Emotional labor of nurses in the front line against the COVID-19 pandemic

To analyze nurses’ experiences in the front line of the fight against the COVID-19 pandemic regarding the performance of emotional labor (EL), aiming at its characterization and identification of support strategies and development opportunities of nurses and practices.

Methods:

Qualitative, descriptive, and exploratory study, with content analysis of eleven written narratives and reports from a focus group composed of nurses with experience in caring for patients with COVID-19 from different Hospital Centers in Lisbon, Portugal.

Results:

Five themes were extracted: 1) Challenges experienced by nurses in the frontline; 2) Emotions experienced by nurses in service care; 3) Emotional responses of nurses and patients: impact on care; 4) EL of nurses in the patient care process; 5) Opportunities for development in the face of the emotional challenge required of nurses in combating COVID-19.

Final considerations:

The nurses demonstrated the ability to transform this profoundly emotional experience positively.

Descriptors:
Emotions; Nurses; Nursing Care; Pandemics; COVID-19

THEMES	SUBTHEMS
The challenges faced by nurses on the front line of the fight against COVID-19	•	Situations of special complexity of patients
	•	Perception of a lack of preparation for an atypical and such demanding pandemic
	•	Initial news from Italy
	•	Personal protective equipment
	•	High emotional burden and a demanding physical effort
	•	Physical distancing from the nuclear family to prevent infection
	•	Possibility of being infected by a lethal virus
	•	Metaphors about care dynamics, nurses, and viruses
The emotions experienced by nurses in the care of patients with COVID-19	•	Anticipated emotions like fear and anxiety
	•	Emotional instability
	•	Fear and a mixture of emotions
	•	Awareness and concern about their mental health
The emotional responses of nurses and patients with COVID-19: impact on care	•	Changes in nurses' behavior in relation to the team
	•	Disclosure of nurses' different personality traits
	•	Nurses' physical changes
	•	Intentional reduction of contact between nurse and infected patient
	•	Patient exceptionally negative reactivity
	•	Patients very passive and in denial, or hiding the fact that they are infected
The emotional labor of nurses in the care process of patients with COVID-19	•	Factors that hinder the performance of emotional labor
	•	Factors that facilitate the performance of emotional labor
	•	Emotional labor with focus on the patient and related to care
	•	Self-focused emotional labor
Development opportunities in the face of the emotional challenge demanded of nurses in fighting COVID-19	•	Experience of growth and transformation
	•	Adaptation over time and experience
	•	Increased efficiency of the organization and restructuring caretaking
	•	Team cohesion and feeling of belonging
	•	Recognition of nurses' intervention
	•	Awareness of the importance of things once taken for granted
	•	Increase of development with the support of health institutions

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Paula Diogo pmdigo@esel.pt