The aim of this study was to assess job stress among medical staff exposed to covid-19 patients in different wards of Iran hospitals. For this aim, the demographic information form and the questionnaire of the British HSE indicator tool were used. In the present study, the mean total score of the dimensions obtained by nurses was 2.31, by cleaning crew 2.95, and by doctors 3.53 and the mean score obtained by all occupational groups in this study was 2.63 which indicates the level of stress between moderate to high levels in the medical staff participating in the study. In a study conducted by Hesam Akbari et al., the mean score obtained (final stress score) by the nurses was 3.17, which was in the range of partial to moderate stress . It seems that the reason for the difference between the two studies is the effect of critical conditions caused by Covid-19 crisis such as lack of previous familiarity with the disease (newness), direct exposure to previously unexperienced infectious disease, and lack of access to adequate personal protective equipment for nurses in the present study.
Also, according to the results of the present study, 87% of nurses, 79% of the cleaning crew and 67% of physicians had partial to high stress levels, with a mean of 77.5% of the medical staff participating in this study had at least a partial amount of stress. This level of stress can be due to the high volume of work and the resulting high pressure on personnel compared to pre-pandemic conditions, direct exposure to the risks of Covid-19 and also the fear of transmitting the disease to them. In studies by Yanping Bao et al., Claudia Carmassi et al. and Jianbo Lai et al. they stated that those (medical staff) who work in the field of diagnosis, treatment, and care of corona patients, are facing a high risk of stress and spiritual and psychological problems caused by them; which are completely consistent with the results of the present study [26–28]. Also in the study and Lai et al. who examined the level of stress in the health care workers (HCWS) (including nurses and physicians) exposed to Covid-19 patients in Wuhan, China, about 71.5% of participants had partial to high stress levels. The results are similar to the results of the present study . Also, in the study performed on the frontline health care workers (FHCWs) of the fight against corona, it was stated that the level of stress in the occupational group of nurses was higher than that of physicians, which is consistent with the results of the present study . In addition, in a study by Imran Khalid et al., which was performed on HCWs (including nurses, physicians, and respiratory therapists) exposed to MERS-CoV, stress was divided into four levels of very low (score 0), partial (score 1), and moderate (score 2) and very high (score 3), which the mean score of the participants in this study was about 2.43 (moderate to very high stress level) . The mean stress score obtained by all job groups in the present study was 2.63 (moderate to high stress level), which shows a close similarity with the study of Khalid et al.
In the present study, the mean score of the total dimensions, in a way, indicates the level of job stress in job groups. In this study, in the group of nurses and physicians, there is a significant correlation between the mean total score of dimensions with work experience and job satisfaction and this correlation is a positive correlation in the sense that with increasing work experience and job satisfaction, the mean total score of dimensions increases and indicates a reduction in stress levels in them. Also in the cleaning crew, there is a significant positive correlation between the mean total score of dimensions and job satisfaction. Accordingly, in the study of Robert Kerr et al., which was conducted on job stress of jobs related to health and social services, a positive correlation was observed between the final score of the HSE questionnaire and job satisfaction . Also in the study of JANE E. FERRIE et al., a positive correlation was observed between different parts of the HSE questionnaire (such as role and changes) and mental health .
In the present study, part of the mean total score of dimensions in stress expression according to the HSE questionnaire is affected by support (managers and Colleague). The results are consistent with a study by Kumars Eisapareh et al., which states that social support is effective in reducing stress .
In the present study, the mean total score of the dimensions of the physicians group was obtained as 3.53 which in comparison with the study by F. Cedrone et al. performed on neurophysiological technicians with a mean score of 3.74, are in the same range of stress (34). In the present study, the scores related to communication and role were 3.16 and 3.56, respectively. In the study by F. Cedrone et al., the scores related to these two dimensions were 4.01 and 4.35, respectively, where the difference is caused by the existence of stressful conditions, lack of familiarity with critical conditions induced by the pandemic, as well as lack of proper allocation of roles by higher managers in critical situations due to the outbreak of COVID-19 in the present study .
In the present study, the mean total score of the dimensions obtained by the nurses was 2.31, by the cleaning crew it was 2.95 and by the physicians it was 3.53, indicating a higher level of stress in nurses compared to the cleaning crew and physicians. Accordingly, the stress level of the cleaning crew is higher compared to doctors. In nurses, the lowest score is obtained for changes (2.02) and also the scores related to control (2.12), role (2.13) and demand (2.16) have low values. Although the score related to the dimension of manager support (2.43) has a higher value compared to other dimensions, but it is still at the red level (stress level between medium and high) and shows its effect on stress levels in job groups. So that in the cleaning crew, the lowest score obtained was related to the dimension of manager support (2.02), which had the main effect on the stress level of this job group. In the cleaning crew, the score obtained in the dimensions of communication (2.76), demand (2.89) and changes (2.98) also have lower values compared to other dimensions. In the physicians group, the lowest score obtained was related to the dimension of communication (3.16). Also, the scores related to changes (3.49) and role (3.56) and control (3.76) are at a low level. In the group of physicians, the highest score obtained is related to the manager support (3.87) and shows the high support of managers in the job group of physicians and one of the reasons for obtaining a higher score and lower stress level of this job group campared with nurses and cleaning staff is manager support. Accordingly, in a study conducted by Khanam et al., the increase in government and manager support was identified as a factor in reducing the stress of coronavirus outbreaks at the frontline of the fight against the virus . In addition, other previous studies confirm the effect of support, including manager, colleague, and even family support on staff stress and mental health levels [34–37].
One of the factors affecting the level of stress is demand dimension that nurses, cleaning crew and physicians have obtained scores of 2.16, 2.89, and 3.56, respectively. Demand is recognized as an aspect of the job that is difficult for an employee to achieve. These aspects can be named as workload, work response speed, and work environment conditions. One of the reasons for the low scores obtained by the job groups of the present study (especially nurses and cleaning crews) in this dimension and the result is high stress, were high workload and the need for high response speed and inappropriate working environment conditions compared to the conditions before Covid-19 pandemic. The results are consistent with previous studies performed on radiology staff [38, 39].
In the present study, there was a significant correlation between the mean dimension score and job satisfaction in all job groups and the results showed that job satisfaction has an effect on staff stress levels. In the study of Majid Bagheri Hosseinabadi et al., which was performed on nurses, a significant correlation was found between different dimensions of job stress (demand, control, support, etc.) and job satisfaction , which is consistent with the results of the present study.
The main advantage of the present study is the assessment of job stress caused by COVID-19 pandemic conditions for the first time in Iran, which was used to achieve this goal of the HSE questionnaire. The advantages of this questionnaire include low number of questions, use of appropriate dimensions for job stress assessment, standard job stress assessment and high level of validity and reliability. These features make this questionnaire a convenient tool for assessing staff conditions. Thus, this tool allows the researcher to quickly assess job stress in critical situations in order to help make subsequent decisions.