Norman Elizabeth M, Kowalski Mildred Ortu, Sabatini Roxanne, Jones Carol S, Silverstein Wendy
New York University, New York, NY, USA.
, 8 South Brookwood Drive, Montclair, NJ, 07042, USA.
BMC Nurs. 2025 Aug 18;24(1):1079. doi: 10.1186/s12912-025-03628-2.
The goal of this study was to record and analyze the initial and lingering thoughts and reactions that 41 clinical nurses experienced while caring for individuals hospitalized with COVID-19 during the initial April 2020 surge and over the next 15 months while vaccines and effective treatments became available. The sample represented a diverse group of nurses at one American health care institution in terms of gender identity, age, ethnic group, years of experience, clinical specialty area, and hospital shift worked. At the time of this April surge, nurses were exposed to a virus with no standard treatments and high mortality rates. Using a longitudinal qualitative design, the team hoped to answer questions about what compelled these nurses to continue to come to work? And what leadership lessons about identity, communication, camaraderie can be learned from this unplanned crisis?
A longitudinal design was chosen to capture the changes in nurses’ thoughts about themselves as professionals and their clinical work during COVID-19 after the World Health Organization (WHO) declared COVID-19 a global pandemic on March 11, 2020 (Cucinotta and Vanelli, Acta Biomed 91(1):157–60, 2020 [1]). The research team wondered how a large American suburban medical center staff was dealing with this virus and if there were changing patterns in the experiences and thoughts of clinical nurses as the virus evolved in 2020–2021. We applied the 18th Century philosophy of Immanuel Kant writings on moral thinking to examine the nurses’ thoughts of continuing their clinical work during this time. Using a classic Western philosopher seemed relevant given the worldwide nature of the pandemic which affected everyone, not just health care workers. Interview questions from the literature and research team experiences were developed; an additional file provides details of the interview schedule in English (See Additional file 1 for the interview schedule). Forty-one RNs agreed to participate; each nurse agreed to three interviews over three phases. The first phase occurred from April through November 2020 with 41 RNs participating. Thirty-five RNs from the original 41 returned for a second interview between November 2020 through April 2021. In the final phase the same 35 RNs took part in a final interview between April 2021 and July 2021. We asked the same questions to all nurses during each phase. Similar quotations were grouped into 42 codes, then like codes were collected into five themes: Exposure risk, Professional Self-Image, Communication, Community Reaction and Finding an Emotional Balance. These themes provided a context for describing the ethos of nurses working with pandemic patients.
These nurses put the needs of the greater community before their personal desires. They came to work every day because they believed that they had essential knowledge and skills to help in the pandemic. Despite the realization that many of their patients would die, the nurses adapted their skills within strict isolation protocols. Their greatest stress was infecting their families, a misfortune that did not happen. Effective leadership and the camaraderie that developed among the nurses and other staff sustained them during this time. Interview quotations seemed to mirror interviews conducted by one team researcher on military nurses who served in Vietnam (1962–1975). Comparing these citations suggests that the personal danger, inability to save people and an overwhelming number of patients that taxed resources were similar to veteran and civilian nurses.
The 35 clinical nurses in this study worked through the initial fifteen months of COVID-19 pandemic in America. Kant’s idea of duty for the greater good over personal needs provided an explanation and rationale why the 35 clinical nurses remained in clinical work. Reviewing the transcripts indicated that there seemed to be parallels between nurses’ clinical experiences in the Vietnam War and the COVID-19. Their experience indicated that planning for future disasters is imprecise. Knowledge gleaned from this study suggests that a combination of external factors and personal assets should provide the support for nurses and other health care workers in future plagues.
This study was registered retrospectively on ClinicalTrials.gov NCT06012539 on August 23, 2023.
The online version contains supplementary material available at 10.1186/s12912-025-03628-2.
本研究的目的是记录和分析41名临床护士在2020年4月初疫情激增期间以及接下来的15个月里，在护理新冠肺炎住院患者时最初和持续的想法及反应，这期间疫苗和有效治疗方法陆续出现。该样本代表了美国一家医疗机构中一群在性别认同、年龄、种族、工作经验年限、临床专业领域和工作班次等方面具有多样性的护士。在2020年4月疫情激增时，护士们面对的是一种没有标准治疗方法且死亡率很高的病毒。采用纵向定性设计，该团队希望回答以下问题：是什么促使这些护士继续来上班？从这场意外危机中可以汲取哪些关于身份认同、沟通和同志情谊的领导经验？
选择纵向设计，以捕捉2020年3月11日世界卫生组织（WHO）宣布新冠肺炎为全球大流行后，护士们对自己作为专业人员以及临床工作的看法变化（库奇诺塔和瓦内利，《生物医学学报》91(1):157 - 160，2020 [1]）。研究团队想知道美国一家大型郊区医疗中心的工作人员是如何应对这种病毒的，以及随着病毒在2020 - 2021年的演变，临床护士的经历和想法是否有变化模式。我们运用18世纪伊曼努尔·康德关于道德思考的哲学著作来审视护士们在此期间继续从事临床工作的想法。鉴于这场影响到每个人而非仅仅医护人员的全球大流行的性质，运用一位经典西方哲学家的思想似乎是恰当的。根据文献和研究团队的经验制定了访谈问题；另一个文件提供了英文访谈时间表的详细信息（见补充文件1中的访谈时间表）。41名注册护士同意参与；每位护士同意在三个阶段接受三次访谈。第一阶段从2020年4月持续到11月，41名注册护士参与。最初41名护士中的35名在2020年11月至2021年4月期间返回接受第二次访谈。在最后阶段，同样的35名护士在2021年4月至7月期间参加了最后一次访谈。我们在每个阶段向所有护士提出相同的问题。相似的引语被归为42个编码，然后类似的编码被归纳为五个主题：暴露风险、职业自我形象、沟通、社区反应和找到情绪平衡。这些主题为描述护理大流行患者的护士精神风貌提供了背景。
这些护士将更广泛社区的需求置于个人愿望之上。他们每天来上班是因为他们相信自己拥有在疫情中提供帮助所必需的知识和技能。尽管意识到许多患者会死亡，但护士们在严格的隔离规程内调整了自己的技能。他们最大的压力是感染家人，而这种不幸并未发生。有效的领导以及护士与其他工作人员之间形成的同志情谊在此期间支撑着他们。访谈引语似乎反映了一位团队研究员对在越南服役的军事护士（1962 - 1975年）进行的访谈。对比这些引语表明，个人危险、无法挽救患者以及大量消耗资源的患者数量，在退伍军人护士和平民护士中是相似的。
本研究中的35名临床护士在美国经历了新冠肺炎大流行的最初15个月。康德关于为了更大利益而履行职责高于个人需求的理念，为这35名临床护士为何继续从事临床工作提供了解释和依据。审查访谈记录表明，护士们在越南战争和新冠肺炎疫情中的临床经历似乎存在相似之处。他们的经历表明，对未来灾难的规划并不精确。从本研究中获得的知识表明，外部因素和个人特质的结合应为未来疫情中的护士和其他医护人员提供支持。
本研究于2023年8月23日在ClinicalTrials.gov上进行了追溯注册，注册号为NCT06012539。
在线版本包含可在10.1186/s12912 - 025 - 03628 - 2获取的补充材料。
