Iran Journal of Nursing

Introduction
In the frontline of combating emerging diseases, there are medical staff of hospitals, including nurses, who put their lives at risk to help people. Nurses play an important role in providing health care. They are considered as the largest part of health care organizations. During the COVID-19 pandemic, the nurses from psychiatric departments were also affected. Reality testing of psychiatric patients during pandemics, due to the delay in receiving psychiatric services or not being admitted on time, is more difficult; their hospitalization with such conditions make the work of nurses in psychiatric departments more difficult during pandemics. Nurses working in psychiatric departments face additional challenges of caring for psychiatric patients, which can affect their mental health. The present study aims to determine the effect of psychological immunization on perceived stress and the anxiety caused by COVID-19 in nurses from psychiatric departments of hospitals in Zahedan, Iran.

Methods 
This is a quasi-experimental study. All nurses of psychiatry departments of Baharan Hospital in Zahedan city were included in the study by a census method and were assigned to intervention and control groups by a lottery method. Inclusion criteria were at least 6 months of work experience, not taking psychiatric drugs, not participating in other training programs at the same time, and not having any traumatic event in the past 6 months such as the loss of a first-degree relative. Exclusion criteria were absence from the sessions, changing the workplace during the study, contracting COVID-19 during the study.
The data collection tool was a three-part self-report questionnaire. The first part surveyed personal information, vaccination status, including age, sex, marital status, educational level, work experience, COVID-19 infection status, and history of underlying disease. The second part was the perceived stress scale (PSS) which has 14 items rated on a four-point Likert scale, and a total score ranging from 0 to 56. The third part was the corona disease anxiety scale (CDAS), developed by Alipour et al. in 2020. The scoring was based on a 4-point Likert scale as 0=Never, 1=Sometimes, 2=Often, and 3= Always. Therefore, its total score ranges from 0 to 54, with higher scores indicating a higher level of anxiety. The questionnaires were completed in two groups before the intervention and two months after the intervention. To prevent information leakage, first the control group completed the questionnaires. The psychological immunization program was provided in two four-hour workshops by observing all health protocols for the intervention group. The educational content was implemented based on the stress immunization program designed by Meichenbaum. Data analysis was done in SPSS software, version 16 using descriptive (mean and standard deviation) and inferential (chi-square test, independent t-test, paired t-test, and Fisher’s exact test) statistics. P<0.05 was considered statistically significant.

Results
The findings showed that 84% of nurses in the intervention group and 72% in the control group were infected with COVID-19. In addition, 100% of nurses in the intervention group and 88% in the control group were vaccinated. The mean score of CDAS in the intervention group decreased significantly (P=0.004), while the mean score of PSS in the intervention group showed no significant difference (P=0.8). The result of the analysis of covariance showed that the mean scores of CDAS and PSS did not have a significant change in any groups after psychological immunization.

Conclusion 
The results showed that psychological immunization had no effect on perceived anxiety and stress caused by COVID-19 in nurses of psychiatric departments. The hospital managers should pay attention to the psychological problems of nurses during pandemic.

Ethical Considerations
Compliance with ethical guidelines
All ethical principles, such as obtaining informed consent from the 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 Zahedan University of Medical Sciences (Code: IR.ZAUMS.REC.1400.288)

Funding
This article was extracted from a master’s thesis of Reza Gholami approved by Department of Psychiatric Nursing, School of Midwifery Nursing, Zahedan University of Medical Sciences. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors  

Authors' contributions
Data analysis and editing: Mahnaz Ghaljeh; Writing proposal and performing intervention: Reza Gholami; Supervision and review: Nasrin Rezaee.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The researchers would like to thank the nurses of psychiatric department in Baharan Hospital who participated in this study for their cooperation.

 

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