A grounded theory of clinical nurses' process of coping during COVID-19

To explore clinical nurses' process of coping during COVID-19 and develop a grounded theory that can be used by leaders to support clinical nurses during a disaster.

The COVID-19 pandemic has provoked widespread disruption to clinical nurses' work. It is important to understand clinical nurses' processes of coping during disasters to support the nursing workforce during events such as global pandemics.

We employed the Corbin and Strauss variant of grounded theory methodology, informed by symbolic interactionism, and applied the EQUATOR guidelines for qualitative research publication (COREQ).

Data collection entailed semi-structured interviews with experienced clinical nurses (n =20) across diverse settings. We analysed data by identifying key points in the nurses' coping processes inductively building concepts around these points.

The predictor of nurses' outcomes in this grounded theory was their confidence in their ability to cope during the pandemic. When nurses lacked confidence, they experienced working in the context of acute COVID-a state of chaos and anxiety, with negative consequences for nurses. However, when nurses were confident in their abilities to cope with the pandemic, they experienced working in the context of chronic COVID, a calmer state of acceptance. There were many workplace factors that influenced nurses' confidence, including adequacy of personal protective equipment, clear information and guidance, supportive leadership, teamwork and adequate staffing.

Understanding clinical nurses' experience of coping during COVID-19 is essential to maintain the nursing workforce during similar disasters.

Nurse leaders can target areas that support nurses' confidence, such as adequate PPE and staffing. In turn, increased confidence enables clinical nurses to cope during disasters such as a global pandemic.