記住我
ORIGINAL ARTICLE
Year : 2023 | Volume
: 67
| Issue : 1 | Page : 61-65
Attitude of the staff nurses toward COVID care and work challenges faced by them
Purnima Kundu1, Binapani De2, Lakhsmi Pandit3
1 Principal, College of Nursing, Medical College and Hospital, Kolkata, West Bengal, India
2 Senior Lecturer, College of Nursing, BMC&H, Bankura, West Bengal, India
3 Acting Principal, College of Nursing, BSMC&H, Bankura, West Bengal, India
Correspondence Address:
Purnima Kundu
Principal, College of Nursing, Medical College and Hospital, 88 College Street, Kolkata - 700 073, West Bengal
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijph.ijph_921_22
Abstract
Background: At the beginning of pandemic, many of the nurses were scared of contracting COVID infection by themselves. The work of nurses during the pandemic was highly appreciated by the society though they worked with severe challenges. Hence, it was utmost necessary to explore the attitude of the nurses toward COVID care and what challenges they faced during caring for the COVID patients. Objectives: The main objectives of the study were to assess the attitude of the nurses toward working in COVID units, to identify the challenges faced by the nurses, and to find out the relationship between the nurses attitude and challenges. Methods: The study was carried out adopting descriptive survey design with 190 conveniently selected staff nurses working in the selected COVID care units of Kolkata and Bankura. Two self-developed rating scales were administered using self-reporting method to measure the attitude and challenges of the nurses. Results: All the staff nurses expressed their favorable (positive) attitude. Maximum (64.21%) of the staff nurses had a high level of challenges. A very weak positive correlation found between attitude of the staff nurses toward COVID care and challenges they faced (ρ = 0.197, P = 0.006). Computation of Chi-square test revealed that neither attitude nor challenges was influenced by any of the personal characteristics of the nurses. Conclusion: In spite of working with a high level of challenges, the majority of the nurses demonstrated favorable attitude toward taking care of COVID patients.
Keywords: Coronavirus disease 2019 infection, nurse's attitude, pandemic, working challenges
Introduction 
The coronavirus disease in 2019 (COVID-19) was not only the deadly outbreak disease but also it affected the mental health status of the population including the nurses. Nurses play a vital role in dealing with COVID-19 victims. Nurses' infection control measures were influenced by their knowledge, attitude, practice, and psychological response toward COVID-19.[1]
Inadequate knowledge and incorrect attitude among healthcare workers (HCWs) can directly influence practices and lead to delayed diagnosis, poor infection control practice, and spread of disease.[2]
Understanding the nurse's attitude, practice is utmost important to manage the pandemic situation. They were sometimes scared to contract the infection and facing various other challenges to meet the care demand of the victims.[3]
Nurse's positive attitude is required for good quality patient care. Nurses should display attributes of respect, compassion, wisdom, sensitivity, and care. It was utmost necessary to explore their attitude toward caring the victims and what challenges they face during caring for the patients. To throw light on these important questions, we felt the need to undertake a study on attitude toward COVID care and challenges faced by the nurses working in the COVID-19 unit. The study was carried out with the purpose of assessing the attitude and explores the challenges faced by the nurses. The justification of undertaking the study was to identify the gaps and take corrective measures accordingly and thereby be prepared for future health crisis situation such as disaster and pandemics. The aim was to explore the attitude of the staff nurses toward COVID care and challenges faced by the staff nurses working in COVID units. It also indirectly aimed at helping the nurse administrators to address and mitigate the challenges, thereby motivating the nurses for working in the COVID units or similar situation in future.
Materials and Methods Study design and study population
Quantitative approach with an exploratory survey design was adopted as we wanted to identify the various challenges they faced. The study was carried out during the period from December 2020 to May 2021. The subjects were the staff nurses working in COVID ward attached to the government hospitals.
Inclusion and exclusion criteria
The female staff nurses willing to participate, available during data collection and working in the COVID unit and severe acute respiratory infection (SARI) ward at least for 1 week were included in the study. The nurses working in the swab collection centers were excluded from the study.
Study setting, sample selection, and data collection
The pilot study was conducted at Durgapur State General Hospital, Durgapur, and we carried out the final study at Kolkata Medical College, Bankura Sammilani Medical College and Hospital, Bankura, and Onda Super Specialty Hospital (COVID), Bankura, West Bengal.
Convenient sampling technique was adopted to select 190 staff nurses working in the COVID units and SARI wards who met the inclusion criteria, and the pilot study was conducted among 20 staff nurses. A list of the staff nurses who worked at COVID units and their contact number was collected from the nursing superintendent of each respective hospital. It was noticed from the list that almost all of the staff nurses had the working experience in COVID units either in SARI or COVID wards. From the list, we selected those who were conveniently available for the survey.
Ethical consideration
Ethical clearance was obtained from the Institutional Ethics Committee, BSMC, Bankura. Informed consent was taken from the participants. Confidentiality and anonymity of the data were assured.
Data collection tool and technique
We developed three instruments, tested for validity and reliability which were used to collect the data. Demographic proforma was used to collect personal characteristics, a five-point attitude rating scale was used to collect the data regarding attitude of the nurses, and a five-point rating scale was used to measure the challenges faced by the nurses. The staff nurses were approached either over telephone or face to face to attend the Government College of Nursing at Medical College and Hospital, Kolkata and Bankura, respectively, as per their convenient time and day. As they attended the college of nursing, the purpose of the study was explained, and by self-reporting technique, data were collected.
Statistical analysis
Data obtained were coded, checked, and entered into MS Excel and analyzed using R programming version 3.1.3 (https://stat.ethz.ch/pipermail/r-announce/2015/000582.html) and are presented in tables. Frequency and percentage distribution was used to describe personal characteristics, attitude, and challenges faced by the staff nurses. Spearman rank order correlation (rho) was computed to find out the relationship between the attitude toward COVID care and challenges faced by the staff nurses. Unpaired t-test was used to show the difference between challenges faced by the staff nurses and attitude of the staff nurses who had an experience of COVID care for <6 and ≥6 months. To determine the association of personal characteristics with attitude and challenges, Chi-square test was computed. The level of significance was considered at 0.05 level.
Results Computed data are organized and presented under various subheadings according to the objectives of the study.
Personal characteristics
Among the staff nurses, 77.9% belonged to ≤35 years of age, 13.16% were graduate nurses, 78.95% had ≤6 months experience in COVID care, 74.10% did not get any COVID care training, 49.47% were from Medical College and Hospital, Kolkata, and others (60.53%) were working in the Hospitals at Bankura.
Attitudes of the staff nurses toward COVID care
The results revealed an important fact that all the staff nurses (100%) expressed their favorable (positive) attitude (score ≥60%), no one had unfavorable (negative) attitude, where total score range was 1–65.
Among the participants, 45.26% strongly agreed that they were confident in providing COVID care, 82.11% of them strongly agreed that all HCW should get training, 58.95% had strongly agreed that it is their responsibility to give care knowing, that they may contract the infection 62.63% strongly agreed that HCPs (health care Providers) should not get panicked but handle the patient with precautions, only 33.16% strongly agreed that it is an opportunity to work in a rare pandemic situation, 64.21% had strongly agreed that Health Care Providers (HCPs) should have empathy for these patients, and 31.58% strongly agreed that it is natural that the HCPs have fear of contracting COVID.
Challenges faced by the staff nurses during rendering care
The results depicted that 64.21% of the staff nurses had faced high level of challenges (score ≥70%), 35.26% faced moderate challenges (score 40%–69%), and only few of them (0.53%) had faced low level of challenges (score <40%) where the total score range was 1–100.
Type of challenges faced by the nurses
The nurses faced various challenges those were described under three subheadings, namely, organizational, personal and family related, and psychological challenges depicted in [Table 1].
Organizational challenges
Among them, 65.78% felt a lack of safety measures, 72.63% faced difficulty to get leave, 81.57% had become overburdened with shortage of staffs, 56.84% suffered from nonavailability of residential facility, 70.52% had lack of training, and 47.84% expressed about nonsupportive authority.
Personal- and family-related challenges
Among the nurses, 81.57% had to stay away from kids and family, 60% of them had to face social discrimination and violence, 36.31% had conflict with husbands, 83.68% of them faced increased self-care burden, 87.36% felt tired and fatigue, and most (73.15%) had sleep disturbances.
Psychological challenges
Psychological challenges include feeling stressed (76.31%), 48.42% had a lack of concentration and attention, and 58.42% got irritated with trivial issues.
Relationship between attitude and various components of challenges of the staff nurses
Spearman rank correlation showed a very weak positive correlation between attitude of the staff nurses toward COVID care and total challenges (ρ = 0.197 at P = 0.006); attitude and personal- and family-related challenges (ρ = 0.147, P = 0.04); and psychological challenges (ρ = 0.167, P = 0.02) but no significant correlation found between attitude of the staff nurses toward COVID care and organizational challenges (ρ = 0.136, P = 0.06) at 0.05 level.
Results of t-test
Computed t-value revealed that there was neither significant differences between the attitude of the nurses working in the COVID care unit for more than and less than 6 months, nor there was significant differences of challegges faced by the nurses. Results of t-tests are depicted in [Table 2] and [Table 3].
Table 2: Unpaired t-test depicting difference in challenges faced by the staff nurses working in the coronavirus disease unit for <6 months and ≥6 months (n=190)
Table 3: Unpaired t-test depicting difference in the attitude of the staff nurses working in the coronavirus disease unit for <6 months and ≥6 months (n=190)Association of attitude, challenges, and personal characteristics
No significant associations were found between challenges and personal characteristics, attitude, and personal characteristics; hence, it was concluded that neither attitude nor challenges were influenced by any of the personal characteristics of the nurses.
Discussion At the very beginning of this pandemic, no one knew what to do and how to take care of the patients and self as well. The health personnel got scared and reacted as they could. Sometimes, the nurse's negative attitude was discussed in the media, and the challenges they faced during working in COVID care came into public too. It was true that few of the nurses expressed negative attitude, but most of the time the nurses had to work with severe challenges, especially during the 1st and 2nd wave of COVID pandemic and they have been appreciated for their courage and hard work globally. In our study, we tried to explore the nurses' attitude toward caring COVID-positive patients and what challenges they faced while working in the COVID care unit. This discussion aimed at comparing our findings with other studies.
Attitude toward COVID care
The results revealed an impressive fact that all the staff nurses (100%) had favorable (positive) attitude. Similar findings have been reported by Dixit et al.[4] in India, which showed that 100% of the health workers had highly positive attitude and Marthoenis and Maskur[5] in Indonesia reported that overall attitude of the nurses was positive. Near similar results have been reported in an online survey in Qatar by Nashwan et al.[6] that 88.1% of nurses were willing to give COVID care, and from a South Ethiopian study by Yesse et al.,[7] it was found that 84.2% of nurses had a positive attitude. Whereas contradictory finding was reported by Tadesse et al.[2] where it showed that 72% of the nurses had favorable attitude and Shampile et al.[8] from Zambia reported that only 60.3% of the nurses had positive attitude. From the above studies, we can understand that the nurses had varied attitudes toward care of COVID patients.
Among the nurses in our study, 45.26% agreed strongly that they were confident in working in the COVID unit. The study findings by Wen et al.[9] from China reported in line with our findings who reported that 36.3% of the nurses felt competent and confident in giving COVID care though 65.3% of them believed that they had good knowledge of COVID care. Our study result showed that 94.73% of the nurses had expressed that it is their responsibility to give COVID care, similarly, a qualitative study conducted by Liu et al.,[10] in China generated the theme “this is my duty” with regard to giving COVID care. A contradictory result was reported by Dave[11] from a study carried out in New Delhi that only 32% of the nurses were completely prepared and 54% were somewhat prepared for delivering COVID care.
Challenges faced by the nurses
We explored the challenges which revealed that maximum (64.21%) of the staff nurses had faced high level of challenges, 35.26% faced moderate challenges, and only few of them (0.53%) had low level of challenges. We failed to find out any other studies which reported the level of challenges of the nurses.
Regarding the types of challenges faced by the nurses, we found out that the majority (65.78%) of the nurses suffered from a lack of safety because of nonavailability of personal protective equipments (PPEs) in the work areas. This result is partially supported by Dave[11] who reported that 80% of the nurses have talked about nonavailability of N-95 masks and also 58% of the nurses were concerned about the availability of PPEs. Abdel Wahed et al.[12] reported from Egypt (2020) that the health workers also talked about nonavailability of PPEs in their work place.
As we explored the challenges of nonavailability of accommodation, we found out that 56.84% had faced the problem which is in line with a report of Joshi.[13]
We found out that 87.36% of our study participants had expressed about the personal and family's risk of contracting COVID infection which is similar to the result revealed by Marthoenis and Maskur.[5] in Indonesia who found out that 91.53% of the participants had fear of contracting COVID infection and the study of Ezypt[12] also reported that 83.1% of the participants had the same fear. Similarly, Dave[11] also reported that 64% of the participants were highly concerned about the personal and family safety. A qualitative study carried out[10] in China also has found out the theme that the participants had “the fear of becoming infected and infect others.”
We explored that 60% of the nurses had the challenge of facing societal violence and discrimination which is much higher than that reported in the study at Indonesia[5] where it was reported that only 12.81% of the participants felt rejection from neighbors and 9.09% had felt rejected by the family members.
We found out that 76.31% of the nurses had suffered from fear and anxiety, a contradictory result was reported by a study in China,[9] where it was reported that the only 9.3% of the participants had anxiety and depression and Dave[11] reported that 44% of the participants were extremely concerned about their health issues. A similar result was reported by a study in Indonesia as 86.36% of their participants had felt anxious, a qualitative study carried out by Sun et al.,[14] also developed the theme “fear and anxiety.” A Cui et al.[15] also found out that 0.44% of the participants had severe, 34% had mild, and 13.54% expressed moderate anxiety.
Results of our study revealed that 87.36% of the nurses had physical fatigue and tiredness. A similar result was reported by Dave[11] that 75% of the respondents were stressed and frustrated due to workload, 22% of the nurses were concerned about mandatory overtime, 64% were concerned about length of shift, and 44% about number of offs after shifts. Sun et al.[15] developed a theme of “fatigue, discomfort, and helplessness,” Liu et al.[10] also developed a theme of “exhaustion due to heavy workload and protective gear,” and Joshi.[13] reported physical exhaustion and mental stress of the nurses working at COVID unit.
The similarity and dissimilarity of the findings of the studies discussed may be due to the reason that every nurse and health worker is unique in their knowledge, attitude, and practice, their perception regarding the situation and personal characteristics as well. Hence, the results of different studies might have been unique too.
Conclusion Based on the result, we conclude that all of the nurses under study had favorable attitude toward COVID care. They faced various challenges while rendering care to such patients. There is no significant correlation between the challenges and their attitudes toward COVID care. It is interesting to note that there was no significant differences of attitude and challenges found between the nurses working in the COVID unit for less than and more than 6 months.
We recommend further studies in various other issues as COVID pandemic is over issues covering extensive geographical areas and including larger samples. Further study may be carried out to compare the attitude and issues among the different states of India. We suggest qualitative studies of the nurses to explore the challenges in depth.
Acknowledgment
Investigators acknowledge the administrators of the respective hospitals permitting to conduct the study and the participants for the willingness to be a part of the study. They are also grateful to Ms. Dhitashree Paria and Mr. Asit Panda for their contribution in data computation.
Financial support and sponsorship
The total funds were borne by the investigators from their own salary.
Conflicts of interest
There are no conflicts of interest.
References 
留言 (0)