دو تجربۀ درهم‌تنیده؛ روایت پرستاران بخش عفونی و بیماران بهبودیافته از کرونا در بیمارستان رازی اهواز؛ مطالعه‌ای با روش نظریۀ داده‌بنیاد

کرونا طی چند ماه قاره‌ها را درنوردید و اینک به ویروسی جهانی بدل شده است. پس از شناسایی اولین مبتلا به این ویروس در اسفند 1398 در استان خوزستان، این استان پیک‌های مختلفی از این بیماری ویروسی را تجربه کرده است و از آن روز تاکنون به جدی‌ترین عامل تهدید زندگی شهروندان و اصلی‌ترین عامل مراجعۀ بیماران به بیمارستان‌های استان بدل شده است. این مطالعۀ کیفی با هدف فهم تجارب درهم‌تنیدۀ پرستاران بخش عفونی و ایزولۀ بیمارستان‌های مرکز کرونا و بیماران بهبودیافته در استان خوزستان انجام شده است. روش استفاده‌شده در این پژوهش، نظریۀ داده‌بنیاد نسخۀ 2015 کوربین و اشتراوس به‌منزلۀ یکی از روش‌های اصلی پژوهش کیفی است. داده‌های این پژوهش ازطریق مصاحبۀ عمیق و شیوۀ نمونه‌گیری هدفمند نظری با بیست‌وچهار نفر از ذینفعان مرتبط با این پدیده گردآوری و برای تحلیل داده‌ها از پنج مرحله کدگذاری باز و تشخیص مفاهیم، توسعۀ مفاهیم در جهت ابعاد و ویژگی‌ها، تحلیل داده‌ها برای زمینه، واردکردن فرایند به تحلیل و یکپارچه‌سازی مقولات استفاده شد. بعد از کدگذاری، دوازده مقولۀ اصلی از داده‌ها پدیدار شد که هر یک از مقوله‌ها به‌صورت کامل با استناد به متن مصاحبه‌ها تحلیل شده‌اند. پاردایم ظهوریافته شامل سه بعد شرایط، کنش – تعامل‌ها و پیامدهاست که در بعد شرایط شامل ماهیت ناشناختۀ ویروس، درهم‌تنیدگی رنج بیماری و فشردگی شیفت‎‌ها، تمنای درک عمومی دقیق، تکرار پی‌درپی لحظات سرنوشت‌‎ساز، اضطراب و تردید در رویارویی با خانواده و در بعد کنش – تعامل شامل احساس به انتها رسیدن توان، بر هم خوردن تعادل مناسبات و روابط اجتماعی، بازاندیشی پی‌درپی شغلی و شخصیتی، اضطراب و تردید در رویارویی با خانواده و در بعد پیامدها شامل تلاقی پرفشار نقش‌ها، اذعان به حجم زیاد وظایف، نه امنیت جانی و نه امنیت شغل است که پیرامون یک مقولۀ هسته به نام دو تجربۀ درهم‌تنیدۀ تلخ و دشوار متاثر از کرونا شکل گرفته‌اند. نتایج پژوهش نشان می‌دهند به‌دلیل ماهیت ویروس و همچنین ماهیت شغل پرستاری، تجربۀ درهم‌تنیده‌ای از رویارویی با این ویروس در بیمارستان‌های استان در جریان است که براساس آن، بیماران و پرستاران لحظات سرنوشت‌سازی را در فرایند مبارزه با این ویروس از سر گذرانده‌اند.

Two Mixed Experiences: The Narration of Nurses of the Infectious Ward and Patients Recuperated from Covid 19 at Razi Hospital in Ahvaz: A Study based on the Grounded Theory Approach

IntroductionCoronavirus is a large family of viruses that cause respiratory infections (Jiang et al., 2020). The virus, previously unknown, was found in a significant number of patients in the city of Wuhan, China (Najo et al., 2020). It swept across countries’ borders so quickly that on April 1, 2020, 360783 cases of the virus were found in 205 countries of the world (Kate Louis et al., 2021). In Iran, the virus soon swept through the borders of the provinces and cities revealing itself as a multidimensional problem. One of the groups that have suffered double dealing with the virus was nurses working in hospitals. Nurses in the Khuzestan province were also experiencing a battle with the Coronavirus. This experience caused many sufferings. Because of the unknown nature of the Coronavirus, at the early spread of the virus, the nurses, like other groups of people, felt threatened with the disease. On the other hand, they felt morally and organizationally obliged to do their job well, and this made them continue to live in the environment and serve the patients suffering from the virus, despite their fear and panic. This was the most important reason for investigating the mentioned issue. The present study used the interpretive approach with the aim of understanding the common experiences of patients from the Coronavirus and the nurses involved in the infectious and isolated sections at Razi Hospital in Ahvaz. The present study explores the understanding of the experiences of individuals involved with the corona, especially the nurses of this sector and patients who have been infected with the virus and hospitalized. Based on the results of this study, the challenges that patients with Covid19 have faced include the experience of death anxiety, disease experience, uncertainty experience, emotion caused by quarantine, etc. These painful experiences can delay the patient’s recovery (Rahmati Nejad, Yazdi, Khosravi, & Shahisadrabadi, 2020). The nurses responded similarly in the same situation. Based on research by Riocci et al. (2020), nurses were afraid to deal with cases of Covid19 for their own safety and health, but after the deployment of standard methods, they were partly reassured of protecting themselves from the disease.  Materials and MethodsIn this study, the grounded theory method, as one of the important methods in qualitative research, was used. The approach used in this study was based on the view of Corbin and Strauss (2015). In this study, the participants were 22 of the nurses and patients hospitalized and improved at Razi Hospital and several other hospitals in Khuzestan province. The participants had sufficient information and knowledge about the subject under study. The sampling method in this study was purposeful; in addition, the sample selection in the process of data gathering, considering the degree of saturation of categories, was carried out in the direction of the qualities and dimensions.The main technique used to collect data in this study was indepth interviews with each participant conducted around one and a half hours. First, by interviewing six of the participants, the main questions of the research were modified and adjusted. The modified questions were then used. The purpose of the interview was the to extract concepts, categories, and paradigms related to the study.Data analysis was based on five coding stages considering the 2015 version of the proposed grounded theory method of Corbin and Strauss. At the beginning of the coding phase, the data were analysed line by line and the initial concepts were extracted. In the next step, the code that was connected in terms of the concept and feature was organized by the centrality of the main categories. In the axial coding stage, they were related to the main categories. Selective coding was followed using the selection of concepts and issues that were considered effective in extracting the main category of the study.In this study, the authors used five research strategies to obtain the confidence level for the scientific approval of the study including observing colleagues, checking by contributors, long participation, continuous observation in the field of research, and deep and rich descriptions. Discussion of Results and ConclusionsThe appeared paradigm consists of three main dimensions of terms, interaction, and outcomes, which include the unknown nature of the virus, the interconnectedness of illness and the compression of shifts, a desire for accurate general understanding, successive iteration of decisive moments, anxiety and uncertainty. The interaction aspect includes feeling towards the end of power, disrupting the balance of relations and social relations, rethinking of employment and personality, anxiety, and uncertainty in facing the family. The outcome dimension includes the confluence of roles, acknowledging the high volume of tasks, no life and job security for nurses which were formed around a core paradigm called ‘two intertwined experiences influenced by the Coronavirus’.The research participants talked about the unique suffering that was strongly influenced by the unknown nature of the virus in the early days. The ignorance of the virus and the unfamiliarity of the world with its contagious and lethal power led to the anxiety and stress in the medical staff. They were concerned about themselves, their protection, their patients, their families and other citizens. Nurses in the infectious and isolated sections, although experienced in the use of protective equipment such as gowns, masks, and disinfectants, all indicated that new conditions lay ahead. With the increase in the number of patients and also the increase in the number of daily hospitalizations and the duration of hospitalization days, the infectious section became the busiest part of the hospital and unique experiences of having the fear and hope of nurses and patients were recorded. Both groups of patients and nurses longed for family visits, but more than ever believed in the unpleasant imposed aspect of protocols and chose to maintain distance.When conducting health care for covid patients, nurses are generally exposed to fluid and unstable situations; patients who do not have physically stable conditions and face a state of confusion with not responding to the nursing care. Nurses are always under pressure from people, hospital administrations, sick companions, patients, and other hospital staff. The nursing station can be considered a place of collision between a patient and a nurse; the place in which the companions unaware of a nurse’s duties will seek medical care, impatience, not cooperating, labeling, urging for an answer, prejudice, complaint and judicial treatments, overcoming of emotions on the better judgment, disrespecting the nurse, having a bad attitude, etc. which will result in devaluing and far expectations.The findings of the World Health Organization show that the rapid outbreak of Covid19 disease at the beginning of 2020 in the world put severe physical and psychological pressure on the medical staff of hospitals involved in the care of patients with Covid19, to the extent that the risk of posttraumatic stress disorder (PTSD) increased for this group. It is essential to increase the resilience of nurses and medical staff in their work, as well as to help patients who are seriously challenged with the disease, through strategic measures. Social support, as mentioned by Hou et al. (2020) can improve the mental health of medical staff through resilience, especially among middleaged staff because resilience and mental health in this group have become poorer than the youth.