The Journal of Nursing Research ▪ VOL. 28, NO.

3, JUNE 2020

Nursing Perspectives on the

Impacts of COVID-19
Shu-Ching CHEN1 • Yeur-Hur LAI2 • Shiow-Luan TSAY3*

The Impact of COVID-19 as a related pneumonia have combined to create the current pan-
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demic crisis, which is impacting greatly on health, economics,

Global Crisis and social life on a global scale. Massive medical manpower
The outbreak of the coronavirus disease (COVID-19) was and resources have been invested in the prevention and treat-
first reported in Wuhan, China, in December 2019 (Chen, ment of severe pneumonia, increasing the burdens on, and
Zhou, et al., 2020; Wang, Hu, et al., 2020). It has since even threatening the exhaustion of, healthcare systems across
spread rapidly across China, Asia, the Middle East, Europe, the world. Restrictions on normal life, trade activities, and
North America, and other parts of the world (https://www. travel as well as lockdowns of cities and countries to prevent
worldometers.info/coronavirus/). There have been 3,579,479 the spread of COVID-19 have severely impacted the world
confirmed cases and 248,445 confirmed deaths globally (latest economy, threatening an economic depression (Anzai et al.,
update: May 4, 2020, Central European Time 10:00, World 2020; Maffioli, 2020; Pan et al., 2020). In addition to finan-
Health Organization). COVID-19 was declared a public health cial woes, psychological reactions such as fear of infection
emergency of international concern on January 30, 2020 (Chew & Eysenbach, 2010; Signorini, Segre, & Polgreen,
(World Health Organization, 2020) and is now a pandemic. 2011), uncertainty, worry, anxiety, and panic have been re-
ported globally.
Since the first outbreak of the disease in Wuhan, China,
Clinical Characteristics, the travel restrictions on China have led to certain stigmas
Transmission, and Spread because of the perceived threat of the virus and caused the
negative labeling of and social bias toward countries and
The most common symptoms in patients infected with
COVID-19 are fever and cough (Chen, Zhou, et al., 2020; ethnicities (Andrasik et al., 2020; Madiba & Josiah, 1919;
Person et al., 2004; Yang et al., 2013). Country-based travel
Guan et al., 2020; Huang et al., 2020) followed subsequently
restrictions and lockdowns have decreased communications
by shortness of breath, fatigue, muscle pain, dyspnea, headache,
among people and among countries, leading to social dis-
hemoptysis, and diarrhea. Some patients developed further fatal
tancing and isolation on an international scale as well as
complications, including sepsis, septic shock, pulmonary edema,
to large-scale disruptions in international travel and trade.
severe pneumonia, and acute respiratory distress syndrome
The massive costs of the damage wrought by the COVID-19
(Chen, Guo, et al., 2020; Huang et al., 2020). The median incu-
pandemic both to human health and to the economy are
bation period of this disease is 4 days (Guan et al., 2020). How-
ever, some infected patients report no symptoms, with the currently unknowable.
asymptomatic ratio currently estimated at around 30.8%
(Nishiura et al., 2020). Asymptomatic expression makes the unde-
tected transmission and massive spreading of this disease possible.
1
COVID-19 is transmitted primarily from person to person PhD, RN, Professor, School of Nursing and Geriatric and Long-Term
through respiratory droplets (Malta, Rimoin, & Strathdee, Care Research Center, College of Nursing, Chang Gung University of
Science and Technology; Jointly Appointed Professor, School of
2020). Unsanitary conditions, places with high population Nursing, College of Medicine, Chang Gung University; and Adjunct
densities, and enclosed spaces with heavy foot traffic (e.g., Research Fellow, Departments of Radiation Oncology and Proton
malls, airports, and public transportation) increase the risks Center, Chang Gung Memorial Hospital at LinKou, Taiwan, ROC •
2
PhD, RN, Professor, School of Nursing, College of Medicine, National
of community-based transmission and rapidly spreading this Taiwan University, Taipei; and Director, Department of Nursing,
disease (Chen, Zhou, et al., 2020; Lai, Shih, Ko, Tang, & National Taiwan University Cancer Center, Taiwan, ROC • 3PhD, RN,
Hsueh, 2020). Furthermore, clusters of nosocomial infections Professor and Dean, College of Nursing and Health Sciences, Da-Yeh
University, Taiwan, ROC.
have occurred in hospitals (Wang, Wang, Chen, & Qin, 2020).
Copyright © 2020 The Authors. Published by Wolters Kluwer Health,
Inc. All rights reserved.
The Pandemic Crisis of COVID-19 This is an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use,
The rapid and undetected spread of COVID-19 and the (po- distribution, and reproduction in any medium, provided the original
tentially) relatively high mortality rate from COVID-19- work is properly cited.

1
The Journal of Nursing Research Shu-Ching CHEN et al.

Nurses' Contribution in infection than the general population. Patients with cancer,
especially those with hematological malignancies, who are
Anti-COVID-19 currently receiving chemotherapy as well as patients receiv-
Because of the mild or even undetectable nature of symptoms ing immunosuppressive therapies or bone marrow transplants
of COVID-19 in some infected patients, this new respiratory must be particularly well educated and cared for to prevent
disease has been able to spread rapidly on a global scale. infection. Educating patients on self-protection strategies
Nurses are the frontline healthcare professionals who work is a critical function of nurses (American Society of Clinical
across acute care hospitals, long-term care agencies, nursing Society, 2020; CDC, 2020).
homes, schools, community, and government healthcare The fifth and final domain is providing care to patients
agencies. The multiple roles and functions played by nurses with COVID-19 who are in an acute or critical condition.
are particularly important during this COVID-19 pandemic. COVID-19 may induce severe pneumonia and even lead to
These important roles and functions cover five domains. mortality in every age group, with the highest risk groups in-
The first domain is providing health education, screening cluding older adults and individuals with immune deficits.
services, and support for the general public and for individ- Thus, it is important to provide urgent, intensive care to
uals in high-risk categories. Health education should cover patients who are infected and symptomatic, particularly so
strategies for infection prevention (e.g., washing hands regu- for those with severe conditions. Ensuring that healthcare
larly; avoiding touching the eyes, nose, and mouth; canceling providers are fully protected by adequate personal protec-
group activities and communal dining) and early detection of tion equipment is necessary to prevent them from becoming
infections signs (respiratory symptoms, cough, fever, and muscle infected. Intensive care capacities in terms of both manpower
soreness). Screening services focuses on screening individuals for and equipment are very important. In intensive care, nursing
potential infections, whereas support focuses on providing staffs provide direct life-sustaining care to help patients
emotional support to those isolated because of COVID-19 recover from COVID-19-induced pneumonia as well as pro-
(Jernigan & CDC COVID-19 Response Team, 2020; Patel, vide psychological support to patients in states of panic
Jernigan, & 2019-nCoV CDC Response Team, 2020). or distress (Jin et al., 2020; Lai et al., 2020; Liew, Siow,
The second domain is nosocomial infection prevention and MacLaren, & See, 2020).
surveillance. Nurses screen suspected cases (recording case
histories of contact travel); implement standard precautions
(hand hygiene, respiratory hygiene, personal protective equip-
Key Challenges Faced by Nursing
ment, injection safety, medication storage and handing, and Professionals During COVID-19
disinfection); and educate and train patients, families, and Infection prevention and control in primary, community, and
healthcare staff (Centers for Disease Control and Prevention acute care settings present healthcare and nursing professionals
[CDC], 2016) to prevent nosocomial infections. Furthermore, with huge challenges. Important practice issues remain to be re-
nurses implement isolation care and monitor (using the solved (CDC, 2020; National Institute for Health and Care
mobile location finder system), provide supplies to, conduct Excellence, 2017). The key challenges to nursing professionals
fever and respiratory symptoms assessments of, and provide during the COVID-19 pandemic are discussed hereinafter.
emotional support to individuals under mandatory home-
quarantine restrictions (Jernigan & CDC COVID-19 Response Providing Support to Reduce Gaps in
Team, 2020; Patel et al., 2020).
Critical Knowledge
The third domain is implementing appropriate prepara-
tions and precautions in nursing home and long-term care set- As COVID-19 is a newly identified disease, effective vaccines
and treatments are still in development. Thus, in tackling this
tings. Patients in long-term care facilities and nursing homes
newly identified infectious disease, nurses face a potential risk
are highly vulnerable to infection, with those contracting
of infection as well as potential work-related anxiety and men-
COVID-19 facing a high instance of experiencing severe
tal health problems (Khalid, Khalid, Qabajah, Barnard, &
pneumonia or even death. Thus, preparing safe and protec-
Qushmaq, 2016). It is important to apply the latest knowl-
tive care and environment at these sites is a very important
role of nurses during this pandemic. Care plans for residents edge to protect healthcare professionals and nursing staff
and patients in these institutions should include strategies for who are caring for patients with COVID-19. Healthcare pro-
rapidly identifying and managing ill residents, developing viders must be educated about the dangers of infectious disease,
including the proper use of personal protective equipment,
safe visiting policies that restrict the number of visitors, main-
proper personal hygiene practices, and related environmental
taining a protective environment, conducting critical training
measures (Aldohyan et al., 2019).
and education, and issuing proper sick-leave policies for health-
care staffs (CDC, 2020).
The fourth domain is the protection of patients with im- Preventing Inadequacies in the Healthcare
mune deficits or underlying diseases such as chronic obstruc- System
tive pulmonary disease, chronic illnesses, and cancer. These The rapid spread of COVID-19 has caused challenges world-
patients face significantly higher health risks from a COVID-19 wide, especially in terms of delivering sufficient personal

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COVID-19 and Nursing VOL. 28, NO. 3, June 2020

protective equipment to the healthcare system. The disease prevention in both healthcare and community settings will
mainly spreads through respiratory droplets. Insufficient per- be valuable. Exploring the impact of cultural differences on
sonal protective equipment (facial mask, gloves, impervious the perception and prevention of COVID-19 will be one of
gowns, and eye protection) has been associated with occupa- the most significant issues related to the spread and manage-
tional exposure and illness (Kilmarx et al., 2014). Previous ment of COVID-19 across countries and cultures.
studies have reported on inadequate personal protective Furthermore, exploring the psychological distress and
equipment and medical supplies in hospitals and healthcare social burdens experienced by healthcare professionals and
agencies during past events (Lautenbach, Saint, Henderson, nurses during this outbreak will be vital as well. Better under-
& Harris, 2010; Rebmann, Wilson, LaPointe, Russell, & standing the perceptions, stress, and concerns of nursing and
Moroz, 2009). Improving production and procurement is other healthcare professionals may provide critical new infor-
critical to ensuring security and safety in the workplace. mation that administrative systems may use to better support
these professionals during future infectious disease outbreaks.
Policies and Strategies to Prevent Staffing
Shortages Conclusions
Outbreaks of recognized contagious illnesses such as COVID-19
The rapid spread of COVID-19 poses a serious threat to
highlight the risk of safety problems for healthcare providers
human health and is impacting severely on public health,
and nurses. Manpower shortages during infectious disease
global communications, and economic systems worldwide.
outbreaks may be caused by uncertainties regarding life-
Nurses are key members of healthcare teams charged to con-
threatening infectious sources and real cases of infection
trol and prevent the spread of infectious diseases. Moreover,
among healthcare staff (Musau, Baumann, Kolotylo, O'Shea,
nurses work on the front line, providing direct care to indi-
& Bialachowski, 2015). Policies from government, healthcare, viduals infected with COVID-19. Further effort is necessary
and nursing administration systems may help prevent the
to develop strategic recommendations and to integrate new
rapid spread of COVID-19 through measures including
knowledge into education. The immediate efforts to control
infection control education, protective equipment use, and
and prevent COVID-19 and to care for those who are infected
isolating patients who have been infected from the nonin-
remain ongoing.
fected population. These and other measures may protect
healthcare staffs. Nurse administrators and clinicians also
play important roles in developing and promoting effective Accepted for publication: April 6, 2020
*Address correspondence to: Shiow-Luan TSAY, No. 168, University Rd.,
anti-infection protective environments and strategies. Poli- Dacun Rural Township, Changhua County, 51591 Taiwan, ROC. Tel: +886-
cies on employment benefits and incentives may also be used 4-8511888 ext. 7200; Fax: +886-4-8511701; E-mail: sltsay0308@gmail.com
to increase staff retention during outbreaks (Stone, Clarke, The authors declare no conflicts of interest.
Cimiotti, & Correa-de-Araujo, 2004). Cite this article as:
Chen, S. C., Lai, Y. H., & Tsay, S. L. (2020). Nursing perspectives on the
Psychological and Social Support for impacts of COVID-19. The Journal of Nursing Research, 28(3), e85
https://doi.org/10.1097/jnr.0000000000000389
Patients, Healthcare Professionals, and
Nurses
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