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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 2  |  Issue : 2  |  Page : 61-67

The psychological status investigation on the nursing staff in a 3A-level hospital during the prevalence of COVID-19 and the analysis of its influencing factors


1 School of Nursing, Lanzhou University, Lanzhou, Gansu, China
2 Department of Liver Diseases, Lanzhou University Second Hospital, Lanzhou, Gansu, China
3 Department of EICU, Lanzhou University Second Hospital, Lanzhou, Gansu, China
4 School of Nursing, Lanzhou University; Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China

Date of Submission22-Apr-2020
Date of Decision26-Apr-2020
Date of Acceptance02-May-2020
Date of Web Publication08-Jul-2020

Correspondence Address:
Xin-Man Dou
Department of Nursing, Lanzhou University Second Hospital, No. 82, Cuiyingmen, Lanzhou 730030, Gansu
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jin.jin_25_20

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  Abstract 


Objective: The objective of the study is to investigate the psychological status of nursing staff both working on nonfront line and on the front line during the epidemic period of COVID-19 and to analyze the influencing factors related to mental health state, as well as to provide targeted psychological intervening measures for nursing staff in the face of this major public health event.
Methods: We used data from January 28, 2019, to February 08, 2020, on the number of cases who worked in the 3A-level hospital as nonfront-line nurses (n = 29, 54%) and those who worked in Wuhan infectious hospital as the front-line supporters (n = 25, 46%) came from the 3A-level hospital. The participants completed the symptom checklist 90, and the researchers recorded data on demographics, psychological status, and the influencing factors.
Results: In our baseline scenario, we estimated that the total symptom index was 1.676 ± 0.654 for nurses who worked on the front line, 1.260 ± 0.304 for those who worked as the front-line reserve nurses, and was 1.486 ± 0.647 for those who worked as the nonfront-line nurses. The results of correlation analysis show that the factors related to the psychological status of nurses include age, professional title, marital status, and family support; different factors have different effects on psychological status.
Conclusion: In the face of major public health emergencies, both front-line nursing staff and nonfront-line staff are confronted with different degrees of psychological stress, so effective psychological support should be given to improve the working efficiency and enthusiasm of nurses.

Keywords: COVID-19, front-line nurses, influencing factors, psychological status, reserve force


How to cite this article:
Chen HX, Pei JH, Wang XL, Nan RL, Dou XM. The psychological status investigation on the nursing staff in a 3A-level hospital during the prevalence of COVID-19 and the analysis of its influencing factors. J Integr Nurs 2020;2:61-7

How to cite this URL:
Chen HX, Pei JH, Wang XL, Nan RL, Dou XM. The psychological status investigation on the nursing staff in a 3A-level hospital during the prevalence of COVID-19 and the analysis of its influencing factors. J Integr Nurs [serial online] 2020 [cited 2021 Sep 16];2:61-7. Available from: https://www.journalin.org/text.asp?2020/2/2/61/289189




  Introduction Top


COVID-19 is the major public health emergency that has attracted great attention from the World Health Organization and all over the world[1],[2] not only because of its property of high infectivity and high fatality rate but also the diversity and uncertainty of clinical manifestations.[3],[4],[5],[6] After the outbreak of the COVID-19 epidemic, hospitals have become the main locations to receive and treat infected patients.[7] In China, medical staff from all over the country arrived at Wuhan as the supporters at the beginning of outbreak and became the backbone in the fight against the epidemic. On the one hand, nursing staff has a high risk of being infected while caring the infected patients. On the other hand, the growing number of patients leads to a shortage of nursing resources. In this situation, long work hours and heavy workload make the nurses suffer from psychological disorders.[8] Some studies have reported the psychological status of the front-line nurses fighting COVID-19 and pointed out that most of them had stress reactions, which are mainly manifested as anxiety, terror, interpersonal sensitivity, and other psychological problems.[9]

In this study, we provide some relevant demographic data and psychological status of nonfront-line and the front-line nurses and analyze the influencing factors of these psychological issues. This study presented to hospital managers that the nurses working on the front-line need to receive psychological intervention, as well as to a portion of nonfront-line nurse staff.


  Methods Top


Data sources

The current study was conducted between January 28, 2019, and February 08, 2020, in a 3A-level hospital in China. The 54 participants were nurses who worked in the 3A-level hospital as the front-line reserve personnel (n = 15, 28%), duty nurses/nonfront-line nurses (n = 14, 26%) in general departments, and who worked in Wuhan infectious hospital as the front-line supporters (n = 25, 46%) came from the 3A-level hospital. All participants completed the symptom checklist-90 (SCL-90).[10] The researchers recorded data on demographics, psychological status, and influencing factors.

Ethical considerations

The questionnaire survey was conducted anonymously, and the purpose and significance of the survey were informed to the participant before the survey. We also promised that all information would just be used for research and keep strictly confidential.

Measurement

In this study, general information questionnaire made by researchers and SCL-90 compiled by an American psychologist Derogatis in 1975 were used for psychological test to assess the actual psychological status of participants in the current or recent week. SCL-90 includes nine dimensions of somatization, which are compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, fear, paranoia, psychosis, and one other factor including diet, sleep. The 5-grade scoring method was adopted, 1 = none, 2 = mild, 3 = moderate, 4 = severe, and 5 = quite serious. There are no rigid rules to the definition of “mild, moderate and severe,” just was understood by the individuals themselves.

Research workers recorded data on demographic characteristics (age, gender, professional title, identity of the personnel, marital status, education background, job category, and family support), as shown in [Table 1], and the symptom scores on each dimension.
Table 1: Demographic data

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Statistical analysis

The collected data were entered using EpiData 3.02 by two researchers to establish a database. We used SPSS 25.0 for statistical analysis (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). The logistic ordered regression model and logistic regression model were used to analyze the influencing factors related to mental health status of nurses.


  Results Top


Among the front-line nurses, 10 (40%) of the nursing staff thought that they needed psychological support. According to the national norm, 19 (76%) nurses' habit in diet and sleep changed; 17 (68%) nurses had mild somatization; 14 (56%) nurses developed severe obsessive-compulsive symptoms; 7 (28%) nurses reported various levels of hostility; 6 (24%) nurses experienced mild depression; and 5 (20%) nurses had moderate-to-severe somatic symptoms, manifested as obvious physical discomfort, such as headache and lumbago. Two (8%) showed significant anxiety and two (8%) showed significant interpersonal sensitivity; there were 10 (40%) person-times of the front-line nursing staff with abnormal factors such as fear, paranoia, and psychosis.

Overall, there were 13 (52%) nurses whose total symptom index was between 1.5 and 2.5, indicating some mild symptoms that occurred infrequently. Three were 12% of the nurses whose total symptom index was between 2.5 and 3.5, indicating that these nurses had more severe and frequent symptoms. Comparing with reserve staff and nursing staff in general departments, the total symptom index of front-line nursing staff was higher (P < 0.05), as shown in [Table 2] and [Table 3].
Table 2: Symptom checklist 90 factors of front-line nurses, reserve nurses, and nonfront-line nurses

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Table 3: Total symptom index of front-line nurses, reserve nurses, and nonfront-line nurses

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Among front-line reverse nurses, 2 (13%) nurses considered that psychological support was needed; 12 (80%) nurses had mild somatization; and 9 (60%) nurses had minor and less frequent changes in their eating and sleeping status. One (6.7%) developed severe obsessive-compulsive symptoms.

Among nonfront-line nurses working in general wards, 6 (43%) of them thought that they needed psychological support; 11 (78%) nurses had a slight change in their eating and sleeping status; 10 (71%) nurses had mild somatization; 4 (29%) nurses had obsessive-compulsive symptoms range from moderate to severe; depression occurred in 2 (14%) nurses; 1 (7%) had severe physical discomfort; and 1 (7%) showed a predisposition to anxiety.

The results of influencing factors analysis are shown in [Table 4]. The occurrence of obsessive-compulsive symptoms is associated with age, professional title, level of family support for the current work, and the current departments they work in. Age between 41 and 50-year-old, primary title, family attitude of neutrality, general wards work, and thought they do not need psychological support are the independent risk factors for the obsessive-compulsive symptoms. [Table 5] shows that interpersonal sensitivity is closely related to marital status, family attitude toward the current work, and the need for psychological support. Unmarried status, family's neutral attitude, and self-belief that psychological support is not needed are independent risk factors for interpersonal sensitivity. As is shown in [Table 6], the occurrence of depression is related to age and professional title. Age between 41 and 50 years and primary and intermediate professional titles are independent risk factors for depression. As shown in [Table 7], the occurrence of anxiety is closely bound up with marital status, family attitude, and psychological support needs. Unmarried status, family neutral attitude, and self-belief that psychological supports are not needed are independent risk factors for anxiety. Both professional title and psychological support needs are related to the score of total symptom index, while the primary professional title and the ones who believe that they did not need psychological support are the independent risk factors to the total symptom index, shown in [Table 8]. As is shown in [Table 9], both family attitude and psychological support needs are related to fear, while psychological support needs are related to paranoia.
Table 4: Logistic regression analysis of risk factors for obsessive-compulsive symptoms

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Table 5: Logistic regression analysis of risk factors for interpersonal sensitivity

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Table 6: Logistic regression analysis of risk factors for depression

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Table 7: Logistic regression analysis of risk factors for anxiety

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Table 8: Logistic regression analysis of risk factors for total symptom index

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Table 9: Logistic regression analysis of risk factors for fear and paranoia

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  Discussion Top


Psychological reactions of nursing staff to the COVID-19 epidemic

In the three nursing groups participating in this study, there are various degrees of psychological stress reaction, manifested as the discomfort of somatization, compulsive symptoms, sensitive interpersonal relationships, depression, anxiety, hostility, terror, paranoia, psychosis, and changes of diet and sleep pattern in daily life.

The mental health status of the front-line nurses fighting the COVID-19 epidemic

The outbreak of the COVID-19 epidemic is a disaster. Psychological quality is the basis of an effective response to disaster relief. The occurrence of a disaster will have a huge impact on the psychology of each individual. Individuals who involve in the disaster will have an emotional response and tend to have a high risk of mental health problems,[9],[11] which is consistent with the results of this study. Among front-line nurses, scores for abnormal factors such as physical symptoms, obsessive-compulsive symptoms, sensitive interpersonal relationships, and changes in sleep pattern and diet are higher than those of nonfront-line ones. On the one hand, the appearance of physical symptoms in front-line nurses may be related to high-intensity and overloaded work; on the other hand, this may be related to changes in their dietary patterns and rest rhythms and a long time of wearing airtight isolation clothing to save protective equipment. The presence of obsessive-compulsive symptoms is related to psychological stress of afraid of being infected for front-line nurses face numerous confirmed infected cases directly. Abnormal interpersonal relationships and abnormal sleep and diet may be closely related to the face of unfamiliar environments and other unfamiliar medical workers.[12]

Mental health status of nonfront-line support nursing staff

The COVID-19 has a characteristic of a wide area of infection, strong infectivity, and diversity of transmission. Facing the situation of epidemic outbreak, nonfront-line nurses also generally have different degree of psychological stress, with an abnormality in physical symptoms, obsessive-compulsive symptoms, sensitive interpersonal relationships, and changes of sleep and diet. This indicates that psychological stress and poor response in the face of major public health emergencies are common among nursing staff, which should be taken seriously. The score of the terror factor is higher than that of front-line nursing staff, which may be related to the lack of protective equipment compared to the front-line nursing staffs. It can be seen that under the current epidemic situation, the mental health of nursing staffs in ordinary wards should be paid attention to.

Analysis of psychological stress-related factors of nursing staff

When engaged in anti-infection-related work, health-care workers are at risk of being infected. A previous research[13] has shown that this concern is the most potent cause of stress. In addition, this study shows that physical and psychological stress responses are also closely related to age, job title, marital status, and family support. (1) As women grow older, changes in hormone levels in the body can cause a series of emotional reactions,[14] leading to compulsive symptoms in older ones. (2) Nursing staff with primary and middle titles are more vulnerable to psychological stress, and depression is more likely to occur to them under high pressure comparing to nursing staff with senior professional titles.[15] (3) Unmarried individuals are more likely to have psychological problems such as anxiety than married, which may related to the degree of the family support system. (4) Family members' attitude toward the nursing staff's work is negatively related to the generation of psychological stress. A strong family support system can promote the nursing staff to have more courage to face the disaster and strengthen their determination to overcome disaster.

Strategies to improve the psychological coping ability of nursing staff

First, strengthen the training of psychological ability and psychological support in the face of major public health emergencies. The current epidemic situation is serious, and a large number of nursing staff need to be deployed for front-line anti-epidemic work. However, the total number of nursing resources in China is currently relatively insufficient, and the ratio of doctor to nurse is imbalanced. Front-line nurses and general department nurses both face great occupational stress. Studies have shown that work stress can affect the physical and mental health of nurses, reduce the enthusiasm of the nurses, produce fatigue, and affect the quality of work.[16],[17] Therefore, hospitals need to conduct comprehensive psychological stress training for all nursing staff in a timely manner and develop a targeted psychological support plan. Studies[18],[19],[20] have shown that mindfulness decompression training can effectively improve mood and reduce stress, burnout, and anxiety. For nurses who are older, junior to intermediate professional titles, unmarried, and have poor family support, it is necessary to provide in psychological comfort and support, to keep abreast of the psychological status of such nurses, and to provide psychological intervention when necessary.

Second, strengthen the training of emergency response ability for major public health emergencies. According to the analysis of questionnaire entries, 35% of nursing staff are worried that it will be difficult to complete the task. It can be seen that in this epidemic, the lack of knowledge and skills related to infection is one of the factors causing the change of mental health status of nursing staff. Therefore, the hospital conducts relevant knowledge and skills training in a timely manner and through intensive exercises to make the nursing staff proficient in relevant skills and has the ability to respond to major public health emergencies. Through training, the nursing staff's confidence in the competence of the work can be strengthened, while their anxiety and psychological stress can be reduced and alleviated.


  Conclusion Top


In this study, the SCL-90 scale was used to evaluate the mental health of nursing staff in the 3A-level hospitals during the period of the COVID-19 epidemic. It is both the front-line nurses fighting the epidemic and the general ward nurses that face different levels of psychological stress. Through correlation analysis, the factors affecting the mental health of nursing staff in the face of major public health emergencies are summarized, and the aim is to provide a reference for psychological support for nursing staff in epidemic prevention and control. The limitation of this study is that due to the influence of the epidemic situation, the data of questionnaires were used to collect on line instead of face-to-face method. In addition, the selection of research subjects may have sample selective shifts and lack of multicenter data support. Moreover, more clinical studies of psychological support programs are needed to refine emergency psychological training for major public health emergencies.

Financial support and sponsorship

This work was supported by the Lanzhou city science and technology project: Psychological Intervention Study of COVID-19 Isolation and Protection Medical Workers by Mindfulness Behavior Delivery.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zhu N, Zhang D, Wang W, et al. Anovel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33.  Back to cited text no. 1
    
2.
World Health Organization. Statement on the Second Meeting of the International Health Regulations. Emergency Committee Regarding the Outbreak of Novel Coronavirus (2019-nCoV). World Health Organization; c2005. Available from: https://www.who.int/news-room/detai l/30-01-2020-statement-on-the-second-mee ting-of-the-international-health-regulat ions-(2005)-emergency-committee-regar ding-the-outbreak-of-novel-coronav irus-(2019-ncov). [Last accessed on 2020 Jan 30].  Back to cited text no. 2
    
3.
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 3
    
4.
Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199-207.  Back to cited text no. 4
    
5.
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.  Back to cited text no. 5
    
6.
Sohrabi C, Alsafi Z, O'Neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020;76:71-6.  Back to cited text no. 6
    
7.
Muller MP, Siddiqui N, Ivancic R, et al. Adenovirus-related epidemic keratoconjunctivitis outbreak at a hospital-affiliated ophthalmology clinic. Am J Infect Control 2018;46:581-3.  Back to cited text no. 7
    
8.
Brooks SK, Dunn R, Sage CA, et al. Risk and resilience factors affecting the psychological wellbeing of individuals deployed in humanitarian relief roles after a disaster. J Ment Health 2015;24:385-413.  Back to cited text no. 8
    
9.
Brooks SK, Dunn R, Amlôt R, et al. Social and occupational factors associated with psychological wellbeing among occupational groups affected by disaster: A systematic review. J Ment Health 2017;26:373-84.  Back to cited text no. 9
    
10.
Wang ZH, Ye Y, Shen Z, et al. An analysis of the evaluation results of symptom checklist 90 for female medical workers. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2018;36:745-8.  Back to cited text no. 10
    
11.
Dückers ML, Thormar SB, Juen B, et al. Measuring and modelling the quality of 40 post-disaster mental health and psychosocial support programmes. PLoS One 2018;13:e0193285.  Back to cited text no. 11
    
12.
Suleiman K, Hijazi Z, Al Kalaldeh M, et al. Quality of nursing work life and related factors among emergency nurses in Jordan. J Occup Health 2019;61:398-406.  Back to cited text no. 12
    
13.
Su TP, Lien TC, Yang CY, et al. Prevalence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak: A prospective and periodic assessment study in Taiwan. J Psychiatr Res 2007;41:119-30.  Back to cited text no. 13
    
14.
Toffol E, Heikinheimo O, Partonen T. Hormone therapy and mood in perimenopausal and postmenopausal women: A narrative review. Menopause 2015;22:564-78.  Back to cited text no. 14
    
15.
Yang H, Thompson C, Bland M. The effect of clinical experience, judgment task difficulty and time pressure on nurses' confidence calibration in a high fidelity clinical simulation. BMC Med Inform Decis Mak 2012;12:113.  Back to cited text no. 15
    
16.
Burns C, Harm NJ. Emergency nurses' perceptions of critical incidents and stress debriefing. J Emerg Nurs 1993;19:431-6.  Back to cited text no. 16
    
17.
Botha E, Gwin T, Purpora C. The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: A systematic review of quantitative evidence protocol. JBI Database System Rev Implement Rep 2015;13:21-9.  Back to cited text no. 17
    
18.
Smith SA. Mindfulness-based stress reduction: An intervention to enhance the effectiveness of nurses' coping with work-related stress. Int J Nurs Knowl 2014;25:119-30.  Back to cited text no. 18
    
19.
Reive C. The biological measurements of mindfulness-based stress reduction: A systematic review. Explore (NY) 2019;15:295-307.  Back to cited text no. 19
    
20.
Kulka JM, De Gagne JC, Mullen CK, et al. Mindfulness-based stress reduction for newly graduated registered nurses. Creat Nurs 2018;24:243-50.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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