Management of patients with Long Covid: A qualitative study exploring the roles of nurses in healthcare pathways

Management of patients with Long Covid: A qualitative study exploring the roles of nurses in healthcare pathways | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Management of patients with Long Covid: A qualitative study exploring the roles of nurses in healthcare pathways Linda KAMDEM, Jessica GUYOT, Caroline DUPRE, Pauline GOUTTEFARDE, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3888605/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim Investigate the various roles played by nurses in the care of patients afflicted with Long COVID. Background Effectively managing Long Covid requires a multidisciplinary approach - a healthcare pathway that necessitates collaboration among various members of the medical profession to monitor the patient. Among these professions, nursing plays a crucial role. This article compiles information on how nurses are involved in the care of patients afflicted with Long Covid: What roles do they play in enhancing the care of these patients? Are these roles distinct from those they perform in other chronic conditions? Methods We conducted a qualitative study among healthcare professionals in France and enrolled eighteen participants in our study. Semi-structured interviews were conducted with professionals working across various care sectors in France, including private practice, hospitals, schools, and research. A thematic content analysis was performed, and emerging themes were subsequently discussed until the most significant categories were identified. This study was conducted in accordance with the COREQ checklist. Results Nurses play a wide range of roles within their practices, depending on their practice settings. For instance, a nurse practitioner may work in a range of settings such as hospital outpatient clinics, private group practices, inpatient units, or urgent care units. Depending on their work environment, nurses' roles within healthcare pathways may encompass screening and guidance, clinical patient monitoring, providing relational support, patient education, collaborative care and coordination as well as involvement in research. Conclusion The predominant role identified in our study involves coordinating the management of the Long Covid syndrome. The next step would be the implementation of a city-hospital Long Covid healthcare pathway. Implication for the Nursing & Health Policy Perspectives Nursing work is difficult to specify, as it includes numerous recognised and unrecognised aspects. The results of this study highlight a new essential role which is that of coordinating the health pathways of patients suffering from Long Covid. Long Covid Nurse’s roles Healthcare Pathway Health organization Professional practice INTRODUCTION Coronavirus disease is caused by SARScov2; certain variants exhibit higher contagion rates than others. Globally, nearly 7 million official deaths and confirmed cases of COVID-19 have been reported to the World Health Organization [ 1 ]. Although COVID-19 is no longer dominating headlines, it continues to pose a significant public health challenge. Recent data from Public Health France indicates there is still a 12% weekly incidence rate in France [ 2 ]. COVID-19 is a viral infection characterized by a range of systemic symptoms, including fatigue, palpitations, and muscle pain, varying in severity [ 3 ]. The emergence of Long COVID-19 symptoms was observed as early as spring 2020. Clinicians swiftly recognized the diverse clinical presentations, leading to both asymptomatic and severe forms, although the latter is infrequent. The wide variety of symptoms for Long COVID and their high frequency rate have given rise to an epidemic within the pandemic [ 4 ]. The term "Covid Long" has been coined by patients [ 5 ], while researchers use "Post-Covid Syndrome" to put together various sometimes unexplained symptoms persisting for weeks after COVID-19 infection [ 6 ]. According to WHO criteria, 10 to 20% of patients infected with COVID-19 develop Long COVID [ 7 ]. While a standardized nomenclature and definition are lacking, there exists consensus in the medical literature and healthcare organizations that symptoms persist for ≥ 4 weeks following initial infection[ 8 ]. The period between 4 and 12 weeks is further classified as subacute or ongoing symptomatic infection [ 9 , 10 ]. Long COVID affects all sections of the population equally, with patients reporting a spectrum of symptoms impacting multiple organ systems. Previous studies of patients with Covid-19 have demonstrated long- term reductions in lung and exercise capacity, as well as diminished quality of life [ 11 ]. Dyspnea, fatigue, and difficulty concentrating are among the most frequently reported symptoms [ 11 , 12 , 13 ]. Presently, clear and standardized guidelines for the management of Long COVID are lacking. Nevertheless, several studies propose a holistic approach [ 14 , 15 , 16 ] or a multidisciplinary approach [ 17 ]. The National Institute for Health and Care Excellence (NICE), High Authority for Public Health in France, and other guides from learned societies recommend integrated rehabilitation services that encompass a range of specialized skills and expertise [ 6 ]. These patients' situations may parallel those with chronic diseases; hence, their management should be similarly comprehensive, tailored to individual needs, and involve a multidisciplinary team of healthcare professionals. The nursing profession involves a variety of essential responsibilities, including analyzing, organizing, assessing, and delivering nursing care. Lee et al. [ 18 ] outlined five pivotal roles that nurses undertook during the pandemic. These roles included the reorganization of nursing systems, enhancing team communication, coordinating essential materials, improving healthcare efficiency as frontline caregivers, and providing support to fellow nurses. Nurses also play a significant role in the collection of clinical and epidemiological data, participating in prevention initiatives, conducting screenings, offering training, and engaging in health education activities, in accordance with the guidelines outlined in the Public Health Code [ 19 ]. In addition to their specialized qualifications, nurses have developed skills that consider the unique needs of the individuals under their care, as well as the broader environmental factors, including social dynamics. Laurence Bernard notes that: “nurses' professional identity is profoundly shaped by their work environment, encompassing the professional context, socio-political influences, and the organizational culture within the healthcare institution where they work” [ 20 ]. A systematic review conducted by Poitras et al. [ 21 ] identifies four areas within nursing practice: conducting comprehensive assessments of individuals with chronic illnesses, managing care, promoting health and well-being, and fostering collaborative relationships between nurses and physicians. Furthermore, Saenprasarn et al. [ 22 ] emphasize the pivotal role of nurses in promoting quick recovery and mitigating chronic illness and complications among patients infected with and diagnosed with COVID-19, especially those at risk of developing Long COVID. Nurses serve as beacons of knowledge, offering guidance on recovery, serving as role models in rehabilitation, facilitating positive psychological well-being, orchestrating social support for patients and their families, and providing holistic care that addresses physical, psychological, social, and spiritual aspects of illness. Long COVID is a recent medical syndrome, and as such, management strategies are continuously evolving. Despite this, there is a limited body of literature exploring the roles of nurses in managing Long COVID [ 22 , 23 ] .These roles may vary based on the healthcare organization in which the nurse is employed, whether it be in private practice, a hospital setting, or an educational institution. The primary objective of this article is to investigate the various roles played by nurses in the care of patients afflicted with Long COVID. Understanding the significance of nurse’s roles within the Long COVID healthcare pathway holds the potential to enhance the care provided to patients who may otherwise find themselves wandering. MATERIALS AND METHODS Study Design For this study, we adopted a qualitative exploratory descriptive approach, using semi-structured interviews to gain insight into the experiences of nurses. The interviews were conducted over a nine-month period, spanning from October 2022 to June 2023. Qualitative research, as employed in this study, adopts a comprehensive approach, prioritizing the description of processes over the explanation of causes. It involves progressively developing an understanding of the phenomenon and allows for recursive investigation, with flexibility in the approach, predominantly inductive in nature [ 25 ]. This study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines [ 26 ]. Participants Eighteen participants were included in our study, comprising two males and sixteen females. Among the participants, one was a physiotherapist, and another was a nurse. Data collection Following obtaining informed consent, semi-structured interviews were conducted with participants using an interview guide. Semi-structured, in-depth interviews are a widely employed format for individual or group interviews [ 27 ]. To ensure consistency, we tested the guide with three nurses from our team. Participants were informed about the study, their voluntary participation rights, and the minimal associated risks. Interviews were conducted either face-to-face or via telephone at their workplaces, with durations ranging from 20 to 45 minutes. Audio-recordings were deleted once transcripts were confirmed, in accordance with ethical committee approval. To ensure representative sampling, we included nurses from various practice settings, such as private practice (PP) , hospitals (H) , schools (S) , research (R) , and dedicated pathways (DP) . All participants had experience in caring for Long COVID patients. Our interview matrix comprised four main sections: 1) General information about the COVID-19 pandemic, 2) Knowledge about Long COVID, 3) Management of Long COVID, and 4) The roles of nurses in Long COVID care. Socio-demographic data, including gender, years of experience, and practice location, were also collected. Data analysis : All participants volunteered to partake in the study, and our inclusion criterion was being a healthcare professional involved in Long COVID management. We determined the sample size following the principle of theoretical data saturation [ 27 , 28 ]. Interviews were audio-recorded, anonymized, and transcribed verbatim. They were conducted in French. The principle investigator coded the data first. Another senior researcher, trained in qualitative analysis, also coded the data independently. Nvivo software was employed to compare, and merge identified themes. Thematic content analysis was carried out [ 30 ], with emerging themes discussed until the most significant categories were identified across the semi-structured interviews. Three central themes emerged from the analysis: 1) Long COVID, Lack of Knowledge about this new syndrome, 2) Long COVID treatment as an interprofessional challenge, and 3) The multifaceted role of nurses in Long COVID care. Results Description of data: The characteristics of the participants are shown in the table below. Five of them have a maximum of 5 years' experience as a nurse. For all the others, the average number of years of experience is 13. Twelve out of eighteen participants worked in hospitals settings. Table: Characteristics of participants N° Gender Years' experience Place of practice Specificity P1 F 19 years Private practice Screening-Guidance- Collaboration P2 F 21 years Hospital Monitoring- Guidance P3 F 10 years School Screening P4 F 13 years Hospital Therapeutic Education P5 F 13 years Private practice Screening-Guidance- Collaboration P6 F 3 years Hospital Monitoring- Guidance P7 F 10 years Private practice Screening-Guidance- Collaboration P8 F 11 years Private practice Screening-Guidance- Collaboration P9 F 3 years Hospital Monitoring-Orientation P10 M 18 years Private practice Screening-Guidance- Collaboration P11 F 2 years Hospital Monitoring-Guidance P12 F 5 years Hospital Monitoring- Guidance P13 F 5 years Hospital Monitoring- Guidance P14 F 13 years Hospital Research- Coordination-Dedicated Pathway P15 F 31 years Hospital Therapeutic Education- Coordination- - Dedicated pathway P16 F 20 years Hospital Therapeutic Education - Dedicated pathway P17 F 23 years Hospital Therapeutic Education - Dedicated pathway P18 M 9 years Hospital Physiologist- Coordination-Dedicated pathway The problem of managing patients with Long COVID has emerged insidiously. Some healthcare professionals have pointed out the perplexing nature of the various clinical cases. A common feature, described by all participants, is the challenge of dealing with distressed patients who often express a lack of recognition of the severity of their condition. The inability to resume normal professional activities was a common criterion frequently reported, especially for those grappling with debilitating fatigue: “Basically, people tell them, you're tired but you've just got to get moving, get out of bed and you'll feel better” (P17, DP). Additionally, there are accounts of wandering patients seeking solutions: "I recall people wandering around, seeking help from multiple doctors" (P16, DP). Some professionals also acknowledge the initial difficulty in providing care, given that many general practitioners are unfamiliar with this syndrome: "This persistent fatigue has left doctors somewhat perplexed" (P1, PP). The primary findings of our study emerged when we explored the roles of nurses in the care of Long COVID patients. The roles reported included identifying and screening Long COVID patients, offering guidance and support, conducting therapeutic education, engaging in clinical research, and coordinating care in collaboration with other healthcare professionals such as general practitioners, specialists, physiotherapists, and other paramedical staff. These roles were identified as vital in delivering holistic care to Long COVID patients. Theme 1: Long Covid- Lack of Knowledge about this new syndrome The problems associated with the complexity of the syndrome have been highlighted on several occasions: "It's a complex condition, and it often baffles us" (P16, DP). In this new scenario, "Families, friends, and even some doctors are perplexed as diagnostic tests show no clear answers" (P18, DP). Care is organized according to the specific clinical situations that arise, with patients facing difficulties in accessing appropriate care. And when they do a notable clinical feature is the psychological distress experienced by these patients: "Psyche scars are often the most prominent clinical feature" (P18, DP). Professionals have had to adapt to the wide range of symptoms, many of which lack established treatment options. The lack of knowledge on the subject makes treatments difficult. These symptoms include respiratory problems, attention and concentration issues, and difficulties in returning to work: "Symptoms encompass ageusia, severe and chronic fatigue, chronic pain, neurological disorders, cardiac complications, and mood and morale impacts" (P4, DP). Professionals working in specialized pathways note that psychological distress and fatigue fluctuate over time: "Psychological distress and fatigue in Long COVID patients exhibit fluctuations, which profoundly affect their morale" (P14, DP). All participants emphasize that given the current healthcare landscape, training on Long COVID is imperative to better support patients: "It would be beneficial to train nurses to recognize and differentiate Long COVID from other pathologies that may be similar to it." (P3, S). Such training would enable improved screening and diagnosis: "Diagnosing Long COVID is challenging, as it can often mimic other conditions. Is it long Covid or is it link to another pathology?" (P12, H). Furthermore, it would equip healthcare professionals to provide information to patients who may not be aware they have Long COVID: "It's during conversations that we sometimes discover patients have lingering COVID symptoms" (P2, H). Participants suggest various measures to enhance Long COVID patient care, including collaboration with patient associations and facilitating access to suitable healthcare pathways: "We should be able to refer patients to relevant organizations and resources, including families, not just patients" (P13, H). Many other actions are proposed to enhance Long COVID care, including empowering patients to be active partners in their own care: "I see these pathologies which are these functional disorders, as an opportunity to work together and to work differently with patients. We're really in a different culture. Our Western culture is really focused on top-down medicine, so we're not really working together. We prescribe and the patient complies, but for disorders like these, like fibromyalgia, like long Covid, we can't provide this kind of response, or rather it's not enough. We don't have any symptoms, we don't have any treatment to give, we don't have any medication to give, so we must reinvent ourselves, so I also see it as an opportunity to try and get things moving. We must try to put the patient at the centre and take him or her as a whole " (P4, H). Theme 2: Long COVID Treatment - An Interprofessional Challenge Similar to many chronic illnesses, Long COVID necessitates long-term care and collaboration among various healthcare professionals: "Depending on the type of lingering symptoms, we may refer patients to specialists for tailored treatment" (P2, H). A comprehensive, personalized approach is emphasized during patient follow-up, including a comprehensive interview with the patient. During this interview, a shared educational assessment is carried out. All areas of the patient’s daily life are covered to determine the patient’s difficulties and resources. "The assessment is extensive, aiming to gather as much information as possible about the individual to identify the best solutions" (P18, DP). Professionals involved in rehabilitation recommend that patients dedicate their time exclusively to recovery, without combining it with other professional activities, as this can impede progress. This would make recovery difficult or even ineffective. "Some individuals attempted part-time work while undergoing rehabilitation, which proved counterproductive as it drained their energy" (P17, DP). At present, there are limitations to the care that can be provided to Long COVID patients due to the shortage of specialized professionals in this field. The nurses interviewed described this as a source of frustration. The few specialists mentioned during the study were neuropsychologists and speech therapists concentrating on taste and smell rehabilitation. " For the moment, there is an imbalance, we are well aware that we are not offering a complete programme, unfortunately" " (P16, DP). Theme 3: The nurse - A professional with multiple roles All interviewed professionals acknowledged their essential role in caring for Long COVID patients. They assume a diverse range of responsibilities in their practices, including medication management, clinical monitoring, patient reception, providing emotional support, patient education, and coordinating care. Relational Role In this distressing pathology, healthcare professionals emphasize the paramount importance of listening as the initial therapeutic intervention for patients. Indeed, participants noted the profound relief experienced by patients when they find themselves in an environment where they are "finally heard" and "without judgment." "Simply listening to the patient already provides comfort and reassurance" (P5, PP). Screening and Guidance Roles This role is often fulfilled by nurses, particularly those working in private group practices who frequently serve as the first point of contact. This role can be succinctly summarized as encompassing screening and guiding patients towards dedicated care pathways. To identify these symptoms, nurses routinely inquire about patients' present complaints, medical history, and potential exposure to Covid-19. "There is a genuine need to distinguish between individuals with long Covid and those with other conditions" (P3, S). Once these patients are identified, nurses provide them with essential information and direct them towards available resources. "Our responsibility includes directing individuals to specialized centers" (P12, H). Collaborative Role Irrespective of their practice settings, whether in private practices or hospitals, nurses collaborate closely with the broader medical team to formulate personalized care plans for patients and continuously monitor their progress over time. "It is an integral part of our role to provide feedback to the General Practitioner: how has the patient been this week? How are they feeling? What feedback have they provided?" (P1, PP). Patient Education Role This role is mainly mentioned by professionals involved in dedicated pathways, particularly those specializing in therapeutic education. Nurses specializing in therapeutic education use shared assessments to identify the specific needs of long Covid patients and provide them with the tools to adopt a balanced lifestyle that will enable them to have a better management of persistent symptoms. "We have a role to play in supporting these patients through therapeutic education, teaching them how to regain their quality of life" (P8, PP). Coordination Role The role is essential in ensuring ongoing monitoring of patients throughout their recovery journey. Different individuals within specialized long Covid management pathways may assume this coordination function. The coordinator ensures there is good communication among all professionals involved in the patient's care and conducts assessments at the program's commencement, midpoint, and conclusion, in collaboration with the entire team. "We work closely together, it's a team effort, and having motivated and committed individuals is crucial" (P4, H). Researcher Role In addition to their caregiving responsibilities, nurses also contribute to research efforts. They express that patients are interest in taking part in such work and that they emphasize the opportunity to meet specialist doctors. The research outcomes contribute to improve Long Covid management. "Our protocol is designed to collect observational data, make predictions, identify common patient patterns, and understand the nuances of long Covid" (P14, R). DISCUSSION The aim of this study was to explore the diverse roles that nurses play in the care of long Covid patients. The findings of this study reveal the different roles nurses fulfill based on their practice settings. Nurses play various roles in the healthcare pathways of long Covid patients, including screening, guidance, clinical monitoring, emotional support, patient education, collaboration, care coordination, and research. The study's first result shows the limited knowledge we have of this emerging syndrome. The lack of Knowledge and the resemblance of symptoms to those in other conditions pose challenges in acknowledging patients' complaints. This observation is coherent with findings in diseases with similar characteristics, such as fibromyalgia and chronic fatigue syndrome [ 31 ]. The findings also emphasized that the current management of Long Covid is based on a consensus for a multidisciplinary and individualized approach to the way long Covid should be managed [ 31 , 32 ]. Collaboration is key to enhancing care and the quality of life of patients [ 34 ]. Given the substantial societal impact of long Covid [ 35 ], healthcare professionals, including nurses, face considerable challenges. The management processes are varied and reflect the different approaches based on practice settings (private practice or hospital). Nurses play an essential role alongside other healthcare providers. With a primary focus on patient well-being, nurses are uniquely positioned to contribute to innovative interventions [ 36 ]. This highlights the effectiveness of nursing in managing chronic illnesses [ 36 , 37 ] and the ethical principle of continuous nursing care, emphasizing respect for the individual under care [ 39 ]. This study's data analysis has stressed the central roles of nurses in long Covid patient care pathways. Although it appears that general practitioners are the primary healthcare professionals consulted by patients with long-term Covid symptoms [ 40 ], nurses coordinate care activities and collaborate with all members of the medical team to set up individualized care plans tailored to the different needs of patients. They carry out comprehensive assessments (shared educational assessments) to gain insight into patients' persistent symptoms and needs. Nurses also provide symptom management, patient education, and invaluable psychosocial support to patients. While these roles are similar to those in the management of other chronic conditions [ 41 ], the coordinator role in the Long Covid management has its own specificities. Undoubtedly, the results of our study tend to indicate that this coordinating role is both medical and social role. It facilitates connections between patients and the various resources, services, and social support they require [ 42 ]. Strengths and limitations Up till now it seems that few research studies have investigated the role of nurses in supporting patients suffering from Long Covid. The inclusion of professionals from different healthcare sectors have made it possible to cross-reference various healthcare sectors, including private practice, hospitals, research, and dedicated pathways. However, there are certain limitations to consider. Firstly, the small number of specific healthcare systems included in our study restricted our ability to collect data from multiple French regions. Additionally, the fact that I, as one of the authors, am a nurse, may have influenced the interpretation of the results. There might be a natural inclination to emphasize nursing roles in managing chronic conditions compared to other healthcare disciplines. To try and reduce this potential bias, we were helped by a senior researcher in the coding of data until the main themes were identified. It is also worth noting that the nurses who participated in the study have a substantial number of years of work experience. However, Long COVID is a relatively novel condition, and there is no universally recognized date for the establishment of the first dedicated care pathway for Long COVID patients, which may vary between countries and healthcare institutions. It can be said that the first measures taken regarding long Covid only began to emerge in 2020 with increased efforts to understand and meet the needs of these patients. Furthermore, among the participants surveyed, there is an imbalance in gender representation, with more women than men. This gender disparity reflects the broader trend of feminization in the nursing profession [ 43 ]. Another limitation of our study is its transferability. Our study was carried out in France in a specific environment. The various professionals involved in the project had already worked together in other circumstances. The results of the study might therefore be different in the absence of the initial study conditions. However, the healthcare policy in France is highly regulated. The structures are similar from one territory to another. The results of our study can therefore be replicated in another comparable environment. CONCLUSION The findings of this study shed light on the management of Long COVID and the role played by nurses. Nurses assume a multitude of roles in improving the quality of life for patients suffering from this complex condition. Their role as coordinators is particularly unique in the care of Long COVID patients. Interdisciplinary collaboration is emphasized in the best interest of patients, with nurses working closely with a spectrum of professionals involved in monitoring Long COVID patients. Long COVID shares numerous similarities with other chronic pathologies. However, its management poses diagnostic challenges, highlighting the importance of nursing expertise in its recognition and appropriate management. Innovative approaches to care are essential to address the complexities of this emerging condition. A potential next step could involve piloting a city-hospital pathway that assigns nurses a central role in Long COVID patient care. Declarations AUTHOR CONTRIBUTIONS Study design: JG, FR, EBN, BB Data collection: LK, PG, MPV, MF Data analysis: LK, JG, CD Manuscript writing: LK Critical revision for important intellectual content: DH, EBN, CN, FR, BB AKNOWLEDGEMENTS The authors thank all the SPACO+ team investigators. The members of PRESAGE institute: Franck Chauvin, Veronique REGNIER, Frederic ROCHE, Nathalie BARTH, Yves MBAMA, Elie SHIKITELE, Fanny COLLANGE, Amandine BAUDOT. The authors thanks Chrystel BOST for the English review. FUNDING INFORMATION This study is part of the SPACO+ project, which has received funding from the ANRS- French National Research Agency / Emerging infectious diseases. (Grant number: ANRS283). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. DATA AVAILABILITY STATEMENT The full interviews’ data are not publicly available due to privacy or ethical restrictions. However, data is available upon reasonable request from the corresponding author. Ethical approval and consent to participate This study was conducted in accordance with the declaration of Helsinki. Ethical approval for this study was sought from the “Terre d'Ethique” ethics advisory committee of the Saint-Etienne University Hospital (Approval number: IRBN1282023/CHUSTE. Prior to the interview, the participants were informed verbally and in writing, that the data from the recorded interviews would not be used for any purposes other than the research. Furthermore, the participants were assured that to protect their human rights and guarantee their anonymity, the researchers would not use any personal information that might reveal their identity. All participants gave their written consent to participate. Consent for publication Not applicable . Competing interests The authors declared no competing interests. References WHO, « WHO Coronavirus (COVID-19) Dashboard ». 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Cárdaba-García, C. Durantez-Fernández, L. P. Pérez, M. Á. Barba-Pérez, et E. Olea, « What Do We Know Today about Long COVID? Nursing Care for a New Clinical Syndrome », Int. J. Environ. Res. Public. Health , vol. 19, n o 14, p. 8642, juill. 2022, doi: 10.3390/ijerph19148642. J. Lee, H. S. Cho, et S. R. Shin, « Nursing strategies for the post-COVID-19 era », Int. Nurs. Rev. , vol. 68, n o 2, p. 149‑152, 2021, doi: 10.1111/inr.12653. G. Imbert, « L’entretien semi-directif : à la frontière de la santé publique et de l’anthropologie », Rech. Soins Infirm. , vol. 102, n o 3, p. 23‑34, 2010, doi: 10.3917/rsi.102.0023. A. Tong, P. Sainsbury, et J. Craig, « Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups », Int. J. Qual. Health Care J. Int. Soc. Qual. Health Care , vol. 19, n o 6, p. 349‑357, déc. 2007, doi: 10.1093/intqhc/mzm042. « Book Review: Corbin, J., & Strauss, A. (2008). 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Parkin et al. , « A Multidisciplinary NHS COVID-19 Service to Manage Post-COVID-19 Syndrome in the Community », J. Prim. Care Community Health , vol. 12, p. 21501327211010994, 2021, doi: 10.1177/21501327211010994. Z. Yan, M. Yang, et C.-L. Lai, « Long COVID-19 Syndrome: A Comprehensive Review of Its Effect on Various Organ Systems and Recommendation on Rehabilitation Plans », Biomedicines , vol. 9, n o 8, p. 966, août 2021, doi: 10.3390/biomedicines9080966. A. J. Berendsen, W. H. Benneker, J. Schuling, N. Rijkers-Koorn, J. P. Slaets, et B. Meyboom-de Jong, « Collaboration with general practitioners: preferences of medical specialists – a qualitative study », BMC Health Serv. Res. , vol. 6, n o 1, Art. n o 1, déc. 2006, doi: 10.1186/1472-6963-6-155. D. Salmon Céron et al. , « Les formes prolongées de la COVID-19 ou COVID long : formes cliniques et prise en charge », Me decine Mal. Infect. Form. , p. S2772743221000118, janv. 2022, doi: 10.1016/j.mmifmc.2021.12.001. C. Colin, S. Gendron, G. Gérauld-Pointel, et J.-P. Deschamps, « Infirmières et santé publique… …infirmières de santé publique », Sante Publique (Bucur.) , vol. 16, n o 2, p. 181‑183, 2004, Consulté le: 7 avril 2022. [En ligne]. Disponible sur: https://www.cairn.info/revue-sante-publique-2004-2-page-181.htm N. Helou, A. Zanchi, et M. Shaha, « La contribution infirmière à la prise en charge multidisciplinaire des patients vivant avec une néphropathie diabétique : une revue intégrative de la littérature », Rev. Francoph. Int. Rech. Infirm. , vol. 3, n o 2, p. 79‑86, juin 2017, doi: 10.1016/j.refiri.2017.03.003. H. Yousefi, E. S. Ziaee, et P. Golshiri, « Nurses’ consultative role to health promotion in patients with chronic diseases », J. Educ. Health Promot. , vol. 8, p. 178, 2019, doi: 10.4103/jehp.jehp_146_19. L. M. Haddad et R. A. Geiger, « Nursing Ethical Considerations », in StatPearls , Treasure Island (FL): StatPearls Publishing, 2023. Consulté le: 1 octobre 2023. [En ligne]. Disponible sur: http://www.ncbi.nlm.nih.gov/books/NBK526054/ L. Kohn et al. , « Difficultés rencontrées par les patients COVID long dans le système de santé belge », Santé Publique , vol. 34, n o 5, p. 663‑673, 2022, doi: 10.3917/spub.225.0663. A. H. Gross, J. Driscoll, et L. Ma, « The nurse coordinator role: fulfillment of the nursing profession’s compact with society », Isr. J. Health Policy Res. , vol. 8, p. 5, janv. 2019, doi: 10.1186/s13584-018-0280-6. V. Misra, K. Sedig, D. R. Dixon, et S. L. Sibbald, « Prioritizing coordination of primary health care », Can. Fam. Physician , vol. 66, n o 6, p. 399‑403, juin 2020, Consulté le: 23 août 2023. [En ligne]. Disponible sur: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292521/ S. Bessière, « La féminisation des professions de santé en France : données de cadrage », Rev. Fr. Aff. Soc. , n o 1, p. 17‑33, 2005, doi: 10.3917/rfas.051.0017. Additional Declarations No competing interests reported. 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Saint-Etienne","correspondingAuthor":true,"prefix":"","firstName":"Bienvenu","middleName":"","lastName":"BONGUE","suffix":""}],"badges":[],"createdAt":"2024-01-22 17:30:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3888605/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3888605/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57249850,"identity":"f43a2b59-eff7-4835-9d6a-5ff8872154a3","added_by":"auto","created_at":"2024-05-28 06:57:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":610557,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3888605/v1/3f3ce01d-e0ca-4303-9780-0cf8ba0bcf18.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Management of patients with Long Covid: A qualitative study exploring the roles of nurses in healthcare pathways","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCoronavirus disease is caused by SARScov2; certain variants exhibit higher contagion rates than others. Globally, nearly 7\u0026nbsp;million official deaths and confirmed cases of COVID-19 have been reported to the World Health Organization [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although COVID-19 is no longer dominating headlines, it continues to pose a significant public health challenge. Recent data from Public Health France indicates there is still a 12% weekly incidence rate in France [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCOVID-19 is a viral infection characterized by a range of systemic symptoms, including fatigue, palpitations, and muscle pain, varying in severity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The emergence of Long COVID-19 symptoms was observed as early as spring 2020. Clinicians swiftly recognized the diverse clinical presentations, leading to both asymptomatic and severe forms, although the latter is infrequent. The wide variety of symptoms for Long COVID and their high frequency rate have given rise to an epidemic within the pandemic [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe term \"Covid Long\" has been coined by patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], while researchers use \"Post-Covid Syndrome\" to put together various sometimes unexplained symptoms persisting for weeks after COVID-19 infection [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. According to WHO criteria, 10 to 20% of patients infected with COVID-19 develop Long COVID [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile a standardized nomenclature and definition are lacking, there exists consensus in the medical literature and healthcare organizations that symptoms persist for \u0026ge;\u0026thinsp;4 weeks following initial infection[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The period between 4 and 12 weeks is further classified as subacute or ongoing symptomatic infection [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLong COVID affects all sections of the population equally, with patients reporting a spectrum of symptoms impacting multiple organ systems. Previous studies of patients with Covid-19 have demonstrated long- term reductions in lung and exercise capacity, as well as diminished quality of life [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Dyspnea, fatigue, and difficulty concentrating are among the most frequently reported symptoms [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Presently, clear and standardized guidelines for the management of Long COVID are lacking. Nevertheless, several studies propose a holistic approach [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] or a multidisciplinary approach [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The National Institute for Health and Care Excellence (NICE), High Authority for Public Health in France, and other guides from learned societies recommend integrated rehabilitation services that encompass a range of specialized skills and expertise [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese patients' situations may parallel those with chronic diseases; hence, their management should be similarly comprehensive, tailored to individual needs, and involve a multidisciplinary team of healthcare professionals.\u003c/p\u003e \u003cp\u003eThe nursing profession involves a variety of essential responsibilities, including analyzing, organizing, assessing, and delivering nursing care. Lee et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] outlined five pivotal roles that nurses undertook during the pandemic. These roles included the reorganization of nursing systems, enhancing team communication, coordinating essential materials, improving healthcare efficiency as frontline caregivers, and providing support to fellow nurses.\u003c/p\u003e \u003cp\u003eNurses also play a significant role in the collection of clinical and epidemiological data, participating in prevention initiatives, conducting screenings, offering training, and engaging in health education activities, in accordance with the guidelines outlined in the Public Health Code [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition to their specialized qualifications, nurses have developed skills that consider the unique needs of the individuals under their care, as well as the broader environmental factors, including social dynamics.\u003c/p\u003e \u003cp\u003eLaurence Bernard notes that: \u0026ldquo;nurses' professional identity is profoundly shaped by their work environment, encompassing the professional context, socio-political influences, and the organizational culture within the healthcare institution where they work\u0026rdquo; [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA systematic review conducted by Poitras et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] identifies four areas within nursing practice: conducting comprehensive assessments of individuals with chronic illnesses, managing care, promoting health and well-being, and fostering collaborative relationships between nurses and physicians.\u003c/p\u003e \u003cp\u003eFurthermore, Saenprasarn et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] emphasize the pivotal role of nurses in promoting quick recovery and mitigating chronic illness and complications among patients infected with and diagnosed with COVID-19, especially those at risk of developing Long COVID. Nurses serve as beacons of knowledge, offering guidance on recovery, serving as role models in rehabilitation, facilitating positive psychological well-being, orchestrating social support for patients and their families, and providing holistic care that addresses physical, psychological, social, and spiritual aspects of illness.\u003c/p\u003e \u003cp\u003eLong COVID is a recent medical syndrome, and as such, management strategies are continuously evolving. Despite this, there is a limited body of literature exploring the roles of nurses in managing Long COVID [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] .These roles may vary based on the healthcare organization in which the nurse is employed, whether it be in private practice, a hospital setting, or an educational institution.\u003c/p\u003e \u003cp\u003eThe primary objective of this article is to investigate the various roles played by nurses in the care of patients afflicted with Long COVID. Understanding the significance of nurse\u0026rsquo;s roles within the Long COVID healthcare pathway holds the potential to enhance the care provided to patients who may otherwise find themselves wandering.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eFor this study, we adopted a qualitative exploratory descriptive approach, using semi-structured interviews to gain insight into the experiences of nurses. The interviews were conducted over a nine-month period, spanning from October 2022 to June 2023. Qualitative research, as employed in this study, adopts a comprehensive approach, prioritizing the description of processes over the explanation of causes. It involves progressively developing an understanding of the phenomenon and allows for recursive investigation, with flexibility in the approach, predominantly inductive in nature [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eEighteen participants were included in our study, comprising two males and sixteen females. Among the participants, one was a physiotherapist, and another was a nurse.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eFollowing obtaining informed consent, semi-structured interviews were conducted with participants using an interview guide. Semi-structured, in-depth interviews are a widely employed format for individual or group interviews [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. To ensure consistency, we tested the guide with three nurses from our team. Participants were informed about the study, their voluntary participation rights, and the minimal associated risks. Interviews were conducted either face-to-face or via telephone at their workplaces, with durations ranging from 20 to 45 minutes. Audio-recordings were deleted once transcripts were confirmed, in accordance with ethical committee approval.\u003c/p\u003e \u003cp\u003eTo ensure representative sampling, we included nurses from various practice settings, such as private practice \u003cb\u003e(PP)\u003c/b\u003e, hospitals \u003cb\u003e(H)\u003c/b\u003e, schools \u003cb\u003e(S)\u003c/b\u003e, research \u003cb\u003e(R)\u003c/b\u003e, and dedicated pathways \u003cb\u003e(DP)\u003c/b\u003e. All participants had experience in caring for Long COVID patients.\u003c/p\u003e \u003cp\u003eOur interview matrix comprised four main sections: 1) General information about the COVID-19 pandemic, 2) Knowledge about Long COVID, 3) Management of Long COVID, and 4) The roles of nurses in Long COVID care. Socio-demographic data, including gender, years of experience, and practice location, were also collected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eData analysis\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eAll participants volunteered to partake in the study, and our inclusion criterion was being a healthcare professional involved in Long COVID management. We determined the sample size following the principle of theoretical data saturation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Interviews were audio-recorded, anonymized, and transcribed verbatim. They were conducted in French. The principle investigator coded the data first. Another senior researcher, trained in qualitative analysis, also coded the data independently. Nvivo software was employed to compare, and merge identified themes. Thematic content analysis was carried out [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], with emerging themes discussed until the most significant categories were identified across the semi-structured interviews. Three central themes emerged from the analysis: 1) Long COVID, Lack of Knowledge about this new syndrome, 2) Long COVID treatment as an interprofessional challenge, and 3) The multifaceted role of nurses in Long COVID care.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eDescription of data:\u003c/h2\u003e\n\u003cp\u003eThe characteristics of the participants are shown in the table below. Five of them have a maximum of 5 years' experience as a nurse. For all the others, the average number of years of experience is 13. Twelve out of eighteen participants worked in hospitals settings.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable: Characteristics of participants\u003c/em\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN\u0026deg;\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYears' experience\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePlace of practice\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSpecificity\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate practice\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eScreening-Guidance- Collaboration\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonitoring- Guidance\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSchool\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eScreening\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTherapeutic Education\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate practice\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eScreening-Guidance- Collaboration\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonitoring- Guidance\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate practice\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eScreening-Guidance- Collaboration\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate practice\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eScreening-Guidance- Collaboration\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonitoring-Orientation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate practice\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eScreening-Guidance- Collaboration\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonitoring-Guidance\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonitoring- Guidance\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMonitoring- Guidance\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eResearch- Coordination-Dedicated Pathway\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTherapeutic Education- Coordination- - Dedicated pathway\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTherapeutic Education - Dedicated pathway\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTherapeutic Education - Dedicated pathway\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePhysiologist- Coordination-Dedicated pathway\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe problem of managing patients with Long COVID has emerged insidiously. Some healthcare professionals have pointed out the perplexing nature of the various clinical cases. A common feature, described by all participants, is the challenge of dealing with distressed patients who often express a lack of recognition of the severity of their condition. The inability to resume normal professional activities was a common criterion frequently reported, especially for those grappling with debilitating fatigue:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Basically, people tell them, you're tired but you've just got to get moving, get out of bed and you'll feel better\u0026rdquo; (P17, DP).\u003c/p\u003e\n\u003cp\u003eAdditionally, there are accounts of wandering patients seeking solutions:\u003c/p\u003e\n\u003cp\u003e\"I recall people wandering around, seeking help from multiple doctors\" (P16, DP).\u003c/p\u003e\n\u003cp\u003eSome professionals also acknowledge the initial difficulty in providing care, given that many general practitioners are unfamiliar with this syndrome:\u003c/p\u003e\n\u003cp\u003e\"This persistent fatigue has left doctors somewhat perplexed\" (P1, PP).\u003c/p\u003e\n\u003cp\u003eThe primary findings of our study emerged when we explored the roles of nurses in the care of Long COVID patients. The roles reported included identifying and screening Long COVID patients, offering guidance and support, conducting therapeutic education, engaging in clinical research, and coordinating care in collaboration with other healthcare professionals such as general practitioners, specialists, physiotherapists, and other paramedical staff. These roles were identified as vital in delivering holistic care to Long COVID patients.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eTheme 1: Long Covid- Lack of Knowledge about this new syndrome\u003c/h2\u003e\n\u003cp\u003eThe problems associated with the complexity of the syndrome have been highlighted on several occasions:\u003c/p\u003e\n\u003cp\u003e\"It's a complex condition, and it often baffles us\" (P16, DP).\u003c/p\u003e\n\u003cp\u003eIn this new scenario,\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\"Families, friends, and even some doctors are perplexed as diagnostic tests show no clear answers\" (P18, DP).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eCare is organized according to the specific clinical situations that arise, with patients facing difficulties in accessing appropriate care. And when they do a notable clinical feature is the psychological distress experienced by these patients:\u003c/p\u003e\n\u003cp\u003e\"Psyche scars are often the most prominent clinical feature\" (P18, DP).\u003c/p\u003e\n\u003cp\u003eProfessionals have had to adapt to the wide range of symptoms, many of which lack established treatment options. The lack of knowledge on the subject makes treatments difficult. These symptoms include respiratory problems, attention and concentration issues, and difficulties in returning to work:\u003c/p\u003e\n\u003cp\u003e\"Symptoms encompass ageusia, severe and chronic fatigue, chronic pain, neurological disorders, cardiac complications, and mood and morale impacts\" (P4, DP).\u003c/p\u003e\n\u003cp\u003eProfessionals working in specialized pathways note that psychological distress and fatigue fluctuate over time:\u003c/p\u003e\n\u003cp\u003e\"Psychological distress and fatigue in Long COVID patients exhibit fluctuations, which profoundly affect their morale\" (P14, DP).\u003c/p\u003e\n\u003cp\u003eAll participants emphasize that given the current healthcare landscape, training on Long COVID is imperative to better support patients:\u003c/p\u003e\n\u003cp\u003e\"It would be beneficial to train nurses to recognize and differentiate Long COVID from other pathologies that may be similar to it.\" (P3, S).\u003c/p\u003e\n\u003cp\u003eSuch training would enable improved screening and diagnosis:\u003c/p\u003e\n\u003cp\u003e\"Diagnosing Long COVID is challenging, as it can often mimic other conditions. Is it long Covid or is it link to another pathology?\" (P12, H).\u003c/p\u003e\n\u003cp\u003eFurthermore, it would equip healthcare professionals to provide information to patients who may not be aware they have Long COVID:\u003c/p\u003e\n\u003cp\u003e\"It's during conversations that we sometimes discover patients have lingering COVID symptoms\" (P2, H).\u003c/p\u003e\n\u003cp\u003eParticipants suggest various measures to enhance Long COVID patient care, including collaboration with patient associations and facilitating access to suitable healthcare pathways:\u003c/p\u003e\n\u003cp\u003e\"We should be able to refer patients to relevant organizations and resources, including families, not just patients\" (P13, H).\u003c/p\u003e\n\u003cp\u003eMany other actions are proposed to enhance Long COVID care, including empowering patients to be active partners in their own care:\u003c/p\u003e\n\u003cp\u003e\"I see these pathologies which are these functional disorders, as an opportunity to work together and to work differently with patients. We're really in a different culture. Our Western culture is really focused on top-down medicine, so we're not really working together. We prescribe and the patient complies, but for disorders like these, like fibromyalgia, like long Covid, we can't provide this kind of response, or rather it's not enough. We don't have any symptoms, we don't have any treatment to give, we don't have any medication to give, so we must reinvent ourselves, so I also see it as an opportunity to try and get things moving. We must try to put the patient at the centre and take him or her as a whole \" (P4, H).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eTheme 2: Long COVID Treatment - An Interprofessional Challenge\u003c/h2\u003e\n\u003cp\u003eSimilar to many chronic illnesses, Long COVID necessitates long-term care and collaboration among various healthcare professionals:\u003c/p\u003e\n\u003cp\u003e\"Depending on the type of lingering symptoms, we may refer patients to specialists for tailored treatment\" (P2, H).\u003c/p\u003e\n\u003cp\u003eA comprehensive, personalized approach is emphasized during patient follow-up, including a comprehensive interview with the patient. During this interview, a shared educational assessment is carried out. All areas of the patient\u0026rsquo;s daily life are covered to determine the patient\u0026rsquo;s difficulties and resources.\u003c/p\u003e\n\u003cp\u003e\"The assessment is extensive, aiming to gather as much information as possible about the individual to identify the best solutions\" (P18, DP).\u003c/p\u003e\n\u003cp\u003eProfessionals involved in rehabilitation recommend that patients dedicate their time exclusively to recovery, without combining it with other professional activities, as this can impede progress. This would make recovery difficult or even ineffective.\u003c/p\u003e\n\u003cp\u003e\"Some individuals attempted part-time work while undergoing rehabilitation, which proved counterproductive as it drained their energy\" (P17, DP).\u003c/p\u003e\n\u003cp\u003eAt present, there are limitations to the care that can be provided to Long COVID patients due to the shortage of specialized professionals in this field. The nurses interviewed described this as a source of frustration. The few specialists mentioned during the study were neuropsychologists and speech therapists concentrating on taste and smell rehabilitation.\u003c/p\u003e\n\u003cp\u003e\" For the moment, there is an imbalance, we are well aware that we are not offering a complete programme, unfortunately\" \" (P16, DP).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eTheme 3: The nurse - A professional with multiple roles\u003c/h2\u003e\n\u003cp\u003eAll interviewed professionals acknowledged their essential role in caring for Long COVID patients. They assume a diverse range of responsibilities in their practices, including medication management, clinical monitoring, patient reception, providing emotional support, patient education, and coordinating care.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eRelational Role\u003c/h2\u003e\n\u003cp\u003eIn this distressing pathology, healthcare professionals emphasize the paramount importance of listening as the initial therapeutic intervention for patients. Indeed, participants noted the profound relief experienced by patients when they find themselves in an environment where they are \"finally heard\" and \"without judgment.\"\u003c/p\u003e\n\u003cp\u003e\"Simply listening to the patient already provides comfort and reassurance\" (P5, PP).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eScreening and Guidance Roles\u003c/h2\u003e\n\u003cp\u003eThis role is often fulfilled by nurses, particularly those working in private group practices who frequently serve as the first point of contact. This role can be succinctly summarized as encompassing screening and guiding patients towards dedicated care pathways.\u003c/p\u003e\n\u003cp\u003eTo identify these symptoms, nurses routinely inquire about patients' present complaints, medical history, and potential exposure to Covid-19.\u003c/p\u003e\n\u003cp\u003e\"There is a genuine need to distinguish between individuals with long Covid and those with other conditions\" (P3, S).\u003c/p\u003e\n\u003cp\u003eOnce these patients are identified, nurses provide them with essential information and direct them towards available resources.\u003c/p\u003e\n\u003cp\u003e\"Our responsibility includes directing individuals to specialized centers\" (P12, H).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eCollaborative Role\u003c/h2\u003e\n\u003cp\u003eIrrespective of their practice settings, whether in private practices or hospitals, nurses collaborate closely with the broader medical team to formulate personalized care plans for patients and continuously monitor their progress over time.\u003c/p\u003e\n\u003cp\u003e\"It is an integral part of our role to provide feedback to the General Practitioner: how has the patient been this week? How are they feeling? What feedback have they provided?\" (P1, PP).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003ePatient Education Role\u003c/h2\u003e\n\u003cp\u003eThis role is mainly mentioned by professionals involved in dedicated pathways, particularly those specializing in therapeutic education. Nurses specializing in therapeutic education use shared assessments to identify the specific needs of long Covid patients and provide them with the tools to adopt a balanced lifestyle that will enable them to have a better management of persistent symptoms.\u003c/p\u003e\n\u003cp\u003e\"We have a role to play in supporting these patients through therapeutic education, teaching them how to regain their quality of life\" (P8, PP).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eCoordination Role\u003c/h2\u003e\n\u003cp\u003eThe role is essential in ensuring ongoing monitoring of patients throughout their recovery journey. Different individuals within specialized long Covid management pathways may assume this coordination function. The coordinator ensures there is good communication among all professionals involved in the patient's care and conducts assessments at the program's commencement, midpoint, and conclusion, in collaboration with the entire team.\u003c/p\u003e\n\u003cp\u003e\"We work closely together, it's a team effort, and having motivated and committed individuals is crucial\" (P4, H).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003eResearcher Role\u003c/h2\u003e\n\u003cp\u003eIn addition to their caregiving responsibilities, nurses also contribute to research efforts. They express that patients are interest in taking part in such work and that they emphasize the opportunity to meet specialist doctors. The research outcomes contribute to improve Long Covid management.\u003c/p\u003e\n\u003cp\u003e\"Our protocol is designed to collect observational data, make predictions, identify common patient patterns, and understand the nuances of long Covid\" (P14, R).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe aim of this study was to explore the diverse roles that nurses play in the care of long Covid patients. The findings of this study reveal the different roles nurses fulfill based on their practice settings. Nurses play various roles in the healthcare pathways of long Covid patients, including screening, guidance, clinical monitoring, emotional support, patient education, collaboration, care coordination, and research.\u003c/p\u003e \u003cp\u003eThe study's first result shows the limited knowledge we have of this emerging syndrome. The lack of Knowledge and the resemblance of symptoms to those in other conditions pose challenges in acknowledging patients' complaints. This observation is coherent with findings in diseases with similar characteristics, such as fibromyalgia and chronic fatigue syndrome [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe findings also emphasized that the current management of Long Covid is based on a consensus for a multidisciplinary and individualized approach to the way long Covid should be managed [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Collaboration is key to enhancing care and the quality of life of patients [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Given the substantial societal impact of long Covid [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], healthcare professionals, including nurses, face considerable challenges. The management processes are varied and reflect the different approaches based on practice settings (private practice or hospital).\u003c/p\u003e \u003cp\u003eNurses play an essential role alongside other healthcare providers. With a primary focus on patient well-being, nurses are uniquely positioned to contribute to innovative interventions [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This highlights the effectiveness of nursing in managing chronic illnesses [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] and the ethical principle of continuous nursing care, emphasizing respect for the individual under care [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study's data analysis has stressed the central roles of nurses in long Covid patient care pathways. Although it appears that general practitioners are the primary healthcare professionals consulted by patients with long-term Covid symptoms [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], nurses coordinate care activities and collaborate with all members of the medical team to set up individualized care plans tailored to the different needs of patients. They carry out comprehensive assessments (shared educational assessments) to gain insight into patients' persistent symptoms and needs.\u003c/p\u003e \u003cp\u003eNurses also provide symptom management, patient education, and invaluable psychosocial support to patients. While these roles are similar to those in the management of other chronic conditions [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], the coordinator role in the Long Covid management has its own specificities. Undoubtedly, the results of our study tend to indicate that this coordinating role is both medical and social role. It facilitates connections between patients and the various resources, services, and social support they require [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eUp till now it seems that few research studies have investigated the role of nurses in supporting patients suffering from Long Covid. The inclusion of professionals from different healthcare sectors have made it possible to cross-reference various healthcare sectors, including private practice, hospitals, research, and dedicated pathways. However, there are certain limitations to consider. Firstly, the small number of specific healthcare systems included in our study restricted our ability to collect data from multiple French regions. Additionally, the fact that I, as one of the authors, am a nurse, may have influenced the interpretation of the results. There might be a natural inclination to emphasize nursing roles in managing chronic conditions compared to other healthcare disciplines. To try and reduce this potential bias, we were helped by a senior researcher in the coding of data until the main themes were identified.\u003c/p\u003e \u003cp\u003eIt is also worth noting that the nurses who participated in the study have a substantial number of years of work experience. However, Long COVID is a relatively novel condition, and there is no universally recognized date for the establishment of the first dedicated care pathway for Long COVID patients, which may vary between countries and healthcare institutions. It can be said that the first measures taken regarding long Covid only began to emerge in 2020 with increased efforts to understand and meet the needs of these patients.\u003c/p\u003e \u003cp\u003eFurthermore, among the participants surveyed, there is an imbalance in gender representation, with more women than men. This gender disparity reflects the broader trend of feminization in the nursing profession [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother limitation of our study is its transferability. Our study was carried out in France in a specific environment. The various professionals involved in the project had already worked together in other circumstances. The results of the study might therefore be different in the absence of the initial study conditions. However, the healthcare policy in France is highly regulated. The structures are similar from one territory to another. The results of our study can therefore be replicated in another comparable environment.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe findings of this study shed light on the management of Long COVID and the role played by nurses. Nurses assume a multitude of roles in improving the quality of life for patients suffering from this complex condition. Their role as coordinators is particularly unique in the care of Long COVID patients. Interdisciplinary collaboration is emphasized in the best interest of patients, with nurses working closely with a spectrum of professionals involved in monitoring Long COVID patients. Long COVID shares numerous similarities with other chronic pathologies. However, its management poses diagnostic challenges, highlighting the importance of nursing expertise in its recognition and appropriate management. Innovative approaches to care are essential to address the complexities of this emerging condition. A potential next step could involve piloting a city-hospital pathway that assigns nurses a central role in Long COVID patient care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design: JG, FR, EBN, BB\u003c/p\u003e\n\u003cp\u003eData collection: LK, PG, MPV, MF\u003c/p\u003e\n\u003cp\u003eData analysis: LK, JG, CD\u003c/p\u003e\n\u003cp\u003eManuscript writing: LK\u003c/p\u003e\n\u003cp\u003eCritical revision for important intellectual content: DH, EBN, CN, FR, BB\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all the SPACO+ team investigators. The members of PRESAGE institute: Franck Chauvin, Veronique REGNIER, Frederic ROCHE, Nathalie BARTH, Yves MBAMA, Elie SHIKITELE, Fanny COLLANGE, Amandine BAUDOT.\u003c/p\u003e\n\u003cp\u003eThe authors thanks Chrystel BOST for the English review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING INFORMATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is part of the SPACO+ project, which has received funding from the ANRS- French National Research Agency / Emerging infectious diseases. (Grant number: ANRS283). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe full interviews\u0026rsquo; data are not publicly available due to privacy or ethical restrictions. However, data is available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the declaration of Helsinki. Ethical approval for this study was sought from the \u0026ldquo;Terre d\u0026apos;Ethique\u0026rdquo; ethics advisory committee of the Saint-Etienne University Hospital (Approval number: IRBN1282023/CHUSTE. Prior to the interview, the participants were informed verbally and in writing, that the data from the recorded interviews would not be used for any purposes other than the research. Furthermore, the participants were assured that to protect their human rights and guarantee their anonymity, the researchers would not use any personal information that might reveal their identity. All participants gave their written consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWHO, \u0026laquo; WHO Coronavirus (COVID-19) Dashboard \u0026raquo;. Consult\u0026eacute; le: 9 ao\u0026ucirc;t 2023. [En ligne]. Disponible sur: https://covid19.who.int\u003c/li\u003e\n \u003cli\u003eSPF, \u0026laquo; COVID-19 : point \u0026eacute;pid\u0026eacute;miologique du 31 mai 2023 \u0026raquo;. Consult\u0026eacute; le: 19 juillet 2023. [En ligne]. 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Soc.\u003c/em\u003e, n\u003csup\u003eo\u003c/sup\u003e 1, p. 17‑33, 2005, doi: 10.3917/rfas.051.0017.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Long Covid, Nurse’s roles, Healthcare Pathway, Health organization, Professional practice","lastPublishedDoi":"10.21203/rs.3.rs-3888605/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3888605/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvestigate the various roles played by nurses in the care of patients afflicted with Long COVID.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEffectively managing Long Covid requires a multidisciplinary approach - a healthcare pathway that necessitates collaboration among various members of the medical profession to monitor the patient. Among these professions, nursing plays a crucial role. This article compiles information on how nurses are involved in the care of patients afflicted with Long Covid: What roles do they play in enhancing the care of these patients? Are these roles distinct from those they perform in other chronic conditions?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a qualitative study among healthcare professionals in France and enrolled eighteen participants in our study. Semi-structured interviews were conducted with professionals working across various care sectors in France, including private practice, hospitals, schools, and research. A thematic content analysis was performed, and emerging themes were subsequently discussed until the most significant categories were identified. This study was conducted in accordance with the COREQ checklist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNurses play a wide range of roles within their practices, depending on their practice settings. For instance, a nurse practitioner may work in a range of settings such as hospital outpatient clinics, private group practices, inpatient units, or urgent care units. Depending on their work environment, nurses' roles within healthcare pathways may encompass screening and guidance, clinical patient monitoring, providing relational support, patient education, collaborative care and coordination as well as involvement in research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe predominant role identified in our study involves coordinating the management of the Long Covid syndrome. The next step would be the implementation of a city-hospital Long Covid healthcare pathway.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplication for the Nursing \u0026amp; Health Policy Perspectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNursing work is difficult to specify, as it includes numerous recognised and unrecognised aspects. The results of this study highlight a new essential role which is that of coordinating the health pathways of patients suffering from Long Covid.\u003c/p\u003e","manuscriptTitle":"Management of patients with Long Covid: A qualitative study exploring the roles of nurses in healthcare pathways","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-12 17:40:51","doi":"10.21203/rs.3.rs-3888605/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"30ed8290-d654-4e4b-b72f-1f21ed03a6e6","owner":[],"postedDate":"February 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-28T06:48:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-12 17:40:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3888605","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3888605","identity":"rs-3888605","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}