Stress of conscience of COVID-19 among perianaesthesia nurses having worked in a COVID-ICU during the coronavirus pandemic: an international perspective

Abstract

Background Several studies have reported that working in a COVID-ICU impacted nurses’ mental well-being. Yet little is known about how perianaesthesia nurses who have been working in a COVID-ICU perceived their stress of conscience. The aim of this study was to: (1) describe and compare stress related to troubled conscience among perianaesthesia nurses in three countries who have been working in a COVID-ICU during the pandemic, (2) compare their levels of troubled conscience between working in a COVID-ICU and their usual workplace, and (3) compare nurses that usually work in an ICU department with nurses who usually work outside of the ICU. Methods A descriptive, international cross‐sectional online survey including the Stress of Conscience Questionnaire (SCQ) was distributed between organizational member countries of the International Collaboration of PeriAnaesthesia Nurses. Results A total of 246 nurses from three countries participated. Significant differences were found in stress of conscience when working in the Covid-ICU between Sweden 31.8 (8.6), Denmark 23.1 (8.6), and Netherlands 16.4 (6.5) p < 0.001. Significant differences were also found between nurses working in a COVID-ICU in contrast with their usual workplace: 23.1(5.6) versus 17.7(5.3), p < 0.001. The most stressful aspect of conscience reported was that work in the COVID-ICU was so demanding, nurses did not have sufficient energy to be involved with their family as much as they desired. No statistical differences were found between nurses that usually work in an ICU department with nurses who usually work outside of the ICU. Conclusion The COVID-19 pandemic has negatively impacted stress of conscience among nurses working in the COVID-ICU. Swedish nurses were found to be more significantly impacted. This could be related to low numbers of existing ICU beds and ICU nurses prior to the pandemic necessitating a longer time required for working in a COVID-ICU. Stress of conscience also increased when working in the Covid-ICU compared to working in the usual workplace, and the most stressing aspect reported was that COVID-ICU work was so demanding that nurses did not have the energy to devote themselves to their family as they would have liked.

Moral Distress among Frontline Physicians and Nurses in the Early Phase of COVID-19 Pandemic in Italy

“…Then, the SCQ was validated in Finnish showing a two-factor solution with items that were inconsistent with those of the original validation [ 37 ]. Likewise, more recently, the SCQ was adapted to the Dutch context to investigate moral distress among nurses working in direct contact with COVID-19 patients, showing results like those obtained in the Finnish context [ 29 ]. Although two factors were identified, most studies have opted to show and interpret the result of the SCQ as a total sum score of all items without using the subscales [ 34 , 35 ].…”

“…We decided to adopt this measure because recent work by Nillson et al, demonstrated that SCQ was an especially promising measure for assessing moral distress among nurses working in direct contact with COVID-19 patients. The authors found that nurses from three different countries (i.e., Sweden, Denmark, and the Netherlands) reported greater stress of conscience when called to perform unfamiliar tasks compared to those working in their usual wards, indicating that this measure could be particularly suitable to reveal moral distress arising from the change in duties during the pandemic [ 29 ]. The authors also found considerable differences across countries and called for more research on this topic in other nations [ 29 ].…”

“…The authors found that nurses from three different countries (i.e., Sweden, Denmark, and the Netherlands) reported greater stress of conscience when called to perform unfamiliar tasks compared to those working in their usual wards, indicating that this measure could be particularly suitable to reveal moral distress arising from the change in duties during the pandemic [ 29 ]. The authors also found considerable differences across countries and called for more research on this topic in other nations [ 29 ]. Then, by providing a first Italian adaptation of the SCQ, we addressed this call while testing how and when the change in duties during the pandemic affected the psycho-physical well-being of healthcare professionals in direct contact with COVID-19 patients.…”

“…Thus, it would be desirable to provide the scientific community with further instruments to select the most suitable tool for different medical settings. Based on recent literature and item characteristics, the SCQ can be considered a promising instrument to detect moral distress despite the medical specialties considered [ 29 ].…”

Psychosocial factors associated with career success among nurses: A latent profile analysis

“…they are unable to support high-quality care; Heikkila et al, 2022). The stress of conscience refers to the pressure caused by the uneasiness felt when failing to comply with one's conscience (Nilsson et al, 2022).…”