Stress, Burnout, and Coping Strategies of Frontline Nurses During the COVID-19 Epidemic in Wuhan and Shanghai, China

Abstract

Background: Nurses at the frontline of caring for COVID-19 patients might experience mental health challenges and supportive coping strategies are needed to reduce their stress and burnout. The aim of this study was to identify stressors and burnout among frontline nurses caring for COVID-19 patients in Wuhan and Shanghai and to explore perceived effective morale support strategies. Method: A cross-sectional survey was conducted in March 2020 among 110 nurses from Zhongshan Hospital, Shanghai, who were deployed at COVID-19 units in Wuhan and Shanghai. A COVID-19 questionnaire was adapted from the previous developed "psychological impacts of SARS" questionnaire and included stressors (31 items), coping strategies (17 items), and effective support measures (16 items). Burnout was measured with the Maslach Burnout Inventory. Results: Totally, 107 (97%) nurses responded. Participants mean age was 30.28 years and 90.7% were females. Homesickness was most frequently reported as a stressor (96.3%). Seven of the 17 items related to coping strategies were undertaken by all participants. Burnout was observed in the emotional exhaustion and depersonalization subscales, with 78.5 and 92.5% of participants presenting mild levels of burnout, respectively. However, 52 (48.6%) participants experienced a severe lack of personal accomplishment. Participants with longer working hours in COVID-19 quarantine units presented higher emotional exhaustion (OR = 2.72, 95% CI 0.02-5.42; p = 0.049) and depersonalization (OR = 1.14, 95% CI 0.10-2.19; p = 0.033). Participants with younger age experienced higher emotional exhaustion (OR = 2.96, 95% CI 0.11-5.82; p = 0.042) and less personal accomplishment (OR = 3.80, 95% CI 0.47-7.13; p = 0.033). Conclusions: Nurses in this study experienced considerable stress and the most frequently reported stressors were related to families. Nurses who were younger and those working longer shift-time tended to present higher burnout levels. Psychological support strategies need to be organized and implemented to improve mental health among nurses during the COVID-19 pandemic.

Nurses’ burnout and associated risk factors during the COVID-19 pandemic: a systematic review and meta-analysis

“…After the screening of the titles and abstracts, we removed 191 records and we added 4 more records found by the reference lists scanning. Finally, we included 14 studies [27][28][29][30][31][32][33][34][35][36][37][38][39][40] in this systematic review that met our inclusion criteria and among them six studies in the meta-analysis that included the appropriate data.…”

“…Main characteristics of the 14 studies included in our systematic review are shown in Table 1. Study population included only nurses in five studies, 27,28,33,36,40 while nine studies [29][30][31][32]34,35,[37][38][39] included HCWs in general. A total of 17,390 nurses were included in this systematic review, while two studies 37,38 did not report the number of nurses.…”

“…A total of 17,390 nurses were included in this systematic review, while two studies 37,38 did not report the number of nurses. All studies were cross-sectional, while 12 studies [27][28][29][30][33][34][35][36][37][38][39][40] used a convenience sample method and two studies 31,32 used a snowball sampling method. Eight studies 27,28,30,[33][34][35]37,40 was conducted in Asia (China, India, Japan, Turkey, Singapore, Taiwan, and Iran), four studies 29,32,36,39 in Europe (United Kingdom, Spain, and Italy), and two studies 31,38 in North America (USA and Puerto Rico).…”

“…All studies were cross-sectional, while 12 studies [27][28][29][30][33][34][35][36][37][38][39][40] used a convenience sample method and two studies 31,32 used a snowball sampling method. Eight studies 27,28,30,[33][34][35]37,40 was conducted in Asia (China, India, Japan, Turkey, Singapore, Taiwan, and Iran), four studies 29,32,36,39 in Europe (United Kingdom, Spain, and Italy), and two studies 31,38 in North America (USA and Puerto Rico). Eleven studies [27][28][29][30]33,34,[36][37][38][39][40] were published in journals and three studies 31,32,35 in pre-print services.…”

“…Quality was moderate in the majority of studies (n=12) 29,[29][30][31][32][33][34][35][36][37][38][39][40] and good in two studies 27,28 . The most frequent bias is that the studies did not take into account confounding factors and did not apply multivariable methods to eliminate them.…”