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Investigating Nurses’ and Nurse Managers’ Experiences During the COVID-19 Pandemic: A Phenomenological Study

Year 2024, Volume: 17 Issue: 3, 385 - 400, 15.07.2024
https://doi.org/10.46483/jnef.1516060

Abstract

Background: Türkiye is ranked close to last among OECD countries in terms of the ‘number of nurses per 1,000 people’. Nurses and nurse managers already devotedly provided services under difficult conditions during normal periods before the pandemic, and this became even harder during the pandemic. Therefore, it is important to investigate the experiences of nurses and nurse managers during the pandemic to make improvement in nursing care for future possible pandemics.

Objective: This study aimed to explore the experiences of nurses and nurse managers during the COVID-19 pandemic.

Method: The study used the phenomenological qualitative approach. The sample consisted of 14 nurse managers and 14 nurses who were working during the COVID-19 pandemic. Data were collected via online voice and video calls using a semi-structured interview form. The findings were reported in accordance with the consolidated criteria for reporting qualitative research.

Results: Following analysis of the data, the attitudes of nurse managers and nurses in Türkiye related to the COVID-19 pandemic challenges and experiences divided into three themes: “Communication”, “Training”, and “Working Conditions/Environment”.

Conclusion: In the study, nurses emphasized that their work environments were negatively impacted during the COVID-19 pandemic. Additionally, it was concluded that nurse managers exerted significant efforts to facilitate communication, to meet nurses’ needs for training, and to improve staff nurses’ working conditions. Some nurses noted that hospital administrators and nursing service managers provided social and psychological support. The study also revealed that the sensitivity and genuine approach of nurse managers enhanced nurses’ resilience. Nurse managers’ management skills and nurses’ experiences during the pandemic provide valuable insights and evidence for effectively managing future pandemics and similar disasters.

References

  • Bianchi, M., Prandi, C., & Bonetti L. (2021). The experience of middle management nurses during COVID‐19 pandemic in Switzerland: A qualitative study. J Nurs Manag, 29(7), 1956-1964.https://doi.org/10.1111/jonm.13339
  • Butler-Henderson, K., Tan, S., Lalani, K., Mandapam, S. K., Kemp, T., Rudolph, J., & Crawford, J. A. (2021). Update of the COVID-19 higher education literature database (CHELD v2). Journal of Applied Learning & Teaching, ;4(1):1-4. https://doi.org/10.37074/jalt.2021.4.1.22
  • Catania, G., Zanini, M., Hayter, M., Timmins, F., Dasso, N., Ottonello, G., Aleo, G., Sasso, L., & Bagnasco, A. (2021). Lessons from Italian front‐line nurses’ experiences during the COVID‐19 pandemic: A qualitative descriptive study. J Nurs Manag, 29(3):404-411. https://doi.org/10.1111/jonm.13194.
  • Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In Valle, R. S., King, M., Existential phenomenological alternatives for psychology (pp48-71). New York: NY Plenum.
  • Creswell, J. W., & Poth, C. N. (2016). Qualitative inquiry and research design: Choosing among five approaches. London: SAGE Publications.
  • Freysteinson, W. M., Celia, T., Gilroy, H., & Gonzalez, K. (2021). The experience of nursing leadership in a crisis: A hermeneutic phenomenological study. J Nurs Manag, 29(6):1535-1543. https://doi.org/10.1111/Jonm.13310.
  • Gan, I. (2019). How do nurses’ work arrangements influence nurse managers’ communication? A qualitative study. J Nurs Manag, 27(7):1366-1373. https://doi.org/10.1111/jonm.12817
  • Gao, X., Jiang, L., Hu, Y., Li, L., & Hou, L. (2020). Nurses’ experiences regarding shift patterns in isolation wards during the COVID‐19 pandemic in China: A qualitative study. J Clin Nurs, 29(21-22):4270-4280. https://doi.org/10.1111/jocn.15464
  • García‐Martín, M., Roman, P., Rodriguez‐Arrastia, M., Diaz‐Cortes, M. D. M., Soriano‐Martin, P. J., & Ropero‐Padilla, C. (2020). Novice nurse’s transitioning to emergency nurse during COVID‐19 pandemic: A qualitative study. J Nurs Manag, 29(2):258-267. https://doi.org/10.1111/jonm.13148
  • Geremia, D. S., Vendruscolo, C., Celuppi, I. C., Adamy, E.K., de Oliveira Toso, B. R. G., & de Souza, J. B. (2020). 200 Years of Florence and the challenges of nursing practices management in the COVID-19 pandemic. Revista latino-americana de enfermagem, 28: e3358. https://doi.org/10.1590/1518-8345.4576.3358
  • Griffiths, P., Dall’Ora, C., Simon, M., Ball, J., Lindqvist, R., Rafferty, A. M., Schoonhoven, L., Tishelman, C., & Aiken, L. (2014). Nurses’ shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety. Medical Care, 52 (11): 975-981. https://doi.org/10.1097/MLR.0000000000000233
  • Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Fostering compassion and reducing burnout: How can health system leaders respond in the Covid-19 pandemic and beyond?. Nurs Educ Today, 94:104502. https://doi.org/10.1016/j.nedt.2020.104502
  • Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu,J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wie, Y., Wu, W., Xie, X., Yin, W., & Li, H. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223):497-506. https://doi.org/10.1016/S0140‐6736(20)30183‐5
  • International Council of Nursing. Covid‐2019 update: Data on infected healthcare workers and access to protective equipment in the prevention of the virus. (2020). https://www.icn.ch/news/icn‐covid‐2019‐update‐data‐infected‐healthcare‐workers‐and‐access‐protective‐equipment‐vital.
  • Lambert, V. A., & Lambert, C. E. (2012). Qualitative descriptive research: An acceptable design. Pacific Rim International Journal of Nursing Research, 16(4), 255-256.
  • Lin, C. F., Huang, H. Y., & Lu, M. S. (2013). The development of nursing workforce allocation standards for acute care general wards in Taiwan. Journal of Nursing Research, 21(4):298-306. https://doi.org/10.1097/jnr.0000000000000002
  • Liu, Q., Luo, D., Haase, J. E., Guo, Q., Wang, X. Q., Liu, S, Xia, L., Liu, Z., Yang, J., & Yang, B. X. (2020). The experiences of health-care providers during the COVID-19 crisis in China: A qualitative study. The Lancet Glob Health, 8(6):e790-e798.https://doi.org/10.1016/S2214-109X(20)30204-7
  • Maben, J., & Bridges, J. (2020). Supporting nurses’ psychological and mental health. J Clin Nurs, 29(15-16):2742-2750. https://doi.org/10.1111/jocn.15307
  • Morrow, R., Rodriguez, A., & King, N. (2015). Colaizzi’s descriptive phenomenological method. The psychologist, 28(8), 643-644. https://doi.org/10.1016/j.jcin.2015.03.00
  • Muz, G., & Erdoğan Yüce, G. (2021). Experiences of nurses caring for patients with COVID‐19 in Türkiye: A phenomenological enquiry. J Nurs Manag, 29(5):1026-1035. https://doi.org/10.1111/jonm.13240
  • OECD. Nurses. (2021). https://data.oecd.org/healthres/nurses.htm
  • Ohta, R., Matsuzaki, Y., & Itamochi, S. (2020). Overcoming the challenge of COVID‐19: A grounded theory approach to rural nurses’ experiences. Journal of General and Family Medicine, 22(3):134-140. https://doi.org/10.1002/jgf2.410
  • Palese, A., Papastavrou, E., & Sermeus, W. (2021). Challenges and opportunities in health care and nursing management research in times of COVID‐19 outbreak. J Nurs Manag, 29(6):1351-1355. https://doi.org/10.1111/jonm.13299
  • Polit, D. F., & Beck, C. (20212). Nursing research: Generating and assessing evidence for nursing practice. 9th Edition (pp213-242). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
  • Rodriguez, A., & Smith, J. (2018). Phenomenology as a healthcare research method. Evidence-Based Nursing, 21(4), 96-98. https://doi.org/10.1136/eb-2018-102990
  • Rosa, W. E., Schlak, A. E., & Rushton, C. H. (2020). A blueprint for leadership during COVID-19. Nursing Management, 51(8):28-34. https://doi.org/10.1097/01.NUMA.0000688940.29231.6f
  • Rosen, J. (2015). Establishing a strong culture of compassion improves quality of care, bottom line. Schwartz Centre for Compassionate Care. http://www.theschwartzcentre.org/
  • Sandelowski, M. (2010). What’s in a name? Qualitative description revisited. Research in Nursing & Health, 33(1), 77-84. https://doi.org/10.1002/ nur.20362.
  • Stimpfel, A.W., Fatehi, F., & Kovner, C. (2020). Nurses’ sleep, work hours, and patient care quality, and safety. Sleep Health, 6(3):314-320. https://doi.org/10.1016/j.sleh.2019.11.001
  • Taylor, C., Xyrichis, A., Leamy, M. C., Reynolds, E., & Maben, J. (2018). Can Schwartz Center Rounds support healthcare staff with emotional challenges at work, and how do they compare with other interventions aimed at providing similar support? A systematic review and scoping reviews. BMJ Open, 8(10):e024254. http://dx.doi.org/10.1136/bmjopen-2018-024254
  • Thakur, V., & Jain, A. (2020). COVID 2019-suicides: A global psychological pandemic. Brain Behav Immunity, 88:952-953. https://doi.org/10.1016/j.bbi.2020.04.062
  • Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6):349-357.
  • Türk, M. O. K., Akkus, C. H., Atay, G., Erdogan, S., Cakir, D., & Sali, E. (2021). Therapeutic plasma exchange (TPE) treatment in COVID-19 related Multisystem inflammatory syndrome in children (MIS-C) who admitted withacute abdomen clinic. Jour Umraniye Pediatr, 1(1):14-19.
  • Turkish Medical Association. COVID-19 pandemic bi-monthly assessment report. (2020). https://www.ttb.org.tr/userfiles/files/covid19-rapor.pdf
  • White, J. H. (2021). A phenomenological study of nurse managers’ and assistant nurse managers’ experiences during the COVID‐19 pandemic in the United States. J Nurs Manag, 29(6):1525-1534. https://doi.org/10.1111/jonm.13304
  • World Health Organization. WHO Coronavirus (COVID-19) Dashboard. (2021). https://covid19.who.int/
  • Wu, Y., Wang, J., Lu, C., Hu, S., Lin, X., Anderson, A. E., Bruera, E., Yang, X., Wei, S., & Qian, Y. (2020). A comparison of burnout frequency among oncology physicians and nurses working on the 12frontline and usual wards during the COVID-19 epidemic in Wuhan, China. Journal of pain and symptom management, 60(1):e60-e65. https://doi.org/10.1016/j.jpainsymman.2020.04.008
  • Yıldırım, A., & Şimşek, H. (2016). Sosyal Bilimlerde Nitel Araştırma Yöntemleri 10. Baskı. Ankara.

Hemşirelerin ve Hemşire Yöneticilerin COVID-19 Salgını Sırasındaki Deneyimlerinin İncelenmesi: Fenomenolojik Bir Çalışma

Year 2024, Volume: 17 Issue: 3, 385 - 400, 15.07.2024
https://doi.org/10.46483/jnef.1516060

Abstract

Giriş: Türkiye, ‹1.000 kişiye düşen hemşire sayısı› açısından OECD ülkeleri arasında sonuncuya yakın sırada yer almaktadır. Hemşireler ve hemşire yöneticiler zaten pandemi öncesi normal dönemlerde zor şartlar altında özveriyle hizmet veriyorlardı ve bu pandemi döneminde daha da zorlaştı. Bu nedenle hemşirelerin ve hemşire yöneticilerin pandemi sürecindeki deneyimlerinin araştırılması gelecekteki olası pandemilere karşı hemşirelik bakımında iyileştirme yapılması açısından önemlidir.

Amaç: Bu çalışma, hemşirelerin ve hemşire yöneticilerin COVID-19 pandemisi sırasındaki deneyimlerini araştırmayı amaçlamıştır.

Yöntem: Araştırmada fenomenolojik nitel yaklaşım kullanılmıştır. Örneklemi, COVID-19 pandemisi sırasında çalışan 14 yönetici hemşire ve 14 hemşire oluşturmuştur. Veriler, yarı yapılandırılmış görüşme formu kullanılarak sesli ve görüntülü görüşme yapılarak çevrimiçi olarak toplanmıştır. Bulgular, nitel araştırmaları raporlamak için birleştirilmiş kriterlere dayalı olarak rapor edilmiştir.

Bulgular: Verilerin analizinin ardından, Türkiye’deki hemşire yönetici ve hemşirelerin COVID-19 zorluklarına ve deneyimlerine yönelik tutumları üç temaya ayrılmıştır: “İletişim ve İş birliği”, “Eğitim/Gelişim” ve “Çalışma Koşulları/Çevre”.

Sonuç: Araştırma, hemşire yöneticilerin iletişimi kolaylaştırmak, hemşirelerin eğitim ve gelişim ihtiyaçlarını karşılamak ve personel hemşirelerin çalışma koşullarını iyileştirmek için büyük çaba sarf ettiği sonucuna varmıştır. Araştırma ayrıca, hemşire yöneticilerin hassas ve samimi yaklaşımlarının hemşirelerin dayanıklılığını artırdığını buldu. Hemşire yöneticilerin yönetim becerileri ve hemşirelerin pandemi sürecindeki deneyimleri, gelecekte ortaya çıkabilecek pandemi ve benzeri afetler in etkili bir şekilde yönetilmesi için değerli bilgiler ve kanıtlar sunmaktadır.

References

  • Bianchi, M., Prandi, C., & Bonetti L. (2021). The experience of middle management nurses during COVID‐19 pandemic in Switzerland: A qualitative study. J Nurs Manag, 29(7), 1956-1964.https://doi.org/10.1111/jonm.13339
  • Butler-Henderson, K., Tan, S., Lalani, K., Mandapam, S. K., Kemp, T., Rudolph, J., & Crawford, J. A. (2021). Update of the COVID-19 higher education literature database (CHELD v2). Journal of Applied Learning & Teaching, ;4(1):1-4. https://doi.org/10.37074/jalt.2021.4.1.22
  • Catania, G., Zanini, M., Hayter, M., Timmins, F., Dasso, N., Ottonello, G., Aleo, G., Sasso, L., & Bagnasco, A. (2021). Lessons from Italian front‐line nurses’ experiences during the COVID‐19 pandemic: A qualitative descriptive study. J Nurs Manag, 29(3):404-411. https://doi.org/10.1111/jonm.13194.
  • Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In Valle, R. S., King, M., Existential phenomenological alternatives for psychology (pp48-71). New York: NY Plenum.
  • Creswell, J. W., & Poth, C. N. (2016). Qualitative inquiry and research design: Choosing among five approaches. London: SAGE Publications.
  • Freysteinson, W. M., Celia, T., Gilroy, H., & Gonzalez, K. (2021). The experience of nursing leadership in a crisis: A hermeneutic phenomenological study. J Nurs Manag, 29(6):1535-1543. https://doi.org/10.1111/Jonm.13310.
  • Gan, I. (2019). How do nurses’ work arrangements influence nurse managers’ communication? A qualitative study. J Nurs Manag, 27(7):1366-1373. https://doi.org/10.1111/jonm.12817
  • Gao, X., Jiang, L., Hu, Y., Li, L., & Hou, L. (2020). Nurses’ experiences regarding shift patterns in isolation wards during the COVID‐19 pandemic in China: A qualitative study. J Clin Nurs, 29(21-22):4270-4280. https://doi.org/10.1111/jocn.15464
  • García‐Martín, M., Roman, P., Rodriguez‐Arrastia, M., Diaz‐Cortes, M. D. M., Soriano‐Martin, P. J., & Ropero‐Padilla, C. (2020). Novice nurse’s transitioning to emergency nurse during COVID‐19 pandemic: A qualitative study. J Nurs Manag, 29(2):258-267. https://doi.org/10.1111/jonm.13148
  • Geremia, D. S., Vendruscolo, C., Celuppi, I. C., Adamy, E.K., de Oliveira Toso, B. R. G., & de Souza, J. B. (2020). 200 Years of Florence and the challenges of nursing practices management in the COVID-19 pandemic. Revista latino-americana de enfermagem, 28: e3358. https://doi.org/10.1590/1518-8345.4576.3358
  • Griffiths, P., Dall’Ora, C., Simon, M., Ball, J., Lindqvist, R., Rafferty, A. M., Schoonhoven, L., Tishelman, C., & Aiken, L. (2014). Nurses’ shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety. Medical Care, 52 (11): 975-981. https://doi.org/10.1097/MLR.0000000000000233
  • Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Fostering compassion and reducing burnout: How can health system leaders respond in the Covid-19 pandemic and beyond?. Nurs Educ Today, 94:104502. https://doi.org/10.1016/j.nedt.2020.104502
  • Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu,J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wie, Y., Wu, W., Xie, X., Yin, W., & Li, H. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223):497-506. https://doi.org/10.1016/S0140‐6736(20)30183‐5
  • International Council of Nursing. Covid‐2019 update: Data on infected healthcare workers and access to protective equipment in the prevention of the virus. (2020). https://www.icn.ch/news/icn‐covid‐2019‐update‐data‐infected‐healthcare‐workers‐and‐access‐protective‐equipment‐vital.
  • Lambert, V. A., & Lambert, C. E. (2012). Qualitative descriptive research: An acceptable design. Pacific Rim International Journal of Nursing Research, 16(4), 255-256.
  • Lin, C. F., Huang, H. Y., & Lu, M. S. (2013). The development of nursing workforce allocation standards for acute care general wards in Taiwan. Journal of Nursing Research, 21(4):298-306. https://doi.org/10.1097/jnr.0000000000000002
  • Liu, Q., Luo, D., Haase, J. E., Guo, Q., Wang, X. Q., Liu, S, Xia, L., Liu, Z., Yang, J., & Yang, B. X. (2020). The experiences of health-care providers during the COVID-19 crisis in China: A qualitative study. The Lancet Glob Health, 8(6):e790-e798.https://doi.org/10.1016/S2214-109X(20)30204-7
  • Maben, J., & Bridges, J. (2020). Supporting nurses’ psychological and mental health. J Clin Nurs, 29(15-16):2742-2750. https://doi.org/10.1111/jocn.15307
  • Morrow, R., Rodriguez, A., & King, N. (2015). Colaizzi’s descriptive phenomenological method. The psychologist, 28(8), 643-644. https://doi.org/10.1016/j.jcin.2015.03.00
  • Muz, G., & Erdoğan Yüce, G. (2021). Experiences of nurses caring for patients with COVID‐19 in Türkiye: A phenomenological enquiry. J Nurs Manag, 29(5):1026-1035. https://doi.org/10.1111/jonm.13240
  • OECD. Nurses. (2021). https://data.oecd.org/healthres/nurses.htm
  • Ohta, R., Matsuzaki, Y., & Itamochi, S. (2020). Overcoming the challenge of COVID‐19: A grounded theory approach to rural nurses’ experiences. Journal of General and Family Medicine, 22(3):134-140. https://doi.org/10.1002/jgf2.410
  • Palese, A., Papastavrou, E., & Sermeus, W. (2021). Challenges and opportunities in health care and nursing management research in times of COVID‐19 outbreak. J Nurs Manag, 29(6):1351-1355. https://doi.org/10.1111/jonm.13299
  • Polit, D. F., & Beck, C. (20212). Nursing research: Generating and assessing evidence for nursing practice. 9th Edition (pp213-242). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
  • Rodriguez, A., & Smith, J. (2018). Phenomenology as a healthcare research method. Evidence-Based Nursing, 21(4), 96-98. https://doi.org/10.1136/eb-2018-102990
  • Rosa, W. E., Schlak, A. E., & Rushton, C. H. (2020). A blueprint for leadership during COVID-19. Nursing Management, 51(8):28-34. https://doi.org/10.1097/01.NUMA.0000688940.29231.6f
  • Rosen, J. (2015). Establishing a strong culture of compassion improves quality of care, bottom line. Schwartz Centre for Compassionate Care. http://www.theschwartzcentre.org/
  • Sandelowski, M. (2010). What’s in a name? Qualitative description revisited. Research in Nursing & Health, 33(1), 77-84. https://doi.org/10.1002/ nur.20362.
  • Stimpfel, A.W., Fatehi, F., & Kovner, C. (2020). Nurses’ sleep, work hours, and patient care quality, and safety. Sleep Health, 6(3):314-320. https://doi.org/10.1016/j.sleh.2019.11.001
  • Taylor, C., Xyrichis, A., Leamy, M. C., Reynolds, E., & Maben, J. (2018). Can Schwartz Center Rounds support healthcare staff with emotional challenges at work, and how do they compare with other interventions aimed at providing similar support? A systematic review and scoping reviews. BMJ Open, 8(10):e024254. http://dx.doi.org/10.1136/bmjopen-2018-024254
  • Thakur, V., & Jain, A. (2020). COVID 2019-suicides: A global psychological pandemic. Brain Behav Immunity, 88:952-953. https://doi.org/10.1016/j.bbi.2020.04.062
  • Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6):349-357.
  • Türk, M. O. K., Akkus, C. H., Atay, G., Erdogan, S., Cakir, D., & Sali, E. (2021). Therapeutic plasma exchange (TPE) treatment in COVID-19 related Multisystem inflammatory syndrome in children (MIS-C) who admitted withacute abdomen clinic. Jour Umraniye Pediatr, 1(1):14-19.
  • Turkish Medical Association. COVID-19 pandemic bi-monthly assessment report. (2020). https://www.ttb.org.tr/userfiles/files/covid19-rapor.pdf
  • White, J. H. (2021). A phenomenological study of nurse managers’ and assistant nurse managers’ experiences during the COVID‐19 pandemic in the United States. J Nurs Manag, 29(6):1525-1534. https://doi.org/10.1111/jonm.13304
  • World Health Organization. WHO Coronavirus (COVID-19) Dashboard. (2021). https://covid19.who.int/
  • Wu, Y., Wang, J., Lu, C., Hu, S., Lin, X., Anderson, A. E., Bruera, E., Yang, X., Wei, S., & Qian, Y. (2020). A comparison of burnout frequency among oncology physicians and nurses working on the 12frontline and usual wards during the COVID-19 epidemic in Wuhan, China. Journal of pain and symptom management, 60(1):e60-e65. https://doi.org/10.1016/j.jpainsymman.2020.04.008
  • Yıldırım, A., & Şimşek, H. (2016). Sosyal Bilimlerde Nitel Araştırma Yöntemleri 10. Baskı. Ankara.
There are 38 citations in total.

Details

Primary Language English
Subjects Nursing (Other)
Journal Section Research Articles
Authors

Handan Alan 0000-0001-7414-2288

Feride Eşkin Bacaksız 0000-0002-1627-7683

Arzu K Harmancı 0000-0002-4478-7234

Serkan Güngör 0000-0002-0441-9701

Osman Bilgin 0000-0001-7637-3071

Ülkü Baykal 0000-0001-5790-5992

Early Pub Date July 15, 2024
Publication Date July 15, 2024
Published in Issue Year 2024 Volume: 17 Issue: 3

Cite

APA Alan, H., Eşkin Bacaksız, F., Harmancı, A. K., Güngör, S., et al. (2024). Investigating Nurses’ and Nurse Managers’ Experiences During the COVID-19 Pandemic: A Phenomenological Study. Etkili Hemşirelik Dergisi, 17(3), 385-400. https://doi.org/10.46483/jnef.1516060

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