MINI STRY OF EDUCATION

MINISTRY OF HE ALTH

AND TRAINING
HANOI MEDICAL UNIVERSITY

JI <•=£>— —

PHAM THI DUNG
PERCEPTION AND BARRIERS OF INTENSIVE CARE
UNIT NURSES IN COMPREHENSIVE CARE DURING
COVID-19 PANDEMIC IN HANOI MEDICAL
UNIVERSITY’ HOSPITAL. VIETNAM

GRADUATION THESIS
BACHELOR OF SCIENCE IN NURSING
Advanced Program in Nursing
2016-2021
Supervisor:

Assoc. Prof. Hoang Bui Hai. M.D. Ph.D
Mai Till Hue. MPH

Hanoi. 2021

r-u -ÍM Qỉ ugc V
Hl


ĩii

ACKNOWLEDGEMENT
I would like to express my deepest gratitude to my supervisor. Assoc.
Prof. Hoang Bui Hai. M.D. P11.D arid Mrs. Mai Till Hue. MPH. for the
excellent guidance, caring, patience and providing with the tremendous support
during this research.
I am also grateful to all lecturers in 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
Care Unit 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 sliaring expertise, valuable support and encouragement extended to me.
Hanoi. May 5th. 2021
Thesis author

Plain Thi Dung

r-u -ÍM Qỉ ugc V
Hl


ỉv

DECLARATION
I hereby declare that this thesis is composed by myself, which lias not
been previously submitted, either in a part or in full, for a degree to any other
institution or university. As far as I know, material lias 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 Till Dung

CONTENTS

3.32.

The expected factors that should be available to achieve

RECOMMENDATION

59

REFERENCES
APPENDIX.
LIST OF TABLES


LIST OF FIGURES
Figure 2.1 The process of Qualitative data collection......................................17
Figure 2. 2 The Qualitative research process....................................................19


5

LIST OF ABBREVIATIONS
COVID-19

HCWs

Coronavirus disease 2019
Health-care workers

ICU

Intensive care unit

HMƯH
WHO

Hanoi Medical University
Hospital
World Health Organization

r-u -ÍM Qỉ ugc V
Hl


INTRODUCTION
Comprehensive patient 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 highincome countries such as the United States, tire United Kingdom Australia, and
the Netherlands [2]. [3], [4], (5). it is quite a vague concept in mam' resources’
constraint


countries.

Particularly,

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.
In 2013 and 2016. Nutan Potdar et al performed studies in the Intensive
care unit (ICU) 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 barriers for medical staffs [6], [7].

The complex
(COVID-19)
pandemic
progression
has
of of

catastrophically
the
coronavirus
been
disease
a global
2019
health
consequently
care
burden.
changed
Ill
to adapt
addition
to
nursing
this
new
care
situation.
lias
To
accommodate,
fluffily
practiced
the
Vietnamese
“comprehensive
nurses

care"
in the
that
ICU
consisted
have
ofa
dedicated
unacccpting
model
the
assistance
for
COVID-19
care.
the
patient’s
relatives
as

r-u -ÍM Qỉ ugc V
Hl


7

There lias so far liot been any understanding related to the comprehensive
care in Vietnam, especially in the ICƯ during the COVID-19 pandemic. Thus,
we conducted this study with 2 objectives:
1. To describe barriers of nurses in comprehensive care during the COMD19 pandemics in the Intensive Care Cnit at Hanoi Medical University

Hospital, I ietnam from October to November 2020.

To understand
these
nurses'
perspectives
about Hospital,
comprehensive
Intensive
Care
care
Unitduring
at
the
Medical
COIID-19
University
pandemics
in the
Vietnam
from
October
toHanoi
November
2020.

CHAPTER 1: LITERATURE REVIEW

1.1.


Comprehensive care model

1.1.1.

Comprehensive care definition

Comprehensive care is an advanced healthcare model worldwide that has
been widely acknowledged as the best way forward to achieve the integral
healthcare demand of multimorbid 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 [1]. 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 senices are provided by numerous HCWs [12]. Multiple theories
have been proposed to “patient- centred care" 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. Titus, comprehensive health care is always considered as an
essential part of every health facility as a mean to promote treatment outcomes
of patients [ 1 ].
1.12. Comprehensive care and the COVID-19 pandemic

-c -ÍM Qỉ ugc V Hl


8


1.12.1.

Overview oftheCOV'ID-19 pandemic

According to World Health Organization (WHO), the COVID-19 is an
infectious disease caused by a newly discovered coronavirus. It lias triggered off
a worldwide pandemic of a respiratory illness that was first identified in
December 2019 in Wuhan City' in China [13].
This novel coronavirus is structurally associated with the virus that causes
severe acute respiratory syndrome (SARS). This has also been explored in prior
studies that these symptoms of COVTD-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, and lymphopenia [14], [15], [16], [17]. Moreover, previous studies
have emphasized tliat person-to-person transmission is a primary infectious
pathway for COVID-19 [17]. [IS]. The spreading occurs primarily via direct
contact or through droplets 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 bv washing your hands or using
alcohol-based detergents frequently and not touching your face as suggested by
WHO [19]. Additionally, maintaining a distance of at least 1 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 other people.
The appropriate use. storage, and cleaning or disposal are essential to make
masks as effective as possible.


On top
of
that,
awith
large
number
recent
studies
have
recognized
health
is
the
that
ongoing
COVID-19
outbreak
is
theof
latest
respiratory
threat
to564
disease.
global
Indeed,
and
byworldwide.
March
it488

lias
6.
affected
2021.
there
nearly
have
every
been
region
115
2S9of
961confirmed
the
world
people;
cases
2
confirmed
the
deaths
of
more
than
2
000

-c -ÍM Qỉ ugc V Hl



9

cases 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 COVID-19 outbreak have been under extraordinaty
stress and baniets associated with a high risk of infection, stigma, lack of staff,
and uncertainty. For instance, the following studies were conducted on HCWs’
experiences. Front-line medical staff who take care of patients with COVID-19
are at 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 stressful situations. T1ŨS has also been explored in
prior studies in 2020 by Yicen Van and his colleagues, insufficient and excessive
protection will have adverse effects on the skin and mucous membrane of
healthcare workers [22].
LU.2. rite situation of comprehensive care before the COV1D-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 performed 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 ill multiple countries.
Studies are considered to be of high quality if they meet five criteria: design's
strength (review, meta-analysis, or controlled trials with the equivalent
concurrent control groups), adequacy of the sample (representative sufficient


-w.- -ÍM QỈ Hgc V
Hl


1
0

number), the validity of measures, reliability of data analysis techniques, and
rigor of data analysis.
Some reviews in 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 the potential to refine quality,
efficacy, or health-related outcomes of care for patients were identified [12].
Furthermore, most reviews provide limited information about the content of the
comprehensive care program. Therefore, relevant information from the nonrandomized trials and information on the impact programs have on caregiver
outcomes is barely summarized.

Besides
care
in moderate
there
multiple
were
countries,
inconsistent
each
results
country'

of
also
comprehensive
had
mixed
effectiveness.
brokered
by
the
In
Sax
2015.
Institute
an
“evidence
for
theof
check”
Australian
rapid
Commission
review
on
for
Safety
the
effectiveness
regarding
lite
of

best
comprehensive
available
care
research
in
acute
evidence
settings
step-by-step
as
defined.
approach
By
to
providing
gain
insight
an
iterative,
into
the
systematic,
characteristics
and
programs
effectiveness
for
patients,
of

these
they
new
emphasized
that
following
the
new
comprehensive
three
elements:
care
systems
standard
to
will
support
incorporate
care:
development
comprehensive
of
care
comprehensive
and
quality
care
in
plans;
health

delivery
care.
In
of
addition,
they
the
results
found
16
were
articles,
mixed
and
of
which
consisted
regarding
12
their
(75%)
effects,
were
of
were
moderate
of
to
high
methodological

quality,
three
(18.75%)

quality. and one (6.25%) was of low quality. All were relevant for. and
generalizable to. the Australian acute care settings and populations [29].

Additionally, little is known about program features that may be relevant
to positive outcomes of care and about the groups of patients who may benefit
most from comprehensive care. For instance, the effectiveness of comprehensive
care was comparable or more positive than that of ordinan- care. Ulis 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 Brain and his colleagues [1] that tile 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
has 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 for the profitable effects of
comprehensive care on cognitive function, depressive symptoms, functional
status, mortality', quality of life on physical function, and caregiver burden.

-w.- -ÍM QỈ Hgc V
Hl


1
1


Despite the fact tliat several (good quality) studies have been performed
over the years to estimate the value of comprehensive care for multimodal and/or
frail patients, there is insufficient evidence for the efficacy of which. More goodquality studies and/or studies that enable meta-analysis are needed to determine
which particular taiget groups will benefit from comprehensive care.
Furthermore, evaluation studies can be improved by utilizing more appropri ate
outcome measures, for example, measures related to care goals defined by
patients (individuals).
However, this information is critical because of growing interest in what
will help the best care for patients with multimorbidity. especially in the ICU
which supports and improves patients* health with multimodal and/or frail.
A number of questions regarding the effectiveness of comprehensive care
in ICU remain to be addressed. Rarely public research in Illis 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], mental health unit
[3]. gerontology unit [12]. [23]. et. Unfortunately, these mentioned studies are
not available for Vietnam. Therefore, evaluating and improving the quality of
care and the urgency of implementing a new comprehensive model at ICU in
Vietnam is a difficult challenge.
1.12.3.

The situation of comprehensive care during the cot ID-19

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 ICU.
While it is clear tliat incomprehensive cate could weaken treatment efforts in
every health facility, this issue is far worse in the ICU. including in Vietnam


-w.- -ÍM QỈ Hgc V
Hl


1
2

when the COVID-19 outbreaks occur. As nurses are now. in the context of
COVID-19 pandemics, the medical staff cannot depend on patients’ relatives for
non-treatment supports.

In Vietnam
led
to aVietnamese
demand
the
consequence
forhospitals,
thecare.
medical
ofParticularly,
the
staff
COVID-19
that
pandemic
has
to several
adopt

liasa
central
new
concept
of patient
including
Hanoi
ICU
in

Medical University Hospital (HMUH) to designate comprehensive care 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 comprehensive care

Nurses play a crucial role in the evaluation and implementation of
comprehensive cate which contributes a lot to the patient healing process. Nurses
not only maintain the patient safety and decrease mortality but also provide
extensive quality senices to reach their satisfaction. Even though there are
competent physicians present in the 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 the
patient is denied appropriate care the 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 tire nurses in their work
environment and to improve the nursing senices at the same time.

Furthermore, in the COVID-19 stages, the 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 provide the accurate and promptly care for
multiple patients including patient with COVID-19: suspected patient; non
COVID-19 patient.

-w.- -ÍM QỈ Hgc V
Hl


1
3

1.3.

The barriers of nurses in comprehensive cares

As we have known, since care has an effect on cultural, economic, and
social factors, there are diverse baniers in the realization of care. Especially in
Asian countries, family traditions are maintained and highly respected, they
assume one of the ancient conceptions that the sick hospitalize all trust and
empoweT their relatives for no- treatment care. Therefore, for a 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, roll 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
patient. Because of that idea, health workers, including nurses, have uncompleted
the sufficient function, especially in the non-treatment care: basic personal needs,
daily diets, and mental care. Insuffici ent care has a strong relationship with the
quality of care.

Furthermore,
arise
from
reasons:
most
problems
available
related
supporter
to
not
resources
completing
from
aand
task
the
patient’s
workload
[30].
relative;
Aincreased
recent
the

serious
study
lack
2016
of
by
staffing
Nuian
Potdar
and
his
staff
colleagues
to
comprehensive
assessed
nursing
the
barriers
care
in
perceived
ICƯ
of
Krishna
by
medical
Hospital.
correlation
Karad.

between
The
stresses
result
of
that
it
shows
are
faced
that
by
the
doctors
and
barrier
during
to
comprehensive
working
are
care
significantly
in
ICƯ.
In
associated
addition,
with
it

the
concluded
supplies
in
tliat
diverse
attitudes
workloads,
among
colleagues,
less
equipment,
and
fewer
and
nurses
staff-patient
[7]
ratios
are
major
barriers
for
doctors
and

Besides, healthcare providers are critical resources for patient health

improvement that cannot be ignored. Their health and safety are crucial not only
for continuous and safe patient care, but also for control of any outbreak.

However, health-cate providers caring for patients during the severe acute
respiratory syndrome (S ARS) and Middle East respiratory syndrome (MERS)
outbreaks were under extraordinary stress related to high risk of infection.
stigniatisatiotL understailing, and uncertainty, and comprehensive support was a
high priority during the outbreaks and afterwards.
Quantitative studies have shown that frontline healthcare providers
treating patients with COVID-19 have greater risks of 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

-w.- -ÍM QỈ Hgc V
Hl


1
4

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 care during the
COVID-19 pandemic. To assess the effectiveness of comprehensive care to them,
it is necessary to gain insights into their experience and tlie barriers they have
met.
1.4.

Comprehensive care in ICU'Vietnam

To respond, the Ministry of Health issued Decision No. 123/QD-K2DT in
2013 aimed at promoting comprehensive care in Vietnam. Accordingly,
continuous training materials and programs would be available for healthcare

staff to update knowledge, skills, and promote attitudes 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. Nurses’ daily
tasks in Vietnam are. in nature, heavily involved in clinical treatment. with little
focus on non-treatment aspects.
The complex progression of the coronavirus disease (COVID-19)
pandemic in Vietnam and the consequent demand to adapt inpatient cate
provided to this health emergency led ICƯ in a few central Vietnamese hospitals,
including

Hanoi

Medical

University

Hospital

(HMUH)

to

designate

comprehensive care as a dedicated unit for the COVID-19 care, will ch fulfils
care accomplished based on the significance of patient satisfaction without the
support of patients' relatives.
In the primary response to COVID-19 crisis in Vietnam, the ICƯ 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 the
community. The subsequent challenge was smooth operation with the new and

-w.- -ÍM QỈ Hgc V
Hl


1
5

unstandardized model while coping with human resources shortage and work
overwhelming.

Although
designed
there
to
accomplish
are
several
these
studies
goals,
on
noailing
models
consensus
of
care

exists
on
which
consent,
models
when
can
reached,
improse
may
clinical
inform
outcomes
inservices
healthcare
the
ICU. Such
offered
system
reform
by
increasingly
efforts
and
popular.
helps
toour
shape
the


-w.- -ÍM QỈ Hgc V
Hl


16

CHAPTER 2: SUBJECTS AND METHOD
Study time & setting

2.1.

The study was conducted in the ICU at HMUH, Vietnam from October to
November 2020.
Study participants

2.2.

We recruited all nurses working in the ICU at HMUH who were
accomplishing comprehensive care for patients during the COVID-19 pandemi c.
Inclusion criteria:
•

Nurses working in the ICƯ were 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:

•

ICƯ nurse in an administrative position and head of ICC nurse

■ Nurses refused to participate in the study or online interview through Zoom
meetings.
Study design

2.3.

• A qualitative study was performed to describe barriers of nurses in
comprehensive care and understand these nurses’ perspectives on
comprehensive care during the COVID-19 pandemics in 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. Them the raw data was transcribed from the audio data to
textual data.
• A31 audio recordings and transcripts were saved on a passwordprotected

r-u -ÍM Qỉ ugc V
Hl


17

computer.
Study instruments

2.4.


We used a semi-structured questionnaire (15 questions) to collect
information regarding study 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, working position, years of experience, education levels. (7
questions)
(2) Barriers when providing comprehensive care for patients: nurses were
asked to provide their views and thoughts about what you do every day to
take care of your patients before COVID-19 pandemics? What do you do
every day to take care of your patients curraitly when COVID-19 occurs?
What are the differences between before and after COVID-19 pandemics in
the way of caring for patients? What difficulties that you have been facing
to take care of the patients during COMD-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 ftiture? What do you think about the feasibility of
integrating standardized comprehensive care protocols in your department?
What factors/ conditions/ ingredients should be available to achieve
comprehensive care? (3 questions)

r-u -ÍM Qỉ ugc V
Hl


18

Besides, another study tool was Zooin 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. 1 The study parameters
Parameters

Items

Demographic

Al

Gender

information

A2

Age

A3

Marital status

A4

Education level


A5

Years of experience

A6

Working position

Bl

Routine nursing activities before the COVID-19

Barriers of
comprehensive care

Information

pandemic
B2

Routi ne nursing activities during the COXTD
-19 pandemic

B3

The difference nursing care between before and
during the COVID-19 pandemic

B4


Barriers of nursing perform comprehensive care
durin g the co VID -19 pandemic

B5

Kind of supports the ICƯ nurses have received
durin g the COVID 4 9 pandemic

Perception of

Cl

comprehensive care

The ICU 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

r-u -ÍM Qỉ ugc V
Hl



19

Data collection

2.6.

- 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.
- In the interview implementation, after introducing the study purposes, the
nurse was invited to take part 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 aforeconstructed questions. The interviewers based on emerging ideas,
information from nurses’ responses to ask additional questions to shape a
frill picture of the research objectives. Data collection was continued until
the researchers were confident that no more new ideas, concepts, and
categories emerged.
- 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.

Concludingly.
data

analysis.the researcher had text data to facilitate

r-u -ÍM QỈ Hgc V
Hl


20

Choose the data collection method
Group interview

Plan the data collection procedure
Sampling: all ICƯ nurses at HML'H divided two random groups Location: an online
software (Zoom meeting), 2 times Time: November 5 and November 6.2021
Study instrument a semi- structured questionnaire (15 questions)
Management data: using sound and image recording function via Zoom meeting

Implement the Interview

Follow up the data collection procedure

Transcript the audio data
Transcript from original audio data via Zoom meeting

Having available text data for analysis

Figure 2. 1 The process of Qualitative data collection

r-u -ÍM Qỉ Hgc
ugc V

V
Hl


21

2.7. Data analysis

All raw data was recorded and precisely transcribed. Using Excel
software, the data was synthesized and interpreted by applying a content analysis
strategy.
First of the data analysis process, the researcher read all tire transcript several
times to gain an understanding of meanings conveyed, identifying significant
phrases and restating them in general terms, formulating meanings and validating
meanings...
Second, labeling of codes was conducted using the words of participants
and perceived concepts of the text. Similar codes were placed in one category
that called “meaning unit” and formed the categorization of codes. The
categories with similar concepts were located around a common and core axis.

Then, categories
withobjectives.
similar
concepts
and
similar a
subjects
sub-themes
were
indicated

into
"a
specific
"sub-theme".
theme”Summarizing
to develop
various
full
description
ofmerged
study

r-u -ÍM Qỉ ugc V
Hl


Designing and accomplishing
study-tools

Study design and sampling

Data collection procedure

Data analysis

Conclusion

2.8.

Figure 2. 2 The Qualitative research process

The trustworthiness of a qualitative research
Trustworthiness or rigor of a qualitative study refers to die degree of

confidence in data, interpretation. and methods utilized to ensure the quality of
study.


*
2.8.1.

Credibility of this study

The data and processes of analysis address the intended focus on nurses'
experience about the implementation of comprehensive care, particularly the
barriers and perception of them in ICƯ at HMƯH in the context of the COVID19 pandemic. Besides, choosing the focus group interview allows for the
exchange of ideas, opinions, and viewpoints that might not be revealed through
surveys or interviews. which helps researchers better understand the topic at
hand. F urthermore. one of the crucial issues in the study method is select the
most suitable meaning units. The analysis included, reading the transcript several
times to perceive meanings conveyed, identity significant phrases, and had the
consult from experts. Moreover, all of the categories and themes cover data were
sincerely reveal by ICƯ nurses and they are completely responsible for all their
speech associated with comprehensive care during the COVID-19 pandemic.
Triangulation has been intimated as "the process of corroborating
evidence from various individuals, data types, or data collection methods". In
particular, data sources might be interviews, observations of this meeting
(including nonverbal expressions of participants), information got from semistructured questionnaires. Triangulation can also mention the collection of
information from multiple types of participants about the same phenomenon. The
effect of the triangulation method is to create a more holistic picture of the
phenomenon that are studying and to prevent over-reliance on a single method or

data collection source.
2.82.

Dependability of tliis study

Dependability mentions the extent to which approximate findings would
be obtained if the study were repeated. However, variability should be expectant
in qualitative studies. The best strategy to assist the dependability of a study is to


guarantee that the method is described in sufficient derail so that it can be
reproduced by others and any restrictions discussed. Triangulation of the
methods will also improse the dependability of the results.
2.83.

Transferability of this study

Transferability indicates how well research results can be applied to other
similar organizations. Tile ability of others to appreciate whether tlie findings are
transferable depends oil a detailed description of the study context, the selection
of participants, and the results. This is associated with a "thick description".
2.9.

Ethical consideration

- The stud}' subjects were explained clearly about the purpose of the study
before the telephone interview. Tile questionnaires were given only when
subjects agreed to participate. The right to withdraw at any time was
explained clearly to the participants.
- The study tool was not involved sensitive or intimate problems and did not

affect the subject’s emotion.
- Collected data was used for research. The results of the study were
proposed for improving the quality’ of nursing care, not for other
purposes.

Participants’
information
was keptrewaling
secret. names
All information
and comments
personal
information.
were
encoded without
and


CHAPTER 3: RESULT
3.1.

General characteristics of participants
Overall. 12 participants were enrolled in the sample. Demographic

characteristics of all participants were detail shown in table 4.1 and table 4.2. The
age of all ICƯ nurse in the ICƯ at HMƯH ranged from 25 years old to 38 years
old which were disided into 2 groups: 20-30 years old. 31-40 years old and no one
in the period of above 41. Among participants, two-thifds of the participants (S)
were female and 4 were male. There is a balanced ratio between married nurse
and single nurse. Furthermore, the participants who had been reported to be

college level was 1 and for other participants in bachelor's degree was 11. All of
them had more than 1-vear of experience in the ICƯ. Besides, about the job
position, they totally in particular had the analogous working as nurses, and no
one was head of the nurse or nurse supervisor.
Table 3. 1 Participants' demographic information
Age. Gender Marital
Work
years

status

Education

Job

level

position

More than 2

Bachelor’s

Nurse

years

degree

More than 2


Bachelor’s

years

degree

More than 2

Bachelor’s

years

degree

1-2 years

Bachelor’s

experience.
years

Nurse 1
Nurse 2

Nurse 3
Nurse 4

30


29
29
25

Female
Female

Female
Female

Single
Marred

Marred
Single

Nurse

Nurse
Nurse

degree
Nurse 5

29

Female

Single


-ÍM CỊỈ ugc V
Hl

More than 2

Bachelor's

years

degree

Nurse