Even when you are afraid, you stay': Provision of maternity care during the Ebola virus epidemic: A qualitative study (original) (raw)
Related papers
International Journal of Africa Nursing Sciences, 2017
In this study we explored the experiences of nurses and midwives, including the process involved in deciding whether or not to render care to patients during the Ebola outbreak in Liberia, West Africa. Data were collected from 30 registered nurses and registered midwives through face-to-face, semi-structured, tape-recorded interviews. We combined both Corbin and Strauss (2015) and Charmaz (2014) grounded theory methods of data collection and analysis. The result is a description of the experiences and a conceptual model that describes the social process involved in the work decisions made by the study participants. The core category identified in the data is "living in fear and terror." The work decisions of nurses and midwives were primarily influenced by family responsibilities and demands. The findings of this study could be applied to education, research, and working policies when planning for future disease outbreaks in Liberia and other regions in the world.
Pregnant, laboring, and postpartum women represented a particularly vulnerable population during the 2013-2015 Ebola epidemic in Sierra Leone. While scholarship has explored factors related to risk, infectiousness, and the medical difficulties in treating this population, few studies have examined this topic from the perspective of healthcare workers themselves. To address this gap, we conducted a qualitative study to explore the subjective experiences of healthcare providers working with this difficult-to-treat population. Data were collected between 2015 and 2017 as part of the Ebola 100 Project, an interdisciplinary research initiative that seeks to capture the stories of those who contributed to ending the West African Ebola epidemic. Via in-depth interviews (N=30) with both Sierra Leonean and expatriate nurses, physicians, midwives, and traditional birth attendants, we examine how healthcare workers navigated the moral and practical dilemmas in attending to pregnant and laboring women in a context of both fear and medical uncertainty. Our findings indicate that the emergence of Ebola was particularly traumatic for local care providers, whose tenuous employment and the neglected state of maternal health nationally, as well as community distrust, stigmatization, and personal experiences of loss, made their jobs especially difficult. International care providers, used to working in higher-resource settings, often struggled to maintain a sense of relative control and safety by properly managing risk. This they did via repeat trainings, meticulous adherence to procedures, and the creation of strict guidelines, which often by necessity prioritized their own safety and that of the public before their patients. As the epidemic waned, however, shifts in risk management occurred, and local knowledge and “gut instinct” blended with more objective criteria around clinical decision-making. These findings speak to the diverse experiences surrounding care practices during the Ebola epidemic and have relevance both for the current healthcare landscape in Sierra Leone and for informing future global health responses of this nature.
Ebola virus disease: caring for patients in Sierra Leone - a qualitative study
Journal of Advanced Nursing, 2016
Aim. The aim of this study was to describe Norwegian healthcare staffs' experiences of participating in care of patients with Ebola virus disease in Sierra Leone. Background. Ebola is one of the most feared viruses known. Ebola virus disease is highly contagious with high mortality. The few qualitative studies made on experiences among healthcare professionals have highlighted problems as lack of protective resources, insufficient personnel and risk of societal stigmatization. Design. Descriptive study with qualitative approach. Method. Individual narrative and focus group interviews were obtained during 2015 with eight nurses and one physician who had worked in Ebola care in Sierra Leone. The interviews were analysed using qualitative content analysis. Result. The analysis resulted in the two themes: 'Experiencing security by learning to manage risks'; and 'Developing courage and growth by facing personal fears'. Subthemes were: 'Relying on safeguard actions', 'Managing risk of contagion', 'Developing strategies for care despite risks', 'Constantly reminded of death', 'Successively defeating fears' and last, 'Increasing motivation through meaningfulness'. The participants described the reliance on training, organized effort, strict guidelines and equipment. They were respectful of the risk of transmission, made risk assessments, took responsibility, handled risky situations and were reminded of suffering and death. Conclusion. Despite challenges, the hazardous work with Ebola virus disease patients was experienced as meaningful which was an important motivator. Safe care was central in working with Ebola patients, but the care relation was challenged.
Global Public Health, 2020
Although the experiences of healthcare workers regarding caring for Ebola patients during the West African Ebola outbreak have been explored, little is known about healthcare workers' experiences in providing care to Ebola survivors. We employed a qualitative design to address this gap in the literature. Healthcare providers described the health complaints of Ebola survivors as similar to those of ordinary patients, but disproportionately frequent and severe. During the Ebola outbreak, fear of infection with the Ebola virus affected healthcare providers' confidence to provide care to survivors leading to the provision of symptomatic or no treatment. At the close of the Ebola outbreak, healthcare providers cited previous experience in providing care to Ebola patients, being more knowledgeable, peer support, commitment to professional duty and the implementation of the CPES programme as motivators that helped boost their confidence to providing care. However, healthcare providers described the unavailability of medicines, the inability to undertake laboratory investigations, the lack of access to specialised care and uncoordinated referrals from peripheral health units as their current challenges to providing care. Such enablers and barriers need to be prioritised within the Sierra Leone health system to further strengthen initiatives aimed at improving healthcare delivery to Ebola survivors.
PLOS Neglected Tropical Diseases, 2021
Background The 2014–2016 Ebola epidemic devastated families and communities throughout West Africa. Due to its high mortality rate and infectious nature, most Ebola research to date has focused on healthcare response and interventions; however, little is known about the experiences of Ebola survivors and communities. This qualitative study aimed to better understand the lived experiences of community members, including children, during and after the Ebola epidemic in Sierra Leone. Methods During June 2016 and June 2017, we conducted four focus groups comprised of primary school students, female caretakers, male caretakers, and teachers, and two individual in-depth interviews with local nurses in Calaba Town, a small village outside of Freetown. Interviews were recorded, transcribed verbatim, and coded using a modified grounded theory methodology. Findings All participants shared that they experienced significant challenges during and after the Ebola epidemic. During the epidemic, pa...
Background: The 2014 Ebola Virus Disease epidemic evolved in alarming ways in Sierra Leone spreading to all districts. The country struggled to control it against a backdrop of a health system that was already over-burdened. Health workers play an important role during epidemics but there is limited research on how they cope during health epidemics in fragile states. This paper explores the challenges faced by health workers and their coping strategies during the Ebola outbreak in four districts – Bonthe, Kenema, Koinadugu and Western Area-of Sierra Leone. Methods: We used a qualitative study design: key informant interviews (n = 19) with members of the District Health Management Teams and local councils, health facility managers and international partners; and in depth interviews with health workers (n = 25) working in public health facilities and international health workers involved with the treatment of Ebola patients.
Hidden Tales of Ebola: Airing the Forgotten Voices of Ugandan "Ebola Nurses
Journal of transcultural nursing : official journal of the Transcultural Nursing Society, 2021
INTRODUCTION According to the Centers for Disease Control and Prevention, Ebola has affected the lives of thousands, including health care workers. With few studies describing the experience of nurses who survived Ebola, the study aimed to describe Ugandan nurses' experiences. METHOD Using a phenomenological design, in-depth interviews were conducted among five Ugandan nurses who contracted Ebola and survived. RESULT Thematic analysis revealed themes of expectations of dying, hopelessness, loneliness, and betrayal by family, community, and the health system. DISCUSSION Results support the need for policies targeting holistic practice protocols to protect all health care professionals during future outbreaks. Last, nursing survivors should have access to government-guaranteed support programs, including free health care and financial stipends. These results and recommendations transcend to the current reality of living with COVID-19 (coronavirus disease 2019). Efficient practice ...
Although research on the epidemiology and ecology of Ebola has expanded since the 2014–15 outbreak in West Africa, less attention has been paid to the mental health implications and the psycho-social context of the disease for providers working in primary health facilities (rather than Ebola-specific treatment units). This study draws on 54 qualitative interviews with 35 providers working in eight peripheral health units of Sierra Leone's Bo and Kenema Districts. Data collection started near the height of the outbreak in December 2014 and lasted 1 month. Providers recounted changes in their professional, personal and social lives as they became de facto first responders in the outbreak. A theme articulated across interviews was Ebola's destruction of social connectedness and sense of trust within and across health facilities, communities and families. Providers described feeling lonely, ostracized, unloved, afraid, saddened and no longer respected. They also discussed restrictions on behaviors that enhance coping including attending burials and engaging in physical touch (hugging, handshaking, sitting near, or eating with colleagues, patients and family members). Providers described infection prevention measures as necessary but divisive because screening booths and protective equipment inhibited bonding or 'suffering with' patients. To mitigate psychiatric morbid-ities and maladaptive coping mechanisms—and to prevent the spread of Ebola—researchers and program planners must consider the psychosocial context of this disease and mechanisms to enhance psychological first aid to all health providers, including those in peripheral health settings.