Mental distress and influencing factors in nurses caring for patients with COVID‐19

Abstract

Background Nurses are experiencing tremendous stress during the new coronavirus disease 2019 (COVID‐19) pandemic, especially intensive care nurses. The pandemic of the disease is a tragedy, which may leave a catastrophic psychological imprint on nurses. Understanding nurses' mental distress can help when implementing interventions to mitigate psychological injuries to nurses. Aims and objectives To quantify the severity of nurses' post‐traumatic stress disorder (PTSD) symptoms and stress and explore the influencing factors of their psychological health when caring for patients with COVID‐19. Design A cross‐sectional survey. Methods The PTSD Checklist‐Civilian and the Perceived Stress Scale were administered from 11 to 18 March 2020, to 90 nurses selected from another city to go and help an intensive care unit (ICU) in Wuhan, China. These nurses were selected because of their high levels of clinical performance and resilience status. Results Nurses' average PTSD score was 24.62 ± 6.68, and five (5.6%) of the nurses reported a clinically significant level of PTSD symptoms (>38 points). Nurses' perceived stress averaged 19.33 ± 7, and 20 nurses (22.22%) scored positively >25 points. Nurses' stress and PTSD symptoms were positively correlated (P < .01). Major stress sources included working in an isolated environment, concerns about personal protective equipment shortage and usage, physical and emotional exhaustion, intensive workload, fear of being infected, and insufficient work experiences with COVID‐19. Conclusions This study showed that even relatively highly resilient nurses experienced some degree of mental distress, including PTSD symptoms and perceived stress. Our findings highlight the importance of helping nurses cultivate resilience and reduce stress. Relevance to clinical practice Recommendations for practice include providing adequate training and orientation before assigning nurses to ICU to help, offering disaster‐emergency‐preparedness training to keep nurses prepared, providing caring and authentic nursing leadership, offering ongoing psychological support to frontline nurses.

Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: A systematic review and meta-analysis

“…Stress was estimated in 40 studies [ 18 , 20 , 25 , 27 , 29 , 33 , 35 , 36 , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] ]. The overall pooled point estimates of prevalence for stress varied between 10% and 84% ( Fig.…”

“…The pooled prevalence according to the month of data collected was as follows: February: 32% ( n = 14; 95% CI 25–41; I2 = 98), March: 45% (n = 6; 95% CI 37–53; I2 = 96) and April: 50% ( n = 13; 95% CI 35–66; I2 = 98). Seventeen studies [ 20 , 35 , 36 , 39 , 43 , 44 , 46 , 54 , [57] , [58] , [59] , [60] , [61] , [62] , [63] , 67 , 69 ] involving nurses who were working on the frontline showed stress prevalence at 46% (95% CI = 39–54; I 2 = 97), whereas 20 studies including mixed nurses working in the frontline and second line showed the stress prevalence was 42% (95% CI = 31–53, I 2 = 99). Thirteen studies that used the Perceived Stress Scale (PSS) showed a pooled prevalence of stress at 50% (95% CI = 41–59, I 2 = 98), whereas eight studies [ 35 , 45 , [54] , [55] , [56] , 63 , 64 , 67 ] using the Impact of Event Scale-Revised (IES-R) had a pooled prevalence of 50% (95% CI = 37–63, I 2 = 99).…”

Prevalence of posttraumatic stress disorder after infectious disease pandemics in the twenty-first century, including COVID-19: a meta-analysis and systematic review

“…Those who lived in a city [43] and previous or current tobacco users [67,71] were also at greater risk. Poor psychological status including higher levels of anxiety and depression [43,51,91,99], poor sleep quality [21,76,79], high stress levels [8,49,51], low levels of distress tolerance [55], neurotic and psychopathic personality [70,78], and any other psychiatric disorder or history [31,35,50,58,61,67,69,73,84,107] all were associated with higher risk of PTSD. In addition to these aspects of an individual's psychological status, personal physical comorbidities [30,39,58,67,71] and PTSD symptoms among their family members were also associated with more risk [75].…”

“…Among healthcare workers, nurses [29,71,74], frontline workers [8,53,65,95,105,108], those working in high-risk community [57], technicians [8], general practitioners [65], nonlocal aid workers supporting the highest-hit areas [92], were all groups at higher risk of developing post-pandemic PTSD. Healthcare workers who had less working experience [8,49,74,91,108], low job satisfaction [83], and longer work shifts [74,92] were at more risk. Feeling fearful of potential harm, death, and life out of control due to the pandemic [102], having a colleague infected/hospitalized/in quarantine/deceased [65,91], and having concerns that a person the healthcare worker lived with may be infected [57] were also associated with healthcare workers being at higher risk.…”

“…Lower level [67,90,97,103] Being a graduating/final year student [79,97] Living in a city [43] Smoker [67,71] Physiological and psychological comorbidity or history Comorbidity: anxiety [43,51,91,99], depression [43,51,91,99], poor sleep quality [21,76,79], higher stress level [8,49,51], having physical comorbidity [30,39,58,67,71] History: psychiatric or neurological disorder history [31,35,50,58,61,67,69,73,84,107], neurotic and psychopathic personality [70,78], low distress tolerance [55], trauma or adverse experience history [99,107] experiences [51] Family member having higher PTSD score [75] Inappropriate coping strategy High internet addiction [51] or anxiolytic substances use…”