"Without Filters" Nurse and Healthcare Worker Personal Protective Equipment Injuries and the COVID-19 Experience: An International Social Media Ethnographic Study.

Selfies of nurses and healthcare workers (HCWs) with painful personal protective equipment (PPE) injuries posted to social media provided early warning of the global PPE shortage impact during the COVID-19 pandemic. We aim to describe contextual factors associated with these injuries and describe factors that influenced posting on social media. A social media ethnographic study used purposeful sampling of Instagram posts (selfies/text) from March-October 2020 (170 posts; 26 countries). Posts were coded using focused content analysis to identify contextual factors. Data were reduced to understand and interpret the "essence" of the posts and discern themes. Themes included the following: (1) grueling shifts filled with unimaginable loss; (2) faces forever marked by the physical and emotional scars of COVID-19; (3) the COVID-19 battlefront; (4) dire and unprecedented PPE shortages; (5) pervasive fear (for self, colleagues, and family); (6) extreme emotional and physical consequences; (7) creating a collective voice. Examining injuries within the context of the nurses'/HCWs' experiences provided new insights into the emotional scars, pervasive fears, and extreme emotional and physical consequences. An urgent need exists to address these harms and facilitate recovery. Before addressing emergency preparedness for the next pandemic event, psychosocial support is needed to address the harms incurred during the COVID-19 pandemic. Moreover, it is critical to understand past experiences to truly prepare for future pandemics.