Strong support system
This study aimed to explore how people react towards nurses when they knew that these nurses are consecutively exposed to a contagious disease. The majority had positive experiences regarding societal response towards them, despite different impacts of the pandemic on individuals:
“I tested positive with COVID-19, home quarantined for one month, during all this my family supported me a lot. Now I am performing my duty with the full-time support and assistance of my family. My family is side by side with me. They did not leave me alone in this battle to fight with. We still cannot overcome the crisis and win this battle without constant support of our families.” (P13)
“I was pregnant last year and tested positive with COVID-19. Although it could be unmanageable for me to handle the situation but, I must say, my husband, in-laws and all my family supported me a lot. So, I managed everything well and fulfilled all my personal responsibilities with the support of my husband. Even at work my fellow nurses and all other staff helped me to manage my things while I was on duty in COVID-19 units.” (P16)
The responses of the participant nurses clearly indicate that they received full support from family members when they were performing tough duties in the hospital. Nurses mentioned that it was not an easy thing to manage their responsibilities during the worst crisis of their career. Not only their family members encouraged them, but their colleagues also proved to be a great source of assistance and support to handle the unforeseen situations.
Strong social bonding
Although the situation might differ compared to other countries or even to nurses from other hospitals, we explored from the experiences of the study participants that they had a strong support system and strong social bonding. The spouses of married nurses supported them to manage their duties and it happened because of their strong bonding. However, there were some people who avoided interacting with them, but it was all because of the fear of contracting the virus. Respondents of the study were also concerned about the health, protection and safety of their family members. Therefore, they tried not to visit them for a longer period of time:
“I myself avoided frequent social interaction in order to keep people safe if I carry the virus. My husband helped me a lot to remain honest with my profession. On both sides I had my own people to care for.” (P14)
Participants mentioned that they received support from the hospital to be able to limit social interactions:
“I received full cooperation while I was serving in COVID-19 intensive care unit. I stayed in a nursing hostel to limit my interaction with people just to keep them safe. I avoided visiting my family for a long time. […] When I am on duty in Corona units, I prefer to stay in a nursing hostel because I assume it is better for my family.” (P21)
Fear
Nurses were fearful of COVID-19, particularly in the initial stages of the pandemic. Mostly, nurses were more concerned about their families than themselves, because they tried to avoid contracting the disease and transferring it to their children and other family members:
“If I say that I wasn’t fearful of the disease, I must be lying to you. Yes, I had fears.” (P17)
“Being an active participant of the medical field and exposed to COVID-19 patients, I didn’t want to become a source of transmitting the disease to my family and other people around me.” (P26)
Fear was common among many respondents in the very beginning of the pandemic.
“Initially, I was concerned about my performance and I literally wanted to overcome my fear because I didn’t want to compromise on my duties.” (P28)
“Sometime when I had symptoms of normal fever, I thought what happen if I test positive for this disease? Who would take care of my kids even if I die?” (P27)
The responses of the nurse clearly indicate that they experience fear while performing their duties in the initial stages of the pandemic. These fears might have badly impacted their mental health. Nurses had gone through such experiences in the very beginning of the outbreak of COVID-19 when there was uncertainty and ambiguity. Later on, they not only controlled their own fear but also helped and guided others to behave properly.
Depression and Anxiety
From the experiences of nurses, it is revealed that they were aware of the impacts of their mental condition on their job and quality of care they provided to the patients. Furthermore, they were fully aware and understood the severity of these conditions while they were handling COVID-19 patients.
Respondents described various factors behind their anxiety and stressful conditions, including restless routine, haziness about the treatment and nature of the disease (at initial stages), severity of the disease, stress for the event of a grievous circumstances, and overall a restless and questioning environment. There was an initial feeling of sudden emergency and consecutive stress of an unfortunate environment. The majority of nurses narrated that they faced anxiety because in the initial stages of the outbreak there was no clarity of the existence and treatment of the disease even among healthcare providers:
“We didn’t know much about the disease. How could we stay calm while witnessing people dying with corona virus when the cases were on their peak in the country… Even the attendants of patients were unable to bid them last farewell. It was so heart wrenching and emotional thing to see and pay focus on performing our duties.” (P 18)
“I won’t deny the fact that I was panicked… I used to get panic… I still remember… Although, we see people dying every day, the situation in the case of the corona virus was entirely different. People should not treat it as a joke.” (P4)
It was highly difficult for the nurses to see people dying without having their loved ones with them in their last moment. Witnessing these worse situations made nurses emotional and more empathetic towards their COVID-19 patients:
“We are used to handle situations of emergency. However, this pandemic made us experience many worst things. We see people dying of it and their loved ones cannot be with them! It is difficult to handle such emotional situations sometimes.” (P21)
COVID-19 has changed the lifestyle of many people. When nurses were asked to explain the situation of the pandemic, they frequently managed the psychological impact and their experiences related to it. Nurses, more specifically married ones, were quite worried about their kids. They did not want to bring them an undesirable situation:
“My family was my biggest concern and I did not want to become the cause of their pain if they might get the disease. Even now, every time when I go home, I don’t interact with my family unless I change my uniform, take proper bath and proper sanitization.” (P20)
“Being a mother, I had so much to do for my kids and I thought what will happen if I die soon. These thoughts were enough to put me under depression. I have little kids to look after. I cannot rely on anyone in this matter. This was my biggest worry while handling patients in COVID-19 special units.” (P30)
The experiences of nurses handling patients with a contagious disease have highlighted the impacts of this ongoing pandemic on their lives, responsibilities and mental wellbeing.
Impact on physical health
Nurses are frequently called as “Superheroes” or “Life Savers” by the public as a result of the tasks they have successfully fulfilled during the COVID-19 pandemic. Appreciation by the people added much worth and appeasement in the healthcare professions. However, at the same time, it put more pressure on healthcare workers, by leaving no chance of mistake from their end. Furthermore, fulfilling the tasks puts pressure on them and negatively impacts on their physical health.
COVID-19 positive
In the case of Pakistan, many healthcare workers sacrificed their lives while handling COVID-19 patients. All respondents of this study performed their duties in specially allocated COVID-19 units. A few nurses even got COVID-19 positive themselves. Responses of the nurses related to their contraction of the disease are described below:
“I was tested positive with Corona virus last year and home quarantined myself for 15 days. I not only recovered from it but I am absolutely fine. Although I belong to the upper age group, still I don’t have major complications after contracting the virus – except for a few ones.” (P13)
“I tested positive last year while I was pregnant and I was really upset about how to manage this toughest routine while expecting a baby.” (P16)
Furthermore, the study participants also mentioned that a few of their staff members sacrificed their lives in the line of duty.
Fatigue
When nurses were asked about the impact of COVID-19 on their physical health, almost all of them spoke on it and narrated their experiences related. The pandemic has altered the life of every individual. Due to heavy workload and excessive precautionary measures to handle the patients along with standardized operating procedures (SOPs), the lives of nurses also got hectic: They had to wear protective gears (like face masks, gloves, protective gowns), sanitization of everything was necessary, and nurses had to change their dress everyday as soon as they reached their hostels or homes. Initially, nurses had to perform excessive work that became a cause of their sleeplessness. Heavy workload in hospitals and tough routines by following SOPs may lead to extreme fatigue. All nurses – particularly those who were infected with COVID-19 themselves – experienced weakness:
“I felt extreme weakness and fatigue while I was performing my duties in COVID-19 wards.” (P30)
“I did not focus on my diet while I was serving in a COVID-19 unit. That was also the reason behind my weakness. Actually, because of extensive sanitization and safety protocols, I got so much exhausted and had no desire to do anything but relax.” (P29)
Furthermore, study participants mentioned that due to the work burden they could not focus on their own health and had fatigue. Carrying personal protective equipment enhanced their work and made them exhausted:
“Although I was not fearful, but yes… I had fatigue while I was serving in COVID-19 units because of following SOPs and excessive precautionary measures which is even today mandatory to follow by every nurse who handles patients with COVID-19 in the hospital. Moreover, I do not take proper care of me, but now I realized that self-care is highly important in order to handle this situation. Otherwise, I would be of no use. And I don’t want that to happen.” (P2)
In fact, the respondent nurses mentioned that excessive protective measures and adopting COVID-19 SOPs increased their work. Body fatigue was normal in emergencies, but the prolonged duration of COVID-19 actually brought negative impacts on the health of nurses:
“Body fatigue is a normal thing for us in situations of emergencies and workload. But this time it was a mental fatigue as well. Initial uncertainty, misinformation and myths played a huge role in increasing our duty, because it took us a lot of energy and time to educate people that their lack of care could further spread the disease. Sometimes, even now it becomes really difficult to handle attendants of the patients in terms of following safety protocols and implementing social distancing.” (P10)
Experience of handling contagious diseases
When nurses were asked about their experience of handling patients with a contagious disease like COVID-19, two themes emerged from data which relate to professional requirements and (nurses’) intensions to serve the humanity.
Professional requirements
All study respondents had experiences of handling contagious diseases caused e.g. by the Human Immunodeficiency Virus (HIV), Hepatitis (A, B and C), dengue and then most importantly COVID-19:
“We became used to this situation because it is our profession. For me, my profession is more than anything else. I have no regrets to join this. At least I am satisfied with what I am doing.” (P4)
The participants of this study highlighted the fact that they encountered initial fear because of the uncertainty and misconceptions about the virus. But, later on, they became familiar with the situation and took it as their professional responsibility:
“We came in this profession to serve people. I even handled patients who were suffering from AIDS and cancer in my entire career. I have seen the pain and misery of people. However, this time it was not only for us, but the entire world was battling hard with it. Even though few countries have got some hold on it. But we can clearly see the all-time worst situation of Corona virus in India. It is a requirement of our profession and we are always here to serve in any situation.” (P13)
“Even having suffered from this COVID-19 pandemic by myself I am still motivated and good to perform my duty without any fear.” (P13)
Nurses showed that they were motivated to cope with the crisis because it was their duty to do it:
“Yes, when there is some uncertainty about the disease like this pandemic in the very beginning we had some fearful thoughts, but we know that it is our profession and we have to do our job no matter what happens.” (P25)
The nurses were motivated to manage their work and family life along with battling COVID-19 in the frontline.
Serving the humanity
Nurses join this profession by knowing its hardness and in case of pandemics and emergencies they know that they have to work wholeheartedly and provide their serves to the public. Almost all nurses responded that no matter how fearful and restless they get in the beginning of any emergency, they have to work to manage themselves and overcome their fear to serve the people in need of care:
“We took oath to serve humanity so we know it is the requirement of our profession and we came into this profession by knowing the severity and demands of it. Neither we can run away from this situation nor should we!” (P24)
The nurses participating in this study were all ready to serve humanity. They were passionate to work during the pandemic and motivated enough to beat it:
“I was not at all fearful. Not even in the beginning of the pandemic in Pakistan. I worked in COVID-19 special units. My only concern was the pain and misery of the people who were dying of it. I was very sympathetic towards them. I do my best to serve my people. Even if I have to devote my entire life to serve humanity, I would literally love to do that! It might be surprising for you but, I am like this. I feel the pain of my patients.” (P2)
Irrespective of initial fear and anxiety, nurses were more concerned about their profession performance and providing their best services to the patient than anything else.