Iran Journal of Nursing

Introduction
In the hospital, nurses constitute the largest part of the human force, who provide their services in the form of direct and indirect patient care. They also take other responsibilities, some of which sometimes deviate them from their primary mission (i.e., patient care). In this regard and considering the prevailing conditions of the society and the COVID-19 pandemic, it is necessary to conduct studies to measure the time of providing care in intensive care units (ICUs). The ICUs during pandemic have significantly focused on electronic health systems and have different role due to the widespread prevalence of COVID-19. This study aims to determine the performance of nurses working in the ICU of Shohadaye Haft-e Tir Hospital affiliated to Iran University of Medical Sciences, during the COVID-19 pandemic.

Methods
This is a descriptive, cross-sectional, and observational study conducted in six months. The study population consists of all nurses working in the ICU of Shohadaye Haft-e Tir Hospital. Of these, 42 were randomly selected from those working in different shifts (14 form each morning, evening and night shifts). Their performance was continuously observed and their time of activities was recorded by the researcher using the stopwatch mobile application. The data collection tool was the Persian version of the International Classification for Nursing Practice (ICNP) checklist with acceptable face and content validity according to opinions of 5 faculty members and 10 nurses. It is used to record the time and frequency of patient care. In this study, due to pandemic, some items such as Washing and disinfecting hands, change or removal of personal protective equipment, and filling out the nursing report sheets, were added. Descriptive statistics (frequency, mean, standard deviation, minimum, and maximum) were used for analysis in SPSS software, version 22.

Results
Most of nurses (60%) were in the age group of 30-39 years and 72% had a work experience of 11-20 years. Most of nurses were female (85%) and married (80%). The longest time of indirect patient care was related to writing nursing reports (34.9± 10.5 minutes) and the shortest time was related to the removal of personal protective equipment (6.11±3.19 minutes). The results showed that, although patients need more direct care and continuous and active presence of nurses during the pandemic and there was advanced equipment and more facilities in the ICU, the nurses spent more time for indirect care. Nurses perform different activities during their shifts which can be eliminated to increase their time for direct care.

Conclusion
The findings of our study showed that nurses in the ICU of Shohadaye Haft-e Tir Hospital spent their most of the time for providing indirect care to COVID-19 patients. The longest time spent for indirect care was related to filling out the nursing report sheets. Before the pandemic, the findings of some studies such as Hosseinpour et al. [14], showed that the least time spent in indirect care was related to writing nursing reports (28%) and the longest time was related to patient education (73%). This can be due to the fact that the report of patient conditions is more important during the COVID-19 pandemic. In some other studies, the most of the time spent in indirect care by nurses was related to answering phones (33.3%) and answering the frequent questions of patients and their companions about the time of visit by the specialist (37. 56%). The increase in the time for proving indirect patient care compared to pre-pandemic period may be because of the fact that nurses had to do more handwashing, using personal protective equipment, and filling out more nursing report sheets. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1399.1316). The information of participants were kept confidential and they were free to leave the study at any time.

Funding
This study was extracted from a master thesis in Nursing Management, Iran University of Medical Sciences and did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Conceptualization, Review & editing: Fatemeh Asvad and Marzieh Adel Mehraban; Investigation, writing, and data analysis: Fatemeh Asvad and Mahboubeh Rasouli.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the Personnel of Shohadaye Haft-e Tir Hospital all participants for their cooperation.

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