Factors associated with post-traumatic stress disorder in nurses after directly caring for COVID-19 patients: a cross-sectional study.
COVID-19
Leadership
Nurses
Organizational Culture
Post-traumatic
Stress Disorders
Working Conditions
Journal
BMC nursing
ISSN: 1472-6955
Titre abrégé: BMC Nurs
Pays: England
ID NLM: 101088683
Informations de publication
Date de publication:
24 Aug 2023
24 Aug 2023
Historique:
received:
11
03
2023
accepted:
04
08
2023
medline:
25
8
2023
pubmed:
25
8
2023
entrez:
24
8
2023
Statut:
epublish
Résumé
Nurses are particularly at risk of suffering from post-traumatic stress disorder (PTSD) owing to their overwhelming workload, risk of infection, and lack of knowledge about the coronavirus disease 2019 (COVID-19). PTSD negatively affects an individual's health, work performance, and patient safety. This study aims to assess factors related to PTSD among nurses after providing direct care to COVID-19 patients. This study is a secondary analysis aimed at identifying factors influencing PTSD among nurses who provided direct care to COVID-19 patients. Data from 168 nurses, collected between October and November 2020, were analyzed. The independent variables were personal, interpersonal, and organizational and COVID-19-related factors (experience of quarantine and direct care of COVID-19 patients), and the dependent variables were PTSD symptoms evaluated based on the PTSD Checklist-5. The nurses' experience of direct care for COVID-19 patients in the designated COVID-19 isolation wards during the first wave of the pandemic (February 2020 to May 2020) was included. Among the nurses, 18.5% exhibited symptoms of PTSD. When providing direct care to a patient in the designated COVID-19 isolation ward, nurses witnessing the death of a patient (p = .001), low level of nurse staffing (p = .008), and inconvenience of electronic health records programs (p = .034) were associated with PTSD symptoms. The experience of quarantine owing to COVID-19 was also associated with PTSD symptoms (p = .034). Additionally, the higher the nurse managers' ability, leadership, and support of nurses in the current ward, the higher the possibility of lowering nurses' PTSD symptoms (p = .006). Governments and hospitals should prepare and implement organizational intervention programs to improve nurse managers' leadership, nurse staffing levels, and electronic health records programs. Additionally, because nurses who have witnessed the death of a COVID-19 patient or are self-isolating are vulnerable to PTSD, psychological support should be provided.
Sections du résumé
BACKGROUND
BACKGROUND
Nurses are particularly at risk of suffering from post-traumatic stress disorder (PTSD) owing to their overwhelming workload, risk of infection, and lack of knowledge about the coronavirus disease 2019 (COVID-19). PTSD negatively affects an individual's health, work performance, and patient safety. This study aims to assess factors related to PTSD among nurses after providing direct care to COVID-19 patients.
METHODS
METHODS
This study is a secondary analysis aimed at identifying factors influencing PTSD among nurses who provided direct care to COVID-19 patients. Data from 168 nurses, collected between October and November 2020, were analyzed. The independent variables were personal, interpersonal, and organizational and COVID-19-related factors (experience of quarantine and direct care of COVID-19 patients), and the dependent variables were PTSD symptoms evaluated based on the PTSD Checklist-5. The nurses' experience of direct care for COVID-19 patients in the designated COVID-19 isolation wards during the first wave of the pandemic (February 2020 to May 2020) was included.
RESULTS
RESULTS
Among the nurses, 18.5% exhibited symptoms of PTSD. When providing direct care to a patient in the designated COVID-19 isolation ward, nurses witnessing the death of a patient (p = .001), low level of nurse staffing (p = .008), and inconvenience of electronic health records programs (p = .034) were associated with PTSD symptoms. The experience of quarantine owing to COVID-19 was also associated with PTSD symptoms (p = .034). Additionally, the higher the nurse managers' ability, leadership, and support of nurses in the current ward, the higher the possibility of lowering nurses' PTSD symptoms (p = .006).
CONCLUSIONS
CONCLUSIONS
Governments and hospitals should prepare and implement organizational intervention programs to improve nurse managers' leadership, nurse staffing levels, and electronic health records programs. Additionally, because nurses who have witnessed the death of a COVID-19 patient or are self-isolating are vulnerable to PTSD, psychological support should be provided.
Identifiants
pubmed: 37620908
doi: 10.1186/s12912-023-01431-5
pii: 10.1186/s12912-023-01431-5
pmc: PMC10464410
doi:
Types de publication
Journal Article
Langues
eng
Pagination
282Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in china, 2019. NEJM. 2020;382(8):727–33. https://doi.org/10.1056/NEJMoa2001017 .
doi: 10.1056/NEJMoa2001017
pubmed: 31978945
World Health Organization Coronavirus Dosease (COVID-19.) Dashboard [ https://covid19.who.int/ . Accessed 10 Jan 2023.
Yoo KJ, Kwon S, Choi Y, Bishai DM. Systematic assessment of South Korea’s capabilities to control COVID-19. Health Policy. 2021;125(5):568–76. https://doi.org/10.1016/j.healthpol.2021.02.011 .
doi: 10.1016/j.healthpol.2021.02.011
pubmed: 33692005
pmcid: 7927652
Song X, Fu W, Liu X, Luo Z, Wang R, Zhou N, et al. Mental health status of medical staff in emergency departments during the coronavirus disease 2019 epidemic in China. Brain Behav Immun. 2020;88:60–5. https://doi.org/10.1016/j.bbi.2020.06.002 .
doi: 10.1016/j.bbi.2020.06.002
pubmed: 32512134
pmcid: 7273140
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5) / american Psychiatric Association. Washington: American Psychiatric Publ; 2013.
doi: 10.1176/appi.books.9780890425596
Carmassi C, Foghi C, Dell’Oste V, Cordone A, Bertelloni CA, Bui E, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: what can we expect after the COVID-19 pandemic. Psychiatry Res. 2020;292:113312. https://doi.org/10.1016/j.psychres.2020.113312 .
doi: 10.1016/j.psychres.2020.113312
pubmed: 32717711
pmcid: 7370915
Yunitri N, Chu H, Kang XL, Jen HJ, Pien LC, Tsai HT, et al. Global prevalence and associated risk factors of posttraumatic stress disorder during COVID-19 pandemic: a meta-analysis. Int J Nurs Stud. 2022;126:104136. https://doi.org/10.1016/j.ijnurstu.2021.104136 .
doi: 10.1016/j.ijnurstu.2021.104136
pubmed: 34856503
Zhou T, Guan R, Sun L. Perceived organizational support and PTSD symptoms of frontline healthcare workers in the outbreak of COVID-19 in Wuhan: the mediating effects of self-efficacy and coping strategies. Appl Psychol Health Well Being. 2021;13(4):745–60. https://doi.org/10.1111/aphw.12267 .
doi: 10.1111/aphw.12267
pubmed: 33742781
pmcid: 8250830
Marshall B. Impact of COVID-19 on nurses’ mental health. Issues Ment Health Nurs. 2020;41(10):853–4. https://doi.org/10.1080/01612840.2020.1819083 .
doi: 10.1080/01612840.2020.1819083
pubmed: 32960681
Johnson SU, Ebrahimi OV, Hoffart A. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PLoS ONE. 2020;15(10):e0241032. https://doi.org/10.1371/journal.pone.0241032 .
doi: 10.1371/journal.pone.0241032
pubmed: 33085716
pmcid: 7577493
Marcomini I, Agus C, Milani L, Sfogliarini R, Bona A, Castagna M. COVID-19 and post-traumatic stress disorder among nurses: a descriptive cross-sectional study in a COVID hospital. Med Lav. 2021;112(3):241–9. https://doi.org/10.23749/mdl.v112i3.11129 .
doi: 10.23749/mdl.v112i3.11129
pubmed: 34142675
pmcid: 8223933
Ayalew M, Deribe B, Abraham Y, Reta Y, Tadesse F, Defar S. Post-traumatic stress disorder symptoms and its predictors among healthcare workers following COVID-19 pandemic in Southern Ethiopia: a cross-sectional study. Front Psychiatry. 2021;12:818910. https://doi.org/10.3389/fpsyt.2021.818910 .
doi: 10.3389/fpsyt.2021.818910
pubmed: 35058824
Schuster M, Dwyer PA. Post-traumatic stress disorder in nurses: an integrative review. J Clin Nurs. 2020;29(15–16):2769–87. https://doi.org/10.1111/jocn.15288 .
doi: 10.1111/jocn.15288
pubmed: 32372541
Ayotte BJ, Schierberl Scherr AE, Kellogg MB. PTSD symptoms and functional impairment among nurses treating COVID-19 patients. SAGE Open Nurs. 2022;8:23779608221074651. https://doi.org/10.1177/23779608221074651 .
doi: 10.1177/23779608221074651
pubmed: 35198734
pmcid: 8859481
Jung H, Jung SY, Lee MH, Kim MS. Assessing the presence of post-traumatic stress and turnover intention among nurses post–middle east respiratory syndrome outbreak: the importance of supervisor support. Workplace Health Saf. 2020;68(7):337–45. https://doi.org/10.1177/2165079919897693 .
doi: 10.1177/2165079919897693
pubmed: 32146875
Levi P, Patrician PA, Vance DE, Montgomery AP, Moss J. Post-traumatic stress disorder in intensive care unit nurses: a concept analysis. Workplace Health Saf. 2021;69(5):224–34. https://doi.org/10.1177/2165079920971999 .
doi: 10.1177/2165079920971999
pubmed: 33357068
Moon DJ, Han MA, Park J, Ryu SY. Post-traumatic stress and related factors among hospital nurses during the COVID-19 outbreak in Korea. Psychiatr Q. 2021;92(4):1381–91. https://doi.org/10.1007/s11126-021-09915-w .
doi: 10.1007/s11126-021-09915-w
pubmed: 33788071
pmcid: 8010492
Bae SY, Yoon HJ, Kim Y, Kim J. Posttraumatic stress disorder and related factors among nurses working during the COVID-19 pandemic. J Nurs Manag. 2022;30(5):1096–104. https://doi.org/10.1111/jonm.13615 .
doi: 10.1111/jonm.13615
pubmed: 35403266
pmcid: 9115141
Liao Q, Cowling BJ, Lam WW, Ng DM, Fielding R. Anxiety, worry and cognitive risk estimate in relation to protective behaviors during the 2009 influenza A/H1N1 pandemic in Hong Kong: ten cross-sectional surveys. BMC Infect Dis. 2014;14(1):169–79. https://doi.org/10.1186/1471-2334-14-169 .
doi: 10.1186/1471-2334-14-169
pubmed: 24674239
pmcid: 3986671
Kim J-H, An JA-R, Min P-K, Bitton A, Gawande AA. How south Korea responded to the COVID-19 outbreak in Daegu. NEJM Catalyst. 2020;1(4). https://doi.org/10.1056/CAT.20.0159 .
Cho E, Choi M, Kim EY, Yoo IY, Lee NJ. Construct validity and reliability of the korean version of the practice environment scale of nursing work index for korean nurses. J Korean Acad Nurs. 2011;41(3):325–32. https://doi.org/10.4040/jkan.2011.41.3.325 .
doi: 10.4040/jkan.2011.41.3.325
pubmed: 21804341
Lake ET. Development of the practice environment scale of the nursing work index. Res Nurs Health. 2002;25(3):176–88. https://doi.org/10.1002/nur.10032 .
doi: 10.1002/nur.10032
pubmed: 12015780
Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov. 2013;10(4):206.
Park JE, Kang SH, Won SD, Roh DY, Kim WH. Workbook for assessment in disaster behavioral health. Anxiety and Mood. 2016;11(2):91–105.
Wortmann JH, Jordan AH, Weathers FW, Resick PA, Dondanville KA, Hall-Clark B, et al. Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychol Assess. 2016;28(11):1392–403. https://doi.org/10.1037/pas0000260 .
doi: 10.1037/pas0000260
pubmed: 26751087
Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–98. https://doi.org/10.1002/jts.22059 .
doi: 10.1002/jts.22059
pubmed: 26606250
Lee DH, Gu M, Kwon W, Kim S. A study on reliability and validity of the korean version of PCL-5 (posttraumatic stress disorder checklist for DSM-5) for adults. Korean J Counsel Psychotherapy. 2020;32(2):559–82.
doi: 10.23844/kjcp.2020.05.32.2.559
Salmerón-Gómez R, García Pérez J, López Martín MDM, García CG. Collinearity diagnostic applied in ridge estimation through the variance inflation factor. J Appl Stat. 2016;43(10):1831–49. https://doi.org/10.1080/02664763.2015.1120712 .
doi: 10.1080/02664763.2015.1120712
Cenat JM, Blais-Rochette C, Kokou-Kpolou CK, Noorishad PG, Mukunzi JN, McIntee SE, et al. Prevalence of symptoms of depression, anxiety, insomnia, posttraumatic stress disorder, and psychological distress among populations affected by the COVID-19 pandemic: a systematic review and meta-analysis. Psychiatry Res. 2021;295:113599. https://doi.org/10.1016/j.psychres.2020.113599 .
doi: 10.1016/j.psychres.2020.113599
pubmed: 33285346
Mensinger JL, Brom H, Havens DS, Costello A, D’Annunzio C, Durning JD, et al. Psychological responses of hospital-based nurses working during the COVID-19 pandemic in the United States: a cross-sectional study. Appl Nurs Res. 2022;63:151517. https://doi.org/10.1016/j.apnr.2021.151517 .
doi: 10.1016/j.apnr.2021.151517
pubmed: 35034708
Sahebi A, Yousefi K, Moayedi S, Golitaleb N, Esmaeili Vardanjani A, Golitaleb M. Prevalence of posttraumatic stress disorder among firefighters in Iran: a systematic review and meta-analysis. Iran J Psychiatry. 2020;15(4):358–65. https://doi.org/10.18502/ijps.v15i4.4301 .
doi: 10.18502/ijps.v15i4.4301
pubmed: 33240386
pmcid: 7610073
Cai Z, Cui Q, Liu Z, Li J, Gong X, Liu J, et al. Nurses endured high risks of psychological problems under the epidemic of COVID-19 in a longitudinal study in Wuhan China. J Psychiatr Res. 2020;131:132–7. https://doi.org/10.1016/j.jpsychires.2020.09.007 .
doi: 10.1016/j.jpsychires.2020.09.007
pubmed: 32971356
pmcid: 7489269
Allan SM, Bealey R, Birch J, Cushing T, Parke S, Sergi G, et al. The prevalence of common and stress-related mental health disorders in healthcare workers based in pandemic-affected hospitals: a rapid systematic review and meta-analysis. Eur J Psychotraumatol. 2020;11(1):1810903. https://doi.org/10.1080/20008198.2020.1810903 .
doi: 10.1080/20008198.2020.1810903
pubmed: 33244359
pmcid: 7678680
Tahernejad S, Ghaffari S, Ariza-Montes A, Wesemann U, Farahmandnia H, Sahebi A. Post-traumatic stress disorder in medical workers involved in earthquake response: a systematic review and meta-analysis. Heliyon. 2023;9(1):e12794. https://doi.org/10.1016/j.heliyon.2023.e12794 .
doi: 10.1016/j.heliyon.2023.e12794
pubmed: 36685451
pmcid: 9850193
Adriaenssens J, de Gucht V, Maes S. The impact of traumatic events on emergency room nurses: findings from a questionnaire survey. Int J Nurs Stud. 2012;49(11):1411–22. https://doi.org/10.1016/j.ijnurstu.2012.07.003 .
doi: 10.1016/j.ijnurstu.2012.07.003
pubmed: 22871313
Lake ET, Narva AM, Holland S, Smith JG, Cramer E, Rosenbaum KEF. Hospital nurses’ moral distress and mental health during COVID-19. J Adv Nurs. 2022;78(3):799–809. https://doi.org/10.1016/j.ijnurstu.2012.07.003 .
doi: 10.1016/j.ijnurstu.2012.07.003
pubmed: 34402538
Pan L, Xu Q, Kuang X, Zhang X, Fang F, Gui L, et al. Prevalence and factors associated with post-traumatic stress disorder in healthcare workers exposed to COVID-19 in Wuhan, China: a cross-sectional survey. BMC Psychiatry. 2021;21(1):572–80. https://doi.org/10.1186/s12888-021-03589-1 .
doi: 10.1186/s12888-021-03589-1
pubmed: 34781901
pmcid: 8591965
Foli KJ, Forster A, Cheng C, Zhang L, Chiu YC. Voices from the COVID-19 frontline: nurses’ trauma and coping. J Adv Nurs. 2021;77(9):3853–66. https://doi.org/10.1111/jan.14988 .
doi: 10.1111/jan.14988
pubmed: 34314068
pmcid: 8447369
Shigemura J, Ursano RJ, Kurosawa M, Morganstein JC, Benedek DM. Understanding the traumatic experiences of healthcare workers responding to the COVID-19 pandemic. Nurs Health Sci. 2021;23(1):7–8. https://doi.org/10.1111/nhs.12766 .
doi: 10.1111/nhs.12766
pubmed: 32761839
Vehko T, Hypponen H, Puttonen S, Kujala S, Ketola E, Tuukkanen J, et al. Experienced time pressure and stress: electronic health records usability and information technology competence play a role. BMC Med Inform Decis Mak. 2019;19(1):160–8. https://doi.org/10.1186/s12911-019-0891-z .
doi: 10.1186/s12911-019-0891-z
pubmed: 31412859
pmcid: 6694657
Kang J, Jang YY, Kim J, Han SH, Lee KR, Kim M, et al. South Korea’s responses to stop the COVID-19 pandemic. Am J Infect Control. 2020;48(9):1080–6. https://doi.org/10.1016/j.ajic.2020.06.003 .
doi: 10.1016/j.ajic.2020.06.003
pubmed: 32522606
pmcid: 7834720
Cyr S, Marcil M-J, Marin M-F, Tardif J-C, Guay S, Guertin M-C, et al. Factors associated with burnout, post-traumatic stress and anxio-depressive symptoms in healthcare workers 3 months into the COVID-19 pandemic: an observational study. Front Psychiatry. 2021;12:668278. https://doi.org/10.3389/fpsyt.2021.668278 .
doi: 10.3389/fpsyt.2021.668278
pubmed: 34305675
pmcid: 8295587
Shim E, Tariq A, Chowell G. Spatial variability in reproduction number and doubling time across two waves of the COVID-19 pandemic in South Korea, February to July, 2020. Int J Infect Dis. 2021;102:1–9. https://doi.org/10.1016/j.ijid.2020.10.007 .
doi: 10.1016/j.ijid.2020.10.007
pubmed: 33038555