Nursing on the Front Lines of COVID-19 and the Role of Ambulatory Care in Pandemic Control

Purpose: To understand the experiences of front-line nurses during the COVID-19 outbreak in Hubei and investigate their views on the role of ambulatory care in the management of COVID-19 and future infectious disease outbreaks.

Background: The emergence of the novel coronavirus disease (COVID-19) continues to stretch the capacity of health care systems worldwide. High hospitalization rates for infected patients have put immense strain on health care workers who tirelessly exert themselves to deliver quality inpatient care amidst critical resources shortages. Exploring their experiences may identify ways in which ambulatory health care can be incorporated into infection control and prevention responses and ease the pressure on hospital resources during future pandemics.

Methods: Purposive, convenience, and snowball sampling were used to recruit 60 registered nurses who provided inpatient care during the COVID-19 outbreak in Hubei. Semi-structured interviews were conducted. Participants were asked to share their work experiences during the pandemic, including challenges faced in patient care, related coping strategies, and suggested improvements for future pandemic responses. Interviews were audio recorded and transcribed verbatim. Resulting data was coded and analyzed thematically according to Braun and Clarke’s (2006) framework.

Results: Participants reported multiple challenges in their experiences of delivering patient care during the COVID-19 outbreak. Due to high caseloads, nurses worked lengthier shifts and took on additional responsibilities in order to make up for shortages in hospital staff, leading to an increase in psychological and physical distress. Support came in the form of fever clinics which reduced nurses’ burden by screening patients for COVID-19 in the community and freeing up valuable hospital resources. Suggestions to improve future epidemic responses and prevent the overburdening of hospital staff included the installation of additional fever clinics and the delivery of reliable public health education in primary care settings, which may raise awareness on infection prevention and control measures and potentially lower overall infection rates.

Conclusions: Nurses in hospital settings have been overstretched due to an unprecedented surge in patients requiring hospitalization. Psychological and physical stress were frequently reported, with a potential reduction in the quality of inpatient care. To protect and reduce strain on hospital staff, ambulatory health care may be explored as a solution to increase community capacity in responding to future infectious disease outbreaks, thus allowing hospital resources to be directed towards the most serious patients and further optimizing pandemic control efforts.