INTRODUCTION

Following the emergence of the Coronavirus Disease 2019 (COVID-19) pandemic, the Korean government established Residential Treatment Centres (RTCs) to accommodate patients requiring isolation. Large hotels and training institutes were converted into these facilities, admitting individuals who were asymptomatic or exhibited only mild symptoms [1]. Although RTCs were not classified as hospitals, they were staffed by nurses, physicians, and support personnel who monitored patient conditions, provided essential care, and transferred patients to the hospital if necessary [2,3]. To minimize direct patient contact, staff primarily communicated with patients through telephone calls, walkie-talkies, and smartphone applications [1,2]. Nevertheless, significant shortages in treatment-related infrastructure and resources persisted [4,5].

Given the rapid transmission of COVID-19, nurses across healthcare settings faced numerous challenges [6]. As frontline professionals in closest contact with patients, nurses are uniquely positioned to recognize and respond to patient needs. Furthermore, the prevailing social climate and public attitudes toward infectious diseases directly influence the quality of nursing care delivered [7]. Accordingly, exploring nurses’ experiences offers valuable insights into the care requirements of patients with COVID-19 and other emerging infectious diseases that may arise in the future.

Throughout the COVID-19 pandemic, considerable academic and media attention had been directed toward nurses working in intensive care units, isolation wards, and screening stations. This focus has yielded extensive knowledge regarding their dedication, professionalism, and the challenges they encountered [8-10]. However, as of December 2021, approximately 30% of COVID-19 patients in Korea were treated in RTCs [11], yet research on the experiences of nurses working in these facilities remains limited. Although RTCs are not traditional hospitals, they constitute a distinct nursing practice environment, as they involve both nursing professionals and patients requiring care.

Therefore, this study aimed to explore the experiences of nurses who provided care to COVID-19 patients within the unique context of RTCs. The findings are expected to offer valuable insights for developing effective patient care strategies during future infectious disease outbreaks and to inform the operational management of RTCs, thereby enhancing the quality and safety of nursing care in comparable healthcare settings.

METHODS

This study employed qualitative design utilizing indepth interviews and qualitative content analysis. The research was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research [12].

1. Participants

Participants were recruited using purposive sampling with snowballing techniques, specifically targeting nurses with prior experience working at RTCs. No prior relationships existed between the researchers and participants before study initiation. Following each interview, participants were invited to recommend additional potential participants who met the inclusion criteria, who were subsequently contacted via mobile application messaging. Eligibility criteria required that participants had worked at an RTC within one year of the interview date and had at least one year of hospital experience prior to their RTC employment. This requirement was established with the expectation that nurses with general hospital experience could provide comparative perspectives between the RTCs and traditional hospital settings. Recruitment continued through seven interviews, at which point data saturation was achieved and recruitment ceased. One participant withdrew prior to the scheduled interview due to personal circumstances. Participant characteristics are summarized in Table 1.

2. Data collection

Semi-structured interviews were conducted between July 11 and August 27, 2022. To maintain COVID-19 infection control protocols, participants were offered the choice between video conferencing or face-to-face interviews. Four participants selected video conferencing, while three chose face-to-face interviews at their workplace. All interviews were conducted privately with only the researchers and a participant present. All authors participated in the interview process: the first author conducted the interviews while the other authors documented nonverbal expressions, including gestures and facial expressions, to minimize interpretation errors. Prior to each interview, participants received comprehensive information regarding study content, methodology, audio recording procedures, researcher backgrounds, institutional affiliations, and research rationale. Written informed consent was obtained from all participants, and demographic information was collected via a brief questionnaire. Interviews were conducted using a non-directive approach with open-ended questions designed to facilitate comprehensive expression of participants' experiences while avoiding leading questions. Each participant was interviewed once, with interview duration ranging from 60 to 80 minutes. Primary interview questions included: "Please describe your experience caring for COVID-19 patients in a residential treatment center," "Please specify your primary role at the center," "Please describe the challenges you encountered," and "If centers were reestablished in the future, what factors would be most crucial for ensuring efficient operation?"

3. Data analysis

Audio recordings were transcribed immediately following each interview, and data analysis commenced promptly. The study employed inductive content analysis methodology as described by Elo and Kyngäs [13], which involves a cyclical process of data comprehension, open coding, grouping, categorization, and abstraction. Initially, all authors reviewed transcribed interviews and field notes to develop familiarity with the raw data. Through iterative readings, meaningful statements were identified and extracted. During the open coding phase, the authors examined meaningful statements and assigned appropriate concepts or phrases representing the essence of each statement, creating a comprehensive coding list. Microsoft Excel was utilized as a coding software platform. In the final categorization and abstraction phase, the authors systematically reviewed the coding list, comparing similarities and differences among concepts and phrases. Similar elements were integrated and abstracted to form subthemes, which were assigned descriptive names. Subthemes underwent additional evaluation to identify conceptual similarities or differences, and integrated concepts were subsequently abstracted into overarching themes. Throughout this process, disagreements among the authors were resolved through discussion until consensus was achieved.

During the analytical process, several instances illustrate the rigorous consensus-building approach employed. For instance, when one researcher proposed the code "Experienced nurses are needed," a second researcher observed that "the importance of experienced nurses represents a well-established phenomenon in healthcare, rendering it non-specific to this study's context." Upon consultation with a third researcher, consensus emerged that this code lacked uniqueness to the RTCs setting, resulting in its exclusion from the final analysis. Another example involved the hierarchical relationship between themes and subthemes. Following completion of initial coding and preliminary theme identification, "Assumption of responsibilities beyond assigned duties" and "A struggle from beginning to end" were derived as independent themes, respectively. However, through iterative comparison of conceptual similarities and differences among themes and subthemes, one researcher proposed that this theme could be interpreted as reflecting participants' substantial efforts to persevere through challenging circumstances while maintaining RTC operations. This observation prompted all researchers to reexamine the interview data, engage in comparative analysis of each theme and subtheme, and ultimately reclassify "Assumption of responsibilities beyond assigned duties" as a subtheme within the overarching theme "A struggle from beginning to end".

Data saturation was considered to have been reached when no new insights or themes regarding the experiences of nurses in RTCs emerged from the analysis of each interview or data source.

4. Trustworthiness

Study trustworthiness was evaluated using Lincoln and Guba's [14] qualitative research criteria: credibility, transferability, dependability, and confirmability. All authors possessed emergency department nursing experience, with the first author having additional experience in COVID-19 intensive care units and RTCs for four and two months, respectively. The first author had previously conducted qualitative research on nursing experiences. This study emerged from the first author's clinical experience and academic interests. Recognizing the potential for experiential bias, a semi-structured interview guide was employed, with deliberate efforts to allow participant-led discussions. The authors facilitated free expression of each participant's thoughts without attempting to elicit predetermined responses. All authors collaboratively analyzed data, and this minimized individual subjectivity and bias. All researchers acknowledged the study's underlying assumptions, with direct quotations used to support findings. The results were shared with participants for accurate verification of the interview content. Transferability was enhanced through detailed descriptions of the study context and participant backgrounds. The authors' preparation included: the corresponding author (H.Y.), a doctoral student who completed a graduate-level qualitative research course for a year and directed the entire study; and the first and third authors (J.H.H. and Y.H.P.) who attended qualitative research seminars or workshops to develop methodological expertise.

5. Ethical considerations

Ethical approval was obtained on July 8, 2022, from the Institutional Review Board of the hospital with which the authors were affiliated (IRB No. H-2205-138-1327). All participants provided informed consent after receiving comprehensive information regarding study purpose, methods, and procedures from research team members. Participants were informed of their right to withdraw from the study at any time without consequence. Written informed consent was obtained from all participants prior to interview commencement. Data collection excluded potentially identifying information except for gender, age, and tenure. Participant anonymity was maintained through password- protected storage of all transcripts on the first author's computer, with audio recordings similarly secured.

RESULTS

Data analysis yielded 85 meaningful statements, which were systematically organized into three primary themes and 11 subthemes (Table 2). The emergent themes were: "A struggle from beginning to end," "Unexpected challenges," and "Insecure system like a house built on sand."

1. Theme 1: A struggle from beginning to end

Participants assumed central roles within RTCs, bearing responsibility for comprehensive activities spanning patient admission through discharge. They functioned as communication intermediaries between departments while demonstrating clinical expertise in patient care delivery. However, unclear role boundaries and insufficient infection control competencies among non-medical personnel gradually necessitated nurses' assumption of non- medical responsibilities beyond their professional scope. Participants accepted these expanded roles to ensure operational continuity. This theme encompasses four subthemes.

1) Comprehensive involvement from admission to discharge

Participants reported engagement in virtually all aspects of patient care throughout the entire treatment trajectory. They emphasized that even minor care components required nursing involvement, representing an unprecedented scope of responsibility compared to their previous hospital experiences.

It was just like in a hospital! Nurses did nurses' jobs like patient assessment and monitoring, medication administration, and so much more. They even taught the patients how to wear and take off gowns, and sanitized the room after the patient left … If a patient needed to be transferred to a hospital, nurses found a hospital that could accept the patient and arranged an ambulance. I truly believe that nurses were involved in every aspect of the patient's journey, from admission to discharge. They were truly invaluable!(RN3)

Nurses were the first to assess patients. … Once we'd put on our personal protective equipment (PPE), we went into the patient's room and took care of everything for them. We checked their vital signs and taught them how to use the application. Even us nurses had to move some patients to other rooms if needed.(RN5)

Discharging a patient is not just a simple leaving. We had to decide which patients to discharge first, what they needed to take home, and what time they would go, and other related details. Additionally, we had to create a list of these details and deliver it to the management team.(RN6)

2) Active clinical contributions to patient care

Despite conducting patient assessments primarily through telephone consultations, participants leveraged their clinical expertise to identify patient problems and facilitate appropriate treatment interventions.

The number of patients was quite overwhelming, especially when you consider the number of doctors. It was a challenge for the doctors to keep up with all of them. … So, we did most of the follow-ups and frequently made suggestions to the doctors about treatment. For example, we might say, "This patient is still running a high fever. Should we repeat the chest X-ray?".(RN2)

Public health doctors changed every two weeks, with three doctors rotating shifts, which made it tough to keep up with patient follow-ups. … We often had discussions like, "We've tried A drug, and the patient isn’t getting better, so why not try B drug?" or "We have C drug, why don't we try that?".(RN3)

It's totally understandable that patients might not want to mention their symptoms, as they might worry it will lead to delays in their discharge. If a patient says that she doesn't have anything wrong, the nurse won't just hang up - instead, they'll ask, "How are you feeling today?" to help the patient to tell something. And if the patient continues to talk, they may cough or sound like they have a runny nose - the nurse will then ask again, "You seem to be having symptoms, but are you sure you don't have any?" This usually got them to be honest. Some patients said, "Could you turn a blind eye to me? I must go to work," … which is why nurses should have some insight.(RN5)

3) Provision of emotional support to patients

While participants lacked specialized psychiatric nursing training, their nursing background enabled them to deliver emotional support to patients experiencing psychological distress related to social isolation.

I didn't work in psychiatry, but I learned it in school, and I knew the manual (for psychological support), so I was able to respond. … I think it was because I'm a nurse that I was better able to provide psychological and emotional support.(RN2)

I think the biggest part of my role was helping patients with their emotions when they were feeling anxious. The best part was when I said something nice to a patient who seemed a little down in the dumps, and they thanked me. The nurses also did a screening for psychological counseling. … I think it was helpful for them to have someone to talk to and listen to if they were feeling depressed.(RN1)

4) Assumption of responsibilities beyond assigned duties

Due to the nascent operational status of RTCs, role boundaries remained unclear. Additionally, frequent turnover of government supervisors and inadequate handover processes resulted in nurses assuming duties that typically fell outside the medical team's scope of practice.

Everything was new, and as we needed to establish a system, there were lots of attempts to get the nurses involved. … There were a lot of moments where I thought, "Are we even doing this?".(RN3)

There were no clear boundaries of practice, and a lot of things were left to us. ... PCR (polymerase chain reaction) tests before patients' discharge were supposed to be done by public health doctors, but we gradually got involved. ... If a patient needed to be moved to another room due to heating or lighting issues (which was originally assigned to the maintenance team), we eventually became involved. ... The officer (from the government) changed every two to four weeks, and they didn't handover correctly, so the successor was like, "Isn't this supposed to be the medical team's job?" Then, they left it to us.(RN4)

The person who decided who could be admitted to the center was not a medical professional. They often admitted patients who were not eligible for the center. For instance, they sometimes admitted pregnant women or patients with underlying diseases. This happened repeatedly. At last, they said, "It makes sense for nurses to do this." So, we took over that too.(RN6)

2. Theme 2: Unexpected challenges

Participants encountered challenges seldom observed in hospital settings, resulting in additional responsibilities and increased workload. This theme comprises four subthemes.

1) Functioning as a customer service intermediary

Participants reported frequently receiving patient complaints uncommon in hospital settings and noted that the time dedicated to addressing these concerns often exceeded the time spent on their clinical responsibilities as healthcare providers.

One day, a piece of hair came out of a patient's meal! If I were in a hospital, I would be able to call the relevant employee, like the nutritionist or the cook. But at the center, everyone told the nurse everything, so I had to step in and figure it out. ... If a patient wanted to issue a certain document in a hospital, you just direct them to the administration department. But in the center, I had to find out all the procedures and related departments.(RN2)

We got all the complaints because it's mainly the nurses who call the patients. So, we're the ones who had to direct them to whoever in the department they need to talk to. … I think that was my main role at the center, to be a kind of go-between for everyone.(RN3)

2) Managing uncooperative patients

Participants reported challenges in patient management arising from uncooperative behaviors-stemming from misunderstandings of isolation protocols or dissatisfaction with the facility-which resulted in angry or threatening interactions and an unforeseen increase in workload.

They (some patients) told me, "The public health officer told me to take the bus. I never said I wanted to come here." ... Many elderly patients said, "They (officers) just told me to mark 'yes,' so I did, and that's how I ended up here. I don't know where I am. I want to go home." ... Everybody was already upset.(RN7)

It was a quarantine to prevent the spread of the virus, but people who didn't understand that kept calling and saying, "Why am I here, you locked me up." ... "You locked me up, so I can't work, and you should pay me back."(RN2)

I once worked in a residential treatment center for foreigners, and one day a patient ran away during the night. I thought he wasn't hungry because his dinner was still at the door, but the next day his breakfast was still at the door. So, I went to his room and found him gone.(RN3)

3) Addressing emergency situations with limited resources

RTCs' restricted resources impeded timely responses to patient deterioration, eliciting anxiety among nursing staff.

As the patient's pneumonia worsened, his oxygen demand increased, and it was difficult to arrange a hospital or ambulance at night, so I stayed up all night changing his oxygen tanks. I was worried about taking care of him in an unmonitored area and having to change his oxygen tanks every few hours.(RN6)

It was around 2 a.m., a patient complained of shortness of breath, we went into the room to check his vital signs, and the oxygen saturation was between 50-70%. We immediately administered oxygen and requested transfer to a hospital. However, at that time, hospitals were overwhelmed with COVID-19 patients, and no beds were available. Inevitably, we had to monitor the patient throughout the night, using up all the oxygen in the center.(RN4)

4) Assisting patients with unfamiliar medical equipment

Although equipment such as pulse oximeters required minimal technical skill, many patients struggled with their use, further increasing nursing workload due to necessary training and direct assistance.

The oximeter simply clips on the finger and works, but very few people used it correctly. And many patients confused the pulse and oxygen levels on the monitor and entered the wrong values.(RN6)

Each patient had to take their own vital signs and enter the results into the app. However, some patients were admitted who had difficulty doing this. For example, an elderly person, a preschooler, even a 3-month-old baby, or a blind person. ... Caring for these patients often increased my workload because it took more time to care for them.(RN5)

3. Theme 3: Insecure system like a house built on sand

Participants identified substantial operational deficiencies within RTCs, expressing concern that these weaknesses could compromise patient management and care delivery. This theme comprises three subthemes.

1) Responding to patients amid frequent guideline changes

Frequent and inconsistent guideline updates, coupled with delayed staff notifications, impeded nurses' ability to provide timely and accurate information, eroding patient trust.

Sometimes the policies were different in different centers, and patients complained about that. For example, discharge instructions were different, and it's important for patients to get out of the center quickly. (RN1)

The policy changed almost every day, so when we explained it to the patients, we said different things, so they didn’t seem to trust us, and we were embarrassed to explain it to them.(RN2)

As a healthcare provider, we should have known more than the patient to make them feel more comfortable. It's true that things happened quickly, but I wish we could have known the policies or plans before the patients, because sometimes the patients found out first (through social media). I don't think patients trusted the medical staff when that happened.(RN7)

2) Infection control non-compliance among non-medical staff

Participants reported that non-medical personnel frequently disregarded infection control protocols, raising concerns about intra-staff transmission and undermining overall safety.

The entire medical team took infection control very seriously, while the other staff did not. They kept getting mixed up together... The medical team continued to maintain a high level of infection control, and the rest of the staff didn't and...(RN5)

When you go into the break room, you're supposed to take off your PPE, but non-medical personnel were going in with their PPE on. In that situation, a person without PPE came in and took a sample ... I challenged them, "Why do you keep coming in with your PPE on?" and they said, "We've been doing this since the beginning, and there has never been a problem. No one has ever gotten COVID-19."(RN3)

3) Necessity of systematic patient record management

Participants noted that RTC patient records, despite constituting medical documentation, were managed chaotically. Consequently, nurses were compelled to devise ad hoc recordkeeping methods, substantially increasing their administrative workload.

When I first came to the center, they were using Google Sheets for charting, and it was something that the nurses had put together... I didn't think that was how medical records should be managed.(RN1)

A lot of it was organizing what I did in Excel, because (patient care or related tasks) were first done by verbal orders, which only I knew, and then I had to write it down. … It was not easy to keep nursing records.(RN7)

DISCUSSION

This study explored the experiences of seven nurses who provided care to patients with COVID-19 in RTCs. Inductive content analysis revealed three overarching themes: "A struggle from beginning to end," "Unexpected challenges," and "Insecure system like a house built on sand."

The first theme, "A struggle from beginning to end," illustrates that participants not only delivered patient care in an unfamiliar environment but also assumed duties beyond their professional scope. They managed every phase of the patients' journey, from admission through discharge, thereby positioning nurses at the core of RTC operations. Although the Korea Disease Control and Prevention Agency (KDCA) provided guidelines delineating role boundaries, these were frequently disregarded in practice. Similar to hospital settings during the pandemic, nurses progressively assumed non-medical duties to sustain operational continuity within the centers [15,16]. This expansion of roles likely stemmed from the urgent necessity to prevent healthcare system collapse and to strengthen infection control measures, rather than to uphold conventional professional demarcations. However, the blurring of professional boundaries had been shown to exacerbate nurse burnout, thereby undermining patient safety and the overall quality of care [17,18]. Moreover, prolonged involvement in tasks beyond the nurses' professional scope has been linked to heightened psychological distress, diminished motivation, and increased workplace conflict [10,15,16]. Considering the protracted nature of the pandemic, cumulative fatigue among nursing staff poses a potential threat to patient safety [19]. Accordingly, the establishment of detailed protocols that clearly define professional roles and responsibilities is imperative for future infectious disease responses.

Despite experiencing significant psychological stress, participants exhibited a strong commitment to their professional nursing roles. Although constrained by the limitations of non-face-to-face monitoring and assessment, they played a pivotal role by actively engaging in patient care and drawing upon prior clinical experience. Similar findings have been reported in hospital settings, where nurses expressed a sense of pride and fulfilment in their work [10,15]. In the context of abrupt environmental changes and public health crises, enhanced interprofessional cooperation and coordination are essential, highlighting the expanded responsibilities of nurses due to their central role in complex care processes [20].

Furthermore, participants underscored the importance of providing emotional support to patients. Previous studies have documented the psychological distress of hospitalised COVID-19 patients [9,16], while patients in RTCs have reported experiences of anxiety and depression [21, 22]. Given that physical symptoms in RTCs were generally milder than those in hospitals, the need for psychological care may have been even greater. A study of quarantined individuals in RTCs reported high levels of satisfaction with emotional support provided by medical staff [2], suggesting that the mental health care function of nurses is likely to become increasingly vital in future infectious disease emergencies.

The second theme, “Unexpected challenges,” highlights the distinctive stressors encountered in RTCs arising from their atypical physical environments and staffing structures. Nurses were frequently required to address various patient requests unrelated to medical issues, including meal dissatisfaction, facility concerns, and documentation inquiries. These non-medical demands had diverted valuable time and resources away from direct clinical care. Although similar challenges have been reported in hospital settings [16,23], the shortage of dedicated support personnel in RTCs exacerbated nurses’ workloads, often compelling them to prioritize complaint management over essential healthcare duties.

In addition, disruptive patient behaviors, ranging from verbal aggression to attempted elopement stemming from misunderstandings of isolation protocols, further complicated care delivery. Kim [4] noted that some patients displayed uncooperative attitudes or attempted to leave the facility in response to perceived infringements of personal rights. The recurrence of such incidents may erode nurses’ motivation and compromise the quality of care, leaving patients with greater needs insufficiently supported. Given that RTC patients generally exhibit milder physical symptoms compared with hospitalized individuals, their non-medical needs tend to be more prominent. Accordingly, future facilities should establish targeted measures, including the deployment of adequate support staff and the enhancement of public education on quarantine regulations, to ensure effective and sustainable care delivery [23].

According to KDCA guidelines, only patients with no comorbidities or mild symptoms were eligible for admission to RTCs; however, approximately 10% required subsequent transfer to hospitals for advanced medical treatment[ 22,24,25]. Owing to the absence of emergency resources and institutional infrastructure, participants expressed considerable anxiety about the possibility of sudden patient deterioration. While hospitals also experienced shortages of essential supplies such as masks and PPE [16], they generally maintained access to alternative resources and personnel support. In contrast, RTCs were required to await hospital acceptance for transfers, often resulting in substantial delays and heightened stress among nursing staff [19]. Although RTCs were designed to manage mild cases, the potential for clinical deterioration [22] underscores the need for comprehensive emergency preparedness protocols [26].

Another significant challenge concerned patient selfmonitoring of vital signs. In hospital settings, PPE-clad nurses conducted direct assessments or utilized remote monitoring systems [9,10]. In RTCs, however, patients were instructed to measure and record their own vital signs using a designated mobile application. Despite initial training, unfamiliarity with the equipment frequently led to measurement errors, necessitating repeated instruction and direct assistance from nurses. Given the operational limitations of RTCs and the necessity for efficient resource utilization, implementing more user-friendly medical devices may improve both patient adherence and the overall effectiveness of care. In this regard, emerging wearable health technologies with integrated monitoring functions offer promising potential for future application in similar care settings [27].

The final theme, “Insecure system like a house built on sand,” captures the difficulties and anxiety nurses faced while working within a hastily established system during the pandemic. One major challenge, also observed in hospital settings, was the frequent revision of operational guidelines [7,8,28]. Continuous updates, combined with inconsistent implementation across different centers, eroded patient trust in healthcare teams and impeded effective management. Participants further expressed concern regarding non-medical staff’s limited understanding of, and compliance with, infection control protocols, fearing that such lapses could contribute to intra-center transmission and operational disruption.

During this global crisis, nurses made considerable personal sacrifices to prevent viral spread, meticulously adhering to PPE protocols and monitoring their own practices [10, 16]. Consequently, they experienced heightened anxiety when working alongside personnel who did not demonstrate similar diligence. Even within hospital environments, non-medical staff often received insufficient training in infection prevention and control [23]. Effective infection prevention extends beyond physical infrastructure to include organizational culture and staff attitudes; when these elements are coherently aligned and infection control is collectively prioritized, the delivery of high-quality care becomes achievable [29]. Therefore, it is essential to provide comprehensive infection control education and training for all support staff, including those not directly involved in patient care.

The management of patient records emerged as a critical area requiring improvement within RTCs. Participants reported that documentation was often disorganized and vulnerable to unauthorized disclosure. In the absence of a dedicated electronic medical record system equivalent to those used in hospitals, nurses devised ad hoc methods to compile and maintain patient information. As nursing records serve not only to document care provision but also to guide subsequent care planning and inform quality improvement initiatives [30,31], the establishment of a standardized and secure record management system is essential. Such a system would enhance data integrity, ensure continuity of care, and ultimately improve the overall quality of nursing practice within RTCs.

This study demonstrated that nurses working in RTCs faced many of the same challenges experienced by hospital- based COVID-19 caregivers, while simultaneously contending with unique difficulties stemming from limited resources and underdeveloped operational systems. Although previous experiences with infectious disease outbreaks contributed to shaping the COVID-19 response, the pandemic’s unprecedented global scale and novel logistical demands required the adoption of new strategies. Given the recurrent emergence of novel pathogens, it is imperative to re-evaluate and reinforce human resources, support mechanisms, and operational protocols for community- based infection control, including RTCs, to ensure effective preparedness for future pandemics.

CONCLUSION

This study examined the experiences of nurses working in RTCs who provided care to patients with COVID-19. While many of the challenges mirrored those faced by hospital- based nurses, distinctive difficulties were also identified, largely stemming from the limited resources and underdeveloped operational systems of RTCs. Effective community- based infection control is crucial during pandemics such as COVID-19; therefore, in the event of future outbreaks, RTCs must be adequately equipped to deliver comprehensive and sustainable care.

This study has several limitations. The sample was small and purposively selected from a limited number of RTCs, and the data were collected after the centers had ceased operation, which may limit the transferability of the findings. Future research should replicate this study with a larger and more diverse sample of RTC nurses to strengthen understanding and inform preparedness strategies for future pandemics.

Despite these limitations, this study provides an important contribution by illuminating the often-overlooked experiences of RTC nurses, whose commitment and professionalism demonstrated a profound sense of duty in responding to the unprecedented challenges of the COVID-19 pandemic.