Through semistructured interviews with 9 frontline nurses, four themes were summarized: ①feeling tension, anxiety, and loneliness; ②interpersonal disturbances; ③psychological needs; ④working environment, specifically expectations regarding working hours and work intensity.
3.1 | Tension, anxiety, and loneliness
3.1.1 | There were 26 nurses who felt nervous and anxious about entering the frontline position in the fight against COVID-19. They were afraid that the disease would be highly contagious. In addition, they felt lonely because they were quarantined in a away from their families and children during their employment. Nurses 11, 23, 28, 39, 45, and 50 expressed the following: "I was with the first batch of nurses to enter the COVID-19 ward and have direct contact with patients. Because many procedures have not been determined, I don’t know how to deal with patients. I feel nervous. The hospital isolation environment makes me feel anxious, and I can only fall asleep late at night." Nurses 2, 9, 12, 35, and 43 said, "I pay more attention to my family and children, and I use WeChat videos to call home every day...". Nurses 4, 44, 47, and 49 said, "I always help my son with homework every day. I'm not at home for the tutoring homework, and his father is not good at tutoring. Yesterday, the teacher criticized my son in the WeChat group. I called and reprimanded my son last night." Nurses 5, 8, 14 and 19 said, "I feel anxious these days. Maybe because of a change of environment, I don’t sleep well at night and often wake up." Nurses 6, 17, 18 and 31 said, "I think I will feel anxious when I enter the isolation ward, especially for the night shift. I cannot wait for the end of the shift as soon as I enter the ward. I feel very tired when my work is particularly busy." Nurses 20, 24, and 29 said, "I saw on my phone that the epidemic is so serious, and so many people have died. I am worried about what my family will do if I get infected. So when I enter the isolation ward, I am very nervous and afraid of not wearing protective equipment in the right way. I ask my colleagues to help me repeatedly check whether the protective suit is torn."
3.1.2 | Fear of being infected. Thirty-two nurses expressed worry about being infected. Nurses 4, 8, 10, 24, 28, 34, 37, 46 and 48 said, “For the three infected people admitted today, they just ate together at one meal. I feel that the COVID-19 is very contagious... we need to take protective measures. There was a patient who talks so close to me and coughs, and I am afraid that he is positive." Nurses 3, 5, 13, 16, 20, 22, 23, 25, 41, and 43 said, "I feel that the medical surgical masks we are using are thinner than before. I am worried that they are not as protective as before. I am still afraid of being infected, even though the head nurse told us that although there is a shortage of supplies, the supplies provided to us are absolutely qualified." Nurses 14, 17, 30, 35, 41, 44, and 50 said, "When I atomize a patient or perform other nursing operations, the patient coughs, and I will worry for a long time and worry that I will be infected." Nurses 26, 27, 33, 39, 45, and 49 said, "There is a patient who has repeatedly tested positive for nucleic acid. She can never get out of the hospital. I think she is highly infectious. Every time I perform a nursing procedure for her, I am always scared."
3.1.3 | Physical discomfort caused by protective equipment Forty-one nurses reported that their physical discomfort increased after wearing protective clothing and goggles. Nurses 5, 14, 26, 33, 37, 42, 47, and 49 said, "When I entered the isolation ward for the first time, I had the night shift. I felt a lack of air and then felt very sick and wanted to throw up, but fortunately, I had my colleagues." Nurses 8, 10, 18, 20, 23, 28, 34, and 44 said, "It's very hard to breath. When I get busy, my body is all sweaty, and then I feel very cold when I have time to take a break." Nurses 2, 6, 15, 24, 35, and 39 all said in the interview, "After taking off the protective clothing and protective mask, I feel that the world is mine." Nurses 12, 21, 25, 40, and 46 said, "After putting on protective equipment, nursing procedures become more difficult. I almost can't place an intravenous infusion." Nurses 3, 7, 29, and 45 said, "I have become slower." Nurses 4, 11, 19, 32, 38, and 41 said, "The N95 mask makes me have an allergic reaction. No matter how good my skin care products are, they can’t save me. The markings caused by the N95 mask won’t go away." Nurses 9, 13, 17, and 27 said, "I'm okay. I mainly have hypoxia, and opening my mouth to breathe makes my mouth feel dry."
3.2 | Interpersonal relationship troubles In the interview, 18 nurses reported experiencing psychological pressure in their relationships with colleagues and leaders. Nurses 5, 6, 14, 23, 33, and 44 said, "I’m not familiar with many colleagues and doctors here. I feel like I can't handle relationships with everyone, and I feel like there is no tacit understanding between us." Nurses 3, 22, 27, 36, 45, and 49 said, "I think doctors go to the isolation ward less frequently and have less contact with patients every day. We go in the ward for six straight hours, which is a bit unfair." Nurses 14, 39 and 41 said, "The manager mentioned something a few days ago about changing the double shift to a single shift. I feel like I am more anxious working alone in the isolation ward with no one to talk with." Nurses 17, 30, and 32 said, "When I was working with a certain colleague, she always found excuses not to go to the ward, so I spent more time doing aerosol inhalation and measuring vital signs. I am worried that it will increase the risk of infection for me."
3.3 | Psychological needs Thirty-one nurses felt that they needed psychological care. Nurses 12, 15, 23, 31, 35, 43, and 50 said, "Communicating more with friends will make me feel happy, and my stress will be reduced a lot." Nurses 1, 9, 11, 16, 24, 29, and 33 said, "I video chat with my daughter every day, and talking to my daughter reduces my negative emotions." Nurses 3, 5, 13, 18, 37 and 46 said, "I used to feel anxious and become stressed easily, and sometimes it is difficult for me to adjust by myself...". Nurses 17, 25, 32, 38, 42, and 47 said, "I think sometimes the care and encouragement of the manager is also very important. On the third day, when I had bad sleep and stressed, I had a conversation with the manager for a while and felt much better." Nurses 8, 19, 26, 39 and 49 said, "I sometimes feel like I need professional psychological counseling."
3.4 | The longest working duration and the greatest work intensity that can be withstood In the interview, 29 nurses indicated that they can work continuously for 6 hours at most, 11 nurses indicated that 8 hours of continuous work is acceptable, and 10 nurses indicated that the best uninterrupted work duration is 4 hours. Nurses 1, 4, 6, 39, 44, 46, and 47 said, “It’s too stuffy to wear protective clothing. If I stay in the isolation ward and never come out, I think 6 hours is my limit. In terms of work intensity, if the patient’s condition is mild, each nurse can manage about 10 patients.” Nurses 2, 3, 12, 20, 30 said, "At the beginning of the epidemic, there were not enough people. My single shift lasted 12 hours in the ward. To save protective clothing, I didn't come out. I think 8 hours is acceptable now." Nurses 11, 13, 15, 17, 19, 22, 24, and 27 said, "Six hours is the most. If the patient needs intravenous infusion or sputum suction, I think I can only manage three patients at most." Nurses 7, 10, 21, 34, 35, and 38 said, "Six hours is the maximum, and after 6 hours, I will be a little irritable. As for the intensity of work, I have not encountered severely ill patients up to this point, and there is generally no problem with managing 9 patients.” Nurses 33, 40, 41, 42, 49, 50, 23, and 16 said, "Six hours is already my limit, and maybe I'm used to it....” Nurses 31, 32, 36, 37, 43, and 45 said, "I receive an average of more than 70 patients per day. I think I can bear it for 8 hours." Nurses 5, 8, 9, 14, 18, 25, 28, 29, 26, and 48 said, "If I can’t eat, drink water or use the toilet for 12 hours, I definitely won’t be able to last. I think 6 hours is a bit too long. It’s even better if a shift is only 4 hours."