Nurses’ Experiences in Service Provision a COVID-19 Dedicated Tertiary Public Hospital ()
1. Introduction
Experience refers to conscious events in general, more specifically to perceptions, or to the practical knowledge and familiarity that is produced by these conscious processes. Understood as a conscious event in the widest sense, experience involves a subject to which various items are presented. Nurses’ experiences are opportunities and challenges faced by nurses during practical contact. The experience of providing nursing care in this context has the potential to have significant short- and long-term consequence for individual nurses, society and the nursing profession. Service provision is a term used to describe a wide range of activities, including the provision of assistive devices, rehabilitation services, therapy and health services
Nurses are at the forefront of promoting health, advocating for patients and advancing the science of care. The World Health Organization designated the year 2020 as the Year of the Nurse and the Midwife. Organizations within the World Health Assembly such as the International Confederation of Midwives, International Council of Nurses, Nursing Now and the United Nations Population Fund planned to celebrate nurses worldwide, to address challenges nurses face and to highlight nurses’ vast contributions throughout 2020.
The year of the Nurse and the Midwife, however, was quickly overshadowed by the international invasion of the novel coronavirus disease 2019 (COVID-19). The effects of COVID-19 have been felt in and continue to ripple through all areas of the world. Anecdotes continue to emerge as nurses engage in the power of storytelling to share their individual reality of COVID-19. Curating and archiving these pandemic experiences are important and necessary. This study aims to scientifically examine the resilience and experiences of registered nurses (RNs) practicing during the pandemic [1].
Respiratory diseases annually cause about 5 million deaths worldwide; however, an epidemic is likely to increase this number significantly. Recently, these diseases have been associated with viruses such as coronavirus. A novel coronavirus, designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19, was erupted in Wuhan, China, at the end of 2019 The COVID-19 quickly spread throughout the world so that the world health organization (WHO) declared the outbreak a global pandemic on 11 March 2020 (WHO). The spread of the disease has been rapid as such it has become a worldwide pandemic. Since there is currently no valid treatment for this disease, the main approach is symptomatic and supportive treatments, which include keeping vital signs, preserving oxygen saturation and blood pressure and treating complications such as secondary infections or organ failure.
To this end, it is also important to prevent its infection or further spread by individuals travelling to viral epidemic sites through measuring their body temperature and recommending them to have self-care for 14 days [2].
Bangladesh is a low resource country in South Asia which ranks 8th in population and 17th in the order of COVID-19 infection worldwide; its first case was officially identified on 8 March 2020. The doctor to patient disparity is significantly high. The International WHO estimated 3.05 physicians per 10,000 population and 1.07 nurses per 10,000 population in Bangladesh based on the Ministry of Health and Family Welfare Human Resources Development Unit. These numbers show healthcare professionals as among the most vulnerable segment in society who need to be protected in order to continue supporting the healthcare system of the country. However, healthcare professionals are critically affected daily during the pandemic as the increasing numbers of infection and death shows Chan Yeung. In Bangladesh, among frontlines, doctors hold the highest mortality rate from COVID-19 although the actual figure is not available. Thus, it is essential to protect healthcare professionals [3].
The aim of the study is to find out the nurses’ experiences in service provision during COVID-19 pandemic. Nurses’ who were getting PPE, N95 mask, Hand sanitizer, donning-doffing area, hand washing facilities, availability of RT-PCR test, isolation and quarantine facilities or not who has adequate training or not, necessary equipment and facilities available for patient care, workload and working hour also identified. This study also focused mental and emotional condition of nurses when providing care of COVID-19 patient. Therefore, this study gathers adequate information about nurses’ experiences in service provision during COVID-19 pandemic, which will help to our superior in future planning regarding proper management of nursing services and to ensure quality patient care.
2. Materials and Methods
This descriptive cross-sectional study was conducted in one tertiary level public hospital namely Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from January to December 2021.Sample size was n = 376. Data were collected through face-to-face interview using a structured questionnaire containing demographic details and experiences faced by the nurses in service provision during COVID-19. Data was analysed by using SPSS (Statistical Package for Social Science) software version 23.
Inclusion criteria
· Nursing staffs in both sexes who were actively involved to management of COVID-19 patients. · Nurses who were give informed consent to participate. · Nurses who were available in duty time. · Nurses who were willing to participate in this study.
Exclusion criteria
· Nurses who were already suffering from major psychological illness.
3. Results
The findings revealed that the mean age of the respondents was 32.35 ± 7.248 years, the minimum age was 23 years and maximum age was 58 years. About half of the respondents 52.1% were in 21 - 30 years. The majorities 89% were female. More than half of the respondent 72.6% were Muslim and 63.83% of respondents were completed Diploma in nursing. Less than half 48.9% respondents working experience were 1 to 5 years. About 32.2% respondents were living with senior citizen, 33% respondents were infected by COVID-19, 24.23% respondent mention nurse-Patient ratio in general ward was 1:7 and 71.08% mention nurse-patient ratio in I.C.U/C.C.U. was 1:3 (December 2021). PPE were available among 88.0% respondents and N95 mask were available among 84.0% respondent. Hand sanitizer were available among 97.9%, Donning and doffing area were available among 93.6%, Hand washing facilities were available among 96.8%, RT-PCR/ RAT test facilities were available among 94.7%. About 34.8% respondent got COVID-19 guideline training and 32.4% got donning and doffing training. More than half of the respondents 76% stated that equipment is adequate, 91.2% respondent mention that Pulse oximeter is adequate, 75.0% stated adequate of high flow nasal cannula, 99.7% mention adequate of blood pressure machine, 99.5% mention adequate of portable and central oxygen supply, 98.7% mention adequate of suction machine, 39.1% mention adequate of Intubation set, 95.7% mention adequate of emergency medication, 99.5% mention adequate of wheelchair, 97.9% mention adequate of Stretcher, 29.0% mention adequate of Cardiac monitor, 28.2% mention adequate of Mechanical ventilator machine, 44.9% mention adequate of ECG machine, 29.8% mention adequate of Syringe pump and 22.3% mention adequate of ABG machine. 56.38% respondents mention that insufficient of nurses and 53.7% were mention insufficient of subordinate staff. About 22.6% respondents faced social stigma and majorities 96.5% respondent mention they were got proper family support (See Tables 1-7, and Figure 1).
![]()
Figure 1. Distribution of the respondents by availability of equipment (n-376) [8].
![]()
Table 1. Socio-demographic characteristics of the respondents [4].
![]()
Table 2. Job and nursing personnel management related experiences [4].
![]()
Table 3. Resource and facilities related experiences [5] [6].
![]()
Table 4. Training related experience [7].
![]()
Table 5. Distribution of the respondent by adequate of equipment (n-376) [8].
![]()
Table 6. Availability of manpower [9].
![]()
Table 7. Mental and emotion related experiences [9] [10] [11].
4. Discussion
Corona virus disease is a highly contagious disease affecting all population in all ages with high infection transmission rates. Only nurses keep close contact with patient and providing 24 hours service providing service to the COVID-19 patient is very difficult because nurses have lack of COVID-19 guideline training and facilities. This cross-sectional descriptive study was conducted at Dhaka Medical College Hospital, Dhaka. (COVID-19 dedicated), to determine the Nurses’ experience in service provision a COVID-19 dedicated tertiary public Hospital. The study was conducted from January to December 2021. Total 376 samples were collected from Dhaka Medical college Hospital. Samples were selected conveniently for data collection, which was done by face-to-face interview. The data was analysis by SPSS. The Significant findings of the study were discussed below.
The Study shows that the youngest respondents were 23 years of age where the oldest was 58 years of age. The mean ages were 32.35 ± 7.248 years. Most 52.1% respondents were in 21 - 30 years, followed by 37.2% were in 31 - 40 years, 6.6% were in 41 - 50 years, 4.0% were in 51 - 60 years. A study conducted in Bangladesh found minimum age 25 years and maximum age 45 years. (Moustaq, 2021) [8]. The study shows that the majorities 88% were female and 11% were male. Majorities 81.9% were married 17.6% unmarried, 0.3% widow/widower and 0.3% were divorced. More than half 72.6% were Muslim, 26.3% were Hindu and 1.1% respondents were Christian. About 7.7% respondents working experience were below 1 year, 48.9% were 1 to 5 years, 30.9% were 6 to 10 years, 3.5% were 11 to 15 years, 1.3% were 16 to 20 years, 3.5% were 21 to 25 years, 2.7% were 26 to 30 years and 1.6% respondents working experience were 31 to 35 years. More than half 63.83% of respondents were completed Diploma in nursing, 27.13% completed B.Sc in nursing and 9.04% completed M.Sc in nursing/MPH. A study was conducted by Mahmuda, 2021 [9] found that 75% were female and 25% were male that was similar to this study because Bangladesh government allowed only 10% male nursing student, also shows that 85% married and 15% were unmarried. 70% respondent were Muslim, 30% others. Working experience were 6.94 years shows that 70% respondent completed Diploma in nursing, 15% completed B.Sc in nursing and 15% completed MSN/MPH. Both study few numbers of Post graduate respondent because shortage of post graduate nursing institute in Bangladesh.
This study shows that 4.5% were pregnant and 95.5% of participants were not pregnant. Study findings among 308 respondents 10.71% of respondents husband/ wife’s occupation was businessman, 88.31% were service holder, 0.53% were retired person and 0.32% husband/wife’s occupation was student. About 32.2% respondents were living with senior citizen and 67.8% of respondents were not living with senior citizen. Majorities 371 (99%) of respondent’s current designation was Senior staff nurse and 5 (1%) of the respondent’s current designation was staff nurse. This study shows that 18.88% respondents working in medicine department, 32.45% in surgery department, 10.64% in paediatric, 1.60% in cardiology, 17.29% in ICU, 4.79% in CCU,6.38% in gynaecology department, 0.80% in emergency,0 .3% in Dialysis, 1.33% in urology department and 5.59% respondent’s working department in cabin. A study conducted in Hong Kong found that 58.9% respondent were register nurse, 20.5% were advanced practice nurse, 2.6% were Senior nursing officer, 7.7% ward manager, 7.75 nurse consultant and 2.6% respondent were department operations managers, also found 41.0% worked in Isolation ward, 20.6% in Intensive care unit, 23.5% accident and emergency department, 2.9% in Medical and geriatric ward, 14.7% in paediatric ward and 5.1% others role (Janita, 2021) [4].
The Study shows that 11.2% respondent mention he/she more involved in non-nursing work and 88.8% mention he/she is not involved in non-nursing work. In this study shows that among 293 respondents, 17.o6% respondents mention he/she has full responsibility for 5 patients, 18.77% has responsibility for 6 patients, 24.23% respondent has responsibility for 7 patients and 39.93% has responsibility more than 7 patients (actual nurse-patient ratio in ward). This study shows that among 83 respondents, 2.4% respondents mention that he /she has responsibility for 1 patient, 7.23% has responsibility for 2 patients, 71.08% has responsibility for 3 patients and 19.28% respondents has responsibility more than 3 patients (actual nurse-patient ratio in I.C.U./ C.C.U). A study conducted in Bangladesh by Moustaq, 2021 (8) on Experiences of front-line nurses caring for patients with COVID-19 (qualitative study) represent shortage of nursing staff and an increase in the number of patients; (P19) mention a nurse is responsible for more than 40 patient per shift; (P15) stated a nurse in a government hospital typically deals with more than 70 patients. Both studies represent nurse-patient ratio in Bangladesh is higher or across the standard nurse-patient ratio.
The study shows that 88.0% respondents mention that they were getting available PPE and 12.0% told that they were not getting available PPE. 84.0% were getting available N95 mask and 16.0% were not getting available N95 mask. 97.9% were getting available hand sanitizer and 2.1% were not, 92.0% respondents have dress changing room available and 8.0% have not, 93.6% have donning and doffing area available and 6.4% have not, 96.8% have hand washing facilities available and 3.2% have not, 94.7% have wash room and RT-PCR/ RAT test facilities and 5.3% have not wash room and RT-PCR / RAT test facilities. A study conducted by Moustaq, 2021 [8] in Bangladesh represent non-standard Personal Protective Equipment. Respondents narrated the following statement, (p8) opinion my hospital gave me a pair of PPE that were of low quality, so my husband got me two pairs that were of good quality; (p17) told our surgical mask belts sometimes break within hours of use and some mask belts break while wearing the mask; (p20) opinion surgical gloves tear while working; (p14) told Gowns are thick and uncomfortable, and nurses always sweat. It is very in interesting and hopeful that previous study represents lacking of resources but this study represents facilities and resource condition is comparatively better than previous study.
In this study shows that among 376 respondents, 37.2% were getting orientation training and 62.8% were not, 23.7% were getting departmental training and 76.3% were not, 31.1% were getting Infection prevention and control training and 68.9% were not, 34.8% were getting COVID-19 guideline training and 65.2% were not, 32.4% were getting donning and doffing training and 67.6% were not. A study was conducted by Janita, 2021 [8] on Nurses Experiences of caring for people with COVID-19 in Hong Kong shows 89.7% respondent were getting COVID-19 related training and 10.3% were not getting COVID-19 related training. Hong Kong study represent majority of respondent trained up but this study training condition is not satisfactory.
The study shows that 285 (76%) respondents stated that equipment is adequate and 91 (24.20%) told equipment is inadequate to cope with the current situation. The study shows 91.2% respondent mention that Pulse oximeter is adequate, 75.0% mention adequate of High flow nasal cannula, 99.7% mention adequate of blood pressure machine, 99.5% stated adequate of portable and central oxygen supply, 98.7% mention adequate of suction machine, 39.1% stated adequate of Intubation set, 95.7% told adequate of emergency medication, 99.5% told adequate of wheelchair, 97.9% mention adequate of stretcher, 29.0% mention adequate of Cardiac monitor, 28.2% stated adequate of Mechanical ventilator machine, 44.9% mention adequate of ECG machine, 29.8% mention adequate of Syringe pump and 22.3% mention adequate of ABG machine. Moustaq, 2021 (8) study shows lack of necessary medical equipment. The majority of the respondents claimed that there is a lack of necessary medical equipment in the hospital. Such as a BP machine, Pulse oximeter, Thermometer, Syringe pump etc. Participants described the following statement: (p7) mention A thermometer for more than forty COVID-19 patients. Sometimes we only feel by hand whether the patient has a high temperature or not; (p2) mention the nurse take one serial after another to get BP machine and pulse oximeter to check the patient’s vital sign; (p1) opinion we have no enough ventilator machine to save the COVID-19 patient as per patient quality.
The study shows that among 376 respondent, 167 (44%) respondent’s opinion manpower were sufficient and 209 (56%) opinion manpower were insufficient. 36.7% respondents mention insufficient of physician and 63.3% mention adequate of Physician. 212 (56.38%) respondents mention that insufficient of nurses and 164 (43.62%) were mention nurses were sufficient. 53.7% were mention insufficient of Sunordinate staff and 46.3% were mention sufficient of subordinate staff. Moustaq, 2021(8) represent Shortage of Nursing staff.
The study shows that among 376 respondents, 203 (54%) respondents worried about themself due to caring of COVID-19 patient and 173 (46%) were not worried about themself because of caring of COVID-19 patient. 174 (46.3%) respondent mention he/she feel strong pressure because of nurses have full responsibility for the patient and 202 (53.7%) mention he/she were not feel strong pressure because of nurses have full responsibility for the patient. A study conducted by Mahmuda, 2021, (5) represent participant are not wanted to work in infection wards because they were felt anxious. They were felt fear because COVID-19 is a pandemic fatal disease there is no treatment in the world for this reason we were not agreed to work at that time. 304 (81%) respondents mention he/ she feel fear because of more chance of infection and transmission of virus to them and their family members In this study shows that 22.6% respondent opinion that they were getting social stigma or social discrimination. Among 376 respondents, (96.5%) respondents mention that family members were supporting to them and 13 (3.5%) mention were not getting family members’ support. A study conducted by Zohreh, 2020 [10] shows (p2) opinion “I’m not calm at all, and I do not know what’s going on”; (p4) opinion “I don’t think anything good will happen”; (p9) opinion “I haven’t met my family for a long time”; (p8) “I don’t know what my kids are doing now”; (p5, p11) mention “These days, all of our work is hard and people have their own problems” Zohreh, 2020 [10] studies participant mental and emotional condition is not so good but this study respondent mental and emotional condition is comparatively satisfactory because their worried and strong pressure condition is not so good but fear, Social stigma or social discrimination and family support condition is better than previous study. There was a significant association found between Professional educational qualification and satisfaction of current designation (p value = 0.001 < 0.05).
5. Conclusion
Despite the difficult conditions posed by COVID-19 in most countries in the world in general and healthcare workers in particular, urgent preparedness of facilities in such outbreaks is inevitable. The rapid spread of COVID-19 poses a serious threat to human health and is impacting severely public health, global communications and economic systems worldwide. Nurses work on the front line, providing direct care to individuals infected with COVID-19. This cross-sectional descriptive study was conducted with the aim to find out the Nurses’ experiences in service provision at COVID-19 dedicated tertiary public hospital. The study found that significant proportion of the respondents was showing their concern about lack of COVID-19 guideline training, lack of donning and doffing training, lack of infection prevention and control training and also fire, departmental and orientation training. Manpower is not adequate especially insufficient nurses and subordinate staff, high nurse-patient ratio, and fear about more chance of infection and transmission of virus to himself/ herself and their family members. Ensuring the fulfillment of all lacking and insufficiency is essential to provide effective care for COVID-19 patients and future preparedness. The findings of the study will be helpful for the authority in planning for future course of action.
Acknowledgements
I am deeply indebted to my respected supervisor Dr. Mohammad Asraful Alam, Assistant professor, Department of Public Health and Hospital Administration of NIPSOM and express best regards, hearty gratitude and sincere appreciation for his guidance, inspiration and close co-operation throughout the period of this study.
I would like to acknowledge excellent help and assistance from all staff of Department of Public Health and Hospital Administration, and my course mate in both Hospital Management (HM) and Health Service Management and Policy (HSMP) and all the staff in NIPSOM. Finally, I would like to thanks to all respondents who co-operated with me in providing necessary information for the study during data collection period.