key: cord-0700842-fupniqyh
authors: Demir, Gokce; Şahin, Sevil
title: Experiences of nurses providing care to patients with COVID‐19 in intensive care units: A qualitative study
date: 2022-02-28
journal: Nurs Forum
DOI: 10.1111/nuf.12716
sha: 77c34381018eeba0ce7d63a9ca528f478f318e02
doc_id: 700842
cord_uid: fupniqyh

AIM: The aim of this study was to evaluate the experiences of nurses providing care to intensive care unit patients diagnosed with coronavirus disease 2019 (COVID‐19) in Turkey. METHODS: The research employed the descriptive phenomenological approach. The interviews were analyzed with Colaizzi's seven‐step method. RESULTS: The experiences of nurses providing care to COVID‐19 patients in the intensive care unit can be summarized under three themes. It was determined that all nurses experience physical, psychological, and social difficulties along with negative emotions during the care process for COVID‐19 patients, for which nurses use coping processes. CONCLUSION: This study shows the difficulties faced by nurses who provide intensive care to patients with COVID‐19. It is important to identify these challenges early to protect and improve the health of nurses.

appeared, it was found that 71.3% of healthcare professionals had below threshold and mild, 22 .4% had moderate, and 6.2% had severe mental health disorders right after the pandemic. 10 In another study, it was determined that nurses experienced negative emotions or conditions such as fatigue, discomfort, fear, anxiety, and helplessness early in the care process. 11 Nurses working in intensive care should have sufficient knowledge and skills to provide quality, holistic patient care and to perform their roles efficiently and effectively. Intensive care nurses receive training for all the requisite competencies through certificate programs according to nationally recognized standards; in Turkey. 12 However, because of the pandemic, nursing service nurses and freshman nurses without any intensive care experience began working in ICUs in the hospital where this study was conducted after receiving a short course on the care of COVID-19 patients and protocols in ICUs.

Nurses, especially those without intensive care and infectious disease experience, face a greater risk of COVID-19 transmission and difficulties in adapting to their new work environments. Thus, their health may be affected in all dimensions (physical, psychological, social).

There are studies in the literature on the experience of healthcare personnel in the process of caring for COVID-19 patients. As of yet,

there are no such studies in Turkey. [8] [9] [10] [11] Identifying the experiences and difficulties faced by nurses caring for COVID-19 patients during the pandemic and learning key lessons will help to create crisis action plans to achieve the desired performance without succumbing to exhaustion in the fight against COVID-19, thus achieving a sustainable solution. Therefore, the present study was conducted to determine the experience of nurses giving care to patients with the diagnosis of COVID-19 in ICUs.

Throughout this study, the authors followed the Standards for Reporting Qualitative Research. 13 This qualitative study was designed according to a descriptive phenomenological approach to evaluate the experiences of nurses who provided care to patients with the diagnosis of COVID-19 in ICUs. Descriptive phenomenology describes individuals' daily life experiences, as well as the meanings of these experiences as interpreted by those who live them. 14 After review of the relevant literature, the authors developed an interview form which consisted of three semi-structured questions as follows:

• What did you feel while caring for an individual diagnosed with COVID-19?

• What were your difficulties as a nurse during the COVID-19 outbreak?

• Could you please explain your views on your coping strategies when caring for a patient diagnosed with COVID-19?

All interviews were conducted by the researchers. The data were collected via an individual, in-depth interview technique. Due to the safety measures taken within the scope of COVID-19, individual, indepth interviews were conducted by researchers in a one-on-one, face-to-face format via the Internet. In the first stage, the aim and content of the study were explained and an appointment plan was established. In the second stage, individual interviews were conducted with each participant. Each participant was interviewed three times. During each interview, the interviewer and participant were alone. The interviews were also recorded with permission from participants. Sessions were terminated when the obtained data began to be repetitive. Each interview lasted for an average of 30-35 min.

İnterview reports recorded in writing, reviewed by the authors. Interview transcripts were sent to the participants for approval, further comments, and/or corrections.

The interviews were analyzed with Colaizzi's seven-step method. 16 The analysis included reading the transcript several times to gain an understanding of meanings conveyed, identifying significant phrases and restating them in general terms, formulating meanings and validating meanings through research team discussions to reach consensus, identifying and organizing themes into clusters and categories, and developing a full description of themes. 16, 17 The acquired themes and codes were examined by an expert, experienced academician apart from the main researchers, and the results were determined to overlap. Audio recordings were transcribed and missing expressions were completed by comparing the written material and audio recordings. The data from the interviews were sorted according to the themes developed by the researchers.

In qualitative research, the term "trustworthiness" is used instead of validity and reliability. In qualitative research, it is stated that four basic criteria should be considered for credibility, dependability, confirmability, and transferability. 15, 18 Credibility was achieved by in-depth interviews followed by peer debriefing. Two coauthors analyzed the transcripts independently by bracketing data on preconceived ideas and strictly following the adapted Colaizzi's method described above. For ensuring credibility, the researchers independently read the transcripts repeatedly and classified the interviews. For ensuring dependability, all translated transcripts were reviewed by two bilingual experts fluent in English and Turkish who were experienced in qualitative research and were aware of the subject of the study. For ensuring confirmability, the original interviews were adhered to and the responses of the nurses were presented directly.

To ensure transferability, the research sample, environment, and process were presented clearly. Intertextual participant statements were quoted directly, and detailed definitions were developed between the studied context and the study itself.

To strengthen the validity of the findings obtained from the research, direct quotations were made from the statements of the nurse participants when interpreting findings. 

All nurses who participated in the study provided care to COVID-19 patients in intensive care and were still working in ICUs at the time of the interview. Five nurses were male and seven were female. The mean age was 26.00 ± 4.39, and four nurses had no work experience.

Those four nurses had no previous nursing experience and no previous ICU experience. The duration of work in COVID-19 intensive care was at least 10 days, and no more than 2 months (Tables 1 and 2 her concern about the contagiousness of the disease with the quotation below:

The 

Nurses expressed the "physical" as well as "psychological" and "so- Some of our colleagues had problems of low blood pressure due to excessive perspiration because they did not drink water to avoid having to urinate or going to the toilet Some of our colleagues used (wore and urinated into) patient diapers when they had to drink water (because they could not use the toilet in the room) (N11).

With none of the nurses having previous infectious disease experience, increased workload and the process of caring for COVID-19

patients in the ICU resulted in psychological difficulties. intensive care.

In the present study, nurses' experiences with regard to the care process were grouped under three themes: "fear and anxiety compromise care"; "difficulties in caring for COVID-19 patients in intensive care"; and "practices to cope with the difficulties experienced."

In the present study, it was found that nurses experience negative emotions such as "stress, fear, anxiety, pessimism, fatigue, nervousness, despair, tension, curiosity, sadness, incompetence, resentment, and loneliness" while caring for COVID-19 patients.

Previous studies have also shown that nurses caring for patients with novel infectious diseases such as severe acute respiratory syndrome, Intensive care nurses are known to experience physical, social, and psychological health problems because of the way they work and their working conditions. 25 

This study shows the difficulties faced by nurses who provide intensive care to patients with COVID-19. It was determined that all nurses experience physical, psychological, and social difficulties along with negative emotions during the care process for COVID-19 patients, for which nurses use coping processes. Nurses stated that they were trying to cope with the difficulties in caring for individuals with COVID-19 through support from colleagues, families, and friends; empathizing with patients; seeking spiritual energy within;

thinking positively; and receiving support from experts. It is important to identify these challenges early to protect and improve the health of nurses. In addition, these difficulties can be prevented by training the nurses who will work in intensive care in the future. Therefore, comprehensive support for nurses should be provided to address the adversities experienced by them.

This study was conducted in Turkey early in the pandemic. It 

This study was conducted only with nurses working in Turkey. The results of this study can only be generalized to the individuals included in the study.

The authors thank the nursing participating in this study.

The authors declare no conflicts of interest.

Ethical permission ( 

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