Iran Journal of Nursing

Introduction
Due to the COVID-19 pandemic, in addition to the general population, health care workers, including nurses, faced psychological disorders which affected various aspects of their work and life. One of these psychological disorders was death anxiety. The fear and anxiety caused by COVID-19 can put a destructive and heavy psychological burden on people, including nurses, and lead to the occurrence of mental disorders, weakening of the immune system, and reduced quality of patient care, as well as the reduced job satisfaction. Considering the importance of paying attention to the psychological health of nurses, especially those working in intensive care units (ICUs), and given the destructive effects of the COVID-19 pandemic, the need to know the prevalence of death anxiety and its related factors, as well as the lack of studies in the current conditions, this study aims to determine the death anxiety level of nurses working in the ICUs for COVID-19 patients in hospitals medical affiliated to Tehran University of Medical Sciences in 2020.

Methods
This is a descriptive cross-sectional study. Participants were 179 nurses working in the ICUs for COVID-19 patients in two hospitals located in Tehran and Qom cities. Continuous sampling method was used in this study. Data collection was done from December 5, 2020 to February 24, 2021. A demographic form was used to survey information such as age, sex, marital status, work experience, and level of education, and Templer’s Death Anxiety Scale (DAS) was used to measure death anxiety which has 15 items answered by yes or no. Its total scores ranges 0-15, with a higher score indicating more death anxiety. 
The analysis was done in SPSS software, version 24. The descriptive statistics including frequency and percentage were used for qualitative variables and while mean and standard deviation were used for quantitative variables such as death anxiety. The inferential statistics including independent t-test and one-way analysis of variance were used to assess the study hypotheses.

Results 
The mean death anxiety score of nurses was 8.74±2.007 out of 15, which is higher than the median score (i.e., 7.5). The results of one-way analysis of variance showed that the death anxiety score was significantly different between nurses only in terms of age (P=0.000). Tukey’s post hoc test showed that the mean DAS score in nurses aged 30-39 was lower than in nurses aged ≥40 years and <30 years. There was no statistically significant difference in death anxiety between nurses in terms of other demographic factors (P>0.05). 

Conclusion 
The results showed that the ICU nurses experienced a high level of death anxiety during the COVID-19 pandemic. This indicates the importance of paying attention to the psychological health of nurses, especially those working in ICUs. It is necessary that the policy makers and educational, medical or hospital managers develop educational and interventional programs including online in-service programs or educational booklets to help nurses overcome the COVID-19-related conditions. 

Ethical Considerations
Compliance with ethical guidelines
Ethical approval was obtained from the ethics committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1399.644). The participants’ information was kept confidential and their informed consent was obtained.

Funding
This study was funded by Iran University of Medical Sciences.

Authors' contributions
Editing & review, data collection: Zahra Abbasi and Zahra Siahmansour khorin; Project administration and preparing the orginal draft: Akram Salamat; Review and methodology: Maryam Khalili; Data collection and analysis: Leila Ghanbari.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all the nurses participated in this study and the officials of the Faculty of Nursing and Midwifery for assistance in sampling.


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