Mental images of nurses regarding COVID-19: A metaphor study.

AIM: The purpose of this study is to understand the thoughts and perceptions of nurses caring for patients with COVID-19 diagnosis about the COVID-19 pandemic.
BACKGROUND: The nursing profession, with the basic duty of caring for people, is among the professional groups most affected by COVID-19. The high rate of transmission of COVID-19, inadequate numbers of nurses for the increasing case numbers, inadequate personal protective equipment and increases in numbers of deaths negatively affected nurses, as they affected all health professionals.
METHODS: This research is phenomenological research. A parallel mixed design including quantitative and qualitative research methods was used in the research. A sociodemographic data form and metaphor perception related to the COVID-19 pandemic form were used for data collection. Responses of nurses to the open-ended metaphor questions were evaluated with descriptive analysis and content analysis using the document investigation method.
RESULTS: The research was completed with 227 nurses. Most of the nurses were employed in COVID-19 wards (68.3%), were not diagnosed with COVID-19 (65.2%) and had not lost any relatives to COVID-19 (59.0%). It was determined that the answers given by the nurses comprised 151 metaphors collected in eight categories in total.
CONCLUSION: The results show that the metaphors mentioned by nurses involve hopelessness. IMPLICATIONS FOR NURSING MANAGEMENT: This study reflects the ideas of nurses who are working with all their might during the COVID-19 pandemic and reveals the psychological status of the nurses.

BACKGROUND

Pandemics are epidemics that spread around the world. Negative events in social and economic terms experienced in countries during pandemics affect humans, defined as biopsychosocial beings, from all aspects (Bulut & Suluk, 2020). The nursing profession, with the basic duty of caring for people, is among the professional groups most affected by this process (Purabdollah & Ghasempour, 2020). The high rate of transmission of COVID‐19, inadequate numbers of nurses with the increasing case numbers, inadequate personal protective equipment and increases in numbers of deaths negatively affected nurses, as they affected all health professionals (Galehdar et al., 2020; Purabdollah & Ghasempour, 2020). Nurses in close contact with patients affected by infectious diseases like SARS and MERS‐CoV in recent times were observed to face situations like psychosocial loneliness, anxiety, fear, fatigue and sleep problems (Kim, 2018). Studies reported that during the COVID‐19 pandemic nurses experienced different emotional changes like despair, stress, physical and mental fatigue, feelings of loneliness and hopelessness (Hacimusalar et al., 2020; Huang et al., 2020). All these changes are thought to be associated with the meaning given by nurses to the COVID‐19 pandemic and forms of interpretation of the pandemic. It is very difficult to determine the feelings and thoughts felt by nurses during this process with standard developed scales.

Metaphors were frequently used with the aim of identifying perceptions about cases and events faced by individuals in recent years. Metaphors are tools used by individuals to name their perceptions developed about cases (Dalcalı & Kaya, 2020). Metaphors allow the opportunity to reveal how a person interprets experiences and events (Woodside, 2018). Many studies were performed with nurses during the COVID‐19 pandemic, whereas very few study results investigated the thoughts of nurses about the pandemic (Fernandez et al., 2020; Galehdar et al., 2020; Huang et al., 2020; Lep et al., 2020; Sun et al., 2020). The aim of our research was to understand the thoughts and perceptions of nurses caring for patients with COVID‐19 diagnosis about the COVID‐19 pandemic though metaphors and analyse the data with phenomenological methods.

METHODS

Using the unequalled effect of metaphors to gain an understanding of complex and abstract ideas and to shape nursing practices, this study used a mixed method including both qualitative and quantitative methods. The research was completed with phenomenological type to analyse the thoughts and perceptions about the COVID‐19 pandemic of nurses caring for patients with COVID‐19 diagnosis. In the quantitative aspect of the study, the sociodemographic characteristics of the nurses and their employment status in the COVID‐19 ward, experience of COVID‐19 symptoms, being diagnosed with COVID‐19 and the loss of any relatives due to COVID‐19 were examined. In the qualitative dimension, a descriptive phenomenological research design from the qualitative research methods was used to examine nurses' perceptions of COVID‐19. According to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist, we selected participants who shared a specific work environment and provided rich and varied information (Tong et al., 2007).

Setting and study population

The population for the study comprised a total of 900 nurses employed in a university hospital in Turkey country. The sample targeted 270 nurses with 5% error and 95% confidence interval using the sample calculation formula for a universe with known numbers. A total of 270 nurses were reached within the scope of the study, but the study was completed with a total of 227 nurses when unexplained and unrelated metaphors were removed.

Data tools

Data were collected in the research using a sociodemographic data form and the metaphor perception related to the COVID‐19 pandemic form.

Sociodemographic data form: This comprised a total of 10 questions related to age, gender, educational level, presence of chronic disease, total duration of employment as a nurse, work in the COVID‐19 ward and diagnosis of COVID‐19 status.

Metaphor Perception related to the COVID‐19 Pandemic form: When preparing the open‐ended metaphor form used within the scope of the qualitative study, previous studies completed in the field of nursing were taken as models (Dalcalı & Kaya, 2020; Kale & Cicek, 2015). The metaphor perception form asked the question ‘The COVID‐19 pandemic is like … … …. Because … … …’ to nurses to identify perceptions related to the COVID‐19 pandemic. While the ‘like’ section was to determine how nurses perceived the COVID‐19 pandemic, the ‘because’ section presented the opportunity for nurses to express their thoughts and feelings underlying this perception (Işık et al., 2020).

Data collection

Data collection forms prepared online were sent to participants through WhatsApp groups from January 2021 to March 2021, and they were requested to participate in the research.

Data analysis

Data were analysed with the IBM SPSS Statistics for Windows, Version 23.0. (Armonk, NY: IBM Corp.) program and document investigation methods. Descriptive data are summarized as percentages. Responses of nurses to the open‐ended metaphor questions were evaluated with descriptive analysis and content analysis with the document investigation method. Analysis stages progressed in the form of (1) writing metaphors in alphabetical order, (2) separation of data, (3) categorization of data, and (4) creation of categories. First, whether nurses explained their metaphor or not was examined, and all metaphors related to the COVID‐19 concept were coded (e.g., death and earthquake). Metaphors were considered in terms of the topic of each metaphor, source of the metaphor and correlation of the metaphor to COVID‐19 and metaphors not related to the topic or not explained were excluded from the research. In the next stage, each metaphor was investigated and assessed for common aspects. All metaphors were read and analysed. Then, a total of 227 metaphors were collected in a total of 16 categories in terms of common features (recalling death, people, animals, disasters, etc.). After the categorization stage for metaphors, three researchers read the metaphors and explanations together to reach consensus. Later, the data were reviewed and metaphor statements representing each metaphor were determined and listed. Views thought to represent the general opinions of nurses were determined and these are presented as example statements.

Ethical approval

Before beginning the study, permission to perform the research was obtained from the Republic of Turkey Ministry of Health Scientific Research Studies about COVID‐19 Commission (20.12.2020/Decision No: 2020‐12‐23T16_02_26), institutional permission was granted by the hospital where the study was performed, and ethics committee permission was granted by the clinical research ethics committee of a university (Date: 24.12.2020/Decision No: 2020/269). The study was completed in line with the Helsinki Declaration. The first page of the online data collection form informed participants about the aim and duration of the study and the purpose that data would be used for, and participants continued to the data collection form after providing consent.

RESULTS

When Table 1 is investigated, the mean age of nurses was 30.27 ± 7.36 years, 84.6% of nurses were women, and 86.8% had undergraduate degrees. Within the scope of the study, 87.2% of nurses did not have chronic disease, 68.3% worked in the COVID‐19 ward, 50.2% had experienced COVID‐19 symptoms, 65.2% had not received COVID‐19 diagnosis and 59.0% had not lost anyone close due to COVID‐19.

TABLE 1

Personal characteristics of nurses (N = 227)

Variables
Age (mean ± SD)	30.27 ± 7.36
		n	%
Gender	Female	192	84.6
	Male	35	15.4
Education	Associate degree	18	7.9
	Graduate degree	197	86.8
	Postgraduate	12	5.13
Comorbid chronic disease	Yes	29	12.8
	No	198	87.2
Work in COVID ward	Yes	155	68.3
	No	72	31.7
COVID symptoms	Yes	113	49.8
	No	114	50.2
COVID diagnosis	Yes	79	34.8
	No	148	65.2
Loss of someone close due to COVID	Yes	93	41.0
	No	134	59.0

When the nurses' metaphors related to COVID‐19 are investigated, it appears a total of 151 metaphors were collected in eight categories. When the categories of the metaphors are investigated, they can be listed as living organisms, emotions, danger, death, object/place, food‐drink, recalls infinity and lastly unclassified metaphors (Table 2).

TABLE 2

Metaphors related to COVID‐19

Themes	Subthemes	n	%	Metaphor
Living organisms	People Animal Plants	40	17.62	Enemy (7); snake (5); ivy (3); person (2); flea (2); snail (2); grass (2); chief nurse (1); hypocritical person (1); common enemy (1); ex‐lover (1); murderer (1); teacher (1); thief (1); dictator (1); biased manager (1); uninvited guest (1); goat (1); python (1); scorpion (1); chameleon (1); butterfly (1) cat (1); tick (1); couch cactus (1)
Emotions	Fear Pain Moods	39	17.18	Nightmare (9); fear (2); monster (2); night (2); black (1); horror movie (1); Gargamel (1); scream (1); bottomless well (1); love (4); loneliness (3); despair (2); pain of love (2); pain (1); cruelty (1); suffering (1); punishment (1); trauma (1); friendly dagger (1); life in birdcage (1); depression (1)
Danger	Disaster Hazard	39	17.18	Earthquake (6); fire (4); natural disaster (3); storm (2); whirlwind (2); catastrophe (2); match flame (2); devil (2); fog (2); traffic accident (2); coup (2); fire (1); calamity (1); avalanche (1); trouble (1); landslide (1); whirl pool (1); stove (1); exploding volcano (1); forest fire (1); darkness (1)
Death	Recalls death Disease	37	16.29	Poison (5); flu (4); grim reaper (4); death (4); biological warfare (2); cancer (2); war (2); bomb attack (1); apocalypse (1); time of death (1); staying in purgatory (1); grave (1); purgatory(1); chemical gas (1); genocide (1); holding breath (1); experience (1); normal disease (1); paranoid personality disorder (1); deadly disease (1); poisoned apple (1);
Object/place		21	9.25	Prison (3); matryoshka (2); label (2); dominos (2); box (1); wet wood (1); brush (1); cologne (1); candle (1); tweezers (1); bicycle with chain off (1); swamp (1); insurmountable mountain (1); home imprisonment (1); jail (1); wall (1); cliff (1)
Food‐drink		5	2.20	Alcohol (2); tomato paste (1); popcorn (1); prickly pear (1)
Recalls infinity		5	2.20	Life (2); road (1); horizon (1); journey (1)
Unclassified		41	18.06	Exam (3); exam question (2); lottery (2); head over heels (2); new order (2); obstacle (2); turning point (1); uncertainty (1); marriage (1); draining task (1); world problem (1); TV series ‘Back Streets/Arka Sokaklar’ (1); competition (1); robbery (1); warning (1); lesson (1); specter (1); experience (1); soap bubbles (1); gossip (1); money and faith (1) practical joke (1); tear in the bottom of the wheat sack (1); equation with many unknowns (1) project (1); drug (1); unfunny joke (1); motor breakdown (1); parasite (1); gamble (1); change (1); ignorance (1); rust (1); human shadow (1)

Note: The numbers in brackets represent the number of people who gave that answer.

Living organism

When the metaphors used by nurses within the scope of the study are investigated, the first theme appears to be living organisms. Within this theme, nurses used 40 different metaphors in the subthemes of people, animals and plants. The first subtheme obtained in the study was identified as people. A common point among metaphors in the people subtheme is the focus on negative people and features harming other people. The most frequent metaphors in this category were enemies and people. Apart from enemy and people, metaphors were only mentioned once.

COVID‐19 is like an unliked person. Because they're always at the end of your nose, when you try to get away, they come. (N 142)

COVID‐19 is like the enemy. Because they can kill you. (N 201)

COVID‐19 is like the enemy. Because we fight against them like soldiers. (N 220)

The second subtheme obtained in the study is the animal subtheme. The most frequent metaphors in this subtheme were observed to be snake, flea, snail and wolf. The metaphors in this subtheme appear to focus on animals that harm humans and sneaky animals.

COVID‐19 is like a snake, it's not certain where it will come from and how it will kill you. (N 37)

The third subtheme obtained in the study was the plant subtheme. In this subtheme, the most frequent two metaphors were ivy and couch grass. Notable plants in the metaphors in this subtheme were included because of their feature of rapidly taking over their location.

It's like couch grass. You think you've dug out the root, but a tiny remnant multiplies impudently. (N 72)

Emotions

When metaphors used by nurses within the scope of the study are investigated, the next theme was emotions. This theme included the subthemes of fear, pain and mood.

The first subtheme obtained in this theme is fear. The most frequent two metaphors in this category were nightmares and fear.

COVID‐19 is like the monster in horror movies. It is always at your neck; you can't win against it or get away from it. You wait on guard continuously. The end is not certain. (N 77)

COVID‐19 is like a bad nightmare. Because I could not have imagined it, but I could have experienced this much in a bad dream. (N 225)

When a person is diagnosed and has contact with others, those people are negatively affected. (N 98)

The second subtheme in this theme is pain. In the pain subtheme, the two most common metaphors were love and the pain of love. In this subtheme, the focus was on concepts that cause physical or emotional pain to people.

COVID‐19 is like the pain of love; it will kill you or make you miserable. (N 13)

COVID‐19 is like oppression in every detail. Because a lot of people have been hurt and continue to be hurt. (N 45)

COVID‐19 is like a grave. Because you're trapped inside it and you can't breathe. (N 115)

Another subtheme in the study was seen to be the mood subtheme. The metaphors in this subtheme included loneliness, despair and depression. The metaphors drew attention to the loneliness and desperation of people due to the disease.

It's like despair because a whole lot of people from a whole lot of families have lost their lives and people can do nothing for their loved ones. (N 144)

Danger

When metaphors created by nurses within the scope of the study are investigated, another theme was that of danger. Within this theme, subthemes were identified as disaster and hazard.

One of the most important subthemes obtained in the study appears to be the disaster subtheme. The most frequent metaphors in this subtheme were observed to be earthquake, natural disaster, storm, whirlwind and catastrophe. The common feature of all metaphors included in this subtheme is that they are destructive and harmful.

COVID‐19 is like an earthquake. Because if we don't take the necessary precautions, it can result in death. (N 62)

Another subtheme in the study appears to be the hazard subtheme. The most frequent metaphors in this subtheme were determined to be coup, fire, match flame, devil, fog and traffic accidents. When the common features of metaphors in the subtheme are investigated, it appears these are concepts requiring people take care and that may harm people and nature.

COVID‐19 is like a traffic accident. It's not certain when it will happen, how we will overcome it and what the results will be. (N 207)

COVID‐19 is like fire. If you get burned once, the scar remains. (N 116)

COVID‐19 is like a stove. Because dry and powerless will burn, while sturdy and wet ones won't. (N 117)

COVID‐19 is like a coup. Everything goes into the order it wants. We are trapped in our houses. Our lives are in danger. We are afraid of losing those close to us. Our safety is in danger. Our peace of mind is gone. (N 134)

Death

Another theme identified when nurse expressions are investigated within the scope of the study was death. Within this theme, there were two subthemes of recalling death and disease.

Metaphors included in the recalling death subtheme are concepts causing death or related to death. The most frequent metaphors in the recalling death category were identified as poison, death, and grim reaper.

COVID‐19 is like the grim reaper. Because it brings death immediately. (N 59)

COVID‐19 is like poison. Because it poisons all our lives. (N 80)

Another subtheme in the study was seen to be the disease category. The most frequent metaphors in this subtheme were identified to be flu and cancer. Different from the other subthemes, negative metaphors related to the COVID‐19 pandemic were not present and flu and usual infection metaphors normalizing the situation were included.

It's like a deadly flu. The picture can change at any moment. (N 198)

It's like cancer. Because you say I will not catch it, but if you don't take precautions, it can kill. (N 146)

Another category obtained in the study is objects/place. The most common metaphors in this category were identified as matryoshka, labels, prisons and dominoes. The common features of metaphors in this theme were objects that are nested in each other and affect each other, or which may hurt or injure people if misused. All the metaphors in the places theme were places where people are imprisoned, obstructed or dangerous to humans.

COVID‐19 is like a matryoshka. Because just as you say it is finishing, it's not. (N 60)

COVID‐19 is like a label. Because when it sticks, it will not let go. Even if it comes off, it leaves a mark. (N 71)

COVID‐19 is like dominoes. Because if one person is diagnosed and has contact with others, those people are negatively affected. (N 98)

COVID‐19 is like a prison. Because there's distance between people and it causes people to be imprisoned in their houses. (N 28)

COVID‐19 is like a prison, many of your freedoms are taken away. (N 25)

Another category in the study is the food‐drink category. The most frequent repeated metaphor in this category was alcohol. The point of the metaphor was that it harms people, rapidly proliferates and spreads around the surroundings.

COVID‐19 is like alcohol. Because it's doesn't have the same effect on everyone. (N 190)

The seventh category in the study was the category recalling infinity. The most frequent metaphor in this category appeared to be life.

COVID‐19 is like life. Because it overwhelms our plans and turns everything upside‐down. (N 12)

Some metaphors obtained in the study did not appear to combine in a single category. While metaphors were not collected in any category, the general features were all related to negative, unending and change‐inducing metaphors. The most frequent repetition among unclassified metaphors were tests, exam questions, lottery, head‐over‐heels, new order and obstacle metaphors.

COVID‐19 is like an exam recalling the importance of health. Because our lives were overturned in one moment, and the most important thing is that we saw again that our most valuable blessing is our health. (N 101)

DISCUSSION

In this study aiming to reveal the mental images related to the COVID‐19 pandemic among nurses, the first theme obtained was living organisms. The subthemes within this theme were identified to be humans, animals and plants.

In this theme, the first subtheme was the human category. The most important metaphor in this category was enemy. Additionally, all metaphors were created by expressing negative features of people. Perception of an enemy that needs to be fought against is an expected result in this pandemic which threatens all habits, lifestyles and most importantly the health of people in the world in general (Lep et al., 2020). Another subtheme obtained by classifying metaphors used by nurses was identified as the animal subtheme. The metaphor emerging most often in this subtheme was snakes and other related metaphors used by nurses were determined to focus on animals that harm humans. The most notable finding in this theme was the focus on negative features like harmfulness and causing pain among living organism metaphors. In the COVID‐19 pandemic, it is expected that nurses who witnessed patient experiences and continued to work with the fear of infection in difficult working conditions create metaphors related to negative features.

The second theme reached within the scope of the study was the emotions theme. The subthemes included within this theme were fear, pain and mood. Fear was first metaphor obtained in this theme. In these metaphors, nurses were identified to focus on metaphors related to fear like nightmare, fear, monster and horror movies. Galehdar et al. (2020) investigated the psychological experience of nurses during care for individuals with COVID‐19, whereas Fernandez et al. (2020) performed a systematic review study of the experiences of nurses working during the COVID‐19 pandemic. Like the findings in this study, these studies identified that nurses mentioned fear metaphors and experienced most fear in terms of the virus infecting their families. In extraordinary situations like the pandemic, the increasing workload of nurses, inadequacies experienced in terms of the necessary personal protective equipment, concerns about catching the virus and transmitting to others and inability to predict the process of the disease are among the basic reasons for experiencing fear (Maben & Bridges, 2020). The study findings support the literature. Metaphors used by nurses related to COVID‐19 were also classified in the pain subtheme. Many studies in the literature reported that many mood disorders may be present due to psychological pain and painful emotions among health workers actively caring for patients during the COVID‐19 pandemic (Kang et al., 2020; Lai et al., 2020; Mohindra et al., 2020; Xiao et al., 2020). Stress encountered by people during life is reported to cause a painful and worrying situation affecting physical and mental processes (Urcos et al., 2020). Nurses who are primarily responsible for care of patients during the COVID‐19 pandemic describing COVID‐19 as painful is an expected result. Another metaphor subtheme obtained in the study is concepts related to mood, and it was determined that loneliness, despair and depression were represented in this subtheme. At the same time, Olufadewa et al. (2020) in a study of individuals who were diagnosed with COVID‐19 and survived the process and Fernández‐Castillo et al. (2021) in a study of nurses working in intensive care during COVID‐19 identified that feelings of loneliness and despair were intensely felt, like the metaphors in our study. The reduced social support for nurses during this process, living distant from families when necessary and loss of patients and relatives despite all care and all interventions are associated with these metaphors.

Another theme emerging from the results obtained by investigating nurse statements is the theme of danger. The subthemes included within this theme were disaster and hazard. In the disaster subtheme, nurses were observed to use metaphors related to the dangers of natural disasters. Due to reasons such as the COVID‐19 pandemic changing the lives of people in the whole world in a moment, worsening prognosis at unexpected moments and rapid spread, many publications in the literature have defined COVID‐19 as a disaster (Agarwal et al., 2020; Cvetković et al., 2020; Lotta et al., 2020).

Another theme obtained in the study was the death theme. The subthemes emerging in this theme were recalls death and disease. Nurses were found to frequently use metaphors like poison, the grim reaper, war and biological warfare in this theme. Fear of death is known to be always present during the history of humanity. When considered from this aspect, it is an expected result that the first perception in the mind of nurses is death and perceptions related to death (Menzies & Menzies, 2020). Nurses witnessing death due to COVID‐19 and the risk of infection due to caring for patients infected in the pandemic are included among factors causing nurses to think about death (Lai et al., 2020). Another metaphor subtheme determined in this theme was concepts related to diseases and within this scope, nurses were mostly determined to use metaphors related to diseases like flu and cancer. Alipour et al. (2020), Moradi et al. (2020) and Galehdar et al. (2020) determined that individuals, participating in their qualitative studies completed with the aim of determining psychological changes induced in individuals by COVID‐19, defined COVID‐19 as a difficult and unpredictable disease process. It is a normal situation that this process, which affects the whole world and many people both physically and psychologically, is perceived by nurses as a widespread disease.

Another theme of metaphors used by nurses appeared to be the objects/place theme. When metaphors in this category were investigated, nurses appeared to use objects like matryoshka, which sit inside each other and dominoes which progress by knocking others over. In the COVID‐19 pandemic, first reported in China in December 2019, despite the falls in case numbers which occasionally gave people hope, the excess case numbers reported around the world, rapid spread of the mutating virus from one region to another and the high transmission rate are the basic reasons for nurses thinking this way. Within the scope of these metaphors, COVID‐19 was determined to be associated with places that negatively affect human life like prisons, swamps or insurmountable mountains and that are associated with uncertain feelings. A study by Moradi et al. (2020) determined that individuals defined COVID‐19 as living with uncertainty, like the findings of our study. Reasons such as the inability to predict the course of the pandemic, continued increases in case numbers despite the initiation of vaccination and mutation of the virus are considered to possibly cause nurses to despair.

Strengths and limitations

This study has a few limitations. First, the research was carried out in a single centre. However, it can be cautiously suggested that our findings may also apply to nurses working in the COVID‐19 pandemic in other cities and countries. Second, the existence of more than one independent metaphor in the study created difficulties in categorizing the metaphors. This is another limitation of the study.

CONCLUSION

In this study, planned to determine perceptions of nurses about the COVID‐19 pandemic, the most frequent metaphors related to COVID‐19 used by nurses were nightmare, enemy, poison, grim reaper, earthquake, snake and fire. The high diversity of metaphors used by nurses shows the diversity in psychological reactions of everyone faced with the COVID‐19 pandemic. The features emerging most among metaphors used by nurses appear to be death, fear and unpredictability related to the end of the pandemic. When results obtained from nurses' metaphors are investigated as a whole, most expressions appear to indicate hopelessness. For nurses undertaking basic responsibility for care of individuals during the pandemic, controlling their feelings and maintaining hope carry great importance in terms of the quality of care. For this reason, it is recommended that strategies be planned to protect the psychosocial health and sustain the hopes of nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

This study, which reflects the perceptions of the nurses about the COVID‐19 pandemic as they work with all their strength against COVID‐19, highlights some important points for nursing managers.

First, in this study, we determined that nurses experience hopelessness and have macabre perceptions regarding the COVID‐19 pandemic. These results reflect the need for good mental health support for nurses. Nurse managers should support the nurses in their teams psychosocially. Second, the fact that the metaphors mentioned are different from each other and the emergence of many different categories also reveals the uniqueness of human beings. For this reason, trainings to be planned for nurses should be multidimensional to appeal to everyone. Finally, this study highlights that it is very important to make effective plans from now on to improve the mental health of nurses who experienced burnout in all aspects during the COVID‐19 pandemic.

CONFLICT OF INTEREST

The authors have no funding or conflicts of interest to disclose.

FUNDING INFORMATION

This research did not receive any specific grant from funding agencies in the public, commercial or not‐for‐profit sectors.

ETHICAL APPROVAL

Before beginning the study, permission to perform the research was obtained from the Republic of Turkey Ministry of Health Scientific Research Studies about COVID‐19 Commission (20.12.2020/Decision No: 2020‐12‐23T16_02_26), institutional permission was granted by the hospital where the study was performed, and ethics committee permission was granted by the Clinical Research Ethics Committee of Ordu University (Date: 24.12.2020/Decision No: 2020/269).