Analysis of data showed, a total of 18 health care- providers including 7 women and 11 men with work experience of 11.2519 ± 6.14 years and average age of 35.12 ± 6.67 years were participated in the study (Table 1). Analysis of data showed that Patients with Covid-19 may have different clinical manifestations with varied patterns. Qualitative data analysis revealed 10 categories. (Table 2).
Table1: Characteristics of participants
Number of Participant
|
Level of Education
|
Work Experience
|
Ward
|
Marital Status
|
Position
|
1
|
Post graduate
|
1
|
ICU
|
Single
|
Nurse
|
2
|
Bachelor
|
20
|
General
|
Married
|
Nurse
|
3
|
Bachelor
|
7
|
Laboratory
|
Single
|
Laboratory technician
|
4
|
Bachelor
|
7
|
Laboratory
|
Single
|
Laboratory technician
|
5
|
Bachelor
|
16
|
General
|
Married
|
Head nurse
|
6
|
Bachelor
|
16
|
General
|
Married
|
Nurse
|
7
|
Bachelor
|
12
|
Prehospital
|
Married
|
Emergency technician
|
8
|
Anesthesia resident
|
25
|
Critical ward
|
Married
|
Physician
|
9
|
Bachelor
|
|
General
|
Married
|
Nurse
|
10
|
Surgery resident
|
20
|
Operational room
|
Single
|
Physician
|
11
|
Bachelor
|
10
|
Emergency
|
Married
|
Head nurse
|
12
|
Bachelor
|
7
|
Emergency
|
Divorced
|
Nurse
|
13
|
Bachelor
|
8
|
ICU
|
Married
|
Nurse
|
14
|
Bachelor
|
8
|
Prehospital
|
Married
|
Emergency technician
|
15
|
Bachelor
|
11
|
Prehospital
|
Married
|
Emergency technician
|
16
|
Bachelor
|
11
|
Prehospital
|
Married
|
Emergency technician
|
17
|
Bachelor
|
13
|
Emergency department
|
Married
|
Nurse
|
18
|
Post graduate
|
10
|
Emergency department
|
Married
|
Nurse
|
Table 2: categories of data
Categories
|
Respiratory disorders
|
Fever and chills
|
Body pain
|
Fatigue
|
Headache
|
Skin disorders
|
Gastrointestinal disorders
|
Taste and olfactory disturbances
|
Insomnia
|
Stress and anxiety
|
Respiratory disorders: Among the most important symptoms of Covid-19 patients are respiratory problems. The disease may start with dry coughs which gradually deteriorate over time. One participant said:"... I've had the influenza before, but I haven't had such severe coughs..." (1). Participants' experiences indicated that respiratory problems resembled the aspiration of a foreign body, or that the airway was being pressurized by a foreign body in an intermittent way. One of participant mentioned: ".... in addition to the above symptoms, I felt that my throat was being squeezed with a rope or a grip, and then I was relieved, and this continued over and over..." (5). Another participant said: "... I had a strange sore throat, I had pain only when I swallowed saliva which it didn't go down while I felt something stuck in my throat" (6). Another noted: "…every time I breathed in, I felt like my lungs were such a sponge soaking in water…". They also reported severe persistent chest pain disturbing sleep. One participant said: "…but the next day, I had severe pain in my chest, and I felt my ribs penetrating into my flank ..." (2), and another noted: " ... recently, I have had a feeling of a heavy mass on the left side of my chest, it was like someone putting and pressuring his foot on my chest and... "(4). The same participant mentioned the chest pain as the most annoying clinical symptom of the disease and continued: ".... feeling heaviness in chest was more painful for me than other symptoms because it was nocturnal and waked me up as soon as I fall asleep, on the other hand, I was concerned that I might have had cardiac problems... "(4). The participants' experience also showed that patients had more difficulties exhaling, and that it was hard to drain the lungs while inhaling. In this regard, one of them said: "I felt like I couldn’t get the air out of my lungs ..." (1). Another participant said: "... as I gradually felt pressure on my chest, I could inhale more easily, but when I exhaled, I felt my throat was contracting and I couldn't exhale…" (7). In connection with this, another participant expressed: "... I feel that the air enters the respiratory duct to a certain extent, and while breathing, I feel that the air hardly enters my lungs through a narrow straw.... "(13).
Participants' experiences indicated that patients were unable to breathe, and they avoided deep breath in order to prevent the pain. One participant mentioned: "…with deep inhales, my breath was ceased, and I had to take shallow breath…"(2). On the other hand, patients’ trachea burns from top to the end, a feeling like reflux. A participant noted that "… I feel that may throat burns all over when I cough…." (1). The participants declared that although the lung hearing was normal, the patient may be clinically unstable. There were reports of severe lung involvement despite a good general condition. One of the participants says: "...... we had patients with not very bad conditions but extensive lung involvement, and they finally died despite being young and not having respiratory distress ..." (6). He continued: "... I didn't have much problems with hearing in my lungs, but this was not consistent with my clinical condition, and I felt very ill ..." (6).
Fever and chills: Data analysis showed that one of the symptoms of patients with Covid-19 is fever and chills. The participants noted that they experienced a fever more severe than expected, and that the fever may be cyclical. The fever is so severe that only the use of diclofenac as a suppository can relieve it. Participants also reported that patients suffered from severe cold sweats, as if the person had been soaked by an external source, and this condition even worsened during the night. One of the participants mentioned: "…. I was feeling like a water balloon being emptied on my head... "(2). Another participant said of his fever experience: ".... I have never had a viral illness that has a long period of fever .... I had 41fever episodes over a 5-day period ... "(6). The same participant continues: "... to the extent that the fever did not subside with two naproxen tablets and one 500-mg acetaminophen, and I also used a 100 mg diclofenac suppository to reduce my fever to some extent ...."(6). Another participant says that because of severe fever and sweating, I had to change my clothes and sheets several times a night, and I was getting wet again with sweat after each bath.... "(15). Another participant complained of severe chills, saying: "... although the room temperature was good, I used a few blankets which exacerbated the fever again, and I had to put the blankets aside, and this was going on until morning ..." (3).
Severe body pain: Data analysis showed that one of the most important symptoms of the disease is severe body pain. Most participants reported that their symptoms began with body aches that exaggerated over time. Participants' experiences suggested that the pain may spread to patients’ joints, especially the lower extremities, so that they could not stand on their feet, and the pain persists until the end of the illness. One participant mentions: "...the body and joint pain, especially the lower limbs, lasted for about 16 days. My body ache, especially in the shoulders, was like someone had beaten me. The major pain was in my joints and the lower trunk. Every single joint in my fingers was in pain. I had never had such a severe pain that my whole body was in so much pain ... "(6). Addressing the onset of symptoms, another participant said: "... the disease started with fever, chills, and severe body aches in a way that I could not drive and brought myself to hospital emergency department..."(3). The same participant compared his joint pain to that of brucellosis fever and stated: "... all my body parts, from the head to toe, ached like a patient with brucellosis infectious disease, the whole body and even my bones and joints ached..." (3).
Severe fatigue: Data analysis showed that another common symptom of Covid-19 disease was severe lethargy. The participants' experiences showed that this disease may be so severe that patients may be reluctant to talk to others, unable to do simple daily tasks or even to meet his or her nutritional needs. Some participants attributed the weakness and lethargy to malnutrition. One participant said: "… anorexia and lack of appetite had made my body much weaker, so I couldn't stand on my feet ..."(3). Another participant said: "... I couldn't chew food, and I couldn't stand up at all ..." (2). Another mentioned: "... I felt so weak and lethargic that I couldn't stand on my own feet ..." (5). Someone else stated: "... It was like I had to hardly pull along my legs, and I couldn't walk…" (6).
Headache: Data analysis showed that patients may experience severe headaches during the disease course. The participants' experience showed that the headache was similar to that of hypotension and felt like the middle of head was empty at the time. One of them stated: “…I had a severe headache that I had never experienced before, and I felt empty inside and in the middle of my head ... "(2). Another participant compared his headache to that caused by hypotension and mentioned "…I experienced headaches similar to that of hypotension, I felt like someone who developed hypotension, it looked like my head was suddenly emptied leading to black eyes…"(4). Another participant addressing its sight mentioned: "…I wanted to calm myself with studying, but my sight was compromised because of the lethargy caused by the disease…"(5).
Skin disorders: Data analysis showed that patients may experience skin problems during the illness. The participants' experiences suggest that the patients may experience itching and hives in the hands and chest a few days after the infection onset. One participant noted: "…interesting thing is that exactly 21 days after I got infected, my daughter and I developed hives on our hands and chests, after counseling with an infectious diseases specialist, he confirmed that they may be Covid-19 complications…"(6). Another participant described the onset of the disease with >1-cm-diameter skin lesions with irregular margins and said: "…it was accompanied by itching and scaling of my skin starting on the back of the scapula and arms spreading towards the abdomen and legs, then they became pale and light after 2 weeks and pale and dull after 3 weeks (18).
Gastrointestinal disorders: Data analysis showed that patients may experience various digestive problems such as diarrhea, anorexia, nausea, and vomiting during the course of the disease. The participants' experiences showed that the patients may experience diarrhea, bloating, and colic. They noted that the diarrhea may continuously recur throughout the disease period, and that the patient may experience cyclical abdominal pains and cramping and feel gas-free bloating, similar to a state of bowel volvulus. In this regard, one participant said: "…I had diarrhea for five days and was injected with potassium chloride at the hospital... "(8). Another participant mentioned: " ...my abdominal pain was like muscle contraction cycling over one-hour apart periods ..."(4). The same participant resembled his digestive problems to intestinal volvulus and continued: "…My abdominal cramps were like there were volvulus in my intestine, like gas-free bloating, I had nausea, and my symptoms aggravated at night. I could bear my symptoms during the day ... (4) ".
Taste and olfactory disturbances: Data analysis showed that patients had taste and olfactory problems during the disease course. The participants' experiences revealed that taste and olfactory impairments may appear at the onset and then slowly and gradually improve during the course of the disease. In this regard, one participant mentioned: "… at the days 12th to 13th, I felt better and could breathe easier, my taste, which had reduced since the onset of the disease, improved and I could feel tastes again…"(7).
Insomnia: Data analysis showed that the patients had nighttime sleep disorder secondary to various problems and symptoms experienced during the illness. According to the participants' experiences, most manifestation such as systemic signs, respiratory and gastrointestinal complications, headache, and anxiety exacerbated at night interfering with sleep. The patients may stay awake all night while with the improvement of symptoms at day, patients may have been able to sleep. One participant said: "... I was very restless at night, and I had a feeling of heaviness in my chest so I couldn't sleep ..." (7). Another participant said: "...I had pain, fever, and chills at night, my nighttime sleep was disturbed, and I slept during the day..." (3). Another participant stated: ".... but dyspnea was much worse at night, respiratory distress had been exacerbated during the night causing sleep disturbances ...." (4).
Stress and anxiety: Data analysis indicated that one of the patients’ clinical symptoms was anxiety and restlessness. The patients experience a lot of anxiety at the onset and during progression of the disease, especially at night. One of the participants mentioned: "… I had a better mental condition at day, but I was restless at night so that I couldn't sit still, I don't know if it was because of the physical or psychological effects of the disease..." (5). Another participant explained: "... I was anxious that day; the beginning of the disease, it started with fever and body aches, and because of my stressful personality, I was never so nervous and anxious until that day... "(6). The same participant said: "...I am too attached to my little girl, and the thought of how she would feel after my death made me feel bad and very worried. During this time, I had so much anxiety and stress...... "(6). This participant further explained: "… I was thinking to myself, what should I do to my family if this situation worsens? Sometimes, I was considering writing a testament, but I feared that this might further worry my wife ... "(6).
Another participant noted about death anxiety: ".... I think death from Covid-19 is strange, and it is actually a death in exile...." (5), and continued: "… I was anxious as I did not know what would happen ... "(5). Another participant described his anxious as: "... with every shortness of breath, I was feeling myself in the grave, the image I had on burial ceremonies of these patients, and that they were buried with a shovel, the lime poured on them, it was a bad imagination that made me very worried.... (3). Another participant mentioned: "....in the evenings, I felt more frustrated...I felt like I was in the grave ... "(2). Another participant said: "... I'm afraid of getting sick again and not being immune to the disease, and even though I've started working again, I'm constantly worried about getting infected again" ... "(17). Another participant revealed: "... because I was newly married, I was worried about what would happen to my wife after my death ..." (13).