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. 2021 Dec 22;55(1):25–33. doi: 10.1177/08445621211064691

Photovoice Exploration of Frontline Nurses’ Experiences During the COVID-19 Pandemic

Ruhina Rana 1,✉, Nicole Kozak 2, Agnes Black 3
PMCID: PMC9936175  PMID: 34935505

Abstract

Background

The current COVID-19 global pandemic has had a profound impact on the health care system and on the physical and psychological well-being of nurses. Previous pandemics have led to nurses leaving the profession. Therefore, it is important that we hear the voices of nurses who experienced the pandemic on the frontlines to influence future planning and policy development.

Purpose

The purpose of this study was to explore frontline nurses’ experiences during the COVID-19 pandemic through photos, narratives, and group discussions.

Methods

Twelve nurses in two groups shared their lived experiences through Photovoice, a participatory action approach. Photos and narratives were collected over five weeks per group. One group at the beginning of the pandemic and the other group six months later. Focus group discussions were held following each group.

Results

Five themes emerged from the photovoice data: (1) The work of nursing; (2) Miscommunication; (3) Fatigue; (4) Resilience; and (5) Hope for the future. Various subthemes were noted within each theme to delineate the lived experience of frontlines nurses working in the COVID-19 pandemic.

Conclusions

The voices of nurses and their experiences on the frontlines of the COVID-19 pandemic need to be considered in pandemic planning and integrated into health care policy, guidelines, and structural changes.

Keywords: Photovoice, COVID-19, nurses, lived-experience

Background and Purpose

The current COVID-19 global pandemic, like previous pandemics, has had a profound impact on the health care system and on the physical and psychological well-being of nurses. Nurses represent the largest number of health care providers in all health systems around the world, but these are complex organizations that tend to be resistant to change (Corless et al., 2018; Reid et al., n.d.). Previous pandemics have led to nurses leaving the profession (Ang et al., 2018; Fernandez et al., 2020; Kim, 2018; Maunder, 2004). With health care systems worldwide committed to meeting the needs of their communities and the prevention and treatment of disease, it is important that we hear the voices of nurses who experienced the pandemic on the frontlines. Understanding the experiences of frontline nurses may influence policy and structural changes within the health care system. The purpose of this study was to explore the experiences of frontline nurses through photographs the nurses took themselves through participatory action research known as photovoice. Art provides a tangible way for people to communicate their experiences and even inform policy (Wang et al., 2004).

Literature Review

The experiences of nurses during pandemics were noted during previous public health emergencies with recommendations for mitigating the psychological and physical impacts on health care personnel. However, few policy and structural changes were implemented. During the SARS and MERS epidemics, nurses endured numerous personal and practice challenges that left them feeling exhausted, isolated, fearful, and stigmatized by the public (Kim, 2018; Maunder, 2004). Similar experiences have been documented during the COVID-19 pandemic, and various physical and psychological symptoms have been reported (Crowe et al., 2021; Gordon et al., 2021; Karimi et al., 2020).

Burnout is a constant theme from nurses as they navigate the complex and ever-changing health care system during the COVID-19 pandemic. Hoseinabadi et al. (2020) found that nurses caring for suspected or confirmed COVID-19 patients had significantly higher rates of burnout compared to nursing colleagues not caring for COVID-19 patients. They noted that burnout can lead to physical and mental health issues for nurses, affecting their ability to care for others (Hoseinabadi et al., 2020). Common psychological symptoms include anxiety, fear, isolation, and helplessness (Crowe et al., 2021; Gordon et al., 2021; Karimi et al., 2020; Sun et al., 2020). Crowe et al. (2021), in their study of Canadian critical care nurses, highlighted that 38% of nurses had significant psychological and associated physical symptoms of post-traumatic stress disorder (PTSD) due to caring for COVID-19 patients.

Physical symptoms reported by nurses caring for COVID-19 patients include headaches, exhaustion, discomfort, breathlessness, and insomnia (Gordon et al., 2021; Krupa et al., 2021; Sun et al., 2020). Krupa et al. (2021) found that nurses, more than any other group of health care professionals, suffer high rates of sleep disturbances and those caring for COVID-19 patients report worsening insomnia. A lack of psychological and physical wellbeing is associated with poor job satisfaction. Nurses who care for COVID-19 patients have reported significantly lower job satisfaction than nurses not caring for COVID-19 patients and are more likely to leave the profession (Savitsky et al., 2021). There are nurses who continue to feel motivated and committed to help others, despite the personal risk (Demirci et al., 2020; Savitsky et al., 2021; Sun et al., 2020).

Nurses are renowned for their self-sacrifice. However, during a pandemic, personal strategies, including self-care, need to be made a priority to ensure nurses are prepared to care for the public (Ramalho et al., 2020). Self-care activities can include connecting with family and friends; faith or spirituality; personal wellness practices; adequate nutrition, hydration, and sleep; and skin and eye care (Gordon et al., 2021; Kuhnke et al., 2021; World Health Organization, 2020). However, inadequate organizational support, such as unsafe staffing levels, make self-care difficult to accomplish. Ang et al. (2018) examined resiliency in the face of compassion fatigue, burnout, and PTSD, recognizing that increased resilience is associated with improved personal health, job satisfaction, and retention. They noted that resilience takes time, experience, and the building of supportive work environments (Ang et al., 2018). Recommendations from studies conducted during previous pandemics, as well as the current COVID-19 pandemic, are often vague, calling for increased psychological supports and strategies to reduce stress, but with limited specific interventions to support nurses’ psychological health (Crowe et al., 2021; Hoseinabadi et al., 2020; Kim, 2018; Krupa et al., 2021).

Organizational recommendations tend to include more specific interventions but systemic integration varies. Enhancing global surveillance and preparedness; infection prevention and control procedures; development of early reporting networks; disaster and crisis management training; and integration of nurses into policy development were strategies offered to support nurses and the health care system during a future pandemic (Alduraywish et al., 2019; Corless et al., 2018; Demirci et al., 2020; Karimi et al., 2020; Sun et al., 2020). Using nurses to narrow the guideline-practice gap and provide support to new policy and guideline rollout can also be an effective organizational strategy (Lam et al., 2016). Organizations also need to provide practical supports such as adequate personal protective equipment (PPE), safe staffing levels, and child or elder care for nurses (Fernandez et al., 2020; Sun et al., 2020). In addition, nurses need to receive clear, concise information as it becomes available to safely care for their patients (Fernandez et al., 2020). The need for integration of pandemic preparedness and resilience education into nursing curriculums is also emphasized (Alduraywish et al., 2019; Ang et al., 2018). This study aims to strengthen health systems by sharing and making transparent the experiences of nurses working on the frontlines during the COVID-19 pandemic using the participatory action approach known as photovoice.

Methods and Procedures

Photovoice

Photovoice is a type of community-based, participatory action research that focuses on social justice and, within the health care system, bridges the divide between frontline care providers and policy makers, researchers, and clinicians. Community-based research (CBR) posits that research should be inclusive, with all voices heard and with knowledge created by those who lived the experience. The result is shared responsibility for knowledge creation (Wang & Burris, 1994). Using the power of the visual image to share lived experience, expertise, and knowledge (Wang et al., 1998), participants document and reflect on strengths and challenges in their community, creating knowledge about lived experiences within the community, advocating for change, and establishing dialogue with policy makers and end-users (Walsh et al., 2010).

In CBR, the investigators/facilitators are immersed in the narratives and thus cannot be objective in their data collection. Therefore, they practice reflexivity, a process of reflecting on and acknowledging one's assumptions, values, and biases and remaining open to themes that emerge through discussion. The investigators’ journal and document their thoughts, feelings, and judgments that arise as discussions occur. To promote transparency, the decision-making process during the study is documented, ensuring rigor in the study design.

Recruitment

Twelve frontline nurses from hospitals in British Columbia, Canada, participated in our photovoice study. Participants were recruited using purposive sampling through social media groups for nurses, as well as newsletters and posters placed in hospitals around the province that directed interested nurses to an email address to receive more information on the study. Participants were eligible if they worked as nurses with COVID-19 patients in a hospital or care facility. No other criteria were required as we wanted to hear from a variety of perspectives.

Participants were provided with an information sheet about the study, the inclusion and exclusion criteria, and the consent form to review. If nurses self-identified as having met the criteria (including having access to a digital camera and a computer or device that supports video and videoconferencing) and were interested in participation, they were asked to complete the consent form and return it via email. Once enough participants were enrolled, the cycle began. The first cycle, at the beginning of the pandemic, involved five participants; the second cycle involved seven participants and took place six months later. Ethics approval for this study was granted by the institutional Research Ethics Boards for both participating organizations, #JN20.12a and H20-02370-A002.

Data Collection

The participants were provided with one video per week to support them in the photovoice process. The five weekly videos included (1) welcome and introduction to photovoice; (2) a discussion about confidentiality and ethics; (3) information about the art of photography and exploring metaphors; (4) common themes and suggestions about how to dive deeper; and (5) information about photo sharing. Photographs and reflections that represented frontline nurses’ experiences during the COVID-19 pandemic were collected weekly over five weeks per cycle. At the end of each cycle, we facilitated a virtual focus group discussion of all the photos with all participants. The guiding questions in the group discussions were from the SHOWeD guide (Wallerstein, 1987). The purpose of the group discussions was to engage in deeper discussions of the lived experiences of participants and not to comment on their photos or photography skills. In photovoice, participants are seen as knowledge generators and contribute to the research by telling stories and sharing ideas, creating rich research data, offering critical reflection, and influencing public policy, and increasing awareness of health care issues (Wang et al., 1998).

The group discussions were recorded and transcribed. All participants were made aware of the recording; they were assured that all personal information would be removed from the transcript; and the recording would not be shared with anyone except the research team. Due to the deeply personal nature of the narratives, complete anonymity was not possible, and all participants were made aware of this potential risk. Immediately following each group discussion, a debriefing session was facilitated to address challenging emotions or memories the participants may have discussed. Participants who required additional debriefing had the opportunity to do so following the session and in the following days as needed. The facilitator coordinated follow-up sessions and access to additional supports.

Data Analysis

Data were analyzed using an inductive content analysis approach. The data consisted of the photos and reflections submitted by participants, as well as the transcripts of the group discussion. Wang and Burris (1997) state that data collection and analysis should include participants in all three stages: (1) Selecting—which image to photograph and submit as the focus of the experience); 2) Contextualizing—submitting narratives with photos to add meaning to the images; and 3) Codifying—helping identify patterns and themes in the experiences during the group discussion. Participants were involved in all three stages in this study.

Following the group discussion, the data were coded line-by-line using NVivo software and the preliminary patterns were identified by the participants. Codes were then compared with the corresponding photos and textual material creating themes and subthemes by each study team member independently, cross-checking for consistency. The study team discussed the themes until consensus was reached and then contacted the participants by email for member checking, a process of checking understanding and interpretation of conclusions to ensure they accurately represent the participants’ experiences. Member checking and reflexivity also ensure trustworthiness of the findings.

Results

Five themes emerged from the photovoice data: (1) the work of nursing, (2) miscommunication, (3) fatigue, (4) resilience, and (5) hope for the future. Various subthemes were noted within each theme to delineate the lived experience of frontlines nurses working in the COVID-19 pandemic.

The Work of Nursing

The first theme, the work of nursing, represented relationships with patients and colleagues, care activities, unit environment, and personal sacrifices and risks. Although nurses conveyed a sense of pride in the work that they do, they also shared the physical and psychological challenges they faced in their work during the pandemic (see Figure 1).

Figure 1.

Figure 1.

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The work of nursing.

The battlefield and the emotional labor

Nurses described the frontlines of the COVID-19 pandemic as a battlefield. “I see my workplace as entry into battle. I go to work with high hopes and low expectations.” Several nurses commented on the pressure to perform at a high level all the time with life and death consequences, the need to self-sacrifice, and emerging with scars. Nurses commented that there was a significant increase in emotional labor due to families not being allowed to visit hospitalized patients, increased fear, and necessity to “bounce back after a code.” One participant said, “The patient dies, and you’re expected to just go back and carry on with your shift.” This is followed by a complete drain on personal capacity. “You’re good for nothing when you come home from work.”

I love my team and nurses are the glue

Nurses commented that they relied on colleagues during this challenging time to cope with the psychological and physical stresses. They understood each others’ experiences in a way that non-nurses could not. “My team is the only reason I’m happy to go to work.” Having supportive colleagues gave them the strength to carry on. “Your team has a big influence on how long you can run this marathon.” One nurse recalled working with her team and emphasized, “We all have a choice, my choice is I am in.” Many nurses also commented on how proud they were to be a nurse during this unprecedented health crisis. “It's been an honor and a privilege to be called a COVID frontline nurse.” They saw their role as central to the functioning of the health care system with one nurse stating, “Nurses are the glue that keeps this whole hospital together.” Another nurse commented that “the glue is the power of each and every passionate and caring nurse that goes the extra mile to help out.”

Miscommunication

The nurses shared that much of their stress and frustration was due to miscommunication about pandemic guidelines among hospital leaders, public health officials, government, and themselves. They resented having to check multiple locations for information and that they often heard about new guidelines from the public before receiving it from their own organizational leadership.

The nurses described feeling exhausted trying to determine which information was correct, most up to date, and important. Daily emails indicating policy and practice changes and numerous signs caused “sign fatigue.” The complexity and inaccessibility of information created an overload of messaging with “not enough understanding.” Meanwhile, social media was filled with rumors and false claims creating misinformation. Nurses understood that new discoveries were being made each day but resented that they were ill equipped to answer questions or provide the best possible care. “Facts are being updated and policies changing constantly, leaving the nurses feeling left out, unprepared to teach the public.” As a result, there was no collective voice from nursing or health care to guide the community.

Fatigue

Burnout is common following a major health emergency, but with the COVID-19 pandemic lasting well over a year, the exhaustion felt by nurses was overwhelming (see Figure 2). With the demands of work and family life, nurse participants described feeling emotionally drained, disconnected, overworked, and at odds with the public.

Figure 2.

Figure 2.

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Fatigue.

Workload and emotional toll

The increased need for PPE, working short-staffed, and having to support patients because their families could not be with them added to the nurses’ workload. Nurses commented that they were asked to push beyond their limits and work in difficult conditions. One nurse stated, “Nothing prepared us for the experience of working during a pandemic.” Extended shifts and missed breaks became commonplace during much of the pandemic. Many nurses expressed feeling an “emotional burnout” from working on the frontlines during the COVID-19 pandemic. They were not able to leave these feelings behind and they followed them into their personal lives. The exhaustion they felt was beyond physical and included an emotional toll from never feeling they were providing effective care. This fatigue was prominent in many of the nurses’ narratives. “Some days I feel like we’re giving awful nursing care and I’m heartbroken.”

Isolation

Nurses as well as patients felt isolated from others during the pandemic. One nurse recounted the unnatural experience of being isolated: “The only people I’ve touched in months are patients.” Many nurses isolated themselves from their families and friends out of fear of getting them sick. One nurse, dejected from not seeing her loved ones for months, stated, “I miss hugs!” Participants shared that living these separate lives between work and home was incredibly isolating for them.

Gasoline on the fire

Much of the nurses’ fatigue stemmed from frustration with virus deniers, hoaxers, and anti-vaxxers. One nurse said, “I feel as though I’m putting out fires while others pour gasoline on it when I care for Covid patients while the public protests mask mandates.” Another stated how frustrated nurses were with the public for “acting a fool” and not following public health guidance. Others stated they had to stop speaking with certain family members or friends because of disagreements over the pandemic response. One nurse, feeling defeated, said, “I wish it were true to say ‘we’re all in this together,’ but some people don’t take the public health measures seriously.”

Resilience

Nurses also shared the strategies that helped them build resilience and cope during the challenging times of the pandemic. Resilience takes time, intention, and experience to build but the benefits are numerous.

Self-care

The nurses shared their self-care techniques, which included time with family, being in nature, eating well, painting, and running. One nurse said that she would advise other nurses to “take care of yourself like you take care of your patients.” Nurses often sacrifice their own needs to attend to their patients’ needs. They emphasized the need to take time for themselves to engage in hobbies, exercise, or simply to clear their mind. Although organizational supports may be present, they are often not enough. The nurses highlighted the need for nurses to look after themselves.

Recognition matters

Efforts to recognize the work of nursing, such as the seven o’clock clap and discounted hotel rooms, supported resilience in nurses. However, nurses noted this was not enough because recognition needs to come from the organization as well. Nurses have a “desire to be seen and understood.” This means recognizing and valuing the work nurses do and endeavoring to support them with adequate staffing levels. One nurse said, “Self-care is not the only solution. If we don’t safely staff, then we won’t succeed.”

Hope for the Future

As the pandemic raged on, the hope of a vaccine became a reality. Nurses rejoiced in the decreasing morbidity and mortality associated with COVID-19. Figure 3 illustrates the hope many of the participants felt.

Figure 3.

Figure 3.

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Hope for the future.

Feeling hopeful and advice from nurses

The development of a COVID-19 vaccine brought hope that there was “light at the end of the tunnel.” Nurses finally felt that they could beat the odds and eliminate the virus. “With the vaccine roll out we have some promise that we can beat this.” They expressed immense gratitude for their colleagues and health care workers and scientists worldwide working to eradicate the virus. They also shared their gratitude for the members of the public who followed public health orders and supported them in their struggle.

Many nurses shared lessons they had learned during the pandemic including the realization that nurses’ voices need to be amplified. Nurses need to speak up and be heard to influence policy changes. One nurse stated, “That's the reason I participated in this research.” They wanted their voice heard. The nurses also advocated for safe staffing levels with one nurse stating, “We don’t want working short premiums [extra pay for working short staffed], we would rather be fully staffed.” They also demanded better pandemic planning to support them during future pandemics. The nurses realized that their collective voices can support change within the health care system.

Discussion

This study explored the experiences of frontline nurses through their photos, narratives, and group discussions, and yielded five major themes. Many of the themes that emerged echoed previous experiences of nurses during pandemics and other health care emergencies. Caring for patients with COVID-19 caused nurses to suffer psychological and physical consequences when working in high-stress environments, such as on COVID-19 units. Participants reported feeling fatigue from fear and isolation, similar to those in previous studies on the impacts of pandemics on nurses. (Gordon et al., 2021; Kim, 2018; Sun et al., 2020). Increased emotional labor was also described by nurses related to being a surrogate for family members when visitors were not allowed in the hospitals. This reinforced the findings from a study of American critical care nurses (Gordon et al., 2021).

This study also found that this increased emotional labor eventually led to burnout and an inability to provide a comforting connection (Gordon et al., 2021). In addition, the nurses confirmed that they also often felt they were not able to provide high-quality care due to increased workloads and stress (Gordon et al., 2021; Karimi et al., 2020). Many of the organizational challenges noted by our participants, such as the need for safe staffing levels, adequate PPE, improved communication, clearer guidelines, and mental health support programs, paralleled those expressed by nurses in other studies (Crowe et al., 2021; Gordon et al., 2021; Savitsky et al., 2021). Institutions often focus on self-care and mental health supports while overlooking their responsibility to provide appropriate staffing levels and safe work environments. Despite these challenges, nurses tended to feel a sense of duty, pride, and satisfaction in their profession and a profound commitment to the care of their patients (Demirci et al., 2020; Kim, 2018).

Gordon et al. (2021) uncovered one theme that was not shared by our participants, which was the idea of being a health care hero. Although this idea was discussed in the focus groups, all participants stated they were uncomfortable with the idea of being considered a hero by the public. In contrast, the experience of stigma from the public was reported by our participants in the subtheme of gasoline on the fire, where participants reported feeling frustrated and at odds with the public. Previous studies also reported stigma from the public as a common experience for nurses (Gordon et al., 2021; Kim, 2018). The hope surrounding vaccines was not seen in other studies due to the vaccine not being available at the time those studies were conducted.

Strengths and Limitations

A strength of the photovoice methodology is that it amplifies the voices of a community. In this study, we were able to magnify the experiences of frontline nurses and give them a voice to make recommendations to stakeholders and policymakers. It was beyond the scope of this study to examine the impact on health care policy and structural changes. However, the authors of this study used the study results and recommendations from nurses to prepare memos that were shared with provincial health care and nursing leaders to advocate for changes in the health care system. We hope that the participants felt safe to share their authentic experiences but recognize that some participants may have self-censored their contributions. This is a known limitation in photovoice.

Another limitation is that our study was limited to nurses in British Columbia, Canada, but our resulting themes resemble those seen internationally in other qualitative studies on nurses’ experiences. Some participants may have found it difficult to share some memories and emotions of the challenges they have face during the pandemic. However, most participants stated that sharing their photos, narratives, and perspectives was a cathartic and therapeutic experience.

Conclusion

The voices of nurses and their experiences on the frontlines of the COVID-19 pandemic need to be considered and integrated into the health care system. In the future, health care systems need to acknowledge the experience of frontline nurses; involve nurses in pandemic planning and development; and integrate their recommendations into policy, guidelines, and structural changes.

Acknowledgments

The authors would like to acknowledge the courageous nurses who participated in this study and who are advocating for systemic changes in the health care system. We also offer gratitude to all health care providers around the world battling against the COVID-19 virus. The authors would also like to acknowledge the contributions of Esther Kiama, Lauren Wittal, and Megan Scott, our student research assistants, who helped make this study possible. The first author was a participant in the 2021 NLN Scholarly Writing Retreat, sponsored by the NLN/Chamberlain University College of Nursing Center for the Advancement of the Science of Nursing Education.

Author Biographies

Ruhina Rana, RN, MN, is the Health Sciences Research Coordinator and Faculty in the BSN program at Douglas College in Coquitlam, BC, Canada. Her research interests include building research capacity in nursing students and arts-based research methods in qualitative research.

Nicole Kozak, RN, MSc, is faculty in the BSN program at Douglas College in Coquitlam, BC, Canada. Her interests include international public health, global health policy, and planetary health, as well as incorporating these concepts into nursing education.

Agnes T Black, RN, MPH, is the Director, Research and Knowledge Translation at Providence Health Care in Vancouver, BC, Canada, and an Adjunct Professor at the University of British Columbia School of Nursing. Her research interests include supporting research engagement among point-of-care clinicians, including nurses.

Footnotes

The data that support the findings of this study are openly available through the following QR code.

graphic file with name 10.1177_08445621211064691-img1.jpg

The authors confirm that the participants in this research have given written consent to the inclusion of material pertaining to themselves and they acknowledge that they will not be identified by name in the paper; and that we have anonymized them to the best of our ability given the limitations of the photovoice methodology. Photo releases were provided for all included photographs.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Douglas College Research Incentive Grant.

References

  1. Alduraywish T., West S., Currie J. (2019). Investigation of the pandemic preparedness education of critical care nurses. Life: International Journal of Health and Life-Sciences, 5, 40–61. 10.20319/lijhls.2019.51.4061 [DOI] [Google Scholar]
  2. Ang S. Y., Uthaman T., Ayre T. C., Lim S. H., Lopez V. (2018). A photovoice study on nurses’ perceptions and experience of resiliency. Journal of Nursing Management, 27(1), 414–422. 10.1111/jonm.12702 [DOI] [PubMed] [Google Scholar]
  3. Corless I. B., Nardi D., Milstead J. A., Larson E., Nokes K. M., Orsega S., Woith W. (2018). Expanding nursing’s role in responding to global pandemics. Nursing Outlook, 66, 412–415. 10.1016/j.outlook.2018.06.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Crowe S., Howard A. F., Vanderspank-Wright B., Gillis P., McLeod F., Penner C., Haljan G. (2021). The effect of COVID-19 pandemic on the mental health of Canadian critical care nurses providing patient care during the early phase pandemic. A mixed method study. Intensive & Critical Care Nursing, 63(1), article no. 102999. 10.1016/j.iccn.2020.102999 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Demirci A. D., Oruc M., Kabukcuoglu K. (2020). ‘It was difficult, but our struggle to touch lives gave us strength’: The expereince of nurses working on COVID-19 wards. Journal of Clinical Nursing, 30(1), 732–741. 10.1111/jocn.15602 [DOI] [PubMed] [Google Scholar]
  6. Fernandez R., Lord H., Halcomb E., Moxham L., Middleton R., Alananzeh I., Ellwood L. (2020). Implications for COVID-19: A systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic. International Journal of Nursing Studies, 111, 103637. 10.1016/j.ijnurstu.2020.103637 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gordon J. M., Magbee T., Yoder L. H. (2021). The experiences of critical care nurses caring for patients with COVID-19 during the 2020 pandemic: A qualitative study. Applied Nursing Research, 59(1), article no. 151418. 10.1016/j.apnr.2021.151418 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hoseinabadi T. S., Kakhki S., Teimori G., Nayyeri S. (2020). Burnout and its influencing factors between frontline nurses and nurses from other wards during the outbreak of coronavirus disease—COVID-19—in Iran. Investigacion y Educacion en Enfermeria, 38(2), article no. e03. 10.17533/udea.iee.v38n2e03. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Karimi Z., Fereidouni Z., Behnammoghadam M., Alimohammadi N., Mousavizadeh A., Salehi T., Mirzaee S. (2020). The lived experience of nurses caring for patients with COVID-19 in Iran: A phenomenological study. Risk Management and Healthcare Policy, 13(1), 1271–1278. 10.2147/rmhp.s258785 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kim Y. (2018). Nurses’ experiences of care for patients with Middle East respiratory syndrome-coronavirus in South Korea. American Journal of Infection Control, 46(7), 781–787. 10.1016/j.ajic.2018.01.012 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Krupa S., Filip D., Mędrzycka-Dąbrowska W., Lewandowska K., Witt P., Ozga D. (2021). Sleep disorders among nurses and other health care workers in Polan during the COVID-19 pandemic. Applied Nursing Research, 59(1), article no. 151412. 10.1016/j.apnr.2021.151412 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kuhnke J. L., Harley C., Lillington T. (2021). Nurses specialized in wound, ostomy, and continence care: Self-care during the novel coronavirus (COVID-19) pandemic. WCET Journal, 41(1), 12–. 10.33235/wcet.41.1.12-15 [DOI] [Google Scholar]
  13. Lam S. K., Kwong E. W., Hung M. S., Pang S. M. (2016). Bridging the gap between guidelines and practice in the management of emerging infectious diseases: A qualitative study of emergency nurses. Journal of Clinical Nursing, 25(19–20), 2895–2905. 10.1111/jocn.13343 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Maunder R. (2004). The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers in Toronto: Lessons learned. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences, 359(1447), 1117–1125. 10.1098/rstb.2004.1483 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ramalho A., Freitas d. S. S., & Nogueira P., C P. (2020). Medical device-related pressure injury in health care professionals in times of pandemic. WCET Journal, 40(2), 7–. 10.33235/wcet.402.7-8 [DOI] [Google Scholar]
  16. Reid C., Windsor T., David A., Reichert R., Landy A., Berg A. (n.d.). Peer researcher training, participant manual. A training manual created for Imagining Inclusion: Creating Upstream Change in Community Mental Health. https://www.imagininginclusion.ca
  17. Savitsky B., Radomislensky I., Hendel T. (2021). Nurses’ occupational satisfaction during covid-19 pandemic. Applied Nursing Research, 59(1), article no. 151416. 10.1016/j.apnr.2021.151416 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Sun N., Shi S., Jiao D., Song R., Ma L., Wang H., Wang H. (2020). A qualitative study on the psychological experience of caregivers of COVID-19 patients. American Journal of Infection Control, 48(6), 592–598. 10.1016/j.ajic.2020.03.018 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Wallerstein N. (1987). Empowerment education: Freire’s ideas applied to youth. Youth Policy, 9(11), 11–15. [Google Scholar]
  20. Walsh, C. A., Rutherford, G., & Kuzmak, N. (2010). Engaging women who are homeless in community-based research using emerging qualitative data collection techniques. International Journal of Multiple Research Approaches, 4(3), 192–205. 10.5172/mra.2010.4.3.192 [DOI] [Google Scholar]
  21. Wang C., Burris M. (1994). Empowerment through photo novella: Portraits of participation. Health Education Quarterly, 21(2), 171–186. 10.1177/109019819402100204 [DOI] [PubMed] [Google Scholar]
  22. Wang C., Burris M. (1997). Photovoice: Concept, methodology, and use for participatory needs assessment. Health Education & Behavior, 24(3), 369–387. 10.1177/109019819702400309 [DOI] [PubMed] [Google Scholar]
  23. Wang C. C., Anderson R. M., Stern D. T. (2004). Exploring professional values and health policy through photovoice. Medical Education, 38(1), 1181–1202. 10.1111/j.1365-2929.2004.02006.x [DOI] [PubMed] [Google Scholar]
  24. Wang C. C., Yi W. K., Tao Z. W., Carovano K. (1998). Photovoice as a participatory health promotion strategy. Health Promotion International, 13(1), 75–86. 10.1093/heapro/13.1.75 [DOI] [Google Scholar]
  25. World Health Organization (2020, March 18). Mental health and psychosocial considerations during the COVID-19 outbreak. https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf

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