IJCRR - 14(14), July, 2022
Date of Publication: 20-Jul-2022
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Challenges Experienced by ICU Nurses during COVID-19 Pandemic-A Survey from Delhi-National Capital Region (NCR), India
Author: Amit Goel, Deven Juneja, Shikha Jain, Sahil Kataria, Omender Singh
Abstract:Introduction: Corona Virus Disease-19 (COVID-19) has impacted nursing field profoundly in terms of direct care capabilities, practice issues, emotional and financial challenges. Aims & Objectives: We conducted this survey to understand challenges faced by nurses while working in COVID-ICU during COVID-19 pandemic. Method: This was a survey about the challenges faced by the nurses while working in COVID-ICU consequent to the second wave of COVID-19 in Delhi-national capital region (NCR), India. A Google forms-based questionnaire was prepared on the pertinent issues, having 3 demographic and 25 core survey questions. Results: 168 responses were gathered. Most of our participants (63.7%) were from private hospital, and 56% had worked in ICU previously. 88.1% of all the respondents had received brief orientation about the anticipated challenges in COVID-19-ICU. Personal protective equipment (PPEs) was easily available to the majority (88.7%), but only 45.8%, reported it to be good quality. 85.7% of the respondents regularly interacted with the patients admitted to COVID-19-ICU. Carrying infection home (45.2%) was reported to be the greatest fear while working at such areas. Stress & anxiety are the major behaviour change noted. 97.6% have reported having received vaccine against COVID-19. Conclusion: Poor quality of PPEs, lack of workplace, emotional and financial security continues to be the major challenges faced even after 2years & 2 waves of this pandemic. However, despite all the challenges faced, the zeal to work and fight with this dreaded infection was strong amongst all the participants. Most of them have expressed their readiness to work again in COVID-19 ICUs, if required.Nursing education, constructing, and implementing robust care policies, is need of the hour.
Keywords: Nursing Challenges, COVID-19 Pandemic, PPE, Exhaustion, SARSCoV-2, ICU
Globally, the coronavirus disease-19 (COVID-19) pandemic has resulted in an unprecedented number of patients requiring hospitalization. As the COVID-19 pandemic accelerated worldwide, the healthcare system is impacted the most and has been facing tremendous pressure. Nurses constitute the largest workforce in the healthcare sector and their safety, both physical and psychological, needs to be prioritized.1 Exploring the issues faced by the nursing staff during these testing times will help support and strengthen the protocols and improve their preparedness better.2 The critical shortage of nurses, beds, and medical supplies including personal protective equipment (PPEs) are the major issues that the nurses have faced during this pandemic.3,4 These challenges cause nurses to face physical and mental strains and complex ethical issues.5 We planned this study to understand the challenges faced based on the nurses’ lived experiences while working in COVID-19-ICU.
MATERIAL AND METHOD
We conducted a survey about the challenges faced by the nurses while working in COVID-Intensive Care Units (ICU), consequent to the second wave of COVID-19 in Delhi-national capital region (NCR) India, in October 2021. A questionnaire was prepared on the pertinent concerns for the same and based on the previous national & international surveys. We prepared a Google Form-based survey with 3 demographic and 25 core survey questions. Our survey had 27 single option selection types and 1 multiple option selection type simple questions. The absolute inclusion criteria were nurses who had worked in COVID-19 ICU. The survey was designed to auto-exclude core responses from nurses who were not involved in managing COVID-19 patients in ICU. After preparing, we distributed this survey to the nurses in Delhi-NCR via social media platform in around 30 centres.
Institutional ethics committee clearance from our institution could not be obtained as the survey involved individual proprietary data of participants and researchers of several centres. We incorporated consent in this survey for participation and use of this data in the publication process.
We captured response identities so that duplication of responses was avoided. Only nurses who worked in COVID-19 ICU could respond to our core questionnaire. We are presenting the results of this descriptive cross-sectional survey in actual number and percentage form which were calculated using Google spreadsheets. We report the majority when the response rate reaches >50% in any one observation option.
We gathered 168 responses from the nursing staff from Delhi-NCR, who worked in COVID-19 ICUs during COVID-19 pandemic. Table-1&2 shows the detailed demographic characteristics and core questions of survey participants respectively.
Most of the respondents (n=90, 53.6%) in our study were young (20-30 years), enthusiastic females (n=134, 79.8%) from private hospitals (n=107, 63.7%).
56% (n=94)of them had worked in ICU environment before they were deployed for care of COVID-19 patients admitted in ICU.88.1%(n=148)of all the respondents had received brief orientation about the challenges likely to come across while working in COVID-19 ICU. Most of the participants (n=89, 53%) worked for 4-8 hours shift and only8.3% (n=14) reported to have shift duties for more than 12 hours.
PPE was reported to be easily available to the majority (n=149,88.7%) of the participants. But PPE quality was reported to be good quality by only 45.8%(n=77).Most of the participants from private hospital has reported to have received good quality PPE as compared to that of government hospital (58.4%,n=59 vs 26.5 %, n=18).
Proper donning and doffing of the PPE were taught to most (n=149,88.7%) of the participants and57.1%(n=96) had someone to assist them while donning and doffing procedure. Majority(n=159,94.6%) of the participants had designated PPE donning and doffing area and location for the same was near the ICU with most (n=123,73.2%) of them.
Lot of participants (n=144, 85.7%) regularly interacted with the patients admitted to COVID-19 ICU. Due to very high risk of transmission of covid virus, family were not allowed to meet the patients physically as reported by 44.6%(n=75) of the participant, but a regular health update was being given to the family by majority of them (n=112,66.7%). Most of the participants (n=118,70.2%) reported adequate medicine supply for COVID-19 infection treatment.
While reporting safety against COVID-19 infection at the workplace, most of the participants (n=95, 56.5%) felt safe. The greatest fear while working in COVID-19 ICU was reported to be carrying infection with them to their loved ones at home, which was reported by 45.2%(n=76) of respondents. Most (n=130,77.4%) participants were provided post-duty quarantine period, and many (n=118,70.2%)got COVID test done post-completion of their ICU duties. There is always huge risk associated for contracting disease while caring for patients with COVID-19, however many (n=109, 64.8%) of them reported themselves to be free of COVID-19 while performing COVID duties. No extra incentives were provided for COVID duties to most (n=90,53.6%) of the participants.83.9%(n=141) of the participants have their family safe and did not report any mortality. COVID has affected behaviour of most (n=101, 60.1%) of the participants and the major lifestyle affect reported was, stress & anxiety (n=94,56.3%) and health consciousness (n=73,43.7%). The majority (n=164,97.6%) of the participants have reported to have received vaccine against COVID-19. The zeal to work and fight with this dreaded infection is strong amongst all the participant, and most (n=154,91.7 %) of them have expressed their readiness to work again in COVID-19 ICUs if need arises.
This study has examined the challenges experienced by ICU nurses working in a COVID-19 ICU during this pandemic using a qualitative descriptive approach. The survey was done consequent to the second wave of COVID-19 in INDIA.
Private hospitals played measure role while giving care to covid-19 patients. Young females represent the measure percentage of the nursing caregivers in most of countries including India.6 These findings were also noted in our study.
The preparedness of any hospital and nurses plays crucial role in healthcare management in pandemics such as COVID-19. And in our study, most of the nurses were familiarised with the challenges likely to be experienced before going into COVID ICU. The responsiveness of the nurses who work in the ICU setup is finer, as they understand the ICU challenges and it’s working better. Spread of infectious covid virus from patient’s airway to healthcare workers and other patients is always a major concern. All the necessary measures must be established to safeguard oneself and other patients. PPE is an essential tool to protect oneself from contracting this virus while taking care of these patients in ICU. Provision of poor-quality PPEs and lack of PPEs have been reported in most of the studies worldwide.7But in our study, PPE was made available to about 90% of the respondents, but it was of average quality in most (50%) of the cases. Handling of PPEs (donning and doffing areas, buddies, and practice) was reported to be good by most (80%) of our participants.
Nurses play a vital role for the communication and psychological counseling of both relatives and patient who is away from their family and see everyone in PPE attire. This was done in most of the cases (>90%) in our study. But as the risk of contracting virus and getting affected was high, very small number of respondents (11%) reported that the attendants were allowed to meet the patient in person in ICU.
Most of the respondents claimed working in COVID-19 ICU with proper attire made them feel safe against contracting infection. Post duties most of the respondent were provided quarantine. Two third of the participants got a COVID-RTPCR test was done at the end of the quarantine period before they met their family members as most common apprehension among nurses was taking infection home with them post duties.
Unfortunately, one-third of respondents in our study suffered from COVID-19 disease while they were on duties and almost 16% reported deaths in their families due to COVID-19.
COVID pandemic has influenced the lifestyle of every individual in the world and most importantly healthcare workers.8 Nurses have suffered with lack of sleep, developed anxiety and stress, with altered food habits. The positive lifestyle impact had been regular exercises, Yoga and more careful approach to individual health. Nevertheless, all the nurses are ready to offer their services again with great enthusiasm if required.
Strength and Limitation-We have captured the responses of nursing challenges in COVID-ICU in October 2021 consequent to the second wave of COVID-19 in India. We believe study from large population of national and international nursing groups is required to understand the issues better. Further validation from experts would be better to give credibility to these concerns. However, that is beyond the scope of present survey.
Nurses are at the forefront of COVID-19 case management. Our survey concluded that the poor quality of PPE and lack of emotional security are the major challenge, which continues to affect nurses during this pandemic. Better quality of PPEs, workplace emotional and financial security must be provided to the nurses. The government and healthcare systems must minimize physical and psychological burdens on nurses. It is high time such recognition needs to be translated into policies to support and protect nurses, which may finally translate into better patient care and outcome.
Acknowledgement-We thank all the respected nurses, who shared their experiences in this study and worked relentlessly.
Conflict of interest-None
Source of Funding-None
Prior publication -None
AG, DJ, SJ, conceived study, designed, and analysed the data. AG, SK, OS defined analytic tools and collected data. AG, SJ, SK reviewed literature, edited, and drafted the manuscript. Final manuscript read and approved by all the authors.
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