Unmasking Stigma: A Qualitative Exploration of Nurses in Urban and Rural Indonesia during the COVID-19 Pandemic

Abstract

Background Studies investigating the manifestations of stigma on nurses during COVID-19 pandemic in Indonesia are still limited. Moreover, previous studies have primarily focused on nurses directly involved in COVID-19 care. Objective This study aims to thoroughly explore the sources of stigma and the spectrum of stigma manifestations—enacted, anticipated, and internalized—experienced by Indonesian nurses working across different levels of healthcare in the urban and rural settings of Indonesia during COVID-19 pandemic. Methods A qualitative descriptive study using semistructured interviews was conducted. Thirty-three nurses who worked in the urban area of Jakarta and in rural areas of West Kalimantan participated. Data analysis was carried out using the framework method. Results The findings showed that Indonesian nurses, regardless of their context (i.e., place of stay, COVID-19 status, level of health service, or area of service), encountered stigma during the pandemic. Sources of stigma varied widely and included self-stigma, stigma from family members, friends, health care recipients whether in hospital or out of hospital, colleagues, and other staff in the workplace, workplace policy and practices, the community surrounding their homes, markets, transport drivers, room rental owners, religious community, and online communities (netizens). Nine forms of enacted stigma, two forms of anticipated stigma, and four manifestations of internalized stigma were identified. Conclusion Not only do nurses bear the stigma related to the COVID-19 threat, but nurses also endured and felt stigma related to their nursing profession and the stigma associated with mental health issues. Indonesian nurses faced a triple burden of stigma during a pandemic, such as COVID-19, as stigma perpetuated from multiple levels of sources and intersected with other issues beyond the threat of the virus itself. To enhance nurses' resilience in future health crises, greater efforts are required to mitigate stigmatization against them.