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Objective: To describe stress and anxiety, and coping strategies among nursing personnel in Maharaj Nakorn Chiang Mai Hospital during a new outbreak of the COVID-19, the relationship between stress and anxiety, and coping strategies, and their associated factors
Methods: A cross-sectional survey was conducted in June-July 2021. The stratified sampling recruited 390 nursing personnel working during April-May 2021 in the Nursing Department, Maharaj Nakorn Chiang Mai Hospital. The research instruments were the demographic questionnaire, the Stress and Anxiety to Viral Epidemics -9 items for healthcare workers: SAVE-9 (Thai), and the nursing personnel coping strategies questionnaire. The data were analyzed using descriptive statistics, Pearson’s product- moment correlation, Spearman rank correlation, and Eta coefficient.
Results: The total number of respondents was 382 (97.9%) nursing personnel. Participants had moderate stress and anxiety about the COVID-19 epidemic. The mean score of SAVE-9 was 19.05 ± 6.56. Considering only the anxiety part compared to the Generalized Anxiety Disorder-7 (GAD-7) ≥ 5, 140 (36.6%) nursing personnel had anxiety. The mean score of nursing personnel coping strategies was also moderate (37.86 ±4.69). There were significant negative relationships between stress and anxiety for the spread of COVID-19 and nursing personnel coping strategies (r=-.18, p=.001). Factors significantly related to stress and anxiety were age (r= -.12, p=.02) and work experience (r=-.12, p=.02). Furthermore, factors significantly related to nursing personnel coping strategies were age (r=.22, p<.001), work experience (r=.23, p<.001), type of nursing personnel (η=.20, p<.001), and type of patient care (η=.13, p=.001).
Conclusions: The results of this study provide information for the nursing administrators to formulate guidelines for human resource management and mental health promotion for nursing personnel to care for patients amid the COVID-19 outbreak.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความหลังผ่านการปรับแก้จากกองบรรณาธิการแล้ว เป็นลิขสิทธ์ของวารสารจิตเวชวิทยาสาร โรงพยาบาลสวนปรุง กรมสุขภาพจิต กระทรวงสาธารณสุข ห้ามเผยแพร่เพื่อประโยชน์ทางการค้าโดยไม่ได้รับอนุญาต แต่อนุญาตให้เผยแพร่บทความดังกล่าวเพื่อประโยชน์ทางการศึกษาแก่ประชาชนทั่วไป ทั้งนี้กองบรรณาธิการไม่จำเป็นต้องเห็นด้วยกับบทความหรือข้อคิดเห็นใดๆ ที่ปรากฏในวารสารสวนปรุง
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020 Feb 20;382(8):727-33. PMID: 31978945.
World Health Organization (WHO). Evaluation of COVID-19 vaccine effectiveness. Geneva: World Health Organization Department of Immunization, Vaccines, and Biologicals; 2021.
Worldometer. COVID-19 coronavirus pandemic [Internet]. 2021 [cited 2021 May 17]. Available from:
Ministry of Public Health, Thailand. Report of Novel Coronavirus (2019-nCoV) situation in Thailand 2020 [Internet]. 2020 [cited 2021 May 17]. Available from: https://ddc.moph.go.th/viralpneumonia/
Ministry of Public Health, Department of Disease Control. Coronavirus 2019 situation in Thailand [Internet]. 2019 [cited 2021 May 19]. Available from: https://ddc.moph.go.th/viralpneumonia/
Chiangmai Provincial Public Health office. Situation of coronavirus 2019 in Chiang Mai Province [Internet]. 2021 [cited 2021 May 19]. Available from: https://www.chiangmaihealth.go.th/cmpho_web/coronavirus_situation.php
Chiang Mai University, Faculty of Medicine. Announcement of the Faculty of Medicine Chiang Mai University about personnel infected with corona virus 2019 [Internet]. 2019 [cited 2021 Apr 12]. Available from: https://www.med.cmu.ac.th/
Huang L, Lei W, Xu F, Liu H, Yu L. Emotional responses and coping strategies in nurses and nursing students during Covid-19 outbreak: a comparative study. PLoS One. 2020 Aug 7;15(8):e0237303. PMID: 32764825.
Kincaid E. One year into the pandemic, more than 3000 healthcare workers have died of COVID-19. Medscape Medical News [Internet]. 2021 [cited 2021 Mar 12]. Available from: https://www.medscape.com/viewarticle/947304
Wong TW, Yau JK, Chan CL, Kwong RS, Ho SM, Lau CC, et al. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. Eur J Emerg Med. 2005 Feb;12(1):13-8. PMID: 15674079.
Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, et al. Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: a large-scale cross-sectional study. EClinicalMedicine. 2020 Jun 27; 24:100424. PMID: 32766539.
Aksoy YE, Koçak V. Psychological effects of nurses and midwives due to COVID-19 outbreak: the case of Turkey. Arch Psychiatr Nurs. 2020 Oct;34(5):427-33. PMID: 33032769.
Tayyib NA, Alsolami FJ. Measuring the extent of stress and fear among Registered Nurses in KSA during the COVID-19 Outbreak. J Taibah Univ Med Sci. 2020 Oct;15(5):410-6. PMID: 32905033.
Arnetz JE, Goetz CM, Arnetz BB, Arble E. Nurse reports of stressful situations during the COVID-19 pandemic: qualitative analysis of survey responses. Int J Environ Res Public Health. 2020 Nov 3;17(21):8126. PMID: 33153198.
Jackson D, Bradbury-Jones C, Baptiste D, Gelling L, Morin K, Neville S, et al. Life in the pandemic: some reflections on nursing in the context of COVID-19. J Clin Nurs. 2020 Jul;29(13-14):2041-3. PMID: 32281185.
Maben J, Bridges J. Covid-19: supporting nurses' psychological and mental health. J Clin Nurs. 2020 Aug;29(15-16):2742-50. PMID: 32320509.
Neto MLR, Almeida HG, Esmeraldo JD, Nobre CB, Pinheiro WR, de Oliveira CRT, et al. When health professionals look death in the eye: the mental health of professionals who deal daily with the 2019 coronavirus outbreak. Psychiatry Res. 2020 Jun;288:112972. PMID: 32302817.
Ali H, Cole A, Ahmed A, Hamasha S, Panos G. Major stressors and coping strategies of frontline nursing staff during the outbreak of coronavirus disease 2020 (COVID-19) in Alabama. J Multidiscip Healthc. 2020 Dec 31;13:2057-68. PMID: 33408479.
Garbóczy S, Szemán-Nagy A, Ahmad MS, Harsányi S, Ocsenás D, Rekenyi V, et al. Health anxiety, perceived stress, and coping styles in the shadow of the COVID-19. BMC Psychol. 2021 Apr 6;9(1):53. PMID: 33823945.
Lazarus RS, Folkman S. Transactional theory and research on emotions and coping. Eur J Pers 1987;1(3):141-69.
Janitra FE, Melastuti E, Yusuf AH, Fadhilah H, Wibawa YA. Perceived stigma, psychological response, and nurse coping in the covid-19 pandemic in Indonesia. Journal Keperawatan Padjadjaran 2021;9:10-7. doi: 10.24198/jkp.v9i1.1561.
Hamby S, Grych J, Banyard VL. Life paths measurement packet: finalized scales. Sewanee, TN: Life Paths Research Program; 2015.
Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas 1970;30:607-10.
Chaimay B. Sample size determination in descriptive study in public health. Thaksin J 2013;16:9-18. (in Thai)
Pariwatcharakul P, Ratta-apha W, Chung S, Shin Y, Suh A. SAVE-9 (Thai): stress and anxiety to viral epidemics - 9 items for healthcare workers [Internet]. 2020 [cited 2020 May 18]. Available from: https://www.save-viralepidemic.net
Chung S, Kim HJ, Ahn MH, Yeo S, Lee J, Kim K, et al. Development of the stress and anxiety to viral epidemics-9 (SAVE-9) scale for assessing work-related stress and anxiety in healthcare workers in response to COVID-19. PsyArXiv 2020 Jun 11.
Lee J, Lee HJ, Hong Y, Shin YW, Chung S, Park J. Risk perception, unhealthy behavior, and anxiety due to viral epidemic among healthcare workers: the relationships with depressive and insomnia symptoms during COVID-19. Front Psychiatry. 2021 Mar 19;12: 615387. PMID: 33815164.
Mosolova E, Chung S, Sosin D, Mosolov S. Stress and anxiety among healthcare workers associated with COVID-19 pandemic in Russia. Psychiatr Danub. 2020;32(3-4):549-56. PMID: 33370765.
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020 Mar 2;3(3):e203976. PMID: 32202646.
Aly HM, Nemr NA, Kishk RM, Elsaid NMAB. Stress, anxiety and depression among healthcare workers facing COVID-19 pandemic in Egypt: a cross-sectional online-based study. BMJ Open. 2021 Apr 30;11(4):e045281. PMID: 33931409.
Oktovin, Basit M, Peni MR. Psychological stress of nurses during the Covid-19 pandemic. KnE Life Sciences; 2021;6(1):256-67.
doi: 10.18502/kls.v6i1.8613 .
Alsharif F. Nurses’ knowledge and anxiety levels toward COVID-19 in Saudi Arabia. Nurs Rep. 2021;11:356-63.
Hong Y, Lee J, Lee HJ, Kim K, Cho IK, Ahn MH, et al. Resilience and work-related stress may affect depressive symptoms in nursing professionals during the COVID-19 pandemic era. Psychiatry Investig. 2021 Apr;18(4):357-63. PMID: 33951781.
Ahn MH, Shin YW, Suh S, Kim JH, Kim HJ, Lee KU, et al. High work-related stress and anxiety as a response to COVID-19 among health care workers in South Korea: cross-sectional online survey study. JMIR Public Health Surveill. 2021 Oct 22;7(10):e25489. PMID: 34478401.
Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag. 2020 Jul;28(5):1002-9. PMID: 32255222.
Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 May 6;24(1):200. PMID: 32375848.
Shen Y, Zhan Y, Zheng H, Liu H, Wan Y, Zhou W. Anxiety and its association with perceived stress and insomnia among nurses fighting against COVID-19 in Wuhan: a cross-sectional survey. J Clin Nurs. 2021 Sep;30(17-18):2654-64. PMID: 33497526.
Chiangmaidatacenter. Information on the COVID situation in Chiang Mai [Internet]. 2021 [cited 2021 Jul 16]. Available from: https://www.facebook.com/Chiangmaidatacenter/
Mattila E, Peltokoski J, Neva MH, Kaunonen M, Helminen M, Parkkila AK. COVID-19: anxiety among hospital staff and associated factors. Ann Med. 2021 Dec;53:237-46. PMID: 33350869.
Natividad MJB, Aljohani KA, Roque MY, Gamboa HM. Feelings, stress, and coping of nurses amidst COVID-19 outbreak in Saudi Arabia. Sudan JMS [Internet]. 2021 [cited 2021 Jun 10];16:285-300. Available from: https://www.researchgate.net/publication/352847632_Feelings_Stress_and_Coping_of_Nurses_Amidst_COVID-19_Outbreak_in_Saudi_Ara bia
Aziznejadroshan P, Qalehsari MQ, Zavardehi FS. Stress, anxiety, depression among nurses caring for COVID-19 patients in Babol, Iran: a logestic regression. Research Sqare 2020:1-26. doi: 10.21203/rs.3.rs-98099/v1.
Folkman S. Stress, coping, and hope. Psychooncology. 2010 Sep;19(9):901-8. PMID: 20799373.
Özçevik Subaşi D, Akça Sümengen A, Şimşek E, Ocakçı AF. Healthcare workers' anxieties and coping strategies during the COVID-19 pandemic in Turkey. Perspect Psychiatr Care. 2021 Oct;57(4):1820-8. PMID: 33650693.
Zyga S, Mitrousi S, Alikari V, Sachlas A, Stathoulis J, Fradelos E, et al. Assessing factors that affect coping strategies among nursing personnel. Mater Sociomed. 2016 Apr;28(2):146-50. PMID: 27147924.
Andolhe R, Barbosa RL, Oliveira EM, Costa AL, Padilha KG. Stress, coping and burnout among Intensive Care Unit nursing staff: associated factors. Rev Esc Enferm USP. 2015 Feb;49:58-64. PMID: 26761693.
Temiz Z. Nursing students' anxiety levels and coping strategies during the COVID-19 pandemic. Int Arch Nurs Health Care 2020;6:150. doi: 10.23937/2469-5823/151 0150.
Labrague LJ. Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: a systematic review of quantitative studies. J Nurs Manag. 2021 Oct;29(7):1893-905. PMID: 33843087.
Guo J, Feng XL, Wang XH, van IJzendoorn MH. Coping with COVID-19: exposure to COVID-19 and negative impact on livelihood predict elevated mental health problems in Chinese adults. Int J Environ Res Public Health. 2020 May 29;17(11): 3857. PMID: 32485859.
Tan W, Hao F, McIntyre RS, Jiang L, Jiang X, Zhang L, et al. Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce. Brain Behav Immun. 2020 Jul;87:84-92. PMID: 32335200.
Ye Z, Yang X, Zeng C, Wang Y, Shen Z, Li X, et al. Resilience, social support, and coping as mediators between COVID-19-related stressful experiences and acute stress disorder among college students in China. Appl Psychol Health Well Being. 2020 Dec;12(4):1074-94. PMID: 32666713.
Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit. 2020 Mar 5;26:e923549. PMID: 32132521.
Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of COVID-19 outbreak on frontline nurses: a cross-sectional survey study. J Clin Nurs. 2020 Nov;29:4217-26. PMID: 32786150.