The global spread of coronavirus disease 2019 (COVID-19), initiated by the SARS-CoV-2 virus in December 2019, led the World Health Organization (WHO) to declare a pandemic in March 2020, the highest warning level for infectious diseases [1]. The emergence of new variants, such as Beta, Delta, and Omicron, intensified COVID-19’s global threat and the populace’s anxiety [2]. Despite international efforts to combat the virus, the WHO declared it endemic in May 2023 after three years of fighting the pandemic [1]. The history of infectious diseases, including severe acute respiratory syndrome (SARS) in 2003, H1N1 in 2009, and Middle East respiratory syndrome (MERS) in 2015, suggests that the threat of both new and reemerging infectious diseases is ongoing [3]. The unprecedented crisis presented by the COVID-19 pandemic significantly impacted healthcare services, society, and the economy, highlighting the need for developing and implementing proactive management and prevention strategies against such infectious diseases [4].
To ensure systematic infection control, relevant laws were amended in 2016, in South Korea while the standards for infection control staffing were strengthened for each type of hospital, thereby intensifying the roles and responsibilities of infection control nurses (ICNs) [5]. ICN nurses play a pivotal role in preventing disease outbreaks and curbing the spread of infections among patients, caregivers, and staff [6]. During the COVID-19 pandemic, their duties expanded from standard infection control practices to tasks such as information gathering, reporting, policy-related decision-making and implementation, staff education (e.g., regarding infection, isolation procedures, and use of personal protective equipment), advising and consulting, coordination of epidemiological investigations, and management of exposed individuals. The additional responsibilities also increased their administrative workload [6].
During the prolonged COVID-19 pandemic, ICNs experienced significant physical and mental exhaustion due to overwhelming workloads and the pressure to manage all aspects of infection control at the frontline [7]. The broad scope of their responsibilities increased their stress [8,9]. Continuous work-related stress in nurses can cause them to become disinterested in their patients, decrease their work efficiency and productivity, increase their turnover and absenteeism rates, increase depression, and, ultimately, cause burnout—a state of physical, emotional, and mental exhaustion [9,10]. Thus, it is important to assess the extent of the increased stress and burnout among ICNs in a challenging context such as the COVID-19 pandemic.
Burnout is a negative experience caused by repetitive exposure to stressors; it refers to a state of energy depletion that induces emotional exhaustion, feelings of anger, powerlessness, and depression [11]. Nurses who fail to cope with increases in work-related stress and consequently experience burnout have reduced job satisfaction, exhibit a poor quality of care, and have high turnover rates, thereby creating a cycle of negative outcomes [12]. Persistent burnout not only affects individuals but also impacts organizational efficiency and effective personnel management [13]. Thus, nurses’ burnout is a major issue for clinical practice.
Self-efficacy and social support have been identified as factors that mitigate stress and reduce burnout [13–18]. Self-efficacy refers to an individual’s belief in their ability to achieve goals in specific situations [19]. Nurses who lack self-efficacy have low confidence in their ability to manage and prevent infectious diseases [20], which may increase their work-related stress and ultimately lead to burnout [10]. Social support refers to the encouragement and support nurses receive from their colleagues, superiors, and family [18, 21]. As infection control entails working in emergencies and high-risk environments, nurses are bound to face severe emotional pressure [8]. Inadequate social support provision under stressful circumstances leads to feelings of isolation, thereby increasing the risk of burnout among nurses [13]. Conversely, enhanced self-efficacy and social support can alleviate the stress associated with nursing duties and thus reduce burnout [18].
Previous studies on ICNs have examined the relationship between work satisfaction, ego resilience, and job stress [8], path models for burnout and retention intention [22], the core competencies of ICNs [5], and the important roles of ICNs [23]. Studies have also explored ICNs’ work experiences during the COVID-19 outbreak [7]; however, few studies have examined ICN burnout.
In this study, we established a conceptual framework of the study’s variables based on Lazarus & Folkman's [24] stress, appraisal-coping model to investigate the relationship between stress and burnout among ICNs. Previous studies on stress-coping and adaptation have used this model as a theoretical framework because it provides a systematic and logical framework for understanding the processes of appraisal, coping, and adaptation in response to stressful events [25, 26]. As stress is conceptualized as an interaction between the individual and their environment, as opposed to a simple stimulus [24], we included personal-level factors (gender, age, education, spouse, position, salary, type of hospital, clinical career, infection control career, and certification) as contextual factors that could affect burnout. We used stress as the environmental variable, social support and self-efficacy as coping resources (mediators), and burnout as the negative outcome.
In order to effectively prepare for emerging infectious disease crises in the future, it is important to determine the factors that affect burnout among ICNs and utilize such data to reduce ICN burnout, cultivate experts in infection prevention at healthcare facilities, and promote patient safety and nursing care quality. Therefore, this study aims to provide basic data for developing nursing intervention programs by identifying the relationship between stress and burnout in infection control nurses during the COVID-19 pandemic based on Lazarus & Folkman's [24] stress, appraisal-coping model; in this way, this study sought to confirm the mediating effect of self-efficacy and social support in burnout alleviation.