Experiences health impact and care practices of COVID-19 infected nurses in the hospitals of Kathmandu valley, Nepal.

Research Report.

EXECUTIVE SUMMARY: Background and objectives: Corona virus disease-2019 (COVID-19) is causing a global pandemic. Nepal officially announced its first confirmed covid-19 on 24 January 2020 in a 32-year old male patient, who had returned from Wuhan city, China. Since mid-June 2020, the case load have been raised sharply. Its association with a very high rate of infectivity has led to a high level of fear and anxiety of getting infected resulting in severe restrictions on the free movements of human beings, and the lockdown of almost all countries across the World. Its second wave have had created greater impact on the health of all and second lockdown was initiated from April 26, 2021. Healthcare workers (HCWs) specially nurses caring for patients with covid-19 are facing challenges in current scenario having higher rate of infection to themselves and by extension to have to contend with the risk of infecting their families. There is a huge gap in the scientific literature about the experiences, knowledge, health impact, care practice and quality of life of nurses who are infected in the context of Nepal. Hence, a need was felt to study on nurses who are the frontline health care workers and directly involved in the screening, diagnosis, treatment, and care of patients with covid-19. The objective of this study is to explore experience, knowledge, impact of physical, dermatological, and psychological health, care practice and quality of life of COVID-19 infected nurses. Methodology: This was a cross-sectional study conducted among 418 COVID infected nurses of the hospitals designated for covid-19 care in Kathmandu valley. The self-administered questionnaire was use for data collection which consisted of seven sections. The data was entered In EpiData and then transferred to statistical package for social sciences (SPSS) software version 20 and analyzed for the relevant information's according to the objectives. Study findings: The socio-demographic data covid-19 infected nurses revealed that the mean age was 29.69 years( range: 19-68 years). The interviewed nurses had Hindu religion (91%), 57% were of upper caste group (Brahmin and Chhetri's) whereas relatively advantaged janjati were 25.1%, unmarried nurses were 60.3% . 31.6% had bachelor's degree in nursing (BN), 61.2% were living in own house, the monthly income of majority of nurses %) was NPR 30,000-50,000, most nurses were staff nurse (80.1%), working experience of one third (34.7%) was between 2-5 years, above half (56.5%) were working in the COVID designated area and only (17%) received training related to covid-19.Some respondents (14%) have suffered from chronic diseases. Regarding the knowledge of covid-19, 83.3% of the respondents had excellent level of knowledge with mean+- SD (95% CI)25.6+_ (25.3-25.9).Whereas only 43.1% had responded correctly as 2-14 days incubation period. Majority of respondents said symptoms of covid-19 were headache, fever, myalgia, shortness of breath and 84% had knowledge about antiviral therapy as treatment. Hand washing was the main prevention measures mentioned by 97% and 93-99% said the complications as pneumonia, ARDS. Regarding the physical, majority suffered myalgia, headache, tiredness, sore throat, and cough Isolation measures were practices by 77% of respondents while 8 were treated in critical care unit and 26 respondents received antiviral therapy. 63% had negative PCR test after 14 days of isolation. The dermatological health impact was found on 24% respondents and major symptom were itching (18%) and redness (15%). Psychological health status of the respondents revealed that 62% had suffered mild, moderate to severe anxiety level. The care practices of covid-19 infected nurses were wearing PPE (>90%), follow donning and doffing procedure (87%), follow WHO guidelines of hand washing procedure (79%) and ate nutritious food (86%). The type of relaxation technique used was music for 60% respondents followed by yoga/ meditation (43%). The experiences and quality of life of covid-19 infected nurses were various feelings with problems of sleeplessness including insomnia, irregular sleeping pattern due to fearfulness, worry, overthinking, palpitations, shortness of breath, cough fever, severe headache, decreased oral intake, heart burn, and myalgia. About 20 respondents said that they were over sleepy whole night and at daytime due to tiredness and confining in the isolation. One respondent expressed her sleeplessness for more than a week and expressed feeling of dying. The eating pattern of majority covid-19 infected nurses was good they took vitamin rich meal five to six times a day with plenty fluids. Few respondents suffered from complete loss of taste and smell. Conclusion: Most of the respondent nurses had excellent level of knowledge on covid-19 based on composite score, however in single item responses many respondents did not know the actual incubation period of disease as only 43.1% answered correctly. Very few respondents have received training on covid-19 disease management and tit could be the reason that many of nurses are being infected. Nurses with chronic disease were also assigned in COVID units which was not appropriate as they were already in the high-risk group. Regarding physical symptoms, more common symptoms were myalgia, headache, fever and sore throat. Most of the respondents had used vitamin supplement and majority of the respondents had stayed at home isolation with sufficient rest. However, this shows that the COVID infected nurse were well knowledge and did good practice to maintain self-health and prevent transmission of covid-19 disease to others. There is statistically association between frequency of hand washing and maintaining two meter physical distance and level of knowledge. The experiences and quality of life was very much poor some respondents. Majority of respondents had sleepless night due to fear, fear of death and complications and stress. The findings of the study clearly pointed out the gap between nurses in certain areas for which it would be helpful to develop training packages regarding knowledge, care practice on covid-19. It also indicated a gross need to arrange psychological counseling package and counseling centers for nurse and health care workers.