"Frontline Nurses Readiness": How Did Nurses
Learn About Nursing Care During the Pandemic in Indonesia?
Riski Amalia*, Nurul Hadi, Nani Safuni, Irfanita
Nurhidayah, Nurhasanah, Yuni Arnita
Faculty of Nursing, Universitas Syiah Kuala, Banda
Aceh, Indonesia
*Corresponding
author: riskiamalia@usk.ac.id
Submitted: 29.05.2024 Accepted: 08.07.2024 Published: 01.08.2024
Keywords: COVID-19, health service,
nursing care, experience, pandemic, phenomenological study
Introduction
The
COVID-19 virus has multiple forms and mutations; therefore, we must be
well-prepared to restrict its spread. Unfortunately, many individuals continue
to disregard viral alterations, which can spread illness and limit vaccination
efficacy
The COVID-19 pandemic has increased the load on global
health systems, necessitating realignment and reorganization of medical
treatment
The global impact and mutation of COVID-19 have
increased the challenges for nurses as frontline workers
Furthermore,
Previous study has focused on nurses' COVID-19
pandemic experiences. No systematic study has examined nurses' readiness to
provide optimal patient care during the pandemic and their challenges,
especially in Aceh, Indonesia. While providing nursing care to patients during
the pandemic, nurses encounter a variety of challenges. These include a
shortage of nursing staff, working under pressure, grappling with negative
self-stigma, attempting to survive in inadequate conditions due to limited
human resources, incomplete equipment, and a lack of knowledge and skills in
patient care during a pandemic. In addition, the death rate of nurses and other
health workers while caring for patients is increasing. The challenges faced by
nurses while caring for patients during the pandemic are impacting their
physical and psychological aspects. Despite the end of the COVID-19 pandemic,
nurses still seem unprepared when it comes to handling emergency conditions of
respiratory diseases. This is particularly true when it comes to providing fast
and precise treatment, fostering good team cooperation through
interprofessional collaboration, and addressing the lack of adequate facilities
and resources. The patient referral system is ineffective and unevenly
integrated, limiting its focus to just one hospital. This inexperience is a
concern for the preparedness of nurses to face pandemic conditions in the
future. Understanding these nurses' experiences can help create better pandemic
protocols. Learning from nurses' experiences regarding handling care during
previous pandemics can serve as a guideline for preparing nursing care
protocols for COVID-19 patients that are relevant and optimal in the future.
Nursing care protocols in the optimal handling of pandemic problems in the
future might lower mortality and morbidity rates, which are detrimental to all
countries facing the pandemic. This research explores the readiness of nurses
to provide nursing care during the COVID-19 pandemic in Indonesia.
Method
This
research employed a phenomenological study design, aiming to explore the
readiness of nurses to provide nursing care during the COVID-19 pandemic. The purposive sampling technique was used to
select samples from a population defined by researchers based on the problem
being examined so that it could represent previously known characteristics.
Participants in this study were hospital nurses working in Banda Aceh,
Indonesia. The key informant in this research was the head of the emergency
department, a nurse who was directly involved and interacted with the executive
nurses during the COVID-19 pandemic. The researcher created inclusion criteria
to select key informants. Based on data saturation, a purposive sampling
strategy was used to choose 13 individuals. Purposive sampling is appropriate
for use in qualitative design research or research that does not generalize
because the researcher wants to target a participant with the traits of
interest in a research study. Participants in this research had to meet the
following inclusion criteria: (1) nurses who had cared for and provided
services during the COVID-19 pandemic for at least one month, (2) education
level of at least an associate's degree in nursing, and (3) can speak
Indonesian, while the exclusion criteria for this study included nurses who
were not on leave were excluded.
In
this investigation, the researcher served as the instrument. Data were
collected in December 2022. In this study, data was acquired through in-depth
interviews with participants while adhering to normal health practices to
prevent the COVID-19 virus from getting information on nurses' experiences and
issues treating suspected COVID-19 patients. In-depth interviews were conducted
using open-ended interview guidelines.
The
results of the Content Validity Index (CVI) of three expert judgments were
0.86. Nursing experts provide expert opinions, which include those with Ph.D.
in nursing, master’s in nursing, and master’s in medical surgical nursing. The
interview guide consists of the following questions: What is your response to
the current developments in the COVID-19 case? What are your thoughts on the
current handling of COVID-19 cases? What are your strategies for maintaining
service quality during the COVID-19 pandemic? What are your preparations for
providing nursing care during the COVID-19 pandemic? What are your obstacles as
a nurse in carrying out services during the COVID-19 pandemic? What are your
expectations as a nurse providing care during the COVID-19 pandemic?
Before
starting the interview, all participants agreed and signed informed consent
provided by researchers. The following step is conducting interview. During the
interview, the researchers initiated a discourse about light pandemic-related
services to create confidence with the participants. This contributed to a more
conducive climate for communication. The researchers then conducted in-depth
interviews with the individuals using a semi-structured interview approach that
she had previously devised. When providing information during the interview
process, researchers protected the confidentiality of personal research
participants by not disclosing recorded interviews to unauthorised parties. In
addition, interviewers conducted one-on-one interviews with participants. This
technique in covering a wide variety of general to specific parts of the
participants' experiences, followed by a probing strategy to elicit additional
specific information. The probing approach delivers follow-up statements based
on the interview guide's key assertions, allowing participants to express their
opinions in greater depth.
Researchers
conducted in-depth interviews to uncover comprehensive information about
participants' activities at the hospital. The interviews were conducted in a
free-flowing manner, allowing for spontaneous inquiries and replies without the
use of pre-prepared leading questions. This approach aimed to create a more
dynamic and engaging setting. The actions were performed in a repetitive
manner. Once to prepare for the first interview, the researcher spent maximum
three days establishing a rapport with the nurse. This helped to make the
interview process smoother. On the first day, the researcher introduced himself
and talked about the phenomenon of patient care in hospitals. On the second
day, the researcher conducted a short interview regarding nurses' experiences
in providing nursing care to patients during the pandemic and post-pandemic.
Next, on the third day, researchers conducted in-depth interviews related to
research questions to develop more in-depth follow-up questions and provide
continued, prolonged engagement. The prolonged engagement was completed, the
researcher obtained verbal and written consent from the participants to record
the interview. Conduct interviews with participants directly while implementing
health protocols, such as keeping a distance, washing hands, and wearing masks.
The interview was recorded using a tape recorder and a smartphone recording.
The interview procedure took approximately 40 minutes. The interview technique
used probing while considering the participants' ethical considerations. During
the interview, the researcher quiet methods to allow participants to recall and
relive their experiences preparing to offer care during the pandemic.
The
researcher then conducted in-depth interviews with participants using
semi-structured interview techniques, that he had designed and tested for topic
validity. The researcher did not direct the participants' answers by allowing
the participants to express their experiences freely regarding the questions
asked during the interview process so that natural information was obtained
according to the participants' experiences. Before ending the interview, the
researcher terminated by re-evaluating and clarifying each meaningful
expression from the participant to avoid mistakes. The researcher also entered
a contract regarding the need for a second meeting to explain the results of
the analysis carried out by the researcher. Researchers utilized field notes to
acquire data. The interview transcript was prepared using the whole interview
tape and field notes.
Data
analysis used the Collaizzi method, which consisted of (1) reading stages and
transcripts of all participant interview descriptions, (2) extracting, (3)
describing the meaning contained in significant statements, (4) combining the
formulated meanings into a group theme, (5) developing a complete description
of the theme, (6) identifying the underlying structure of the phenomenon and
(7) returning to participants for validation. Data was analyzed
using the Non-Numerical Unstructured Data Indexing Searching and Theorizing
version 12 (NVivo-12) application.
The
data's trustworthiness was ensured to meet criteria for this phenomenological
research. Guba (1985), defines credibility, dependability, confirmability,
transferability, and authenticity. Researchers fulfil credibility by using
prolonged engagement techniques. Credibility is established through prolonged
engagement techniques, which involve holding meetings with participants in the
hospital for a week. Credibility is fulfilled by researchers using prolonged
engagement techniques. Prolonged engagement is carried out by holding meetings
with participants in the hospital for 1 week. During the one-week period, the
researcher called the participants and scheduled a meeting. The researcher
conducted an elaborate introduction procedure to better understand the
participant's personality, with the goal of developing a mutual trusting
connection.
The
confirmability test was conducted simultaneously with the dependability test;
in which the researchers validated the answers that were unclear to the
participants. Researchers achieve transferability by formatting papers as
extensive descriptions. Dependability suggests that the research findings are
reliable; that is, if the study is repeated on the same individuals using the
same context or procedure, the same results will be produced. Transferability
is achieved by researchers blinding the report as a detailed account of all
archives and materials used during the study process. The following principle
is authenticity, which refers to the presentation of nurses' experiences
expressed as the reality of nurses' lives during the COVID-19 pandemic including
emotions, language of experience, and living circumstances in interview
transcripts.
Transcripts
of participants' interview responses were translated into English, and one of
the professional translators proofread and back translated the translated
participant interview replies from Indonesian to English, as well as the
English to Indonesian translation. Authenticity in this study was carried out
by presenting experiences of how the readiness of nurses to provide nursing
services during the COVID-19 pandemic in Aceh, Indonesia, was reflected by
life's reality.
Ethical
consideration
This
study was authorized by the Institutional Review Board of the affiliated
research institute from the Faculty of Nursing, Universitas Syiah Kuala, under
the ethical number 113009040821.
Results
Socio-demographic
Analysis of respondents
Table
1 provides demographic information for 13 hospital nurses in Aceh, Indonesia,
with an average age of 28.54 years (SD=2.602). The majority
of participants were female (61.5%.). Most of the civil status were
married (76.9%). All levels of education were nurse professional education
level (100%). In general, nurses have an average work experience of one year
(46.2%). Most nursing placements were in the Emergency Room (53.8%).
Table
1. Demographic data of participants
|
Categories |
frequency |
Percentage |
|
Age (M= 28.54; SD= 2.602) |
|
|
|
Gender |
|
|
|
Male |
5 |
38.5 |
|
Female |
8 |
61.5 |
|
Marital Status |
|
|
|
Single |
3 |
23.1 |
|
Married |
10 |
76.9 |
|
Level of Education |
|
|
|
Nurse Professional |
13 |
100 |
|
Job Experience |
|
|
|
1 year |
6 |
46.2 |
|
2 years |
2 |
15.4 |
|
3 years |
4 |
30.8 |
|
5 years |
1 |
7.7 |
|
Placement of Nurses |
|
|
|
Emergency room |
7 |
53.8 |
|
Surgical inpatient room |
6 |
46.2 |
Theme 1: Modifying health services during a pandemic
The
three sub-themes of modifying health services during a pandemic are: changing
hospital services; changing education during the pandemic; and adapting nursing
care.
Changing
in hospital health services
One
of the adjustments in hospital services during the COVID-19 pandemic was to
ensure the protection of patients and healthcare personnel against direct
exposure. Despite the fact that the patients'
treatment status was unclear, the majority of
participants said that nurses followed health standards and used complete PPE.
The participant also mentioned that the screening process mechanism facilitates
the flow of services for patients who enter the hospital. Two participants
stated:
"During
this pandemic, even though all the patients came in negative, we still use
N-95, we still wear Google glasses" (P3)
"During
the COVID-19 period, the flow of service quality strategy changed; now, as soon
as a patient enters, there is a screening officer who is immediately screened,
especially the patient's body temperature, and the staff wears personal
protective equipment according to the area, then the patient enters to keep
their distance, the patient must also wear the personal equipment protection at
least a mask" (P10).
Changing
in education during the pandemic
The majority of
participants' responses were to regularly deliver effective information about
the COVID-19 pandemic to patients and their families by following health
guidelines. Education is provided to positive COVID-19 patients while
preserving health procedures and self-isolation.
"We
always provide education for patients regarding what to do during this pandemic
even though the patient is contaminated, detected as a Covid patient or not,
but we also have to educate them slowly and even some are angry, but we still
call other families we educate" (P1).
"Another
strategy, maybe we can educate the patient, even when our patient is being
examined at the hospital, the antigen swab is positive, we can educate him so
that he always takes care of and implements health protocols by self-isolating
at home or directly to the COVID hospital at the Pinere
Emergency Room to ask for the covid drugs" (P2).
Adaptation
of nursing care service during a pandemic
Most
participants reported that they were cautious of expecting COVID-19 patients
and avoided direct communication, resulting in a shorter time spent providing
nursing care.
"Preparations
in providing nursing care during a pandemic used to care more for patients, now
we have to be suspicious of patients, don't be close to them, must maintain a
distance of one meter if, for example, we serve patients. If there used to be
touch, say hi, if now we touch less, at least say hello from a far" (P6).
"When
examining patients from head-to-toe examination, for now, we may do it in
indirect communication because to avoid or the time we do to carry out an
assessment, for example, we can reduce it to ten minutes to five minutes"
(P13).
Theme
2: Coping mechanisms for nurses dealing with a pandemic
This study identified two sub-themes: protective
behaviour and the psychological impact of nurses.
Self-protective
behaviour
The
COVID-19 pandemic has increased the psychological burden on nurses while
providing nursing care, namely self-protective behaviour and the psychological
impact nurses experience. The majority of participants
stated that nurses' self-protective behaviour against the COVID-19 virus
consisted mostly of maintaining discipline when performing health standards.
"We
have considered the patients we suspect of having COVID as other patients with
other diagnoses, but how do we protect ourselves? For example, washing hands
before contact with patients and washing hands after contact and wearing masks
is mandatory" (P13).
The
psychological impact of nurses
The
COVID-19 pandemic has had psychological impact on nurses, who serve as
frontline providers of nursing care. Most nurses are worried by the severe
changes in conditions caused by the COVID-19 pandemic, namely feelings of
anxiety, fear, and anxiety.
"There
is a feeling of anxiety when I provide services to patients, especially when I
am pregnant again, isn't it? A little anxious, afraid of contracting it"
(P4)
"The
COVID pandemic has indeed caused a lot of fear or anxiety from various
parties" (P11).
"Our
psyche at the beginning of facing the pandemic was very disturbed, especially
with very little personal protective equipment, and we didn't know how the
transmission system works?" (P13).
Theme
3: Barriers to providing nursing care during a pandemic
In
this study, there were eight sub-themes, which included incomplete medical
equipment during the COVID-19 pandemic, discomfort using personal protective
equipment, disobedience to self-isolation, refusal of vaccination, refusal of
the early detection test for COVID-19, and noncompliance with the
implementation of health protocols. Nursing care documentation is incomplete,
the referral procedure is inadequate during a pandemic, and patients are
dishonest about their symptoms.
Incomplete
medical equipment during the COVID-19 pandemic
Nurses
encounter a variety of challenges while implementing health-care initiatives
and providing nursing care during a pandemic. Incomplete personal protective
equipment became an impediment in the early days of the COVID-19 pandemic as
the number of COVID-19 patients increased on a daily basis.
Most participants reported a lack of personal protective equipment; gowns and
robes were not provided, thus nurses had to purchase them themselves. Some
participants also reported that the usage of medical masks was restricted.
Participants also reported a paucity of isolation rooms at hospitals.
"In
that room, there were problems with personal protective equipment, maybe yes,
because there was not enough personal protective equipment in the room, such as
the gown or robe itself, which the hospital did not provide. So, it must be
provided personally by nurses or health workers at the hospital. Then, for
example, for masks, it is limited. It is limited; for example, one person can
only take one or two a day. Masks limited to ordinary medical masks" (P4).
"This
hospital still lacks isolation rooms, and the facilities for personal
protective equipment are still limited (P6).
Discomfort
using personal protective equipment
Nurses
must constantly use personal protective equipment to avoid transmitting the
COVID-19 virus, yet they frequently express discomfort with it. Participants
reported that wearing personal protection equipment made them feel overheated
and caused blisters on their noses.
"We
have to wear complete Personal Protective Equipment, such as gowns, facials,
like that, sometimes it does feel hot" (P1).
"KN-95 is hard if it's on the nose, so if
you use it, it's like a wound on the nose, so it's uncomfortable; that's why we
(nurses) don't use it" (P5).
"When
serving patients, but the receptionist also wears a mask all the time, it's
uncomfortable, we don't want to have Covid, we just use it when there are
patients" (P10).
Disobedience
to self-isolation
One
of the explanations for the increase in COVID-19 cases is patient noncompliance
with the self-isolation procedure. Several participants felt that persons
returning from distant areas needed to be better aware of the importance of
independent isolation, and that the care of COVID-19 cases was solely focused
on patients with severe symptoms.
"Some
people who have just returned from faraway places are not aware or don't want
to carry out independent isolation, and some even have symptoms but don't
immediately visit the COVID-19 service centre (P11).
"The
handling of serious COVID-19 cases shows symptoms with comorbidities, while
there are many out there whose status of independent isolation patients is not
handled properly where patients who are isolated are free to roam out there, in
coffee shops, gathering with family regardless that independent isolation is
should not be in contact with other people" (P12).
Refusing
the early detection test for COVID-19
Public
knowledge about vaccination is still deficient; fear, lack of information, and
other reasons strengthen the government's refusal to vaccinate.
"Even
though the government has made a vaccination program for the community and
indeed many people have done the vaccine, there are also ordinary people either
because of fear or lack of information, but they each refuse to do the vaccine for
various reasons that justify strengthening their reasons" (P11).
Despite the fact that
COVID-19 early detection tests are free, a tiny minority of patients still
decline them, preferring to go home There was one patient who insisted on being
treated but was was unwilling to undergo a rapid
test.
"Many
patients who have signs and symptoms of COVID but don't want to be swabbed, the
patients go home again" (P9).
"There
are some patients or families who insist on being treated, but they are not
willing to do the previous rapid test" (P11).
Non-compliance
with the implementation of health protocols
At
the beginning of the pandemic, most individuals followed health protocols as a
preventive measure against the spread of COVID-19. However, some people must
continue to follow health procedures. Most participants said that they did not
follow hand hygiene guidelines, kept their distance, and did not wear masks.
"Lack
of awareness from the patient himself in maintaining hand hygiene, keeping a
distance and not using a maker" (P4).
"Some
patients or their families rarely use masks when they need services at the
hospital" (P10).
Incomplete
documentation of nursing care
Several
participants said that nursing care documentation was completed rapidly due to
the significant number of patients who need immediate intervention.
Documentation of nursing care is still done manually, with handwriting on
documentation paper, which takes a long time.
"The
medical records for nursing care are still being rushed because the time is
running out; if it's, for example, one patient... two, it's safe, no one is
holding it. But if the patient arrives, five people are lucky; that's what we
(the nurses) are in a hurry for; two actions are already over, the shift is
over, and the documents are not ready; that's the rush. Until now, there is a
lot of nursing documentation that has to be written
after being given nursing service actions" (P5).
Ineffective
referral process during a pandemic
One
of the challenges faced by nurses during the COVID-19 pandemic was that
numerous COVID-19 referral hospitals refused to take patients because they were
overcrowded, forcing patients to wait.
"We
called several referral hospitals for COVID-19, they were not accepted because
they were full, so patients had to wait" (P5).
Dishonesty
of patients with their symptoms
During
the COVID-19 pandemic, nurses had a challenge: patients with COVID-19 symptoms
were dishonest. Some participants stated that patients covered up their
complaints regarding COVID-19 symptoms and responded indifferently to the
nurse's assessment. The statement of the participant is as follows:
"There
must be data that has been hidden from the patient. If we ask for complaints
over the past few days, is it coughing, sore throat, definitely not, but when
we check for positive wheezing for COVID-19, the patient is coughing"
(P1).
"The
problem is that when we ask again about the study, they are already
indifferent, so the data we get is no longer accurate" (P2).
Theme
4: Making wish come true during a pandemic
This
study has nine sub-themes, including: the pandemic is over, nursing services
are more effective, nurse preparedness during the pandemic, always complying
with health protocols, increasing the number of nurses, continuing effective
education, patient honesty in their condition, legal protection for nurses
during a pandemic, and complete vaccination in all societies.
Furthermore,
everyone, especially nurses, expects the pandemic to stop soon so that they may
resume their everyday tasks securely.
"Everyone's
expectation may not just be mine. Hopefully, this COVID will disappear from the
face of the earth, and we can do our activities as usual" (P10).
"What
is most expected as a nurse is this pandemic is over, finished, and there is no
more" (P11).
More
effective nursing services
Nursing
services are more successful during a pandemic because they provide education
and improve coordination with other health teams.
"It
is expected that nurses will be able to provide good education to their
patients, so there will be no misunderstandings or misinformation received by
patients and families provided by nurses" (P11).
"The
establishment of cooperation between one nurse and another nurse, the
establishment of cooperation between nurses and patients so that maximum
nursing services are achieved" (P12).
"I
hope the patient understands that the pandemic or COVID is still there. In that
way, every patient who enters the hospital when we explain that it is
cooperative and the service that I provide as a nurse is optimal" (P13).
Nurse
preparedness through the pandemic
Nurses,
as front-line personnel, are required to be able to prepare for rapid and
unexpected changes in dealing with a pandemic. One of the participants
mentioned that they must be prepared to give nursing services during a
pandemic.
"Hopefully,
we should be more alert to any stories; whether we like it or not, we are at
the forefront" (P1).
Always
comply with health protocols
The
nurse expects that the community and nurses will always follow health standards
and develop the habit of caring for themselves and people around them.
"The
community complies with the government's directives to maintain mutual health
protocols" (P8)
"The
hope is to increase awareness, the use of personal protective equipment, which
is very strict, meaning that it is by the proper procedures" (P9).
"It
is also hoped that in carrying out nursing services during this pandemic, we
will provide services sincerely by continuing to maintain health
promotion" (P12).
Increasing
the number of nurses
During
the COVID-19 pandemic, nurses aspire for more nurse resources to ensure that
nursing services are as effective as possible. The increase in the number of
health professionals was owing to an increase in patients during the pandemic,
which prevented a decrease in the quality of nursing care.
"The
service from the nurse's point of view can be added even more because it's a
bit lacking regarding the health workers in the room. Not according to the
number of patients. During a pandemic like this, some carried out independent
isolation in one shift. Once, there was one person who guarded the night alone
because there was a nurse who had COVID-19, so the service for caring for
patients was not optimal” (P4).
Continuous
effective education
Education
is crucial during a pandemic to reduce the pressure between nurses and patients
while providing nursing care during the COVID-19 pandemic. Most nurses in
hospitals expect nurses to be able to provide therapeutic education for
patients and their families. "It is expected that the nurse will be able
to provide good education to the patient, so there will be no misunderstanding
or misinformation received by the patient and family provided by the
nurse" (P11).
Honesty
of the patient in his condition
Patient
honesty about being exposed to COVID-19 is highly prioritised in order to avoid and minimize COVID-19 transmission.
"If
you say that the hope is to make the examination easier, is it honesty from the
patient that is the main thing, that's the most important thing" (P1).
Legal
Protection for Nurses during a Pandemic
The
expectation for nurses in hospitals during a pandemic is that they have legal
protection, such as guarantees for safety and health in hospitals when
providing health services for patients.
"My
hope is for our safety as nurses, for our safety (nurses) from the hospital, we
have to work and try our best, if something goes wrong, we (nurses) should be
protected by the hospital and the agency" (P5).
Complete
vaccination for all people
A comprehensive vaccination program can prevent and
stop the development of COVID-19; thus, health personnel and the public are
urged to actively support the immunizations mandated by the government.
"The vaccination process must be complete.
Hopefully, the pandemic will end soon, and we will return to how we used to be,
no longer needing to wear masks" (P11).
"I hope that the point is that everyone will be
vaccinated. I also hope that the government will not get bored vaccinating
people because what I feel after being vaccinated has decreased the number of
patients who have been confirmed with COVID-19" (P13).
This
study explores nurses' experiences providing health care during the COVID-19
pandemic in a hospital in Aceh, Indonesia. The fundamental subject of this
study was to adapt health-care services during a pandemic. According to
subsequent research by
In
this research, the most dominant sub-theme from theme modifying health services
during a pandemic obtained changing in hospital health service participants,
who stated that nurses comply with health protocols by always using complete
PPE even though the status of the patient seeking treatment is unknown. Changes
in the flow of services for patients who enter directly into the hospital
through the screening process mechanism. During COVID-19, a research
participant experienced a shift in health-care approaches. Patients must be
screened for body temperature by police wearing PPE, according to guidelines.
Patients must also wear masks and observe social distancing guidelines. Based
on the screening results, the patient is sent to emergency department triage,
outpatient care for COVID-19, or non-COVID-19 outpatient care. There are
restrictions on the number of visitors, including families. The importance of
nurse support and preparation in overcoming pandemic problems requires hospital
leadership with timely and transparent planning
Table
2. Theme and Sub-theme
However, during the previous COVID-19 pandemic,
practically all hospitals required timely and clear planning preparedness
guidelines. Transparent in dealing with the pandemic. This is demonstrated by
the increasing mortality and morbidity of health care workers, particularly
nurses, who treat COVID-19-positive patients. Nurses need to implement strict
hospital rules in implementing health protocols for handling the pandemic.
There is also continuous disaster training, especially care during the pandemic.
Most participants answered that nurses' self-protection behaviour from the
COVID-19 virus was mainly disciplined in implementing health protocols by
washing hands, using hand spoons, and wearing surgical masks. Nurses also
employ personal protective equipment to protect themselves and others from the
dangers of transmitting COVID-19
Furthermore, in the sub-theme changing in hospitals in
education during the pandemic, it was found that most of the answers from the
participants were to consistently provide effective education by observing
health protocols for patients and their families about how to deal with the
dangers of the COVID-19 pandemic. Most participants stated they were suspicious
of anticipating COVID-19 patients, avoiding direct communication to shorten the
time. Education is carried out for positive COVID-19 patients while maintaining
health protocols and self-isolation. The COVID-19 pandemic demands changes in
the healthcare system, including providing nursing care. The results of
Furthermore, in the sub-theme of changing in hospitals
in education during the pandemic, it was discovered that most participants'
responses were to consistently provide effective education by observing health
protocols for patients and their families about how to deal with the dangers of
the COVID-19 pandemic. Most participants expressed suspicion about expecting
COVID-19 patients and avoided direct communication to save time. Education is
provided to positive COVID-19 patients while preserving health procedures and
self-isolation. The COVID-19 pandemic requires reforms in the healthcare
system, particularly nursing care. Lord et al. (2021) found that good
communication is a critical component of emergency situations during the
COVID-19 pandemic to enhance nurses' desire to care for COVID-19.
Nurses' roles in providing education during a pandemic
were halted, disrupted, and changed to accommodate workplace environmental
conditions, new processes, and innovative programs in order
to maintain interaction and meet the needs of remote health care
The second subject of this study is coping techniques
for nurses dealing with pandemics. In this study, the most cited sub-theme was
nurses' psychological influence. The COVID-19 pandemic has also had a
psychological impact on nurses, who serve as frontline providers of nursing
care. Most nurses are worried by the severe changes in conditions caused by the
COVID-19 pandemic, namely feelings of fear, and anxious. In this study, several
individuals reported experiencing worry because of contracting the virus, a
lack of PEE, and a lack of knowledge regarding the transmission mechanism.
Nurses who provide treatment during a pandemic face significant stress
Nurses must offer nursing care despite higher
workloads while also accommodating new guidelines and ongoing changes in
infectious disease
According to the findings of following research
A positive psychological response is one of the most
components in training nurses to interact patients during the pandemic. Nurses
are required to be prepared to face dynamic changes due to the pandemic. Nurses
overcame pandemic problems due to their enthusiasm and positive interest in
facing the burden of care during a pandemic
However, the results of research from
Apart from that, nurses also use various coping
strategies in dealing with COVID-19 patients, including nursing self-strategies
(self-emotional regulation, empathy for patients, self-protection and
recreational activities, nursing strategies at the ethical level (application
of nursing knowledge, attitudes and values, following evidence-based
practice.), employer techniques (problem-focused coping, such as effective
planning and adequate instrumental support, and skill mix: a combination of
experience and new nurses), and nursing leader strategies fostering strong
teamwork among nurses
The next theme in this study is the barriers to
provide nursing care during the pandemic. The prominent sub-theme was
incomplete PPE, which became an impediment in the early days of the COVID-19
pandemic because to the growing number of COVID-19 patients each day. The majority of participants stated a shortage of PPE, the
hospital had limited masks, and gowns or robes were not provided. Hence, the
nurses had to buy them themselves. Barriers to the use of PPE, according to
research by
Nurses must constantly use PPE to avoid spreading the
COVID-19 virus, but nurses often complain that they are uncomfortable using it.
Participants stated that using personal protective equipment sometimes felt
hot, and sores appeared on the nose. According to
One of the reasons for the increase in COVID-19 cases
is patient non-compliance in adhering to the self-isolation protocol. Several
participants stated that there was a lack of awareness among people who
returned from remote areas to carry out independent isolation and that the care
of COVID-19 cases only focused on patients with severe symptoms. Community
non-compliance with self-isolation has led to the emergence of novel viral
mutations. The results of
Patient non-compliance might increase the subjective
risk assessment of contracting the virus, resulting in further increased
psychological distress, especially depression
To overcome non-compliance with prevention during the
pandemic, the government conducted several strategies i.e. enforces health
protocols, large-scale social restrictions, health services and treatment
through hospitals and other health facilities, temporary closure of public
places and public facilities, work-from-home arrangements, school-from-home
regulations, regulation worship from home, field inspections by law enforcement
officers, and the application of criminal sanctions against violators of policy
regulations
Furthermore, the ultimate subject of this study is
weaving optimism amid a pandemic. Most participants in this theme were hoping
the pandemic will end soon so they can safely carry out their daily activities.
Most participants in this theme were expected the pandemic will end soon so
they can safely carry out their daily activities. In addition, nurses expect to
provide therapeutic education to reduce the tension between nurses and patients
while providing nursing care during the COVID-19 pandemic, to increase
collaboration with other health teams, and to prepare for fast and sudden
changes in dealing with a pandemic.
One of the participants mentioned that they must be
prepared to provide nursing services during a pandemic. Expectation during a
pandemic, according to
The minority of participants demand legal protection,
namely a guarantee of safety and health in the hospital when providing health
services to patients. The ethical challenges of nurses while providing nursing
services include the safety of nurses, co-workers, and families, shortage of
nurses, lack of concentration due to mental fatigue, life-threatening
illnesses, many patients, performing nursing actions in dangerous conditions,
giving importance to nurses
Conclusions
This study examined nurses' COVID-19 pandemic
experience in Aceh, Indonesia, through four themes and 22 sub-themes. During a
pandemic, most nurses agreed that hospital services must follow tight health
regulations, adjust education, and modify nursing care. Pandemic health
services altered coping strategies, including strict virus prevention and
psychological problems. During a pandemic, nurses face many challenges,
including incomplete PPE, inconvenience in using it, patient and family
non-compliance with self-isolation measures, refusal to take early detection
tests for COVID-19, non-adherence to health protocols, incomplete nursing care
documentation, and ineffective referrals. The recommended investigations should
include nurse safety and security, government pandemic control measures, and
care optimization. The research recommended that optimizing services
during the pandemic is crucial, with an emphasis on providing comprehensive PPE
to protect the safety and security of nurses. However, further research is
needed on the precise government initiatives used to restrict the development
of COVID-19 in nursing facilities. Examining the effective tactics that nurses
used in Aceh, Indonesia, is critical to delivering nursing care throughout the
pandemic.
Acknowledgement
Acknowledge the hospital nurses who participated in
this study and offered their experiences during the COVID-19 pandemic. Special
appreciation is also extended to the Director of the Aceh Hospital for allowing
this study to be conducted there.
Funding Source
This research did not receive any specific grant from
funding agencies.
Conflict of Interest
The authors declare no potential conflict of interest
concerning this article's research, authorship, and publication.
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