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

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).

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

“…14,23,24,45,49 Such compassion facilitated by moral imagination stimulated one of their professional duties, that is, the intense ethical responsibility to respond to vulnerable human persons' appeals and to protect and improve patients' dignity. 23,[50][51][52] On the other hand, although nurses were compassionate towards their patients' suffering, they also felt vulnerable and anxious about the uncertainty surrounding this unprecedented health crisis. This nervousness and unease were felt at professional and personal levels.…”

“…16,43,50,53,54,57 Nurses were also concerned about infecting others beyond the immediate care context, like the possibility of infecting their loved ones or anyone else they might come in contact with. 16,25,43,48,[51][52][53][54]57 These life-anddeath health and safety concerns caused them to be afraid of coming in close contact with own family, leading to feelings of emotional isolation, loneliness, and familial separation.…”

Validity of Acute Physiology and Chronic Health Evaluation (APACHE) IV for the Prediction of Prolonged Intensive Care Unit (ICU) Length of Stay in Dr. Sardjito General Hospital in the COVID Era

“…20 When there is a shortage of health workers, health workers may be forced to prioritize the interventions that must be given to patients, such as cutting back on CPR, conducting suction as necessary, and lowering the standard of care to increase the number of interventions. 21 There is also a prioritization of COVID patients. 22 Non-COVID patients are on lack supervision, and the number of patients is limited when there is no emergency.…”

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

“…In addition, the surge in patients requiring hospitalization led to a shortage of medical supplies. The existing health infrastructure is still inadequate to handle the increase in COVID-19 cases (Mailani et al, 2022). Therefore, COVID-19 booster vaccines are recommended to prevent the risk of more severe symptoms.…”