The COVID-19 pandemic is the worst humanitarian disaster since World War II (1, 2). According to statistics, there have been 423,437,674 confirmed cases of Covid-19 globally as of February 22, 2022, with 5,878,328 deaths. Iran has 6,942,452 cases of infection and 135,040 instances of death out of this total (3).
Despite the general advice to quarantine and stay at home during the pandemic, health workers were compelled to be present at work because of their role in handling the pandemic. As a result, due to direct exposure to patients, a large number of medical staff contracted the disease and in some cases died (1). On the other hand, according to the International Council of Nurses (ICN), health care staff account for around 10% of all Covid-19-confirmed cases so far (4). Iran is also among the top ten countries globally, with the highest incidence and loss from the disease (5, 6) .In addition, Iran has a higher incidence of covid-19 infection among medical staff compared to average incidence around the world (7). According to the ICN research, more than 60,000 nurses in Iran have been infected with Covid-19 as of December 26, 2020, accounting for 45 percent of the country's nursing workforce (4). Also, according to the Iranian Nursing Organization report as of April 2021, 100,000 nurses have contracted Covid-19 since the beginning of outbreak that 120 of them have died. (8)
Statistics indicate that during Covid-19 pandemic, nurses have been under an unprecedented pressure and exposed to many physical and mental health risks (4, 9). The extent of these problems for nurses has gone beyond the individual level and has affected their family and social lives (10, 11). The unexpected Covid-19 pandemic, on the other hand, created unprecedented and unique conditions for nurses, resulting in a significant increase in workload, a severe shortage of equipment, particularly personal protective equipment, a lack of timely access to information and instructions, and receiving multiple and sometimes contradictory instructions (12). As a result, during the Covid-19 outbreak, paying attention to the health and safety difficulties of health care workers, as well as preserving their health, became a major public health priority (13).
Part of the nurses' individual efforts to protect themselves and others encountering the pandemic has been to adopt protective behaviors (14). Protective behaviors are defined as measures that people take to protect themselves from harm (15). The level of adherence to these preventive and protective measures depends on the intensity of risk perception, the amount of information available about the phenomena, and validity of these information (16). During this especial situation, nurses had to manage their self-protective behaviors in a way that they can keep themselves, their families and their patients as safe and healthy as possible (17, 18). However, given the speed of spread and severity of the Covid- 19 pandemic worldwide, little information is available on the nature of nurses' protection measures in these extraordinary circumstances in Iran and other countries.
Nurses have a critical role in managing infectious diseases outbreaks. Therefore, it is necessary to conduct more research to find the factors and risks leading to occupational injuries, methods of protecting nurses, as well as their individual action on protective measures in the event of epidemics (14, 19, 20).
During literature review, we found a study that investigated protective strategies adopted by nurses during Covid-19 pandemic. In that study, the protective strategies were classified into two categories: responsible behaviors, such as following standard precautions and modifying work procedures, and imbalanced reactions such as refusing to take care of patients, obsessive self-checkup and assuming others sick (14). Another study found that nurses adopted strategies like following infection prevention guidelines, wearing personal protective equipment, and having adequate food and drinks to cope with their concern of getting infected by Covid-19 (21). However, the literature review reveals a significant gap in existing knowledge on the protective strategies utilized by nurses during the Covid-19 pandemic, indicating that more research on this field is needed. Particularly the reasons why nurses are adopting various protective strategies and consequences of adopting each one is not much investigated. Particularly the motivations for nurses' employment of protective behaviors and the consequences of those strategies have received less attention. Therefore, the aim of this study was to explore the protective strategies of nurses in the Covid 19 pandemic.