|Year : 2022 | Volume
| Issue : 2 | Page : 39-42
COVID-19-Related Stress among Nursing Professionals Working in COVID ICU: A Cross-Sectional Survey
KP Jyotishana, L Gopichandran, Mamta Choudhary
Faculty in Nursing, College of Nursing, AIIMS, New Delhi, India
|Date of Submission||12-Jul-2021|
|Date of Decision||10-Sep-2021|
|Date of Acceptance||22-Sep-2021|
|Date of Web Publication||15-Jun-2022|
AIIMS, New Delhi
Source of Support: None, Conflict of Interest: None
Background: During the pandemic situation of coronavirus disease 2019 (COVID-19), nursing professionals being frontline warriors, need to fight with the disease of unknown dimensions, put efforts to manage misunderstandings among the general population, face health risks for self and family members, and experience challenges to improve professional skills. All these demanding situations act as stressors and can enhance stress among them. Materials and Methods: The cross-sectional survey was conducted using web-based questionnaire. Information was collected from 200 nursing personnel's working in the COVID intensive care unit of selected tertiary care hospitals. The questionnaire used for data collection comprised two sections: First section focused on sociodemographic profile of subjects and the second section included the Psychometric Evaluation of Healthcare Workers' Stress Related to Caring for Patients with a Highly Infectious Disease scale. Results: The result revealed that maximum 57% of the subjects had moderate COVID-19 related stress. The highest stress scores were identified for items: (i) Ethical dilemma as humanitarian visitation is banned due to quarantine measures; (ii) Restrictions on eating and drinking at work; (iii) Feeling overburdened with work; (iv) Limited number of staff allowed access to the isolation room and thus inability to obtain adequate assistance; and v) Feeling breathless with an N95 or P100 face mask. Discomfort caused by protective equipment was the top-most stressor identified by the participants, followed by fear of social isolation and the burden of caring for patients. Conclusions: The hospital administration and nurse managers should continuously monitor the psychological health of Nursing Professionals in this COVID-19 era and plan timely interventions to promote their health.
Keywords: Coronavirus disease 2019, highly infectious respiratory disease, nursing professionals, stress
|How to cite this article:|
Jyotishana K P, Gopichandran L, Choudhary M. COVID-19-Related Stress among Nursing Professionals Working in COVID ICU: A Cross-Sectional Survey. J Appl Sci Clin Pract 2022;3:39-42
|How to cite this URL:|
Jyotishana K P, Gopichandran L, Choudhary M. COVID-19-Related Stress among Nursing Professionals Working in COVID ICU: A Cross-Sectional Survey. J Appl Sci Clin Pract [serial online] 2022 [cited 2022 Jul 4];3:39-42. Available from: http://www.jascp.com/text.asp?2022/3/2/39/347592
| Introduction|| |
Novel coronavirus pneumonia (coronavirus disease 2019 (COVID-19)) formerly caused by CoV-2019 came into existence in 2019. It shares similarity with severe acute respiratory syndrome (SARS) which was first identified in 2003. Although the pathway of transmission is unclear, its mode of spread is human to human transmission through respiratory droplets. The COVID-19 was declared as a pandemic by the WHO on March 11, 2020, because of its rapid transmission and notable effect on the global health-care system.,, As the burden of noncommunicable diseases in developing countries is increasing at faster rate, so do the risk of COVID infection. Being an emerging disease; many clinical dimensions of COVID-19 are still unknown. The role of health care workers in supporting and helping patients in such crisis situations is of paramount importance. However, health-care personnel have to introduce themselves with numerous challenges while being part of the fight against such diseases. These challenges can range from the limited supply of personal protective equipment, inadequate manpower, increase demand of beds and ventilators, rising mortality, risk of transmission of disease to self and family, to much more. Numerous changes were made in the original schedule of hospital staff during pandemic including the caring patient in negative pressure isolation rooms, rotational quarantine shifts for health workers, prolonged working hours, which resulted in considerable physical and mental stress.
Stress at work is regarded as the process of interaction between the individual and the work environment that leads to the assemblage of negative emotions created by the work. Various researches show high stress among hospital staff while dealing with several pandemic situations. During pandemics, hospital staff needs to fight with the disease of unknown dimensions, put efforts to manage misunderstandings among the general population, face health risks for self and family members, and experience challenges to improve professional skills. All these demanding situations act as stressors and enhance stress. Chung and Lou conducted a survey at the time of SARS spread to major stressors among physicians and nurses. The survey found infection control anxiety and patient care burden as major stressors impacting the psychological health of health care workers. Nurses are one of the most vulnerable groups among health care workers to experience stress as they are working as frontline warriors in caring and helping COVID-19 patients. Although many researches,, are quantifying the magnitude of the impact of care of patients with COVID-19 on the psychological health of health-care workers, evidence from the Indian setting is very limited. Thus, the invigilators conducted this survey to assess perceived stress among nurses Professionals working in COVID intensive care unit (ICU).
| Materials and Methods|| |
The cross-sectional survey was conducted from September 2020 to December 2020, using web-based questionnaire. Information was collected from 200 nursing personnel's working in COVID ICU of selected tertiary care hospitals. Eligibility criteria for inclusion included nursing professionals working in COVID ICU since the beginning of the pandemic, who can understand or read the English language and who were willing to participate in the study. New recruits, Contractual employees, and outsourced nursing professions were excluded from the study. Details of the survey website were provided to 212 Nursing Professionals recruited in the study using consecutive sampling techniques. Information received from 200 nursing professionals who completed the survey questionnaire, depicting response rate of 94%, was compiled for analysis.
The questionnaire used for data collection comprised of 2 sections: First section focused on the sociodemographic profile of subjects which included age, gender, marital status, educational level, and years of experience; the second section included the Psychometric Evaluation of Healthcare Workers' Stress Related to Caring for Patients with a Highly Infectious Disease scale developed by Chuang and Lou (2005). This Likert scale consisted of 4 subscales-(a) fear/worry of social isolation (10 items), (b) discomfort caused by protective equipment (8 items), (c) difficulties and anxieties related to infection control (7items) (d) burden of caring for patients (7 items). Each item was rated on a 4-point Likert scale with score ranging from 0 to 3. The score ranged from 0 to 96, where a higher total score indicated severe stress. A total score of 47–96 indicated severe stress, 33–46 indicated moderate stress, 0–32 indicated low stress, and 0 indicated no stress. The content validity index of the scale tested by Chuang and Lou (2005) in their study was 0.92. Chuang and Lou (2005) reported Cronbach's α values 0.84–0.90 for the four sub-scales. In the current study, Cronbach's α value of the complete scale was 0.93, and Cronbach's α value for the subscales ranged from 0.82 to 0.92.
| Results|| |
Information collected from web-based survey was compiled and analyzed using SPSS software (version 21). Sociodemographic variables were analyzed using descriptive analysis and are presented in [Table 1]. Majority 63.5% of the subjects were of the age group from 25 to 30 years and more than half of the subjects were females. Majority of 83% of subjects were postgraduate in nursing and maximum 58% had experience more than 2–5 years. More than half 52% of subjects were unmarried or single. The result revealed that maximum 57% of the subjects had moderate COVID-19 related stress, 34% had Mild stress, while least 9% had severe COVID-19-related stress [Table 2].
|Table 1: Association of COVID-19 related stress with selected sociodemographic variables (n=200)|
Click here to view
|Table 2: Level of COVID-19-related stress among nursing professionals (n=200)|
Click here to view
The comparison of scores of subscales revealed that discomfort caused by protective equipment was the top-most stressor identified by the participants, followed by fear of social isolation and the burden of caring for patients [Table 3]. The mean score of perceived COVID-19 related stress of all 32 items was 33 ± 8. The mean scores of each subscale and ranking are depicted in [Table 3]. The highest stress scores were identified for items: (i) Ethical dilemma as humanitarian visitation is banned due to quarantine measures; (ii) Restrictions on eating and drinking at work; (iii) Feeling overburdened with work; (iv) Limited number of staff allowed access to the isolation room and thus inability to obtain adequate assistance; and (v) Feeling breathless with an N95 or P100 face mask [Table 4]. However least number of participants identified items such as discrimination or exclusion of oneself or one's family by others, no place to stay and no place to live after work, and relatives and friends do not support, such as asking one to refuse to take care of patients with COVID-19 or resign from the job, as stressors.
|Table 4: Perceived COVID-19-related stressors among nursing professionals (n=200)|
Click here to view
The highest mean stress score of 33.18 ± 8.02 was in the age group of 25–30 years. The mean stress score was comparatively more in female participants (33.59 ± 8.21) as compared to their counterparts. Participants with educational qualification of B. Sc. Nursing had more mean stress score of 34.16 ± 9.23 as compared to other groups. Participants with professional experience of > 2–5 years reported higher mean stress score of 33.47 ± 8.00. However, the association of COVID-19 related stress with selected sociodemographic variables was found to be nonsignificant at P < 0.05.
| Discussion|| |
The study was conducted among Nursing Professionals to investigate the COVID-19 related stress while working in COVID ICU, using a web-based survey. The study found that maximum (57%) of the nursing professionals had moderate COVID-19-related stress. AA similar studies found that nurses had higher COVID-related stress as compared to other type of staff in the hospitals.,,,, Other studies also reported in their study that the burden of care of patients with COVID-19 was associated with a higher risk of stress among health care workers, especially nurses.,, reported that nursing professionals experienced heightened stress from the fear of infectious diseases, insufficient isolation-patient-care-systems and ethical dilemmas. Discomfort caused by protective equipment was the highest rate stress subscale by nursing professionals. Ethical dilemma as humanitarian visitation is banned due to quarantine measures and restrictions on eating and drinking at work were the highest scored stressors among nursing professionals, however discrimination or exclusion of oneself or one's family by others and no place to stay and no place to live after work were the least scored stressors. Various studies around the globe had found many stressors such as anxieties related to infection control, discomfort caused by protective equipment, ethical dilemmas while caring for patients with COVID-19, fear of impaired skin integrity following frequent handwashing, etc., adding to stress among health-care professionals.,,,,,,,,, Majority of participants were female (57.5%) and relatively young in the study. Higher stress was reported by the female which suggests that there might be gender differences in terms of psychological reaction while expressing and reporting discomfort. The study had various limitations as the survey was administered online due to pandemics. Therefore, the sampling was web-based, creating the possibility of selection bias. Second, the survey was conducted only in one tertiary care hospital in Delhi, which cannot reflect the whole situation of Nursing Professional stress level while working in COVID ICU.
| Conclusions|| |
The results showed that the majority of Nursing Professionals had moderate levels of stress. Furthermore, over one-quarter of them had mild levels of stress. The COVID-19 pandemic put Nursing professionals in an unprecedented situation and having to work under extreme pressures lead to increase the level of stress. The hospital administration and nurse managers should continuously monitor the psychological health of Nursing Professionals during this COVID-19 era and plan timely interventions to promote their health.
The study was approved by the Institutional Ethical Committee of selected tertiary care hospital.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Monjazebi F, Dolabi SE, Tabarestani ND, Moradian G, Jamaati H, Peimani M. Journey of nursing in COVID-19 crisis: A qualitative study. J Patient Exp 2021;8:1-7.
LoGiudice JA, Bartos S. Experiences of nurses during the COVID-19 pandemic: A mixed-methods study. AACN Adv Crit Care 2021;32:14-26.
Kuo FL, Yang PH, Hsu HT, Su CY, Chen CH, Yeh IJ, et al.
Survey on perceived work stress and its influencing factors among hospital staff during the COVID-19 pandemic in Taiwan. Kaohsiung J Med Sci 2020;36:1-9.
Choudhary M, Sharma K, Sodhi JK. Knowledge regarding preventive measures of coronary artery disease among patient attending out patient departments of selected hospital of Ludhiana city. Int J Healthc Sci 2014;2:60-3.
Mira JJ, Carrillo I, Guilabert M, Mula A, Martin-Delgado J, Pérez-Jover MV, et al.
Acute stress of the healthcare workforce during the COVID-19 pandemic evolution: A cross-sectional study in Spain. BMJ Open 2020;10:e042555.
Chung PY, Lou MF. Health care workers' stress and willingness to care for patients with severe acute respiratory syndrome. Natl Taiwan Univ Hosp J Nurs 2005;3:23-35.
Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. Mental health survey of medical staff in a tertiary infectious disease hospital for COVID-19. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2020;38:192-5.
Restauri N, Sheridan AD. Burnout and posttraumatic stress disorder in the coronavirus disease 2019 (COVID-19) pandemic: Intersection, impact, and interventions. J Am Coll Radiol 2020;17:921-6.
Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 2020;88:901-7.
Yu WC, Lee SH, Yuan SC, Yin YC. Job stress and coping in emergency room nurses confronting severe acute respiratory syndrome crisis. Chung Shan Med J 2007;18:25-41.
Bai Y, Lin CC, Lin CY, Chen JY, Chue CM, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv 2004;55:1055-7.
Huh S. How to train health personnel to protect themselves from SARSCoV-2 (novel coronavirus) infection when caring for a patient or suspected case. J Educ Eval Health Prof 2020;17:10.
Rebmann T, Carrico R, Wang J. Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses. Am J Infect Control 2013;41:1218-23.
Shenal BV, Radonovich LJ Jr., Cheng J, Hodgson M, Bender BS. Discomfort and exertion associated with prolonged wear of respiratory protection in a health care setting. J Occup Environ Hyg 2012;9:59-64.
Zhang Y, Wang C, Pan W, Zheng J, Gao J, Huang X, et al
. Stress, burnout, and coping strategies of frontline nurses during the COVID-19 epidemic in Wuhan and Shanghai, China. Front Psychiatry 2020;11:565520.
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al
. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020 Mar 2;3(3):e203976. doi: 10.1001/jamanetworkopen.2020.3976. PMID: 32202646; PMCID: PMC7090843.
Said Hendy A, Moohamed Aboeid A, Karawan Sallam G, Abboud Abdel Fattah H, Ahmed Abdelkader Reshia F. Predictive factors affecting stress among nurses providing care at COVID-19 isolation hospitals at Egypt. Nurs Open 2021;8:498-505.
Heo YJ, Kim JH, Jeong J, Lee S. Nurses' experience in caring for patients with infectious diseases in a hospital isolated unit. J Korean Assoc Qual Res 2019;4:32-9.
[Table 1], [Table 2], [Table 3], [Table 4]