In this study, ten nurses who worked in COVID-19 and ICU COVID-19 wards were interviewed. Four participants were male and the rest were female (Table 1).

Table 1 The participants’ demographic characteristics

Analysis of the data revealed 4 main themes: (1) Physical, psychological, and social burden of care, (2) Unmet needs, (3) Positive experiences, and (4) Strategies. (Table 2).

Table 2 The themes and sub-themes extracted after data analysis

Table 2: The main themes and sub-themes that emerged from the data collected from nurses experiences in caring for patients with COVID-19 disease.

The physical, psychological and social burden of care

This theme refers to the physical, psychological, and social problems experienced by the nurses.

Excessive workload

All the participants in this study pointed to the difficulties of working in the COVID-19 ward. Excessive workload, hard work, feeling of extreme heat due to wearing protective clothing, thirst, skin problems due to excessive sweating and wearing a mask, difficulty in going to the toilet, and strict compliance with protective protocols were some of the problems reported by the participants. They stated that these problems put them under a lot of work pressure and they became exhausted. For instance, one of the participants said, “From the onset of the shift and entering the ward, we could not rest even for a moment … It was terrible. I felt I was taking part in a war and I was fighting” (Participants No. 4).

Fear, anxiety, and worry

The participants stated that various issues made them feel afraid and anxious. This anxiety persisted not only at work but also outside the workplace. It was so serious that in some cases it led to the participants’ irritation and alertness to hear the news about the transmission of the disease by them to family members. The most important causes of the nurses’ fear and anxiety were the risk of COVID-19 infection, the possibility of transmitting the disease to family members, sudden deterioration of some patients’ conditions, high mortality rates, preoccupation with the possibility of a low engagement or not making enough effort to save patients, and knowledge and skill inadequacy to help critically-ill patients. “I’m stressed for transmitting the disease to my family members, so that every time my phone is ringing, I get a heartbeat. I always fear that they call me and tell me they have the symptoms of the disease” (Participant No. 5).

Compassion fatigue

The nurses stated that they suffered from mental distress due to exposure to anxiety, fear, suffering, family rejection, and patients’ death in isolation: “the nurse’s worst experience can be a moment one of the patients takes your hand and says she is choking, or suddenly starts shivering or screaming in pain in the chest. The scenes bothered me a lot and made me nervous” (Participant No. 2).

Unpleasant social experiences

Most of the nurses stated that they experienced the fear and the risk of being rejected by people or their families and described it as an unpleasant experience. They also considered the lack of empathy of colleagues in other wards and some cases the family’s dissatisfaction with their work in the ward for COVID-19 patients as unpleasant social experiences. One of the nurses said, “When I left the ward, everyone was running away from me, even my relatives were staying away from me, and it was not pleasant” (Participant No. 6).

Unmet needs

These needs refer to personal and professional needs that were not met and made the nurses feel anxious.

Personal needs

The nurses stated that their physical and mental needs were neglected and they highlighted their need for receiving more psychological support. They also believed that in addition to the physical and mental needs, the need for job security which is important to every individual was not considered by the authorities because some unemployed nurses were hired under short-term employment contracts following the call of the Ministry of Health, and these nurses had no job security. They also needed to be appreciated by the authorities. The participants complained that the increase in their pays due to their work in the ward for patients with COVID was not commensurate with the difficulty of their work and was not a fair increase. As an example, one of the nurses said, “Unfortunately, no one takes into account our mental and psychological needs. It would be good if the authorities paid attention to this issue as well” (Participant No. 10).

Professional needs

According to the participants, lack of personal protection facilities and equipment, especially at the onset of the COVID-19 epidemic, lack of appropriate dressings for the treatment of pressure sores caused by constant wearing of masks, lack of nursing and service staff, lack of oxygen ventilators, and lack of proper ventilation in the ward were among the most common unmet professional needs reported by the nurses in this study. “Early on when we opened the ward, we did not even have a service worker to disinfect the surfaces” (Participant No. 2).

Positive experiences

In addition to negative experiences and high workload, the nurses participating in this study also reported that they had pleasant and positive experiences. These experiences were divided into two subcategories:

Pleasant social experiences

These experiences refer to receiving positive feedback, support, and empathy from family members and people in the community. “When I introduced myself as a nurse working in the COVID-19 ward, salesclerks gave me a discount, or people prayed for me or helped me if I needed help, and this created a good feeling in me”. (Participant No. 1).

Internal satisfaction

In addition to receiving positive feedback from people, the participants also reported that they had internal and personal satisfaction. Some of them stated that a spiritual atmosphere prevailed in the ward and this spiritual atmosphere and self-sacrifice in the ward were enjoyable for them. All of the participants considered themselves almost national heroes and were proud of themselves. They also stated that the patients’ recovery made them feel happy, relieved of fatigue, and increased their motivation to continue working and caring for patients. According to the participants, it was because of these positive experiences that almost all of them were ready to work in conditions similar to this pandemic and believed that if they wanted to decide again to choose a workplace, they would still choose to work in the COVID-19 ward. “One day one of our patients was discharged from the ward after a month. The patient and her son danced in front of the nursing station (to appreciate our services). The joy of seeing this scene is indescribable”. (Participant No. 4).

Strategies

The nurses stated that they used different strategies to cope with the stress of working in a high-mortality and busy ward:

Problem-solving strategies

Most of the nurses reported that they tried to find the root cause of the stress. For instance, they resorted to exercise and good nutrition to reduce stress caused by the risk of developing the disease. Besides, to relieve the stress caused by the possibility of transmitting the disease to others, they tried to maintain a physical distance from others and avoided contact with others. They also lived in a separate place to avoid any contact with other family members. Furthermore, they used a negotiation and persuasion strategy to reduce the stress caused by family members’ disagreement with their work in the COVID-19 ward. “I equipped a room in the backyard to separate myself from my family members”. (Participant No. 7).

Stress symptom mitigation strategies

The participants reported that in some cases, they used different strategies to reduce the symptoms of stress. These strategies were keeping their negative thoughts away, walking, reading books, using relaxation techniques, and reliance on God. Furthermore, adopting a professional approach to working in the COVID-19 ward and a sense of responsibility to help resolve the COVID-19 pandemic crisis also helped them to develop a rational attitude toward their work in the COVID-19 ward and reduce their anxiety. “I was very scared that I might pass the disease on to my family members, but I relied on God and tried to keep those thoughts away from me” (Participant No. 1).

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