Feelings, Stress, and Coping of Nurses Amidst COVID-19 Outbreak in Saudi Arabia
Keywords:
COVID-19, Saudi Arabia, nurses,, feelings, factors causing stress, coping strategies
Abstract
Background: A year after the COVID-19 pandemic spread around the world, the pandemic is still affecting healthcare systems with an increasing number of infected healthcare workers. Such a unique situation may often result in emotional turmoil, anxiety, depression, and fear, which could lead to resignation and burnout. The study intended to assess the feelings of nurses toward the COVID-19 outbreak; ascertain the factors that cause stress; and determine their coping strategies and factors contributing to coping.
Methods: A descriptive cross-sectional design was utilized to recruit 313 nurses working in the Ministry of Health (Saudi Arabia) hospitals that accommodate COVID-19 patients. The study instrument was adapted and modified from the ”MERS-CoV Staff Questionnaire” and the Brief COPE.
Results: The results showed that female, married, those with a bachelor’s degree, and aged 25–34 years had higher significant coping strategies. On the other hand, Filipino nurses assigned in the Outpatient Department and COVID-19 Isolation Ward had more negative feelings and encountered several factors causing stress but were coping in a better way than others.
Conclusion: Nurses’ commitment to their profession appears to be an intrinsic motivation to continue caring for COVID-19 patients despite the risk of infection. Comfort with religion, spiritual beliefs, and the presence of a support system were the coping strategies used by nurses to ameliorate the stress and negative feelings during the COVID-19 outbreak.
References
[1] World Health Organization. (February 27, 2020). A Joint Statement on Tourism andCOVID-19 – UNWTO and WHO Call for Responsibility and Coordination. WHO.
[2] Al-Mandhari, A., Samhouri, D., Abubakar, A., et al. (2020). Coronavirus disease2019: preparedness and readiness ofcountriesintheeasternMediterraneanregion.Eastern Mediterranean Health Journal, vol. 26, no. 2, pp. 136–137.
[3] Jiang, X., Rayner, S., and Luo, M.-H. (2020). Does SARS-Cov-2 have a LongerIncubation Period than SARS and MERS. Journal of Medical Virology, vol. 92, no. 5,pp. 476–478.
[4] Patel, A. and Jernigan D. (2020). Initial public health response and interim clinical
guidance for the 2019 novel coronavirus outbreak-United States, December 31,2019–February 4, 2020. Morbidity and Mortality Weekly Report, vol. 69, no. 5, pp.140–146.
[5] Diaconu, C. (2020). A novel coronavirus threatens the world. Archives of the BalkanMedical Union, vol. 55, no. 1.
[6] Windarwati, H. D., Ati, N. A. L., Paraswati, M. D., et al. (2020). Stressor, copingmechanism, and motivation among health care workers in dealing with stress due tothe COVID-19 pandemic in Indonesia. Asian Journal of Psychiatry, vol. 56, p. 102470.
[7] Kisely, S., Warren, N., McMahon, L., et al. (2020). Occurrence, prevention, andmanagement of the psychological effects of emerging virus outbreaks on healthcareworkers: rapid review and meta-analysis. BMJ, vol. 369, p. m1642.
[8] Barello, S. and Graffigna, G. (2020). Caring for health professionals in the COVID-19pandemic emergency: toward an “epidemic of empathy” in healthcare. Frontiers inPsychology, vol. 11, p. 1431.
[9] Marton, G., Vergani, L., Mazzocco, K., et al. (2020). 2020s heroes are not fearless:the impact of the COVID-19 pandemic on wellbeing and emotions of Italian healthcare workers during Italy Phase 1. Frontiers in Psychology, vol. 11, p. 2781.
[10] World Health Organization. (April 28, 2020). WHO Calls for Healthy, Safe, and DecentWorking Conditions for All Health Workers Amidst COVID-19 Pandemic. WHO.
[11] Babore, A., Lombardi, L., Viceconti, M. L., et al. (2020). Psychological effects of theCOVID-2019 pandemic: perceived stress and coping strategies among healthcareprofessionals. Psychiatry Research, vol. 293, p. 113366.
[12] Cai, H., Tu, B., Ma, J., et al. (2020). Psychological impact and coping strategiesof frontline medical staff in Hunan between January and March 2020 during theoutbreak of coronavirus disease 2019 (COVID-19) in Hubei, China. Medical ScienceMonitor: International Medical Journal of Experimental and Clinical Research, vol.26, pp. e924171-1.
[13] World Health Organization. (March 18, 2020). Coronavirus Disease (COVID-19) Outbreak: Rights, Roles and Responsibilities of Health Workers, IncludingKey Considerations for Occupational Safety and Health. Retrieved from:https://www.who.int/docs/default-source/coronaviruse/who-rights-roles-responhw-covid-19.pdf?sfvrsn=bcabd401_0[14] Khalid, I., Khalid, T. J., Qabajah, M. R., et al. (2016). Healthcare workers’ emotions,perceived stressors, and coping strategies during a MERS-CoV outbreak. ClinicalMedicine & Research, vol. 14, no. 1, pp. 7–14.
[15] Kim, Y. (2018). Nurses’ experiences of care for patients with the Middle Eastrespiratory syndrome-coronavirus in South Korea. American Journal of InfectionControl, vol. 46, no. 7, pp. 781–787.
[16] Lima, C., Carvalho, P., and Neto, M. (2020). The emotional impact of coronavirus2019-nCoV (new Coronavirus disease). Psychiatry Research, vol. 287, p. 112915.
[17] Huang, L., Lei, W., Xu, F., et al. (2020). Emotional responses and coping strategies innurses and nursing students during Covid-19 outbreak: a comparative study. PLoSONE, vol. 15, no. 8, p. e0237303.
[18] Chen, Q., Liang, M., Li, Y., et al. (2020).Mental health care for medical staff in Chinaduring the COVID-19 outbreak. The Lancet Psychiatry, vol. 7, no. 4, pp. e15–e16.
[19] Raosoft. Sample Size Calculator 2004. Retrieved from http://www.raosoft.com/samplesize.html
[20] Abdo, M. S., Hammad, M. A., Harun, S. N., et al. (2020). Evaluation of knowledge,attitude and practice of healthcare providers towards life-threatening drug-druginteractions in Penang General Hospital, Malaysia. Clinical Epidemiology and GlobalHealth, vol. 8, no. 4, pp. 1253–1258.
[21] Zaidi, S. F., Mgarry, R., Alsanea, A., et al. (2021). A questionnaire-based survey toassess the level of knowledge and awareness about drug–food interactions amonggeneral public in western Saudi Arabia. Pharmacy, vol. 9, no. 2, p. 76.
[22] NovoPsych. (2018). Brief-COPE. Retrieved from: https://novopsych.com.au/assessments/brief-cope/
[23] Bonnie, R. J., Stroud, C., and Breiner, H., et al. (Eds.). (2015). Young adults in the21st century. In Investing in the Health and Well-Being of Young Adults. NationalAcademies Press (US).
[24] Borghuis, J., Denissen, J. J. A., Oberski, D., et al. (2017). Big five personality stability,change, and codevelopment across adolescence and early adulthood. Journal ofPersonality and Social Psychology, vol. 113, no. 4, pp. 641–657.
[25] Shek, D. T. L., Dou, D., and Cheng. M. N. S. (Eds.) (2020). Transition from adolescenceto emerging adulthood. In The Encyclopedia of Child and Adolescent Development(pp. 1–10). Wiley. Retrieved from: https://doi.org/10.1002/9781119171492.wecad325
[26] Huremović, D. (Ed.) (2019). Quarantine and isolation: effects on healthcare workers.In Psychiatry of Pandemics. Springer, Cham. Retrieved from: https://doi.org/10.1007/978-3-030-15346-5_10
[27] Gao, X., Jiang, L., Hu, Y., et al. (2020). Nurses’ experiences regarding shift patterns inisolation wards during the COVID−19 pandemic in China: a qualitative study. Journalof Clinical Nursing, vol. 29, no. 21–22, pp. 4270–4280.
[28] Vagni, M., Maiorano, T., Giostra, V., et al. (2020). Coping with COVID-19: emergencystress, secondary trauma and self-efficacy in healthcare and emergency workers inItaly. Frontiers in Psychology, vol. 11, p. 566912.
[29] Zhang, Y., Wang, C., Pan, W., et al. (2020). Stress, burnout, and coping strategiesof frontline nurses during the COVID-19 epidemic in Wuhan and Shanghai,China. Frontiers in Psychiatry, vol. 11, p. 1154.
[30] Al-Dossary, R., Alamri, M., Albaqawi, H., et al. (2020). Awareness, attitdes,
prevention, and perceptions of COVID-19 outbreak among nurses in SaudiArabia. International Journal of Environmental Research and Public Health, vol.17, no. 21, p. 8269.
[31] Ahn, M. H., Shin, Y. W., Suh, S., et al. (2020). High Work-related Stress and AnxietyResponse to COVID-19 among Healthcare Workers in South Korea: SAVE Study.Retrieved from: https://doi.org/10.31234/osf.io/9nxth
[32] Bettinsoli, M. L., Di Riso, D., Napier, J. L., et al. (2020). Mental health conditionsof Italian healthcare professionals during the COVID−19 disease outbreak. AppliedPsychology: Health and Well−Being, vol. 12, no. 4, pp. 1054–1073.
[33] Salman, M., Raza, M. H., Mustafa, Z. U., et al. (2020). The psychological effects ofCOVID-19 on frontline healthcare workers and how they are coping: a web-basedcross-sectional study from Pakistan. medRxiv. Retrieved from: https://doi.org/10.1101/2020.06.03.20119867
[34] Jones, S., Sam, B., Bull, F., et al. (2017). Even when you are afraid, you stay: provisionof maternity care during the Ebola virus epidemic: a qualitative study. Midwifery, vol.52, pp. 19–26.
[35] Duncan, D. L. (2021). What the COVID-19 pandemic tells us about the need to developresilience in the nursing workforce. Nursing Management, vol. 28, no. 2.
[36] Labrague, L. J., and De los Santos, J. A. A. (2020). COVID−19 anxiety amongfront−line nurses:predictive role of organisational support, personal resilience and socialsupport. Journal of Nursing Management, vol. 28, no. 7, pp. 1653–1661.
[37] Yu, F., Raphael, D., Mackay, L., et al. (2019). Personal and work-related factorsassociated with nurse resilience: a systematic review. International JournalofNursing Studies, vol. 93, pp. 129–140.
[38] Yuan, N., Yang, W. X., Lu, J. L., et al. (2020). Investigation of adverse reactionsin healthcare personnel working in Level 3 barrier protection PPE to treat COVID-19. Postgraduate Medical Journal, vol. 97, pp. 351–354.
[39] Onyeaka, H., Zahid, S., and Patel, R. (2020). The unaddressed behavioral healthaspect during the coronavirus. Cureus, vol. 12, no. 3, p. e7351.
[40] Park, J. S., Lee, E. H., Park, N. R., et al. (2018). Mental health of nurses working ata government-designated hospital during a MERS-CoV outbreak: a cross-sectionalstudy. Archives of Psychiatric Nursing, vol. 32, no. 1, pp. 2–6.
[41] Li, J., Xu, J., Zhou, H., et al. (2021). Working conditions and health status of 6,317front-line public health workers during the COVID-19 epidemic across5 provinces inChina: a cross-sectional study. BMC Public Health, vol. 21, article 106.
[2] Al-Mandhari, A., Samhouri, D., Abubakar, A., et al. (2020). Coronavirus disease2019: preparedness and readiness ofcountriesintheeasternMediterraneanregion.Eastern Mediterranean Health Journal, vol. 26, no. 2, pp. 136–137.
[3] Jiang, X., Rayner, S., and Luo, M.-H. (2020). Does SARS-Cov-2 have a LongerIncubation Period than SARS and MERS. Journal of Medical Virology, vol. 92, no. 5,pp. 476–478.
[4] Patel, A. and Jernigan D. (2020). Initial public health response and interim clinical
guidance for the 2019 novel coronavirus outbreak-United States, December 31,2019–February 4, 2020. Morbidity and Mortality Weekly Report, vol. 69, no. 5, pp.140–146.
[5] Diaconu, C. (2020). A novel coronavirus threatens the world. Archives of the BalkanMedical Union, vol. 55, no. 1.
[6] Windarwati, H. D., Ati, N. A. L., Paraswati, M. D., et al. (2020). Stressor, copingmechanism, and motivation among health care workers in dealing with stress due tothe COVID-19 pandemic in Indonesia. Asian Journal of Psychiatry, vol. 56, p. 102470.
[7] Kisely, S., Warren, N., McMahon, L., et al. (2020). Occurrence, prevention, andmanagement of the psychological effects of emerging virus outbreaks on healthcareworkers: rapid review and meta-analysis. BMJ, vol. 369, p. m1642.
[8] Barello, S. and Graffigna, G. (2020). Caring for health professionals in the COVID-19pandemic emergency: toward an “epidemic of empathy” in healthcare. Frontiers inPsychology, vol. 11, p. 1431.
[9] Marton, G., Vergani, L., Mazzocco, K., et al. (2020). 2020s heroes are not fearless:the impact of the COVID-19 pandemic on wellbeing and emotions of Italian healthcare workers during Italy Phase 1. Frontiers in Psychology, vol. 11, p. 2781.
[10] World Health Organization. (April 28, 2020). WHO Calls for Healthy, Safe, and DecentWorking Conditions for All Health Workers Amidst COVID-19 Pandemic. WHO.
[11] Babore, A., Lombardi, L., Viceconti, M. L., et al. (2020). Psychological effects of theCOVID-2019 pandemic: perceived stress and coping strategies among healthcareprofessionals. Psychiatry Research, vol. 293, p. 113366.
[12] Cai, H., Tu, B., Ma, J., et al. (2020). Psychological impact and coping strategiesof frontline medical staff in Hunan between January and March 2020 during theoutbreak of coronavirus disease 2019 (COVID-19) in Hubei, China. Medical ScienceMonitor: International Medical Journal of Experimental and Clinical Research, vol.26, pp. e924171-1.
[13] World Health Organization. (March 18, 2020). Coronavirus Disease (COVID-19) Outbreak: Rights, Roles and Responsibilities of Health Workers, IncludingKey Considerations for Occupational Safety and Health. Retrieved from:https://www.who.int/docs/default-source/coronaviruse/who-rights-roles-responhw-covid-19.pdf?sfvrsn=bcabd401_0[14] Khalid, I., Khalid, T. J., Qabajah, M. R., et al. (2016). Healthcare workers’ emotions,perceived stressors, and coping strategies during a MERS-CoV outbreak. ClinicalMedicine & Research, vol. 14, no. 1, pp. 7–14.
[15] Kim, Y. (2018). Nurses’ experiences of care for patients with the Middle Eastrespiratory syndrome-coronavirus in South Korea. American Journal of InfectionControl, vol. 46, no. 7, pp. 781–787.
[16] Lima, C., Carvalho, P., and Neto, M. (2020). The emotional impact of coronavirus2019-nCoV (new Coronavirus disease). Psychiatry Research, vol. 287, p. 112915.
[17] Huang, L., Lei, W., Xu, F., et al. (2020). Emotional responses and coping strategies innurses and nursing students during Covid-19 outbreak: a comparative study. PLoSONE, vol. 15, no. 8, p. e0237303.
[18] Chen, Q., Liang, M., Li, Y., et al. (2020).Mental health care for medical staff in Chinaduring the COVID-19 outbreak. The Lancet Psychiatry, vol. 7, no. 4, pp. e15–e16.
[19] Raosoft. Sample Size Calculator 2004. Retrieved from http://www.raosoft.com/samplesize.html
[20] Abdo, M. S., Hammad, M. A., Harun, S. N., et al. (2020). Evaluation of knowledge,attitude and practice of healthcare providers towards life-threatening drug-druginteractions in Penang General Hospital, Malaysia. Clinical Epidemiology and GlobalHealth, vol. 8, no. 4, pp. 1253–1258.
[21] Zaidi, S. F., Mgarry, R., Alsanea, A., et al. (2021). A questionnaire-based survey toassess the level of knowledge and awareness about drug–food interactions amonggeneral public in western Saudi Arabia. Pharmacy, vol. 9, no. 2, p. 76.
[22] NovoPsych. (2018). Brief-COPE. Retrieved from: https://novopsych.com.au/assessments/brief-cope/
[23] Bonnie, R. J., Stroud, C., and Breiner, H., et al. (Eds.). (2015). Young adults in the21st century. In Investing in the Health and Well-Being of Young Adults. NationalAcademies Press (US).
[24] Borghuis, J., Denissen, J. J. A., Oberski, D., et al. (2017). Big five personality stability,change, and codevelopment across adolescence and early adulthood. Journal ofPersonality and Social Psychology, vol. 113, no. 4, pp. 641–657.
[25] Shek, D. T. L., Dou, D., and Cheng. M. N. S. (Eds.) (2020). Transition from adolescenceto emerging adulthood. In The Encyclopedia of Child and Adolescent Development(pp. 1–10). Wiley. Retrieved from: https://doi.org/10.1002/9781119171492.wecad325
[26] Huremović, D. (Ed.) (2019). Quarantine and isolation: effects on healthcare workers.In Psychiatry of Pandemics. Springer, Cham. Retrieved from: https://doi.org/10.1007/978-3-030-15346-5_10
[27] Gao, X., Jiang, L., Hu, Y., et al. (2020). Nurses’ experiences regarding shift patterns inisolation wards during the COVID−19 pandemic in China: a qualitative study. Journalof Clinical Nursing, vol. 29, no. 21–22, pp. 4270–4280.
[28] Vagni, M., Maiorano, T., Giostra, V., et al. (2020). Coping with COVID-19: emergencystress, secondary trauma and self-efficacy in healthcare and emergency workers inItaly. Frontiers in Psychology, vol. 11, p. 566912.
[29] Zhang, Y., Wang, C., Pan, W., et al. (2020). Stress, burnout, and coping strategiesof frontline nurses during the COVID-19 epidemic in Wuhan and Shanghai,China. Frontiers in Psychiatry, vol. 11, p. 1154.
[30] Al-Dossary, R., Alamri, M., Albaqawi, H., et al. (2020). Awareness, attitdes,
prevention, and perceptions of COVID-19 outbreak among nurses in SaudiArabia. International Journal of Environmental Research and Public Health, vol.17, no. 21, p. 8269.
[31] Ahn, M. H., Shin, Y. W., Suh, S., et al. (2020). High Work-related Stress and AnxietyResponse to COVID-19 among Healthcare Workers in South Korea: SAVE Study.Retrieved from: https://doi.org/10.31234/osf.io/9nxth
[32] Bettinsoli, M. L., Di Riso, D., Napier, J. L., et al. (2020). Mental health conditionsof Italian healthcare professionals during the COVID−19 disease outbreak. AppliedPsychology: Health and Well−Being, vol. 12, no. 4, pp. 1054–1073.
[33] Salman, M., Raza, M. H., Mustafa, Z. U., et al. (2020). The psychological effects ofCOVID-19 on frontline healthcare workers and how they are coping: a web-basedcross-sectional study from Pakistan. medRxiv. Retrieved from: https://doi.org/10.1101/2020.06.03.20119867
[34] Jones, S., Sam, B., Bull, F., et al. (2017). Even when you are afraid, you stay: provisionof maternity care during the Ebola virus epidemic: a qualitative study. Midwifery, vol.52, pp. 19–26.
[35] Duncan, D. L. (2021). What the COVID-19 pandemic tells us about the need to developresilience in the nursing workforce. Nursing Management, vol. 28, no. 2.
[36] Labrague, L. J., and De los Santos, J. A. A. (2020). COVID−19 anxiety amongfront−line nurses:predictive role of organisational support, personal resilience and socialsupport. Journal of Nursing Management, vol. 28, no. 7, pp. 1653–1661.
[37] Yu, F., Raphael, D., Mackay, L., et al. (2019). Personal and work-related factorsassociated with nurse resilience: a systematic review. International JournalofNursing Studies, vol. 93, pp. 129–140.
[38] Yuan, N., Yang, W. X., Lu, J. L., et al. (2020). Investigation of adverse reactionsin healthcare personnel working in Level 3 barrier protection PPE to treat COVID-19. Postgraduate Medical Journal, vol. 97, pp. 351–354.
[39] Onyeaka, H., Zahid, S., and Patel, R. (2020). The unaddressed behavioral healthaspect during the coronavirus. Cureus, vol. 12, no. 3, p. e7351.
[40] Park, J. S., Lee, E. H., Park, N. R., et al. (2018). Mental health of nurses working ata government-designated hospital during a MERS-CoV outbreak: a cross-sectionalstudy. Archives of Psychiatric Nursing, vol. 32, no. 1, pp. 2–6.
[41] Li, J., Xu, J., Zhou, H., et al. (2021). Working conditions and health status of 6,317front-line public health workers during the COVID-19 epidemic across5 provinces inChina: a cross-sectional study. BMC Public Health, vol. 21, article 106.
