Lived experiences and ensuing notion of staff nurses as COVID-19 survivors in India: A phenomenological approach

Pushpa Oraon; Rajni Thapa; Johny Kutty Joseph; Rupali

doi:10.4103/iopn.iopn_61_21

ORIGINAL ARTICLE

Year : 2022 | Volume : 19 | Issue : 1 | Page : 16-27

Lived experiences and ensuing notion of staff nurses as COVID-19 survivors in India: A phenomenological approach

Pushpa Oraon, Rajni Thapa, Johny Kutty Joseph, Rupali
Department of Nursing, Shri Mata Vaishno Devi College of Nursing, Katra, Jammu and Kashmir, India

Date of Submission	08-Jul-2021
Date of Decision	08-Sep-2021
Date of Acceptance	20-Sep-2021
Date of Web Publication	05-Jul-2022

Correspondence Address:
Mr. Johny Kutty Joseph
Shri Mata Vaishno Devi College of Nursing, Katra, Jammu and Kashmir
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/iopn.iopn_61_21

Abstract

Background: Nurses are central to the entire spectrum of responses to the novel coronavirus (COVID-19) pandemic including the mental health effects of the outbreak. Methods: This study investigated a significant number of Physiological and Psychological Experiences and Ensuing the notion of staff nurses as COVID-19 Survivors using Phenomenological Approach. A total of 12 interviews were conducted with 12 participants. Results: The study result was described into five main thematic categories which included Preparedness for COVID-19, Physiological Experiences, Practices Social Distancing, Psychological Experiences, and Ensuing notion toward pandemic. We found that nurses were presented with mild-to-moderate physiological symptoms of COVID-19 illness. As well as, negative psychological experiences existed in the early stage of recovery among nurses; later they themselves developed optimistic and adjustment approaches to cope up with the situation to stay mentally healthy. Conclusion: In the ensuing notion Nurses' suggested to follow the Universal Precautions, Self coping style and more emphasizes to add herbal and ayurvedic remedies in their balanced diet.

Keywords: COVID-19 survivors, physiological and psychological experiences, staff nurses

How to cite this article:
Oraon P, Thapa R, Joseph JK, Rupali. Lived experiences and ensuing notion of staff nurses as COVID-19 survivors in India: A phenomenological approach. Indian J Psy Nsg 2022;19:16-27

How to cite this URL:
Oraon P, Thapa R, Joseph JK, Rupali. Lived experiences and ensuing notion of staff nurses as COVID-19 survivors in India: A phenomenological approach. Indian J Psy Nsg [serial online] 2022 [cited 2023 Mar 29];19:16-27. Available from: https://www.ijpn.in/text.asp?2022/19/1/16/349889

Introduction

Novel coronavirus (COVID-19) immensely affect the whole world, it disrupts the system of all the countries in terms of financial, occupational, material supply, preparedness, and health care system.^[1] Currently, there has been substantial confusion about the methods of transmission of novel coronavirus (COVID-19), who is at risk of spreading or catching the virus, and where spreads originate (https://www.who.int). These misconceptions may circulate across mainstream media, on social networking platforms or in society, and they can conflict with attempts to respond to public health issues.^[2] Nurses hold a vital function, as one of the most distinguished health service teams, in delivering public awareness regarding disease prevention and in decreasing the dissemination of myths regarding the epidemic.^[3] According to a study conducted via Google forms on knowledge, attitude, and practice regarding the COVID-19 outbreak among health-care workers of India reveal that nurses have sufficient scientific understanding of the pandemic situation and they adhere to the protocol and advisory of the competent authorities in the fight against this pandemic.^[4]

The fiery role played by nurses as frontline warriors in the fight against the novel coronavirus (COVID-19) is commendable. At times of high demand of health workforce to manage patients affected by the novel coronavirus (COVID-19) pandemic nurses are coming forward willingly to work tirelessly for long, uncertain shifts.^[3] The experience of working in an isolation unit could be physically, emotionally, and psychologically draining for nurses.^[3] Although health-care workers tried to fight back the disease in a short period, nurses are facing issues regarding management, work environment, family cross-infection, self infection risk, assault, emotional and physical drain, and psychological stress.^[5] The novel corona virus (COVID-19) epidemic has crossed across the globe in a span of months and the World Health Organization has declared it “Pandemic.” The first known case of novel coronavirus (COVID-19) was reported on 30 January 2020 in India.^[6] The government of India launched measures to curb the spreading of this virus. Mainly, included steps like cluster containment, isolation of cases, and quarantine of contacts.^[6] For all suspected cases had been hospitalized and kept in isolation in designated hospital till lab testing confirm the diagnosis. Hospitalization is extended in isolation wards till two of their samples are tested negative as per MoHFW's discharge policy (https://www.mohfw.gov.in). Isolation here refers to the separation of individuals who are ill and suspected or confirmed of novel coronavirus (COVID-19). In isolation units care is provided tirelessly by nurses round the clock.^[7]

Need of the Study

In countries, health professionals have been severely affected by novel corona virus (COVID-19) such as Italy, Spain, the USA, and India.^[8] Shortage of masks and other forms of PPE have become widespread, putting medical professionals at severe risk. A scarcity of medical workers had also plagued countries that are struggling with the novel coronavirus (COVID-19) pandemic (https://www.who.int). The shortage of medical professionals in India is even direr, and the few that are available are being called on to ration crucial supplies.^[9] Nurses are central to the entire spectrum of responses to the novel coronavirus (COVID-19) pandemic including the mental health effects of the outbreak.^[9] As the largest health-care profession with nearly 3.1 nurses and midwives per 10,000 populations; this is around one-quarter of the World Health Organization benchmark of 22.8 doctors, nurses, and midwives per 10,000 populations (https://www.who.int). Nurses are already addressing the physical and mental health aspects of the pandemic directly through hospital and community patient care.^[10] Health system and nursing leaders must ensure that their clinical nursing staff are protected and supported so that they can provide this crucial dimension of novel coronavirus (COVID-19) care.

The outbreak of the novel coronavirus (COVID-19) as a new infectious disease severely tested the country's public health system.^[7] In this context, medical workers as the main force in the battle against the epidemic, bear the monumental task. Unfortunately, many front-line personnel have sacrificed their own well-being and have been infected or died which causes increasing psychological experience.^[11] According to the MoHFW's India by date (28 August 2020) over 87 K healthcare professionals were infected and 573 died while providing services during the Pandemic.^[12] Due to the sudden outbreak of the epidemic, nurses from the department of infectious disease had to enter the negative ward to care for the patients after only undergoing a brief training on novel coronavirus (COVID-19).^[13] Nurses from other departments were required to go through training stages before starting nursing duties for the patient with novel coronavirus (COVID-19).^[14] Because novel coronavirus (COVID-19) is a new disease, research is needed on the psychological experiences of frontline nurses fighting against novel coronavirus (COVID-19). Therefore, we planned a phenomenological study to study the lived experiences and ensuring the notion of staff nurses as COVID-19 survivors.

Research design

The investigators used Colaizzi's phenomenological method to qualitatively analyze the physiological and psychological experiences of staff nurses who were exposed to COVID-19 while working. Colaizzi's phenomenological approach shares the common findings rather than the individual. This scientific approach guarantees the authenticity of the collected experiences of the participants to adhere to scientific standards.

Study population – Selection and data collection

The telephonic semi-structured interviews were conducted with the participants of the selected health care facility. The participants were approached through prior intimation from September 2020 to November 2020. The investigators requested to hospital authority to provide a list of their staff nurses who became positive with novel coronavirus (COVID-19) infection while caring for the patient which could be utilized in this study as participants. Purposive (homogenous) and snowball methods of sampling were used in this study. The participants' list was obtained for the interview session. Later, few of the participants of the interview were also identified through the snowball sampling technique. Only those participants (staff nurses) were included who were infected with COVID-19 and were provided care to novel coronavirus (COVID-19) patients admitted at the selected hospital. Finally, a total of 12 such participants were included and studied. The inclusion criteria included (1) nurses who provided nursing care for confirmed novel coronavirus (COVID-19) patients and (2) volunteers who participated in the study. The exclusion criteria were the inability to conduct two or more interviews during the study period. Investigators determined the number of required respondents by interviewing nurses who met the inclusion criteria until the data were saturated and no new topics were generated. Finally, a total of 12 such participants were included and studied.

Data were collected by an in-depth interview. Interviews were conducted from September to November 2020. The interview protocol was developed, tested, and revised as per the guidelines provided by Jacob and Furgerson (2012). Verbal consent was taken beforehand from the interviewees for recording the interview. As well participants were explained the purpose of the study. Semi-structured interviews were used to collect the data. Interviews were conducted by a member of the research team and then shared with other members of the team to extract the themes. All interviews were conducted through video conferencing. In some cases, if there was any ambiguity, a phone call was made after the interview. Interviews were conducted at a time convenient for the participants. Interviews lasted from 30 min to 45 min. The criterion for stopping sampling was data saturation. The interview protocol narrowed down to five sections, namely “preparedness for covid-19,” ”physiological experiences,” ”practices social distancing,” ”psychological experience” and ”ensuing notion.” Demographics were also collected before the start of the interview. The open-ended questions allowed the interviewees to freely share their experiences. The recordings were transcribed verbatim in form of textual data, which were subjected to thematic analysis.

Analysis and presentation

To analyze the data, the content of recorded interviews was written word by word. Preliminary data were repeatedly and simultaneously retrieved by the study team members to give a general understanding of them. Then, they were analyzed by continuous comparison and inductive analysis. Finally, subcategories, main categories, and themes were summarized. After the coding process, categorized codes and meanings derived from them were interpreted as the theme. Noted discrepancies among various clusters, avoiding the temptation of ignoring theme that does not fit. Formulated an exhaustive description of lived experiences of staff nurses who were exposed with novel coronavirus (COVID-19) while working as clear statement of identification as possible. At the end ask all the participants about the findings so far as final validation. In this study, data validation was improved by respective participants.

Ethical considerations

This study was approved by Project Evaluation Committee with a reference number of SMVDCoN/PEC/2020/129. Principles of presenting objectives of the study to the participants, confidentiality of information, obtaining informed consent for conduction of the interview, and recording of the conversation, and the right to withdraw from the research at any stage were followed in this study.

Results

A total of 12 interviews were conducted with 12 participants. The demographic profile of participants revealed that the majority (67%) of the participants were female nurses with the median age being 26 years and median years of work experience being 5 years (range 1–5 years); 83% of the participants had a bachelor degree of nursing education and the rest had above bachelor degree education; 66% appointed at a designation of nurse assistant.

Totally, 444 codes were produced without calculating the overlaps. For more accurate coding and facilitating the study process, code merge was performed; and eventually, 20 codes were remained, which were placed in 10 subcategories. Ultimately, five main thematic categories were obtained. Thematic categories were conceptualized as (1) preparedness for COVID-19 (2) physiological experiences, (3) practices social distancing, (4) psychological experiences (5) ensuing notion: Adopted coping strategies. [Table 1] demonstrates the process of extraction of this theme from categories, subcategories, and codes, which is as follows:

Table 1: Themes, subthemes and codes in relation to COVID-19 survivors

Click here to view

Theme: Preparedness for COVID-19

Organizational preparedness

Training program for infection control

COVID-19 Team was formed in the selected setting during pandemic which deals with providing training to health care personnel's before placement in the COVID-19 ward. All participants have undergone training for novel coronavirus (COVID-19) which comprises the source of infection, prevention of cross-infection, donning and doffing, utilization of PPE kit, masks, entry and exists ways, self-prevention at their residence, etc. The following is an example of participants' quotations: ”I got training of donning and doffing and how to deal with situation thoroughly taught by COVID-19 TEAM of our hospital.” (P₇).

Managerial support during pandemic

When managers showed an understanding of employees' needs, preferences, and circumstances when it came to work arrangements, employees felt it provided the individualized support they needed to help them accomplish work goals. This practice appreciated, recognized, and appraised by every participant was especially relevant at the beginning of the pandemic and remains true as the crisis continues. A participant said ”Hospital management support was fantastic; they provide everything, quality PPE kits, free testing, well equipped hygienic quarantine centres and healthy nutritious meal.” (P₂).

Individual preparedness

First instinct/first response/first inclination

Exploring the first instinct that nurses felt after the allocation of their duties in the COVID-19 ward. Majority of the participants mentioned that they perceived stress, anxiety and fear initially when they were allocated to work in the COVID-19 ward reflecting the danger of getting the infection. Rest of the participants mentioned that they felt prepared in regard to patient and self-care because they themselves were a part of the COVID-19 Team. The verbatim of participants in Major mentions is as follows: ”Yes, I was stressed initially by listening news of pandemic because outside the country COVID-19 warriors were getting infected also.” (P₆). Minor mentions ”I was a member of COVID-19 Team, If I scared who will take initiative”.(P₃).

Theme: Physiological experiences

Participants experienced mild-to-moderate symptoms, but the patients they cared like older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes were at higher risk for developing more serious complications from COVID-19 illness. The most commonly mentioned physiological experiences were feverish (low, moderate, high) pains and aches in the muscles, chest and entire body, dizziness and tiredness, headache as well as loss of smell and taste. Other physiological experiences shared by the COVID-19 survivors' but with fewer mentions were loss of appetite, difficulty in breathing, cough (severe, persistent, and dry), cold and chills, and sore throat. In addition, these symptoms last for 11–15 days. Besides, after effect also reported such as body aches and weakness lasts for 2 months even after getting the negative report. Major Mentions:”Initially, I was suffered with frontal headache and body aches, next day I got fever (101°F–102°F), feeling of tiredness and dizziness were also present to the extent that I was not able to get up from my bed even though my taste and sense of smell were also diminished which lasts for 10 days.” (P₄) ”My symptom started with severe body-aches while doing duty in the ward, next day I got positive report and the severity of body-aches increased gradually and remains even after negative report which came on 11^th day.”(P₇).

Minor mentions

“At first, I was suffered from high-grade fever with cold, chills, and sore throat. Persistent dry cough was also present, and after 2 days I was having complaint of breathing difficulty for that I took steam inhalation and practiced prone position to relieve respiratory discomfort as advised by my wife who is working as an RN in UK which helps to ease discomfort.”(P₉).

Theme: Psychological experiences

COVID-19 is associated with a very high rate of infectivity, which has led to a high level of fear and anxiety of getting infected. Resultantly, the pandemic has led to severe restrictions on the free movements of human beings and the lockdown of almost all countries across the world. Positive Mentions: Emerging compassion, courage, and resilience: Nurses have always played an important role in infection prevention and control. Providing these aspects of care at this capricious time the nurses were working under enormous pressure to battle this life-threatening viral infection. Worryingly it is clear that many of these nurses and health care professionals are not only fighting with the virus, they are also fighting the humanitarian crisis and putting their own lives on the line. The courage, compassion, work enthusiasm, and resilience of these staff nurses are commendable because when they were asked by the investigator about “would they like to continue their duties in the COVID-19 ward?” The psychological resilience of these nurses was on a great extent. As they answered “I'm a health personnel, and I ought to do my duties. Following full precautions and protocol I will carry my duties if I denied as a nurse who will take care of sick ones” If I am scared who will care.” Hopeful of not dying: The nurses experience positive learning about their life because they are able to sustain physiological and psychological during their COVID-19 viral infection. As well as they developed the insight that anything can happen in their life and nothing to worry about the death because they sought that their colleagues who were infected with this viral infection were also recovered to their normal state of life after 11–15 days period; among them, no one experience severity of the disease and none of them were hospitalized as this creates hope of not dying among our participants. As when our participants were asked about “are you afraid of dying due to COVID-19 viral infection”? The answers were remarkable as one of the answers is as: ”I am not afraid of dying due to COVID-19 viral infection because I have seen many of my friends and colleagues were recovered and back to their normal duties after 11–15 days period.”(P₁₂).

Cared for and motivated

During isolation, all the participants were satisfied with the care provided by their hospital management, COVID-19 Committee team, and friends as they were provided with provision of self-monitoring, medication, three times balanced meal, well-equipped isolation center with the facilities to be used their mobile phones, internet surfing, TV watch areas and recreational areas (with strict social distancing norms). They were also allowed to express their needs and feelings with management team members, colleagues, and friends. Along with that, all the nurses were approached by management team members for their well-being and requirements which makes them motivated and being cared for. As participant said ”During isolation, my friends helped me a lot they provided me the food and other things which I told them telephonically”(P₂)” I would like to mention that team members helped me in every aspect they usually called two times a day and asked for my well-being and for the required things”(P₁₀).

Negative mentions: symptoms of worry, anxiety, stress, fear, worry, and thinking too much about pandemic

Most of the participants at the initial phase experienced some negative thoughts related to the symptoms of the disease as they were thinking it wouldn't happen to them because they have provided with proper PPE kit and supplies and they have followed isolation and standard precautions during the care of sick ones. Majority of the participants expressed that lot of chaos created by the media which showed that in other hospitals of India and all around the world the health-care system was struggling and imbalanced. Many media channels reported that young doctors, nurses, and other health-care professionals were dying as the situations were out of control so this creates anxiety and stress amongst them for self-life threat as well as the risk of affecting and spreading the infection to family and loved ones. Many of them worried about the severity and duration of the disease as till that time there was no availability of specific treatment and vaccination and many new certain strains of viruses were evolving without any control. The participant's mentions are: ”I was worried about my symptoms because lower limbs pain was severe however once I thought of might be I have the rheumatic infection.”(P₁) ”I am scared of being re-infected because I don't want to go in isolation again” (P₃).

Social stigmatization and misapprehension

Nurses reported that as COVID-19 stigmatized because of the negative approach by the society related to the spread of the infection in their areas as they consider health-care workers would be the main source of infection. Therefore, many of the nurses did not reveal their health status to their family members. Majority of the female nurses have some fear and misapprehension that if they inform their family members about themselves they would be called back to home which can lead to cross-infection to their family members and also they perceived their family members would be more anxious than them so better to conceal the information. “I never directly told to my parents that I'm positive with COVID-19 symptoms because I felt that they would be more anxious about me, they would take only tension and can't take any action and I managed by self.”

Theme: Practices social distancing

Social distancing also called “physical distancing,” means keeping a safe space between persons. COVID-19 spreads mainly among people who are in close contact (within about 6 feet) for a prolonged period. Spread happens when an infected person coughs, sneezes, or talks, and droplets from their mouth or nose are launched into the air and land in the mouths or noses of people nearby. A practice of quarantine and isolation keeps such people away from others so they don't unknowingly infect anyone in their vicinity. Herewith the participants who were positive with COVID-19 were kept isolated at quarantine centers of hospital premises. Clinical interventions adopted and quality of care during recovery: The participants received the optimal supportive and symptomatic care and they themselves include the herbal remedies in their diet. As said by the participant ”I was provided with Tab. Paracetamol SOS, Tab vitamin C OD; Capsule Evion OD, Multivitamins OD, Tab Azythromycin OD. Also, I preferred steam inhalation as it gave me intense relief. In addition with I took Kadha (ayurvedic), turmeric milk, Ginger lemon tea, warm drinking water more often which help me a lot.”(P₅).

Meet the challenges

The period of 21 days in self-isolation would have been the most challenging to deal with for COVID-19 Survivors because they were away from their families. No amount of face time and digital immersion can kill the evil of loneliness. Participants perceived apathy due to isolation as they reported that they were feeling bored, would keep on moving inside their rooms, and look outside through their rooms' windows, they expressed difficulty in passing their time initially for the first 2–3 days of Isolation; later they Adopted mind relaxation approaches and new ADL'S. Participant Verbatim “However, I can say after suffering this it is not possible for everyone to stay alone in a room as it creates boredom. I was irritated and stressed in one room and one building, even though I was not in mood to talk with others.”(P₂) ”At first for 2–3 days I was getting bored, but I have planned daily activity schedule for myself and started to follow morning online yoga classes, exercises, reading books, interact with friends and family members, playing online video games, watching movie on the mobile phone.”(P₁₁).

Theme: Ensuing notion: Adopted coping strategies

Strategies to thrive

As COVID pandemic striking all over the world creating panic situation among the public, but the frontline warriors accepted the challenges and took the initiative to deal with it. While battling with the infection they developed their own coping strategies to handle their stress, panic situation, and uncontrolled negative thoughts and developed themselves their own new strengths. As they felt that following strict COVID-19 prevention protocol given by the WHO was necessary for them to prevent further spread of disease along with that they felt the need of homemade remedies were very effective in controlling the symptom of disease along with intake of allopathic medicine. ”I have followed symptomatic treatment as prescribed but in addition, I emphasize more on steam inhalation 2–3 times a day, also includes Kadha (ayurvedic), turmeric milk, ginger lemon tea, and warm drinking water.”(P₂) ”During isolation I followed social distancing norms with colleagues, wearing N95 masks every time and cleanliness and sanitization of each item before and after use.”(P₅).

Suggestion to cope

Maximum participants recommended that wearing the mask in hospitals and in public places is the most important practice in the prevention of the spread of COVID-19 infection. Second, they emphasize on social distancing followed by sanitation and cleanliness of hospital articles/surfaces and home items. The participant mentions ”I would like to say that everyone should follow universal Precautions strictly in Hospital and Public premises especially by those people who are taking this disease over granted.”(P₆) ”My suggestion is if anyone wants to protect themselves from this viral infection they must wear mask every time and everywhere” (P9).

Adjustment mechanism

During isolation of COVID-19 infection, some of them developed negative emotions which they overcome by themselves to reduce the stress by adopting various mechanisms such as focusing on meditation, online yoga, exercise, progressive muscle relaxation techniques, recreational activities such as listening to music, reading motivational books, mobile surfing, interacting with friends as social media, watching entertainment channels on television with avoidance of news channels. ”I did Meditation, Yoga, Progressive muscle relaxation, exercise to spend time during isolation period.”(P₅) ”I adopted the hobby of book reading, Internet surfing which saved me from Boredom” (P₁).

Life transformation: flourish patience, willpower, developed positive coping insight

Most of the participants experienced that this duration of infection brought life transformation change in them by flourishing their patience will power to battle their own worries and anxiety, overcome their own weakness and they felt new insight was developed in them to handle any life and death situation like this.”Now I can say after combat this infection I'm enough confident to handle any situations like this at my level.”(P₅) ”Likely before, I got panic easily; at the present time, I am feeling ample positive strength inside me after battling with this infection” (P₁₂).

Discussion

This study investigated a significant number of physiological and psychological experiences and the ensuing notion of staff nurses as COVID-19 survivors using phenomenological approach. A total of 12 interviews were conducted with 12 participants. The study result was described into five main thematic categories which were “preparedness for COVID-19,” “physiological experiences,” “practices social distancing,” “psychological experiences,” and ensuing notion toward pandemic.”

The first thematic category was Preparedness to COVID-19. This focuses on two dimensions such as organizational preparedness and individual preparedness. It showed that the staff nurses have received training on COVID-19 from the COVID-19 training team which was formed by their respective authority during the pandemic as recommended by the CDC. The training focused on how to properly put on and take off their PPE to protect themselves and ultimately to fight against COVID-19 (https://www.cdc.gov). In addition, staff nurses appraised the management role to understand the employee's needs preferences and circumstances to accomplish the work goals during the pandemic. While, exploring under the subcategories of individual preparedness, the first instinct that nurses felt after the allocation of their duties in the COVID-19 ward was assessed. Majority of the participants mentioned; they perceived stress, anxiety and fear initially when they were allocated to work in COVID-19 ward reflecting the danger of getting the infection. These findings are consistent with another similar study by Al Baalharith and Pappiya in 2021.^[15]

The investigators identified the physiological symptoms experienced by the study subjects. It was reported that participants had mild to moderate symptoms as mentioned were feverish (low, moderate, high) pains and aches in the muscles, chest and entire body, dizziness and tiredness, headache as well as loss of smell and taste. In addition, these symptoms last for 11–15 days. Besides this, after effect of COVID-19 was also reported such as body aches and weakness which lasts for 2 months. Our findings of the actuality of physiological symptoms in our nurses were in contrast to the result of several studies which reported severe dyspnoea presented among nurses.

The study found some of the psychological experiences of the participants while recovering from the novel coronavirus (COVID-19). The reported experiences revealed that many of these participants had a negative mental health experience initially, while few had a positive mental experience. The study found that symptoms of worry, anxiety, fear, stress, worry, and thinking too much about pandemic, social stigmatization and misapprehension were common negative psychological experiences present in the early stage of recovery among many of the COVID-19 survivors. This could be due to the life-threatening nature of the virus which causes hundreds of young health professionals' deaths across the globe (https://www.who.int). Furthermore, the study found some positive experiences developed in the later stage of recovery among nurses which were extracted in code as emerging compassion, courage and resilience, hopeful of not dying, cared for and motivated. In this study, nurses' psychological experiences developed in the early and later stage of recovery were consistent with the study of Sun et al. in 2020.^[13]

In the thematic category of practices social distancing; the nurses' who were positive with COVID-19 were kept isolated at quarantine centers of hospital premises. The participants received the optimal supportive and symptomatic care and they themselves include the herbal remedies in their diet. Participants perceived apathy due to isolation as they reported that they were feeling bored, would keep on moving inside their rooms, and look outside through their rooms' windows, they expressed difficulty in passing their time initially for the first 2–3 days of isolation; later they adopted mind relaxation approaches and new ADL'S. It is quite evident from the various case studies (Reagu. et al. in 2020)^[16] of COVID-19 survivors, that isolation and quarantine centers hampered the psychological support and create a negative impact of quarantine on patients.

The psychological adjustments adopted by the nurses during their recovery were also detected under the thematic category of ensuing notion (adopted coping strategies); then the four subcategories were made as per the response of the nurses such as strategies to thrive, the suggestion to cope, adjustment mechanism, life transformation (flourish patience, will power, developed positive coping insight). Majority of the nurses felt that their strategies to thrive in this situation and the common reason of their fastest recovery were following the COVID-19 prevention protocol to prevent further spread of disease; along with that, they felt the use of homemade remedies were very effective in controlling the symptom of disease in addition of conservative treatment. As well, the nurses' suggested that wearing the mask in hospitals and in public places is the most important practice in the prevention of the spread of COVID-19 infection. Second, they emphasize on social distancing followed by sanitation and cleanliness of hospital articles/surfaces and home items. It is very common for isolated people to experience acute mental issues while recovering from an infection. The participants had tried to overcome from these acute mental health issues by adopting optimistic approaches such as focusing on meditation, online yoga, exercise progressive muscle relaxation techniques, recreational activities such as listening to music, reading motivational books, mobile surfing, interacting with friends on social media/phone, watching entertainment channels on television with avoidance of news channels. Besides this, after recovery from viral infection nurses' believed about life transformation changes in them by flourishing their patience, willpower to battle their own worries and anxiety, overcome their own weakness and they felt new insight was developed in them to handle any life and death situation like this. The nurses' optimistic approaches adopted during recovery were steady with the study of Olufadewa et al. which showed that positive emotions and optimistic approaches play an important role in recovery and reducing psychological trauma [Annexure].^[13],[14]

It was suggested that any pandemic situation like COVID-19 may endanger the world at any time. Hence, the front-line health care workers must be prepared physically and psychologically to combat such situations. Only training is not sufficient to battle any novel disease there should be also a provision of psychological strengthening of the nurses before assigning them such duties, during critical working hours. Overall, the investigators noted that the experiences of our participants selected from single setting were different at some level in contrast to other study findings.

Strength and weakness of the study

This is the first study conducted in India which explores the Physiological and Psychological experiences of staff nurses as COVID-19 survivors. This study is limited by virtue of scope, as the respondents narrated their individual experiences which might not be reflective of the broader population at large. Further, participants were chosen form single setting and were selected using the snowball sampling technique, which may lead to skewed samples representative of certain specific healthcare settings and environments. Utmost care has been taken in recording and coding the narratives of the respondents, analyzing the textual data, and presenting them in the form of templates. Researcher's biasness and their reflections in the study cannot be ruled out.

Conclusion

This study provided a comprehensive and in-depth understanding of the Nurses' perspectives to conquer the battle of the novel coronavirus (COVID-19). Nurses physiological, psychological and ensuing notions (adopted coping strategies) were assessed through a phenomenological approach. We found that nurses were presented with mild-to-moderate physiological symptoms of COVID-19 illness. As well as, negative psychological experiences existed in the early stage of recovery among nurses; later they themselves developed optimistic and adjustment approaches to cope up with the situation to stay mentally healthy. In the ensuing notion nurses' suggested to follow the universal precautions, self-coping style and more emphasizes to add herbal and ayurvedic remedies in their balanced diet.

This study provided fundamental data in regard to thrive in this situation positively with minimal trauma and fastest recovery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Annexure

Semi Structured Interview Schedule

sociodemographic variables:

Code No. and Name,
Age
Professional qualification
Designation
Joining date
Working experience
Area of working.

Semi-structured Interview (Questionnaire)

Section-A (regarding work area):

What you first felt while you were assigned to work in COVID-19 ward?
When you settled down with your routine after assigning in COVID-19 ward?
Did you get training before posting in COVID-19 ward?
What was the severity of COVID-19 positive patients?
For how many hours and weeks you have worked in COVID-19 ward?
What was the length of care of COVID-19 patients in days?
Have you get tested for COVID-19 after completing duties of COVID-19 ward?
What experience did you get while caring for a patient diagnosed with COVID-19 (Physiological and Psychological)?
Do you want to say anything about PPE kit?
Did you get any extra support from you team members?

Section-B (COVID-19 Exposure)

Part-1 physiological experiences:

Did you ever experience any symptoms of flu since March 2020?
If experienced, have you gone for testing? Yes or No, If No why?
How and when you get infection and what could be the source?
What was the reason for testing and Source of payment?
What were your symptoms?
When you get your first negative test after exposure?
Did you get any reinfection?

Part-B (isolation and quarantine):

What was the duration and place of quarantine during treatment?
Did you get extra nutritious diet during quarantine? (immune booster)
What was your daily routine during quarantine? (Physical activity, sleep, recreation, social Interaction and mode, personal Hygiene, cleaning and hygiene of quarantine room)
Did your daily vital monitoring was done during quarantine?
What was your feeling during quarantine?
Which treatment was prescribed for you?
Did you take any herbal or ayurvedic remedies?

Part-C (psychological experience):

What were your insights/feelings in the face of COVID-19 exposure? (Sleep, Anxiety, Fear related to death and severity)
Did you informed your family members (yes/no) and with whom you have shared your information, If yes, what was their reaction, If no, Why?
Do you have a fear of getting infected again?
Do you like to continue your services in COVID-19 ward again?
What has changed in your life?

Ensuing notion: Coping abilities:

Could you please explain your view on your coping strategies adopted to thrive in a crisis situation?
Now what you feel about yourself your strength and abilities related to crisis
What was your expectation during the whole course of treatment?
What is your suggestion how the situation should be handled in a better way
How do you cope with changes in your work and life?
Do you like to give appreciation that helped you during this pandemic?
What precautionary measures should be followed to prevent reinfection?
In your view what were the lackings during the crisis and how it should be rectified.

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