MINISTRY OF HEALTH

MINISTRY OF EDUCATION

AND TRAINING

HANOI MEDICAL UNIVERSITY

PHANI THI DUNG
PERCEPTION AND BARRIERS OF INTENSIVE CARE

UNIT NURSES IN COMPREIlENSIVE Care during
COVTD-19 PANDEMIC IN HANOI MEDICAL
UNIVERSITY HOSPITAL. VIETNAM

GRADUATION THESIS

BACHELOR OF SCIENCE IN NURSING
Advanced Program in Nursing

2016-2021

Supervisor.

Assoc. Plot. Hoang Bui Hai. M.D, Ph D
Mai Thi Hue. MPH

Hanoi. 2021

TW jfcfc «s. ■>

iii

AC K NOWLEDG EM E NT
I would like to express my deepest gratitude to my supervisor. Assoc.

Prof. Hoang Bui Hal. M.D. Ph.D and Mrs. Mai Thi Hue. MPH. for the
excellent guidance, caring, patience and providing with tlie tremendous

support during this research.
I am also grateful to all lecturers m the Institute of Intensive care and
Emergency department, Hanoi Medical University for their comments, helps

and supports.

I would like to express my sincere thanks to all hospital staff in
Intensive CaieUnit at Hanoi Medical University Hospital for their facilitation
in data collection process.

I place on my record, my sincere gratitude to all members in the research

team for sharing expertise, valuable support and encouragement extended to me.

Hanoi. May 5’b. 2021
Thesis author

Pham T1Ũ Dung


iv


DECLARATION
I hereby declarethat this thesis is composed by myself, which has not
been previously submitted, either in a pan or in full, for a degree to any other

institution or university. As far as 1 know, material has been previously

published or written by other persons are not contained in my thesis except
where reference has been shown in the text.

Hanoi. May 5*. 2021
Thesis author

Pham Thi Dung

-w .ã* CN ôG


V

CONTENTS
ACKNOWLEDGEMENT

ill

DECLARATION

iv

CONTENTS ••••• ••• ••••••••


LIST OF TABLES.

•••••

••
••

•• •

•’

•••••••••••a \

... ...... vm

T»

ix

IN 1 kODCTON...................

ãããããã ô

ãã

........... 1

ã ãM


CHAPTER 1: LITERATURE REVIEW
1.1 Comprehensive care model........

1.11. Comprehensive care definition

••• ••••

3
3

1.12. Comprehensive care and the COVID-19 pandemic.......... 3
1.12.1. Overview of the COVID-19 pundemi c.................. 3
1.12.2. The situation of comprehensive care before the

c OVID-19 pandemic............................ -............................... 5
1.12.3. The situation of comprehensive care during the
COVID-19 pandemic................................

8

1.2. The nursing role in comprehensive care............. ................................9
1.3. The barriers of nurses in comprehensive cares...-............................ 10
1.4. Comprehensive care in ICƯ, Vietnam........... .................................. 11
CHAPTER 2: SUBJECTS AND METHOD................ -............................ 13

2.1.

study time & setting.....................................

13


2.2.

Study participants........................................

13

2.3.

Studydesign-......... ............ -...............

13

2.4.

Study instruments.....................................................

14


vi

2.5.

study parameters —............................................

15

2.6.


Data collection.......... .................................. ..........

16

2.7.

Data analysis

........ ...........

18

2.8.

The trustworthiness of a qualitative research....

20

2.8.1. Credibility of this study.......................... _...

20

2.82. Dependability of Ulis study.

••

!•

2.83. Transferability of this study
2.9.


21

Ethical consideration

22
3.1. General cliaracteristics of participants

22

3.2. The barriers of nurses performing Comprehensive care in Intensive
care unit during the COVID-19 pandemic...... ............................25

3.2.1. Banners related to insufficiency of human resource........ 26

3.22. Barner related to ovet whelmed and stressed by the nursing
workload.

—.................................. .................................. 29

3.23. Barrier rdated to the unprofessional structure of the ICƯ35
3.2.4.

Barrier related to

non-cooperation

of tile

patient’s


relatives.......................................................................................... 37
3.23. Barner related to the uncertainty and anxiety of being
infected COVID-19 and infecting others........-........................... 38
3.3. The perception of nurses about comprehensive care in the ICƯ

during COVID-19 pandemic • ••••••••••••••••••••••••••••••••••••••••••••••••••• 41

3.3.1. The participant's perspective about the future nursing
care model...... ’ •• • •- •••••• •• •••••••••••••••••••••• ••••••«••••••«• •••••« «• • •• «• • •• •••«•••» 41


3.32. The expected factors that should be available to achieve
comprehensive care in the future.................

42

CHAP I ER 4: DISCUSSION.......................................... .......................... 46
4.1. General characteristic of stud}’............................

46

4.2. The barriers of nurses performing comprehensive care in the ICU
during the COVID-19 pandemic....................

48

4.2.1. Ranier related IO insufficiency of human resource.......... 49

4.22. Barrier related to overwhelmed and stressed by the nursing


workload

50

4.23. Barrier related to the unprofessional structure ofthe ICU51
4.2.4.

Barrier related

to

non-cooperation

of the

patient's

relatives........................................................................................... 52
4.23. Barrier related to the uncertainty and anxiety of being
infected with COVID-19 and infecting others..............................53
4.3. The perception of nurses about comprehensive care in the ICƯ

during the COVID-19 pandemic...............

54

4.3.1. The participant's perspective about the future nursing care
model


...H....34

4.32. The expected factors that should be available to achieve
comprehensive care in the future.................

55

4.4. Limitation Of this study....................................

56

4 5. The research proposal..
CONCLUSION......................................................

RECOMMENDATION........................................ ....................................... 59
REFERENCES......................................................

........................................ 1

APPENDIX.........................................................................................................


viii

LIST OF TABLES
Table 2. 1 The stud}- parameters.......................................

-................ 15

Table 3. 1 Participants' demographic information................


22

Table 3.2 Characteristics of the study participant.......... .......

24

Table 3. 3 Main themes reflecting the barriers of nurses performing

Conxpt ehens ive care in ICC’ during COVID-19 pandemic.-.......................... 26
Table 3.4 Barrier related to insufficiency
• of human resource. —.....................27
Table 3. 5 Barner related to overwhelmed and exhausted by the nursing

workload.................

—................30

Table 3.6 Barrier related to the unprofessional structure ofthe ICC............ 35
Table 3. " Barner related to non-cooperation of the patient’s relatives..........37
Table 3. 8 Barrier related to the uncertainty and anxiety of being infected
COVID-19 and infecting others. —..................................

39

Table 3.9 The participant's perspective about the future nursing care modcl41
Table 3. 10 The expected factors that should be available to achieve

comprehensive care in tile future


....... 43

Table 3. 11 Human resources factor that should be available to achieve
comprehensive care in the fixture.... ..................................

43

Table 3. 12. Medical materials factor that should be available to achieve
comprehensive care in the future....................................................................... 44


ix

LIST OF FIGI RES
Figure 2. 1 The process of Qualitative data collection....... -........................... 17
Figure 2.2 The Qualitative research process....................... -........................... 19

-w .ã* CN ôG


X

LIST OE ABBREVIATIONS
COVID-19

Coronavirus disease 2019

HCWs

Healthcare workers


ICƯ

Intensive care unit

HXflJH

Hanoi Medical University Hospital

WHO

World Health Organization

-w .ã* CN ôG


INTRODUCTION
Comprehensive pattern care is a highly nursing healthcare model which

has been widely developed in many parts of the world to meet the increasing
demand of patients. Its principles are based on the combination of both the

clinical treatment and non-treatmenT aspects which include personal hygiene,
daily diets. and mental care [ 1 ].

While this model of care has been fundamentally well-established in

high-income countries such as the United States, the United Kingdom

Australia, and the Netherlands [2J. [3 J. [4]. [5]. it is quite a vague concept ill


many

resources'

constraint

countries.

Particular^.

in

Vietnam,

the

implementation of comprehensive care has only been constricted to highly

standardized, private hospitals: and most public hospitals have been absent or
incomplete of this healthcare model. In fact, several nursing cares associated
to non- treatment aspects have been realized by patient's relatives.
ỉn 2013 and 20 Id. Nutan Potdai el al performed studies in the Intensive

care unit (ICV) of Krishna hospital. India regarding multiple barriers
experienced by nurses and doctors when providing comprehensive care for
patients. They revealed that increased workload, less equipment and lack of
human resources were major baniers for medical staffs [6]. [7].

The complex progression of the coronanius disease 2019 (COVID-19)


pandemic has catastrophically been a global health care burden. In addition,

nursing care lias consequently changed to adapt to tins new situation. To
accommodate. the Vietnamese nurses in the 1CU have fluff ly practiced

“comprehensive care" that consisted of unacccpting the assistance of the

patient's relatives as a dedicated model for COVID-19 care.


There- has so far not beefl any understanding related to the comprehensive
caie in Vietnam especially in the ICL’ during the COVID-19 pandemic. Thus,
we conducted this study with 2 objectives:

ỉ. Tơ describe barriers of nurses in comprehensive care during the
COi 'ID-19 pandemics in the Intensive Care I nil at Hanoi Medical

I nrversity Hospital, I ietnam from October to Nos ember 2020.
2. Jo understand these nurses' perspectives uhout comprehensive care
during the C0Ĩ1D-19 pandemics in theIntensive Care I’nlt at Hanoi
Medical University Hospital, Vietnam from October to November

2020.

TWM*M«K> ■> *4:


3


CHAPTER 1: LITERATURE REVIEW
1.1. Comprehensive care model

1.1.1. Comprehensive care definition

Comprehensive care is an advanced healthcare model worldwide tliat

has been widely acknowledged as the best way forward to achieve the integral
healthcare demand of multimortid patients [1Ị. [8], [9]. [10], [11]. [12]. In
addition, comprehensive care can be defined as active initiatives seeking to

structure and coordinate care and improve health outcomes while limiting

health care expenditures [IJ. Many different terms are being applied for

comprehensive care consisting

of integrated

care, care according

to

guidelines, cases and general care management. Moreover, the models are
considered comprehensive if they meet several of the health care needs of

people with multiple chronic illnesses, functional disabilities, and/or high

levels of health care utilization and if the health care services are provided by
numerous HCWs [12]. Multiple theories have been proposed to "patient-


centred cure" as a comprehensive care criterion [ 10). [ 11 ]. [ 12].

Its principles are based on the combination of both the clinical
treatment and non-treatment aspects which include personal hygiene, daily

diets, and mental care. Thus, comprehensive health care is alwajs considered
as an essential part of every health facility as a mean to pranote treatment

outcomes o f pat rent s [ 1 ].

1.12. Comp reh enũve care and the co VII) 19 pandemic

1.12.1. Overview of the COliD-19 pandemic

According to World Health Organization (WHO). the COVTD-19 is an
infectious disease caused by a newly discovered corcnavirus. It has ưiggered
off a worldwide pandemic of a respiratory illness that was first identified in

December 2019 in Wuhan City in China [13Ị.


4

This novel coronavirus is stnrcturaly associated with the virus that

causes severe acute respiratory syndrome (SaRS). Tins has also been
explored in prior studies that these symptoms of COVID-19 can range from a
mild cold to moderate diseases, even life-threatening. In addition, fever,


cough, and fatigue are the most common symptoms at the onset of COVID-19

illness

while

other

symptoms

include

sputum production,

headache,

haemoptysis, diarrhoea, dyspnoea, aid lymphopenia [14], [15], [16], [17].
Moreover,

previous

studies

have

emphasized

that

person-to-person


transmission is a primary infectious pathway for COV1D-19 [17]. [18]. The

spreading occurs primarily via direct contact or through diopiets by coughing

or sneezing from an infected individual. The critical solution to prevent and
slow transmission is to have a proper perception of the COVID-19 virus, the
disease it causes, and how it spreads. Protect yourself and others from
infection by washing your hands or using alcohol-based detergents frequently
and not touching your face as suggested by' WHO [19], Additionally,

mamtannng a distance of at least I meter between yourself and others is also
the best way to reduce the risk of infection when they cough, sneeze or speak.

Maintain greater distance between yourself and others when indoors. Make
wearing a mask normal part of being around Ollier people. The appropnate

use. storage, and cleaning or disposal are essential to make masks as effective
as possible.

Ou top of that, a large number of recent studies have recognized tlrat
COVID-19 is the latest threat to global health is the ongoing outbreak of

respiratory disease. Indeed, it lias affected nearly every region of the work!
and by March 6. 2021, there have been 115 289 961confirmed cases

worldwide. with the deaths of more than 2 564 000 people; 2 4SS confirmed


5


eases and 35 deaths have been reported in mainland Vietnam and as known as
having clusters of cases of transmission classification [19],

Therefore, health- care workers (HCWs) have played a vital role in

every country Their health and safety are crucial not only for continued and
safe patient care but also for controlling any outbreaks [20]. However, health
care providers during a severe COV1D-19 outbreak have been under

extraordinary stress and barriers associated with a high risk of infection,
stigma, lack of staff, and uncertainty. For instance, the follow ing studies were
conducted on HCWs’ experiences. Front-line medical staff who take care of

patients with COVID-19 are al increased risk for mental health problems,
such as anxiety, depression, insomnia, and stress [21]. Frontline doctors and

nurses with no expertise in this infectious disease face additional challenges
as they adapt to a completely new work environment in these stressfill

situations. This has also been explored in prior studies 111 2020 by Yicen Yan
and his colleagues, insufficient and excessive protection will have adverse

effects on the skin and mucous membrane of healthcare workers [22].

J.U.2. Dre situation ofcomprthaaive care before the COHD-19
pandemic
By enhancing the quality and continuity of care, comprehensive care

aims improve patient health outcomes, while at the same time creating


efficient use of healthcare resources.

There have been numerous

studies

to investigate overview of

comprehensive care programs pfTfornrd for patients with multiple chronic
diseases indicated that evidence of their effects on patients and caregivers is
inconsistent [12], [23], [24]. [25], [26]. [27], [28]. In most of these reviews,

the criteria for inclusion in the studies were rather narrow in multiple
countries. Studies axe considered to be of high quality if they meet five


6

criteria: design's strength (review. meta-analysis. or controlled trials with the

equivalent concurrent control groups). adequacy of tile sample (representative
sufficient number), the validity of measures, rd lability' of data analysis

techniques, and rigor of data analysis.
Some reviews LU general consist of randomized controlled trials [12],

[24], [26], while others only evaluated the impact of programs on patient
outcomes [12], [26]. [27]. [28] or included studies showing positive effects of
comprehensive care programs that have shown tire potential to refine quality,

efficacy, or health-related outcomes of care for patients were identified [12],
Furthermore, most reviews provide limited information aboui the content of

the comprehensive care program. Therefore, relevant information from the
non-randomized trials and information on the impact programs have on
caregiver outcomes is barely summarized.

Besides there were inconsistent results of comprehensive care in

multiple countries, each country also had mixed effectiveness. In 2015. an
"evidence check” rapid review brokered by the Sax Institute for the
Australian Commission on Safety' regarding the best available research
evidence for the effectiveness of comprehensive care in acute settings as

defined. By providing an iterative, systematic, step-by-step approach to gain
insight into the characteristics and effectiveness of these new comprehensive

care programs for patients, they emphasized that tile new comprehensive care
standard will incorporate the following three elements: systems to support

care: development of comprehensive care plans: delivery of comprehensive
care and quality in health care. In addition, they found 16 articles, of which
regarding tlieir effects, the results were mixed and consisted of 12 (75%) were

of moderate to high methodological quality, thr ee (18.75%) were of moderate


7

qualty. and one (6.25%) was of low quality. All were relevant for. and

generalizable to. lite Australian acute care settings and populations [29].
Additionally, little is known about program features tliat may be

relevant to positive outcomes of care and about the groups of patients who

may benefit most from comprehensive caie. For instance, the effectiveness of
comprehensive care was comparable or more positive than that of ordinary

care. This has also been explored in a prior systematic study in multiple
electronic databases for English language papers published between January
1995 and January 2011 by De Bruin and his colleagues [1] dial die profitable

effects of comprehensive care on inpatient health care utilization. Besides,
evidence is also found for the positive effects of comprehensive care on

patient health behaviour. perceived quality of care, and satisfaction of patients
and caregivers. Insufficient evidence lias been found for the profitable effects

of comprehensive care on quality of life related to mental health, outpatient
healthcare utilization, medication use. and healthcare costs No evidence was
found fox the profitable effects of comprehensive care oil cognitive function,

depressive symptoms, fiinctionai status, mortality, quality of life on physical
function, and caregiver burden.

Despite the fact tliat several (good quality) studies have been performed

ovex the years to estimate the value of comprehensive care for multi modal
and or frail patients, there is insufficient evidence for the efficacy' of which.
More good-quality studies and oi studies that enable mcta-analysis are needed

to determine which particular target groups will benefit from comprehensive

care. Furtlierniore. evaluation studies can be improved by utilizing more
appropriate outcome measures, for example. measures related to care goals

defined by patients (individuals).


8

However. this information is critical because of growing interest in

what will help the best care for patients with multi morbidity. especially in the
ICU which supports and improves patients’ health with multimodal and/or
frail.

A number of questions regaldmg the effectiveness of comprehensive
care in JCU remain to be addressed. Rarely public research in this area IS

performed not only in Vietnam but also in over the world. Instead of that, it

was developing knowledge in specific units such as the endocrinology unit

[2 J. mental health unit [3]. gerontology unit [12]. [23J. et. Unfortunately,
tliese mentioned studies are not available for Vietnam. Therefore, evaluating
and improving rhe quality of care and the urgency of implementing a new-

comprehensive model at ICƯ in Vietnam is a difficult challenge.
J.U.3. The situation of comprehensive care during the COỈ1D-Ỉ9


pandemic

The

COVID-19

was

declared

with

a

rapid

global

outbreak.

Unfortunately, a large proportion of infected patients need admission and
comprehensive management, however. the knowledge about the effectiveness

of comprehensive care as well as barriers of medical staff accomplishing this
model on those patients have been generally limited, especially in ICƯ.
While it is clear tliat incomprchensive care could weaken treatment efforts in

every health facility, this issue is far worse in the ICU. including in Vietnam

w hen ÚMC COMD-19 outbreaks occur. As nurses are now-. in the context of

COVID-19 pandemics, the medical staff cannot depend on patients* relatives

fot non-treatment supports.

In Vietnam, the consequence of the COVID-19 pandemic has led to a
demand for the medical staff that has to adopt a new concept of patient care.
Particularly, ICU in several central Vietnamese hospitals, including Hanoi


9

Medical University Hospital (HMƯH) to designate comprehensive cate as a

dedicated unit for COV1D-19 care, which fulfils care accomplished based on

the significance of patient safety without the support of patients' relatives.
1.2. The nursing role in comprehendve care

Nunes play a crucial role in the evaluation and implementation of

comprehensive cate which contributes a lot to the panent healing process.
Nurses not only maintain the patient safety and decrease mortality but also

pros ide extensive quality sen ices to reach their satisfaction. Even though
there are competent physicians present in die institution. It would not be

adequate when deficiencies the appropriate nursing care. Nurses have 24-hour
contact with patients as well as near to them, so they are seen like the

frontline Accordingly, the patients have the orientation to expect more from


them and nurses should also respond to patient's needs with competence and
compassionate access. If tire patient is denied appropriate care tile treatment
process is obviously compromised on this path assessing barriers and critical
care units while providing nursing care is vital to identify the obstacles to the

nurses in their wort: environment and to improve rhe nursing services at rhe

sanr time.
Furthermore, in the cOVID-19 stages,

die duty

of nursing is

increasingly on a remarkable point. Each patient has various characteristics
and manifestations that require nurses to maintain critical thinking and make

decisions properly.
Moreover, working in a completely new context to prevent the

spreading of coronavirus that made nurses prov ide the accmate and promptly

care for multiple patients including patient with COVID-19; suspected
patient; non COVID-19 patient.


10

1.3. The barriers of nurses In comprehensive cares


As we have known. since care has an effect on cultutal economic. and
social factors, tliere are diverse bamers in the realization of care. Especially in
Asian countries, family traditions are maintained and highly respected, they

assume one of tile ancient conceptions that the sick bosjxtahze all trust and

empower their relatives for no- treatment care. Therefore, fora long time, the

patient's family members occupy a significant position in the treatment

process as well as improve the patient's mental health. They play a vital role
in helping patients with basic needs: observe and report the patient’s

condition, personal hygiene, feeding, roil over, urine monitor, make a warm

compress when the patient get fever, mobility support, mental support... In
addition, relatives will not be secure when we are not directly involved in

taking care of and observing the paiient. Because of that idea, health workers,
including nurses, have uncompleted the sufficient function, especially in the

noirtreatmenl care: basic personal needs, daily diets, and mental care
Insufficient care has a strong relationship with the quality of caje,
Furthermore, most problems related to not completing a task arise from
reasons: available supporter resources from the patient's relative: the serious

lack of staffing and workload [30], A recent study in 2Ơ1Ó by Nuran Pordar
and his colleagues assessed the barriers perceived by medical staff to


comprehensive nursing care in ICU of Krishna Hospital Karad. The result of
it shows tlwt tile correlation between stresses that are faced by docton and

nurses during working are significantly associated with the barrier to
comprehensive care in ICC. In addition, it concluded tliat
workloads,

less equipment,

increased

and supplies in diverse attitudes

among

colleagues, and fewer staff-patient ratios are major barriers for doctors and

nurses (7]


11

Besides, healthcare providers are critical resources for patient health

improvement iliat cannot be ignored. Tlieii health and safely ate crucial not
only for continuous and safe patient care, but also for control of any outbreak.

However, health-care providers caring for patients during the severe acute

respiratory syndrome (SARS)and Middle East respiratoiy syndrome (MERS)

outbreaks were under extraordinary’ stress related to high risk of infection,

stigmatisation, understating, and uncertainty, and comprehensive support

w as a high priority during the outbreaks and afterwards.
Quantitative studies have shown that frontline healthcare providers
Heating patients with COVID-19 have greater risks of mental health

problems, such as anxiety, depression, insomnia, and stress [21]. Frontline
doctors and muses with no expertise in this infectious disease face additional
challenges as they adapt to a completely new work environment in these
stressful situations.

To our knowledge, no qualitative studies of the barriers of these
healthcare providers have been published performing comprehensive caie

during

the

COXTD-19

pandemic.

To

assess

the


effectiveness

of

comprehensive care to them, it is necessary to gain insights into their
experience and the bar riers they have met.

Ỉ.4. Comprehensive care ỉn lev. Vietnam

To respond, the Ministry of Health issued Decision No. 123QD-K2DT
in 2013 aimed at promoting comprehensive care in Vietnam Accordingly,

continuous training materials and programs would be available for healthcan?
staff

to

update

knowledge,

skills,

and

promote

altitudes

towards


comprehensive care [31 ]. Unfortunately, the implementation of comprehensive
care has only been constricted to highly standardized, private hospitals; and

most state hospitals have been absent or incomplete of this healthcare model.


12

Nurses’ daily tasks in Vietnam are. in nature. heavily* involved in clinical
treatment. with little focus oil non-treatment aspects.

The complex progression of the coronavirus disease (COVID-19)

pandemic in Vietnam and the consequent demand to adapt inpatient care
provided to this health emergency led ICU in a few central Vietnamese
hospitals, including Hanoi Medical University Hospital (HMUH) to designate

comprehensive care as a dedicated unit for tire COVID-19 care, winch fillfils

care accomplished based on tire significance of patient satisfaction without the
support of patients' relatives.
In lire primary response to COVID-19 crisis in Vietnam. the ICU at

HMUH has strived to separate illness inpatients from their relatives who have
a high risk of the COVID-19 crisis from the public as much as possible. This

implementation is to minimize the ability of inpatients to get COVID-19 from

tile community. Tile subsequent challenge was smooth operation with the new

and unstandardized model while coping with human resources shortage and

work overwhelming.
Although there are several studies on models of care designed to

accomplish these goals, no consensus exists on which models can improve

clinical outcomes in the ICU. Such consent, when reached, may inform our

ailing healthcare system reform efforts and helps to shape the services offered

by increasingly popular.


13

CHAPTER 2: SUBJECTS AND METHOD
2.1.

Study time & setting

The study was conducted in the 1CU at HNÍVH. Vietnam from October
to November 2020.

2.2.

Study participants
We recruited all nurses working in the ICƯ at HMUH who were

accomplishing comprehensive cane for patients during the COVID-19

pandemic.
Jhchuian criteria:

• Nurses

working in the

ICV "-ere

directly

practicing

in

comprehensive care for patients.
■

Out of vacation time and during the COVID-19 episode

"

Nurses were willing to participate in

■ Nurses had the ability to implement an online interview through

Zoom meetings.
Exclusion criteria:
■


ICU nurse in an administrative position and head of ICƯ nurse

■

Nurses refused to participate in the study or online interview-

through Zoom meetings
2.3.
•

Study design
A qualitative study wus performed to describe barriers of nurses in
comprehensive care and understand these nurses’ perspectives on

comprehensive cate during the COVID-19 pandemics III the ICƯ.
•

Data collection was by group interviews via the internet based on the

Zoom meeting platform In which, using sound and image recording
function of this software. Then the raw data was transcribed from the

audio data to textual data.


14

•

All audio recordings and transcripts were saved on a password­

protected computer.

2.4.

Study instruments

We used a semi-struemred questionnaứe (15 questions) to collect

information regarding studs objectives. The questionnaire was included three
main sections: (1) General information. (2) Barriers when providing

comprehensive care for patients (3) Nurse’ perspectives about comprehensive
care.

(1) General information: nurses were asked to provide information regarding
age. gender, wot king position, years of experience, education levels. (7
questions)

(2) Barriers when proriding comprehensive care for patients: nurses were
asked to provide their views and thoughts about what you do even' day to
lata? care of your patients before COVID-19 jwndemics? What do you do

even day to take care of your patients currattly when COVID-19 occurs?

What are the differences between before and after COV1D-19 pandemics in

tbe nay of caring for patients? What difficulties that you have been facniH to
take care of the patients during COXTD-19 pandemics? What kind of support

do you receive during COVID-19 TO be able to fulfill your current need of

care? (5 questions)

(3) Perceptions about comprehensive care: What is the idea of nursing care
should be in the future? What do you think about die feasibility of integrating
standardized comprehensive cate protocols in your department? What factors.'

conditions/ ingredients should be available to achieve comprehensive care? (3
questions)


15

Besides, another study tool was Zootn meetings Software and all participants
had a computer or smartphone that can enroll the online interview through

zoom meetings.

2.5.

Study parameters

Table 2. I The study parameters
Information

Parameters

Items

Demographic


Al

Gender

information

A2

AS*

A3

Marital status

A4

Education lex-el

AS

Years of experience

A6

forking position

Bl

Routine nursing activities before the COVID 19


Barriers of
comprehensive care

pandemic

B2

Routine nursing activities during the COVID -19
pandemic

b;

The difference nursing care between before and

during the COVID-19 pandemic
B4

Barriers of nursing perform comprehensive care

during the COVID -19 pandemic
B5

Kind of supports the 1CU nurses have received

during the COVID -19 pandemic
Perception of

Cl

comprehensive care


Ibc lev nurses’ perspective about the future

nursing care model
C2

The feasibility of integrating a standardized

comprehensive care protocol

C3

The expected factors should be available to

achieve comprehensive care

-w .ã* CN ôG


16

2.6.
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Data collection

Data was collected through group interviews via an online software

called Zoom meeting. In which. this study used sound and image
recording function of this software during the interview time.

“

All of the participants were randomly divided into two subgroups that
were consistent with two interviews.

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In the interview implementation, after introducing the study purposes,
the nurse was invited to lake pan in the study. All online interviews

were conducted in a private room to make sure a comfortable
environment and confidentiality. Interviewers were first to warm up the
conversation with greetings. The interview heavily, but not merely,

depends on afore-constructed questions. The interviewers based on
emerging ideas, information from nurses’ responses to ask additional

questions to shape a full picture of the research objectives.

Data

collection was continued until tlx? researchers were confident that no
more new ideas, concepts, and categories emerged
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After the interview, we obtained two audio and video recordings. The

next step of the data collection procedure was to transcribe the raw data

from audio data to text data. In addition, confidentiality was assured by

using numbers instead of names (eg. Nurse 1. Nurse 2, etc) and

removing identifying information from the transcripts.

Concluding!?, the researcher had text data to facilitate data analysis.