High positive rate of anxiety and depression symptoms amongst surgical nurses during COVID-19
Although several studies reported that medical staff might suffer adverse psychological disorders, such as anxiety, fear and stigmatization, the psychological wellbeing of surgical nurses are little studied, and this should not be neglected. Importantly, surgical nurses encountering this situation are under extreme pressures. In the current cross-sectional study of 3492 surgical nurses, 24.83% and 22.39% of participants reported anxious and depressive symptoms, respectively, during the COVID-19 epidemic in Anhui province of China. Compared with the normal Chinese SAS and SDS score, the anxious and depressive levels of surgical nurses were relatively high.
Due to the special feature of surgical nursing care, COVID-19 epidemic may impact on the mental welling of surgical nurses. Firstly, COVID-19 causes many medical personnel to be easily infected in a short time when treating patients. Also surgical nurses play an important role in this pandemic; hence they face huge challenge and experience more stress. Secondly, in the initial period of COVID-19, not all patients undergoing emergency operation have been tested for viral nucleic acid, and it was impossible to determine whether the patient had a history of exposure to SARS-CoV-2. For those patients undergoing emergency operation, there was no time to test for viral nucleic acid. In addition, there were some confirmed SARS-CoV-2 cases that required surgical treatment. Moreover, surgical patients will not be reduced due to the outbreak of the epidemic. Consequently, these surgical nurses may have had a sense that the virus could impact on their workplace at any time, even though not always facing COVID-19 directly. Therefore, the surgical nurses had increased risk of infection, and would inevitably worry more about this risk, and the huge psychological pressure caused the anxiety and depression.
Influencing factors of anxiety and depression in surgical nurses during COVID-19
There were several factors that may have resulted in reduced mental wellbeing amongst surgical nurses during COVID-19. As shown in the results of this study, several risk factors have been found to influence poor wellbeing in surgical nurses following the outbreak. Those factors include having children, being in tertiary general hospitals, participation in care for COVID-19 patients, perception of being infected, and social support. In general, those surgical nurses having children, being in tertiary general hospitals, participating in care for COVID-19 patients, self-perception of being infected, and having lower level of social support, were more likely to have anxious and depressive symptoms during the COVID-19 epidemic.
Having children and divorce/widowed
As surgical nurses have been aware of the seriousness of the epidemic, they were afraid of passing the virus to their families, especially their own children. The majority of this sample were married, had children and usually played multiple roles of nurses, parents, spouses and children. These surgical nurses were under the pressure from both work and family, which could impose an additional emotional burden on them. Moreover, they did not want their families to worry about them. As a result, those nurses having children felt worse mental wellbeing during the COVID-19.
Since the surgical nurses in the single parent family take an important position in their families, while being lack of emotion support, suffering more difficulties, they could face more challenges in the crisis. Especially, they had the fear of exposing family members to COVID-19. In our study, the divorce or widowed nurses experienced more depression than the single and married nurses. If possible, at the COVID-19 outbreak, surgical nurses may be encouraged and supported to use alternative accommodations to reduce the risk of family transmission. Policy makers need to ensure they provide appropriate logistic and financial support to help with this course of action [17].
Being in tertiary general hospitals
In contrast to the surgical nurses in the secondary hospitals, those working in tertiary general hospitals may have perceived more anxiety and depression in our investigation. In general, the tertiary general hospitals were far more likely to treat the COVID-19 patients than the secondary hospitals. Additionally, the tertiary general hospitals treat more emergency and severe surgical patients who possibly have history of exposure to SARS-CoV-2. Therefore, surgical nurses in these hospitals could have high mean score of anxiety and depression during the COVID-19 pandemic.
Participation in care for COVID-19 patients
As the COVID-19 epidemic is a global issue, fighting COVID-19 appears to be a sustained task, which may result in surgical nurses suffering from psychological problems. During the outbreak of COVID-19, Chinese nurses, including surgical nurses have taken an active part in its prevention and treatment in the fever clinics, the observation wards and COVID-19 wards. Surgical nurses believed that people avoided them or their families due to their work with COVID-19 cases. Emerging evidence demonstrates that the frontline staff participating in treatments or procedures for infected COVID-19 cases experienced more stress, as they were at high potential risk of infection [18]. Therefore, surgical nurses having direct contact with COVID-19 patients suffered higher anxiety and depression scores than those who worked in the usual surgical departments. The risk-mitigating strategies [19], such as organizational implementation of infection control measures, avoidance of patients and complying with personal protective equipment can be adopted in the frontline work.
Perception for likelihood of being infected with COVID-19
Feeling unsafe and vulnerable to infection with COVID-19 was also closely related to the poor mental health in surgical nurses. Perceived threat or lack of safety has also been shown to be predictors of anxiety and depression symptoms. It should be noted that poor mental health may bias estimates of risk, and so the correlation between perceived risk and mental health symptoms may be bidirectional. Hence, treatment of the anxiety and depression symptoms themselves, or cognitive behavioral approaches designed to improve the psychological health of those with potential risk. Furthermore, precise and clear information about control measures may help reduce their anxiety and depression. The specialized training may minimize the amount of risk felt by surgical nurses and thus lead to more positive outcomes. Educational interventions aimed at addressing psychological distress and developing coping mechanisms to manage the fear of infection or infecting others should be developed and tested [20].
Level of social support
Our findings demonstrate that there was a negative association between anxiety/depression symptoms and social support. Great social support could be a protective factor against anxiety/depression, while those with poor perceived support were more likely to suffer from adverse outcomes. A recent study indicated that there was a negative correlation between the SSRS scores and the SAS scores, similar to our findings [21]. As family members or friends provide social and emotional support and share empathy [22], social support could help surgical nurses reduce anxiety and depression levels. Furthermore, social interactions are considered to reduce negative emotions such as anxiety and can improve the mood [23]. Adamczyk et al [24] suggested that having a wide social network could help reduce the perception of the threat of stressful events and the physiological response. Brooks suggested that social support from both employers and friends and families appeared to be useful for medical staff [20]. Therefore, building and encouraging the communications between surgical nurses and their families, employers, may relieve their psychological stress and strengthen the confidence in fighting COVID-19. Our findings support for the implementation of measures to improve the social support for surgical nurses during COVID-19 pandemic. In order to reduce feelings of social isolation in surgical nurses, Web-based communication, such as Wechat, QQ, microblog, are recommended to provide support during the crisis with no fear of transmission.
With surgical nurses as one of the medical forces to combat COVID-19, we must not ignore their psychological wellbeing while preventing and controlling the epidemic. As the pandemic is ongoing, important policy and clinical strategies are needed to support surgical nurses. To a certain extent, mental health problems will affect the performance of surgical nurses. Firstly, we need to identify and adjust the poor psychological status of surgical nurses, and promote the prevention and intervention of mental diseases. At the same time, professional psychotherapy teams should take the initiative to support their psychological health and provide individually targeted interventions. Secondly, healthcare managers should ensure there is regular adequate communication of up-to-date facts about the epidemic and how to best protect themselves. Meanwhile, managers should prepare their employees for the potential impact of negative experiences, such as anxiety and depression, and provide support measures for those. Lu et al [25] suggested that in the future advancement of a hospital in China, a human-oriented culture should be promoted to help the medical staff to deal with strain and reduce the risk of suffering from anxiety and depression. Regarding stress reduction, leisure activities and training on how to relax can be properly arranged. Moreover, hospital supporting staff can be organized better to reduce the pressure of ward administration for the surgical nurses. Recently, several UK researchers developed a digital package including evidence-based guidance, support and signposting relating to psychological wellbeing for healthcare workers. They recommend that this package be appropriate for supplementing strategic health and wellbeing provisions for healthcare workers during and after the COVID-19 pandemic [26]. Certainly, this e-package may be suitable for surgical nurses.