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www.elsevier.es/enfermeriaclinica

Nurse’s experience in giving nursing care to Covid-19 patients ^夽

Hotma Royani Siregar

^∗

, Febrina Angraini Simamora,

Nanda Masraini Daulay, Sukhri Herianto Ritonga, Asnil Adli Simamora, Mei Adelina Harahap, Nanda Suryani Sagala, Natar Fitri Napitupulu, Adi Antoni, Fahrizal Alwi, Mastiur Napitupulu

FacultyofHealth,UniversitasAufaRoyhan,Padangsidimpuan,Indonesia Received26September2021;accepted26March2022

KEYWORDS Nurse’sexperience;

Nursingcare;

Patient;

COVID-19

Abstract

Objective: TheobjectivewastodescribeNurse’sexperienceingivingnursingcaretocovid-19 patients.

Method: Phenomenologydesignwasusedinthisstudy.Participantsinthisstudywerenurses who provided nursingcarefor COVID-19 patients. Participant data wereobtained from the nursingofficeandcontactedviacellphonetobecomeparticipants.Afterdatasaturationthe researcherfoundsixnursesasparticipants.In-depthinterviewswereconductedfromJulyto August2020toexploretheexperiencesofnursesgivingnursingcaretoCovid-19patients.Data wasanalyzedusingtheColaizzimethod.

Result: WefoundfivethemesofnursesgivingnursingcaretoCovid-19patients.Thethemes includetheMotivationofnursestoprovidenursingcareduringtheCOVID-19pandemic,the nurseemotionalresponse,thepatientemotionalresponse,theproblems facedby COVID-19 nurses,andtheexpectationsofthenurses.

Conclusion: NursesneedsupportwhilegivingnursingcaretoCovid-19patientstobreakCovid- 19transmission.

©2022ElsevierEspa˜na,S.L.U.Allrightsreserved.

夽 Peer-reviewunderresponsibilityofthescientificcommitteeof the3rdAcehInternationalNursingConference(AINC).Full-textand thecontentofitisunderresponsibilityofauthorsofthearticle.

∗Correspondingauthor.

E-mailaddress:hotmasrg@yahoo.com(H.R.Siregar).

Introduction

StartingfromthephasewhentheGlobalPandemicCOVID-19 outbreakenteredIndonesia,Nurseisaprofessionthatmust carryoutitsprofessionalobligationstobeatthefrontline oftacklingthisvirusinnursingcare.Whenmostworkersdo https://doi.org/10.1016/j.enfcli.2022.03.017

1130-8621/©2022ElsevierEspa˜na,S.L.U.Allrightsreserved.

EnfermeríaClínica32(2022)S50---S53 workathome,oneofthehealthworkerswhostillhaveto

workandcontinuetoserveisanurse.

The nursing profession during the COVID-19 pandemic waschallengedtoprovideprofessionalnursingcarewiththe riskofcontractingandevenbecomingvictimsofCOVID-19.

The dutyof anursein theCOVID-19pandemic is tomeet thebasic needsof patientsandprovide educationsothat patientscantakepreventivemeasuresintheeventofasim- ilarcase. Althoughthechainof transmissionhasnotbeen broken, nurses mustcontinue tocarryout theirduties by providingnursingcareforinfectedpatients.Duringapan- demic,nursestogetherwiththeirpeersneedtodecidehow muchcaretheycangivetoothersinadditiontocaringfor themselves.¹

NursesathospitalswhotreatCOVID-19patientsarefaced withtwochoices,namely continuingtoworkbyupholding professionalism or prioritizing personal and family safety.

Nurses haveaveryimportantrolein providingpromotive, preventive,andnursingcareservicesintheCOVID-19pan- demic. Nurses who are currently involved in the care of COVID-19patientsinallhospitalsaroundtheworldhavesac- rificedpersonalandfamilyinterests.Nurseshavesacrificed safetyandfacethethreatofcontractingavirusthatcould endindeath.ThepurposeofthisstudyistodescribeNurse’s experienceingivingnursingcaretocovid-19patients.

Methods

This researchusesaqualitativestudywithaphenomenol- ogy design. This design was chosen so that participants’

experiences could be explored more clearly so that the description ofthe nursesexperienceduring givingnursing caretoCovid-19patientscouldbeclearlyillustrated.This methodisveryappropriatetobeusedtoexplorethephe- nomenon of nurse’s experience because each nurses has his ownexperience in giving nursing care. The study was conductedintheregionalhospitalinPadangsidimpuancity.

BecausethehospitalbecamereferralhospitalforCovid-19 patientsfromseveralsurroundingplacesofSouthTapanuli Area. The studybegan inJune September2020, datacol- lectionwasconductedinJulytoAugust2020.Thenumber ofparticipantsinthisstudywas6participants.Participants weretakenusingpurposivesamplingwithinclusioncriteria:

willingtobeaparticipant,becomecovid-19nurseandgiving nursingcaretoCovid-19patients.Participantsinthisstudy haveagreedtoprovideinformationandhavebeenkeptcon- fidentialbytheresearcherbynotincludingtheparticipant’s name

Data collectionused in-depth interviews conducted by researcherswitha durationof 50---60minby telephoneto record interviews. The interview was carried out several times to obtain data saturation. Data collection tools in this study were demographic data questionnaires, inter- view guidelines, and mobile phones. The interview guide consistedof5open-endedquestionssuchasmotivationto becomeaCovid-19nurse,nurseemotionalresponse,prob- lemsfacedbynurseswhenprovidingnursingcare,benefits ofbeinganurseduringtheCovid-19 pandemic,andnurse expectation.

Qualitative dataanalysis usingtheColaizzi modelwith 7 stages ranging from reading all the contents of the

interview, identifying significant statements, formulating meaning, clustering themes; developing an exhaustive description, producing the fundamental structure, and seeking verification of the fundamental structure.² Ethical approval was approved by the Universitas Prima Indonesia Health Research Ethics Commission (064/KEPK/UNPRI/III/2021).Thelimitationinthisresearch isthattriangulationofsources,methodsandtheoriesisnot done.

Results

Thecharacteristicsofparticipants

Thenumber ofrespondentsin thisstudywere 6nurses.4 femalenurses,and2malenurses.Agebetween33and38 yearsold4nurses,andagebetween25and32yearsold2 nurses.

Therewere5themesemergedfromthisstudy,namely:

(1) Motivation of nurses to Provide Nursing care in theCOVID-19pandemic,(2)nurseemotional response,(3) patientemotional response,(4)Problemsfacedbynurses, (5)Theexpectationsofthenurse.

Theme1.MotivationofnursestoProvideNursingcarein theCOVID-19pandemic

Nurses explainedthat their motivation toprovide nursing careintheCOVID-19pandemicwasbecauseitwasanobliga- tionfornursestoprovidenursingcaretopatientsregardless oftheircondition.Andalsonursescangetexperiencehow tocarethepatientwithCovid-19.

‘‘yes,nursesstillhavetoprovidenursingcare,itisour dutyto providenursing care, andwe alsoknow about COVID-19,andalsowecanhaveexperiencegivingnursing caretotheCOVID-19patients’’(P2)

Theme2.NurseEmotionalResponse

Providingnursing care inthe COVID-19pandemic wasstill carriedoutbynurses.Therewasafeelingofpleasureand itbecameachallengetobeabletoprovidenursingcareto patients.However,therewerenurseswhoalsofeltafraidof beinginfected withCOVID-19andfeltuncomfortablewith thestigmafromthecommunitytowardsnurseswhoprovide servicesduringtheCOVID-19pandemic.

‘‘iamhappygivingcaretopatients,eventhoughthere isafearofcontractingthemfrompatients’’(P5)

‘‘afraidofbeinginfectedwithcovid-19frompatients, anxious and stressed also taking care of covid-19 patients’’(P4)

‘‘peopleareafraidtoseeuss,theythinkthenurseswill transmitCOVID-19toothers’’(P3)

Theme3.PatientEmotionalResponse

ThemajorityofCOVID-19patientsfeltanxiousandsadsuch asthe patient crying, beinganxious and feeling sad. But somepatients felthappy becausetheywere caredfor by thenurse,consideredbytheir familyandgot supportand motivationfromnurses.

S51

‘‘Patients sometimes cry because they feel sad about theirillness,sotheyfeelstressedwhentheyaretreated

‘‘(P4)

‘‘Therearealsothosewhorefusetobetreated,butover timetheyalsowanttobetreated’’(P5)

‘‘Someofthemfeel happybecausetheyarenot alone intheisolationroom,theytreatedusliketheirfamily’’

(P3)

‘‘We givethem attention and motivation so they feel likewearetheirfamilyandalsotheyfeelliketheyare intheirhome’’(P5)

Theme4.Problemsfacedbynurses

Therearemanyproblemsthatshouldbehandledbynurses while caring for the patient, such as personal protective equipment,difficultymeeting basicneeds andtheimpact ofwearinghazmatsuits.

‘‘whenyouwearhazmatclothes,sometimesit’shardto breathe,sweatispouringoutandyourclothesgetwet’’

(P4)

‘‘Wearinghazmatclothes,youcan’teatanddrink,some- timesyouwanttopee,youhavetoholdituntilyoufinish thetask,theclothesareonlydisposable.’’(P6)

Theme5.Theexpectationsofnurses

Nurses hope that the community does not stigmatize patients and nurses whowork in health servicesand also thecommunitymustcomply withthehealth protocolsset by the government.Hospitals and thegovernment should giverewardstonurseswhotreatCOVID-19patients.

‘‘Ihope thatsociety does not stigmatizepatients and nurseswhoworkinnursingcare’’(P2)

‘‘Itismyhopethatthepublicwillcomplywiththehealth protocolrecommendedbythegovernment,sothatthey canpreventthetransmissionofCOVID-19’’(P1)

Discussion

The study found that the obligation of nurses to provide nursingcaretopatientswasamotivationtotreatCovid-19 patients. Nurses didnotregret choosingnursing asa pro- fession.TheyhadthemotivationtotreatCOVID-19patients and were obliged tohelp people whoneed care.³ Nurses alsogainedexperienceinprovidingnursingcaretoCovid-19 patients.⁴

Negative emotions such as the feeling of fear of con- tractingCOVID-19frompatientsareexperiencedbynurses whenprovidingnursingcareduringtheCOVID-19pandemic.

Healthworkersexperiencefear,especiallyattheincreased risk of exposure,infection andthe possibilityofinfecting theirlovedonesalsobecomesaburden.⁵Manyhealthwork- ers have had to isolate themselves fromtheir family and closestpeopleeventhoughtheydon’thaveCOVID-19.The study found that nurses who worked in providing nursing care topatients duringtheCOVID-19 pandemicwerestig- matizedbysociety.Peoplewereafraidofgettinginfected fromnurseswhotreatpatientsinfectedwithCOVID-19.⁶

Thestudyfoundthatnurseswerehappytobeabletopro- videnursingcaretoCOVID-19patients.Nurseshavepositive emotionssuchashappiness,whichsimultaneouslyorgrad- uallyappearwithnegativeemotions duringan outbreak.⁷ Supportfromhospitalsandpatientsmakesnursesenthusi- asticandresponsiblefortreatingCOVID-19patients.Mutual respect,teamwork, familyandteam supportbringhappi- ness. The hospital had a reward and welfare system to support and motivate nurses. Coworkers’ encouragement alsobrings happinessto nurses and other forms of social supportareimportantfornurses’feelingsofappreciation.⁷ Thestudyfoundthatpatientswerehappywhilereceiving treatmentintheisolationroom.Nursesprovidesupportand motivationtopatientssotheyarenotstressedduringtreat- mentandtreatpatientslikefamily.Withthemotivationand supportofnurseswillhaveapositiveimpactonthepatient sothatthepatientisnotsadabouthissituation.Thefeeling ofpleasurewillcreateagoodrelationshipbetweennurses and patients, so that patients will be cooperative when receiving nursing care. Before patients go home, COVID- 19nurses alsoalwaysprovide health educationrelatedto preventingCOVID-19transmission.

Negativeresponsesarealsofeltbypatients,sometimes cryandalwayslooksadanddonotacceptthediseasethey aresuffering from.In fact, sometimes patients refuse to begivennursingcarebynurseseventhoughnursesalways providesupporttopatientssothatpatients arewillingto accepttherealityoftheirillness.

Thestressexperiencedbypatientsiscaused byvarious things,suchaspatientsthinkingthatCOVID-19isadeadly disease sothat patients always feel sad, especiallywhen patientsaretreatedinisolationroomswithoutanyaccom- panyingfamily.Theexistenceofstigmahasalsoexacerbated thestresslevelofCovid-19patientsandthisisalsoexperi- encedbypatientswhohave beentreatedintheCOVID-19 isolationroom.

Nurses who wear Personal Protective Equipment (PPE) suchaswearinghazmatsuits whenprovidingnursing care feeluncomfortable,suchasdifficultybreathing,experienc- ingexcessivesweatingandalwaysfeelingthirsty.Whenthe nurseiswearingthehazmatsuitthenursecannotopenthe PPE before completing her task. So that the basic needs ofnursessometimescannotbemetwhilewearinghazmat suits. As stated by one of the nurses who worked at the hospital,wearinghazmatsuitsfelthotandsweatyandhad difficultybreathingcausedbythelonguseofhazmat.⁸

The problem facedby nurses in providingnursing care wasthatpatients andfamilies donotcomply withhealth protocols.This findingis in line with other studies which state that the public does not comply with the govern- ment’s appeal about the dangers of COVID-19 and the publicconsidersthatCOVID-19wasjustanordinaryvirus.⁹ Lackofawarenessfromthecommunityitselfregardingthe importanceofusingpersonalprotectiveequipmentforthe prevention of COVID-19. The government’s Covid-19 task force unitis increasingly aggressive in breakingthe chain of transmissionof COVID-19, sothat peopleare awareof followinghealthprotocols.

ThestudyfoundthatbeingaCOVID-19nurse,allnurses feltlikefamily,becausewhileprovidingnursingcare,nurses had tostay in the hospital,thus making fellow COVID-19 nurses closer and feeling like they had a new family. In

EnfermeríaClínica32(2022)S50---S53 addition, nurses alsofeel veryexcited toprovide nursing

care to patients and a sense of empathy for patients is increasing.

After giving nursing care to COVID-19 patients, nurses hopethatthepublicwillcomplywiththehealthprotocols set by thegovernment sothat theincidence of COVID-19 doesnotincrease.Inaddition,thenursealsohopesthatsoci- ety willeliminate thestigmaagainst patientsand nurses, so that patients and nurses can live their lives as usual without discriminationfromthe community.Becausewith theCOVID-19pandemic,nurses’anxietyanddepressionlev- els have increased.¹⁰ The nurses hope that there will be incentivesprovidedbyhospitalsandlocalgovernmentsfor their duties to provide nursing care during the COVID-19 pandemic

The conclusions in this study provide evidence of how nursesexperiencewhileprovidingnursingcaretopatients infectedwithCOVID-19.Nursesexperiencesignificantper- sonalriskandemotionalburdenandnursespresentastrong dedication tocontinuing tocare for sick patients and do notregretworkingasnurses.However,nursesneedsupport fromvariouspartiessothat theycanhave strong motiva- tionwhileprovidingnursingcaretohelpbreakthechainof transmissionofCOVID-19.

Conflict of interest

Theauthorsdeclarenoconflictofinterest.

Acknowledgments

TheauthorswouldliketothanktheUniversityofAufaRoy- han Padangsidimpuanfor helping researchers tofund this research.

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