Highlights
- •Studies on the psychological experience of nurses combating COVID-19 are lacking.
- •We investigated the psychological experience of caregivers of COVID-19 patients.
- •Nurses showed interweaving positive/negative emotions during outbreak of COVID-19.
- •Negative emotions are dominant in the early stages of the COVID-19 outbreak.
- •Coping styles and psychological growth are important for maintaining mental health.
Background
Objective
Methods
Results
Conclusions
Key Words
Introduction
Interpretation of pneumonia diagnosis and treatment scheme for novel coronavirus infection (trial version 6) [EB/OL].(2020). Available at:http://www.nhc.gov.cn/xcs/zhengcwj/202002/8334a8326dd94d329df351d7da8aefc2.shtml. Accessed February 2, 2020
Interpretation of pneumonia diagnosis and treatment scheme for novel coronavirus infection (trial version 6) [EB/OL].(2020). Available at:http://www.nhc.gov.cn/xcs/zhengcwj/202002/8334a8326dd94d329df351d7da8aefc2.shtml. Accessed February 2, 2020
WHO Novel Coronavirus(2019-nCoV) Situation Report –39[EB/OL]. (2020). Available at:https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200228-sitrep-39-covid-19.pdf?sfvrsn=aa1b80a7_2. Accessed February 29, 2020
Office of Health Emergency, National Health Commission. Update on pneumonia of new coronavirus infection as of 24:00 on February 28[EB/OL]. (2020). Available at:http://www.nhc.gov.cn/xcs/yqfkdt/202002/4ef8b5221b4d4740bda3145ac37e68ed.shtml. Accessed February 29, 2020
China Disease Control Report: more than 3,000 medical staff infected with new crown virus [EB / OL]. (2020). Available at: Http://hb.sina.com.cn/news/n/2020-02-18/detail-iimxyqvz3722095.shtml. Accessed February 18, 2020
Methods
Research design
Study subjects
Interview outline
Data collection
Data analysis
Ethical review
Results
Characteristics | N (%) or mean ± SD | Median (range) | |
---|---|---|---|
Gender | Male | 3 (15%) | |
Female | 17 (75%) | ||
Age | 30.60 ± 6.12 | 29 (25-49) | |
Nationality | Han Chinese | 20 (100%) | |
Working Experience | 5.85 ± 6.43 | 3.5 (1-28) | |
Education | Undergraduate | 20 (100%) | |
Duty | Head nurse | 3 (15%) | |
General nurse | 17 (75%) | ||
Marriage and offspring | Married with children | 7 (35%) | |
Married without children | 5 (25%) | ||
Unmarried without children | 8 (40%) | ||
Number of interviews | 3.05 ± 0.89 | 3 (2-5) |
Theme | Subtheme | Quotations |
---|---|---|
I. Significant amount of negative emotions in the early stage | i. Fatigue, discomfort, and helplessness caused by high-intensity work and self-protection | "After working 12-16 hours every day, I feel very tired and can even sleep when standing with pain all over my body." "After putting on protective clothing, nursing duties are awkward to carry out. Protective clothing needs to be worn for 8 hours or more without drinking water and eating food and urinating was done with adult diapers." “When wearing protective clothing for a long time, I have headaches, chest tightness, and palpitations. The surgical mask strap pinches my ears. When I take off my protective clothing, my whole body is sweaty and I feel like I'm going to collapse.” “...There are a lot of patients. Our job is not only to care for them, but also to participate in training, information reporting, disinfection, and isolation. I feel I don't know where to start and I'm under a lot of pressure. But I don't have time to go to psychological counselling, I even don't have time to sleep...” |
ii. Fear of viral infections and concern for patients | “Although I volunteered to work in the Department of Infectious Diseases, I still feel very scared. After all, it is a new infectious disease and there are no specific drugs at present. I was scared to see reports of the sacrifice of medical staff in other cities.” “...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.” “After all, it is a new disease and the patient's condition is unpredictable. I am always worried about what to do if the patient's condition deteriorates in the next second.” “Although the technology and equipment are very good, I am still very worried. If the patient's condition changes and rescue is needed, or the coordination is lacking in various aspects, or there is insufficient manpower, what should we do?” “The patient is suffering after being infected and isolated in a single room. Their psychological condition is very worrying.” | |
iii. Anxiety caused by lack of knowledge, environmental changes, and presence of strangers | “Although I have worked in the Department of Infectious Diseases, a lot of knowledge still needs to be learned because this is a new infectious disease. We also need to train new colleagues. I feel anxious.” "When I first came here, I felt that there were a lot of hallways in the Department of Infectious Diseases. The environment was unfamiliar and my colleagues were also unfamiliar. The operating procedures and disease care routines were different from previous work. I felt very anxious." | |
iv. Bidirectional concerns with their own family members | "I am worried that I will infect my children" "My partner is very worried that I will be infected." "I am the only child and my mother cries every day and fears that I will be infected, and I worry more about them..." "I can't tell my parents about my work, lest they worry about me." "I agreed with my child to talk on the phone twice a day, but every time I get off work, it's already midnight." "I have set aside life and death, but I am worried about the children and the elderly in the family... (crying)" | |
II. Coping and self-care styles | i. Active or passive psychological adjustment | "I've often thought how much better it would be if the epidemic disappeared when I wake up..." "My method is not to think about stress, I shield it out of my life." "...I forget everything when I am busy..." "It makes me feel good to think that I'm treating people every day." "When using diapers, I tell myself you're young enough to become a baby (laughs).” "I write a diary and sometimes write letters." "The progressive breathing relaxation method recommended by my colleague is good, I often use it." "When I rest, I watch comedy, listen to meditation music, or practice yoga." "I can't help crying when I'm under too much pressure and I feel relaxed after crying." "I feel good using mindfulness-based stress reduction." |
ii. Life adjustment | "I feel sleep is the best stress relief, I just want to sleep." "I think eating and drinking will increase my resistance. I don't lose weight now; I eat a lot." "I am exercising less than before because the heavy workload is also exercise and the right amount is the best." | |
iii. Taking the initiative to be altruistic and seeking team support by "huddling together for warmth" | "Everyone is very welcoming and friendly. Experienced colleagues will take the initiative to teach me. I also take the initiative to teach new colleagues." "Everyone is willing to do more work so colleagues can rest more. Colleagues are particularly united." "If someone is uncomfortable, everyone will take care of him and work for him." "We encourage each other. It doesn't feel like I'm fighting alone, I'm not afraid." | |
iv. Adjusting cognition to face the situation rationally | "Through data analysis, compared with the SARS epidemic, this epidemic spread quickly. But the virus is weak, the mortality rate is low, and young people without underlying diseases do not have to worry too much even if they are infected." "In fact, the chance of medical staff infection is very low and the protection of negative pressure wards is better than other departments." "My attitude towards the epidemic is to neither loosen prevention and control nor be overly nervous." "The medical staff in Wuhan is really tough and some have sacrificed their own life. Compared with them, we feel that we are lucky so my mental state has improved." | |
III. Growth under pressure | i. Increased affection and grateful sentiments | "I really appreciate the people who care for and support me and I cherish this emotion." "This experience made me feel that life is precious and family is important..." "To live well every day is to love my family" "After work I find the sky is blue and everything is beautiful." "...I feel this is a special work experience. It is a gift. I cherish it." |
ii. Professional responsibility and identity | "Although I was scared in the face of the epidemic, I haven't flinched. I don't have grand ideas. I think this is responsibility." "I used to work to earn a salary, but now it feels like a responsibility." "Saving lives is the responsibility of nurses and I like this profession more." "Maybe there was a discrimination against nurses in the society but now I am proud of my choice." | |
iii. Self-reflection | "Although I am very tired, I find that I have survived and I have done a good job. I can't believe it." "I never thought I could be so strong." "...I'm not even afraid of death, what else could I be afraid of?" "It feels like there's nothing I can't overcome (laughs)." | |
Ⅳ. Positive emotions occurred simultaneously or progressively with negative emotions | i. Confidence in the government, the medical environment and self-prevention ability ii. Calmness and relaxation at work and with patients iii. Happiness from multiple social support sources | "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." "Equipment in the Department of Infectious Diseases is relatively advanced. We also use robotic aids and the patient's health is guaranteed." "As long as we have 2-way protection and disinfection and isolation steps as required, there is no problem." "I volunteered to sign up and I have no psychological burden when signing up." "I felt quite calm when notified to take part in the fight against the epidemic and did not resist or want to resign." "My mood is much better after starting pre-job training." "After entering the negative pressure ward, I saw that both the patient and the doctor were protected. So, I felt safe and relieved." "Every time I take care of the patients, they will take the initiative to put on a mask. I feel particularly safe in my heart. After treatment, they will keep saying 'thank you' and it feels good." "Patients are very cooperative with our work. Although some patients have emotions due to illness, they show great respect to us." "My family calls or sends WeChat greetings every day, and I feel very happy." "The hospital has an extra bonus for us and we have priority in promotion. The union also gave us gifts and expresses sympathy to us." "Many colleagues called me to encourage me and I felt that there were many people who cared about me." "Online reviews say we are heroes..." "A lot of companies donated money and supplies to support our fight against the epidemic and I was very moved!" r"[institution] also actively paid for our antiepidemic health insurance; it feels like everyone is supporting us." |
Theme 1: Significant amount of negative emotions in the early stage
Theme 2: Coping and self-care styles
Theme 3: Growth under pressure
Theme 4: Positive emotions occurred simultaneously or progressively with negative emotions
Discussion
National Health Commission of the People's Republic of China. The guideline of psychological crisis intervention for 2019-nCoV pneumonia. Available at: http://www.nhc.gov.cn/jkj/s3577/202001/6adc08b966594253b2b791be5c3b9467.shtml. Accessed January 27, 2020.
National Health Commission of the People's Republic of China. The guideline of psychological crisis intervention for 2019-nCoV pneumonia. Available at: http://www.nhc.gov.cn/jkj/s3577/202001/6adc08b966594253b2b791be5c3b9467.shtml. Accessed January 27, 2020.
Strengths
Limitation
Conclusions
References
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WHO Novel Coronavirus(2019-nCoV) Situation Report –39[EB/OL]. (2020). Available at:https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200228-sitrep-39-covid-19.pdf?sfvrsn=aa1b80a7_2. Accessed February 29, 2020
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China Disease Control Report: more than 3,000 medical staff infected with new crown virus [EB / OL]. (2020). Available at: Http://hb.sina.com.cn/news/n/2020-02-18/detail-iimxyqvz3722095.shtml. Accessed February 18, 2020
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Conflicts of interest: None to report.
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