Living in COVID's Disbeliefs,Media,and Fear: Nurses in Brazil and the United States Share Their Experiences

Abstract

During the COVID-19 pandemic, nurses were placed in an unprecedented context in which they engaged with community members, family members, and friends while positioned between dire hospital situations and community disbelief about the seriousness of the pandemic, often along political lines. A secondary analysis of a qualitative study exploring experiences of 39 nurses in the United States and Brazil in engaging with the community and political discourse during the pandemic provided insights into the impact of these interactions on nurses, and implications for how nurses may emerge from this pandemic time stronger and more supported by those in administrative positions.

Keywords

COVID-19 pandemic qualitative methods nursing care community/political discourse

The COVID-19 pandemic has been a novel experience for this generation around the world; though pandemics have occurred historically, this pandemic was experienced differently in the context of global travel and the rapidity with which the disease spread. Nurses found their work highlighted in new ways by the media and by community members, who sought to recognize the work of health-care professionals, initially viewing them as heroes. This heightened awareness of the nursing role created a unique dynamic among nurses and between nurses and the community (Lotta et al., 2021). Faced with large numbers of patients in need of critical and end-of-life care, nurses found themselves central to the community discourse that ensued (O'Leary et al., 2021).

Background

Between January and February 2021, a survey about the impact of the COVID-19 pandemic on nurses was conducted by the American Nurses Foundation (ANF), with a follow-up survey in March 2022, which found that of the more than 12,000 respondents, 52% had considered leaving their jobs; 46% of respondents 35 or younger identified themselves as “not emotionally healthy” (ANF, 2022). The survey findings reveal that nurses faced multiple challenges, not only in the workplace but also within their communities and social circles, and that these experiences may have a lasting influence.

Multiple factors contribute to these statistics. In addition to uncertainty about how the pandemic would evolve, nurses often worked long hours with limited supplies and equipment and unsafe staffing ratios (Lasater et al., 2020). Nurses also faced difficult moral decisions. Fear of spreading COVID to their loved ones meant that nurses were often isolated from others, both outside and inside their work environments, placing them at risk for moral distress based on difficult decisions about continuing to work or leaving in order to protect their families (Godshell, 2021).

Unprecedented attention was given to nurses and other health-care providers, initially labeling them as heroes. As the pandemic continued and rhetoric around COVID-19 increased, violence toward nurses and other health-care providers escalated, with most incidents occurring in areas with low vaccination rates and/or where negative patient outcomes were blamed on hospital staff (Dyer, 2021). The initial appreciation of health-care workers as heroes felt hypocritical to some nurses in light of the divergence in beliefs about how the virus was spread and whether the pandemic was even real (Pangborn et al., 2021). Unlike any other time in recent history, nurses providing direct patient care were faced with highly stressful situations outside of as well as within their work environments. No place, even home, provided refuge from the pandemic.

The initial appreciation of health-care workers as heroes felt hypocritical to some in light of the divergence in beliefs about how the virus was spread and whether the pandemic was even real.

Given all that nurses have faced since the World Health Organization (WHO) officially declared COVID-19 a pandemic (WHO, 2020a), it is no surprise that nurses are seeking other opportunities. Over half of America's nurses are considering leaving their positions in the next six months (ANF, 2022); if intent becomes action, health-care organizations will encounter even more difficult times ahead.

In Brazil and the United States, similar political environments during the onset of the COVID-19 pandemic created challenging situations for health-care providers. Contentious views created societal discord and, at times, violent outbursts. Nurses, viewed as the health-care professionals providing most of the direct care to patients affected by COVID-19, bore the brunt of the attention during this time (Mohammed et al., 2021; Morin & Baptiste, 2020).

Review of Literature

“The acute and prolonged stress of working under surge conditions has intensified the multiple, well-documented sources of chronic distress and 'moral injury’ already endemic among health professionals today, challenging the long-term well-being and stability of the clinician workforce” (Madera et al., 2021, p. 7). Coupled with this was the pervasiveness of inaccurate information about the pandemic. Perpetuated at the highest levels of government, these inaccuracies created challenges for health-care professionals faced with providing direct patient care while striving to be sources of accurate information for the public (Hartley & Khoung, 2020).

“Fake news,” defined as false information presented as verifiable truth (Dass & Ahmed, 2022), has been frequently disseminated through social media, creating a false equivalence between scientific evidence and uninformed opinion. Such information has served to reveal the deep-seated political and epistemological beliefs of individuals who find themselves on opposing sides, feeding a divisive political culture, polarizing public debate, and magnifying the risk of conflict and violence (Hartley & Khoung, 2020; WHO, 2020b). Left unchallenged, fake news has the potential to threaten the advancement of democracy, human rights, and social cohesion (WHO, 2020b, para. 4). The spread of misinformation has been termed an “Infodemic,” a perpetuation of misleading statements that contribute to the spread of disinformation on social media and through media outlets (WHO, 2020b).

Many nurses were exposed to the challenges of providing care to the sickest in their communities while also navigating difficult conversations outside of the health-care environment with some who believed the pandemic was a hoax (Pangborn et al., 2021). Some nurses found themselves engaging in challenging, negative, and potentially dangerous interactions with community members, friends, and even their families (Foli et al., 2021). Early in the pandemic, knowledge about the COVID-19 virus was limited, and expert recommendations were often inconsistent, contributing to confusion and a lack of clear direction (Lam et al., 2020). It is imperative to understand nurses’ experiences during these circumstances.

This article explores nurses’ experiences with the politicization of the COVID-19 pandemic and their interactions with their communities, based on a study about nursing care of patients and families during the COVID-19 pandemic in two countries: The U.S. and Brazil (Rodrigues dos Santos et al., 2022). Politically divisive beliefs were pervasive and influenced public behaviors in both countries. The nature of the pandemic created a change in public perceptions (Morin & Baptiste, 2020) and an unprecedented experience for nurses who worked long hours while fearing for their own health and that of their families. Nurses were confronted with risks in all aspects of their lives, meaning that there was no place of respite for them.

Methods

A secondary analysis of data collected from a qualitative study of nurses in the U.S. and Brazil (Rodriguez dos Santos et al., 2022) was conducted using conventional content analysis as described by Hsieh and Shannon (2005). The research question of the original study was: Tell me about your experiences being a nurse providing nursing care to patients and families during COVID-19. A total of 49 nurses (33 in the U.S. and 16 in Brazil) participated in the original study. During analysis, the research team noted that nurses’ interactions with community discourse emerged as a prominent theme. The team revisited the data to explore a new research question: What is the nurse's experience with politicization of the COVID-19 pandemic and with interactions with the community?

For the original study, registered nurses who cared for adult or geriatric patients and their families in health-care settings any time between March 2020 and April 2021 were eligible to participate. Participants were recruited through purposive and snowball sampling via a variety of professional networks in both countries (e.g., critical/intensive care organizations, oncology nursing associations, state and national nursing associations, local nursing chapters, and hospice and palliative care nursing associations). Recruitment ceased when the research team affirmed adequate data to provide a robust understanding of the study phenomenon. Semi-structured online interviews were conducted individually using a password-protected teleconference. Interviews were audio-recorded and transcribed for analysis.

For the current study, narrative data were reviewed to identify aspects of the nurses’ experiences that described engaging with family, friends, and/or community in some way outside of the workplace. This included descriptions of the impact of social media and news outlets. Codes were derived from the data, then sorted into themes and sub-themes guided by the new research question; team discussions continued until consensus was achieved.

Ethics approval was obtained from the institutions of both countries (University of São Paulo and Winona State University/Minnesota State University, Mankato) for the original study. Researchers removed any identifying information from data and participants were identified using numeric codes.

Results

Five major themes and two sub-themes emerged from the data:

Living with Community Disbelief

•

Facing Community Members’ Risky/Dismissive Behaviors

•

Feeling Devalued by People with Disparate Social and Political Beliefs

Experiencing Positive Interactions with Community Members

Working within Fear

Living with Incessant Exposure to Social Media and News

Educating Community Members

Theme 1: Living with Community Disbelief

Some nurses struggled with bearing witness to the impact of the COVID-19 pandemic, with its contagion and safety threat, and the disconnect they experienced because of dismissive behaviors of community members who denied the gravity of the pandemic and contagion. While community members who did not take the virus seriously may not have personally experienced negative impact from that belief, nurses were caring daily for patients who were facing the consequences of COVID-19.

…[The belief] that the virus is a hoax…People feel offended and entitled to their right to freedom, to everybody else's detriment and to society's right to safety. No matter what they do, we're still on the receiving end. We still have to respond with due diligence to keep people safe. (U.S., 1) Because of the politics in the country, the majority of the population believed that a miracle would come from heaven and that COVID does not exist. We didn't prepare for the vaccine, we didn't prepare for isolation, we left the entire population on the streets, and then we experience the chaos we live today. (Brazil, 22)

….to see the frustration of family members, that people out there in the world don't believe it's real. They're like, if only they could see the pain that people are having and how hard it is for families when they're dealing with it and [being] so careful. (U.S., 2)

The politicization of it, the willful ignorance of some people, is so infuriating, and really bears on my stress a lot. (U.S., 18)

Sub-Theme 1: Facing Community Members’ Risky/Dismissive Behaviors

The perceived risky and/or dismissive behaviors of some community members, such as refusing to wear masks according to community health guidelines, were incomprehensible to some nurses. That some community members chose not to follow precautions created additional distress for nurses who worried about their own families being infected. Some friends and family members were also resistant to wearing masks or were seemingly unconcerned about the impact of COVID if they became infected.

Nurses were confronted with risks in all aspects of their lives—There was no place of respite for them.

It's useless establishing holidays from work if people stay home [but spend time with large groups of people]. I'm working for 24 hours, but before I left yesterday, people nearby were having parties, crowds, and everything. In the midst of occupancy rates of 98%, with a collapse in public and private health—there are no beds! (Brazil, 21)

I am afraid of my family getting it. Those around me that didn't take it seriously…. My friends were like, “I'm young and healthy, I'll probably be fine, if I get it, I'm not too worried about it.” People aren't understanding—It's not about you getting it, it's about somebody else that can't fight it off getting it. I think selfish is a good word—people [with] that selfish mentality. (U.S., 29)

My friends were like, “Oh, this isn't real,” and then some of them got it. This sounds horrible, but there's a couple of them that I was like, “I wish you'd know somebody who got it or you yourself would get it, and understand what this is about.” (U.S., 31)

Listen to the guidelines, because you may not get sick from it, but if you wore a mask, just think how you could protect somebody else from [getting sick]. (U.S., 33)

Sub-Theme 2: Feeling Devalued by People with Disparate Social and Political Beliefs

The fact that community members and others in the nurses’ societal circles ignored or minimized Centers for Disease Prevention and Control (CDC) and WHO recommendations was interpreted as devaluing the knowledge and expertise that was informing professional practice.

I felt like they didn't really value what health-care workers are fighting for and weren't really listening to what we were saying any more. That was disheartening to say, “This is what's recommended by the government, the CDC, it actually helped save lives,” and people are like, “We hear that, but we just want to go about our lives.” That's understandable. But I just felt disheartened. (U.S., 15) I don't even care if they don't agree with it. It's just so hard when people talk like that [disregarding safe practices]. I feel disrespected…[It's a] slap in the face. (U.S., 13)

Instead of receiving support from our institution, from the government, we felt like [we were being] threatened: You have to come, do your job, because it's your duty and your obligation. If you start missing [work] or anything else you will be punished in one way or another. So we had a feeling of helplessness, I didn't feel supported or grateful for anyone but my family who supported me. (Brazil, 5)

I'm just trying to educate people, and that's been frustrating, because I don't have all the answers either.

Theme 2: Experiencing Positive Interactions with Community Members

Despite the challenges and negative experiences with some community members, family, friends, and/ or loved ones, nurses also highlighted times when people went out of their way to be supportive. They identified perceptions that community members had an enhanced awareness of what nurses do, and of the importance of their role during the pandemic.

I've had neighbors in my condo building stop me and thank me from afar. And that's pretty nice. People I hadn't otherwise met in my building have stopped me in my scrubs. (U.S., 12)

I think it's gotten more positive. I'd like to think that it's because the general public knows a little bit more of what nurses do. (U.S., 15)

…If we had been taken care of, some show of concern, as some private companies did. In the middle of the pandemic, at Easter time, we received chocolates from a company, a simple gesture that shows how we felt more support from the population and private companies than the corporate company or the government itself. (Brazil, 05)

Theme 3: Working within Fear

Nurses were impacted by the community's response to their role working on the frontlines. Some family members, friends, and co-workers seemed not to understand or value the commitment to duty nurses felt about providing patient care during the pandemic. Some nurses made significant sacrifices, putting themselves at risk to fulfill their job responsibilities. These decisions were sometimes met with negative responses from family, friends, and/or co-workers.

I've said from the beginning, I would work with COVID for free, because we are making history. I understood that health providers who are afraid of working at this moment should review their concepts, because it's like a war: Won't the military go? Right now, we have to go to war. Although my whole family said, “Don't go, don't expose yourself,” I don't regret it, and I think I made a difference in the lives of many people. (Brazil, 22)

Although my whole family said, “Don't go, don't expose yourself,” I don't regret it, and I think I made a difference in the lives of many people.

There are people I care about…people in my church, my community, my family members, my friends. Part of the stress of this has really built a wall between some of those relationships. (U.S., 18)

…Fear of catching COVID yourself…and whether or not you're going to bring it home for your loved ones … I haven't seen my mom mainly because of that. (U.S., 10)

It was the thing I have been feeling the most: Fear. Most for my family. It seems really like a sacrifice— Even colleagues who do not work with COVID ask me: Are you not afraid? (Brazil, 7)

Living with Incessant Exposure to Social Media and News

Some nurses shared that they avoided social media and news as much as possible as a means of self-care. The constancy of social media information, misinformation, and news reports of controversy about contagion were sometimes overwhelming.

It was difficult to see what we see every day and then come home and see the news saying something different. (U.S., 29)

…All the negativity on social media and the news directly affects your work because that's specifically what you're doing. For self-care, I separate the two [news and information, and personal life]. I really tried not to read emails except at work. (U.S., 29)

Sometimes being at work is less stressful than listening to the news and social media. (U.S., 18) It's frustrating to see what we see on a first-hand basis—patients struggling to breathe and passing away as we're holding their hands—and then see how the news and the politics can get into it. (U.S., 29).

We have people who multiply this [fake news] on social media, to family, to friends, and advocating controversial ideas due to absolute denialism. (Brazil, 21)

Theme 5: Educating Community Members

Some nurses found themselves interacting in community settings such as grocery stores, with conversations arising organically. Nurses viewed these encounters as an opportunity, yet found them challenging at times due to the need to navigate conflicting feelings and beliefs in order to provide science-based information.

I [said], “Can we talk for a minute? From a nursing perspective, as a person who wears a mask all day, how do you think surgeons do 24-hour surgeries? How do you think nurses in the OR do it? They don't drop dead, and they don't faint.” She said, “I've never thought about that before.” (U.S., 18) [I'm] just trying to educate people. And that's been frustrating, because I don't have all the answers either. (U.S., 29)

Discussion

This analysis contributes a perspective from two countries during the early part of the COVID-19 pandemic. The findings validate the experiences of nurses in these divisive environments. Nurses described the challenges and additional stressors they faced, and the impact on their relationships outside of work, including with family and community members who engaged them in public places, adding to a sense of risk, vulnerability, and frustration with the disconnect from what they experienced in everyday practice. Some nurses felt devalued, with the public minimizing the pandemic while they themselves were providing end-of-life care to patients with COVID-19.

Nurses desired to be seen as sources of professional, unbiased information, providing first-hand perspectives that the public could learn from and trust in the context of politicized discourse. The public response compelled nurses to be vigilant with as much scientific and experiential evidence as existed at the time. Nurses described occasionally sharing their own professional experiences with community members as a means to educate and validate the evidence. It is not known whether any of the participants received support from employers or professional organizations in sharing messages with the public.

Though none of the nurses in this study shared an experience of violence directed at them, there have been many reports of such violence (e.g., Özkan Şat et al., 2021), including violence against medical professionals in Brazil related to inaccurate information and beliefs around the pandemic as a hoax (Taylor, 2020). With ongoing rhetoric about the pandemic as a hoax, and as the pandemic wears on and compassion fatigue becomes an issue, there is risk for the incidence of violent acts increasing.

Consistent with the study by Pangborn and colleagues (2021), nurses in the current study appreciated positive recognition from their communities. They recognized the negative impacts from the politicization of the pandemic. The proliferation of inaccurate information added to the burden.

For the first time for many community members, nurses’ role in providing patient care and their professional obligation for providing that care came to the forefront, resulting in greater awareness that nurses carried out their work despite extreme risk of harm to themselves and their loved ones, and of the vital role nurses have in the health-care system. Disparate beliefs in both the U.S. and in Brazil resulted in community behaviors that created unprecedented experiences for nurses. Study participants expressed the need to counteract inaccurate information about the pandemic and about protective guidelines with scientific evidence, while simultaneously protecting themselves. Lack of meaningful support from employers and/or the public was exhausting, and participants sought ways to take breaks from constant service, particularly pausing their exposure to social media.

Conclusion and Implications for Practice

It is important to recognize that while the pandemic brought many challenges, there were also positive impacts. The general public now has a better understanding of how integral the nurse's role is in the health-care system. Nursing can maximize this enhanced public understanding of the nursing role and use the profession's collective voice in policy making to advocate for safe care for patients and for health-care providers. Though the term “hero” often rings hollow, nurses can emerge from this experience stronger and more dedicated, not only to their clients, families, and society, but also to themselves and to their colleagues.

The pandemic revealed deficits in our health-care system; in many cases, nurses were left to pick up the slack and make do with what they had. We encourage administrators to reflect on this pandemic experience and explore ways to better support nurses and other direct care providers. In addition, nurse educators can focus on methods to prepare students to provide evidence-based, politically neutral information within their communities. It is possible that the lessons learned in the COVID-19 pandemic will inform these methods.

Lastly, as is apparent in the narrative comments from this analysis, there is potential for nurses to experience long-lasting psychological distress from the experiences of caring for patients during the pandemic, due in part to interacting in often difficult and discouraging ways with the public as well as with members of their own families and social circles who held inaccurate beliefs about the pandemic. Nurses need support and a chance to heal from this experience. This can only be accomplished by acknowledging and validating nurses’ experiences and by developing substantive and targeted ways to encourage nurses in their work.

Footnotes

Disclosure.

The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

Funding.

The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.

Kristen Abbott-Anderson, PhD, RN, CNE, (she/her), is a Professor and Director of the Glen Taylor Nursing Institute for Family and Society at Minnesota State University, Mankato, School of Nursing, USA.

Maiara Rodrigues dos Santos, PhD, RN, (she/her), is an Assistant Professor at University of Sao Paulo, Department of Maternal-Child and Psychiatric Nursing School of Nursing, Brazil.

Cy Schweiss, DNP, RN, (she/her), is a recent graduate of Minnesota State University, Mankato, School of Nursing, USA.

Sonja Meiers, PhD, RN, AGCNS-BC, FAAN, (she/her), is Acting Dean and Jane W. and James E. Moore Nursing Research Professor with the College of Nursing and Health Sciences, University of Wisconsin, Eau Claire, USA.

Sandra Eggenberger, PhD, RN, (she/ her), is a Professor Emeritus with Minnesota State University, Mankato, School of Nursing, USA.

Julie Ponto, PhD, APRN, CNS, AGCNS-BC, AOCNS, (she/her), is Professor and Program Coordinator for the Adult-Gerontology Clinical Nurse Specialist program at Winona State University—Rochester, Minnesota, USA.

Regina Szylit, PhD, RN, FAAN, (she/ her), is a Professor and Dean at the University of Sao Paulo, School of Nursing, Brazil.

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