DOI: https://doi.org/10.14710/nmjn.v12i2.46250

The Challenges of Intensive Care Unit Nurses Caring for COVID-19 Patients in Indonesia: A Qualitative Study

*Fitri Mailani scopus  -  Faculty of Nursing, Universitas Andalas, Indonesia
Rahmi Muthia  -  Faculty of Nursing, Universitas Andalas, Indonesia
Emil Huriani  -  Faculty of Nursing, Universitas Andalas, Indonesia
Boby Febri Krisdianto  -  Faculty of Nursing, Universitas Andalas, Indonesia
Elvi Oktarina  -  Faculty of Nursing, Universitas Andalas, Indonesia
Open Access Copyright (c) 2022 Nurse Media Journal of Nursing
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Citation Format:
Abstract

Background: After one year of the pandemic, Indonesia experienced a crisis where the addition of COVID-19 cases increased significantly in several big cities; it made the healthcare system collapse, including the intensive care unit (ICU) service for COVID-19. ICU nurses, who are at the frontline of fighting against COVID-19 and defusing this crisis, are faced with various challenges in providing care for COVID-19 patients, and exploring such challenges are significant.   

Purpose: This study aimed to explore the challenges experienced by Indonesian nurses who work in the ICU caring for COVID-19 patients.

Methods: A multi-centered-qualitative study with a descriptive phenomenological design was used. Twenty nurses working in the ICU of COVID-19 in eight COVID-19 referral hospitals in seven major cities in Indonesia were recruited using purposive sampling. Semi-structured individual video call interviews were conducted to collect the data from July-September 2021. Data were analyzed using Colaizzi’s (1978) method.

Results: The nurses reported the challenges throughout caring for COVID-19 patients in ICU, which are described in four major themes: (a) working under pressure and moral distress, (b) choosing to do the best, (c) adaptation, learning, and research, and (e) survive physically and mentally healthy.

Conclusion: This study describes the challenges experienced by nurses working in ICUs during the COVID-19 crisis, such as working under pressure, facing dilemmas caring for patients, and trying to survive working in inadequate professional conditions. An in-depth understanding of these challenges in the current pandemic can help managers in the hospital to provide psychological support, adequate training for ICU nurses, and high-quality protocols for upcoming emergency scenarios, as well as maximizing resource management (human and material).
Fulltext View|Download
Keywords: COVID-19; challenges; intensive care; nurses; qualitative study

Article Metrics:

Article Info
Section: Articles
Language : EN
Recent articles
The Impact of Performance of Non-Nursing Tasks on the Attitudes of Nursing Students toward Nursing Profession Factors Affecting the Quality of Life of Older People during the COVID-19 Pandemic Illuminating the Experience of Stigma among Persons Living with HIV using Participative Drawing Method Editorial Back Matter Editorial Front Matter More recent articles
Most cited articles
Case Study: Evidence-Based Interventions Enhancing Diabetic Foot Care Behaviors among Hospitalized DM Patients Ethical Values in the Nursing Profession as Perceived by Head Nurses and Staff Nurses in Public Hospitals, Banda Aceh, Indonesia: A comparison Study Nausea, Vomiting and Retching of Patients with Cervical Cancer undergoing Chemotherapy in Bali, Indonesia Predicting Factors of Interpersonal and Situational Influences for Performing Stretching Exercises Based on Pender’s Model Family Experiences of Mental Illness: A Meta-Synthesis More cited articles
  1. American Association of Colleges of Nursing (AACN). (2020). AACN members endorse resolution calling for action to address nurse well-being. AACN. https://www.aacnnursing.org/News-Information/Press-Releases/View/ArticleId/24707/ resolution-nurse-well-being-resilience
  2. Bagnasco, A., Zanini, M., Hayter, M., Catania, G., & Sasso, L. (2020). COVID 19—A message from Italy to the global nursing community. Journal of Advanced Nursing, 76(9), 2212–2214. https://doi.org/10.1111/jan.14407
  3. Cadge, W., Lewis, M., Bandini, J., Shostak, S., Donahue, V., Trachtenberg, S., Grone, K., Kacmarek, R,, Lux, L,, Matthews, C,, McAuley, M. E., Romain, F., Snydeman, C,, Tehan, T, & Robinson, E. (2021). Intensive care unit nurses living through COVID‐19: A qualitative study. Journal of Nursing Management, 29(7), 1965-1973. https://doi.org/10.1111/jonm.13353
  4. Catton, H. (2020). Nursing in the COVID-19 Pandemic and beyond: Protecting, saving, supporting and honouring nurses. International Nursing Review, 67(2), 157–159. https://doi.org/ 10.1111/inr.12593
  5. Chen, Q., Liang, M., Li, Y., Guo, J., Fei, D., Wang, L., He, L., Sheng, C., Cai, Y., Li, X., Wang, J., & Zhang, Z. (2020). Mental health care for medical staff in China during the COVID-19 outbreak. The Lancet Psychiatry, 7(4), e15-e16. https://doi.org/10.1016/S2215-0366(20)30078-X
  6. Chiang, Y. C., Lee, H. C., Chu, T. L., Han, C. Y., & Hsiao, Y. C. (2016). The impact of nurses' spiritual health on their attitudes toward spiritual care, professional commitment, and caring. Nursing Outlook, 64(3), 215-224. https://doi.org/10.1016/j.outlook.2015.11.012
  7. Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. Psychology. Oxford University Press
  8. Creswell, J. W., & Poth, C. N. (2016). Qualitative inquiry and research design: Choosing among five approaches. Sage publications
  9. Danielis, M., Peressoni, L., Piani, T., Colaetta, T., Mesaglio, M., Mattiussi, E., & Palese, A. (2021). Nurses’ experiences of being recruited and transferred to a new sub‐intensive care unit devoted to COVID‐19 patients. Journal of Nursing Management, 29(5), 1149-1158. https://doi.org/10.1111/jonm.13253
  10. Eghbali, M., Negrndeh, R., & Froutan, R. (2020). COVID-19 epidemic: Hospital-level response. Nursing Practice Today, 7(2), 81–83. https://doi.org/10.18502/npt.v7i2.2728
  11. Fernández‐Castillo, R. J., González‐Caro, M. D., Fernández‐García, E., Porcel‐Gálvez, A. M., & Garnacho‐Montero, J. (2021). Intensive care nurses' experiences during the COVID‐19 pandemic: A qualitative study. Nursing in Critical Care, 26(5), 397-406. https://doi.org/10.1111/nicc.12589
  12. Galehdar, N., Toulabi, T., Kamran, A., & Heydari, H. (2021). Exploring nurses' perception of taking care of patients with coronavirus disease (COVID‐19): A qualitative study. Nursing Open, 8(1), 171-179. https://doi.org/10.1002/nop2.616
  13. Gordon, J. M., Magbee, T., & Yoder, L. H. (2021). The experiences of critical care nurses caring for patients with COVID-19 during the 2020 pandemic: A qualitative study. Applied Nursing Research, 59, 151418. https://doi.org/10.1016/j.apnr.2021.151418
  14. Guo, Y. R., Cao, Q. D., Hong, Z. S., Tan, Y. Y., Chen, S. D., Jin, H. J., & Yan, Y. (2020). The origin, transmission and clinical therapies on Coronavirus Disease 2019 (COVID-19) outbreak – An update on the status. Military Medical Research, 7(1), 1–10
  15. Hamers, J. P. H., Nijhuis-van der Sanden, M. W. G., Ettema, R. G. A., Heinen, M., Huisman-de Waal, G., de Man-van Ginkel, J. M., Metzelthin, S.F., Zwakhalen, S. M. G., & Schuurmans, M. J. (2016). Essential nursing care: Most provided, least evidence based. The basic care revisited program. Journal of Advanced Nursing, 72(S1), 51-51
  16. Holden, R. J., Rivera-Rodriguez, A. J., Faye, H., Scanlon, M. C., & Karsh, B. T. (2013). Automation and adaptation: Nurses’ problem-solving behavior following the implementation of bar-coded medication administration technology. Cognition, Technology & Work, 15(3), 283-296
  17. Hu, D., Kong, Y., Li, W., Han, Q., Zhang, X., Zhu, L. X., Wan, S. W., Liu, Z., Shen, Q., Yang, J., He, H-G., & Zhu, J. (2020). Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinical Medicine, 24, 100424. https://doi.org/10.1016/j.eclinm. 2020.100424
  18. International Council of Nurses. (2020). COVID-19 and the international supply of nurses. International Council of Nurse 27. https://www.icn.ch/system/files/2021-07/COVID19_internationalsupplyofnurses_Report_FINAL.pdf
  19. James, A. H., & Bennett, C. L. (2020). Effective nurse leadership in times of crisis. Nurse Management (Harrow) 27(4), 32–40. https://doi.org/10.7748/nm.2020.e1936
  20. Jordan, T. R., Khubchandani, J., & Wiblishauser, M. (2016). The impact of perceived stress and coping adequacy on the health of nurses: A pilot investigation. Nursing Research and Practice, 2016, 5843256. https://doi.org/10.1155/2016/5843256
  21. Karimi, Z., Fereidouni, Z., Behnammoghadam, M., Alimohammadi, N., Mousavizadeh, A., Salehi, T., Mirzaee, M. S., & Mirzaee, S. (2020). The lived experience of nurses caring for patients with COVID-19 in Iran: A phenomenological study. Risk Management and Healthcare Policy, 13, 1271–78. https://doi.org/10.2147/RMHP.S258785
  22. Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z., & Hu, S. (2020). Factors associated with mental health outcomes among health care workers exposed to Coronavirus disease 2019. JAMA Network Open, 3(3), e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976
  23. Leng, M., Wei, L., Shi, X., Cao, G., Wei, Y., Xu, H., Zhang, X., Zhang, W., Xin, S., & Wei, H. (2021). Mental distress and influencing factors in nurses caring for patients with COVID‐19. Nursing in Critical Care, 26(2), 94-101. https://doi.org/10.1111/nicc.12528
  24. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. 1st ed. Sage publications
  25. Lipsitch, M., Swerdlow, D. L., & Finelli, L. 2020. Defining the epidemiology of Covid-19- Studies needed. New England Journal of Medicine, 382(13), 1194–1196. https://doi.org/10.1056/NEJMp 2002125
  26. Liu, Q., Luo, D., Haase, J.E., Guo, Q., Wang, X.Q., Liu, S., Xia, L., Liu, Z,, Yang, J., & Yang, B. X. (2020). The experiences of health-care providers during the Covid-19 crisis in China: A qualitative study. The Lancet Global Health 8(6):e790–98. https://doi.org/10.1016/S2214-109X(20)30204-7
  27. Liu, S., Yang, L., Zhang, C., Xiang, Y. T., Liu, Z., Hu, S., & Zhang, B. (2020). Online mental health services in China during the COVID-19 outbreak. The Lancet Psychiatry, 7(4), e17-e18. https://doi.org/10.1016/S2215-0366(20)30077-8
  28. Mahendradhata, Y., Andayani, N. L. P. E., Hasri, E. T., Arifi, M. D., Siahaan, R. G. M., Solikha, D. A., & Ali, P. B. (2021). The capacity of the Indonesian healthcare system to respond to COVID-19. Frontiers in Public Health, 9, 887. https://doi.org/10.3389/fpubh.2021.649819
  29. Mailani, F., Huriani, E., Muthia, R., & Sarfika, R. (2021). Nurses’ intention to work during the COVID-19 outbreak in West Sumatra, Indonesia. Nurse Media Journal of Nursing, 11(1), 50-60. https://doi.org/10.14710/nmjn.v11i1.34093
  30. Mari, G. M., Crippa, J., Casciaro, F., & Maggioni, D. (2020). A 10-step guide to convert a surgical unit into a COVID-19 unit during the COVID-19 pandemic. International Journal of Surgery, 78, 113–114. https://doi.org/10.1016/j.ijsu.2020.04.052
  31. Mays, N., & Pope, C. (2020). Quality in qualitative research. In N. Mays & C. Pope (Eds), Qualitative research in health care (pp. 211-233). Wiley-Blackwell
  32. Mehta, Y., Chaudhry, D., Abraham, O. C., Chacko, J., Divatia, J., Jagiasi, B., Kar, A., Khilnani, G. C., Krishna, B., Kumar, P., Mani, R. K., Rao, B. K., Singh, P. K., 13, Singh, S., Tiwary, P., Wattal, C., Govil, D., Dixit, S., & Samavedam, S. (2020). Critical care for COVID-19 affected patients: Position statement of the Indian Society of Critical Care Medicine. Indian Society of Critical Care Medicine, 24(4), 222. https://doi.org/10.5005/jp-journals-10071-23395
  33. Ministry of Health Republic of Indonesia. (2021). Situasi terkini perkembangan Coronavirus Disease (COVID-19) 12 Mei 2021 [COVID-19 current condition as of 12 May 2021]. https://infeksiemerging.kemkes.go.id/situasi-infeksi-emerging/situasi-terkini-perkembangan-coronavirus-disease-covid-19-12-mei-2021
  34. Moradi, Y., Baghaei, R., Hosseingholipour, K., & Mollazadeh, F. (2021). Challenges experienced by ICU nurses throughout the provision of care for COVID‐19 patients: A qualitative study. Journal of Nursing Management, 29(5), 1159-1168. https://doi.org/10.1111/jonm.13254
  35. Moretti, C., Ceccaroni, S. E., Confortini, R., Roncaglio, C. M., Lionetto, V., Ndocaj, K., Festa, L., Calderone, C., Sarli, L., & Artioli, G. (2021). Taking care. Nursing towards Covid-19 patients during the pandemic emergency in Italy: A qualitative study. Acta Bio Medica, 92(Suppl 2), e2021025. https://doi.org/10.23750/ABM.V92IS2.11944
  36. Nilsson, H. (2022). Spiritual self-care management for nursing professionals: A holistic approach. Journal of Holistic Nursing, 40(1), 64–73. https://doi.org/10.1177/08980101211034341
  37. Paixão G., Mills C., McKimm J., Hassanien, M. A., & Al-Hayani, A. A. (2020). Leadership in a crisis: Doing things differently, doing different things. British Journal of Hospital Medicine, 81(11), 1–9. https://doi.org/10.12968/hmed.2020.0611
  38. Park, S. C., & Park, Y. C. (2020). Mental health care measures in response to the 2019 Novel Coronavirus outbreak in Korea. Psychiatry Investigation, 17(2), 85-86. https://doi.org/10.30773/pi.2020.0058
  39. Phua, J., Faruq, M. O., Kulkarni, A. P., Redjeki, I. S., Detleuxay, K., Mendsaikhan, N., Sann, K. K., Shrestha, B. R., Hashmi, M., Palo, J. E. M., Haniffa, R, Wang, C., Hashemian, S. M. R., Konkayev, A., Mat Nor, M. B., Patjanasoontorn, B., Nafees, K. M. K., Ling, L., Nishimura, M., … Fang, W. F. (2020). Critical care bed capacity in Asian countries and regions. Critical Care Medicine, 48, 654–62. https://doi.org/10.1097/CCM.0000000000004222
  40. Qiu, H., Tong, Z., Ma, P., Hu, M., Peng, Z., Wu, W., & Du, B. (2020). Intensive care during the coronavirus epidemic. Intensive Care Medicine, 46(4), 576-578. https://doi.org/10.1007/s00134-020-05966-y
  41. Rushton, C. H., Batcheller, J., Schroeder, K., Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care, 24(5), 412–421. https://doi.org/10.4037/ajcc2015291
  42. Schroeder, K., Norful, A. A., Travers, J., & Aliyu, S. (2020). Nursing perspectives on care delivery during the early stages of the covid-19 pandemic: A qualitative study. International Journal of Nursing Studies Advances, 2, 100006. https://doi.org/ 10.1016/j.ijnsa.2020.100006
  43. Schwartz, J., King, C. C., & Yen, M. Y. (2020). Protecting health care workers during the COVID-19 Coronavirus outbreak - Lessons from Taiwan’s SARS response. Clinical Infectious Disease, 71(15), 858–860. https://doi.org/10.15797/concom.2019..23.009
  44. Shahmari, M., Nasrabadi, A., N., & Akram, G. (2020). Lived experiences of Iranian ICU nurses in the care of patients with Covid-19: A phenomenological study. Preprints. https://doi.org/10.21203/rs.3.rs-72171/v1
  45. Sun, Q., Qiu, H., Huang, M., & Yang, Y. (2020). Lower mortality of COVID-19 by early recognition and intervention: Experience from Jiangsu Province. Annals of Intensive Care, 10(1), 1-4. https://doi.org/10.1186/s13613-020-00650-2
  46. Woodson, D. (2021). Leadership, job stress and uncertainty among nurses during the Covid-19 pandemic: Impacts and implications in Lieu of pertinent theoretical constructs [College thesis, The University of Southern Mississippi]. https://aquila.usm.edu/honors_theses/762/
  47. World Health Organization. (‎2021)‎. COVID-19 weekly epidemiological update, edition 58, 21 September 2021. World Health Organization. https://apps.who.int/iris/handle/10665/345456
  48. Worldometer. 2021. Corona virus cases. https://www.worldometers.info/coronavirus/
  49. Yunus, F., & Andarini, S. (2020). Letter from Indonesia. Respirology, 25, 1328–1329. https://doi.org/ 10.1111/resp.13953
  50. Zhang, W. R., Wang, K., Yin, L., Zhao, W. F., Xue, Q., Peng, M., Min, B. Q., Tian, Q., Leng, H. X., Du, J. L., Chang, H., Yang, Y., Li, W., Shangguan, F. F., Yan, T. Y., Dong, H. Q., Han, Y., Wang, Y. P., Cosci, F., & Wang, H. X. Mental health and psychosocial problems of medical health workers during the Covid-19 epidemic in China. Psychotherapy and Psychosomatics, 89(4), 242–250. https://doi.org/10.1159/000507639

Last update:

  1. Ethical issues experienced by nurses during COVID-19 pandemic: Systematic review

    Younjae Oh, Chris Gastmans. Nursing Ethics, 31 (4), 2024. doi: 10.1177/09697330231200564

  2. Perception of COVID-19 Vaccination Based on Health Belief Model and the Acceptance of COVID-19 Booster Vaccination

    Risma Arlyani Dewi, Jon Hafan Sutawardana, Ana Nistiandani. Nurse Media Journal of Nursing, 13 (1), 2023. doi: 10.14710/nmjn.v13i1.47694

  3. Knowledge, attitudes, practice, and perceived barriers toward evidence-based practice among Palestinian nurses in intensive care units

    Zeina Dabak, Dalia Toqan, Malakeh. Z. Malak, Rasmieh Al-Amer, Ahmad Ayed. BMC Nursing, 23 (1), 2024. doi: 10.1186/s12912-024-02646-w

Last update: 2024-12-26 18:45:07

No citation recorded.