Abstract
Background
Objective
Methods
Findings
Conclusion
Keywords
1. Introduction
World Health Organization. WHO announces COVID-19 outbreak a pandemic [Internet]. Euro.who.int. 2020 [cited 2022 May 12]. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic.
World Health Organisation. WHO Coronavirus (COVID-19) Dashboard [Internet]. Covid19.who.int. 2022 [cited 2022 May 12]. Available from: https://covid19.who.int.
World Health Organization. WHO announces COVID-19 outbreak a pandemic [Internet]. Euro.who.int. 2020 [cited 2022 May 12]. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic.
World Health Organisation. Saudi Arabia: WHO coronavirus disease (COVID-19) dashboard with vaccination data [Internet]. Covid19.who.int. 2022 [cited 2022 May 27]. Available from: https://covid19.who.int/region/emro/country/sa.
2. Methods
2.1 Study design
2.2 Study context
2.3 Sample
2.4 Ethical considerations
2.5 Data collection
2.6 Data analysis
2.7 Role of researcher and reflexivity
3. Findings
Characteristic | n (%) |
---|---|
Gender | |
Male | 10 (45.4) |
Female | 12 (54.5) |
Age group (years) | |
20–25 | 2 (9.0) |
26–30 | 3 (13.6) |
31–35 | 15 (68.1) |
36–40 | 2 (9.0) |
Nationality | |
Saudi | 4 (18.1) |
Non-Saudi (expatriate) | 18 (81.8) |
Years of ICU experience | |
0.5–5 | 5 (22.7) |
6–10 | 11 (50.0) |
>10 | 6 (27.2) |
Educational level | |
Diploma | 2 (9.0) |
Bachelor's degree | 17 (77.2) |
Master degree | 3 (13.6) |
Number of children | |
0 | 9 (40.9) |
1 | 5 (22.7) |
2 | 5 (22.7) |
3 | 3 (13.6) |
3.1 Pandemic pervasiveness

Second- and third-order categories | Supporting quotations | |
---|---|---|
Family context | Fear/and concern of transferring the virus to their family | ‘When I was posted in the ICU the main concern for me was family.’ (RN04) |
‘We have family and we are working here and then we are going there. So from inside we are doing all precautionary measures even though we are scared about our family for transmitting the infection to them.’ (RN05) | ||
Family status | ‘I took visa for my mother and my father, [but] then the travel ban [was] announced, so they couldn't come.‘(RN13) | |
Family responsibility | ‘My mother is sick she is really near to be bedridden I hope not but she really needs care. Me and my little sister and my four brothers are all in the medical field and I feel like we have to stay with her rather than going [on] duty here I have to arrange my off days with my sister so we can take care of her. Each time I am doing duty I know my mother is sick and she needs me.’ (RN06) | |
Work context | Staff shortage | ‘We are doing 12-h shifts, and most of the time we are handling two patients, since the manpower was not there once we shifted a patient, we will get a new admission, so these are the most stressful things.’ (RN03) |
‘I am working here since 2014 but when I go to another department, I feel like I am a new staff. Floating is so difficult for nurses.’ (RN03) | ||
‘We were having long continuous duties, normally we will have 3-day duties and then 2 days off, but during the peak of covid-19 we used to work for 14–15 days continuous and that was very stressing.’ (RN13) | ||
Team conflict | ‘Physician is acting as everything like he's ruling out nurses, this is not right. And he should listen well to the nurse care plan, because the nurse is the primary care giver for the patient.’ (RN12) | |
‘Onetime I had one patient and there were two consultants so one doctor asked for one order, and I did that order, but the other consultant came and say why you are doing this, so this create a clash …. Then you have to explain for them oh god, the clash will happen.’ (RN03) | ||
Lack of support Blaming the staff for being infected with COVID-19 Lack of financial support | ‘And if the nurse get the infection, they will blame [her/hem], they will say “why you get the infection?“ … They will tell there is a break in your precautions.’ (RN16) | |
‘There is no difference between my salary and OPD staff. I don't have critical area allowance, I don't have hazardous allowance, so there is no difference. Here in ICU, more workloads and we are receiving the same salary.’ (RN17) | ||
The nature of the work during the pandemic Fear of infection Lack of PPE Prolonged use of the PPE Witnessing patient’ death and suffering | ‘It's torture, that you are always exposing yourself to the virus, and you might get infected anytime. And you didn't know how your body responds. And yeah, some of our staff here died.’ (RN01) | |
‘We didn't have many supplies like face masks and PPE. The hospital provided its maximum but sometimes we didn't have these supplies like masks, and it was difficult for bedside staff.’ (RN03) | ||
‘We have to always wear the PPE, not just wear, but the proper wearing of PPE and you know it's suffocating.’ (RN01) | ||
‘We saw patients, very young patients, who deteriorated within one day and expired. So, that was very stressful.’ (RN08) | ||
Changing Policy and guidelines | ‘At the beginning the guidelines were changing rapidly, they told (infection control department) no need to wear facemask and if you wear facial mask infection control will come and will catch [you], then after one week they told “you have to wear complete PPE and N95 face mask”.’ (RN03) | |
Discrimination against As result of infected with covid-19 or handling COVID-19 patient (from colleagues) And racial discrimination (from patient or Colleagues) | ‘After I come back to work, they (colleagues) will be afraid that maybe I still have the symptom[s] and maybe I [am] still a carrier.’ (RN21) | |
‘They (some patients) have a problem with other nationalities, and they consider us like a servant.’ (RN20) | ||
‘They will do groups with each other, the Indian nurses, the Philippino nurses. If she is covering nurse of her same nationality, she will let her take a break for 2 h, especially at night shift. If I went for a break, she would say, “Why are you late[?]".’ (RN22) | ||
Wider world context | Lockdown | ‘When they closed all the social facilities and things, I felt like this is a dangerous thing. So, this also put us under stress.’ (RN20) |
‘There was the lockdown, and we could not go outside. We were going to work, and we were going to home, and we didn't have anything to refresh ourselves, we were really stressed and because of stress we could not concentrate on working properly.’ (RN08) | ||
social gathering bans and social distancing | ‘Even outside the work, we also have to follow social distance measures so this is our problem it is like we can't breathe.’ (RN07) | |
Unknowingness | ‘The most burden for us is the disease itself. It's a new phenomenon, new thing, so we didn't know what this was.’ (RN07) | |
News and social media platforms | ‘When [we] listen to the news and [hear] that cases are increasing like this, we get afraid.’ (RN07) | |
‘It was spreading very fast and what we're seeing, videos in the TV and the new channels, it makes us more afraid, the media is making us more afraid, people are getting panicked with this.’ (RN08) | ||
Prolonged pandemic situation/patient resurgences | ‘The stress is there because the third wave was started and again with vacation, we have a problem, also we have more cases coming so again its difficult.’ (RN13) |
3.1.1 Family context
Most of us have families, so we actually were afraid because after duty we will go home, so this was a concern for us. (RN03)
I was about to bring my family here, so I postponed this plan also; all because of this situation, so it was a bit stressful situation for me, and at that time I was quite depressed. (RN04)
We are far too far [away] from our family; we feel separated.' (RN 10)
I’m alone; my family [is] staying in India. So I’m afraid for my family and my kids, and if something happened to me also, who will take care of me? (RN08)
That was the hardest for me, actually, not just in the pandemic but in my whole life. It was the hardest because … my dad got hospitalized with pneumonia, COVID pneumonia; he stayed there for two weeks. At that time, I was very, very afraid, afraid something will happen to him, [when] I am very, very far. (RN01)
The main problem nowadays is that online classes [are] ongoing. Our children are not fit for that, they like to go to school and study. I have two boys, one of them refuses to attend the online classes alone. So, this [is] also one of the problems. (RN09)
I cannot take care of my kids, my home, even my son who is in the first year of the school, so I decided not to renew my contract here. (RN19)
3.1.2 Work context
3.1.2.1 Staff shortage
The staff shortage problem is the main, biggest problem; it's the main cause for stress, and burnout. (RN02)
3.1.2.2 Team conflict
The charge nurse [has] conflicts with the staff, especially over assignment because some staff will refuse to take care of COVID-19 patients. “Why will I take this patient? He is infected [and] I am immunocompromised [and] taking steroids" they will say. (RN15)
3.1.2.3 Lack of support
It’s not about how we get infected because obviously no one wants to get COVID. It happens, and they shouldn’t, like, [be] blaming [us]; they should [be] supporting [us]. They shouldn’t blame. (RN13)
The hospital didn’t give us COVID-19 money. For 2 years we didn’t receive the money. (RN10)
3.1.2.4 The nature of the work during the pandemic
My patient passed away, then I received another patient from the ward. But when I shifted him to the bed he crashed. We started CPR for him. It was stressful for me. This was my first mortality and my second mortality and it’s in the same day! This impacted me for a very long time. (RN02)
3.1.2.5 Changes in policy and guidelines
There is also social distance protocol, so infection control will catch you if you don’t follow that protocol ….but if I am away from my colleagues like two meters, how I will endorse the case to her? She will not hear me, I need to show her the computer, the lab and medications. (RN07)
3.1.2.6 Discrimination
We are doing everything, and [they are] still behaving as we are servants; really, they treat us like we are servants, no respect, so that [is] the time when we get stressed. We are very polite when treating them, handling them, caring [for] them, but still they will say "get out" [and] they spit. (RN13)
If I received a COVID patient and they received a ‘normal’ patient they will be afraid, they will not come with me they will not eat with me at lunch. (RN18)
3.1.3 The wider world
4. Discussion
- Lobo S.M.
- Creutzfeldt C.J.
- Maia I.S.
- Town J.A.
- Amorim E.
- Kross E.K.
- et al.
- Havaei F.
- Ma A.
- Staempfli S.
- MacPhee M.
- Brooks S.K.
- Greenberg N.
- Wessely S.
- Rubin G.J.
- Rayan A.
- Sisan Mm
- Baker O.
- Dye T.D.
- Alcantara L.
- Siddiqi S.
- Barbosu M.
- Sharma S.
- Panko T.
- et al.
5. Limitations
6. Conclusion
Conflict of interest
Funding
Credit authorship contribution statement
Data availability statement
Acknowledgements
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