Table 3 Categories, sub-categories, and some quotes of the participants

The onset of a new chapter: from avoidance to relapse

Facing emerging developments

“Before the Covid-19 outbreak, we lived with sick family members and commuted with them normally, but suddenly everything seemed to change, and all our routines changed.

It was as if our home nursing was divided into pre-corona and post-corona eras. Everything changed suddenly. And we faced a new and unknown disease “(P8).

leaving the care place

“When Covid-19 came early, I had no desire to continue working in home care at all. When they called me and asked me to help the patient, I refused” (P1).

Re-orientation and gradual return

“Step by step, it became normal for us to go to the patient’s house for care. We were not scared anymore. Step by step, we realized that the Covid-19 is less transmitted through the surface and most of its transmission is respiratory. For example, we no longer needed to disinfect our whole head and body. We went to the patients’ homes more easily for care “(participant 3).

“Well, in the beginning, our income was very low, but well, because they felt the need to raise salaries, the income gradually increased. We also needed money, and step by step, we accepted and returned” (P2).

Burnout

Mental pressure due to vulnerability

“We were very scared and anxious at the very beginning of Covid-19. We were all afraid of getting Covid-19, and since I did not know anything about it, we thought that God knew what would happen to us later” (P7).

Physical injury

“I thought I had gotten Covid-19 because of the long shifts and fatigue. At first, it was accompanied by hoarseness. Then, at night I went to rest. I had a high fever. From the third and fourth day onwards, I lost my sense of smell and taste. It lasted for a month and a half. I had severe shortness of breath and was hospitalized in the ICU for a few days” (P8).

Stress caused by injury

“Well, we have a family. They usually wonder if it has happened to me, it was because of what I accepted to do, but what about my family? I don’t want anything to happen to my family” (P13).

The vortex of moral distress

Spiritual suffering

I always had a pang of conscience about being a vector because one of my family members also got covid-19. I told myself that I must have transmitted the disease to him “(P15).

“I was ashamed of myself for being so ignorant. I felt guilty that the drugs we gave patients didn’t work” (P10).

Resulting helplessness

“I’ve felt useless since Covid-19 came. I feel bad about telling my family that I cannot do anything else. Take your patients to the hospital not to get worse.

It seems that this virus and its mutations are not over, and it does not want to give up on us. You know, the Covid-19 has become like a vortex, where you have to sink more, and you will not get anywhere “(P14).

Social stigma

Perceived stigma

“Everyone, even our own families, was afraid that we would be vectors.

In the patient’s house, if something got into your throat and you coughed, that was enough; they thought you had Covid-19. You couldn’t prove that it was just something that got into your throat and nothing else.(P2)

Perceived discrimination (feeling ignored)

“We, the home nurses, were oppressed during the Covid-19. Everyone on TV was talking about the hospital nurses. No one named us at all.

At the time of vaccination, we were included in the last group of medical staff who were vaccinated “(P10).

Perceived rejection

“Many of us did not say at all that we were working in the ward, especially to the families of the patient at home. If we had said it, they wouldn’t have let us go to their house at all “(P11).

“For example, you used to go to a vegetable shop and say ‘I am a nurse’ then they would treat you very respectfully, but from the moment Covid-19 came, they ran away from us.’

“Once a taxi driver found out that I was a nurse and was working in the Covid-19 ward, he dropped me off for fear of getting the disease” (P12).

Difficulty in breaking the transmission chain

Physical separation difficulties

“As soon as we entered the house, we tried to isolate the environment where we were supposed to stay. For example, I told the family to prepare a separate room to take care of the patient and leave the patient there.

“I also had to stay in the patient’s room a lot if they had Covid-19 disease; or if the patient was ill and we had to stay with him all the time, I would try to open the windows so that there was enough ventilation, but this was not possible in every house.” P4).

Difficulty implementing personal protection strategies

“Especially in those early days, it was very difficult for us to bring food, dishes, spoons, and forks from home. It was very difficult to stay in the protective clothing in that house with a twenty-four-hour shift, we were constantly sweating, and we were in trouble” (P6).

Gradual decline in following the protocols over time

“In the beginning, we were very careful; we were constantly washing our hands and our hands’ skin was always cracked, and the patient’s family disinfected me as soon as I got home; they even disinfected my backpack.

But now it’s not like then. Both we and our family just wear masks, because we have been vaccinated; well, we seem to be less careful” (P5).

“Step by step, we learned that the disease is not transmitted through surfaces and it is more respiratory, and it is enough if we just put on a mask, as if we are not scared anymore and it is normal for us” (P1).

Care inhibitors related to the patients and their families

Family-related care inhibitors

“Every time we told the family that wearing these procedure masks was vital for your patient, they would say, ‘No, my patient is being bothered’ and he would come and take off the patient’s mask” (P12).

“The family tried everything they read on the Internet on the patient (with Covid-19 disease). Or they gave the patient some unknown kind of herbal drink even if we said it could be harmful to the patient and that they had to consult a doctor.(P9).

“Once I saw a patient and accidentally found out that he had Covid-19 and the family hadn’t told the agencies and us about it” (P1).

Patient-related care inhibitors

“Taking care of Covid-19 patients at home was very difficult because I saw several new symptoms and complications from the patient that we had not encountered before. For example, most of these patients had cognitive problems and did not cooperate with the nurse” (P6).

“Most Covid-19 disease patients were terrified because their disease was unknown, and they were all scared of dying” (P3).

Lack of support: crisis of agencies in crisis

Crisis mismanagement

“In my opinion, the nursing home care agencies in my home town during the pandemic were very poorly managed.

They passed a new and hasty law every day and told us to exercise it. Suddenly, they called us and told us to go on an extra shift, otherwise they would cut off their cooperation with us” (P13).

Lack of supervisor competence

“The supervisor plays a vital role in helping the nurses. If I have a problem somewhere, I can get help from her. We did not know much in Covid-19.

For example, I did not know how to work with the BiPap, but our supervisor was not very good either “(P8).

“The supervisor must be able to communicate well with the patient’s family. Many of them could not cope” (P1).

Lack of information support: Lack of comprehensive training

“We did not have any training program in Covid-19. The previous training we had was also canceled during the pandemic and I did not receive any training at all.

This increased our fear and anxiety at work and I was afraid of doing the procedures the wrong way. Or I was afraid of getting COVID-19 because I didn’t know how to protect myself”(P9).

Lack of financial and legal support: No compensation for inefficient services

“Our payment was very, very low.

The same small amount of salary was paid with a total delay. I once got Covid-19and took a sick leave. They told me that I could not be absent for more than three days and that I had to return to my job “(P14).

Lack of logistical support: drug and equipment shortages

“Insurance did not cover home care. All equipment had become very expensive and scarce. For example, nursing care agencies had rationed masks and gloves for us” (P11).

Lack of support for efficient human resources: Human resource mismanagement

“Early on, doctors were either busy in hospitals or were too scared to visit homes. Physiotherapists also did not come to the patient.

The patient’s family begged them but they did not come “(P4).

“The number of nurses in the house was so low that we had to take the whole burden. On the other hand, because there was inadequate human resources, the nursing care agencies started hiring nurses who had no experience in home care and with no training “(P16).