Fear of COVID-19 among Frontline Nurses in a National University Hospital in the Philippines: A Mixed-Methods Study.

Background: Nurses are at the forefront of caring for patients during the height of the COVID-19 pandemic. Nurses themselves are exposed to serious risk and even death while providing care for these patients. Among other healthcare professionals, nurses are mostly exposed to psychologically distressing situations during this time of crisis. Fear of COVID-19 can affect nurses' overall well-being, which in turn may affect their job performance and lead to a decline in the quality of patient care.

Objectives: To determine the level of fear of COVID-19, and to explore the experiences of COVID-19-related fear of frontline nurses in a national university hospital in the Philippines.

Methods: To achieve the study objectives, the study utilized a convergent mixed methodology approach. In the quantitative phase, a random sample of participants completed the Fear of COVID-19 scale (FCV-19S) in order to assess their level of fear of COVID-19. Semi-structured interviews were conducted in the qualitative strand. Participants in the qualitative phase was selected using maximum variation sampling. Integration of data was done through a narrative contiguous approach.

Results: Quantitative data was obtained from 206 frontline registered nurses. The mean age of the participants was 35.5 years (SD =8.17). Overall, the composite score of the fear of COVID-19 scale was 21.76 (SD = 4.92), indicating an elevated level of fear. Having friends and relatives who tested positive predicted fear of COVID-19 (β = -3.658; p = 0.005; CI: -6.213 to -1.104). Three major themes categories emerged from qualitative data analysis: (1) balancing feelings of fear and moral obligation, (2) challenges experienced while providing frontline work, and (3) resilience amidst challenges. For the reporting and integration of our mixed-method results, a narrative contiguous approach was implemented.

Conclusions: Frontline nurses reported an elevated level of fear during the height of the COVID-19 pandemic. This study was also able to capture the impact of COVID-19 on the mental health of nurses, specifically on their fear experiences. Understanding the underlying causes of fear, such as uncertainties surrounding guidelines and protocols, shortage of personal protective equipment, and moral distress, offers invaluable insights for shaping proactive strategies and policies aimed at mitigating these concerns in subsequent pandemics.