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Effect of passage meditation program on nurses' level of hope and resilience who caring for patients with COVID 19

Background: COVID-19 is an acute resolved disease but it can also be deadly, with a 2% case fatality rate. Health care workers are the frontline soldiers against COVID-19. They experienced fear, high level of stress, fatigue, grief and anxiety during facing pandemic. So, development and application of a meditative program that consistent with our culture can be valuable to control and overcome stress, building resilience and hope. Aim: To evaluate the effect of passage meditation program on nurses' level of hope and resilience who working with COVID 19 patients. Subjects and method: Study Design: A quasi-experimental, prepost-test design was utilized in the current study. The study was conducted at Tanta chest hospital affiliated to Ministry of health. It was an online study through using Google forms (Google drive). Subjects: All of nurses (fifty nurses) working at Tanta chest hospital. Tools: two tools were used to gather data for this research, Hearth hope scale and the brief resilience scale (BRS). Method: a WhatsApp group were introduced for all nurses, the studied nurses were divided into five subgroups; each subgroup encompassed 10 nurses. Each subgroup was attending a total of 6 sessions. These sessions were scheduled as 3 sessions per week for duration of 2 weeks. Each session was lasted for about an hour. Results: there is a positive statistically significant relationship between the nurse total resilience score and hope score. Conclusion: the passage meditation program was effective in elevation hope level and improving resilience among nurses Recommendation: the current study suggested, the global nursing organizations work on drafting effective and proactive nurses' human-factor guidelines and network that embeds human factor as a dynamic shock absorber.


Introduction
Since late December, 2019, an outbreak of a novel coronavirus disease  was reported in Wuhan, China, which has subsequently affected the whole world (1) .
The pandemic of COVID-19 has clearly entered a new stage with rapid spread in countries outside China and all members of society must understand and practice measures for self-protection and for prevention of transmission of infection to others (2) . In general, COVID-19 is an acute resolved disease but it can also be deadly, with a 2% case fatality rate. Severe disease onset might result in death due to massive alveolar damage and progressive respiratory failure (2,3) .
Health care workers are the frontline soldiers against COVID-19 (3) , they provide caring for patients during the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks were experienced extraordinary stress related to high risk of infection, stigmatization, understaffing, and uncertainty (4,5) . An important sector of this army are nurses, they play a very crucial role in predestining the healthcare services for managing and extenuating infectious diseases, as COVID-19, which are considered to be the third leading cause of death worldwide (6) . Yet, they face tremendous physical and mental stress as they facing challenges during pandemic, but also, introducing may influential roles (4) .
Firstly, one of the most horrific challenge of the COVID-19 is the time delay in the early identification of infections, due to its long incubation period that might extend to about fourteen days on average. This poses a threat to nurses as they considered the initial point of contact with the infected person (6,7) . Second challenge is the number of patients that required ventilatory support outnumbered the available intensive care unit (ICU) beds.
Moreover the nurse-patient ratio is unbalanced. This put authorities to submit another places as University cities to providing care to those less severity in their signs and symptoms (8) .
Third one is to stay healthy so that nurses can continue to care for others.
Unfortunately with lack of personal protection equipment (PPE), nurses had to set up a clean area at the entrance to their homes to change in and out of scrubs, besides change and shower at work as well. Unquestionably, they have families, and so will naturally be fearful that the virus might reach those they love most.
After then they return their home and isolate themselves from their loving family, another rent a separate house to avoid contact with their families (9) .
Lastly, the most tragic and shameful in some communities is harassment, stigmatization, and attacking nurses during their work, while they are sacrificing their life and time in giving care to those clients with COVID -19 (7,9) . Certainly, nurses play a great role in caring the patient during the different phases of the COVID-19. Besides, providing public education, to prevent and reduce the spread of misinformation around the disease outbreak. Also, tracing of those around the infected person and guide them to prevent spread of infection (6) . Moreover, they have to find a specific balance between professional standards and crisis standards of care which based on the reality of the specific situation, such as the presence or absence of necessary equipment, medications or colleagues (8) .
Among nurses, stress has been linked to problems ranging from depression, decreased job satisfaction, and disrupted personal relationships to reduced concentration, impaired decision making, and poorer relationships with patients (10) .  (6) .  (14) .
Hope is the act by which despair is actively overcome. As an inner strength, hope is perceived as a resource for living in the present and is central to a dignified end of lifetime. Besides, hope for nursing is identifying as this deep-grounded hope that is most germane to our patients and to our practice (15) . Furthermore, inner strength among experienced nurses has been associated with connectedness, firmness, flexibility, creativity, a sense of confidence in oneself yet having faith in others, accepting both the light and the dark side of life, and being the same yet growing into a new garment (16) .
In recent decades, meditation has drawn experienced during formal sitting practice (10) .
In passage meditation, the object of attention is not an image or an external object but an inspirational passage chosen from any of the world's great spiritual traditions and memorized ahead of time (17) . The WHO determine such workplace health programs as one of the best options for mental health and well-being of employees (18) . On top of that, development and application of a meditative program that consistent with our culture can be valuable to control and overcome stress, building resilience and hope.

Aim of the study
To evaluate the effect of passage meditation program on nurses' level of hope and resilience who working with COVID 19 patients.

Research questions:
What is the effect of passage meditation program on nurses' level of hope and resilience who working with COVID 19 patients?
Research hypothesis: x9 related to electronic questionnaire.

Subjects:
All of nurses (fifty nurses) working at Tanta chest hospital.

Method:
1-Official permission to conduct the study was obtained from the responsible authorities.

2-Ethical Considerations:
-Online consent was obtained from nurses after explanation of the aim of the study.
-Privacy and confidentiality was assured.
Nurses were reassured that the obtained information is confidential and used only for purpose of the study.
-Nurses' right to withdraw from the study at any phase were respected.
3-All tools were tested for content validity by a jury of five experts in the field of psychiatric nursing.

4-Tools of the study were translated into
Arabic language and designed by Google forms to be an online questionnaire.
5-All tools were tested for reliability using  The researchers was used the following learning materials: -Images. -Videos.

C-Implementing Phase:
 In this phase, the researchers were meet the study subjects in online bases through Whats App group.
Similarly to what mention in previous  (27) .

Conclusion
Based on the results of the current study, it can be concluded that the passage meditation program was effective in elevation hope level and improving resilience among nurses.

Recommendation
Based on the findings of the current study the following recommendation was suggested: 1-Nurses should be involved in the details of the national plan for high preparedness.

2-
The global nursing organizations work on drafting effective and proactive nurses' human-factor guidelines and network that embeds human factor as a dynamic shock absorber.
3-The role of the psychiatric nursing and mental health department should not be ignored, because they can have a valuable role in reducing the stress and helping nurses in hard times.