In brief
A qualitative grounded theory study of 22 nurses and recovered COVID-19 patients in Iran that describes their intertwined fear, duty, uncertainty, and workload strain, framed as themes rather than statistics.
What this article is about
Quick Answer
A qualitative grounded theory study of 22 nurses and recovered COVID-19 patients in Iran that describes their intertwined fear, duty, uncertainty, and workload strain, framed as themes rather than statistics.
Student takeaways
Key Takeaways
- Using a grounded theory approach with 22 nurses and recovered patients, the study generated a core paradigm the authors named 'two intertwined experiences influenced by the Coronavirus,' organized into conditions, interactions, and outcomes.
- Recovered patients described challenges including death anxiety, the experience of the illness, uncertainty, and the emotional strain of quarantine, which the authors suggest could delay recovery.
- Nurses reported early fear for their own safety when the virus was poorly understood, held alongside a strong sense of moral and organizational duty to keep caring for patients.
- As admissions and length of stay increased, the infectious and isolation ward became the busiest part of the hospital, intensifying nurses' workload and blurring their roles.
- The authors link these experiences to broader concerns about post-traumatic stress risk among healthcare workers and to resilience and social support as protective factors, presented as supporting context rather than measured outcomes of this study.
Student summary
Why This Research Matters
This qualitative study explored the lived experiences of two groups who faced COVID-19 up close during the early months of the pandemic: nurses working in an infectious-disease and isolation ward, and patients who had been hospitalized with the virus and recovered. The research was carried out at Razi Hospital in Ahvaz and several other hospitals in Iran's Khuzestan province, and it used a grounded theory approach based on the methods of Corbin and Strauss (2015). Grounded theory is a research design that builds an explanation, or 'theory,' directly from what participants say, rather than testing a hypothesis set in advance. Twenty-two nurses and patients took part, chosen through purposeful sampling until the researchers reached saturation, the point where new interviews stopped adding new ideas. Data came mainly from in-depth interviews lasting about an hour and a half each, analyzed line by line through several coding stages.
Because this is a qualitative study, it does not report numbers such as infection rates, cure rates, or survey scores. Instead, its results are described as themes. The researchers organized these themes into a central idea they called 'two intertwined experiences influenced by the Coronavirus,' built around three dimensions: the conditions people faced, the interactions they had, and the outcomes that followed. Among the patients, the study describes challenges such as death anxiety, the experience of the illness itself, uncertainty, and the emotional strain of quarantine. The nurses described fear for their own safety early on, when the virus was still poorly understood, alongside a strong sense of moral and professional duty to keep caring for patients. Even though these nurses were experienced with protective equipment like gowns and masks, they felt they were facing entirely new conditions.
The study also describes how the infectious ward became the busiest part of the hospital as admissions and length of stay grew. Both nurses and patients longed for family visits but accepted the need to keep their distance for safety. Nurses reported feeling stretched to the 'end of their power,' a disruption of their normal relationships, and a rethinking of their work and identity. They also spoke about strain at the nursing station, where worried family members and patients sometimes directed impatience, complaints, or disrespect toward them. The reported outcomes for nurses included a blurring, or 'confluence,' of roles, a very high workload, and worry about job and personal security.
The authors connect their findings to wider evidence that the pandemic placed heavy physical and psychological pressure on healthcare workers, raising the risk of post-traumatic stress disorder (PTSD). They point to the importance of building resilience among nurses and of social support as a protective factor for mental health, especially for middle-aged staff. It is important to read these connections as background context and general concern rather than as measured outcomes of this particular study.
For nursing students, this paper is a window into the human side of a public-health crisis. It shows that caring for patients during an emerging, frightening illness is not only a clinical task but also an emotional and moral one. It highlights why trauma-informed and psychologically supportive workplaces matter, and why nurses' own mental health deserves attention, not just patients'. A caution when reading qualitative work like this: the themes reflect the experiences of a specific group of participants at a specific time and place, so they help us understand and empathize, but they cannot be turned into statistics or treated as proof that every nurse or patient reacted the same way. Used well, studies like this can guide compassionate policies, peer-support programs, and honest conversations about the toll of frontline care, while reminding future nurses to protect their own wellbeing as they protect others.
Source abstract
Study Overview
IntroductionCoronavirus is a large family of viruses that cause respiratory infections (Jiang et al., 2020). The virus, previously unknown, was found in a significant number of patients in the city of Wuhan, China (Najo et al., 2020). It swept across countries’ borders so quickly that on April 1, 2020, 360783 cases of the virus were found in 205 countries of the world (Kate Louis et al., 2021). In Iran, the virus soon swept through the borders of the provinces and cities revealing itself as a multi-dimensional problem. One of the groups that have suffered double dealing with the virus was nurses working in hospitals. Nurses in the Khuzestan province were also experiencing a battle with the Coronavirus. This experience caused many sufferings. Because of the unknown nature of the Coronavirus, at the early spread of the virus, the nurses, like other groups of people, felt threatened with the disease. On the other hand, they felt morally and organizationally obliged to do their job well, and this made them continue to live in the environment and serve the patients suffering from the virus, despite their fear and panic. This was the most important reason for investigating the mentioned issue. The present study used the interpretive approach with the aim of understanding the common experiences of patients from the Coronavirus and the nurses involved in the infectious and isolated sections at Razi Hospital in Ahvaz. The present study explores the understanding of the experiences of individuals involved with the corona, especially the nurses of this sector and patients who have been infected with the virus and hospitalized. Based on the results of this study, the challenges that patients with Covid-19 have faced include the experience of death anxiety, disease experience, uncertainty experience, emotion caused by quarantine, etc. These painful experiences can delay the patient's recovery (Rahmati Nejad, Yazdi, Khosravi, & Shahisadrabadi, 2020). The nurses responded similarly in the same situation. Based on research by Riocci et al. (2020), nurses were afraid to deal with cases of Covid-19 for their own safety and health, but after the deployment of standard methods, they were partly reassured of protecting themselves from the disease. Materials and MethodsIn this study, the grounded theory method, as one of the important methods in qualitative research, was used. The approach used in this study was based on the view of Corbin and Strauss (2015). In this study, the participants were 22 of the nurses and patients hospitalized and improved at Razi Hospital and several other hospitals in Khuzestan province. The participants had sufficient information and knowledge about the subject under study. The sampling method in this study was purposeful; in addition, the sample selection in the process of data gathering, considering the degree of saturation of categories, was carried out in the direction of the qualities and dimensions.The main technique used to collect data in this study was in-depth interviews with each participant conducted around one and a half hours. First, by interviewing six of the participants, the main questions of the research were modified and adjusted. The modified questions were then used. The purpose of the interview was the to extract concepts, categories, and paradigms related to the study.Data analysis was based on five coding stages considering the 2015 version of the proposed grounded theory method of Corbin and Strauss. At the beginning of the coding phase, the data were analysed line by line and the initial concepts were extracted. In the next step, the code that was connected in terms of the concept and feature was organized by the centrality of the main categories. In the axial coding stage, they were related to the main categories. Selective coding was followed using the selection of concepts and issues that were considered effective in extracting the main category of the study.In this study, the authors used five research strategies to obtain the confidence level for the scientific approval of the study including observing colleagues, checking by contributors, long participation, continuous observation in the field of research, and deep and rich descriptions. Discussion of Results and ConclusionsThe appeared paradigm consists of three main dimensions of terms, interaction, and outcomes, which include the unknown nature of the virus, the interconnectedness of illness and the compression of shifts, a desire for accurate general understanding, successive iteration of decisive moments, anxiety and uncertainty. The interaction aspect includes feeling towards the end of power, disrupting the balance of relations and social relations, rethinking of employment and personality, anxiety, and uncertainty in facing the family. The outcome dimension includes the confluence of roles, acknowledging the high volume of tasks, no life and job security for nurses which were formed around a core paradigm called ‘two intertwined experiences influenced by the Coronavirus’.The research participants talked about the unique suffering that was strongly influenced by the unknown nature of the virus in the early days. The ignorance of the virus and the unfamiliarity of the world with its contagious and lethal power led to the anxiety and stress in the medical staff. They were concerned about themselves, their protection, their patients, their families and other citizens. Nurses in the infectious and isolated sections, although experienced in the use of protective equipment such as gowns, masks, and disinfectants, all indicated that new conditions lay ahead. With the increase in the number of patients and also the increase in the number of daily hospitalizations and the duration of hospitalization days, the infectious section became the busiest part of the hospital and unique experiences of having the fear and hope of nurses and patients were recorded. Both groups of patients and nurses longed for family visits, but more than ever believed in the unpleasant imposed aspect of protocols and chose to maintain distance.When conducting health care for covid patients, nurses are generally exposed to fluid and unstable situations; patients who do not have physically stable conditions and face a state of confusion with not responding to the nursing care. Nurses are always under pressure from people, hospital administrations, sick companions, patients, and other hospital staff. The nursing station can be considered a place of collision between a patient and a nurse; the place in which the companions unaware of a nurse's duties will seek medical care, impatience, not cooperating, labeling, urging for an answer, prejudice, complaint and judicial treatments, overcoming of emotions on the better judgment, disrespecting the nurse, having a bad attitude, etc. which will result in devaluing and far expectations.The findings of the World Health Organization show that the rapid outbreak of Covid-19 disease at the beginning of 2020 in the world put severe physical and psychological pressure on the medical staff of hospitals involved in the care of patients with Covid-19, to the extent that the risk of post-traumatic stress disorder (PTSD) increased for this group. It is essential to increase the resilience of nurses and medical staff in their work, as well as to help patients who are seriously challenged with the disease, through strategic measures. Social support, as mentioned by Hou et al. (2020) can improve the mental health of medical staff through resilience, especially among middle-aged staff because resilience and mental health in this group have become poorer than the youth.
Evidence appraisal
Main Findings
- Using a grounded theory approach with 22 nurses and recovered patients, the study generated a core paradigm the authors named 'two intertwined experiences influenced by the Coronavirus,' organized into conditions, interactions, and outcomes.
- Recovered patients described challenges including death anxiety, the experience of the illness, uncertainty, and the emotional strain of quarantine, which the authors suggest could delay recovery.
- Nurses reported early fear for their own safety when the virus was poorly understood, held alongside a strong sense of moral and organizational duty to keep caring for patients.
- As admissions and length of stay increased, the infectious and isolation ward became the busiest part of the hospital, intensifying nurses' workload and blurring their roles.
- The authors link these experiences to broader concerns about post-traumatic stress risk among healthcare workers and to resilience and social support as protective factors, presented as supporting context rather than measured outcomes of this study.
Practice transfer
Clinical Relevance
- Recognize that emerging-infection care carries an emotional and moral burden for nurses, not just a physical one, and that psychological support should be planned alongside infection-control measures.
- Support trauma-informed workplaces and accessible peer-support or debriefing so frontline staff can process fear, grief, and uncertainty during outbreaks.
- Attend to patients' emotional experiences, such as death anxiety and isolation distress, because these may affect recovery and warrant compassionate, non-alarmist communication.
- De-escalate conflict at the nursing station by acknowledging family members' fear and clarifying nurses' roles, while protecting staff from disrespect and unrealistic demands.
- Treat these qualitative insights as prompts for reflection and program design rather than as measurable predictors, and confirm any local staffing or wellbeing decisions with broader evidence.
Faculty notes
Educational Relevance
This grounded theory study offers a rich teaching case for qualitative methods and for the psychological dimensions of disaster nursing. Use it to help students distinguish interpretive, theory-building research from quantitative designs: there are no effect sizes or rates here, only themes drawn from in-depth interviews with 22 nurses and recovered COVID-19 patients, coded through Corbin and Strauss's stages and anchored by trustworthiness strategies such as member checking, prolonged engagement, and thick description. The core paradigm, 'two intertwined experiences influenced by the Coronavirus,' with its conditions-interaction-outcomes structure, models how grounded theory organizes data. Clinically, the paper opens discussion on moral distress, the tension between duty and self-preservation, occupational PTSD risk, and the role of resilience and social support. It also surfaces workplace conflict at the nurse-patient-family interface. Ask students to appraise transferability rather than generalizability, to identify where the authors draw on external literature versus their own data, and to consider how findings might inform peer-support programs, debriefing, and trauma-informed staffing policies. The single-region, pandemic-specific context makes it ideal for teaching the limits and legitimate uses of qualitative evidence.
Critical appraisal
Limitations
- This is a qualitative grounded theory study, so its themes describe experiences and cannot be used to estimate rates, effect sizes, or cause-and-effect relationships.
- Findings come from 22 participants at a small number of hospitals in one Iranian province during a specific early phase of the pandemic, limiting how far they transfer to other settings.
- The available metadata provides only an abstract; details such as participant demographics, full interview protocols, and complete audit trails cannot be verified from this summary.
Classroom use
Discussion Questions
- What does the phrase 'two intertwined experiences influenced by the Coronavirus' capture about how nurses' and patients' journeys were connected during the pandemic?
- How does grounded theory differ from a survey or clinical trial, and why might it be the right choice for studying lived experience during a crisis?
- The nurses felt both fear for their safety and a duty to care. How would you describe this tension, and how can workplaces help staff manage it?
- Why might a patient's death anxiety, uncertainty, and quarantine distress affect their recovery, and what nursing actions could ease these feelings?
- What trustworthiness strategies did the researchers use, and how do these strengthen confidence in qualitative findings?
- How should we interpret the study's references to PTSD risk and resilience, given that they come from outside literature rather than this study's data?
- The nursing station is described as a place of collision between staff and worried families. What communication skills could reduce this conflict?
- What does 'transferability' mean in qualitative research, and to which other settings might these themes reasonably apply?
- How can nurses protect their own mental health while caring for patients during a prolonged, high-stakes outbreak?
- If you were designing a peer-support program based on this study, what elements would you prioritize and why?
Knowledge check
Quiz
1. What research design did this study use?
- Randomized controlled trial
- Grounded theory (qualitative)
- Systematic review
- Cross-sectional survey
Rationale: The abstract states the study used the grounded theory method based on Corbin and Strauss (2015), an interpretive qualitative approach.
2. Approximately how many participants took part in the study?
- 22
- 205
- 360
- 1,000
Rationale: The abstract reports 22 nurses and hospitalized/recovered patients as participants; the other numbers refer to global case counts cited as background.
3. What was the study's core paradigm or central theme?
- Two intertwined experiences influenced by the Coronavirus
- The economics of hospital staffing
- A cure for COVID-19
- Vaccine hesitancy in nurses
Rationale: The abstract names this as the core paradigm around which the themes were organized.
4. Which of the following was described as a patient challenge in the study?
- Death anxiety
- Improved appetite
- Faster wound healing
- Lower blood pressure
Rationale: The abstract lists death anxiety, disease experience, uncertainty, and quarantine-related emotion among patients' challenges.
5. What main data collection method did the researchers use?
- In-depth interviews
- Blood tests
- Standardized questionnaires only
- Chart audits
Rationale: The abstract states the main technique was in-depth interviews of about one and a half hours with each participant.
6. Why is it inappropriate to report infection or cure rates from this study?
- Because it is a qualitative study focused on themes, not statistics
- Because the sample was too large
- Because the data were confidential
- Because the study only used lab data
Rationale: Grounded theory produces themes and explanations rather than numerical rates, so quantitative outcomes are not part of its findings.
7. According to the abstract, what dual feeling did nurses experience early in the pandemic?
- Fear for their safety alongside a duty to care
- Boredom and relief
- Confidence and certainty
- Indifference and detachment
Rationale: Nurses felt threatened by the unknown virus yet felt morally and organizationally obliged to continue caring for patients.
8. How does the abstract describe the infectious ward as the pandemic progressed?
- It became the busiest part of the hospital
- It was closed to reduce risk
- It had the fewest patients
- It was converted to a vaccine clinic
Rationale: The abstract states that rising admissions and longer stays made the infectious section the busiest part of the hospital.
9. How should the study's mention of PTSD risk be interpreted?
- As supporting context from outside literature, not a measured outcome
- As the study's primary statistical result
- As a confirmed diagnosis of all nurses
- As unrelated to nursing
Rationale: The abstract cites WHO and other findings about PTSD risk as background; the study itself did not measure PTSD rates.
10. What is the best way to describe how far these findings apply to other settings?
- Consider transferability to similar contexts, not statistical generalization
- Apply them as universal rates worldwide
- Assume every nurse reacts identically
- Ignore context entirely
Rationale: Qualitative findings are judged by transferability to comparable settings rather than by generalizing statistics to whole populations.
Study cards
Flashcards
What type of study is this?
A qualitative grounded theory study based on Corbin and Strauss (2015).
Who were the participants?
22 nurses from an infectious/isolation ward and patients who had been hospitalized with and recovered from COVID-19.
Where was the study conducted?
Razi Hospital in Ahvaz and several other hospitals in Khuzestan province, Iran.
What is grounded theory?
A qualitative approach that builds an explanation or theory from participants' accounts rather than testing a preset hypothesis.
What sampling method was used?
Purposeful sampling continued until saturation of categories.
What does data saturation mean?
The point at which new interviews stop adding new concepts or themes.
What was the main data collection method?
In-depth interviews lasting about one and a half hours each.
What was the study's core paradigm?
'Two intertwined experiences influenced by the Coronavirus.'
What three dimensions organized the findings?
Conditions/terms, interaction, and outcomes.
Name patient challenges the study described.
Death anxiety, the disease experience, uncertainty, and emotion caused by quarantine.
What dual feeling did nurses report early on?
Fear for their own safety combined with a moral and organizational duty to keep caring.
How did the infectious ward change over time?
It became the busiest part of the hospital as admissions and length of stay increased.
What outcomes did nurses report?
A confluence of roles, a very high workload, and worry about job and personal security.
What is the 'nursing station collision' described in the abstract?
Conflict where worried families and patients directed impatience, complaints, or disrespect toward nurses.
How is PTSD discussed in the abstract?
As background context about pandemic pressure on healthcare workers, not as a measured outcome of this study.
What protective factors does the abstract highlight?
Resilience and social support, especially for middle-aged staff.
Why can't this study report cure or infection rates?
It is qualitative; it produces themes rather than numerical statistics.
What is transferability?
The extent to which qualitative findings can inform understanding in similar contexts, used instead of statistical generalization.
Name two trustworthiness strategies the authors used.
Examples include member checking (checking by contributors) and prolonged engagement/continuous field observation, plus thick description.
What is a key nursing takeaway from this study?
Frontline crisis care carries emotional and moral burdens, so nurses' mental health and trauma-informed support deserve attention.
Search-ready answers
Frequently asked questions
What was this study trying to understand?
It aimed to understand the shared, lived experiences of nurses in an infectious/isolation ward and patients who recovered from COVID-19 during the early pandemic in Iran.
Does the study prove that nurses developed PTSD?
No. It discusses PTSD risk as context from outside literature. It did not measure or diagnose PTSD in its participants.
Can I quote infection or recovery rates from this paper?
No. It is qualitative and reports themes, not rates. The large case numbers in the abstract are global background statistics, not study results.
What is grounded theory in simple terms?
It is a method that listens closely to people's stories and builds an explanation from patterns in what they say, rather than starting with a hypothesis to test.
Why are family visits and distancing mentioned?
Both nurses and patients missed family visits but accepted keeping their distance for safety, which added to the emotional strain the study describes.
What does 'confluence of roles' mean for nurses?
It refers to the blurring of many responsibilities at once, so nurses juggled clinical, emotional, and support roles under heavy workload.
How can this study help nursing practice?
It supports designing peer support, debriefing, trauma-informed policies, and compassionate communication for both staff and patients during outbreaks.
How many people were studied and where?
22 participants at Razi Hospital in Ahvaz and other hospitals in Khuzestan province, Iran.
Do these findings apply to my hospital?
Possibly, through transferability if your setting is similar, but they are not statistical proof and should be combined with broader evidence.
Is there any safety caution when using this content?
Yes. Treat the emotional themes sensitively, avoid alarmist conclusions, and remember that support for distress should come from qualified mental-health resources, not self-diagnosis.