Overcoming the challenge of COVID-19: A grounded theory approach to rural nurses' experiences

Introduction: This study inquires into nurses' changing perceptions with regard to the efforts in preparation for working in a COVID-19 ward in the rural Japanese context. Methods: Data were collected using ethnographic methods and semi-structured interviews among 16 nurses working in the COVID-19 ward of a rural community hospital in Japan. A grounded theory approach was used for the qualitative analysis. Results: In total, 70 hours' observation and participation were completed, and 27 pages of field notes were taken and used for the analysis. In addition, 32 interviews were conducted with 16 participants. Four themes emerged from the data: pre-COVID-work perceptions, overcoming fear, shadow cast by working in the COVID-19 ward, and an integrated approach to the fear of COVID-19. The nurses initially felt unpredictable fear. However, the establishment of standard approaches and practices for COVID-19 gave them confidence in their safety and helped them regain sympathy for patients. Nevertheless, working on COVID-19 cases negatively affected their activities outside of the ward, and some of them developed an identity crisis as they feared for the future. Conclusion: Better teamwork, comprehensive understanding of COVID-19, and continuous provision of proper knowledge in rural hospitals should be driven by appropriate understanding and sympathy for nurses and patients in COVID-19 wards. The results of this study can be applied to mitigate nurses' fear, improve teamwork, and ensure understanding of COVID-19 by all medical staff in rural hospitals.