**1. Introduction**

Spain has one of the best health systems in the world [1] and occupies position 15 in the Global Health Security Index ranking [2]. Nevertheless, data indicate Spain as one of the countries to be most affected by the COVID-19 pandemic, and some experts stress the need to individually evaluate how Spain has responded to this pandemic [3]. While waiting for this evaluation to be made, healthcare professionals lived the consequences of the taken measures first-hand and have witnessed the possible impact on healthcare quality.

COVID-19 is an infectious disease caused by a new kind of coronavirus known as SARS-CoV-2 [4]. This virus is transmitted via direct contact or when an infected person releases droplet while talking, coughing or sneezing [5], and possibly via aerosols [6]. Although some cases are asymptomatic, the virus is initially manifested by mild respiratory symptoms after 4–8 incubation days, and can become clinically serious with pneumonia, multisystem failure, and even death, which occur mainly in people with previous diseases [7].

The first cases of COVID-19 disease were detected in the Hubei Province (China) at the end of 2019. The new coronavirus rapidly spread to other Asian countries and had reached Europe by the end of January 2020. The World Health Organization (WHO) declared a pandemic by SARS-CoV-2 on 11 March 2020, with 118,000 cases in 114 countries [8]. There were more than 152 million infected people and almost 3 million worldwide on 1 May 2021 [9].

**Citation:** Torrent-Ramos, P.; González-Chordá, V.M.; Mena-Tudela, D.; Pejó, L.A.; Roig-Marti, C.; Valero-Chillerón, M.J.; Cervera-Gasch, Á. Healthcare Management and Quality during the First COVID-19 Wave in a Sample of Spanish Healthcare Professionals. *Nurs. Rep.* **2021**, *11*, 536–546. https://doi.org/10.3390/ nursrep11030051

Academic Editors: Richard Gray and Sonia Udod

Received: 11 May 2021 Accepted: 8 July 2021 Published: 13 July 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

SARS-CoV-2 has a limited capacity to produce serious disease and its mortality is estimated at 4.8% (95% CI: 1.00–11.4) [7]. However, its marked capacity to transmit this virus and the rapid growing number of cases in a short time led to an unforeseeable increase in the demand and requirement of infrastructures, as well as human and material resources. This meant that healthcare systems all over the world came to a standstill, which compromised healthcare quality [10].

In Spain, the first imported COVID-19 case was notified on 30 January 2020. The increasing number of COVID-19 cases led the Spanish Government to declare a state of alarm that lasted 3 months and 7 days, from 14 March to 21 June [11]. The state of alarm is a legislative instrument contemplated by the Spanish Constitution, which temporarily concentrates power in governments and allows them to make unilateral decisions. This measure can be taken in exceptional situations, such as natural catastrophes or healthcare crises [12].

The intention of this state of alarm was to stop the virus from spreading and to flatten the curve of contagions [13]. To do so, and according to how the curve of contagions progressed, different physic-social distancing measures were taken while the state of alarm lasted, such as restricting the population's movements to shop and purchase medicines, closing public spaces, wearing masks, confining the population, and not performing any non-essential occupational activity during a 15-day period.

Apart from taking these measures to prevent the virus from spreading, other measures were taken to avoid blocking health services, and to ensure that infrastructures and human and material resources were available [14]. Another approved measure was for public health services to manage private health services. The Spanish Government also centralized purchases of the material resources and personal protective equipment (PPE) needed to prevent professionals from catching the virus while attending COVID-19 patients. Retired healthcare professionals were also authorized to return to work, and final-year nursing and medicine students were contracted to work [15].

All these measures have implied relevant changes in the organization of health services and, specifically, in nursing services. Despite the limited literature available so far on how nursing managers and registered nurses are dealing with the organization of health services to cope with the pandemic, recent studies in Spain show the magnitude of decisions and the speed with which they are being taken. This is due to the overwhelming need to increase the nursing workforce, reorganize the organizational model of care, and ensure the availability of material resources [16,17].

Despite all these measures, accumulated cases went from 4231 to 246,835 in 3 months [18], which pushed the operational capacity of Spanish health services to the limit. Recent studies informed how inpatient units were transformed into intensive care units [19] or how healthcare professionals caught the virus because they had no PPE [20]. Hence, the objective of this study was to assess how healthcare professionals from the Castellón Province (Spain) perceive healthcare quality and management during the first COVID-19 wave.
