key: cord-0810274-uennuvoc
authors: Yurtseven, Şeyma; Arslan, Sevban
title: Anxiety levels of university hospital nurses during the Covid‐19 pandemic
date: 2021-01-13
journal: Perspect Psychiatr Care
DOI: 10.1111/ppc.12719
sha: f70d9bc728eb26e3edf2ecf1d26bdb88e2d91737
doc_id: 810274
cord_uid: uennuvoc

PURPOSE: The aim of this study was to determine the anxiety levels of nurses caused by the changes experienced during the Covid‐19 pandemic. DESIGN AND METHODS: The sample of the study consisted of 270 nurses. The data were collected using a questionnaire and the State Anxiety Inventory. The data were analyzed using descriptive statistics, t test, analysis of variance, Kruskal–Wallis and Tukey's test. FINDINGS: It was found that of the total number of nurses, 85.6% had high anxiety levels. PRACTICAL IMPLICATIONS: Early intervention of indirect traumatization might facilitate controlling anxiety resulting from the Covid‐19 outbreak. Conducting further supportive administrative studies to reduce anxiety levels is recommended.

This descriptive study was conducted (using a survey platform) during the Covid-19 pandemic to assess the anxiety levels of nurses working in a university hospital operating as a pandemic hospital, in accordance with the Helsinki Declaration principles.

The population of the sample consisted of 500 nurses working in the university hospital where the study was conducted during the Covid-19 pandemic. Of the nurses invited to take part in the study, 54% volunteered to participate. The sample consisted of 270 nurses, who agreed to participate in the study, who were actively working between May 13 and 20, 2020, and who completed their surveys.

The data of the study were collected with an online survey to reduce face-to-face interaction due to the current isolation policy.

The study was conducted online by sending an invitation containing information about the purpose of the study to the participants.

Participants completed the surveys with a computer or a smartphone by connecting to the website.

The data were collected using a "Personal Information Form" prepared by the researchers in light of the literature and the "State Anxiety Inventory (SAI)."

The form contains 21 questions regarding sociodemographic (age, gender, education level, etc.), occupational (working years, working pattern, duties, etc.), and mental characteristics (coping mechanisms while under stress, receiving support during a mental problem, etc.). 7,12

SAI is a part of the State-Trait Anxiety Inventory. It was developed by Spielberger and associates in 1970 in the United States. The inventory, which was translated to Turkish by Öner and Le Compte, was tested for reliability in 1976, and for validity in 1977. The internal consistency and reliability of the Turkish version of the SAI were between 0.94 and 0.96, respectively. The Cronbach's alpha value of the SAI was 0.93 in our study, which indicates that the reliability of the study is high. It consists of 20 items in total, and it demonstrates how a person feels in certain situations and circumstances. SAI is scored according to the intensity of emotions or behaviors stated in the items with the following options: (1) not at all,

(2) somewhat, (3), moderately so, and (4) very much so. There are 10 reversed items in the inventory, which are 1, 2, 5, 8, 10, 11, 15, 16, 19 , and 20. The state anxiety score is calculated by adding 50 points to the difference between total weighted scores of normal and reversed items. Scores obtained from SAI theoretically range from 20 to 80 points. A score below 36 indicates no anxiety, scores between 37 and 42 indicate moderate anxiety, and a score above 42 indicates high anxiety. Higher total scores obtained from the inventory indicate higher anxiety levels. 16 An ethical board approval from the Nonclinical Research Board of Medical Faculty of Cukurova University (Decision no: 35, Date: April 10, 2020) and necessary institution approvals from the hospital where the study was conducted were obtained to conduct the study.

A voluntary consent form containing information was sent to the participants who had received the questionnaire, and the participants who accepted to take part in the study answered the questions of the inventory.

The data were analyzed using the IBM SPSS Statistics 24 program by using descriptive statistics (frequency, percentage, and mean) and frequency tables. The data were considered statistically significant at p < 0.05 level.

Parametric methods were used for normally distributed data. As parametric methods, an independent samples t test (t table value There was no statistically significant difference between age groups, gender, education level, marital status, having a chronic disease, smoking, having someone they took care of, and living with someone, and the scores of the SAI (p > 0.05; Table 1 ).

There was a statistically significant difference between income levels and the scores of the SAI (F = 8.226; p = 0.000). The SAI scores of the individuals with insufficient income were statistically significantly higher than that of partially sufficient and sufficient income levels ( Table 1) .

There was a moderate difference between anxiety levels and transportation to the workplace, receiving education regarding There was a statistically significant difference between staff and outpatient clinic/special service nurses and charge/head nurse.

Scores of the SAI of staff and policlinic/special service nurses were statistically significantly higher ( Table 2) .

A statistically significant difference was found in the SAI scores according to the ward preference (t = −2.027; p = 0.044). Scores of the SAI of nurses who were assigned to their units were statistically significantly higher than nurses who chose their units themselves (Table 2 ).

There was a statistically significant difference between considering the occupation as suitable for themselves and the scores of the SAI (Z = −2.638; p = 0.008). Scores of the SAI of nurses who did not consider the occupation as suitable for themselves were higher than of those who regarded it as suitable ( Table 2 ).

Although the entire world is confronted with the heavy burden of the Covid-19, nurses, who constitute the most extensive group in the health sector, are the ones being the most affected. Nurses are in close contact with the patients constantly, and they are unable to prevent emotional responses during the period, experiencing intense fear, anger, disappointment, concern, and anxiety, which all reduce their quality of life. 17 Studies suggest that even after these difficult times, psychological symptoms resulting from the pandemic will continue for a long time. [18] [19] [20] This study was conducted in a university hospital operating as a pandemic hospital. Thus, it was possible to reach the nurses who were in the center of this challenging period.

Wang et al. 21 Ahmed et al. 28 found in their study investigating anxiety levels that young adults experienced higher anxiety as compared with other groups. In our study, conducted with a relatively young group with a mean age of 36.83 ± 9.23, a statistically significant difference was not found between age and the SAI scores (p > 0.05; Table 1 ).

In addition, no statistically significant difference was found between gender and anxiety levels. In another study, women were estimated to be more affected during pandemics. 29 Some studies conducted on the topic indicate that women have higher anxiety levels. 21, 30, 31 Unlike these studies, in another study, investigating anxiety and depression symptoms of healthcare personnel working during the Covid-19 outbreak, the male gender experienced an increase in anxiety, whereas the female gender experienced a decrease in anxiety. 32 Qiu et al. 33 

China that women had significantly higher levels of psychological problems as compared with men. It is possible that no statistically significant difference was found in our study, as most of our participants were females (87.8%).

Although there was no statistically significant difference between the education level of nurses and their state anxiety, there was a relative difference, and as education levels increased, anxiety levels decreased (Table 1 ). In another study related to the subject, participants with lower education levels were more anxious, parallel to our findings. 34 Although the results of this study indicate that receiving education regarding Covid-19 does not affect anxiety levels, Tan et al. 35 found that psychological effects (especially anxiety)

of Covid-19 were more common with personnel who did not receive medical education, compared with those who did.

There was no statistically significant difference between having a chronic disease and anxiety scores of nurses, who are, in fact, regarded as suspects. This might be a result of the administrative leaves the nurses were on, in accordance with the country policy; therefore, they were not fully represented in the sample (25.9%).

Wei et al. 34 found in their study that having a chronic disease was a factor for having increased anxiety in nurses.

In addition, living with someone or alone did not cause a statistically significant difference in anxiety levels (p > 0.05; Table 1 ).

However, the literature suggests that psychological distress levels might increase with the fear of having the virus, and the fear of being infected and infecting others might affect their anxieties due to the possibility of infecting other healthcare personnel, as well as their own families, while they continue to work. 36 There was a statistically significant difference between income levels and anxiety scores (F = 8.226; p < 0.001). State anxiety scores of those with insufficient income were higher than those with YURTSEVEN AND ARSLAN partially sufficient and sufficient income levels ( 

This study defines anxiety levels of nurses working during the ongoing Covid-19 pandemic in a broad context. The negative effects of severe anxiety on patient care and the well-being of healthcare professionals traumatized by the pandemic should be considered. 35 Nurses, who are on the frontline in the COVID-19 pandemic and provide 24-h continuous care to patients, are at a risk physically as well as mentally, as they are also being affected psychologically.

Therefore, taking precautions to support psychosocial health of nurses is urgent and of vital importance, to maintain the health of the 

The study has some limitations that need consideration. The responses of the participants are limited to the items of the inventory, and the obtained data are generalized to the hospital where the study was conducted. However, by reviewing the previous literature and the concepts thoroughly, obtaining informed consent and ethical approvals, and analyzing the data in detail, these limitations were reduced to a minimum.

The results of the study demonstrated that the anxiety levels of the nurses providing care to patients were high. It is important to identify those with high anxiety levels and provide administrative support for effective care. Problems related to equipment, consumable materials, and foundational issues, which help provide quality care to patients, should be sufficiently addressed. There should be a focus on reducing anxiety levels of nurses with different activities and trainings on the subject. Providing emotional and informational support might contribute to reduce the difficulties in care duties and enhance the quality of care.

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How to cite this article: Yurtseven Ş, Arslan S. Anxiety levels of university hospital nurses during the Covid-19 pandemic

The authors declare that there are no conflict of interests.

Study conception and design: Sevban Arslan and Şeyma Yurtseven.

Şeyma Yurtseven. Drafting and critical revision of the article: Sevban Arslan, Şeyma Yurtseven, and Sevban Arslan.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

https://orcid.org/0000-0003-2378-682X