2.1. Research question

What are the characteristics and interpretations of the inherent structure of the lived world or the perception of oncology nurses regarding MNC during the COVID-19 pandemic?

3.1. Design

This study adopted an interpretive (hermeneutic) phenomenological approach based on Martin Heidegger’s framework to explore the meanings underlying nurses’ lived experiences. This interpretive framework allows for interpreting research elements and exploring the subjective meanings of the individuals involved [19]. We aimed to understand oncology nurses’ experiences regarding MNC during the COVID-19 pandemic rather than extracting their opinions or theoretical viewpoints. Therefore, examining the nurses’ experiences as they were “lived” aligned with the study’s objectives. Standards for Reporting Qualitative Research (SRQR) were used to report the research.

To gain a broader insight, this study was conducted in oncology departments across various hospitals, where there was greater cultural diversity among participants. Oncology departments where adult patients with multiple types of cancer receive chemotherapy or broad-spectrum antibiotics, typically contain one or two isolation rooms. During the COVID-19 pandemic, hematology and oncology patients who tested positive for COVID-19 were occasionally hospitalized in these departments. All patients in the oncology wards were cared for by nurses with at least a Bachelor’s degree. The nurse-to-patient ratio averaged 1:6 during the day and 1:10 during night shifts. Each room consisted of 2–6 beds.

The research involved qualified interviewers with doctoral degrees in nursing and over ten years of experience. They received specialized training to enhance their interview techniques and understanding of ethical principles. Many had prior qualitative research experience, creating a supportive environment for participants. To ensure interview effectiveness, two pilot interviews were conducted. Feedback from these sessions led to discussions among the research team to address potential issues. These qualifications and the iterative refinement process significantly enhance the credibility and quality of the data collected. The interviewer was mindful of possible biases and assumptions related to participants’ experiences. They also had a strong interest in the research topic.

3.2. Participant

Oncology nurses from inpatient departments (N = 14) were recruited using purposive sampling, aiming to include participants with diverse demographic and professional characteristics to achieve maximum variation. Eligible nurses had at least six months of experience providing care to oncology patients during the COVID-19 pandemic, could communicate effectively, and were willing to share their experiences related to the research topic. To ensure depth and richness of the data, arrangements were made to conduct 28 interviews with 14 participants. Sampling continued until no new codes emerged, and data saturation was reached. Purposive sampling methods primarily emphasize saturation, a core concept in interpretive research, meaning that data collection continues until no new relevant information emerges from additional interviews [20]. Participants did not refuse or withdraw at any point. Table 1 presents the demographic details of participants, including age, gender, marital status, number of children, education level, work experience, unit, shift type, and interview durations.

Download:

• PNG
  larger image
• TIFF
  original image

Table 1. Interview guide and sample probing questions.

https://doi.org/10.1371/journal.pone.0336174.t001

3.3. Data collection

The data were collected through in-depth interviews. The interviews were conducted face-to-face in two sessions with each participant, for an average of 36 minutes per session. Data collection was conducted from February 2023 to March 2025. A total of 32 interviews were conducted, including 4 pilot interviews with 2 participants that were excluded, leaving 28 interviews involving 14 participants for the main analysis. To achieve data saturation, an extra 4 interviews were conducted. Since signs of repetition appeared around the 24th interview, these additional sessions helped confirm saturation and strengthen the study’s findings. The interviews were conducted with informed consent and without imposing bias on the participants. Participants’ privacy was protected by using pseudonyms, storing data securely, and ensuring that no identifying information appeared in the transcripts or reports. Before starting the interviews, participants were contacted by phone to ask preliminary questions, which helped them select suitable candidates and determine the interview time and location. Interviews were conducted in a private room within the oncology wards, ensuring a quiet and comfortable environment. Before each interview, the researcher explained the purpose and significance of the study to the participants and assured them of confidentiality to build trust and encourage open communication. At the beginning of each interview, informal questions were used to “unfreeze’. Demographic information was gathered, including gender, age, marital status, education, work experience, and shift type during the pandemic. The interview questions were developed based on the study objectives and the philosophical underpinnings of Heideggerian interpretive phenomenology. A review of the relevant nursing literature on missed nursing care and nurses’ experiences during the COVID-19 pandemic informed the content of the questions. Open-ended and exploratory questions were designed to elicit rich, in-depth narratives about participants’ lived experiences. Three qualitative research experts reviewed the interview guide to ensure clarity and relevance. Table 1 presents examples of the main and probing questions used in the semi-structured interviews.

All the interviews were audio-recorded and transcribed verbatim. Data saturation was established using a systematic approach, where interviews were conducted until no new themes or significant insights emerged. This point was reached after the 24th interview, as responses became repetitive and aligned with earlier data. Ultimately, 28 interviews involving 14 participants were included in the analysis. The collection was concluded once recurring themes were consistently identified and no new information appeared, indicating that a thorough understanding of oncology nurses’ experiences had been achieved.

3.4. Data analysis

Data analysis was conducted concurrently with data collection, following the seven-step process outlined by Diekelmann et al. (1989), grounded in Heideggerian phenomenology. This process began with meticulous transcription of interviews, followed by multiple rounds of review to develop a comprehensive understanding of the context. Each transcript was interpreted to uncover underlying meanings through systematic coding. Team discussions facilitated the identification and evolution of themes, leading to the emergence of new issues. This iterative dialogue among team members allowed for the extraction of both explicit and implicit meanings from the interview texts, encompassing participants’ verbal statements and the overall atmosphere of the interviews.

The primary objective of data analysis was to derive concepts and identify constitutive patterns that encapsulated the central meanings, similarities, and differences of the concepts. Throughout the analysis, a combined analytical approach was employed, synthesizing interpretive summaries to connect identified themes effectively. A draft version of the themes, accompanied by selected excerpts from the interviews, was presented to the analysis team and individuals familiar with the research methodology. Reflexive analysis involved deep contemplation and iterative reflection, emphasizing a hermeneutic movement from parts to the whole and vice versa at all stages of the analysis.

3.5. Trustworthiness

In this study, adherence to the reliability criteria of credibility, dependability, confirmability, and transferability was ensured in accordance with Lincoln and Guba’s (1985) framework [21].

Credibility: The interviews were transcribed promptly by the researcher, with concurrent external review undertaken by the research team at each stage of analysis. Continuous engagement with participants contributed to the validation of identified themes. All interviews were documented in both written and audio formats, with careful measures taken to ensure confidentiality and ethical handling of the data. Participants were assured that their information would be evaluated objectively and impartially, and strict confidentiality was maintained throughout the research process. Furthermore, the alignment of derived themes with current literature in nursing research relevant to the topic was regularly assessed through ongoing data analysis and participant interaction. Dependability: A pilot study involving two participants was conducted to evaluate the clarity and relevance of the semi-structured interview questions, ensuring their suitability for addressing the research objectives. Confirmability: Feedback from the research team regarding the appropriateness of the interview questions and their relevance to the phenomenon under investigation was solicited to support objectivity. Transferability: Detailed demographic data of the participants were collected and systematically described. Additionally, the findings were shared with non-participating nurses to facilitate comparison and enhance contextual transferability. Data coding and theme extraction were managed using MAXQDA software (2020 version).

3.6. Ethical considerations

This article was derived from a specialized doctoral thesis in nursing, which has received approval under the code IR.TBZMED.REC.1401.1032 (Approval Date: 2023.06.02). Permission to access the research environment was also obtained. At the study’s outset, informed and written consents were obtained from each participant. Participants were provided with necessary explanations regarding the procedures and objectives of the study as well as their right to withdraw from participation at any time and in any aspect of the research. Consent was also sought to record the interviews. To uphold the principles of confidentiality and privacy, the names of the participants remained anonymous throughout all stages of the research, and measures were taken to avoid disclosing any information that could lead to the identification of the interviewees. Accordingly, each participant was assigned a unique code. The Declaration of Helsinki complied with all steps of the study.

4.1. Participant’ characteristics

Table 2 presents the participants’ key demographic characteristics. The average age of the group was 38 years, comprising 9 female and 5 male participants. All participants held a university degree, with most having a Bachelor’s degree. The average duration of work experience as a nurse is approximately 11 years.

Download:

• PNG
  larger image
• TIFF
  original image

Table 2. Demographic characteristics of the participants.

https://doi.org/10.1371/journal.pone.0336174.t002

4.2. Main theme

The theme of “fading connections” captures the weakening or disruption of human and professional relationships in nursing during times of crisis, ultimately compromising the delivery of care. In the nursing context, interactions with patients, colleagues, healthcare teams, the community, and the care environment are not merely routine tasks—they form the foundation of professional experience and nursing identity. During the COVID-19 pandemic, however, these essential connections were profoundly challenged and resulted missed nursing care in oncology departments during the COVID-19 pandemic (Fig 1).

Download:

• PNG
  larger image
• TIFF
  original image

Fig 1. Fading Connections and Missed Nursing Care during the COVID-19 pandemic in oncology departments.

https://doi.org/10.1371/journal.pone.0336174.g001

This theme reflects the lived experiences of nurses who, constrained by structural limitations, infection control measures, social distancing, resource shortages, high workloads, and anxiety about personal risk, were compelled to limit their human and professional interactions. While these constraints may superficially appear as a mere “reduction in communication,” they fundamentally signify a disruption in the nurse’s presence in the world of care, as human connection is inseparable from “being a nurse.” The overarching theme of “fading connections” comprises three subthemesand twelve meaning clusters, each illustrating a distinct dimension of this relational breakdown. Information regarding the main theme, sub-themes, and meaning clusters is presented in Table 3.

Download:

• PNG
  larger image
• TIFF
  original image

Table 3. Main theme, sub-themes and meaning clusters obtained from interpretative phenomenological analysis of interviews by oncology nurses in Iran.

https://doi.org/10.1371/journal.pone.0336174.t003

5.1. Missed care behaviors

The sub-theme of missed care behaviors—namely, enforced omission, care shortening, task-oriented care, delayed care, and discontinued care—closely align with existing definitions of missed care throughout the pandemic context. Safdari and colleagues identified hospital nurses’ care during the pandemic as including care provided at inappropriate times, incomplete care, interruptions in care, and improper care [12]. Oncology nurses frequently omitted care due to overwhelming workloads and time constraints, a phenomenon well-documented in nursing literature. Falk et al. reported that staffing shortages and high patient acuity lead to care omissions [23]. Similarly, Albsoul et al. noted that time pressure forces nurses to prioritize essential tasks, often neglecting psychosocial support [24], aligning with participants’ reports of skipping patient conversations. The necessity to restrict interactions due to infection control measures is further supported by Sugg et al., who observed that PPE protocols and nurse’ reluctance to spend extended time with patients out of fear of COVID-19 transmission led to decreased direct patient contact, consequently undermining the comprehensiveness of care [25]. During COVID-19 pandemic, fears of infection and the necessity of social distancing prompted significant alterations in nursing practices [26]. Participants’ reports of task prioritization—such as focus on life-threatening issues—are consistent with findings by Albsoul et al. and Bruyneel et al., who identified an increase in patient volume and resource shortages lead to missed nursing care during COVID-19 crisis [27,28]. Consequently, resuscitative measures received the highest priority among multipronged care indicators, whereas supportive care, close patient monitoring, and management of adverse events ranked lowest [5,29–32]. This divergence may be attributable to the realities imposed by COVID-19, where resource scarcity and workplace pressures—along with emotional, educational, mobility, and hygienic needs of patients—necessitated the rationing of nursing care, thereby challenging the comprehensiveness of patient management [33]. The transition to task-focused care—emphasizing vital signs and medications over comprehensive patient needs—reflects the resource shortages that drive nurses to concentrate on immediate survival tasks during crises. The study’s focus on specific cancer-related priorities, such as chemotherapy management, introduces a level of specificity, demonstrating how patient reliance on critical interventions exacerbates this shift and highlighting the importance of tailored approaches in challenging circumstances. Patterson et al. similarly observed that task prioritization becomes pronounced in limited resources settings, supporting the current findings [34].

Nevertheless, interruptions or prioritization of care are not invariably negative; certain delays may, in fact, enhance patient safety, comfort, and the accuracy of nursing tasks [35]. Task prioritization can thus serve as an effective strategy for managing constrained resources [34]. When nurses are compelled to ration care, they tend to prioritize clinical tasks that directly affect the immediate well-being of the patient [36]. It is noteworthy that the omission of specific aspects of care among oncology nurses is a common phenomenon. These omissions often involve areas not directly related to therapeutic tasks but may carry increased risks and demand more meticulous planning due to their potential adverse outcomes [37].

Interrupted and delayed care due to emergencies and infection control aligns with Fernandez et al., who documented treatment postponements during COVID-19 due to shifting priorities and safety protocols [38]. The oncology context introduces unique risks, as chemotherapy interruptions, as noted by Participant No. 11, could worsen patient outcomes—a concern less emphasized in general nursing studies but critical here due to patients’ immunocompromised status.

This study expands existing literature by highlighting the particular context of oncology nursing, where the immunocompromised status of patients accentuates the consequences of missed care. Sessa et al. emphasized the vulnerability of cancer patients during pandemics and reported higher mortality rates associated with delays in care [39]. The current study’s finding—that deferred treatments have directly affected patient outcomes—supports this view and demonstrates that the harm caused by missed care within oncology settings entails unique implications. Contrasting with the previous cross-sectional studies which focus on the general nursing population, the phenomenological approach here vividly captures the lived experiences of oncology nurses. The absence of prior experience with emergent infectious diseases has influenced both the risk assessments and perceived competence levels of nurses. The unpreparedness for COVID-19 exposed a tendency among nurses to adhere to “doing things the way we always have,” which could have serious implications for pandemic preparedness—potentially neglecting the scientific evidence and best practices related to infectious disease management [40].

Our interpretation indicates that missed care behaviors among oncology nurses during the COVID-19 pandemic should not be understood simply as failures of performance but as deeply human responses to moral and existential conflicts. Nurses’ decisions to omit, delay, or shorten care reflect their attempts to reconcile ethical responsibilities with the constraints of an overburdened system. These behaviors are situated within a lived tension between the desire to provide holistic care and the necessity of self-protection and survival. From a Heideggerian perspective, such experiences represent a struggle of “being-in-care” — where the nurse’s professional identity is challenged by the impossibility of fulfilling the moral duty to care under crisis conditions.

5.2. Isolation in duty

The sub-theme of isolation in duty, encompassing insufficient backing, imbalance in power, stigmatized isolation, and unmet nurse needs, provides a novel contribution to the MNC literature.

The lack of supervisor support reported by participants echoes Shanafelt et al., who highlighted diminished leadership presence during the pandemic as a morale detractor [41]. This study’s finding that unsupported nurses reduced effort aligns with McClelland et al., linking inadequate backing to lower care quality. If nurses do not receive adequate support to uphold their physical, emotional, and psychological well-being as well as their professional integrity, their capacity to provide effective care and support to patients, families, and communities will be significantly impaired [42]. However, the oncology focus reveals a specific vulnerability, as supervisors’ reluctance to engage with COVID-positive units may reflect heightened risk perceptions not as prominent in other specialties.

Participating nurses acknowledged that teamwork among them faced challenges during the COVID-19 pandemic. according to studies, weaknesses in collaboration among team members were cited as a reason for incomplete care and MNC [43,44]. Indeed, the main challenges in fully executing the nursing role during this period included a lack of support from team members and tensions or communication disruptions within the nursing team [17,45,46]. Conversely, one study reported team cohesion during the COVID-19 pandemic [47]. This contradiction may be influenced by varying organizational cultures, particularly the team working atmosphere and standards of a healthy work environment. Process and structural interventions, such as improving teamwork and increasing the number of nurses, could significantly impact the reduction of MNC and service rationing [48]. The lack of opportunities for oncology nurses to participate in decision-making and management’s disregard for staff concerns are key factors contributing to MNC [49]. One study identified nurse managers’ abilities, leadership, and support for nurses as two influential factors in MNC [50]. During the pandemic, nurses perceived operational issues arising from power imbalances between management and frontline staff [51], which could serve as a contributing factor to MNC [9]. Nurse bullying, along with practice models that undermine the autonomy of clinical nurses, and a hierarchical, inflexible approach to nursing leadership, represent critical weaknesses in the nursing field [52]. Shared decision-making between frontline oncology nurses and leadership personnel is an essential component in oncology nursing, which is realized through addressing systemic issues such as staffing, educational opportunities, nurse well-being, and workplace bullying [53].

Also, Tensions with other clinical professionals in the oncology department negatively affect teamwork [54]. Studies show that the nurse-physician relationship and nurse involvement in hospital affairs are significantly associated with MNC [55]. Also, according to the Kalisch model, communication and teamwork are significant external factors that can lead to MNC [56]. In Iran, due to the traditional and unscientific structure of the healthcare system, the relationship between physicians and nurses is hierarchical, and nurses’ opinions regarding nursing care are often overlooked [57]. Power imbalances between nurses and physicians and hierarchical dynamics may hinder collaborative care during crises. Participant P10’s experience of forced care decisions by surgeons’ underscores this, suggesting oncology nurses face unique pressures due to patient complexity, a nuance less explored in broader literature.

In addition to the fading connections with patients and the treatment team, oncology nurses faced stigma as potential virus carriers, leading to feelings of rejection and social isolation Other studies have also shown that nurses experienced stigma both covertly and overtly during the pandemic [40,58,59]. The study’s identification of social stigma as a contributor to isolation (P7) is particularly significant, as it extends beyond the workplace to community interactions. Social stigma leading to isolation mirrors Ramaci et al., who documented healthcare workers’ alienation due to contagion fears [60]. This study’s oncology nurses faced amplified stigma due to their dual role with immunocompromised and COVID-positive patients, a distinct burden compared to findings in less specialized settings. Enhancing media education programs during the pandemic can reduce stigma and improve public awareness about nurses, ultimately boosting healthcare quality.

The current study’s emphasis on nurses’ unmet emotional, protectional, educational, and financial needs during the pandemic, which significantly impacted MNC. Factors related to the emotional health and overall well-being of nurses were consistently identified as the primary influences on incomplete nursing care during the pandemic [61]. The results of the studies indicated that the prevalence of post-traumatic stress disorder, anxiety, depression, and emotional exhaustion among nurses was high during the pandemic [62]. Given the increase in negative emotions throughout the pandemic, providing mental health support should be an essential component of healthcare services for providers during this crisis to ensure effective nursing care and management of the pandemic [63,64]. Previous studies have also reported that perceived adequacy of PPE is a strong predictor of MNC, with nurses who perceived sufficient PPE in their units reporting fewer instances of missed care [65]. Thus, the perceived lack of PPE emerged as a contributing factor to the concerns and fears experienced by nurses [66]. When the physical and emotional safety of nurses is jeopardized, ethical dilemmas emerge. As professionals, nurses hold responsibilities not only towards their patients but also towards themselves, their families, colleagues, and the broader society. Should the working environment undermine this protective framework, moral distress may arise, negatively impacting communication and, consequently, the nurse-patient relationship [67]. Findings from studies also provide evidence for the need to develop the roles of clinical nurse specialists and professional development training programs in oncology due to their potential benefits for nurses, physicians, patients, family members, and the healthcare system [68]. Consequently, enhancing the education and specialization of nurses within healthcare teams, with a particular focus on strengthening certain personality traits to transform them into more effective and efficient therapeutic agents, is of utmost importance [69]. Government acknowledgment of specialized oncology education and involvement in national cancer control planning play a crucial role in strengthening and maintaining the essential workforce of oncology nursing [52]. This matter holds particular significance during pandemics. Enhancing the roles of oncology nurses, coupled with the requisite training and competencies to formally recognize them as care managers across the continuum of cancer care, has the potential to improve the quality of cancer treatment [70]. Improving safety conditions and providing appropriate equipment can help reduce anxiety, enhance the sense of value among nurses, and ultimately improve the quality of care delivered.

Ultimately, income satisfaction and organizational support were among the factors associated with levels of MNC during the COVID-19 pandemic [17]. Disparities in pay and rewards for nurses on the front lines of the COVID-19 battle created a non-supportive work environment that negatively impacted the quality of nursing care [4]. Nurses participating in a study expressed feelings of unfairness due to inequalities in work and benefits compared to other healthcare providers, including physicians, highlighting the disregard for their professional roles in combating the virus [71]. Fernández et al. also stated that nurses require support from governments, policymakers, and nursing organizations to implement measures in their favor during and after a pandemic [38]. Success in new work patterns necessitated supportive relationships, care, and understanding from colleagues and upper management to alleviate negative feelings [72,73].

In general, it is said that results of a study showed that psychological interventions increase participation and reduce conflict factors within the treatment team. Group therapy focused on changing individuals’ responses to stress-inducing situations can engender more adaptive strategies, enabling caregivers, oncology specialists, and nurses to better assist patients and thereby improve their quality of life [74]. Therefore, it is evident that meeting the social and administrative support requirements of oncology nurses within healthcare teams and at the institutional level is crucial.

We interpret the sub-theme of “Isolation in Duty” as a profound manifestation of moral and relational disconnection. The nurses’ experiences reveal that isolation was not only physical but existential, eroding their sense of belonging and professional authenticity. The imbalance of power and lack of managerial and social support reflect an organizational environment that diminished the meaning of care. This isolation disrupted the relational essence of nursing and created an inner sense of alienation, which can be interpreted as a breakdown of the shared “world of care.” From the authors’ perspective, this isolation points to the urgent need for moral resilience, ethical leadership, and institutional empathy within oncology settings, especially during large-scale crises.

5.3. Disruption of care canvas

The disruption of care canvas, driven by a storm of responsibilities, intensified environmental issues, and forced adaptation, underscores systemic barriers to effective nursing care. Oncology nurses faced challenges arising from the transformation in the care environment. Participants’ reports of Increase in the number of patients, emergency within the unit or deterioration of one of the assigned patients, various interruptions during work and high workload align with Kim et al., and Obregón et al., who noted the challenges of caring for patients during pandemics [26,75]. Additionally, the unpredictable situations reported by our participants have also been documented in studies by Safdari et al, and Hosseini et al, [4,5]. Unexpected rise in patient volume and/or acuity in the unit and urgent patient situations were also issues related to missed nursing care that have been reported in other studies during the pandemic [8,23,31,76–80]. This study’s finding of untrained staff managing chemotherapy highlights a unique oncology challenge, extending beyond general shortages to skill mismatches, an area underexplored in prior research.

The shortages of material and human resources reported by oncology nurses in this study align with other studies conducted in Iran during the pandemic, identified as factors contributing to the missed nursing care [4,5,12,81] and reflecting a broader, underlying issue across the healthcare system. In another study, the results indicated that during the COVID-19 pandemic, Iran’s healthcare system also revealed organizational, resource-related, and managerial challenges and barrier [82]. Blackman et al. also identified workload intensity and workload predictability as key factors associated with missed nursing care prior to the pandemic [83]. The ability of healthcare facilities to act and respond underwent significant changes during the global pandemic triggered by the COVID-19 virus [84]. According to studies, the emergence of new priorities within the healthcare system and the increased demand for care were identified as reasons for unfinished nursing care during the pandemic [26,85]. Different types of PPE, and at times the shortage of PPE, may exert additional pressure on nursing staff, leading to increased anxiety regarding both their potential infection and the risk of transmitting the virus to other patients or family members, particularly those on the front lines [86]. The oncology setting highlights a higher-risk environment and underscores an urgent need for both material and human resources, especially in crisis conditions.

Also, participants discussed the obligation to adapt to issues arising from changes in the work environment during the COVID-19 pandemic. Excessive workload, the requirement to work in isolation, the inability to move items in and out of isolation rooms without donning and doffing personal protective equipment (PPE), stress from infection risks [25,26,87], and were identified by nurses as causes of MNC during the COVID-19 pandemic. The emotional impact of disrupted care environments, such as P8’s difficulty assessing patients through masks, introduces a human element not fully explored in prior research. While Kalisch et al. [56] discuss the economic and ethical implications of MNC, they do not address the emotional toll of environmental constraints. The current study’s findings thus bridge a gap in the literature by linking systemic failures to nurses’ lived experiences, supporting calls by Phillips et al. for research to improve cancer care during pandemics [22].

From an interpretive standpoint, the “Disruption of Care Canvas” symbolizes the collapse of the nurses’ familiar world of care, where environmental, temporal, and relational dimensions of nursing practice were fractured. The pandemic transformed the caring space from one of mutual connection to one of constant vigilance and fragmentation. The nurses’ forced adaptation to changing protocols and restricted physical proximity can be seen as a transformation of their caring embodiment — the body as the medium of empathy and presence became shielded and distant. This interpretation highlights how systemic breakdowns are experienced not only operationally but existentially, affecting nurses’ sense of purpose and professional identity.

The study’s findings contribute to nursing theories related to care quality and nurse well-being, particularly Watson’s Theory of Human Caring and the Missed Nursing Care Model. Theoretically, these findings can be applied to refine nursing frameworks by integrating pandemic-specific challenges. For example, Watson’s theory could be adapted to include strategies for maintaining caring relationships under resource constraints, while the Missed Nursing Care Model could incorporate social stigma as a nurse-related factor. These adaptations would enhance the applicability of these theories to oncology nursing during outbreaks, providing a foundation for future research and practice.

Overall, our interpretive analysis suggests that missed nursing care during the pandemic reflects more than a deficit in healthcare systems — it represents an existential struggle to preserve the essence of caring within a fragmented professional world. The fading connections described by oncology nurses embody the loss of relational, moral, and structural harmony that defines authentic nursing practice. By interpreting these experiences through a phenomenological lens, the authors emphasize the need to view nursing not only as a technical act but as an existential commitment to human connection, which must be supported through empathy-based leadership, organizational solidarity, and cultural recognition of nurses’ moral labor.