Iran Journal of Nursing

Introduction
In early December 2019, a novel coronavirus called “COVID-19” emerged in Wuhan, China and caused pandemic and public health emergency in the world. It is necessary to pay attention to its psychological effects on the society. The extent of spread and the related death rate caused COVID-19-related anxiety, especially among  nurses who were in the front line of battle against the disease. Anxiety can lead to physical problems that can affect the quality of work life (QWL). The QWL refers to employees’ level of satisfaction with the job, payments, security, safety, growth opportunities, social cohesion, and individual rights in the organization. Due to the sensitivity of their job and contact with patients, nurses are always exposed to the risks of physical and mental diseases in the workplace. Therefore, considering the negative effect of COVID-19-related anxiety on mental health and QWL of people, especially nurses, and given the limited number of studies in this field in Iran, this study aims to examine the relationship between COVID-19-related anxiety and QWL in nurses working in the hospitals affiliated to Rafsanjan University of Medical Sciences.

Method
This is a correlational cross-sectional study. The studied population consists of all nurses working in hospitals affiliated to Rafsanjan University of Medical Sciences, including Ali Ibn Abi Talib and Moradi during the COVID-19 pandemic in 2021. The samples were selected by a census method (n=300). After obtaining approval from the ethics committee and obtaining the informed consent from the nurses and giving them the necessary explanations about the study objectives and assuring them of the confidentiality of their information. To collect information, a demographic form, Corona disease anxiety scale (CDAS), and Walton’s QWL scale were used. The CDAS has 18 items (items 1-9 about psychological symptoms and items 10-18 about physical symptoms). Based on its total score, the anxiety intensity are divided into three levels: no anxiety or mild, moderate and severe. Walton’s QWL scale has 24 items whose total score ranges from 24 to 120. Data were analyzed in SPSS software, version 18. Quantitative data were reported with mean and standard deviation and qualitative data were reported with number and percentage. First, the normality of data distribution was checked using the Kolmogorov Smirnov test. Then independent t-test and one-way analysis of variance were used to examine the difference in quantitative and qualitative variables. Pearson correlation test was used to examine the relationship between quantitative variables.

Results
Of 300 nurses, 256 nurses participated in the study, of whom 184 (71.9%) were female, 216 (84.4%) were married, and 231 (90.2%) had bachelor’s degree. The work experience of 128 nurses (50%) was 1-5 years and 177 (69.1%) had children. The mean age of participants was 29.66±6.45 years. The mean total anxiety score was 23.97±9.84, which was at moderate level. The mean anxiety scores of female nurses, married nurses, those with a bachelor’s degree and work experience of 5-10 years, and those with no children were higher. However, these differences were not statistically significant (P>0.05). The nurses’ anxiety scores in the subscales of physical and psychological symptoms were 10.02±5.92 and 13.95±5.65, respectively. Based on the physical symptoms dimension, most of nurses (n=127 49.6%) had severe anxiety, while most of them (73.8%) had moderate anxiety based on the psychological symptoms dimension. The comparison of these scores based on the variables of gender, marital status, educational level, work history, and having/not having children showed no significant difference (P>0.05). 
The mean score of QWL was 79.06±12.38, which was higher than the average level. Although the mean scores of QWL in female nurses, married nurses, those with a master’s degree and a work experience >20 years, and those with children were higher, but the differences were statistically significant (P>0.05). Pearson’s correlation coefficient regarding the relationship between total score and subscale scores of anxiety with the QWL score showed a significant negative relationship only between the physical anxiety score and QWL (r=-0.128, P=0.041).

Conclusion
There is an negative and significant relationship between COVID-19-related anxiety and QWL in nurses in Rafsanjan city. the hospital managers in the study hospitals should pay attention to the mental health and QWL of nurses during the pandemic and take steps to improve their mental health by providing information and appropriate solutions and holding educational workshops. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Rafsanjan University of Medical Sciences (Code: IR.RUMS.REC.1400.060)

Funding
This study was extracted from a research proposal approved by the Student Research Committee of Rafsanjan University of Medical Sciences.

Authors' contributions
Writing initial draft: Ali Nakhaee, Haniyeh Hosni, Lida Abazari and Aida Abazari; Statistical analysis: Zahra Asadollahi; Writing the final draft: Neda Rahimi and Zahra Asadollahi.

Conflict of interest
The authors declare no conflict of interest

Acknowledgments
The authors would like to thank all the nurses participated in this research for their cooperation.
 
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