The psychological experiences of Lebanese ground zero front-line nurses during the most recent COVID-19 outbreak post Beirut blast: A qualitative study

Abstract

Background: For the past 2 months the number of COVID-19 cases in Lebanon has been on the rise, while frontline nurses after the Beirut Blast of August 4th have been practicing through limited resources and a challenging context. Aim: This paper aims at exploring the psychological experiences of Lebanese frontline nurses serving at ground zero hospital during the current COVID-19 outbreak. Setting: This study was carried out in three main ground-zero hospitals in Beirut which are receiving COVID-19 cases. Method: This study have employed a phenomenological exploratory qualitative research design, where virtual interviews were conducted with 18 frontline nurses during the second week of January 2021. Results: Thematic analysis of the data expressed by the frontline nurses working in the approached ground-zero hospitals gave rise to five themes, namely ‘helplessness and impending doom’, ‘increased mortality rates and depressive mood’, ‘fear of death and obsessive thinking’, ‘flashbacks, panic, and incompetence’, and ‘public recklessness, governmental responsibility, and anger‘. Conclusion: The frontline nurses working at ground zero hospitals in Beirut are facing significant psychological challenges that should be mediated by the government and health policymakers in order to safeguard the quality of care and avoid higher mortality rates.

Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review

“…Fear of contracting COVID-19 and infecting family, colleagues, and/or patients, was described by HCWs in 34 articles (59.6%). These studies collectively had the greatest global spread of all PMIDE categories, representing data from participants in the Americas ( n = 10) ( 7 , 11 , 47 – 54 ), Europe ( n = 8) ( 55 – 62 ), South-east Asia ( n = 6) ( 63 – 68 ), Western Pacific ( n = 5) ( 69 – 73 ), Eastern Mediterranean ( n = 4) ( 74 – 77 ), and globally ( n = 1) ( 44 ). Feelings of fear ( 58 , 68 , 72 , 73 , 75 – 77 ), anxiety ( 7 , 44 , 47 , 52 , 73 ), guilt ( 50 , 54 , 56 , 63 , 65 ), and depression ( 73 ) were commonly described throughout the included studies.…”

“…Exacerbating these concerns were shortages in PPE and the uncertainty around what constituted sufficient PPE ( 48 , 54 , 74 ) (United States and Lebanon). In a global cross-sectional study ( 44 ), 62.9% of participants reported a PPE shortage, which was present in nearly all settings and was reported similarly between physicians and other HCWs.…”

“…Given an early lack of clinical guidelines and evidence surrounding COVID-19, HCWs described difficulty deciding on and communicating an appropriate therapeutic course of action and a realistic prognosis in many cases ( 48 , 51 , 53 , 81 , 83 ) (United States, South Africa). Thirty-three articles (57.9%) discussed the idea of providing suboptimal care, representing diverse samples across the globe, including the Americas ( n = 15) ( 7 , 11 , 48 – 54 , 83 – 88 ), Europe ( n = 9) ( 56 – 58 , 60 – 62 , 89 – 91 ), Western Pacific ( n = 3) ( 70 , 72 , 92 ), Eastern Mediterranean ( n = 2) ( 74 , 93 ), South-east Asia ( n = 2) ( 67 , 94 ), and one from Africa ( 81 ) and another with a global scope ( 44 ). From these articles, three subcategories were formed: “PPE negatively impacting care”; “Inability to provide a good death”; and “Unprepared for novel tasks.” HCWs drew connections between providing suboptimal care or seeing patients dying alone and feelings of guilt ( 50 , 54 , 74 ), sorrow ( 11 , 51 ), worry ( 70 , 88 ), and powerlessness ( 72 , 84 ).…”

“…Concerns about the quality of care and support provided to patients were commonly reported ( 48 , 49 , 54 , 83 , 88 , 93 ) (United States, Canada, Iran). HCWs often reported feeling responsible for the patients’ outcomes and experiencing intrusive thoughts and feelings of guilt, despite following institutional recommendations ( 54 , 74 , 83 , 85 ) (United States, Lebanon). Being unable to observe patients achieve the outcomes that they would typically achieve prior to the pandemic led to feelings of hopelessness and lack of control ( 48 , 53 , 72 ) (United States, China).…”

“…Given the influx of patients infected by COVID-19 as well as limited material and human resources, HCWs were often faced with decisions surrounding care prioritization and resource allocation. Twelve articles described these challenges, representing HCWs from the Americas ( n = 6) ( 11 , 48 , 51 , 83 , 85 , 86 ), Europe ( n = 2) ( 89 , 91 ), Western Pacific ( n = 2) ( 72 , 92 ), Eastern Mediterranean ( n = 1) ( 74 ), and globally ( n = 1) ( 44 ). These experiences were sometimes associated with feelings of fear ( 85 ), anxiety ( 86 ), sadness ( 86 ), or guilt ( 91 ).…”