Article

Experiences and Challenges of Nursing Managers’

Preparedness for Timing Response to COVID-19
Pandemic: A Qualitative Study in Iran
Hojjat Farahmandnia Yasamin Molavi-Taleghani
https://orcid.org/0000-0002-3264-6792 https://orcid.org/0000-0003-2969-3587
Health in Disasters and Emergencies Health Management and Economics
Research Center, Institute for Futures Research Center, Department of Health
Studies in Health, Kerman University of Services Management, School of
Medical Sciences, Iran Management and Medical Information
[email protected] Sciences, Isfahan University of Medical
Sciences, Iran
[email protected]

Negar Pourvakhshoori Arash Ziapour

https://orcid.org/0000-0002-4318-137X https://orcid.org/0000-0001-8687-7484
Department of Nursing, School of Cardiovascular Research Center, Health
Nursing and Midwifery, Guilan Institute, Imam-Ali hospital,
University of Medical Sciences, Iran Kermanshah University of Medical
[email protected] Sciences, Iran
[email protected]

Mahdieh Abdolahi
(corresponding author)
https://orcid.org/0000-0003-2429-8991
Department of Nursing, Zarand Branch,
Islamic Azad University, Zarand, Iran
[email protected]

Abstract
The preparedness of nurses in the COVID-19 pandemic is of great importance
with regard to the unknown future of the pandemic and other similar ones.
Identifying nurses’ problems can lead to better planning, preparation and
management. In this study, we aim to explore the experiences and challenges of
nursing managers’ preparedness for timing responses to the COVID-19
pandemic. We conducted the research as a qualitative content analysis in Iran
in 2022. The data were collected through in-depth semi-structured individual
interviews with 15 nursing managers who were selected by purposeful

African Journal of Nursing and Midwifery https://doi.org/10.25159/2520-5293/12419

https://unisapressjournals.co.za/index.php/AJNM/index ISSN 2520-5293 (Online)
Volume 24 | Number 3 | 2022 | #12419 | 14 pages © Unisa Press 2023
 Farahmandnia et al.

sampling. After transcription of the interviews, a content analysis using constant

comparison was performed for data analysis based on the Graneheim and
Lundman approach. The results of the study can be summarised in the following
four main categories and nine subcategories: the necessity of exercises in the
same environment (performing exercises to prepare for possible pandemics,
experiencing scenes similar to real pandemics, creating the experience of similar
environments for the preparation of nurses), educating all members involved in
providing services in the COVID-19 pandemic (preparation of non-specialist
workers for pandemics, training all members of the treatment and non-treatment
team), management and leadership (inappropriate policymaking and unsuitable
planning), and processes and structures (processes for providing services and
ineffective provision of protective equipment). As we pointed out in this study,
it seems that to solve some of these challenges coordination is needed outside
the health sector. In addition, the establishment of the National COVID-19
Control Centre can contribute to developing necessary policies and strategies
for handling the pandemic.

Keywords: challenges; COVID-19 pandemic; nurses; manager; response;

preparedness

Introduction
The coronavirus disease (COVID-19), which is responsible for the widespread flu, was
identified in Wuhan, China, in December 2019. The virus can cause a variety of
symptoms, including the typical cold, fever, coughing, shortness of breath and severe
respiratory issues (Abdollahi, Naseh, Kalroozi et al. 2022; Nopour et al. 2022). Five to
twenty per cent of COVID-19 patients must be admitted to the intensive care unit (ICU),
and the death rate for those with severe sickness and acute respiratory distress syndrome
is approximately 50 per cent. The conditions in every nation’s healthcare system are
complex and unpredictable as a result of the COVID-19 pandemic (Abdollahi, Naseh,
Kazemi-Galougahi et al. 2022; Arab-Mazar et al. 2020). Healthcare personnel, nurses
in particular, are at the forefront of patient care during a pandemic(Joolaee et al. 2021;
Ye, Yang, and Liu 2020). With regard to treating patients and halting the spread of the
disease, nurses are the members of the health team who interact with the community in
the most direct way (Mehraeen et al. 2022; Tavan et al. 2016).

Since nurses spend a lot of time with patients, they are actively involved in the
management of emergencies (Joolaee et al. 2021). They must possess the knowledge
and abilities required to provide clinical treatment, manage resources effectively, lead a
team, and communicate effectively in conditions characterised by fast change. Nurses
are asked to provide care for others in this current pandemic, sometimes even without
access to personal protective equipment (PPE) (Mizutori 2020). Many nurses strive to
provide care for patients while also maintaining their own and their families’ health.
Despite these issues, nurses have continued to provide care for patients (Brucker 2020).
They have a unique role since they are skilled in both the science and the art of caring

2
 Farahmandnia et al.

for patients (Pourvakhshoori et al. 2017). Initial assessment, evaluation, triage, sample
collection, treatment for patients with mild to moderate symptoms, care for critically
sick patients, and even care for the deceased are all tasks that nurses perform in the
management of COVID-19 patients (Sharma, Nuttall, and Kalyani 2020).

Many public wards have been converted to isolated wards for COVID-19 cases during
the recent pandemic as a result of the rise in patients and overcrowding in hospitals, and
also because healthcare professionals without expertise in infectious diseases now had
to care for these patients (Nekoei‐Moghadam et al. 2019). It is crucial to assess the
experiences of this group with regard to their preparedness given the fact that nurses are
one of the first and most important healthcare providers during emergencies and that
there is a need for prepared nurses with the necessary training, experience, knowledge,
skills, independence and self -confidence to provide proper nursing care during
emergencies (Brucker 2020; Jahangiri and Sahebi 2020).

Managing the new coronavirus (COVID-19) pandemic in the nation’s medical

campuses requires identifying difficulties related to hospitals as a front line when
dealing with critically ill patients owing to the high workload and restricted personnel.
Identifying these difficulties can help create a road map for management planning of
future disasters. In order to improve work capacity, standards and handling of disasters,
and to lessen the catastrophic impacts of disasters, it is also important to identify the
capabilities, constraints and shortcomings in the provision of services in hospitals.
Examining the experiences of individuals who were in control during times of disaster
is one way to assess the effectiveness of the disaster management programme and its
strengths and weaknesses.

An effective method for comprehending social reactions to such a pandemic in this

regard is through qualitative research. This technique makes it possible to comprehend
the way people view and interpret health issues and illnesses. Examining various
viewpoints, meanings and motivations can be done through interviews and observations
(Jahangiri and Sahebi 2020; Leach et al. 2020). To illustrate a fuller image of the
experiences and difficulties the nurses encountered while preparing for the pandemic,
we therefore selected this strategy. In this study, we aimed to explore the experiences
and challenges of nursing managers’ preparedness for timing responses to the COVID-
19 pandemic. The study’s conclusions can be used as a foundation for healthcare
decision makers to develop an educational strategy for delivering higher-quality
services and better managing the pandemic.

3
 Farahmandnia et al.

Method
Design
A cross-sectional design with Reg. No. 401000523 was approved by the ethical
committee of the Kerman University of Medical Sciences. The ethics approval code is
IR.KMU.REC.1401.334.

Participants and Setting

In order to gather or create data-rich material, 15 nursing managers were interviewed in
Iran in 2022. A bachelor’s degree in nursing, at least one year of professional experience
as nursing manager and a willingness to engage in the study were the inclusion criteria.
We made an effort to choose nurses who had experience in a range of locations and jobs
to have as much variation as possible. The lack of consent for study participation was
the exclusion criterion. Purposive sampling was used. The interviews lasted between 45
and 55 minutes.

Data Collection and Analysis

This qualitative study was conducted by using in-depth, semi-structured interviews,
starting with open questions and progressively moving on to more in-depth ones. The
study questions were: Please detail your experiences in the COVID-19 pandemic with
patients? What are the main difficulties and flaws facing service providers? What were
the most common causes of these difficulties and flaws? What was the most typical
reason for these difficulties? Would you elaborate further? The questions were tailored
to each participant’s personal observations on the COVID-19 pandemic’s effects on
nursing staff.

The data gathered in this stage were analysed by using the content analysis approach
proposed by Graneheim and Lundman (2004). The researcher examines the recorded
words numerous times during this inductive procedure to ensure complete
comprehension. The meaning-containing units (words, sentences or paragraphs) that
dealt with the problems and difficulties encountered by the nurses in controlling the
COVID-19 pandemic were then reduced and assigned a code. Similar codes that
indicated related ideas were grouped into subcategories before being assigned to a
category (manifest level). Each category was formed from a collection of content that
had something in common, making the categories both internally and externally
homogeneous. As a manifestation of the hidden meaning, the relationship between the
underlying meanings in categories emerged as the central theme. The coding was
managed by the trial version of the MAX QDA 16 software.

Reliability and Validity

In this study, we employed strategies recommended by Lincoln and Guba for reliability
and validity tests (Schwandt, Lincoln, and Guba 2007). A member check was conducted
during the data-collection process to ensure that the analysis accurately reflected the
4
 Farahmandnia et al.

perspectives of the nurses. In addition, we worked continually with the data for more
than four months to increase the veracity. To facilitate follow-up and additional research
for others, we accurately recorded and reported the various study processes. We made
an effort to quote the participants while maintaining the context. In addition, the
maximum variation sampling improved the applicability and transferability of the data.
Some specialists verified the findings of the analysis, including the codes and
subcategories. The external check approach was successful.

Ethical Considerations
All procedures were carried out in conformity to all applicable rules and regulations.
Each individual person who took part in the study gave written informed consent after
receiving all the necessary information. The confidentiality and anonymity of the
participants were maintained during the coding process. The participants in the study
were made fully aware of their right to withdraw at any time and without providing a
reason.

Results
Demographic Data of the Participants
The participants were 15 nurses with a mean age of 36.5 ± 4.8 years, ranging from 25
to 51 years. The mean duration of work experience was 11.25 ± 3.4 years and all the
participants had more than two years of experience in hospital, as presented in Table 1.

Table 1: Demographic information of participants

Demographic Subcategory Number (Percentage of the

Characteristics Sample)
Gender Male 7 (46.66)
Female 8 (53.34)
Age (Years) 25–35 5 (33.33)
36–45 7 (46.66)
≥ 46 3 (20.00)
Work experience 10 ≤ 3 (20.00)
11–20 9 (60.00)
21–30 3 (20.00)
Work position Nursing Manager 5 (33.33)
Clinical Supervisor 6 (40.00)
Educational Supervisor 4 (26.66)
Level of education PhD 3 (20.00)
Master’s degree 5 (33.33)
Bachelor’s degree 7 (46.66)

5
 Farahmandnia et al.

Main Results
The results of the study can be summarised in the following four main categories and
nine subcategories (Table 2):

• the necessity of exercises in the same environment:

performing exercises to prepare for possible pandemics,
experiencing scenes similar to real pandemics,
creating the experience of similar environments for the preparation of nurses;
• educating all members involved in providing services in the COVID-19
pandemic:
preparation of non-specialist workers for pandemics,
training of all members of the treatment and non-treatment team;
• management and leadership:
inappropriate policymaking,
unsuitable planning; and
• processes and structures:
processes for providing services,
inefficient provision of protective equipment.
Table 2: Explore experiences and challenges of nursing managers’ preparedness for
timing response to covid-19 pandemic

Main Categories Subcategories

The necessity of exercises in the same Performing exercise to prepare for possible
environment pandemics
Experiencing scenes similar to real
pandemics
Creating the experience of similar
environments for the preparation of nurses
Educating all members involved in providing Preparation of non-specialist workers for
services in the COVID-19 pandemic pandemics
Training all members of the treatment and
non-treatment team
Management and leadership Inappropriate policymaking
Unsuitable planning
Processes and structures Processes for providing services
Weaknesses in providing protective
equipment

6
 Farahmandnia et al.

The categories and subcategories are described in the sections below.

Necessity of Exercises in the Same Environment

According to the experiences of nurses, preparedness for an effective response to the
pandemic should be practical. One of the ways to increase the effectiveness of this
training is to provide it in a real or similar environment. This category was divided into
three subcategories of performing exercises to prepare for possible pandemics, the
importance of experiencing scenes similar to real pandemics, and the need to create the
experience of similar environments for the preparation of nurses.

Performing Exercises to Prepare for Possible Pandemics

A response based on a revised and modified schedule is a more effective one. Nurses
trained based on a more effective schedule will be more prepared, will provide better
quality services, and will face fewer challenges. Participant 5 mentioned:

After tasks became clear I should give you the necessary programme, training, practice,
and resources. I should tell you that you need a guard for the door and a suitable space
to do triage and an exit here; I will provide these three for you. You should exercise all
of these with PPE.

Experiencing Scenes Similar to Real Pandemics

Nurses must be completely familiar with such environments, which are very different
from the usual scenarios. Participant 15 mentioned:

It is very important to know in what environment we are going to provide care. For
example, in the ICU, special protection is required when providing routine intensive
care and airborne precaution, especially when we are performing procedures that create
aerosols. The care setting is very important. Well, it is the area that requires special
attention.

Creating the Experience of Similar Environments for the Preparation of Nurses

According to the interviews, the nurses experienced conflicting emotions, which were
more negative in the early stages and were accompanied by frustration, uncertainty and
despair. Participant 11 mentioned:

When I was providing care in the COVID-19 pandemic, everything was so different for
me from the normal setting in a way that I continuously thought I needed to be trained
beforehand. That setting is not a normal work setting.

Educating All Members Involved in Providing Services in the COVID-19

Pandemic
Healthcare providers work as a team; therefore, it is not possible to expect only one of
them to be trained and educated. It is necessary that all people who play a role, even a

7
 Farahmandnia et al.

minor role, in the healthcare delivery process receive special training on COVID-19.
This category was divided into two subcategories: preparation of non-specialist
personnel for pandemics and the need to train all members of the treatment and non-
treatment team.

Preparation of Non-Specialist Personnel for Pandemics

Ordinary services personnel, patient transport personnel, kitchen staff, support staff and
security personnel should be trained in the field of infection control, wearing PPE, and
preventing the spread of the virus. Participant 7 described:

Training all individuals is important. Nurses do not work in a vacuum; for instance, even
transport systems are very important, including ambulances and vehicles that are there.
Training these drivers is, in itself, one of the important issues in this field.

Training of Members of the Treatment and Non-Treatment Team

The curriculum should not include only the principles of care, diagnostic sample
preparation, prevention of disease and infection control. Other issues such as
maintaining the mental health of nurses should also be included. Participant 14
mentioned:

Interprofessional training and collaborative activities between health professionals are

needed to combat the pandemic. The medical staff alone cannot deal with the disease.

Management and Leadership

Data from the participant interviews revealed that COVID-19 caused leadership and
management challenges related to ineffective hospital management, disregard for
scientific management, arbitrary interventions by managers, unprofessional
interventions of parallel organisations, incorrect policies of the ministry of health to
forcibly employ medical staff, incorrect policymaking for early calls for and
compulsory enlistment of medical conscripts, and more. This category was divided into
the two subcategories of inappropriate policymaking and unsuitable planning.

Inappropriate Policymaking
The results of this study indicated that improving nurses’ ability to formulate policies is
necessary for appropriate participation in healthcare policymaking. Participant 9
mentioned:

Most of these new improvements should be implemented by nurse leaders and

managers, who should also work to elevate nurses’ status in healthcare policymaking
and enhance their working circumstances.

8
 Farahmandnia et al.

Unsuitable Planning
One of the fundamental tenets of minimising the risk of the COVID-19 pandemic is
having an action plan for hospital readiness and response. Participant 12 mentioned:

There is a lack of effective planning and management communication and coordination

inside and among medical institutions, as well as between superior entities like the
Ministry of Health and the medical universities.

Processes and Structures

During the challenges of maintaining a stable and strong organisational framework, the
management structure plays a significant role in the standard of service. Understanding
the organisational structure is crucial. For instance, poor management lowers employee
motivation and makes decision-making more difficult. This category was divided into
the two subcategories of processes for providing services and ineffective provision of
protective equipment.

Processes for Providing Services

The COVID-19 pandemic has created numerous questions and concerns about the
quality of healthcare services, making healthcare guidelines and standard protocols
crucial in the delivery of health services. Participant 1 mentioned:

The most important challenge is that there are no effective guidelines to sort out the
patients who need to be taken to the hospital by EMS staff from the patients who
themselves must refer to the hospital.

Ineffective Provision of Protective Equipment

The participants who spoke about equipment and supply concerns said they were having
trouble finding personal protective equipment. Participant 6 mentioned:

The shortage of protective equipment such as masks and gowns has shocked us and
endangered the lives of healthcare personnel who are responsible for caring for patients.

Discussion
In the present study, we attempted to identify challenges faced by nursing managers
during the COVID-19 pandemic. Based on the findings of the study, four categories and
nine subcategories were extracted representing the challenges encountered by nursing
managers during the COVID-19 pandemic. The necessity of exercises in the same
environment was identified as the main challenge. One of the measures that can be
applied to expand disaster preparedness in nursing students is to conduct basic training
on disaster management and disaster simulation (Agboola, McCarthy, and Biddinger
2013; Fowkes et al. 2010; Hsu et al. 2013). Farhadloo et al. (2018) discussed training
by using the simulation method of the mock-up model as an efficient method in nurses’
9
 Farahmandnia et al.

preparedness for triage skills during emergencies (Farhadloo et al. 2018). Simulated
response behaviours identify the gaps between programmes and real situations and
indicate the parts that need to be changed (Pourvakhshoori, Khankeh, and Mohammadi
2017).

The importance of educating all those involved in providing services in the COVID-19
pandemic was another important challenge. Aldridge (2005) noted that the level of
knowledge and awareness of all staff should be monitored continuously and that training
related to policies, procedures and protocols of the relevant hospital should be provided
to them (Aldridge 2005). In the study by Houghton et al. (2020), healthcare workers
pointed out that all staff, including cleaning staff, porters, kitchen staff and other support
staff, must be considered when implementing IPC guidelines (Houghton et al. 2020).
Prihatiningsih et al. (2017) reported that interprofessional education and cooperative
practices are required for health professionals to battle natural disasters (Prihatiningsih
et al. 2017).

Hospital administrators frequently encounter new difficulties during a pandemic that

call for unconventional actions. Their past functionality and experience may not be
sufficient to handle these difficulties. The findings of the current study indicated that
one of the managements and leadership issues is the lack of emphasis on scientific
management. Similar to this, Abdi et al. (2021) examined a variety of unique managerial
skills required of healthcare leaders during the COVID-19 pandemic (Abdi et al. 2021).
Sengupta et al. (2021) examined the difficulties faced by healthcare professionals during
the COVID-19 outbreak and came to the conclusion that to improve the healthcare
system requires hiring trained personnel, ensuring equitable staffing and enhancing the
motivation and morale of healthcare professionals. However, there is a gap between the
ideal situation and reality that is frequently seen as managerial inefficiency and
incompetence (Sengupta et al. 2021).

The present study’s findings regarding managerial issues included ineffective hospital
management, arbitrary interventions by managers, a lack of effective hospital
administration, arbitrary actions by managers, and an uncoordinated physician
distribution. The COVID-19 pandemic has created numerous questions and concerns
about the quality of healthcare services, making healthcare guidelines and standard
protocols crucial in the delivery of health services. All institutions and businesses
engaged in the healthcare industry are at risk from the COVID-19 outbreak. The absence
of codified clinical guidelines and the prevalence of contradictory directives distributed
by senior authorities were two service delivery issues mentioned by the research
participants. Sengupta et al. (2021) discovered that the lack of guidelines in the COVID-
19 pandemic had a negative impact on the knowledge, judgement and decision-making
abilities of healthcare workers. This is because there was no established procedure or
prior research on this particular pandemic (Moradi et al. 2021; Sengupta et al. 2021).

10
 Farahmandnia et al.

One of the process-related difficulties mentioned by the participants was the disdain for
expert counsel and recommendations. The major difficulty in managing COVID-19,
according to Mirkazehi Rigi et al. (2020), was that people did not take the illness
seriously. Infrastructural difficulties, such as a lack of diagnostic and treatment
facilities, sufficient beds in the wards and standard isolation rooms in the wards were
among the challenges with service delivery highlighted by the participants
(Mirkazehi Rigi et al. 2020). According to a related study by Begun and Jiang (2020),
the inability of hospitals to handle the rising patient load s posed the first significant
problem they faced during the COVID-19 pandemic. The demand for ICU beds,
ventilators and staff in many locations far exceeds supply. For instance, the number of
ICU patients treated in health hospitals in New York City exceeded the capacity of the
ICUs by more than three times (Mirkazehi Rigi et al. 2020).

Conclusion
Identifying the most important challenges for healthcare providers can play an important
role in improving the management of the new coronavirus pandemic (COVID-19). As
pointed out in this study, it seems that to solve some of these challenges, coordination
is needed outside the health sector. In addition, the formation of a national COVID-19
control centre can contribute to developing necessary policies and strategies for
handling the pandemic. Nurses are expected to provide treatment for COVID-19
patients in unpredictable, hazardous and chaotic environments. The findings suggested
that nurses might draw lessons from earlier outbreaks to strengthen their resilience. In
such circumstances, nurse managers in particular may assist nurses and improve
hospital resilience. The management of the pandemic and the training of nurses as a
sizable group of healthcare professionals can both benefit from these findings. This
efficient group of healthcare professionals should be supported by the necessary
training, adequate PPE and human resources.

Acknowledgements
We would like to express our gratitude to the Research Centre on Health in Disasters
and Emergencies of the Kerman University of Medical Sciences for supporting and
approving this project.

References
Abdi, Z., F. Lega, N. Ebeid, and H. Ravaghi. 2021. “Role of Hospital Leadership in Combating
the COVID-19 Pandemic.” Health Services Management Research 35 (1).
https://doi.org/10.1177/09514848211035620.

11
 Farahmandnia et al.

Abdollahi, A., I. Naseh, F. Kalroozi, M. Kazemi-Galougahi, M. Nezamzadeh, M. Frouzanian,

M. Feyzollahi, and M. Yousefi-Zoshk. 2022. “Is There an Association between Side
Effects of AstraZeneca, Sputnik, Covaxin and Sinopharm COVID-19 Vaccines and
Breakthrough Infections?” Tabari Biomedical Student Research Journal 4 (2): 23–30.
https://doi.org/10.18502/tbsrj.v4i2.9662.

Abdollahi, A., I. Naseh, M. H. Kazemi-Galougahi, F. Kalroozi, M. Nezamzadeh,

M. Feyzollahi, M. Frouzanian, M. Safarian, A. Pahnabi, and M. Yousefi Zoshk. 2022.
“Comparison of Four Types of Vaccines Sinopharm, AstraZeneca, Sputnik V, and
Covaxin in terms of Morbidity and Severity of COVID-19 in Vaccinated Personnel of
Several Selected Medical Centers, Tehran, Iran.” International Journal of Medical
Investigation 11 (2): 56–65.

Agboola, F., T. McCarthy, and P. D. Biddinger. 2013. “Impact of Emergency Preparedness

Exercise on Performance.” Journal of Public Health Management and Practice 19: S77–
S83. https://doi.org/10.1097/PHH.0b013e31828ecd84.

Aldridge, J. 2005, 30 August. “Hospital Security: The Past, the Present, and the Future.”
Security InfoWatch. https://www.securityinfowatch.com/healthcare/press-
release/10608713/securityinfowatchcom-hospital-security-the-past-the-present-and-the-
future.

Arab-Mazar, Z., R. Sah, A. A. Rabaan, K. Dhama, and A. J. Rodriguez-Morales. 2020.

“Mapping the Incidence of the COVID-19 Hotspot in Iran – Implications for Travellers.”
Travel Medicine and Infectious Disease 34: 101630.
https://doi.org/10.1016/j.tmaid.2020.101630.

Begun, J. W., and H. J. Jiang. 2020, 9 October. “Health Care Management during Covid-19:
Insights from Complexity Science.” NEJM Catalyst Innovations in Care Delivery.
https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0541 .

Brucker, M. C. 2020. “Nursing when the World is Upside Down.” Nursing for Women’s
Health 24 (3): 155–156. https://doi.org/10.1016/j.nwh.2020.04.004.

Farhadloo, R., M. Kashani Nejad, M. Haji Mohammad Hoseini, M. Vahedian, and

M. Parvaresh Masoud. 2018. “Investigating the Effect of Training with the Method of
Simulation on the Knowledge and Performance of Nursing Students in the Pre -Hospital
Triage.” Health in Emergencies and Disasters Quarterly 3 (3): 123–30.
https://doi.org/10.29252/nrip.hdq.3.3.123.

Fowkes, V., H. J. Blossom, C. Sandrock, B. Mitchell, and K. Brandstein. 2010. “Exercises in

Emergency Preparedness for Health Professionals in Community Clinics.” Journal of
Community Health 35 (5): 512–18. https://doi.org/10.1007/s10900-010-9221-1.

Graneheim, U. H., and B. Lundman. 2004. “Qualitative Content Analysis in Nursing Research:
Concepts, Procedures and Measures to Achieve Trustworthiness.” Nurse Education Today
24 (2): 105–12. https://doi.org/10.1016/j.nedt.2003.10.001.

12
 Farahmandnia et al.

Houghton, C., P. Meskell, H. Delaney, M. Smalle, C. Glenton, A. Booth, X. H. S. Chan,

D. Devane, and L. M. Biesty. 2020. “Barriers and Facilitators to Healthcare Workers’
Adherence with Infection Prevention and Control (IPC) Guidelines for Respiratory
Infectious Diseases: A Rapid Qualitative Evidence Synthesis.” Cochrane Database of
Systematic Reviews 4 (4). https://doi.org/10.1002/14651858.CD013582.

Hsu, E. B., Y. Li, J. D. Bayram, D. Levinson, S. Yang, and C. Monahan. 2013. “State of
Virtual Reality Based Disaster Preparedness and Response Training.” PLoS Currents 5.
https://doi.org/10.1371/currents.dis.1ea2b2e71237d5337fa53982a38b2aff.

Jahangiri, K., and A. Sahebi. 2020. “Social Consequences of COVID-19 Pandemic in Iran.”
Acta Medica Iranica 662–63. https://doi.org/10.18502/acta.v58i12.5160.

Joolaee, S., M. Ashghali Farahani, B. Haghighi Aski, and A. Manafi Anari. 2021. “Factors
Affecting Hand Hygiene Performance of Pediatric Intensive Care Unit Health Care Team
during the Outbreak of COVID-19 Disease in Iran: A Qualitative Study.” International
Journal of Pediatrics 9 (11): 14783–800.

Leach, M., M. Parker, H. MacGregor, and A. Wilkinson. 2020. “COVID-19 – A Social

Phenomenon Requiring Diverse Expertise.” Institute of Development Studies. Accessed
17 February 2023. https://www.ids.ac.uk/opinions/covid-19-a-social-phenomenon-
requiring-diverse-expertise/.

Mehraeen, E., M. Mehrtak, S. SeyedAlinaghi, Z. Nazeri, A. M. Afsahi, F. Behnezhad,

F. Vahedi, A. Barzegary, A. Karimi, N. Mehrabi, O. Dadras, and S. Jahanfar. 2022.
“Technology in the Era of COVID-19: A Systematic Review of Current Evidence.”
Infectious Disorders – Drug Targets 22 (4): 51–60.
https://doi.org/10.2174/1871526522666220324090245 .

Mirkazehi Rigi, Z., S. Dadpisheh, F. Sheikhi, V. Balouch, and S. Kalkali. 2020. “Challenges
and Strategies to Deal with COVID-19 from the Perspective of Physicians and Nurses in
Southern of Sistan and Baluchestan, Iran.” Journal of Military Medicine 22 (6),: 599–606.

Mizutori, M. 2020. “What Covid-19 Tells Us about the Changing Nature of Disaster Risk.”
Paper presented at the World Economic Forum.

Moradi, S. M., M. Nekoei-Moghadam, A. Abbasnejad, and N. Hasheminejad. 2021. “Risk

Analysis and Safety Assessment of Hospitals against Disasters: A Systematic Review.”
Journal of Education and Health Promotion 10.

Nekoei‐Moghadam, M., N. Heidari, M. Amiresmaeili, and M. Heidarijamebozorgi. 2019.

“Identifying the Health Problems of Slum Residents Using Social Determinants of Health:
Kerman, Iran.” International Journal of Health Planning and Management 34 (2): e1179–
e1187. https://doi.org/10.1002/hpm.2755.

13
 Farahmandnia et al.

Nopour, R., M. Mashoufi, M. Amraei, and M. Saki. 2022. “Performance Analysis of Selected
Decision Tree Algorithms for Predicting Drug Adverse Reaction among COVID-19
Hospitalized Patients.” Journal of Medicinal and Chemical Sciences 5 (4): 505–517.
https://doi.org/10.26655/JMCHEMSCI.2022.4.7.

Pourvakhshoori, N., K. Norouzi, F. Ahmadi, M. Hosseini, and H. Khankeh. 2017. “Nurse in

Limbo: A Qualitative Study of Nursing in Disasters in Iranian Context.” PLOS ONE
12 (7): e0181314. https://doi.org/10.1371/journal.pone.0181314.

Pourvakhshoori, S., H. R. Khanh, and F. Mohammadi. 2017. “Emergency and Disaster

Preparedness in Nurses: A Concept Analysis.” Journal of Holistic Nursing and Midwifery
27 (1): 35–43. https://doi.org/10.18869/acadpub.hnmj.27.1.35 .

Prihatiningsih, T. S., D. Widyandana, E. D. Hapsari, S. Helmiyati, and A. J. N. Ananda. 2017.

“A Lesson Learnt: Implementation of Interprofessional Education in Disaster Management
at Faculty of Medicine Universitas Gadjah Mada, Indonesia.” Journal of Interprofessional
Education & Practice 9: 121–25. https://doi.org/10.1016/j.xjep.2017.10.001.

Schwandt, T. A., Y. S. Lincoln, and E. G. Guba. 2007. “Judging Interpretations: But Is It

Rigorous? Trustworthiness and Authenticity in Naturalistic Evaluation.” New Directions
for Evaluation 114: 11–25. https://doi.org/10.1002/ev.223.

Sengupta, M., A. Roy, A. Ganguly, K. Baishya, S. Chakrabarti, and I. Mukhopadhyay. 2021.

“Challenges Encountered by Healthcare Providers in COVID-19 Times: An Exploratory
Study.” Journal of Health Management 23 (2): 339–56.
https://doi.org/10.1177/09720634211011695.

Sharma, S. K., C. Nuttall, and V. Kalyani. 2020. “Clinical Nursing Care Guidance for
Management of Patient with COVID-19.” Journal of the Pakistan Medical Association
70 (5): S118–S123. https://doi.org/10.5455/JPMA.29.

Tavan, H., W. Menati, A. Azadi, K. Sayehmiri, and A. Sahebi. 2016. “Development and
Validation of a Questionnaire to Measure Iranian Nurses’ Knowledge, Attitude and
Practice Regarding Disaster Preparedness.” Journal of Clinical and Diagnostic Research
10 (8): IC06–IC09. https://doi.org/10.7860/JCDR/2016/19894.8337.

Ye, L., S. Yang, and C. Liu. 2020. “Infection Prevention and Control in Nursing Severe
Coronavirus Disease (COVID-19) Patients during the Pandemic.” Critical Care 24: 1–4.
https://doi.org/10.1186/s13054-020-03076-1.

14
Copyright of Africa Journal of Nursing & Midwifery is the property of Unisa Press and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.