Iran Journal of Nursing

Introduction
In December 2019, a new type of coronavirus named COVID-19 emerged in Wuhan, China and rapidly spread and led to the infection and death of many people in the world. It caused many physical and mental health problems in people. The disease was later declared as a pandemic by the World Health Organization (WHO). The outbreak of COVID-19 led to self-quarantine and closure of many businesses in different countries, while the health centers remained open, and healthcare providers, especially nurses, were in the front line of battle against the disease. Nurses were in direct contact with infected patients from admission to discharge. They not only experienced high occupational stress, but also, due to the long working hours and being in the environments, were at higher risk of contracting the virus, which exposes them to psychological health problems. The nurses in the intensive care units (ICUs) and emergency departments were at higher risk than those in other hospital departments. This study aims to determining the anxiety and fear of COVID-19 in nurses working in ICUs and emergency departments of hospitals affiliated to Iran University of Medical Sciences.

Materials and Methods
This is a descriptive cross-sectional study conducted on nurses working in ICUs and emergency departments of Hazrat-e Rasool Akram, Firozgar, Shohaday-e Haft-e Tir, Yaftabad, Firozabadi and Lulager hospitals from June to September 2021 (n=430). Sampling was done by census method. The inclusion criteria were: no history of any known mental disorders, no history of taking psychotropic medications based on self-report. of 430 nurses, 205 participated in the study. Heavy workload, lack of human resource, and fatigue led to a drop in the number of samples. After preparing the electronic form of the questionnaire using the Porsline website, it was sent to the participants. After receiving the answers online, the desired information was extracted from the confirmed samples. Data collection tools were a demographic form, corona disease anxiety scale (CDAS), and fear of COVID-19 scale. Data were statistically analysed using independent t-test, Scheffe’s post hoc test, and Pearson’s correlation test in SPSS software, version 16.


Results
The mean anxiety of nurses was 18.67±13.25. The mental symptoms domain of CDAS showed the highest score (12.11±6.89), while the physical symptoms domain had the lowest score (6.56±7.11). The mean score of fear was 21.19±6.60. Their anxiety caused by COVID-19 had a significant correlation only with the working time in the corona ICU (P< 0.001), such that, with the increase of working time in this ward, their anxiety significantly decreased by 0.475 units. The fear of COVID-19 was significantly higher in married nurses (P=0.02) and those with a history of COVID-19 infection (P=0.006). There was a statistically significant relationship between the fear of COVID-19 and the frequency of contracting the disease (P=0.021). The fear of COVID-19 was significantly higher in nurses who were infected once than in those who were never infected (P=0.034).

Conclusion
There are moderate anxiety and fear caused by COVID-19 in nurses working in ICUs and emergency department of selected hospitals. The concern about the spread of COVID-19 to the surrounding people is the most important factor causing anxiety in nurses, and with the increase of working time in the corona ICU, the anxiety of nurses decreases significantly. The, married nurses and those with a history of infection with COVID-19 showed significantly higher fear. Considering the many problems that such disorders create for nurses, especially for those in ICUs and emergency departments, there is a need for effective planning to reduce them and improve the physical and psychological health of nurses, in order to help them provide high-quality patient care. Also, considering that nursing managers play an important role in supporting nurses, they are recommended to provide suitable work environment and hold workshops on mental health for nurses and mane the fear and anxiety of nurses so that they can cope with the challenges of the pandemic. Increasing the number of nurses, reducing working hours, psychological support from specialists, effective infection control, using personal protection equipment, and implementation of institutional policies and protocols can also help reduce the anxiety and fear of nurses and thus increase their mental health during the pandemics.

Ethical Considerations
Compliance with ethical guidelines
Ethical approval for this study was obtained from the ethics committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1399.1422). The participants’ information was kept confidential.

Funding
This article was extracted from the master thesis Bahareh Khezri in intensive care nursing. This study was funded by Iran University of Medical Sciences.

Authors' contributions
Data collection, editing, and review: Bahareh Khezri; supervision and project administration: Mehri Bozorgnezhad and Tahereh Najafi Ghezeljeh, Data analysis: Shima Haghani

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the Deputy for Research of Iran University of Medical Sciences for the financial support and all the nurses participated in the study for their cooperation.
 

References

1. Saricam M. COVID-19-related anxiety in nurses working on front lines in Turkey. Nurs Midwifery Stud. 2020; 9:178-81. [Link]
2. Alizadeh A, Khankeh HR, Barati M, Ahmadi Y, Hadian A, Azizi M. Psychological distress among Iranian health-care providers exposed to coronavirus disease 2019 (COVID-19): A qualitative study. BMC Psychiatry. 2020; 20(1):494. [DOI:10.21203/rs.3.rs-29738/v2] [PMID]
3. Nakhostin-Ansari A, Sherafati A, Aghajani F, Khonji MS, Aghajani R, Shahmansouri N. Depression and anxiety among Iranian Medical Students during COVID-19 pandemic. Iran J Psychiatry. 2020; 15(3):228-35. [DOI:10.18502/ijps.v15i3.3815] [PMID] [PMCID]
4. Wu W, Zhang Y, Wang P, Zhang L, Wang G, Lei G, et al. Psychological stress of medical staffs during outbreak of COVID-19 and adjustment strategy. J Med Virol. 2020; 92(10):1962-70. [DOI:10.1002/jmv.25914] [PMID] [PMCID]
5. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020; 24(1):200. [DOI:10.1186/s13054-020-02926-2] [PMID] [PMCID]
6. Labrague LJ, de Los Santos JAA. Fear of COVID-19, psychological distress, work satisfaction and turnover intention among frontline nurses. J Nurs Manag. 2021; 29(3):395-403. [PMID] [DOI:10.21203/rs.3.rs-35366/v1]
7. Caillet A, Coste C, Sanchez R, Allaouchiche B. Psychological impact of COVID-19 on ICU caregivers. Anaesth Crit Care Pain Med. 2020; 39(6):717-22. [DOI:10.1016/j.accpm.2020.08.006] [PMID] [PMCID]
8. Saracoglu KT, Simsek T, Kahraman S, Bombaci E, Sezen Ö, Saracoglu A, et al. The psychological impact of COVID-19 disease is more severe on Intensive Care Unit healthcare providers: A cross-sectional study. Clin Psychopharmacol Neurosci. 2020; 18(4):607-15. [DOI:10.9758/cpn.2020.18.4.607] [PMID] [PMCID]
9. Song X, Fu W, Liu X, Luo Z, Wang R, Zhou N, et al. Mental health status of medical staff in emergency departments during the Coronavirus disease 2019 epidemic in China. Brain Behav Immun. 2020; 88:60-5. [PMID] [DOI:10.2139/ssrn.3605323]
10. An Y, Yang Y, Wang A, Li Y, Zhang Q, Cheung T, et al. Prevalence of depression and its impact on quality of life among frontline nurses in emergency departments during the COVID-19 outbreak.  J Affect Disord. 2020; 276:312-5. [DOI:10.1016/j.jad.2020.06.047] [PMID] [PMCID]
11. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control. 2020; 48(6):592-8. [DOI:10.1016/j.ajic.2020.03.018] [PMID] [PMCID]
12. Sarboozi Hosein Abadi T, Askari M, Miri K, Namazi Nia M. [Depression, stress and anxiety of nurses in COVID-19 pandemic in Torbat Heydariyeh Hospital, Iran (Persian)]. J Mil Med. 2020; 22(6):526-33. [Link]
13. García-Fernández L, Romero-Ferreiro V, López-Roldán PD, Padilla S, Calero-Sierra I, Monzó-García M, et al. Mental health impact of COVID-19 pandemic on Spanish healthcare workers. Psychol Med. 2022; 52(1):195-7. [DOI:10.1017/S0033291720002019] [PMID] [PMCID]
14. Karki P, Katwal GB, Chandra A, Chandra A. Prevalence and measurement of anxiety and depression in nurses during COVID pandemic in Nepal. 2020. [Unpublished]. [DOI:10.21203/rs.3.rs-34462/v1]
15. Alipour A, Ghadami A, Alipour Z, Abdollahzadeh H. [Preliminary validation of the Corona Disease Anxiety Scale (CDAS) in the Iranian sample (Persian)]. Q J Health Psychol 2020; 8(32):163-75. [Link]
16. Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian J Psychiatr. 2020; 51:102076. [DOI:10.1016/j.ajp.2020.102076] [PMID] [PMCID]
17. Coelho CM, Suttiwan P, Arato N, Zsido AN. On the nature of fear and anxiety triggered by COVID-19. Front Psychol. 2020; 11:581314. [DOI:10.3389/fpsyg.2020.581314] [PMID] [PMCID]
18. Pakpour AH, Griffiths MD. The fear of COVID-19 and its role in preventive behaviors. J Concurr Disord. 2020; 2(1):58-63. [DOI:10.54127/WCIC8036]
19. Ornell F, Schuch JB, Sordi AO, Kessler FHP. “Pandemic fear” and COVID-19: Mental health burden and strategies. Braz J Psychiatry. 2020; 42(3):232-5. [DOI:10.1590/1516-4446-2020-0008] [PMID] [PMCID]
20. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale: Development and initial validation.  Int J Ment Health Addict. 2022; 20(3):1537-45. [DOI:10.1037/t78404-000] [PMID]
21. Lu W, Wang H, Lin Y, Li L. Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Res. 2020; 288:112936. [DOI:10.1016/j.psychres.2020.112936] [PMID] [PMCID]
22. Mohamadzadeh Tabrizi Z, Mohammadzadeh F, Davarinia Motlagh Quchan A, Bahri N. COVID-19 anxiety and quality of life among Iranian nurses. BMC Nurs. 2022; 21(1):27.[DOI:10.1186/s12912-021-00800-2] [PMID] [PMCID]
23. Korkmaz S, Kazgan A, Çekiç S, Tartar AS, Balcı HN, Atmaca M. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services.  J Clin Neurosci. 2020; 80:131-6. [DOI:10.1016/j.jocn.2020.07.073] [PMID] [PMCID]
24. Nori Chenashk T. [Qualitatively in search of psychological distress and coping strategies of female frontline nurses (Persian)]. Couns Cult Psychother. 2022; 13(49):279-308. [DOI:10.22054/qccpc.2021.64010.2807]
25. Haftador Mortezaei A, Mohebbi Z, Tehranineshat B, Keshtkaran Z, Mani Kazeroon A, Noori Shadkam M. [The rate of anxiety and its influential factors among nurses caring for COVID-19 patients at hospitals in Iran (Persian)]. Sadra Med J. 2022; 219-30. [Link]
26. Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian nurses’ knowledge and anxiety toward COVID-19 during the current outbreak in Iran. Arch Clin Infect Dis. 2020; 15(COVID-19):e102848. [DOI:10.5812/archcid.102848]
27. Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Res. 2020; 288:112954. [DOI:10.1016/j.psychres.2020.112954] [PMID] [PMCID]
28. Deying H, Yue K, Wengang L, Qiuying H, Xin ZHANG LXZ, Su Wei W, et al. Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine. 2020; 24:100424. [PMID]