Iran Journal of Nursing

Introduction
Two years have passed since the end of the COVID-19 pandemic, but the mutations of the virus still exist. During the pandemic, nurses were at the forefront of the fight against the COVID-19 and faced many stressors. The unpredictability of the situation and the seriousness of the danger can lead to stress and limit a person’s ability to predict and control. One of the factors that played a role in development of anxiety symptoms during the COVID-19 pandemic was intolerance of uncertainty (IU). It consists of a set of negative beliefs about an uncertainty. People with IU believe that not only uncertainty is distressing, but also uncertainty about the future is intolerable. Nurses with IU perceive uncertainties about of COVID-19 as stressful and experience severe anxiety and worry. Anxiety in such situations leads to cognitive avoidance, rumination, or other maladaptive coping strategies. In the current situation, anxiety and uncertainty are an understandable reaction to an abnormal experience, but if the threat and uncertainty continue, it can become a problem and leads to discomfort, stress and negative emotions. The present study aims to determine the IU level about the COVID-19 pandemic in nurses working in teaching hospitals in Tehran, Iran.

Methods
This descriptive cross-sectional study was conducted in 2020 on 240 nurses working in coronavirus wards in teaching hospitals affiliated to Iran University of Medical Sciences (Firoozgar, Hazrat-e Rasool Akram, Hasheminejad, Haft-e Tir, Firoozabadi, Shohadaye Yaftabad, Imam Sajjad in Shahriyar county, and Hazrate Fatemeh in Robat Karim county) who were selected by a census method and based on the inclusion criteria (Bachelor’s degree or higher in nursing, at least 1 year of work experience, no mental illness or use of psychiatric drugs based on nurses’ self-reports, no history of experiencing traumatic event in the past 6 months, such as divorce and the death of relatives). Data collection tools were a demographic form (surveying age, gender, educational level, marital status, number of children, work experience, job position, history of chronic disease, history of COVID-19 infection during work in the hospital, and work experience in the coronavirus ward) and Freeston et al.’s 27-item intolerance of uncertainty scale (IUS). The questionnaires took approximately 10-15 minutes to complete. Data analysis was performed in SPSS software, version 16, using descriptive statistics (minimum, maximum, Mean±standard deviation) and inferential statistics including independent t-test and analysis of variance. The significance level was set at 0.05.

Results
The mean score of IU was 62.58±20.36. The stress dimension of IUS showed the highest score (2.49±0.78) while the dimension of inability to take action showed the lowest score (2.15±0.80). This indicates that nurses have more stress intolerance and believed that uncertainty made them stressed, while they had less intolerance about the inability to take actions and believed that doubt rarely could stop them from acting. The COVID-19 infection was significantly associated with IU (P=0.048). Since the nurses recovered from COVID-19 may be involved with physical, mental and cognitive complications for a long period and feel tired or lack energy to fully resume their work, they were more intolerant of uncertainties.

Conclusion
The nurses working in the coronavirus wards of selected teaching hospitals had IU during the COVID-19 pandemic such that they had more IU regarding stress, but the amount of IU was not so high that can make them unable to perform their duties. However, a one-unit decrease in job performance can have consequences in terms of organizational outcomes and patient care. Providing education to nurses on how to break the cycle of anxiety and IU, changing their beliefs about IU, reducing their negative orientation to problems, controlling and monitoring their performance, and facilitating the provision of care can help optimize nursing care and achieve quality patient care during health-related crises.

Ethical Considerations

Compliance with ethical guidelines
All ethical principles such as obtaining informed consent from participants, protecting their confidentiality, and giving them the right to leave the study, were considered in this study. This study was approved by the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC1399.1104).

Funding
This article was extracted from the master’s thesis of Zahra Tork at Department of Pediatric and Psychiatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences.

Authors' contributions
Conceptualization and data collection: Zahra Tork; Data analysis: Shima Haghani; Supervision and review: Mehrnoosh Inanlou.

Conflict of interest
The authors declared no Conflict of interest.




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