Julia Challinor1, Maria Fernanda Olarte Sierra2, Kathryn Burns3, and Annie Young4
1School of Nursing, University of California San Francisco, San Francisco, California, USA ORCID https://orcid.org/0000-0002-5008-8501
2Independent Medical Anthropology. San Sebastián. Spain
ORCID https://orcid.org/0000-0002-6537-7138
3 Independent Consultant. Qualitative Research. Budapest, Hungary
4 Warwick Medical School, University of Warwick, Coventry, UK
ORCID https://orcid.org/0000-0001-6611-6653
Correspondence to: Julia Challinor Email: jmchallinor@gmail.com
The World Health Organisation (WHO) designated 2020 as ‘International Year of the Nurse and Midwife’. For the world, 2020 was a year like no other and for nurses, it has now been two years of unprecedented challenges due to the COVID-19 pandemic. The situation is far from over and the impact of the coronavirus disease 2019 (COVID-19) pandemic lingers on.
In life-threatening situations of great chaos and devastating consequences of poor planning and preparation, it is important to reflect on the psychosocial impact on healthcare providers and the patients they care for. Here we focus on oncology nurses and their patients in unheralded times and acknowledge the double burden they all face, specifically in LMICs where resources are limited under normal circumstances and now must accommodate COVID-19-related challenges. As we all know, it has not been easy to deal with COVID-19, and the problems are magnified in underserved settings where there is often a weak public health infrastructure and social inequalities mark people’s experiences of access to healthcare [1]. For those people being treated for cancer and their caregivers, this distress is amplified due to uncertainty about cancer and the future and uncertainty about the risk of infection. In this sense, COVID-19 is shaping the lives of people with cancer, their families and their caregivers in various parts of the globe in many ways. The significance of the oncology nurse’s contribution to the care of people with cancer is more relevant than ever before due to their role as the cornerstone of health services, either on the frontline offering compassionate care or in leadership, research and education.
The nurses (and other healthcare professionals) in this special issue reported managing the enormous challenges that COVID-19 is imposing on them in multiple ways; resilience is a salient feature of keeping up the urgent and exhausting work they face each day. Understood as a protective factor, resilience has been conceptualised as a set of characteristics that enable nurses to respond to hardship [2]. Nurses in this series referred to their resilience as a force that helped them to cope. For example, Qian et al., report that “although every team member was well aware of the danger we were in, we had to cope with it in our own ways, showing optimism, confidence and calmness as we guarded the ward 24/7” at the hospital in Wuhan, China. However, resilience cannot be understood as a mere individual skill; it must also be collective and organisational [3]. Traynor et al, 2018, explains that nurses face two sets of stressor factors - one related directly to their work and the fact that nurses are constantly facing suffering and sometimes the death of their patients, as in COVID-19. Other factors are “the result of political decisions, under-resourcing, poor management, dysfunctional and insecure organisations, disempowered nurse managers, sexism, racism in the workplace, which all result in understaffing, perhaps, and high turnover”[3]. Thus, nurses’ efforts must be accompanied by a structural management support system that takes responsibility for ensuring a safe and balanced workplace [4]. In this regard, Anarado et al., from Nigeria, in this special issue express that “there is an urgent need for adequate mental health support with a regular supply of personal protective equipment (PPE) and capacity building to strengthen the nurses’ capacity and resilience to deliver to cancer patients and family optimal psychosocial nursing care”. Similarly, Nurse Abdallah-Doumit from Lebanon, in this special issue, poignantly presents the fundamental role that the Lebanese Order of Nurses has played in ensuring nurses’ proper working conditions from the start of the ongoing pandemic.
This series celebrates the International Year of the Nurse and Midwife 2020 and into 2021, as we acknowledge oncology nurses’ paramount role by illustrating their experience caring for patients and their caregivers from LMICs in all WHO regions. Nurses caring for cancer patients in LMICs were already faced with serious challenges of staff shortages, lack of specialised training in oncology, little or no access to pharmacists for chemotherapy preparation, scant practice resources (e.g. PPE) or other supportive care specialists available in high-income countries such as psychologists, nutritionists, palliative care specialists, or dedicated oncology social workers. In pandemic times, additional nurse stressors include lack of public transportation, increased staff shortages due to diversion to COVID-19 wards, vulnerable nurses with chronic conditions or pregnancy sent home and some nurses infected with COVID-19, dying.
Stories in this issue from LMIC settings with cultures of large extended families living in the same quarters or compounds, reveal the oncology nurses’ terror of bringing COVID-19 into their house and infecting family members, noted by nurse 2 in the account by Yilmaz et al in Turkey and Nurse Celis in Peru. Normal sources of comfort like religious and spiritual worship were closed due to the pandemic and this caused further suffering for patients and nurses as illustrated by nurses Afiyanti and Milanti from Indonesia in this special issue.
In the context of the current pandemic, nurses, as ever, as part of the global healthcare team have risen to the challenge of caring. As one nurse expressed: We won’t have all the answers, nor can we reassure patients that it’s all going to be fine. But we can listen, we can care and we can stay in touch.[5] These unprecedented times require us all to look after each other. Given the strain that COVID-19 has imposed on healthcare workers and the public, the United Nations’ early warning of a global mental health crisis is now a reality. Caring in these troubled circumstances is fraught with anxiety and uncertainty [6] in a period of social isolation, fear, and high numbers of people falling severely ill and many dying simultaneously. This care continues day in, day out; however, ‘resilience to burnout’ is frequently reported [7].
Through the voices of the nurses and oncology patients and caregivers, seldom featured in the media, we have a unique vantage point to come closer and truly understand the challenges, practices and possibilities of oncology nurses brought about by the COVID-19 pandemic, that is what the pandemic has meant for nurses caring for people with cancer daily, at a personal and professional level. Considering the drastic circumstances and consequences of early COVID-19 on healthcare systems and stress and uncertainty for oncology nurses, it is remarkable that so many nurses took the time to tell their stories. Each author was encouraged to write their story in a format that was appropriate to their setting and pandemic experience, and the reader is not offered uniformity in the papers.
The pandemic has made evident the increased health inequalities throughout the globe, perhaps none more so than vaccine distribution, which remains unacceptably inequitable. Cancer does not pause for a pandemic – and oncology nurses do not pause in their care, despite the added personal and professional burden and psychosocial consequences. We leave it to the reader to consider these oncology nurse contributions and narratives from the early days of the pandemic and reflect on the detailed and personal accounts of a globally shared experience.
A supplement containing 15 personal narratives from nurses can be accessed here.
References
[1] Shah SC, Kayamba V, Peek Jr RM and Heimburger D (2019) Cancer control in low-and middle-income countries: is it time to consider screening?. JCO Glob Oncol 5, 1-8
[2] Yılmaz, EB (2017) Resilience as a strategy for struggling against challenges related to the nursing profession. Chinese Nursing Research 4 1, 9-13
[3] Traynor M (2018) Guest editorial: What’s wrong with resilience. Journal of Research in Nursing. 2018;23(1):5-8.
[4] Mayben, J and Bridges, J (2020). Editorial Covid-19: Supporting nurses' psychological and mental health. J Clin Nurs 29, 15-16, 2742-2750
[5] Van Zyl, M (2020) Guiding people with advanced cancer through COVID-19 https://rcni.com/cancer-nursing-practice/opinion/comment/guiding-people-advanced-cancer-through-covid-19-160476 Date accessed: 30/10/2021
[6] Di Trani M, Mariani R, Ferri R, De Berardinis D and Frigo MG (2021) From resilience to burnout in healthcare workers during the COVID-19 emergency: the role of the ability to tolerate uncertainty. Front Psychol 12 987
[7] López Steinmetz LC, Herrera CR, Fong SB and Godoy JC (2021) A longitudinal study on the changes in mental health of healthcare workers during the COVID-19 pandemic. Psychiatry 1-6
