Theses Defense ppt

Presented by:
Gulnaz Banu
Masters of Sciences in Nursing
Session 2017- 1019
Institute of Nursing, UHS
Title:
“Psychological Experience of COVID -19 Patients during Quarantine”
A qualitative study
Supervisor:
Dr. Mansoor Ghani
Assistant Professor
Program Coordinator
Institute of Nursing, UHS
Thesis Defense

• Research Question
• Objectives
• Introduction
• Literature review
• Methodology
• Result
• Discussion
• Conclusion
• Recommendations
• Outcome & utilization
Table of Contents

Research Questions
• Q. 1 What were the psychological experiences of COVID-19 patients during the quarantine period?
• Q.2 What strategies did you adopt to cope your mental health challenges during quarantine period?
Objectives of the Study
1. To explore the psychological experience of COVID-19 patients during the quarantine period.
2. To identify coping strategies of the patients related to mental health challenges during quarantine
period.

• By the end of 2019, the world witnessed the unpleasant and terrifying news of the spread of the
coronavirus disease (COVID19) (Shahrour and Dardas, 2020).
• The speed and aggressiveness of Covid-19 to infect people made it a serious and threatening global
health problem.
• China became the epicenter of coronavirus (Xu et al., 2020).
• Within 03 months after detection of first case in China , 43499 cases, including 60 fatalities were
reported in US (Miller, 2020).
Introduction

• In Europe, Spain, Italy, the United Kingdom, and France, as well as Germany, Russia, Turkey, Belgium, and the
Netherlands were the main centers of the covid-19 pandemic (Thome et al., 2021).
• In Asia, China, India, Sri Lanka, Pakistan, Bangladesh and all low- and middle-income countries were equally
affected.
• In Pakistan, the first case of Covid-19 was reported in Karachi on February 26th, 2020 (Waris et al., 2020).
• Pakistan faced a critical situation and strict measures were needed to be taken to avert the threat of a national
health crisis (Khan et al., 2020).
• Healthcare services in Pakistan were not adequately prepared for the pandemic or disaster management and its
recovery.

• Quarantine facilities were set up in various parts of Pakistan in response to this crisis. As further public health
measures to prevent COVID-19, the government constructed isolation wards and quarantine zones in teaching
hospitals (Saqlain et al., 2020) (Hossain et al., 2020).
• In order to determine if individuals who may have been exposed to an infectious disease become ill and
reduce the risk of spreading the illness to others, quarantine involves isolating and restricting their mobility.
For those who go through it, quarantine is frequently an unpleasant experience. Dramatic impacts can result
from being cut off from loved ones, losing one's independence, not knowing how serious a sickness is, and
being bored (Brooks et al., 2020a).

• In this era of extreme stress, fear of cross infection, delayed testing, limited medical equipment, the
uncertainty of the virus, poor training to deal infectious disease and fear of cross infection caused
psychological stress (Giusti et al., 2020).
• Individuals who may have come into touch with the disease were advised to stay home or in a special quarantine facility
{Brooks, 2020 #69}.
• Stress among the detained population has been linked to a number of factors, including the length of the
confinement, the information provided, boredom and dissatisfaction, worries of infection, financial loss, and
stigma {Imran, 2020 #70}.
• Therefore, the exploration of psychological experience of COVID-19 patients during quarantine and coping
strategies adopted by patients was deemed needed.
Problem Statement

• COVID-19 appeared as a serious public health concern across the globe.
• In November 2019, a pneumonia-like disease was termed as coronavirus disease 2019 (COVID-
19) which was first appeared in Wuhan, China (Rodríguez-Rey et al., 2020).
• COVID-19 has a major impact on the psychological and emotional well-being of peoples life
specially those who were quarantined. (Ahorsu et al., 2020).
LITERATURE REVIEW

• Risk factors for a variety of mental diseases, typically in those with pre-existing mental health
issues, including increased loneliness and decreased social contacts. Many people's levels of
physical activity will decline as a result of the quarantine procedures. Controlling symptoms and
risk factors including obesity, hypertension, and high blood sugar requires regular physical
exercise. Age-related social isolation and less contact with others will rise as a result of quarantine
measures. This might result in an increase in mental health conditions including depression
(Palmer et al., 2020).
• Several studies have demonstrated that during infectious disease epidemics, people may develop
symptoms of psychosis, anxiety, stress, suicidal thoughts, and panic (Moghanibashi-Mansourieh,
2020).
• The negative psychological effects of quarantine may include post-traumatic stress disorder
symptoms, bewilderment, and hostility. Fears of illness, annoyance, boredom, a lack of resources,
incorrect information, financial loss, and stigma (Brooks et al., 2020a).

• Normal sleep habits are undoubtedly disturbed by the COVID-19 outbreak's stress, worry, and despair. People
may develop or experience relapses or worsening of frequent waking during sleep, early awakening
(associated to hyper arousal), and even nightmares or other sleep problems. The prevalence of insomnia has
grown dramatically (Lin et al., 2020).
• Studies showed that the COVID-19 infodemic can cause panic attacks and psychiatric illnesses in people,
which led to psychological ambiguity over whether or not they would live. Due to trusting or not trusting in a
wide range of news and information about the disease, people may become confused or uncertain about what
fate awaits them as the disease progresses and whether their conditions will worsen and they will get closer to
death. This can cause confusion or uncertainty (Moradi et al., 2020).

Study Design:
• Phenomenological, qualitative study design.
Study Population:
• COVID-19 positive cases in Lahore, Pakistan, who were isolated in quarantine centers were
selected according to the inclusion and exclusion criteria.
Study Setting:
• Four public sector hospitals were selected which were designated to deal coronavirus patients.
Methodology

Study Approval :
An approval to conduct the study was taken from UHS ethical review committee and all the four
targeted public sector hospitals.
Sample Size:
Twelve participants were interviews till data saturation.
Sampling Technique:
Purposive sampling.

Sample Selection:
Sample selection from the study population was based on the following inclusion and exclusion
criteria.
Inclusion Criteria:
• Patients Tested Positive for COVID-19 through Reverse Transcription Polymerase Chain Reaction (RT-PCR) and
experienced complete hospital quarantine and tested negative.
• Age 40-70
• Both male/Female
Exclusion Criteria:
• Health professionals
• Person who is still exhibiting any signs of COVID-19 infection
• Individuals’ who is previously diagnosed with any mental disorder.
• COVID patients who are/were on ventilator.
• Patients that may unable to communicate effectively.

Data Collection
1
• Self-Introduction of Investigator to the subjects/Participants.
• Explain the Purpose of Study.
2 • Written Informed Consent was obtained
3 • Interview guide was used to collect the data.
4
• Interviews were recorded on a tape recorder.
• During interviews, the researcher did not disclose his opinion regarding the
outcome of the study.
5 • All the ethical considerations were considered while collecting the data.

Data collection tool:
• Interview guide was used to collect the data.
Data Analysis:
• Braun and Clarke`s thematic analysis was used for the analysis of the data. They have proposed six phases
for thematic analysis
• Step 1: Become aware with the data
• Step2 : Create initial codes,
• Step3 : Examine for themes,
• Step 4 : Review themes,
• Step 5: Define themes,
• Step 6: Write up

• The result section is divided into demographic data and thematic analysis.
• Participants were both male (9) and female (3) from the four major public sector hospitals of
Lahore, Pakistan who were Quarantined during Covid- 19 .
• Total 12 participants were interviewed, nine male and three female according to the inclusion
criteria and exclusion criteria. they were not tested positive for COVID-19 till the time of
interview.
Results

Demographic Data
Demographic Characteristics Categories Results
Gender
Male 09 75%
Female 03 25%
Age
41-50 years 07 58.3%
>50 years 05 41.7%
Marital status
Married 10 83.3%
Unmarried 02 16.7%

Demographic Data
Demographic Characteristics Categories Results
Education Level
Uneducated 03 25%
High School 05 41.7%
>High School 04 33.3%
Days in Hospital
6-10 Days 02 16.7%
> 10 Days 10 83.3%
Monthly Income
<30,000 PKR 4 33.3%
>30,000 PKR 8 66.7%

• Qualitative analysis of the interview findings were categorized into six overarching themes.
Mainly these themes were,
• 1) First response to the COVID-19 disease among the participants,
• 2) Development of unpleasant emotions among the quarantined COVID-19 patients,
• 3) Experience of Fear and stress among them,
• 4) Death Anxiety among the participants due to high mortality rates from corona disease,
• 5) Perceptions of Social and Psychological support which helped them in successful recovery
and stability, and
• 6) Post discharge concerns and Problems which they are going to face after moving homes
from the hospital.

Category:
Psychological Effects
Codes under the category:
Fear of cross infecting the family
Fear of cross infection
Nervousness
Infection prevention training
High mortality rate
Phobia among people
Low motivation
Stress related to low quality of care
Fear due to helplessness
Uncertainty of the virus
Fear of death
Stress in the early stages of pandemic
Theme 1:
Initial response to the
disease
Theme 1: Psychological impact of the pandemic in the early stage
• All patients expressed by denial when presenting clinical
symptoms such as cough with fever and breathing difficulty.
• This study showed that, nearly all participants reported negative
emotions during coronavirus outbreak. They were psychologically
and mentally exhausted. patients were afraid and nervous because
they were fighting with a very new enemy .

• Social Isolation and the absence
of friends
• Hopelessness
• Uncertainty and confusion
• Experience of Anxiety and stress
• Fear of impending death
• Worries about family members
• The absence of a companion or
family members upon arrival to the
ward was one of the key issues
mentioned by the participants
which were disturbing them
emotionally. Many of them claimed
that despite being in poor physical
health, they were alone and
without someone to help them take
care of themselves.
Theme 2: Development of unpleasant emotions
Most of the participants in this study experienced stigmatization during
COVID-19 outbreak because everyone was afraid of being infected.

Category:
• Fear of Relapse
• Fear of Hospital environment
• Majority of the participants were afraid of the nature of
disease that in many cases the disease reoccurs after the
patients were fully recovered.
• The high number of COVID-19 patients was having fear of
crowded hospitals environment. Various hospital factors
contributed to the participants' worries while staying there.
Many participants expressed concern about a lack of
medical supplies and resources, delays in treatment
beginning because of overcrowded hospital wards, and a
scarcity of nurses and doctors.
• Some participants considered hospital as terrifying place as
stated by one of the participants,
Theme 3: Experience of Fear and Stress
One other chief theme take out from the participants’ interviews were
their experience of fear and stress, which was found very common
between the participants due to the novelty and strange nature of
Corona virus disease.

Category:
• Fear of self-Death
• Fear to See peoples are
dying
• Fear of leaving their
families alone
COVID-19 is a kind of disease which killed
a large number of patients in a very short
time. The patients staying in quarantine
witnessed a number of deaths and were
badly affected by such brutal deaths.
Theme 4: Death Anxieties
Participants were having fear of death unexpectedly. They were thinking of
death as an unpleasant and unforeseen event. Their bad clinical condition
was the primary factor in their extreme fear of dying. They were also
concerned that they wouldn't have an Islamic burial and would pass away
without their relatives' presence, visits, or visits. Main subthemes found in
this category were fear of self-death, Fear to see peoples are dying and fear
and scared to leave the families alone.

Category:
• Emotional support of my
Family
• Psychological support from
medical staff
• Religious beliefs
• Patients’ good spirit
Moreover, the support from family and
friends at all levels was also crucial.
Majority of the participants said that
having sufficient social support was
essential in their individual battle against
the disease.
Theme-5: Perceptions of Social and Psychological support
All patients acknowledged that their loved ones served as their spiritual
foundations while they were in the hospital. The term "family emotional
support" describes how an individual perceives the family members’
availability, sufficiency, and quality of assistance during times of COVID-19
crisis. It was the participants’ families who were the primary and most
significant sources of social support, which encouraged them to battle the
illness and to face the pressures it brought on

Application of results in bio-psychosocial
model health and sickness
Psychological Problems due to
COVID-19 during quarantine:
-anxiety from real health
concerns and
Fears
-emotional impact of social
Isolation
Other:
-personality traits
-adaptability
-self-esteem and perception
-grief/loss and trauma
-personal attachment style
Social Problems due to COVID-19
during quarantine:
-social isolation
-changes in ability to work, income,
Other:
-environmental factors (e.g., housing,
Transport, etc.)
-immigration status
(Current and past)
-discrimination/oppression and safety
Physiological Problems due to
COVID-19 during quarantine:
-most common symptoms: fever,
body ache
Dry cough
Suppressed immune system
-sleep disturbances

• The beginning of the disease's initial symptoms is connected to a person's first response to the
disease. Because of this horrible pandemic, there are numerous news articles and stories as well as a
great deal of dread and worry in relation to this sickness in society. People utilize mental defense
strategies like denial when they first encounter the signs of corona as a result of this dread. Denial has
an antagonistic relationship to acceptance and hinders the person from exerting the least amount of
effort to address the issue.
• During interviews majority of the participants expressed negation and denial when showing clinical
symptoms such as cough with fever and stated that it might be a cold and it cannot be COVID-19.
Some participants considered as a sore throat as they believed that the fragrance of various drugs
hurts their throat. Therefore, they did not take it seriously and found it hard to accept that they have
the corona illness.
Discussion

• The second group of experiences included what it was like to have COVID when you first arrived
at the hospital and while you were there. This group covered patients' negative feelings including
loneliness, despair, perplexity, ambiguity, dread, and anxiety. These findings support a research by
Sun et al. that claims that throughout the early stages of sickness, fear, denial, and stigma exist
(Sun et al., 2021).
• In this study the separation from family members upon arrival to the ward was one of the key
issues mentioned by the participants which were disturbing them emotionally.
• The finding is supported by a previous study which claimed that patients with different conditions have
shown that being hospitalized; being in an unfamiliar location, being away from one's family, and being
exposed to new processes and instruments can cause the patient to experience unpleasant emotions like
worry and anxiety.

• The social support of the hospital staff may create the environment for the satisfaction of this
fundamental need due to the physical absence of the patient's family members and their lack of
presence in the hospital, both of which can obstruct the patient's basic need for communication
in the stressful condition of the disease (Rahmatinejad et al., 2020).
• Patients' perceptions of the illness are impacted by the complex nature of disease, ambiguity in
term of treatment and prognosis, which raises worry and concern of uncertainty. Majority of the
participants reported a sense of uncertainty, hopelessness and a feeling of anxiety rising from the
stress of diagnosis with the disease and dealing for COVID-19. These emotional disturbances were
because this disease characterized many unknown features.

• The findings are in line with earlier research that shown that people with chronic respiratory
diseases like COVID-19 frequently experience anxiety, despair, and terror as among of the
disease's many symptoms (Shahyad and Mohammadi, 2020).
• These findings are in line with the research of Ali pour et al., which named psychological torture
as one of the primary problems with COVID-19 psychosocial challenges and worries (Alipour et
al., 2020).
• The findings of multiple research on COVID patients in China throughout the disease's growth
showed that these patients had a high prevalence of certain psychological illnesses, including
anxiety, fear, sadness, mood swings, sleeplessness, and post-traumatic stress disorders (Yang et
al., 2020) (Liu et al., 2020).
• In order to enhance both physical and mental health, suitable psychological intervention
techniques should be developed at various illness phases. To promote openness and reduce
confusion and dread of the condition, staff members should communicate promptly throughout
diagnosis, treatment, and nursing. Additionally, complaints should be heard and addressed
(Kakkar et al., 2021).

• Findings of this current study also revealed that the patients staying in quarantine witnessed a
large number of deaths and were badly affected by such brutal deaths. The fear of one's own
death as well as the deaths of others was shown in a prior study to be a multifaceted topic of
death anxiety (Draper et al., 2019).
• The patients' perception of social support was particularly significant since they were unable to
interact with their families while they were being treated in the wards. In difficult situations and
through significant life changes and transitional phases, social support is a key promoter of
psychological well-being. During this study, all of the patients agreed that when they were in the
hospital, their family members were their spiritual supports at homes. In times of COVID-19 crisis,
a person's perception of the family's availability, sufficient, and quality of support is referred to as
their "family emotional support.“

• Religious beliefs also contribute to the development of faith in eternal peace and God's rewards
in light of the suffering caused by sickness. By reframing death and assisting the patient in
effectively coping with the disease-related experiences, spiritual and religious views, which have
powerful impacts on how people confront the reality of death, reduce the fear of death.
• In the current study, the participants’ believe in God make them feel more empowered because
they know that God is their defender and savior.
• They are convinced that God will help them overcome their illness. It was found that many
individuals turned to religion as a coping technique for their anxieties and stresses.
• These categories included religious practices and convictions. Reading the Quran, which has its
roots in the Muslim culture and social environment, and praying were the two primary activities
that the participants reported doing.

• Using in-depth interviews and a phenomenological methodology, the current study gave a thorough understanding
of the psychological experiences of COVID-19 patients at the start of the pandemic.
• . It was discovered that patients' psychological experiences during the COVID-19 crisis were complicated, involving
COVID-19-related mental distress symptoms, expectations for their post-discharge lives, and attempts to make
sense of their experiences. Stress on the body and mind is present in COVID-19 patients.
• Their views about the illness gradually changed, and depending on the stage of therapy, so did their emotional
reactions, while they were under quarantine.
• Initial stage patients' unpleasant feelings progressively gave way to a mix of both good and bad feelings. Early
psychological remedies can protect people from harm's way and help them develop healthy attitudes and
emotions.
• The majority of the patients vigorously steered their disease-induced self-growth in order to facilitate both short-
and long-term physical and emotional recovery.
Conclusion

• This was a unique study that aimed to clarify the psychological experiences of COVID-19 patients in
Lahore, the region of Pakistan that was most severely affected at the beginning of the epidemic.
• The findings added to current understanding of the psychological experiences of COVID-19 patients,
particularly in the setting of Lahore, and may guide strategies used globally to address these
psychological problems.
• Additionally, our qualitative study's in-depth collection of rich experience was made possible by the
phenomenological technique, which aims to comprehend the fundamental meaning of a lived
experience.
• In light of this, a phenomenological technique is appropriate for inductive thematic analysis through
line-by-line open coding and honoring the interviewees' speech.
• The summary of our results discussed above has implications for healthcare and volunteer
organizations to customize their care models and streamline the workflows for improving patients'
quality of life during and after their illness in high-risk communities, during this pandemic, and in the
event of future disease outbreaks.
Strengths of the Study

• Limitations of this study include the use of self-reported interview guide which might cause some
respondent bias or misreporting of data.
• Another potential limitation of this study was the use of purposive sampling strategy,
• Furthermore, information on the stressful impact due to political or economic status prior to the
pandemic were not determined in the study.
• Because to the urgency of the pandemic's early stages, researchers had to determine inclusion
criteria such as the absence of language barriers subjectively because there was no longer enough
time, money, or other resources to enable doing the more difficult and objective testing.
Limitations of the Study

Recommendations
• Future study should thoroughly and comprehensively investigate the psychology experience of patients to
shed light on the underappreciated good psychology experience of COVID-19 patients.
• Further studies are necessary to learn how to use psychological intervention to safeguard patients' wellness
and promote good emotions while relieving negative ones.
• The purpose of the current study is to describe the experiences of COVID-19 patients who have previously
been admitted to an ICU in one of the Lahore city. It is advised that other facilities for the treatment of
COVID-19 be included in future study to maximize the generalizability of the findings.
Recommendations

• Shahrour, G. & Dardas, L. A. 2020. Acute stress disorder, coping self‐efficacy and subsequent psychological
distress among nurses amid COVID‐19. Journal of nursing management, 28(7): 1686-1695.
• Xu, Z., Shi, L., Wang, Y., Zhang, J., Huang, L., Zhang, C., Liu, S., Zhao, P., Liu, H. & Zhu, L. 2020. Pathological
findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine,
8(4): 420-422.
• Saqlain, M., Munir, M. M., Ahmed, A., Tahir, A. H. & Kamran, S. 2020a. Is Pakistan prepared to tackle the
coronavirus epidemic? Drugs & Therapy Perspectives, 36(5): 213-214.
• Kontoangelos, K., Economou, M. & Papageorgiou, C. 2020. Mental health effects of COVID-19 pandemia: a
review of clinical and psychological traits. Psychiatry investigation, 17(6): 491.
• Sun, N., Wei, L., Shi, S., Jiao, D., Song, R., Ma, L., Wang, H., Wang, C., Wang, Z. & You, Y. 2020. A qualitative
study on the psychological experience of caregivers of COVID-19 patients. American journal of infection
control, 48(6): 592-598.
• Rajkumar, R. P. 2020. COVID-19 and mental health: A review of the existing literature. Asian journal of
psychiatry, 52102066.
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