The present study was aimed to assess the psychosocial status of nurses working in front line to take care of patients with covid-19. For this purpose, 278 nurses from two COVID-19 treatment centers specified by Nepal government were enrolled in the study.
Majority of the nurses (87.1%) were working as a staff nurse. In nationwide hospitals, staff nurses comprised the highest proportion of the workforce. Although, Nepal had not entered into community transmission stage, 55% of the participants had contact history with suspected cases of COVID-19 before baseline data collection. After initiation of nationwide lockdown in Nepal, all international flights were restricted. Therefore, many people locked abroad, which added stress and financial burden to themselves and family members. As one of the reputed news channels also reported hundreds of Nepalese, who wanted to return to Nepal got stuck on Indian border points In this study also, 14% of the nurses had their family members locked abroad due to travel restriction. The high financial worry was found among 12.2% of the participants.
PPE drew the attention of all people during initial days of the pandemic and became one of the scarcest resources during the initial days.The World Health Organization (WHO) encouraged people to wash hands with soap and water or use an alcohol-based hand sanitizer, and proper usage of face masks for protecting them from infection, it put a match to panic-buying and hoarding of those goods, leading to shortages in most of the cities of Nepal including health sectors  . This study found, only 14% had perceived of having adequate PPE. Healthcare became challenging, lots of ethical challenges were present in front of health workers and problems were also faced by health care institutions regarding finance and sustainability of organizations. Probably because of the same reason, 11.2% of participants felt the threat of losing their job due to COVID 19. Nearly one fifth (19.1% )of the participants had chronic health problems like diabetes hypertension etc. Regarding preparation from a personal level, 92.8% were prepared for infection prevention measures to protect self and family from getting infected, followed by extra stock of food by 79.5% and 22.66% had made other preparations like saving of money, some medicines etc.
One web-based survey among health care workers of Nepal found Overall, 13.5% had symptoms of depression in abnormal level as measured by hospital anxiety and depression scale . The present study also found 13.7 % had mild depression Finding of this study was similar to a study conducted among public people of china, which also found mild depression among 13.8% of the participants. Moderate and severe depression were relatively high among Chinese population as compared to this study. This study revealed 9.4% moderate and 1.1% had severe depression. Age of the participants had a significant positive correlation with depression in this study. Similar findings were reported by Khanal et al that, the younger health workers had reported the lesser depressive symptoms in their study. Financial worry and financial burden also had a significant positive correlation with depression score. During the data collection period, none of the institution had initiated corona insurance for their employees. Scarcity of appropriate PPE was also high and employees were managing PPEs of their own. This can also be explained by the evidence of a statistical significant association of availability of PPE with financial worry in this study. Therefore, financial issues might have put extra pressure on them.
The present study revealed, 21.2% of the participants had mild anxiety. This finding is quite higher than the finding of previous study in Nepal 18.3%  and Singapore 14.5% . Those studies were done among all health care workers and reported higher proportion of nurses had anxiety as compared to the other health workers. This may be the reason of a bit higher proportion of mild anxiety in this study. A systematic review from few Asian countries also reported similar levels of anxiety among health workers . Another study of China among public found 7.5% had mild anxiety, which is quiet lower as compared to present study. The present study found 8.6% moderate, 3.2% had severe and 2.2% extremely severe anxiety. Moderate and severe anxiety were found to be lower than the study done in China . Similar to the finding of previous studies done in Nepal and China, the anxiety level was significantly associated with having chronic health problems [1, 13]. Financial burden had a significant positive correlation with anxiety. Similar finding was reported by Gautam et al. in their social media based survey .
Regarding stress, 9% had mild and 1.4% had moderate level of stress while, 0,7% had severe stress. Shrestha et al. Also reported 11% were mild to moderate distressed and 0.5% were severely distressed due to COVID-19 pandemic . The stress score had a significant positive correlation with financial worry and burden. Similar finding was reported in other studies done in Nepal, where low monthly family income had associated with high distress [16, 4].
While conducting the in- depth interview, the reasons of their problems and effects of the pandemic were also supported by quantitative findings. Lack of PPE, fear transmitting the infection to family members, feeling of stigmatization, feeling of pain to isolate the self from family, feeling of incompetency in a new situation, stress due to uncertainty and problems in work life balance were reported by the participants. These feelings are also supported by others' feelings in the studies done across different countries [17–20]. This shows that the healthcare workers sharing similar feelings, condition and problems, regardless of socio-economic status of the country. Pre-intervention mean scores of depression, anxiety and stress scores were comparable to the mean scores in a study done among health workers in Singapore .
After baseline data collection, we provided psychosocial support to the individuals where necessary and one intervention session for all in groups. After 4 to 5 weeks of intervention, mild depression was found among 5.2% and moderate depression was found among 2.1%. Similarly, mild anxiety was reduced to 12% and moderate to severe anxiety was 1%. Stress was also reduced. The reduction in mean scores of depression, anxiety and stress was statistical significant (p = < 0.001 for each). This shows the importance of stress management program for the nurses working in the front line; in their daily practice.
The post intervention reduction in mean scores may be because of low threat perception after managing the cases. Though this study did not quantify the psychological status of nurses before and after managing the patients with COVID 19, one of the participants during an in-depth interview mentioned about reduction of fear after seeing the recovered patients and managing the cases.