Stressors and coping strategies among frontline nurses during COVID-19 pandemic.

BACKGROUND: Frontline nurses are more likely to be in close contact with COVID-19 patients and COVID ward duties make nurses to undergo serious emotional disturbances. The physical, psychological, and social well-being of the nurses can be affected in this time and proper training programs and counseling sessions should be undertaken. This study attempts to understand the stressors and coping strategies of nurses from a tertiary hospital. MATERIALS AND METHODS: Descriptive survey design was adopted and data were collected in 2021 from 92 frontline nurses from a selected tertiary hospital in Raipur. The data collection tools used were sociodemographic proforma, structured questionnaire on stress factors, and structured checklist on coping strategies. RESULTS: The analysis was done using frequency and percentage distribution. Among the nurses, 51% reported stressors related work- and work-related environment, 50% reported stressors related to self-safety, and 52% on stressors related to family concerns. The coping strategies adopted by the nurses included realization of the fact that service to patients comes as first (75%), and availability of personal protective equipment kits, confidence in following strict protective measures (69%), talking to family members over phone daily (71%), and support from family and friends (70%). Learning about COVID-19 (65%), and team work (61%) also created confidence to work as frontline nurses during this pandemic. CONCLUSION: The present survey reports that nurses face various stressors and tries to impart different coping strategies to overcome the stress. Understanding their stressors and coping strategies will help the administration to implement measures to create a working situation which will strengthen the health man power resources.

Voice from the frontline and learning for the future: A qualitative descriptive study on wider perspectives of frontline nurses in India during the COVID 19 global pandemic.

Objective: This study was conducted to explore frontline nurses' experiences of the impact of COVID 19 pandemic and suggestions for improvement in the healthcare system, policy and practice in the future. Method: A qualitative descriptive design was used. Frontline nurses who were involved in providing care to patients affected with COVID 19 in four designated COVID units from the Eastern, Southern and Western regions of India were interviewed during January to July 2021. Interviews were audio-recorded and transcribed manually by researchers from each region and thematically analysed. Result: Twenty-six frontline nurses aged between 22 and 37 years with a range of 1-14 years of work experience following a Diploma or Bachelor's degree in Nursing and Midwifery and working in the COVID units of selected regions in India participated in the study. Three key themes emerged: 'Physical, emotional and social health - an inevitable impact of the pandemic' described effects of the pandemic on nurses' health and wellbeing; 'Adapting to the uncertainties' narrated how nurses accommodated to the uncertainties during the pandemic; and 'An agenda for the future - suggestions for improvement' emphasised on practical strategies for the future. Conclusion: The inevitability of the pandemic had an influence at a personal, professional, and social level with learning for the future. The findings of this study have implications for healthcare system and facilities by enhancing resources, supportive environment for staffs to cope with the challenges imposed by the crisis and ongoing training to manage life threatening emergencies in the future.

A Qualitative Study on Frontline Nurses' Experiences and Challenges in Providing Care for COVID-19 Patients in the Volta Region of Ghana: Implications for Nursing Management and Nursing Workforce Retention.

Since the outbreak of COVID-19, studies related to the COVID-19 pandemic have been published widely. However, there are limited qualitative studies in Ghana that explored and shed light on frontline nurses' experiences and challenges in caring for patients diagnosed with COVID-19. This study aimed to explore frontline nurses' experiences and challenges of providing care for COVID-19 patients in the Volta Region of Ghana. This study adopted a descriptive qualitative research design to collect data. We conducted the study among frontline nurses who provided nursing care for COVID-19 patients in the Treatment Centre for COVID-19 cases in the Volta Region of Ghana. A purposive sampling method was used to select fifteen (15) participants for this study. We collected data through individual in-depth interviews facilitated by a semi-structured interview guide. The content analysis approach was used to analyse the data. The results showed: frontline nurses received inadequate information and training during the initial stages of the pandemic; stress and burnout because of inadequate staffing; logistical challenges; stigmatisation by family members and friends; frontline nurses displeased with the decision to exclude other nurses as frontline workers; participants made some recommendations towards supporting frontline nurses for effective management of patients during pandemics. This study revealed an in-depth understanding of the experiences of frontline nurses who provided nursing care to COVID-19 patients during the pandemic. Our study concludes that the frontline nurses experienced both physical and psychological problems while caring for COVID-19 patients at the treatment centre. Some challenges frontline nurses encountered were inadequate information on COVID-19 prevention and management in the early stages of the pandemic, logistical inadequacies, and stigmatisation in providing care for COVID-19 patients during the pandemic, all of which affected the quality of nursing care, work productivity, and efficiency. Therefore, nurse managers need to provide support to frontline nurses providing care for patients with COVID-19.

Interplay of organizational constraints and workplace status in intent to stay of frontline nurses caring for patients with COVID-19.

This study examined workplace status as a moderator of the relationship between organizational constraints and frontline nurses' intent to stay in their profession. Data were collected from 265 nurses working in hospitals designated for caring for patients with COVID-19 across Nigeria. The measurement and structural models were assessed with partial least squares structural equation modeling (PLS-SEM). The results showed a negative relationship between organizational constraints and intent to stay, whereas workplace status was positively related to intent to stay. Further, the relationship between organizational constraints and intent to stay was moderated by workplace status such that it was more positive when workplace status was high rather than low. The results provide evidence for keeping frontline nurses in their profession by reducing the organizational constraints they encounter and elevating their status in their workplace.

Good death disrupted: Nurses' moral emotions navigating clinical and public health ethics during the first wave of COVID-19 pandemic.

AIM: To explore the moral emotions that frontline nurses navigated in endeavouring to ensure a 'good death' for hospital patients and care home residents during the first wave of the COVID-19 pandemic. BACKGROUND: Under normal circumstances, frontline staff are focused on clinical ethics, which foreground what is best for individuals and families. Public health crises such as a pandemic require staff to adapt rapidly to focus on what benefits communities, at times compromising individual well-being and autonomy. Visitor restrictions when people were dying provided vivid exemplars of this ethical shift and the moral emotions nurses encountered with the requirement to implement this change. METHODS: Twenty-nine interviews were conducted with nurses in direct clinical care roles. Data were analysed thematically informed by the theoretical concepts of a good death and moral emotions. RESULTS: The data set highlighted that moral emotions such as sympathy, empathy, distress and guilt were integral to the decisions participants described in striving for a good palliative experience. Four themes were identified in the data analysis: nurses as gatekeepers; ethical tensions and rule bending; nurses as proxy family members; separation and sacrifice. CONCLUSIONS: Participants reflected on morally compromising situations and highlighted agency through emotionally satisfying workarounds and collegial deliberations that enabled them to believe that they were party to painful but morally justifiable decisions. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Nurses are required to implement national policy changes that may disrupt notions of best practice and therefore be experienced as a moral wrong. In navigating the moral emotions accompanying this shift, nurses benefit from compassionate leadership and ethics education to support team cohesion enabling nurses to prevail. PUBLIC CONTRIBUTION: Twenty-nine frontline registered nurses participated in the qualitative interviews that inform this study. REPORTING METHOD: The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.

Barriers and Facilitators Affecting the Uptake of COVID-19 Vaccines: A Qualitative Perspective of Frontline Nurses in Namibia.

Aim: Vaccinations remain one of the most effective measures to prevent and control the spread of COVID-19, while also reducing hospitalizations and deaths, yet many are unwilling to be vaccinated. This study explores the barriers and facilitators affecting the uptake of COVID-19 vaccines among frontline nurses. Design: A qualitative, explorative, descriptive, and contextual research strategy was employed. Methods: A sample of 15 nurses were selected via purposeful sampling to the point of data saturation. The participants were nurses at the COVID-19 vaccinations Centre in Rundu, Namibia. Data were collected using semistructured interviews and analyzed thematically. Results: Three themes and 11 subthemes were identified, namely: (a) barriers, (b) facilitators, and (c) measures to increase the COVID-19 vaccine uptake. Barriers included living in deep rural areas, unavailability of vaccines, and misinformation, whereas scared of death, availability of COVID-19 vaccines, and family influence and peer pressure emerged as facilitators to the uptake of COVID-19 vaccines. Adoption of vaccination passport as a requirement to work premises and as an international travel requirement were the measures proposed to increase the COVID-19 vaccine uptake. Conclusion: The study found several facilitators and barriers to COVID-19 vaccine uptake among frontline nurses. The identified barriers cover the individual, health system, and social factors hindering the COVID-19 vaccine uptake among frontline nurses. Whereas fear of COVID-19 deaths, family influence, and availability of vaccines were found to promote COVID-19 uptake. This study recommends targeted interventions to improve the uptake of COVID-19 vaccines.

Frontline Nurses' Post-Traumatic Stress Disorder and Associated Predictive Factors During the Second Wave of COVID-19 in Central, Uganda.

BACKGROUND: Prior to the COVID-19 pandemic, the Ugandan healthcare system was already under severe strain due to a lack of human resources, poor working conditions, and poor management. At the center of these challenges are nurses, the backbone of the health system. This study investigated post-traumatic stress disorder and associated predictive factors during the second wave of COVID-19 among frontline nurses in the country. PARTICIPANTS AND METHODS: This was a hospital-based cross-sectional study conducted among 601 nurses between May and June 2021. Post-traumatic stress disorder was assessed using PTSD Checklist-Civilian. The bivariate and multivariate logistic regression analyses were conducted to determine the factors predicting PTSD. P-values less than 0.05 were considered statistically significant at 95% CI. RESULTS: The estimated prevalence of post-traumatic stress disorder was 65.7%. In the multivariate logistic regression, the predictive factors of PTSD among the study participants were social support (AOR: 0.49; 95% CI: 034-0.60; p ≤ 0.001), fear of getting infected with COVID-19 (AOR: 3.10; 95% CI: 2.17-4.43; p < 0.001) and increased workload (AOR: 1.65; 95% CI: 1.16-2.34; p < 0.001). CONCLUSION: The results of the study highlight the impact of COVID-19 on the mental health of front-line nurses. Assessing PTSD among nurses may increase the understanding of COVID-19 induced mental health issues. Identifying the risk factors like lack of social support and heavy workload and providing treatment is essential given that various waves of COVID-19 seem inevitable. Supportive strategies like counseling should be provided to the nurses to prevent or manage PTSD.

COVID-19: The effects of perceived organizational justice, job engagement, and perceived job alternatives on turnover intention among frontline nurses.

Nurses' turnover intention has become a concern for medical institutions because nurses are more needed than ever under the prevalence of COVID-19. This research sought to investigate the effects of the four dimensions of organizational justice on COVID-19 frontline nurses' turnover intention through the mediating role of job engagement. We also tested the extent to which perceived job alternatives could moderate the relationship between job engagement and turnover intention. This descriptive cross-sectional study used an online survey to collect data from 650 frontline nurses working in appointed hospitals in Jiangsu province, China. Hierarchical regression was used to analyze the hypothesized relationships. Findings revealed that all organizational justice components significantly influenced job engagement and turnover intention. Job engagement also significantly affected nurses' turnover intention and mediated the relationships between organizational justice components and turnover intention. Besides, perceived job alternatives moderated the relationships between job engagement and turnover intention. The implications of this study include demonstrating that healthcare authorities should respect human rights through effective organizational justice as this approach could encourage nurses to appreciate their job and be more devoted to staying and achieving their institutional duties, especially under challenging circumstances.

An uncertain time: Clinical nurses' first impressions during the COVID-19 pandemic.

The COVID-19 pandemic overwhelmed the US healthcare system and healthcare providers. Nurses, who comprise one of the most affected groups because they are the largest group of healthcare providers, were in a unique position to speak about their perspectives. As a result of the COVID-19 pandemic, nurses have experienced ongoing physical and psychological challenges while displaying strength and perseverance during uncertain times. In this study, we explored the perceptions and experiences of nurses in clinical practice caring for patients diagnosed with COVID-19 during the pandemic. Researchers conducted a qualitative descriptive study with 20 clinical nurses most of whom were enrolled in a graduate program while working in healthcare settings. Semi-structured interviews conducted through Zoom occurred between August 2020 and December 2020. Thematic analysis was used to analyze the transcripts. Five themes emerged: navigating uncertainty, managing death and loss, acknowledging emotional responses, learning opportunities, and facing community undercurrents. Lack of clinical practice guidelines, and inconsistent access to personal protective equipment when providing care to patients with COVID-19 caused emotional strain for nurses and highlighted future learning opportunities. Providing support to dying patients was devastating to nurses. Concern about community misunderstandings of the pandemic created challenges. Evolving teamwork provided invaluable support to study participants. Nurses shared essential information for revising and creating clinical practice guidelines. Nursing interventions and strategies were used to produce humane and positive patient outcomes and provide a foundation for nurse-driven care in possible future pandemics.

Narratives from a pandemic - critical care nurses' experiences of the first wave of COVID-19

Background: When COVID-19 became a global pandemic, critical care nurses were in the frontline. Because the disease was unknown, nurses had to change their routines and usual care. To get insight into the nurses' experiences, we asked them to tell their COVID-19 story. Aim: To describe the intensive care unit nurses' experiences of care during the first wave of the COVID-19 pandemic. Methods: Twelve intensive care nurses were interviewed. Data was analysed using a Ricoeur-inspired approach;quotes were compiled across data with a first-person narrative. Findings: Six themes emerged which gave an insight into the nurses' experiences of nursing care during COVID-19. Conclusion: Findings show that the pandemic affected the nurses' professional assessment in several aspects. Because the nurses were worried about being infected or transmitting the virus to their families, they had to use their professional assessment in relation to their private lives to ensure optimal infection prevention.

Cross-sectional study of traumatic stress disorder in frontline nurses 6 mo after the outbreak of the COVID-19 in Wuhan.

BACKGROUND: Frontline nurses in Wuhan directly fighting severe acute respiratory syndrome coronavirus-2 diseases are at a high risk of infection and are extremely susceptible to psychological stress, especially due to the global coronavirus disease 2019 (COVID-19) pandemic. The psychological after-effects of this public health emergency on frontline nurses will last for years. AIM: To assess factors influencing post-traumatic stress disorder (PTSD) among frontline nurses in Wuhan 6 mo after the COVID-19 pandemic began. METHODS: A total of 757 frontline nurses from five hospitals in Wuhan, China, participated in an online survey from July 27 to August 13, 2020. This cross-sectional online study used a demographic information questionnaire, the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, the Connor-Davidson Resilience Scale, and the Patient Health Questionnaire-4. The chi-square test and logistic regression were used to analyze the association of demographics, COVID-19-related variables, and PTSD. Logistic regression was also conducted to investigate which variables were associated with PTSD outcomes. RESULTS: A total of 13.5%, 24.3%, and 21.4% of the frontline nurses showed symptoms of PTSD, depression, and anxiety, respectively. The multivariate logistic regression analysis showed that the following factors were strongly associated with PTSD: Having a relative, friend, or colleague who died of COVID-19; experiencing stigma; or having psychological assistance needs, depressive symptoms or anxiety. Showing resilience and receiving praise after the COVID-19 outbreak were protective factors. CONCLUSION: Frontline nurses still experienced PTSD (13.5%) six months after the COVID-19 outbreak began. Peer support, social support, official recognition, reward mechanisms, exercise, better sleep, and timely provision of information (such as vaccine research progress) by the government via social media, and adequate protective supplies could mitigate the level of PTSD among nurses responding to COVID-19. Stigmatization, depression, and anxiety might be associated with a greater risk of PTSD among nurses.

Frontline nurses’ appraisal of organizational attractiveness and the role of management support, interdepartmental collaboration climate and service quality of care

Purpose>This paper aims to examine the factors related to organizational attractiveness (OA), a concept originating in the strategy of employer branding. Previous research on OA has predominantly adopted the perspective of external applicants. In contrast, the present study takes the perspective of internal and current employees, extending further the scope of studies on OA.Design/methodology/approach>Quantitative data were collected from a survey consisting of a sample of 164 nurses, all employees of public hospitals. Confirmatory factor analysis and structural equation modeling were used to analyze the data. Furthermore, the indirect effects were tested by mediator analysis.Findings>Interdepartmental collaboration climate, management support and service quality of care were shown to have a positive effect on OA, with the three factors explaining 45% (R2 = 0.45) of OA. The relationship between management support and OA was found to be mediated through the interdepartmental collaboration climate, and that between the interdepartmental collaboration climate and OA was found to be mediated through the service quality of care.Originality/value>This study contributes to an understanding of OA from a current employee perspective. Specifically, it reveals how the three factors of interdepartmental collaboration climate, management support and service quality of care influence and shape the perception of current employees (nurses) toward the attractiveness of their organization.

The lived experience of frontline nurses: COVID-19 in rural America.

AIM: This multisite study describes the lived experience of registered nurses (RNs) caring for coronavirus (COVID-19) patients during the pandemic in rural America. DESIGN: A qualitative phenomenological design was used. METHODS: From January to June 2021, using the purposeful sampling method, 19 frontline nurses were interviewed regarding their experience caring for seriously ill COVID-19 patients in three Upper Midwest tertiary care hospitals. Three doctoral prepared nurses transcribed and analyzed verbatim interviews with data interpreted separately and conjointly. Approved qualitative methods specific to transcendental phenomenology were used. RESULTS: This phenomenological study identified four themes describing the lived experience: (1) feeling of being overwhelmed, (2) feeling of role frustration related to chaos in the care environment, (3) feeling of abandonment by leaders, families, and communities, and (4) progressing from perseverance to resilience. IMPLICATIONS FOR PRACTICE: Significant implications include ensuring frontline RNs are in communication with leaders, and are involved in tactical planning. Leaders can provide a stabilizing presence, build resilience, confidence, and security. Recommendations for additional research are provided. CONCLUSION: Nurses in intensive care and COVID-19 designated medical units had experiences similar to high population United States and international cities. Their shared experience included high volumes of critically ill patients in hospitals frenzied by rapid change, uncertainty, and capacity strain. Differences in the experience of rural nurses included close social connection to patients, families, and community members. This rural connectedness had both positive and negative effects.

Resilience-Need of the Hour for the "Frontliners".

Samavedam S. Resilience-Need of the Hour for the "Frontliners". Indian J Crit Care Med 2022;26(2):157-158.

Mental Health Outcomes of Perceived Stress, Anxiety, Fear and Insomnia, and the Resilience among Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units.

Background: The coronavirus disease-2019 (COVID-19) pandemic has led to a significant disruption in healthcare delivery and poses a unique long-term stressor among frontline nurses. Hence, the investigators planned to explore the adverse mental health outcomes and the resilience of frontline nurses caring for COVID-19 patients admitted in intensive care units (ICUs). Materials and methods: A cross-sectional online survey using Google form consisted of questionnaires on perceived stress scale (PSS-10), generalized anxiety disorder scale (GAD-7), Fear Scale for Healthcare Professionals regarding the COVID-19 pandemic, insomnia severity index, and the Connor-Davidson Resilience Scale-10 (CD-RISC) were administered among the nurses working in COVID ICUs of a tertiary care center in North India. Results: A considerable number of subjects in the study reported symptoms of distress (68.5%), anxiety (54.7%), fear (44%), and insomnia (31%). Resilience among the frontline nurses demonstrated a moderate to a high level with a mean percentage score of 77.5 (31.23 ± 4.68). A negative correlation was found between resilience and adverse mental outcomes; hence, resilience is a reliable tool to mitigate the adverse psychological consequences of the COVID-19 pandemic. Conclusion: Emphasizing the well-being of the nurses caring for critical COVID-19 patients during the pandemic is necessary to enable them to provide high-quality nursing care. How to cite this article: Jose S, Cyriac MC, Dhandapani M, Mehra A, Sharma N. Mental Health Outcomes of Perceived Stress, Anxiety, Fear and Insomnia, and the Resilience among Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Indian J Crit Care Med 2022;26(2):174-178.

Posttraumatic stress disorders and influencing factors during the COVID-19 pandemic: A cross-sectional study of frontline nurses.

AIMS: To assess the extent of posttraumatic stress disorder (PTSD) symptoms and severity, factors motivating work continuation, and factors influencing PTSD development among frontline nurses caring for patients with COVID-19. BACKGROUND: The COVID-19 pandemic has an emotional toll on nurses. Exposure to traumatic events associated with the pandemic places frontline nurses at risk for developing PTSD. DESIGN: Cross-sectional study. METHODS: Frontline nurses (n = 370) who cared for COVID-19 patients in three governmental hospitals in the United Arab Emirates were recruited from November 2020 to January 2021. The self-reported Posttraumatic Diagnostic Scale (PDS) was used to assess PTSD. The motivational factors for work continuation explored were: work-related factors (e.g., availability of personal protective equipment and management recognition), family support, and obligation to care. We used correlation and multiple regression analyses to investigate factors that influenced PDS score, including sociodemographic characteristics (e.g., gender, age, exercising status, and general health status), work factors (e.g., hospital type [COVID vs non-COVID], prior work experience, and encountering deaths), and factors motivating work continuation. The reporting of this study was consistent with STROBE guidelines. RESULTS: In total, 36.2% participants had a probable PTSD diagnosis (PDS score ≥28) with most reporting unwanted memories. Family support (95.9%) and management recognition (90.8%) were the most frequently reported motivating factors. Factors significantly associated with higher PDS score were smoking, lack of management recognition, not exercising, and encountering COVID-19 deaths; the correlation and regression coefficients (b) were significant (p < 0.05). CONCLUSIONS AND IMPLICATIONS FOR NURSING/HEALTH POLICY: Policy makers must expand healthcare policies to address frontline nurses' mental health as a priority during the pandemic. Nurse leaders must be involved in health policy development to protect nurses in anticipation of and during global health emergencies.

Negative and positive psychological experience of frontline nurses in combatting COVID-19: A qualitative study.

AIMS: To qualitatively explore potential experience among frontline nurses who had been fighting against the COVID-19 infection since the outbreak. BACKGROUND: Disasters are often sudden and uncertain. Since the COVID-19 outbreak in Wuhan city, local frontline nurses had been responsible for treatment of COVID-19 for several months. Qualitative study was required to assess complex multi-component psychological experiences among frontline nurses. METHODS: Twenty local frontline nurses were recruited from a designated hospital of COVID-19 treatment. We conducted semi-structured interview using phenomenological method. Descriptive phenomenological method was applied for thematic analysis. RESULTS: Twenty female frontline nurses (aged 24 to 43 years old) were interviewed. Two broader themes, negative and positive, were identified. Negative experience included refusal and helpless (refusal to work at frontline, shortage of confidence in working and helpless), fear and anxiety, excessive miss, and other health issues. Positive experience included improved interpersonal relationship, sublimation of personal faith and strength, changes in understanding meaning of life and new possibility. CONCLUSION: Both positive and negative psychological response were observed, which can provide evidence based clues for making essential strategies and policy. IMPLICATIONS FOR NURSING MANAGEMENT: Understand subjective experience of frontline nurses can establish evidence for development of effective psychological intervention. Nursing administrator should consider the nurses' psychological experience comprehensively to promote psychological growth and lower post-traumatic psychological burden.

The experiences of frontline nurses in Wuhan: A qualitative analysis of nurse online diaries during the COVID-19 pandemic.

AIMS AND OBJECTIVE: To explore the experiences of frontline nurses through analyzing nurse online diaries during the pandemic. BACKGROUND: Over 42,600 healthcare professionals took care of patients with COVID-19 in Wuhan in the initial months between 23 January 2020 and 8 April 2020. Many used to write online diaries on Sina Microblog and still wrote about their experiences in the front line on this site. However, there has been little research on frontline nurses' experiences in the initial months of the pandemic through analyzing their narratives. DESIGN: A qualitative descriptive design. METHODS: A qualitative content analysis was used to analyze online diaries written by frontline nurses in Wuhan. A total of 205 entries in online diaries were collected from 12 frontline nurses, as accessible to those who subscribed to Sina Microblog social media site, between 23 January 2020 and 8 April 2020. NVivo12 was used to help analyze the data, and COREQ reporting guidelines were also used in this study. RESULTS: Two themes were identified: constructing a better self and constructing a strong support network. A better self was constructed in describing positive emotions, commitment to care, pride and achievements, and whole-person growth. A strong support network was constructed through social support via different sources and gaining self-support via narrating their personal experiences in diaries. CONCLUSIONS: Frontline nurses demonstrated personal growth, psychological well-being, and professionalism in the process of constructing a better self and a strong support network. RELEVANCE TO CLINICAL PRACTICE: The findings indicate that frontline nurses can use narratives as debriefing opportunities and a way of gaining self-support. We suggest that online communities of professional support be used as an essential platform for sharing narratives and gaining a more comprehensive understanding of frontline nurses in the COVID-19 pandemic and other global public health events.

Frontline nurses' willingness to work during the COVID-19 pandemic: A mixed-methods study.

AIM: Frontline nurses' willingness to work has significant implications for maintaining workforce stability and quality of care during the COVID-19 pandemic; however, few studies have investigated their willingness and the corresponding reasons. This study aims to examine frontline nurses' willingness to work, identify its predictors and explore its corresponding reasons. DESIGN: A mixed-methods design was conducted. METHODS: Based on a multilevel behavioural-diagnostic model, a questionnaire survey was used to collect quantitative and qualitative data concurrently from 13 February to 24 February 2020 to explore frontline nurses' willingness to work and the corresponding reasons in two hospitals in Wuhan, China. One was a designated hospital which only received COVID-19 patients, and the other was built up temporarily for COVID-19 patients. RESULTS: Of the 2014 participants, most (n = 1950, 96.8%) indicated their willingness to work, and a few (n = 64, 3.2%) expressed their unwillingness. Binary logistic regression analysis identified five predictors of participants' willingness to work, including monthly family income, average working hours per shift, belief in their colleagues' preparedness, belief in their hospitals' preparedness and levels of depression. These indicators explained 27% of the variance (p < .05). Frontline nurses' willingness to work mainly arose from professional commitment, patriotism and faith, while unwillingness to do so primarily stemmed from safety concerns and family responsibility. CONCLUSION: Most frontline nurses were willing to work and showed great professional commitment. IMPACT: Professional commitment and patriotism were two important individual-level factors affecting frontline nurses' willingness to work during a pandemic. Strategies should be implemented, such as appreciating and acknowledging their contribution, rewarding their valuable work, arranging reasonable working hours, enhancing colleagues' and hospitals' preparedness, and providing emotional support. Moreover, adequate personal protective equipment, self-protection training and social support should be ensured to address frontline nurses' safety concerns and family responsibility.