Experiences of COVID-19-Related Stigma: A Qualitative Study on Nurses Caring for Patients With COVID-19.

BACKGROUND: Healthcare workers caring for patients with Coronavirus Disease 2019 (COVID-19) have been a primary target of stigmatization and discrimination during the COVID-19 outbreak. Thus, there is an urgent need to develop a support system for Asian healthcare workers who care for patients with COVID-19. PURPOSE: This study was designed to understand the characteristics of COVID-19-related stigma experienced by nurses caring for patients with COVID-19. METHODS: A qualitative content analysis methodology was used. This study was conducted between April 2020 and March 2021. The participants were 10 female registered nurses working at three medical facilities that accepted patients with COVID-19. The data included specific narratives on the instances of stigma experienced when caring for patients with COVID-19, including connected situations and ideas. The data were collected using focus group interviews with three or four participants in each group. Data analysis was conducted based on the inductive qualitative analysis approach of Krippendorff. RESULTS: The content analysis identified two categories and seven subcategories of stigma experienced by clinical nurses. The category "directly experienced prejudice and discrimination" included the subcategories "being avoided," "being treated as dirty," "discrimination toward family members," and "others prying." The category "self-imposed coping behavior" included the subcategories "keeping oneself apart," "feeling guilty," and "nondisclosure." CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The participants internalized their experiences of stigma, as Japanese culture emphasizes keeping such things to oneself. Therefore, there is an urgent need to strengthen the support system for nurses who care for patients with COVID-19. This study addressed the problem of the stigmatization of these nurses and their families by others as well as their colleagues. The main findings were that stigma was directly experienced as discrimination and prejudice and often resulted in self-imposed coping behavior. The major implication of these findings is the need to establish systematic, active, and ongoing organizational support programs for nurses who are discriminated against because of COVID-19-related stigma.

Development and Validation of the COVID-19-Related Stigma Scale for Healthcare Workers (CSS-HCWs).

Stigma among healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic is an issue that requires immediate attention, as it may otherwise lead to the collapse of healthcare systems. In this study, we developed the COVID-19-related stigma scale for healthcare workers (CSS-HCWs) and assessed its reliability and validity. Data were collected online from 500 participants, including physicians and nurses involved in COVID-19 care. The first item of the draft scale was developed based on a literature review and qualitative study. The draft scale consisted of 24 items, which were rated on a six-point Likert scale. Descriptive statistics were calculated and the data distribution was analyzed. To assess the scale's validity and reliability, structural validity was evaluated through an exploratory factor analysis. Criterion-related validity was examined through a correlation analysis using the E16-COVID19-S, a COVID-19 scale developed for physicians in Egypt. Reliability was evaluated by examining the scale's stability and internal consistency. The findings revealed that the stigma scale was a valid and reliable instrument. The final scale consisted of 18 items across three domains: personal stigma, concerns of disclosure and others, and family stigma. In conclusion, the scale is a valid and reliable instrument that can measure COVID-19-related stigma among healthcare workers.

Development of disaster pamphlets based on health needs of patients with chronic illnesses.

The aim of this research was to develop a pamphlet that would enable patients with diabetes, rheumatic diseases, chronic respiratory disease, and dialysis treatment to be aware of changes in their physical conditions at an early stage of a disaster, cope with these changes, maintain self-care measures, and recover their health. Illness-specific pamphlets were produced based on disaster-related literature, news articles, surveys of victims of the Great Hanshin-Awaji Earthquake Disaster and Typhoon Tokage, and other sources. Each pamphlet consisted of seven sections-each section includes items common to all illnesses as well as items specific to each illness. The first section, "Physical Self-Care", contains a checklist of 18 common physical symptoms as well as symptoms specific to each illness, and goes on to explain what the symptoms may indicate and what should be done about them. The main aim of the "Changes in Mental Health Conditions" section is to detect posttraumatic stress disorder (PTSD) at an early stage. The section "Preventing the Deterioration of Chronic Illnesses" is designed to prevent the worsening of each illness through the provision of information on cold prevention, adjustment to the living environment, and ways of coping with stress. In the sections, "Medication Control" and "Importance of Having Medical Examinations", spaces are provided to list medications currently being used and details of the hospital address, in order to ensure the continued use of medications. The section, "Preparing for Evacuations" gives a list of everyday items and medical items needed to be prepared for a disaster. Finally, the "Methods of Contact in an Emergency" section provides details of how to use the voicemail service. The following content-specific to each illness also was explained in detail: (1) for diabetes, complications arising from the deterioration of the illness, attention to nutrition, and insulin management; (2) for rheumatic diseases, a checklist of factors indicating the worsening of the illness and methods of coping with stress; (3) for chronic respiratory disease, prevention of respiratory infections and management of supplemental oxygen; and (4) for patients requiring dialysis, conditions of dialysis (such as dry weight, dialyzer, number of dialysis treatments, and dialysis hours) and what to do if a disaster occurs during dialysis. It is expected that these pamphlets will be useful to patients with chronic illnesses, and will be used to prepare for disasters, thereby helping the patients cope with the unusual situation that during a disaster and recover as soon as possible.