COVID-19-Related Effects on the Psychological Well-Being and Resilience of Frontline Expatriate Nurses in the Kingdom of Saudi Arabia: A Qualitative Analysis.

During the global outbreak of coronavirus disease 2019 (COVID-19), the Kingdom of Saudi Arabia (KSA) ranked second in terms of the highest rate of confirmed cases among the Arab Gulf countries. This situation significantly impacted its population, economy, and healthcare system, especially the psychological well-being of frontline healthcare workers, including frontline nurses. However, there is lack of studies on this topic, particularly on the experiences of frontline expatriate nurses in the KSA, necessitating the utilization of descriptive phenomenological design. This study aimed to explore the experiences of frontline expatriate nurses and their influence on psychological well-being while delivering care to patients with COVID-19. The study employed a qualitative, descriptive phenomenological design that adhered to the key features of Husserl's phenomenological approach and purposive sampling to select 17 frontline expatriate nurses. They participated in face-to-face semi-structured interviews. Prior to the 17 semi-structured interviews, written consent was obtained from each of the frontline expatriate nurses. The qualitative data collected were analyzed through thematic analysis and rigor was ensured in this qualitative investigation. Two primary themes were identified from the interviews: (1) psychological effects due to fear of contracting the corona virus, which included two sub-themes pertaining to organizational stressors resulting in having anxiety, depression, fear, mental stress, and stigmatization; and (2) resilience to cope with the challenges brought by the pandemic, which was characterized by three sub-themes focusing on the importance of accurate information, presence of family and social support, and maintaining good health. The expatriate status of frontline nurses is a key factor influencing in their psychological well-being and resilience. Findings indicated that the psychological well-being of frontline expatriate nurses was adversely affected during the pandemic while caring for COVID-19 patients. Consequently, targeted interventions aimed at alleviating the negative psychological impacts of the pandemic are urgently needed to bolster the resilience of frontline expatriate nurses in emergency situations such as the COVID-19 crisis to cope with the associated psychological challenges during the peak of the pandemic, particularly among expatriate nurses.