“Like working on the battlefield”:Experiences of nurses during emerging infectious disease epidemics

Both historical epidemics and the current 2019 novel coronavirus pandemic (COVID-19) have placed tremendous pressure on nurses worldwide. Section One reports a qualitative systematic literature review and thematic synthesis exploring the lived experiences of nurses during historical epidemics and COVID-19. Five databases were searched at two time-points to locate both existing and emerging papers; sixteen studies across five distinct diseases met requirements for inclusion. Within an overarching meta-theme of “working on the battlefield”, four themes were developed: 1) “under pressure and on the verge of collapse”; 2) “our duty was lifesaving”; 3) “wholehearted support” vs “stay away from here”; and 4) “everything was unknown and unknowable”. Of novel importance is the overarching battlefield context. The experience(s) and impact(s) of a lack of choice in “volunteering” to care on infection wards are similarly novel. Qualitative research into nurses worldwide is needed; this synthesis is limited in generalisability as studies explored nurse experiences in majority-Eastern contexts. Section Two reports an empirical study investigating the relationship between moral distress and compassion satisfaction in critical care-based nurses during COVID-19. The mediating effects of team psychological safety and emotional regulation on this relationship were also investigated. Participants (N = 276) completed an online survey comprising of self-report measures of these variables. Mediation analysis revealed that the impact of moral distress on compassion satisfaction can be partially attenuated by higher team psychological safety, which was related to increased compassion satisfaction among nurses in two mediation paths. Four additional COVID-19-specific root causes were synthesised: Restrictions on either caregiving or dignity due to infection control measures and/or workload, knowingly placing other staff into distressing and/or unfairly demanding situations, and taking responsibility for redeployed staff members’ mistakes. Section Three includes a reflection of the author’s relationship to the research topic, and the relevance of the research to clinical psychology