Table 2 Data extraction
Author/ year/ aim | Design/ methodology | Key findings | Sample quotes | Codes | Key/ overarching concepts/ metaphors |
|---|---|---|---|---|---|
Sun et al., (2020) [32] To explore the psychological experiences of nurses caring for COVID-19 patients. | Descriptive phenomenology Purposeful sampling approach to recruit 20 nurses caring for patients with COVID-19 in Henan, China Face to face and telephone interviews conducted Data analysis by Colaizzi’s 7-step method Critical appraisal: Include | Four themes emerged: • Significant number of negative emotions in the early stage: this theme describes participants’ experiences with fatigue, discomfort and helplessness caused by the nature of caring for the patients and wearing the protective clothing. Also, there was fear of contracting the virus, anxiety caused by limited understanding of managing the infection/ presence of strangers as well as concerns about their family members | “After putting on protective clothing, nursing duties are awkward to carry out. Protective clothing needs to be worn for 8 h or more without drinking water and eating food and urinating was done with adult diapers.” “...The moment I walked through the door of the Department of Infectious Diseases, I felt very scared. I felt much better after I got used to it. And I felt scared when I pushed the door of the negative pressure room for the first time, but I was fine the second time.” | Initial psychological chaos; coping and thriving; support Sense of responsibility to care; psychological chaos; support1.1.1.1. | 1. Surviving to thriving in an evolving space 2. Support amid the new normal1.1.1.1. |
• Coping and self-care styles: this theme describes the psychological/ life adjustment processes to face the situation and seeking support from one’s professional group. | “My method is not to think about stress, I shield it out of my life.” “...I forget everything when I am busy...” “We encourage each other. It does not feel like I’m fighting alone, I’m not afraid.” | ||||
• Growth under pressure: this theme describes the personal growth experienced by participants which include the opportunity for self-reflection, gaining a deeper sense of professional identity and increased affection and feelings of gratefulness. | “I used to work to earn a salary, but now it feels like a responsibility.” “Maybe there was a discrimination against nurses in the society but now I am proud of my choice.” “After work I find the sky is blue and everything is beautiful.” “I never thought I could be so strong.” | ||||
• Positive emotions occurring simultaneously or progressively with negative emotions: the theme describes the positive emotions that emerged in the process. These included feelings of confidence in the hospital environment, happiness from multiple sources of support and calmness during the care delivery process. | “I feel that the government has strong prevention and control measures, and the epidemic will be controlled very soon. But after all, we have a large population, and it is a process.” “Patients are very cooperative with our work. Although some patients have emotions due to illness, they show great respect to us.” “My mood is much better after starting pre-job training.” “Many colleagues called me to encourage me and I felt that there were many people who cared about me.” | ||||
Liu et al., (2020) [33] To describe the experiences of nurses and doctors in the early stages of the COVID-19 outbreak | Descriptive phenomenology Purposive and snowball sampling was employed to recruit 9 nurses and 4 physicians in Hubei Province, China Data collection by in-depth telephone interviews Haase’s adaptation of Colaizzi’s method was used to analyse transcripts Critical appraisal: Include | Three themes with 10 subthemes emerged: • Being fully responsible for patients’ wellbeing— “this is my duty”: this theme describes a sense of duty expressed by participants. This included a feeling of being called to duty, caring for the affected persons, and emotionally supporting the patients. | “We must try our best to win this battle. As health-care providers, we are at the forefront. I fight for my family, and I fight more for this society.” “This is my duty because I am a medical worker. No matter what will happen” “Patients are struggling to breathe, and some can only lie in bed. They are very helpless and want care from their families.” | ||
• Challenges associated with working on the COVID-19 wards: working in these wards was a completely new contexts with participants experiencing exhaustion and being overwhelmed with the workload, dealing with uncertainty and fear of contracting the virus/ infecting others, being witnesses of the patients’ experiences, and dealing with the healthcare provider-patient relationship amid the chaos. | “I was very tired. I had to lie in bed for a whole day to recover from the fatigue after work.” “I felt very depressed on the first day in the infectious disease hospital because there was only one entrance and passage for medical staff, and it is a real isolation unit with negative pressure. I felt it was difficult to breathe … This new environment brought a sense of oppression.” “I have to treat many patients who are not in my specialty. Although the country has released six editions of diagnosis and treatment guidelines [for COVID-19], there is still no effective antiviral medicine. It is an unknown disease, and everyone feels powerless.” “I recently contacted a colleague without any protection, who was later diagnosed with COVID-19. Although my CT results did not show any abnormality, I am anxious and waiting to do the throat swab.” | ||||
• Many sources of social support to cope with the situation and transcendence: This theme reflects participants’ sources of support including family, friends, colleagues, and the society. | “I am not overstrained because I trust our hospital. Our hospital gives us strong logistical support, including providing medical protective supplies, accommodations, transportation, food, medicines, and subsidies.” “The head nurse knows we come from different departments and infectious disease is not our specialty, so she sent us some educational videos and materials, and we can learn after work.” “When I feel stressful, I complain to my boyfriend. He is also a nurse, and we are in the same department. We communicate with and understand each other.” | ||||
Kackin et al., (2020) [34] To determine the experiences and psychosocial problems of nurses caring for patients diagnosed with COVID-19 in Turkey. | Descriptive phenomenology Purposive sampling was employed to recruit 10 nurses caring for patients diagnosed with COVID-19 in Istanbul, Turkey Data collection was conducted via questionnaires and semi-structured interviews Colaizzi’s method was used to analyse transcripts Critical appraisal: Include | Three themes and ten subthemes emerged: • Effects of the outbreak: this theme highlights the working conditions, psychological and social effects of the outbreak. The nurses were faced with lack of equipment/ worsening work conditions, stress, feeling threatened, uncertain, depression, fear, aggression, social isolation (spending more time in the hospital) and stigma. • Short-term coping strategies: Participants emotions normalized (accepting the situation and thinking it is a temporal issue), refusal to dwell on the experiences, avoidance (avoiding the media/ comments about the disease), openly expressing their feelings (crying etc) and distraction (being thankful, listening to music, sports etc.) • Needs: nurses required ongoing psychological support and increasing resource availability at the setting. | “Nurses I have never known or seen. They were assigned to our service unit from another one. I don’t know their reactions. .. we had a dispute the other day with another Nurse. .. It feels as if working in another hospital. Different patients, a different order” “‘There is a patient lying there, you know that the patient needs you, but wearing that protective equipment, feeling his/her physical pain in your own body, you may have to work for an hour at most once you wear the helmet. It gives you a headache. You cannot enter the isolation rooms without those garments, and those garments are extremely smothering you. Sometimes, leaving the room when we admit new patients can take 2.5–3 h without exaggeration. When we leave, you find yourself in full of sweat “ “‘I left my family alone. .. My mother suffers from high blood pressure, what happens if she becomes infected. .. there is the fear of losing her.. ..” | Initial sense of psychological chaos; needing ongoing psychological support; coping | |
Karimi et al., 2020 [35] To explore the lived experiences of nurses caring for patients with COVID-19 in Iran. | Descriptive phenomenology Purposive sampling was employed to recruit 12 nurses caring for patients diagnosed with COVID-19 in Iran Data collection was conducted via semi-structured interviews Colaizzi’s method was used to analyse transcripts Critical appraisal: Include | Three themes and six subthemes emerged: • Mental condition: The theme describes the psychological responses of healthcare providers which include stress, anxiety, and fear. These were related to fear of the disease, being worried about their families. • Emotional condition: the theme highlights feelings of suffering and affliction such as uncertainty about the disease process, witnessing death/ dying and separation from their own family • Care context: the theme highlights the turmoil and limited availability of support and equipment. Increasing work pressure, staff shortage, chaos and inexperience in handling the chaos | “Maybe I die, but I still have lots of dreams.” “I’m scared for my family and also for myself.” “How horrible these days are, we’re all dying.” | Initial psychological stress; navigating an unknown disease; dealing with resource limitations | |
Galehdar et al., 2020 [36] To explore nurses’ experiences of psychological distress during care of patients with COVID-19. | Qualitative design Purposive sampling was employed to recruit 20 nurses caring for patients diagnosed with COVID-19 in Iran Data collection was conducted via semi-structured telephone interviews Conventional content analysis was used to analyse transcripts Critical appraisal: Include | Eleven categories and 5 subcategories emerged: • Death anxiety: the nurses experienced psychological distress witnessing the deaths of patients with feelings of helplessness when they could not do anything to alleviate the patient’s symptoms; concerns regarding the high mortality rates • Anxiety due to the nature/ severity of the illness, rate of spread and unknown dimensions of the disease | “It is agonizing to see a person deprived of breath, his heart failing, and you can’t do anything about his suffering .... it sometimes causes me to feel agitated and distressed and becoming really sad and confused about what I’m going to do?” “I myself was caring for a patient with COVID-19, it was really painful to see a person striving to breathe to save himself “ “In my opinion, the nature of the disease is beyond what we are teaching and learning now” | Psychological issues and navigating the death of patients | |
Ardebili et al., 2020 [37] To undertake an in-depth exploration of the experiences of health-care staff working during the COVID-19 crisis. | Qualitative design Purposive sampling was employed to recruit 97 healthcare professionals (pre-hospital emergency services (EMS), physicians, nurses, pharmacists, laboratory personnel, radiology technicians, hospital managers and managers in the ministry of health who work directly or indirectly with COVID-19 cases) caring for patients diagnosed with COVID-19 in Iran Data collection was conducted via semi-structured interviews Thematic analysis was used to analyse transcripts Critical appraisal: Include | Three themes and eleven subthemes emerged: • Working in the pandemic era: This was experienced as high workload and feelings of losing control over the situation, fear, anxiety, and being overwhelmed (Providing futile care) • Changes in personal life and enhanced negative effects • Gaining experience, normalization and adapting to the pandemic (overcoming the initial crisis, gaining experience regarding patient management, reducing referrals and increasing recoveries). • Mental health issues: Experiences of loss of control, heavy workload, severe stress, the experience of a sense of futile care, fear of infection and transmission, self-isolation, and quarantine, decreased emotional relationships, fundamental changes in lifestyle, worrying about the future and the economic situation, all appeared to contribute towards the manifestation of mental health issues). | “In the early days, our workload was very high, we had to move the wards and hospitalized corona patients in the non-infectious wards” “Every day a new drug is introduced, every day a new route of transmission is introduced” “This disease does not have a specific drug, nor can you predict with confidence who will survive and who will die. This made me feel (completely ineffectual and I felt) like I was losing control” “It’s very difficult to wear N95 masks for 12 h, I feel short of breath and I will definitely have problems later (Nurse) They give (you) a body suit in each shift. When we wear these clothes, sweat flows from all over our bodies, we can’t eat anything with these clothes, we can’t drink anything too, we have to wear them for 12 h” “When I was hospitalized in the ICU, I had very severe shortness of breath. When the shortness of breath was present, I thought I was dying (Nurse) I was thinking, I will die alone, without seeing my family, they will not see my body. I will not have a proper funeral” | Initial psychological distress; facing personal changes; adjusting to the situation | |
Al Ghafri et al., 2020 [38] To explore the experiences and perceptions of health care workers (HCWs) in primary health care in the management of COVID-19 with respect to medical response experiences, socio-cultural and religious reforms, psychological impressions, and lessons learned. | Phenomenology Purposive and snowball sampling was employed to recruit 40 healthcare professionals/ stakeholders involved in managing patients diagnosed with COVID-19 in Oman Data collection was conducted via focus group discussions (6 focus group discussions conducted) Thematic analysis Critical appraisal: Include | Three themes emerged: • Medical response experiences: rapid restructuring of public health services, enforcing technology use and increasing burden on limited human resource available. • Socio-cultural and religious reforms: having to stay away from parents and families (inability to participate in social/ religious practices); empathy towards the vulnerable in the society • Psychological issues: being at home was described as depressing, and inability to travel around were distressing; exhaustion among healthcare professionals and fear of transmitting the virus to families/ loved ones. | “we had to work for more than 12 h continuously due to shortages of staff. This was an overburden to us” ““when our colleagues got infected, we all suffered physically and emotionally” | Psychological concerns; adjusting the healthcare system | |
Nyashanu et al., 2020 [39] To explore the triggers of mental health problems among frontline healthcare workers during the COVID-19 pandemic. | Exploratory qualitative study Purposive sampling was employed to recruit 40 frontline staff involved in in private care homes and domiciliary care agencies in the Midlands, UK Data collection was conducted via semi-structured interviews Interpretive phenomenological analysis Critical appraisal: Include | Seven themes noted in the study: • Fear of infection and infecting others • Lack of recognition • Lack of guidance/ frequently changing guidelines creating doubts about operational procedures and triggering anxiety • Unsafe hospital discharge • Loss of professionals/ residents through death • Unreliable testing and delayed results • Staff shortage causing anxiety and worry | “Unfortunately, there have been so many changes on the guidance to COVID-19. Being diabetic the government has placed responsibility on my employer to make suitable safe working arrangements which is difficult. A female learning disability nurse I am really worried with ever changing information from government on how to act during this pandemic …. Honestly, it really makes me anxious” “We have been using agency staff to maintain staff numbers, but we don’t know where else they have been working and this brings so much anxiety.” | Fear, anxiety, worry; lack of guidelines; limited human resources |