It challenges the health care system and our society as we know it. Personal protective equipment (PPE) standards are in place to protect nurses from disease transmission. Table 1 illustrates these categories of self-care and the numbers of nurses who reported using each during the pandemic. The characteristics of this subset of nurses did not differ significantly from those of the sample as a whole. Sign up today.]. Comments from 13 of the 21 nurses represented this theme; those nurses offered ways in which they were doing all they could to keep themselves and their families and friends safe. Jenna A. LoGiudice, Susan Bartos; Experiences of Nurses During the COVID-19 Pandemic: A Mixed-Methods Study. Colaizzis phenomenological method was used for qualitative analysis. Resilience is the capacity to recover quickly from difficulties or the ability to spring back into shape (elasticity).36 One way in which nurses demonstrated resilience was through the use of self-care behaviors. /Length 327872 It hurt to have the family calls explaining [that] their loved ones were failing and not allowing them to visit, even at death. ( So Im, like, is she going infect the staff in the lobby? You dont need to wear N95s all the time.. /Height 1175 Information about the pathophysiology, prevention, and treatment of, as well as recovery from, COVID-19 continues to emerge. /Annots [22 0 R] Curating and archiving these pandemic experiences are important and necessary. The mean score for resilient coping was 15.38 for the 21 nurses included in the qualitative data analysis, indicating that overall they were also medium resilient copers; the breakdown was 7 high resilient copers, 10 medium resilient copers, and 4 low resilient copers. /ColorTransform 0 For example, their mean age was 44.8 years, just 4 years older than the mean age of the entire sample. Message to the Congress on declaring a national emergency concerning the novel coronavirus disease (COVID-19) outbreak, Centers for Disease Control and Prevention, Older adults and Covid-19: the most vulnerable, the hardest hit, Multisystem inflammatory syndrome in U.S. children and adolescents, D-dimer and prothrombin time are the significant indicators of severe COVID-19 and poor prognosis. But this can be a dangerous label with negative consequences. It steeped nurses in power and pride and caused the public to take pause and give voice to an otherwise quietly anonymous profession. ( (J ( /X4 9 0 R Among responses from the 21 nurses whose qualitative data we analyzed, comments from 13 represent in this theme. /X8 10 0 R The 12 nurses whose comments represented this theme expressed strong emotions related to being a nurse at the front lines of the COVID-19 pandemic. Chlo Littzen receives funding from the Sigma Theta Tau International Beta Mu Chapter of the University of Arizona. Last, to this point, within their institutions nurses faced not only limited supplies of PPE but also shortages of body bags and morgue space. 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. Many other nurses described their distraught feelings related to not knowing how to care for these patients, coupled with the fact that they were encouraged to spend as little time as possible in patients rooms in an effort to protect themselves from the virus. >> 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. 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. /G12 8 0 R In the year of Florence Nightingales 200th birthday, nurses continue to embody her spirit. 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. Participants responding to the study selected the activities they most commonly use to care for themselves and to balance out their care of others. endobj Jessica Rainbow receives funding from the National Institute of Occupational Safety and Health, National Council of State Boards of Nursing Center for Regulatory Excellence, The University of Arizona College of Nursing, and HRSA. The looming threat of continued waves of infected patients hangs over the heads and the practice of both novice and expert RNs. Inclusion criteria were (1) age at least 21 years or older; (2) English-language fluency (both reading and writing); and (3) being an RN who has been actively working (full-time, part-time, or per diem) during the COVID-19 pandemic. /F5 12 0 R /Keywords (DAD4IoFLs8c,BACWqN75860) Even more routine aspects of care, such as basic hygiene, were neglected, further contributing to nurse moral distress. /Font << 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. 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. 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. The bond we made as front-line heroes will never be broken unless you were in it, you will never understand fully. (See Table 4, online only at www.aacnacconline.org.). 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. ( ( /X20 20 0 R Even when they were given information about these changes, many health care organizations werent transparent about the reasons behind them and expected nurses to just roll with the punches. /Resources << ( /F6 13 0 R The second theme was the challenges of working on COVID-19 wards.21 The nurses and physicians in the study expressed challenges in dealing with their fears of becoming sick themselves or infecting their family members, their powerlessness when handling patients deteriorating health, and the exhaustion of PPE supplies.21 With regard to the third theme, resilience amid challenges, nurses and physicians discussed their support of one another and the coping solutions they use.21, The second qualitative, phenomenological study, also from China, investigated the psychological experiences of nurses caring for patients with COVID-19.22 The investigators interviewed 20 nurses and identified 4 themes: (1) a significant amount of negative emotions in the early stage; (2) coping and self-care styles; (3) growth under pressure; and (4) positive emotions occurred simultaneously or progressively with negative emotions.22 Those nurses shared that in the early stages, their lack of knowledge about the virus and fear of infecting their families caused their anxiety.22 They also discussed the sense of teamwork they felt with their fellow nurses, and how their appreciation for life and their sense of professional responsibility as a nurse during this time contributed to their growth and positive emotions regarding the experience.22, Resilience is a well-studied concept in nursing and has been investigated among numerous populations including nursing students,23 nurse shift workers,24 and critical care nurses.25 The high-pressure environment of the ICU accelerates symptoms of burnout, such as moral distress and compassion fatigue.26 Stressful job demands, posttraumatic stress disorder, and workplace bullying are associated with high perceived burnout among critical care nurses, whereas social support, self-efficacy, and a sense of well-being help to build resilience.27, The creation and maintenance of a healthy work environment helps mitigate symptoms of burnout among nurses in critical care units. Among the rest, 3 held a doctorate, 9 held a masters degree, and 8 had received an associates degree. /Type /Pages 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). /Annots [27 0 R 28 0 R] ( Where protocols and policies are missing, nurses and health care providers step up and write them. Protecting their own families from COVID-19 was paramount for these nurses. Assistant Professor of Nursing, University of Arizona, Assistant Professor of Nursing, University of Portland, Adjunct Instructor of Nursing, University of Arizona. They discussed how they went into nursing to help people, and how much they love their jobs. The nurses also worried that the sanitation process for N95 masks had not been tested and could potentially break down the mask material, thereby putting them at a higher risk of being exposed to COVID-19. Overall, nurses have high rates of exposure to infectious diseases. /G3 7 0 R 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. ( /Parent 2 0 R All the drama from work and things like that, those dont help. endobj Five overarching themes emerged from the data; these themes describe the essence of being an acute care nurse during the COVID-19 pandemic (Table 3). /F6 13 0 R >> /StructParents 1 Qualitative narratives give meaning to and explain the quantitative numbers. Lack of racial and sexual diversity among study participants is a notable limitation of this study. ) /Contents 23 0 R JFIF C The most frequently used self-care methods were social forms, followed closely by physical self-care practices. 7 0 obj We recruited acute care RNs to participate in the study via professional organizations websites and social media platforms. endobj Similarly, we found that 67% of nurses under 30 are considering leaving their organizations within the next two years. 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. It was very, very stressful.. As the pandemic continues to overwhelm hospitals and communities across the U.S., its effects on nurses need to be carefully considered. >> 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). /G3 7 0 R Although this last point was resolved when hospitals moved to testing all patients regardless of their symptoms, it was stressful for these nurses and illustrates their anxiety. 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. The authors dedicate this manuscript to all of the health care workers who have died while fighting COVID-19. /TrimBox [0.0 7.9200063 612.0 799.92] During our review of the qualitative data, we noted that 22 of the participants responded to the open-ended research question with only a few words or sentences. The environment in which nurses practice has been well studied; research has found that the work environment impacts nurses psychosocial well-being and interpersonal relationships, and the quality of patient care.12 It also contributes to the incidence of burnout and job satisfaction among nurses,13 as well as patient mortality.12 Nurses working in critical care environments have experienced some of the quickest changes to date in response to COVID-19. Masks and vaccines are proven to help prevent the spread of COVID-19. << This has left many nurses feeling unappreciated, undervalued and unsafe. The final portion of demographic data collected related to the participants self-care practices during the pandemic. 4 0 obj Nurses were literally watching family members via an iPad pour their hearts out to [the] patients. In some instances, it would be the last time a patient would speak to their loved one, given how quickly the disease often progressed. ( Specifically, the American Association of Critical-Care Nurses posted the direct link to the study on their website. ( But COVID-19 came without a handbook of best practices. We literally have no idea how to treat this, [and] each week is a guessing game as new data comes out showing what we did the week before made patients worse, an ICU nurse from a community hospital shared. >> The mean and SD score for each item are compiled in Table 2. A qualitative phenomenological study of 9 nurses and 4 physicians in China explored the experience of combating COVID-19.21 Three themes emerged from the telephone interviews researchers conducted with these participants. Finally, nurses mentioned the heaviness and the emotional toll of being in the room on a Zoom call with family saying their last goodbye to their [ventilated and] sedated loved ones. In the words of the nurses themselves, the patients are more than their disease and we are doing our best.. << As one nurse from our study explained: Lack of resources, lack of staffing, lack of getting all our concerns addressed, things like that. % /ModDate (D:20200402174130+00'00') /BitsPerComponent 8 /ExtGState << Evidence remains mixed, however, on how best to remove soiled PPE and to train health care workers in the proper application of PPE.14 During the COVID-19 outbreak, nurses and other health care providers have been facing a global shortage of PPE,15 and institutions have implemented unconventional practices to conserve and reuse PPE. /F7 14 0 R /Type /Page 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. 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. } !1AQa"q2#BR$3br A medical-surgical float nurse from a community hospital expressed it this way: not to mention the fear of bringing the virus home to your family. /MediaBox [0.0 7.9200063 612.0 799.92] A total of 43 nurses participated in the study. Nurses are trained to practice evidence-based health care, and when a method of care works, they will implement it for their patients. Nurses have been exposed to a substantial amount of moral injury, which occurs when they witness, perpetuate or fail to prevent something that contradicts their beliefs and expectations. ( 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.. Unfortunately, what the public may not realize is that their decision to decline vaccination or masking has serious consequences not only for nurses, but also their friends and community members. ( Consequently, it becomes normalized for nurses to work longer hours or extra shifts without consideration for how this may affect them personally. 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. /Font << $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ? It was extremely frustrating. Protection of loved ones and of each other takes priority, and nurses use those imperative social circles to restore well-being. 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. (: ( #( /XObject << ( (: ( Overall, for this study, a high score would demonstrate a participants ability to be positive and to grow during this stressful COVID-19 outbreak, whereas a low score would demonstrate that a participant has not been able to cope well with the situation. They worried that when reusing PPE, especially gowns, they would contaminate themselves while putting it back on. The small sample size is another limitation. /X26 25 0 R Nurses not only see a large number of COVID-19 deaths firsthand, they may also need to provide comfort for those left behind. The mean score on the BRCS for the entire sample (n = 43 nurses) was 14.4 (SD, 2.3). They also expressed frustration with the constantly changing PPE guidelines and the need to reuse PPE throughout the day or even the week. %PDF-1.4 This study aims to scientifically examine the resilience and experiences of registered nurses (RNs) practicing 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. A convergent mixed methods design was applied in this study. ( /TrimBox [0.0 7.9200063 612.0 799.92] 6 0 obj We gathered qualitative data from the personal experiences of RNs working during the COVID-19 pandemic, and we obtained quantitative data from responses to the Brief Resiliency Coping Scale.31 We applied a convergent mixed-methods design,32,33 collecting both types of data simultaneously but analyzing them separately. It is about not just being a nurse in a pandemic but being proud to be a nurse, always. Last, the team wrote an exhaustive description of the essence of the experience of being a nurse during the COVID-19 pandemic. The nurses in our studies put the needs of their patients and society above their own. Participants had a mean age of 40.9 years (range, 23-64 years). We have three managers and seven clinical coordinators on our unit. w !1AQaq"2B #3Rbr I feel terrible for our patients and [their] family members.. << Among the nurses whose responses we included in the qualitative analyses, 18 were White (non-Hispanic), 1 was Asian, 1 was Hispanic, and 1 was multiracial. /Resources << I attribute my success to thisI never gave or took any excuse. 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. Two participants expressed gratitude at the end of their narratives for allowing them to share their experiences and to write them down. /F5 12 0 R /F16 17 0 R doi: https://doi.org/10.4037/aacnacc2021816. We also wrote an exhaustive statement that described the overall experience of being a nurse during the COVID-19 pandemic. Not only have nurses seen a high volume of deaths every day, but they have also been placed in morally difficult situations due to resource shortages, such as oxygen supplies, ECMO machines that support heart and lung function, and hospital beds and staff. /StructParents 2 5 0 obj /F7 14 0 R ( /BM /Normal ( /F15 16 0 R From the 21 narratives, we identified 272 significant statements regarding the experience of being an acute care nurse during the COVID-19 pandemic. 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. Nurses offered the creative ways they were trying to keep their families safe. They were proud to be providing nursing care and appreciated the recognition of their work by local restaurants who donated food to their hospitals.