The Relationship between Emotional Reactions and Coping Strategies of Nurses during the Outbreak of COVID-19 in Ganjavian Hospital in Dezful in 2020

1. INTRODUCTION

As providers of direct care for patients, nurses encounter numerous risks and stressful occasions in their professional activities. One of them is exposure to infectious diseases that can cause severe damage and stress and disrupt health care [1]. Previous studies have shown that when nurses contact patients with emerging infectious diseases, such as SARS, MERS [2, 3], Ebola [4], and H1N1 flu [5], they suffer from various physical and mental problems, including loneliness, anxiety, fear, fatigue, and sleep disorders [6]. Studies have shown that the rates of insomnia, depression, and post-traumatic stress disorder in nurses involved with SARS patients were 38.5%, 37%, and 33%, respectively [6].

One of the reasons for nurses' concerns in the current situation is that the person-to-person transmission of the coronavirus is like the transmission of influenza and other respiratory pathogens. Hence, when a person coughs or sneezes, respiratory droplets form, and these droplets are inhaled by the individuals around [7]. The second reason is that the disease has a latent period. One study has found that this period could be 1-14 days long with an average of 5.2 days. Moreover, the aforementioned study showed that 97.5% of people who develop symptoms become infected within 10.5 days [8]. In addition, it has also been found that the mortality rate of the disease is high and no specific treatment for coronavirus has yet been approved by the US Food and Drug Administration [9].

Nurses use different strategies to manage the emotions, stress, and psychological crisis caused by the unfamiliar COVID-19 pandemic. Due to the high prevalence of death due to COVID-19 among hospital staff, they faced a lot of emotional as well as physical stress. Due to the nature of their job, nurses were in close contact with infectious patients for a long time. In addition, many hospital staff members resigned during the outbreak of the disease, or the number of volunteers was reduced. Therefore, the workload had to be handled by existing nurses which led to an increase in their emotional problems during the COVID-19 pandemic.

Nurses use a variety of strategies to manage the excitement, stress, and psychological crisis caused by COVID-19 pandemic. Due to the high prevalence of mortality caused by COVID-19 among hospital staff, specialist physicians faced a lot of psychological as well as physical stress. Due to the nature of their job, nurses must be in close contact with infectious patients for a long time. In addition, many hospital staff members resigned during the outbreak of the disease, or the number of volunteers was reduced. Therefore, the workload had to be handled by existing nurses, which led to an increase in their emotional problems during the COVID-19 pandemic. COVID-19 affects not only the emotions, but also the coping strategies of the public.

Nurses use different problem-solving styles to manage the current situation. The emotional reactions and problem-solving styles of nurses can affect their behavior toward patients with acute respiratory infections. Healthcare providers are vital resources for any country, not only because they are very important for the health, safety, and continuous care of the patients, but also because of their significant role in controlling any outbreak of the disease [10]. Therefore, it is necessary to study the coping behaviors of nurses in the current situation.

To face a problem requires an attempt to overcome what has happened, reorient the attitudes of people toward the concept of the problem, guide individual lives, and maintain a stable physical, mental, and social status [11]. Coping strategies refer to rational and conscious ways of coping with life stresses [12]. The type of strategy adopted by each person to deal with stress is considered part of the emotional health and vulnerability of that person. Usage of inappropriate strategies to deal with stressors can increase problems [1], while using an appropriate coping strategy that plays a pivotal role in emotional intelligence of people can have beneficial consequences [13].

COVID-19 not only affected public emotions, but also their coping strategies. The emotional reactions and problem-solving styles of nurses can affect their behavior toward patients with acute respiratory infections. Healthcare providers are vital resources for any country, not only because they are very important for the health, safety, and continuous care of the patients, but also because of their significant role in controlling any outbreak of the disease [10]. Therefore, it is necessary to study the coping behaviors of nurses in the current situation.

An attempt to overcome a problem is required to comprehend what has happened, reorient the attitudes of people toward the concept of the problem, guide individual lives, and maintain a stable physical, mental, and social status [11]. Coping strategies refer to rational and conscious ways of coping with life stresses [12]. The type of strategy adopted by each person to deal with stress is considered part of the emotional health and vulnerability of that person. Usage of inappropriate strategies to deal with stressors can increase problems [1], while using an appropriate coping strategy that plays a pivotal role in emotional intelligence of people can have beneficial consequences [13].

There are different coping strategies, such as problem-solving, seeking social support, distraction, denial, and positive thinking. Despite the above-mentioned general conclusion, reducing psychological complications in different studies has been different [14]. One study has shown the effect of problem-solving on reducing grief [15], while other studies have shown that these strategies are not associated with increased anxiety levels [16, 17].

Since nurses are a professional group in the healthcare system, they are responsible for more than 80% of care in developed countries and are in a unique position and can impact public health [18]. When faced with stressful situations caused by different geographical and cultural conditions, they use different strategies to adapt [13].

There are differences in the results of studies on the applicability of coping strategies. Moreover, the type of strategy adopted by nurses to maintain their mental health is of great importance. Besides, COVID-19 has a high prevalence and mortality rate in Iran. Therefore, the present study aimed to examine the emotional reactions and coping strategies of nurses during COVID-19 pandemic. Emotional reactions and coping strategies can help nursing managers to provide the necessary information to support this vulnerable group effectively.

2. METHODS

3. RESULTS

Due to the drop in sample size, 208 questionnaires were completed, and statistical results were calculated based on it. According to Table 1, the mean age of nurses participating in the study was 7.25 ± 31.15. Of all nurses, 173 (83. 2%) were female, 35 (16.8%) were male, 72 (34.6%) were single, 135 (64.9%) were married, and 1 (0.5%) were divorced. Two hundred and six nurses (99%) had a higher education than a diploma. 203 (97.6%) of the participants had a nursing job, and five (2.4%) had an emergency medical job with 46 (22.1%) formal employment, 62 (29.8%) contract employment. Sixty-three people (30.3%) were on a temporary plan, and 37 (17.8%) were contractors. One hundred and ninety-five people (93.8%) were in a rotational shift, and 13 (6.3%) were in the fixed shift. One hundred and nineteen people (57.2%) had 1 to 5 years of work experience, 35 (16.8%) had 6 to 10 years of work experience, 35 people (16.8%) had 11 to 15 years of work experience, seven (3. 4%) had 16 to 20 years of work experience, and 12 people (5.8%) had more than 20 years of work experience.

According to Table 2, the highest emotional response of nurses was related to being emotional (3.29±0.95), and the most coping actions of nurses are related to the strategy of coping with nurses' emotions based on the average (26.87±4.5).

According to Table 3, there was no significant relationship between age and nurses' emotional reactions (P-value <0.05). The level of anxiety of female nurses (3.07±1.22) was higher than male nurses (2.60±1.42), which was a significant difference (P-value= 0.032).

The level of sadness of female nurses (2.77±1.21) was more than male nurses (2.29±1.20), which was a significant difference (P-value= 0.031). Other nurses' emotional responses were not significantly different (P-value<0.05).

The rate of hatred in married nurses (2.63±1.30) was higher than single nurses (2.10±1.11), which was a significant difference (P-value = 0.004). The rate of fear in single nurses was higher than in married nurses (2.99±1.40), which was significantly different (P-value= 0.043). Other emotional responses of nurses were not significantly different (P-value<0.05).

The rate of hatred among nurses whose type of employment was contractual (2.82±1.36) was higher than other types of employment, which was a significant difference (P-value= 0.012). Other emotional responses were not significantly different between nurses (P-value<0.05).

The amount of desire and aspiration in circulating shift nurses (3.49±1.23) was more than fixed morning shift nurses (2.69±1.03). Other emotional responses were not significantly different between nurses (P-value<0.05).

There was no significant difference in the level of emotional responses between nurses with different work histories (P-value<0.05). Anxiety was higher among nurses who had a patient with coronavirus at their workplace (3.06±1.26) than nurses who did not have a patient with coronavirus (2.58±1.23), which was a significant difference (P-value= 0.046).

Other emotional responses were not significantly different between nurses (P-value<0.05).

The level of sadness among nurses who had a patient infected with coronavirus in their workplace hospital (2.79±1.20) was higher than nurses who did not have a patient infected with coronavirus in their workplace hospital (2.13±1.17), which is significantly different (P-value= 0.004). Other emotional responses were not significantly different between nurses (P-value<0.05).

According to Table 4, there was no significant relationship between demographic variables and problem-focused coping strategies (P-value<0.05). Single nurses felt (27.79±4.99) more focused on the coping strategies of married nurses (26.41±4.16), and the difference was significant (P-value= 0.016). In nurses with 11 to 15 years of work experience, the level of coping strategy focused on feelings more (27.71±4.77), which was statistically significant (P-value<0.05). Other demographic variables had no significant effect on emotion-focused coping strategy(P-value < 0.05).

According to Table 5, among the emotional reactions, the relationship between coping strategy focused on problem-solving with emotionality (P-value= 0.006). And hatred (P-value= 0.017), a direct and significant relationship and between coping strategy focused on emotion with anxiety, a direct and significant relationship was found (P-value= 0.004).

4. DISCUSSION

This study aimed to investigate the relationship between nurses' emotional reactions and coping strategies during the outbreak of COVID-19 in Ganjavian Hospital in Dezful in 2020. COVID-19 is a source of stress that the infection and harmfulness of the virus, the increase in the number of deaths, the ignorance of the virus and the negative emotions spread under this unfortunate situation, and its spread threatened the mental health of the people.

Due to these conditions, many people became emotionally distressed and felt helpless, afraid, anxious, depressed, guilty, and nervous, especially those at the center of the epidemic. Nurses play an essential role in managing and controlling epidemics both in the community and in the hospital setting [18, 19, 21].

The results of the present study showed that the most coping actions of nurses were related to emotion-based coping strategy, and the most emotional response of nurses was related to being emotional. Bella Savitsky et al. [22] found that the highest response was moderate anxiety at 42.8%. Gender, PPE deficiency and fear of infection were significantly associated with higher anxiety scores. More robust humor and flexibility were associated with significantly lower anxiety levels, while the loss of mentality was associated with higher anxiety levels. Also, Haneen Ali et al. [23] showed the level of feelings and job burnout and anxiety was high, and other reactions such as stress, sadness and despair were lower, which is in line with the present study. Tobias et al. [24] showed that nursing, as the largest group of the health workforce in coping with epidemics, using emotion-oriented strategies such as empathetic listening, is a powerful strategy in caring for and strengthening nursing professionals.

The results of the present study showed that among the emotional reactions, the relationship between coping strategies focused on problem-solving with emotionality and hatred has a direct and significant relationship, and the relationship between coping strategies focused on emotion has a direct and significant relationship with anxiety. Lorente et al. [25] showed that all stressors have a significant, direct and adverse relationship with nurses' psychological distress. Emotion-focused strategies are directly and indirectly negatively related to nurses' psychological distress through resilience. Problem-oriented strategies are positive and negative, and indirectly related to nurses' psychological distress through emotion-focused strategies which is inconsistent with the present study. Huang et al. [19] showed that the stronger the emotional responses in nurses, the more they tend to use problem-focused strategies.

The results of our study showed that female nurses are more anxious than male nurses, and women feel sadder than men. Moreover, in the wards where Covd-19 patients were present, the nurses' anxiety in these wards was reported higher, which is in line with the results of our study. Studies by Long Huang et al. [19] and Pappa Despoina [18], and the National Health Commission [24-26] noted that having direct exposure to COVID-19 patients in intensive care units or long-term stay in wards due to continued treatment, nurses experience severe anxiety, depression, and distress.

The results of our study also showed that married nurses experienced more feelings of hatred and single nurses experienced more feelings of fear, which is in line with the present study. Long Huang et al. [19] and Khalid et al. [2] stated that special conditions such as pandemics threaten to affect both physical and mental health conditions of the individuals. Persistent worries and fears can be created among people, and everyone can understand this fact differently. Long Huang et al. [19] showed that fear can be the worst enemy for anyone, and as Zhong Nanshan [27] stated that psychological fear can be more frightening than the disease itself.

5. LIMITATION

In this study, one of the limitations was the lack of cooperation in answering the questions of the questionnaire due to work. Therefore, participants were eliminated by measures such as allocating enough time to participants, answering their questions, and referring to work cycles. Because this study was conducted in a cross-sectional design, it may be that the results could not be generalized to other provinces and ethnicities.

CONCLUSION

Due to the high level of anxiety and fear and the use of emotion-focused strategies in nurses, the Ministry of Health and nursing managers must prevent and reduce anxiety and provide adequate support for staff and training to deal with it. Due to nurses' use of various coping strategies in stressful situations, training in effective coping techniques is essential. Also, considering the importance of job anxiety and stress and coping strategies on mental health and the quality of nursing care services, further research with a quantitative and qualitative approach will clarify the nature of emotional reactions and how to use coping strategies.

REFERENCES