Iran Journal of Nursing

Introduction
During the coronavirus disease 2019 (COVID-19) pandemic, nurses risked their lives in the hospitals to show their commitment to their work and patient care. Nurses face health-threatening traumatic events at work, or incidents in which their patients are seriously injured or threatened with death, but they are not in danger (observed trauma). Sometimes they are exposed to inevitable stressful conditions that have to tolerate them. These conditions increase the risk of developing post-traumatic stress disorder (PTSD). The outbreak of COVID-19 increased the stress and anxiety of nurses. On the other hand, nurses are at higher risk of burnout due to high workload and high emotional expectations of patients. Nurses’ burnout can affect the patient’s recovery process, reduce nursing efficiency, and cause physical and behavioral changes in them, which can lead to reduced quantity and quality of services provided to patients and patient dissatisfaction with services. During the pandemic, many nurses were away from their families and friends for many months, and had fear of COVID-19 and anxiety. The present study aims to investigate and compare PTSD, burnout, and psychological disorders in nurses with and without COVID-19.
Materials & Methods 
This is a causal-comparative study. The study population includes all male and female nurses of non-government hospitals in Tehran from July to September 2021. Of these, 220 nurses (110 without COVID-19 infection and 110 with COVID-19) voluntarily participated in the study. Inclusion criteria were Internet access, having at least 5 years of work experience, age 30-50 years, and declaring consent. Return of incomplete questionnaire was the criterion for exclusion from the research. Due to the COVID-19 pandemic the questionnaires were sent and collected online. The questionnaires were the Mississippi Scale for Combat-Related PTSD, the Maslach Burnout Inventory, and the Depression, Anxiety, Stress Scale. Finally, data analysis was performed using multivariate and univariate analysis of variance in SPSS software, version 16. The significance level was set at 0.05.
Results
There was a significant difference between the two groups in terms of PTSD, burnout, and psychological disorders (P<0.05). Nurses with COVID-19 had higher scores in PTSD (F=96.38, P<0.001), emotional exhaustion (P<0.001, F=12.45), depersonalization (F=15.49, P<0.001), depression (F=92.97, P<0.001), anxiety (F=37.94, P<0.001) and stress (F=47.6, P<0.001). The nurses with no COVID-19 had higher score in personal accomplishment. 
Discussion
The findings of the present study showed that nurses who were infected with COVID-19 had lower psychological health compared to non-infected nurses. This may be because when people have infection with COVID-19, they experience physical, cognitive, and social conditions that they have not experienced before. They have to limit their social interactions, stay at home, and avoid close contact with their families. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Baqiyatallah University of Medical Sciences (Code: IR.BMSU.REC.1399.139).

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Farzin Bagheri Sheykhangafshe and Ali Fathi-Ashtiani: Conceptualization, editing & review; Vahid Savabi Niri and Niloufar Sarlak: Editing; Mahdieh Deldari Alamdari: Data collection.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all the nurses who participated in this research.


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