key: cord-293552-k3wvvnmd
authors: Yifan, Tang; Ying, Liu; Chunhong, Gao; Jing, Song; Rong, Wang; Zhenyu, Li; Zejuan, Gu; Peihung, Liao
title: Symptom Cluster of ICU nurses treating COVID-19 pneumonia patients in Wuhan, China
date: 2020-04-08
journal: J Pain Symptom Manage
DOI: 10.1016/j.jpainsymman.2020.03.039
sha: 
doc_id: 293552
cord_uid: k3wvvnmd

Abstract Objective In treating highly infectious COVID-19 pneumonia, ICU nurses face a high risk of developing somatic symptom disorder (SSD). The present study aims to investigate the symptoms and causes of SSD of ICU nurses treating COVID-19 pneumonia. The research results are expected to provide evidence for the establishment of a better management strategy. Methods This study enrolled a total of 140 ICU nurses who were selected by Jiangsu Province Hospital to work in Wuhan (the epicenter of the COVID-19 epidemic in China) on 3rd February 2020. A questionnaire “Somatic Symptom Disorders for ICU Nurses in Wuhan No.1 Hospital” was designed based on the “International Classification of Functioning, Disability and Health” (ICF). Exploratory factor analysis was performed to cluster the symptoms, and logistic regression analysis to find the risk factors of the symptoms. Results Five major symptoms were chest-discomfort-and-palpitation (31.4%), dyspnea (30.7%), nausea (21.4%), headache (19.3%), and dizziness (17.9%). In exploratory factor analysis, the symptoms were classified into three clusters: Cluster A of breathing and sleep disturbances (dizziness, sleepiness, dyspnea); Cluster B of gastrointestinal complaints and pain (nausea, headache), and Cluster C of general symptoms (xerostomia, fatigue, chest-discomfort-and-palpitation). In Cluster A, urine/feces splash, sex, and sputum splash were independent predictive factors. In Cluster B, fall of protective glasses and urine/feces splash were independent predictive factors. In Cluster C, urine/feces splash and urine/feces clearance were independent predictive factors. Conclusion The ICU nurses in Wuhan showed varying and overlapping SSDs. These SSDs could be classified into three symptom clusters. Based on the characteristics of their SSDs, specific interventions could be implemented to safeguard the health of ICU nurses.

COVID-19 pneumonia has been listed Category B infectious disease and is being treated 62 in a category similar to that of Category A by the National Health Commission of China. A 63 large proportion of COVID-19 patients will progress to a critical condition which needs 64 intensive care. However, given the challenges in treating this disease, ICU nurses are highly 65 prone to somatic symptom disorder (SSD) which is associated with the interaction of biology, 66 cognition, emotion, behavior and environment 1 . The ICU nurses must manage a heavy 67 workload requiring frequent invasive procedures and high attention levels. Therefore, safeguarding the physical and psychological health of ICU nurses can provide a major 69 contribution to the success of epidemic control 2,3 . A symptom cluster is a stable group of two 70 or more co-existing symptoms. The symptom clusters in one population may show overlaps 71 and interactions, a phenomenon that should be resolved to improve the efficiency of 72 managing the disorder 4,5 . Currently, no study has investigated SSDs in ICU nurses fighting at 73 the frontline against the COVID-19 epidemic. Previous studies have confirmed that an 74 individual's response to SSD is dependent on physical, emotional and social factors 6 The questionnaires were handed out through WeChat, an online APP. Participants who 108 met the study criteria logged onto a website (http://www.wjx.cn) to complete the survey. The Other general data are shown in Table 2 . cluster was the total of each symptom score (Table 3) .

166 were independent predictive factors of Cluster B; and urine/feces splash and urine/feces 186 clearance were independent predictive factors for Cluster C (Table 5) . "public health emergency of international concern". The infection, with a route of 

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