Analysis on mental state of CSSD staff
According to the survey results, the CPSS score of the CSSD staff was 19.21 ± 7.265, which was lower than that of the clinical nurses [10], but higher than that of community residents in China [11]. The perceived stress is the psychological response of the individual after perceiving and evaluating the threatening stimuli in the environment [12]. The novel coronavirus chiefly transmits via respiratory droplets and close contact [13], and the CSSD staff was not in direct contact with the confirmed or suspected COVID-19 patients, therefore the CSSD staff had the lower perceived stress for the COVID-19 epidemic as compared with the clinical nurses. Due to the nature of work in the CSSD, the CSSD staff was at risk of being infected with the novel coronavirus through occupational exposure, and the CSSD staff had higher perceived stress from the threat of the novel coronavirus as compared with the community residents during the epidemic.
The survey results showed that the CD–RISC score of the CSSD staff was 64.26 ± 15.129, lower than the norm in China [14]. It meant that the CSSD staff had lower resilience. The survey results also showed that the optimism factor score was the lowest and the tenacity factor score was the highest. It was possibly because the novel coronavirus transmitted quickly and widely, the number of confirmed and suspected cases increased continuously with the development of the epidemic, the clinical work load and work pressure also increased [15], the CSSD staff had to handle a high workload and was at risk of infection from occupational exposure. At the early stage of the epidemic, the protective articles were in shortage in China, and the CSSDs were lack of the required protective articles, particularly the facial masks and protective gowns, the CSSD staff was usually unable to effectively cope with and adapt to the stress resulting from the emergent public health event. The CSSD staff with higher tenacity factor score had the higher control power in face of the stress and emergent public health event, and would not easily be influenced. Therefore, the managers are recommended to pay attention to the resilience level of the CSSD staff and provide them with the specific mental support to improve their resilience and decrease the negative impact from the epidemic on the CSSD staff.
According to the study results, the CSSD staff had the lower anxiety level. Their SAS score was 37.39 ± 8.458, lower than the threshold score of SAS, possibly because most of the participants were from Tertiary A hospitals and received strong support from the public and the governments, and the protective measures, disease screening tools and treatment conditions of Tertiary A hospitals could meet their job demands; and most of the participants were of the middle and upper level education background, and they were able to know about the relevant information on the COVID-19 epidemic through proper means and methods, and took the effective self protection.
Analysis on correlation among CD–RISC score, CPSS score and SAS score of the CSSD staff
The survey results showed that the CSSD staff’s CPSS score was positively correlated with their SAS score (r = 0.66, P < 0.01). That is to say, the higher the perceived stress, the more the anxiety. The possible reason was that the perceived stress was expressed as the tension and uncontrollability of the individual, and the individual experienced the negative mood of different extent [16]. As demonstrated by Rooij SRD, the perceived stress increased to some extent when the person was in a state of depression or anxiety [17]. According to the study of Wiegner L, the perceived stress was usually accompanied with increased depression and/or anxiety [18]. The CSSD staff felt the negative pressure brought to their work from the outbreak of coronavirus, and they were prone to anxiety after working under such a stressful condition for a long time. The CD–RISC score was negatively correlated with the CPSS score (r = -0.617, P < 0.01), and the CD–RISC score was also negatively correlated with the SAS score (r = -0.477, P < 0.01), which are basically consistent with the results of He C, et al. [16] and Xie Y, et al. [19]. It indicates that the higher the resilience level, the lower the perceived stress level and the anxiety level, because the individual with higher resilience usually adopts the optimistic and active attitude and handling methods under stressful conditions, and knows how to use the external resources to handle the problems [19]. During the epidemic, the higher the resilience, the higher the consciousness of self-protection. As long as the necessary protection measures are taken and the correct operation procedures are implemented, the stress as well as anxiety can be relieved.
Analysis on influencing factors for CPSS score, SAS score and CD–RISC score
As shown in this study, the job and age of the CSSD staff were two factors having higher influence over the CPSS score. The CPSS score of the CSSD nurses was 20.081 ± 7.008, significantly higher than the CPSS score (15.898 ± 7.009) of the CSSD logistic staff; and the SAS score of the CSSD nurses was 38.332 ± 8.662, higher than the SAS score (35.469 ± 7.307) of the CSSD logistic staff. Due to the simple staffing structure in the CSSD, i.e. there were only the nurses and the logistic staff in the CSSD, and the CSSD logistic staff was responsible for handling most of the devices which required more for the physical labors, while the CSSD nurses played the leading role and were chiefly responsible for guidance and supervision of sterile supply. The CSSD nurses played an important role in controlling hospital acquired infection. During the epidemic, controlling the hospital acquired infection was the top priority for fighting against the epidemic, so the CSSD nurses had the higher level of perceived stress and anxiety as compared with the CSSD logistic staff. Moreover, the CPSS score of the CSSD nurses in the younger age groups was higher than that of the CSSD nurses in the older age groups. The CSSD nurses in the younger age groups had shorter service period, insufficient work experience and few experiences of setbacks, and were lack of the strong will or the strategies in response to stressful conditions [20], but the CSSD nurses in the older age groups had the rich experience in work and life, so the CSSD nurses in the older age groups could maintain the stable mood and had the sufficient skills in response to the emergent public health event.
The political status was a factor having more influence on the CD-RISC score. The CD–RISC score of members of the Communist Party of China was 69.726 ± 12.071, higher than that of people without party affiliation (63.816 ± 15.664), and that of members of the Chinese Communist Youth League and probationary members of the Communist Party of China (59.039 ± 13.676). It was possibly because the members of the Communist Party of China always adhered to the mission of serving the public wholeheartedly, and maintain the spirit of contribution and perseverance.