Overall, the video-based monologues effectively conveyed the emotional impact and lived experiences of nurses during the COVID-19 pandemic, fostering a sense of connection and solidarity among HCPs and the public. The findings evidence interest, involvement and immersion (23) from participants predominantly due to the video's relevance to the research participants. It is broadly understood that narrative interventions such as video-based monologues are naturally more relevant to human beings than other message formats, for example fact-based messages (35, 36). In Shaffer’s (23) theoretical model, involvement requires more active participation by the audience than interest. By being involved with a narrative, the audience is able to actively identify with the character (37) and take their perspective, which allows them to experience empathy (38, 39). As has been noted through the findings, participants unanimously emphasised with the experiences portrayed and those with a nursing background could emotionally identify. Shaffer’s (23) final stage of narrative processing is immersion, which requires a transportation into the narrative and processing incoming information from the perspective of the character involved (35, 39). The findings confirm that most participants were immersed in the video-based monologues, given the language used “brought me back”, “a flashback”. Although the participants were predominantly part of the nursing community and identification would be expected, the fact that members of the public also deemed the video captivating and the almost unanimous call for wider dissemination signifies that this has relevance to a wider audience.
The findings of this study are unique, as far as we know there is very little research related to the impact of COVID-19 related video-based monologies on a nursing and public audience. The closest study we found of used research-based theatre on the societal impact of COVID-19 (40) similar to our study audience members somewhat/strongly agreed research-based theatre is an effective means of understanding health research (93.5%) and offered new perspectives on what people had been experiencing (87.5%). Although comparable research is limited, arts-based approaches using verbatim narratives are known to have a unique power in communicating research findings (41–43). The verbatim approach used in this study ensured that the nurses' voices were preserved with accuracy and integrity, this method not only honoured the authenticity of their experiences but also underscored the raw and unfiltered nature of their emotions, struggles, and triumphs during the pandemic. The findings reveal the remarkable power of rhetoric in conveying these experiences, highlighting that even when these narratives are performed by untrained actors, the impact and emotional resonance remain profound. Despite their lack of formal training, these actors with a nursing background were able to convey the depth of the nurses' experiences effectively, demonstrating that the power of storytelling lies in the genuine expression of human emotion and connection (41–43). This study illustrates that when these real-life stories are delivered with sincerity and empathy, the message transcends the need for professional acting skills, resonating deeply with audiences and fostering a greater understanding and appreciation of the nurses' contributions and sacrifices during COVID-19. Ultimately, this project highlights the significant role of narrative and rhetoric in sharing lived experiences, particularly in times of crisis. It showcases how the raw, unpolished recounting of personal stories can evoke strong emotional responses, promote empathy, and provide valuable insights into the human condition, regardless of the storyteller's training.
The findings collectively highlight that the video accurately depicted the complex and multifaceted experiences of nurses during the pandemic, including feelings of solidarity, frustration, and the contradictory experience of isolation. This underlies the importance of recognising the powerful role of emotions within the workplace, especially under conditions of extreme difficulty, duress, confusion, and the terror of working in ways and places untethered from comfort zones or teams. They underscore the impact of the video in raising relevant issues for nurses such as the need for social support, effective leadership, and empathy in navigating the emotional challenges inherent in healthcare work, particularly during times of crisis. Similar to existing evidence (44), the emotional toll of the pandemic on nurses was deeply felt, with participants resonating with the video’s portrayal of hurt, sadness, loneliness, fear, and uncertainty. For example, in the ICON study nurses reported being deeply affected by what they have experienced, and report being forever altered by the impacts of COVID-19(10). It is widely evidenced that the continuous rush of new information created confusion, uncertainty and added stress to HCPs already demanding roles (45). There was clearly an emotional identification from participants through the memories they recalled depicting the stress of adhering to constantly changing guidelines and protocols while doing their best to ensure the safety of themselves and their patients. Nurses experienced a profound sense of reflection post-viewing the video, highlighting the power of this medium of communication but also the lasting impression of the pandemic on their values, beliefs, and personal lives. Despite the recognition of sacrifices and dedication demonstrated by HCPs, particularly nurses, there was a familiar sense of moral injury and resentment regarding the lack of support and appreciation received post-COVID-19 (46, 47). Discussion of moral injury in the context of the duty to care in reflection of COVID-19 and similar situations warrants future research (46) and dedicated training in self-care strategies (47). Overall, post watching the video participants concluded that nurses were not adequately supported, undervalued and unappreciated, which inflicted more damage on their morale and sense of value than the pandemic itself.
Participants highlighted that the video effectively portrayed how nurses were initially acknowledged for their sacrifice and selflessness in caring for patients during the pandemic, even at the risk of their own well-being. However, in response to the video participants reflected that as the pandemic progressed, the public's perception of nurses changed and later faced increasing scrutiny, scepticism, and even hostility from certain segments of the population. This shift in public perception was defined as beyond the control of individual nurses and contributed to feelings of lack of support, frustration and disillusionment. The labelling “nurse as hero” discourse is widely recognised (48), however the stage where politicians, the mass media and the general public doubted the quality of HCPs provision of front-line care to people with COVID-19 is under-recognised and under-researched. The video did stimulate some sentiment relating to the support received in camaraderie from colleagues similar to that which is evidenced elsewhere globally (49). However, participants reflections post-video focused on their disappointment and frustration at the perceived failure of leadership and lack of support from managers, indicating potential gaps in the support provided to nurses in caring for patients during and after the pandemic. Similarly, other studies (50) have indicated that nurses' opportunities to speak up being frequently thwarted by management highlighting the issues when power, hierarchy, fear and threat might be concerned. Power dynamic in healthcare institutions, is therefore also an area which warrants further exploration and potential policy and practice changes.
Following watching the video, participants almost unanimously agreed that emotional impact experienced by nurses during and after the pandemic underscores the need for policy and practice changes to prioritise the emotional well-being of HCPs. This resonates with the findings from other studies (51) which focus on the impact of burnout for nurses before and during the pandemic and recommend the long-term clinical and preventive psychological interventions which should not be limited to emergencies but extended to address the ongoing challenges faced by nurses. Furthermore, as Connolly et al. state it is of paramount importance that nurses are not blamed for experiencing workplace stress particularly when expressing what is deemed to be normal and appropriate reactions to the extreme circumstances and context of the COVID-19 pandemic (52). In reflection of the video-based monologues, participants emphasised the importance of validation, recognition, and support for nurses' emotions within the nursing profession. Similarly the need for policy and practice change in this realm is ratified by an analysis of mental health effects among nurses working during the COVID-19 pandemic (53) which indicated a prevalence of moderate-to-severe symptoms for anxiety 29.55%, depression 38.79%, posttraumatic stress disorder 29.8%, and insomnia 40.66%. This is particularly relevant given that current literature suggests that experts in policy-making are increasingly recognising the necessity of incorporating narrative as a vital part of the comprehensive evidence base needed to inform complex policy-making processes (54, 55). Given that policy decisions are often driven by values and politics (56), concise, engaging, and pertinent narratives such as those used in this co-created video would be particularly relevant to current health policy debates (55, 57, 58). As most participants emphasised the need for wider broadcasting of the video, particularly to decision-makers in nursing management and policy, more research and targeted dissemination strategies are warranted. Overall, raising awareness and driving positive change through these video-based monologues is validated to preserve and honour the sacrifices made during the pandemic and ensure that policy and practice changes are implemented to better support HCPs and students in future crises.
This study has several limitations. Despite efforts to circulate widely in all possible social media platforms, wider participation was expected therefore the response rate for the survey and audience participation was lower than expected. Missing data from demographic section of the survey was also a limitation. The primarily limitation concerns the representativeness and generalisability of the sample. Most of the sample were from Northern Ireland which limits generalisation globally and were qualified nurses which limits generalisation to the public. The survey was limited to those who had access to a smart phone device, laptop or personal computer and required Wi-Fi signal which also may have been a limitation for some potential participants. Despite these limitations, we believe the methodology was the best option available to gauge the impact of the video via the various mediums previously stated.