2 as Hispanic, 1 as American Indian or Alaska Native, and 1 as multiracial. The Fairfield University Institutional Review Board approved the study. 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. We also wrote an exhaustive statement that described the overall experience of being a nurse during the COVID-19 pandemic. Copyright 20102022, The Conversation US, Inc. 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. 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. /ModDate (D:20200402174130+00'00') The World Health Organization designated the year 2020 as the Year of the Nurse and the Midwife.1 Organizations within the World Health Assembly, such as the International Confederation of Midwives, International Council of Nurses, Nursing Now, and the United Nations Population Fund, planned to celebrate nurses worldwide, to address challenges nurses face, and to highlight nurses vast contributions throughout 2020. More specifically, moral distress occurs when nurses cannot provide compassionate care to patients,16 and it contributes to nursing burnout and compassion fatigue.17 In addition to the reuse of PPE, other factors such as the influx of high-acuity patients, the lack of the presence of family members, and high patient censuses have contributed to increased moral distress among nurses. When considering the entire study population on the basis of their provision of robust narratives, we included in the qualitative analysis 77.8% of the high resilient copers, 52.6% of the medium resilient copers, and 26.7% of the low resilient copers. Last, the team wrote an exhaustive description of the essence of the experience of being a nurse during the COVID-19 pandemic. /Height 1175 /X13 11 0 R /Type /Page At this time this manuscript was prepared, most studies of COVID-19 are from researchers in China, given that the outbreak of the pandemic began there. /TrimBox [0.0 7.9200063 612.0 799.92] ( As in this study, international nurses experienced a profound sense of teamwork and a renewed respect for their profession.21,22. Nurses stepped up to the challenge of caring for patients during the pandemic, and over 1,150 of us have died from COVID-19 in the U.S. As cases and deaths surge, nurses continue working in a broken system with minimal support and resources to care for critically sick patients, many of whom will still die. ( 4 0 obj /XObject << Qualitative methodologyspecifically descriptive phenomenology, which we applied in this studyis ideal when researching an experience for which very limited prior research exists. The overarching concern for safetypersonal safety, the safety of family and friends, and the safety of patientsis echoed through this study and through the previous literature describing nurses experiences in China.21,22 Limited supplies of PPE21 and constantly changing policies and procedures22 were sources of stress and concern for nurses in both this study and those published in the literature. /Parent 2 0 R Nurses Self-Care Practices During the Pandemic (N = 43), Mean Participant Scores on Brief Resilience Coping Scale Items (N = 43), Jenna A. LoGiudice is Associate Professor and Director of the Midwifery Program, Egan School of Nursing and Health Studies, Fairfield University, 1073 North Benson Rd, Fairfield, CT 06824 (. >> /F16 17 0 R It steeped nurses in power and pride and caused the public to take pause and give voice to an otherwise quietly anonymous profession. For the quantitative portion, resiliency was measured by using the Brief Resilience Coping Scale. Ive been living with my parents [who are] in their 60s, feeling guilty about working and then coming home despite stripping my clothes off at the doorway.. >> So, in a way, we were determining code status without really consulting the patient, which to me is very problematic and unethical.. /X4 9 0 R [Over 115,000 readers rely on The Conversations newsletter to understand the world. /X25 24 0 R They appreciated the kindness, but didnt look for it; as they expressed, they are simply doing their job: Its what [they] trained for., They spoke of the support of their communities in the form of donated extension pieces that take the pressure of masks off their ears, and of donated water and snacks. << Even worse, some health care organizations gaslit nurses for being concerned for their own safety. /Type /Catalog 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. 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. >> The small sample size is another limitation. At the same time, these nurses balanced the need to protect themselves and their families, and they discovered new ways to return home each day; these methods often involved disrobing in their garages, sanitizing their clothing, cleaning door handles, and delaying hugs to family members and pets until they had showered. /Parent 2 0 R From 21 robust narratives, Colaizzis qualitative method yielded 5 themes to describe the experience of being a nurse during the pandemic. 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. /Font << ( >> This pandemic has overpowered innumerable elements of societyvulnerable populations, supply chains, families, educational systems, holidays, and personal milestonesbut it had the opposite effect on nursing. ( 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. Curating and archiving these pandemic experiences are important and necessary. 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. As the COVID-19 pandemic continued, although they were doing all they could for every patient, the protocols were not there, and the science was (and is) not yet fully understood. ( /ColorTransform 0 A convergent mixed methods design was applied in this study. Qualitative narratives give meaning to and explain the quantitative numbers. It was extremely frustrating. They were especially empowered by the teamwork in which they and their fellow nurses engaged. ( Assistant Professor of Nursing, University of Arizona, Assistant Professor of Nursing, University of Portland, Adjunct Instructor of Nursing, University of Arizona. When examining the quantitative results in context with the qualitative themes, a clear picture formsone that describes why nurses in this study identify as medium resilient copers. ( /F7 14 0 R As of the end of December 2020, more than 1.6 million health care workers worldwide had been infected by COVID-19, and nurses make up the largest affected group in many countries. We retrieved 2 studies, both from China, that directly explore the experiences of health care providers during the COVID-19 pandemic; they were published in online journals in April 2020. In one study of 472 nurses in California, 79.7% reported anxiety and 19% met the clinical criteria for major depression. 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. /Pages 2 0 R /G12 8 0 R Even more routine aspects of care, such as basic hygiene, were neglected, further contributing to nurse moral distress. /F6 13 0 R Trying to let the patient feel they werent alone in those final moments. Another nurse offered, I cried for them and for me, and for everyone who doesnt have a voice., Again and again, nurses named ways they provided compassionate care at a time when patients were aloneoften going above and beyond to ensure these virtual chats and phone calls happened between patients and their family members. Yet some Americans still refuse to mask, and, as of Nov. 1, 2021, only 67% of the population has received at least one dose of the vaccine. /F5 12 0 R I have attempted to cope with this anxiety by working out and spending time with my dog and fiance. For each emotion mentioned, these nurses offered ways in which they were coping or taking care of themselves. I feel terrible for our patients and [their] family members.. To protect the public, and to enforce governmental suggestions for social distancing, institutions changed visitation policies to stop family bedside presence in efforts to slow the spread of the virus. This timing allowed participants to share rich narratives with specific examples of what it was like to be a nurse during the peak of a pandemic when they were just days or weeks removed from the actual experience. One nurse in the sample identified as male; the other 42 identified as female. And Im, like, youre going to give it to your newborn and your five kids.. /Type /Page Nurses have cared for patients despite working in hazardous work environments. /ProcSets [/PDF /Text /ImageB /ImageC /ImageI] Nurses should be encouraged to advocate for systemic change, innovate, collaborate with other like-minded clinicians, and be an agent of change.28 Certain personality characteristics common to critical care nursesperfectionism, difficulty setting limits, pessimism, competitiveness, and confusing self-interest with selfishnesscontribute to an increase in feelings of burnout.29 Use of creative arts (music, art, dance, and writing programs) in the workplace are recommended interventions to promote well-being and resiliency in critical care nurses.30. So Im, like, is she going infect the staff in the lobby? >> /ColorSpace /DeviceRGB >> more than 1.6 million health care workers, inadequate resources, staffing and safety precautions, 66% of respondents were considering leaving nursing, Alvaro Calvo/Stringer via Getty Images News. /Annots [22 0 R] 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. Overall, the nurses recognized that patients were depressed and fearful. /Subtype /Image My puppy knows that I will not pet him as soon as I walk in the door, as my hands are dirty., They strove to try their best to protect their own families and those they lived with, and they expressed sentiments that demonstrated all their efforts to do so. If a patient was admitted and you had to take care of one, you kind of felt like you were being thrown to the wolves as an experiment.. Nearly half of the sample (n = 20) reported that they had children who still lived at home with them. ( Many organizations instead require overtime and dont provide adequate resources, such as personal protective equipment or support personnel, for safe patient care. Similarly, we found that 67% of nurses under 30 are considering leaving their organizations within the next two years. Exhausted and demoralized nurses are already quitting or retiring at alarming rates. /ExtGState << Nurses not only see a large number of COVID-19 deaths firsthand, they may also need to provide comfort for those left behind. Among the rest, 3 held a doctorate, 9 held a masters degree, and 8 had received an associates degree. /Contents 23 0 R /Resources << From the 21 narratives, we identified 272 significant statements regarding the experience of being an acute care nurse during the COVID-19 pandemic. Nurses working during the COVID-19 pandemic demonstrated medium resilience scores on the BRCS (mean score, 14.4). Of the 41 RNs practicing in the continental United States, 9 typically practiced nursing in Illinois; 8 in Connecticut; 4 in Massachusetts; 3 in California, 2 each in New York and Ohio; and 1 each in Alabama, Arizona, Colorado, New Jersey, Louisiana, North Carolina, Maryland, Minnesota, Pennsylvania, South Carolina, and Texas.

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nurses during pandemic