Covid-19 pandemic? Mental health implications among nurses and Proposed interventions

Vasiliki Georgousopoulou; Panagiota Pervanidou; Pantelis Perdikaris; Efrosyni Vlachioti; Vaia Zagana; Georgios Kourtis; Ioanna Pavlopoulou; Vasiliki Matziou; Vasiliki Georgousopoulou; Panagiota Pervanidou; Pantelis Perdikaris; Efrosyni Vlachioti; Vaia Zagana; Georgios Kourtis; Ioanna Pavlopoulou; Vasiliki Matziou

doi:10.3934/publichealth.2024014

AIMS Public Health

2024, Volume 11, Issue 1: 273-293. doi: 10.3934/publichealth.2024014

Previous Article Next Article

Review Special Issues

Covid-19 pandemic? Mental health implications among nurses and Proposed interventions

1.
Department of Research, Quality Control and Continuing Education, University General Hospital of Alexandroupolis
2.
First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, “Agia Sophia” Children's Hospital
3.
Department of Nursing School of Health Sciences University of Peloponnese
4.
Department of Nursing, ‘Aghia Sophia’ Children's Hospital, Athens, Greece
5.
Department of Nursing, “Sotiria” General Hospital, Athens, Greece
6.
Department of Nursing, National and Kapodistrian University of Athens

Received: 27 October 2023 Revised: 28 February 2024 Accepted: 29 February 2024 Published: 11 March 2024

Background
With its abrupt and huge health and socio-economic consequences, the coronavirus disease (COVID-19) pandemic has led to a uniquely demanding, intensely stressful, and even traumatic period. Healthcare workers (HCW), especially nurses, were exposed to mental health challenges during those challenging times.

Objectives
Review the current literature on mental health problems among nurses caring for COVID-19 patients.

Methods
This is a narrative review and critical evaluation of relevant publications.

Results
Nurses experienced higher levels of stress, burnout, anxiety, depression, frustration, stigma, and depersonalization compared to other HCW. Factors that increased this symptomatology included concerns about infection or infection of family members, inadequate staff protective equipment, extended working hours, insufficient information, a reduced sense of security, and post-traumatic stress disorder. The factors that improved the psychopathology included a general positive attitude, job satisfaction, adequate information and education, harmonious group relationships, post-traumatic development, emotional intelligence, psychological counseling, mindfulness-based stress reduction, stable leadership, guidance, and moral and practical administrative support.

Conclusions
Recent studies clearly show that nurses, especially women, are the most vulnerable subgroup among HCW and are particularly prone to mental health impacts during the COVID-19 pandemic. The documented mental health vulnerability of frontline nursing staff during the COVID-19 pandemic requires preventive nursing management actions to increase resilience and to develop relevant defense mechanisms.
- healthcare workers,
- stress response,
- psychopathology,
- psychological problems,
- COVID-19,
- mental health,
- nurses
Citation: Vasiliki Georgousopoulou, Panagiota Pervanidou, Pantelis Perdikaris, Efrosyni Vlachioti, Vaia Zagana, Georgios Kourtis, Ioanna Pavlopoulou, Vasiliki Matziou. Covid-19 pandemic? Mental health implications among nurses and Proposed interventions[J]. AIMS Public Health, 2024, 11(1): 273-293. doi: 10.3934/publichealth.2024014

Related Papers:

Abstract

Background

With its abrupt and huge health and socio-economic consequences, the coronavirus disease (COVID-19) pandemic has led to a uniquely demanding, intensely stressful, and even traumatic period. Healthcare workers (HCW), especially nurses, were exposed to mental health challenges during those challenging times.

Objectives

Review the current literature on mental health problems among nurses caring for COVID-19 patients.

Methods

This is a narrative review and critical evaluation of relevant publications.

Results

Nurses experienced higher levels of stress, burnout, anxiety, depression, frustration, stigma, and depersonalization compared to other HCW. Factors that increased this symptomatology included concerns about infection or infection of family members, inadequate staff protective equipment, extended working hours, insufficient information, a reduced sense of security, and post-traumatic stress disorder. The factors that improved the psychopathology included a general positive attitude, job satisfaction, adequate information and education, harmonious group relationships, post-traumatic development, emotional intelligence, psychological counseling, mindfulness-based stress reduction, stable leadership, guidance, and moral and practical administrative support.

Conclusions

Recent studies clearly show that nurses, especially women, are the most vulnerable subgroup among HCW and are particularly prone to mental health impacts during the COVID-19 pandemic. The documented mental health vulnerability of frontline nursing staff during the COVID-19 pandemic requires preventive nursing management actions to increase resilience and to develop relevant defense mechanisms.

Acknowledgments

This study is not funded by any agency, and is conducted by the authors independently.

Conflict of interest

The authors state that there is no conflict of interest in this document.

References

[1]	Selye H (1950) Anxiety and the general adjustment syndrome. Br Med J 1: 1383-1392. https://doi.org/10.1136/bmj.1.4667.1383
[2]	Chrousos GP (2009) Stress and stress system disorders. Nat Rev Endocrinol 5: 374-381. https://doi.org/10.1038/nrendo.2009.106
[3]	Taylor S, Landry CA, Paluszek, et al. (2020) COVID stress syndrome: Concept, structure, and correlations. Depress Anxiety 37: 706-714. https://doi.org/10.1002/da.23071
[4]	Vizheh M, Qorbani M, Arzaghi SM, et al. (2020) The mental health of healthcare workers in the COVID-19 pandemic: A systematic review. J Diabetes Metab Disord 19: 1-12. https://doi.org/10.1007/s40200-020-00643-9
[5]	Veitch P, Richardson K (2021) Nurses need support during the Covid-19 pandemic. J Psychiatric Health Nurs 28: 303-304. https://doi.org/10.1111/jpm.12666
[6]	Stelnicki AM, Jamshidi L, Ricciardelli R, et al. (2021) Exposure to potentially psychologically traumatic events among nurses in Canada. Canadian J Nurs Res 53: 277-291. https://doi.org/10.1177/0844562120961988
[7]	Di Tella M, Romeo A, Benfante A, et al. (2020) Mental health of healthcare workers during the COVID-19 pandemic in Italy. J Eval Clin Pract 26: 1583-1587. https://doi.org/10.1111/jep.13444
[8]	Lai J, Ma S, Wang Y, et al. (2020) Factors related to mental health outcomes among healthcare workers exposed to coronavirus disease 2019. JAMA Network Open 3: e203976-e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976
[9]	Nie A, Su X, Zhang S, et al. (2020) Psychological impact of the COVID-19 outbreak on frontline nurses: A cross-sectional research study. J Clin Nurs 29: 4217-4226. https://doi.org/10.1111/jocn.15454
[10]	Shahrour G, Dardas LA (2020) Acute stress disorder, coping with self-efficacy and subsequent psychological distress among nurses amid COVID-19. J Nurs Manag 28: 1686-1695. https://doi.org/10.1111/jonm.13124
[11]	Sarboozi Hoseinabadi T, Kakhki S, Teimori G, et al. (2020) Burnout and its influence factors among frontline nurses and nurses from other wards during the coronavirus disease epidemic -COVID-19- in Iran. Invest Educ Enferm 38: e3. https://doi.org/10.17533/udea.iee.v38n2e03
[12]	Liu Y, Long Y, Cheng, Y, et al. (2020) Psychological impact of the COVID-19 outbreak on nurses in China: A national survey during the epidemic. Front Psychiatry 11: 598712. https://doi.org/10.3389/fpsyt.2020.598712
[13]	Bouza E, Arango C, Moreno C, et al. (2023) Impact of the COVID-19 pandemic on the mental health of the general population and healthcare workers. Rev Esp Quimioter 36: 125-143. https://doi.org/10.37201/req/018.2023
[14]	Harris ML, McLeod A, Titler MG (2023) Health experiences of nurses during the COVID-19 pandemic: A mixed methods study. West J Nurs Res 45: 443-454. https://doi.org/10.1177/01939459221148825
[15]	Vázquez Sánchez MÁ, Ayllón Pérez V, Gutiérrez Sánchez D, et al. (2023) Professional grief among nurses in Spanish public health centers after caring for COVID-19 patients. J Jurs Scholarsh 55: 56-66. https://doi.org/10.1111/jnu.12809
[16]	Stubin CA (2023) Steps towards a resilient future nursing workforce. Int J Νurs Educ Scholarsh 20: 20220057. https://doi.org/10.1515/ijnes-2022-0057
[17]	Alimoradi Z, Jafari E, Lin CY, et al. (2023) Assessment of moral distress among nurses: A systematic review and meta-analysis. Nurs Ethics 30: 334-357. https://doi.org/10.1177/09697330221135212
[18]	Beck JG, Majeed R, Brown TA, et al. (2023) Understanding the role of COVID-19-related work-related stress and institutional betrayal in nurses' mental health: Some heroes wear scrubs. J Trauma Stress 36: 421-432. https://doi.org/10.1002/jts.22920
[19]	Boone LD, Rodgers MM, Baur A, et al. (2023) A comprehensive review of factors and interventions that impact nurses' well-being and safety during a global pandemic. Evid Based Nurs Worldviews 20: 107-115. https://doi.org/10.1111/wvn.12630
[20]	Lee BEC, Ling M, Boyd L, et al. (2023) The prevalence of potential mental health disorders among hospital health workers during COVID-19: A systematic review and meta-analysis. J Affect Disord 330: 329-345. https://doi.org/10.1016/j.jad.2023.03.012
[21]	Dos Santos Alves Maria G, de Oliveira Serpa AL, de Medeiros Chaves Ferreira C, et al. (2023) Impact of mental health on health professionals' sleep patterns during the COVID-19 pandemic in Brazil. J affect disord 323: 472-481. https://doi.org/10.1016/j.jad.2022.11.082
[22]	Atay N, Sahin Bayindir G, Buzlu S, et al. (2023) The relationship between post-traumatic development and psychological resilience of nurses working in pandemic clinics. Int J Nurs Knowl 34: 226-235. https://doi.org/10.1111/2047-3095.12397
[23]	Adams TN, Ruggiero RM, North CS (2023) Addressing mental health needs among frontline healthcare workers during the COVID-19 pandemic. Chest 164: 975-980. https://doi.org/10.1016/j.chest.2023.07.004
[24]	Phillips J, Alipio JK, Hoskins JL, et al. (2023) The experience of frontline nurses during the COVID-19 pandemic: A phenomenological study. West J Nurs Res 45: 327-334. https://doi.org/10.1177/01939459221129944
[25]	Chong YY, Frey E, Chien WT, et al. (2023) The role of psychological flexibility in the relationships between burnout, job satisfaction, and mental health among nurses in the fight against COVID-19: A two-area investigation. J Nurs Scholar 55: 1068-1081. https://doi.org/10.1111/jnu.12874
[26]	He C, Xing L, Lu Y, et al. (2023) Psychological distress and risk factors in frontline nurses dealing with COVID-19 in less severely affected areas. J Health Psychohospital Serv 61: 37-44. https://doi.org/10.3928/02793695-20220902-01
[27]	Che H, Wu H, Qiao Y, et al. (2023) Association between long working hours and mental health among nurses in China under COVID-19 pandemic: Based on a large cross-sectional study. BMC Psychiatry 23: 234. https://doi.org/10.1186/s12888-023-04722-y
[28]	Sagherian K, Steege LM, Cobb SJ, et al. (2023) Insomnia, fatigue, and psychosocial well-being during the COVID-19 pandemic: A cross-sectional survey of hospital nursing staff in the United States. J Clin Nurs 32: 5382-5395. https://doi.org/10.1111/jocn.15566
[29]	Mao X, Dong W, Zhang J, et al. (2023) Mental health status and its related factors among female nurses in normalizing COVID-19 epidemic prevention and control in China. Front Public Health 10: 1088246. https://doi.org/10.3389/fpubh.2022.1088246
[30]	Credland N, Griffin M, Hamilton P, et al. (2023) The impact of COVID-19 on mental health and wellness in critical care nurses-a longitudinal, qualitative study. Nurs Crit Care 29: 32-39. https://doi.org/10.1111/nicc.12930
[31]	Spruijt I, Cronin A, Udeorji F, et al. (2023) Respected but stigmatized: Healthcare workers caring for COVID-19 patients. PloS One 18: E0288609. https://doi.org/10.1371/journal.pone.0288609
[32]	Vianna ECDC, Baptista RV, Gomes RS, et al. (2023) COVID-19 Pandemic: Analysis of health effects on emergency service nursing workers via a qualitative approach. Int J Environ Res Public Health 20: 4675. https://doi.org/10.3390/ijerph20064675
[33]	Ergin E, Ozbolat G (2023) Use of holistic, complementary and alternative methods of medicine by nurses against COVID-19 anxiety. Altern Ther Health Med 29: 66-72.
[34]	Baraka AAE, Ramadan FH, Hassan EA (2023) Predictors of stress, anxiety, and depression of critical care nurses in response to the COVID-19 pandemic. Nurs Care Rev 28: 177-183. https://doi.org/10.1111/nicc.12708
[35]	Almhdawi KA, Alrabbaie H, Arabiat A, et al. (2023) Quality of life and its health and occupational determinants among hospital-based nurses during the COVID-19 pandemic. Work 74: 1321-1329. https://doi.org/10.3233/WOR-211318
[36]	Yarifard K, Abravesh A, Sokhanvar M, et al. (2023) Work-family conflict, burnout, and related factors among nurses during the COVID-19 pandemic in northwestern Iran. Task 76: 47-59. https://doi.org/10.3233/WOR-220210
[37]	Kealeboga KM, Ntsayagae EI, Tsima O (2023) Psychological impact of COVID-19 on nurses caring for patients during the COVID-19 pandemic in Gaborone. Nurs Open 10: 3084-3093. https://doi.org/10.1002/nop2.1557
[38]	Khatatbeh H, Al-Dwaikat T, Alfatafta H, et al. (2023) Burnout, quality of life, and perceived patient adverse reactions among pediatric nurses during the COVID-19 pandemic. J Clin Nurs 32: 3874-3886. https://doi.org/10.1111/jocn.16540
[39]	Hwang S, Lee J (2023) The effect of COVID-19-related resilience on depression, work-related stress, sleep quality, and burnout among intensive care unit nurses. Psychol Front 14: 1168243. https://doi.org/10.3389/fpsyg.2023.1168243
[40]	García Vivar C, Rodríguez Matesanz I, San Martín-Rodríguez L, et al. (2023) Analysis of mental health impacts among nurses working during the COVID-19 pandemic: A systematic review. J Psychiatr Health Nurs 30: 326-340. https://doi.org/10.1111/jpm.12880
[41]	Sampaio F, Gaspar S, Fonseca C, et al. (2023) Sleep quality among nurses and the general population during the COVID-19 pandemic in Portugal: What are the differences?. Int J Environ Res Public Health 20: 5531. https://doi.org/10.3390/ijerph20085531
[42]	Chen R, Sun C, Chen JJ, et al. (2021) A large-scale survey on trauma, burnout, and post-traumatic development among nurses during the COVID-19 pandemic. Int J Mental Health Nur 30: 102-116. https://doi.org/10.1111/inm.12796
[43]	Sorokin MY, Kasyanov ED, Rukavishnikov GV, et al. (2020) Stress and stigma among healthcare workers during the COVID-19 pandemic. Indian J Psychiatry 62: S445-S453. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_870_20
[44]	Azizpour I, Mehri S, Moghaddam HR, et al. (2021) The impact of psychological factors on bereavement among frontline nurses fighting Covid-19. Int J Africa Nurs Sci 15: 100341. https://doi.org/10.1016/j.ijans.2021.100341
[45]	Costa A, Caldas de Almeida T, Fialho M, et al. (2023) Mental health of health professionals: Two years of COVID-19 pandemic in Portugal. Int J Environ Res Public Health 20: 3131. https://doi.org/10.3390/ijerph20043131
[46]	Padmanathan P, Lamb D, Scott H, et al. (2023) Suicidal thoughts and behaviour among healthcare workers in England during the COVID-19 pandemic: A longitudinal study. PloS One 18: e0286207. https://doi.org/10.1371/journal.pone.0286207
[47]	González-Nuevo C, Postigo Á, González-Menéndez A, et al. (2023) Professional quality of life and COVID-19 fear among Spanish nurses: A longitudinal repeatable cross-sectional study. J Clin Nurs 33: 357-367. https://doi.org/10.1111/jocn.16688
[48]	Perego G, Cugnata F, Brombin C, et al. (2023) Analysis of the mental health of healthcare workers during the COVID-19 pandemic: Evidence from a three-wave longitudinal study. J Health Psychol 28: 1279-1292. https://doi.org/10.1177/13591053231168040
[49]	Heesakkers H, Zegers M, van Mol M M C, et al. (2023) Mental well-being of intensive care unit nurses after the second wave of the COVID-19 pandemic: A cross-sectional and longitudinal study. Intensive Crit Care Nurs 74: 103313. https://doi.org/10.1016/j.iccn.2022.103313
[50]	Pappa S, Ntella V, Giannakas T, et al. (2020) Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 88: 901-907. https://doi.org/10.1016/j.bbi.2020.05.026
[51]	Ruiz Fernández MD, Ramos Pichardo JD, Ibáñez Masero O, et al. (2020) Compassion fatigue, exhaustion, compassion satisfaction, and perceived anxiety among healthcare professionals during the COVID-19 health crisis in Spain. J Clin Nurs 29: 4321-4330. https://doi.org/10.1111/jocn.15469
[52]	Badahdah A, Khamis F, Al Mahyijari N, et al. (2021) The mental health of healthcare workers in Oman during the COVID-19 pandemic. Int J Soc Psychiatry 67: 90-95. https://doi.org/10.1177/0020764020939596
[53]	Barello S, Palamenghi L, Graffigna G (2020) Burnout and physical symptoms among frontline health professionals at the height of the Italian COVID-19 pandemic. Psychiatry Res 290: 113129. https://doi.org/10.1016/j.psychres.2020.113129
[54]	Jo S, Kurt S, Bennett JA, et al. (2021) The resilience of nurses against coronavirus (COVID-19): An international view. Nurs Health Sci 23: 646-657. https://doi.org/10.1111/nhs.12863
[55]	Nguyen N, Le DD, Colebunders R, et al. (2021) Stress and related factors among frontline healthcare workers at the epicenter of COVID-19 in Da Nang, Vietnam. Int J Environ Res Public Health 18: 7378. https://doi.org/10.3390/ijerph18147378
[56]	Simonetti V, Della Pelle C, Cerratti F, et al. (2021) Presenteeism levels among Italian nurses. A multicentric survey. Prof Inferm 74: 119-125.
[57]	Hammond NE, Crowe L, Abbenbroek B, et al. (2021) Impact of the 2019 coronavirus disease pandemic on critical care healthcare workers' levels of depression, anxiety, and stress. Aust Crit Care 34: 146-154. https://doi.org/10.1016/j.aucc.2020.12.004
[58]	Bruyneel A, Gallani MC, Tack J, et al. (2021) Impact of COVID-19 on nursing time in intensive care units in Belgium. Intensive Crit Care Nurs 62: 102967. https://doi.org/10.1016/j.iccn.2020.102967
[59]	Kader N, Elhusein B, Al Abdulla S, et al. (2021) Risk perception and psychological impact of the COVID-19 pandemic among healthcare workers in primary and secondary healthcare settings in Qatar: A national study. J Prim Care Community Health 12: 21501327211039714. https://doi.org/10.1177/21501327211039714
[60]	Bizri M, Kassir G, Tamim H, et al. (2021) Psychological distress experienced by doctors and nurses in a tertiary care center in Lebanon during the COVID-19 outbreak. J Health Psychol 27: 1288-1300. https://doi.org/10.1177/1359105321991630
[61]	Maraqa B, Nazzal Z, Zinc T (2021) Mixed method study to investigate ethical dilemmas and the willingness of healthcare workers to work amid the COVID-19 pandemic in Palestine. Front Med (Lausanne) 7: 576820. https://doi.org/10.3389/fmed.2020.576820
[62]	Moore KS, Hemmer CR, Taylor JM, et al. (2021) Nurse stress level during coronavirus disease 2019: A looming workforce issue. J Pract Nurse 17: 702-706. https://doi.org/10.1016/j.nurpra.2021.02.024
[63]	Brady C, Fenton C, Loughran O, et al. (2023) The mental health of Dublin hospital workers during the peak of Ireland's COVID-19 pandemic. Irish J Med Sci 192: 1293-1302. https://doi.org/10.1007/s11845-022-03056-0
[64]	Alfonsi V, Scarpelli S, Gorgoni M, et al. (2023) Healthcare workers after two years of COVID-19: The consequences of the pandemic on psychological health and sleep among nurses and doctors. Int J Environ Res Public Health 20: 1410. https://doi.org/10.3390/ijerph20021410
[65]	Tamrakar P, Pant SB, Acharya SP (2023) Anxiety and depression among nurses in COVID and non-COVID intensive care units. Nursing Care Review 28: 272-280. https://doi.org/10.1111/nicc.12685
[66]	Hegazy AA, Abdel Hamid TA, Zein MM, et al. (2023) Stress among healthcare providers in the NICU department, tertiary pediatric care hospital during the COVID-19 pandemic in Egypt. J Public health Res 12: 22799036221147095. https://doi.org/10.1177/22799036221147095
[67]	Martin SD, Urban RW, Foglia DC, et al. (2023) Wellness in acute care nurse managers: Risk analysis of physical and mental health factors. Worldv Evid-based Nu 20: 126-132. https://doi.org/10.1111/wvn.12646
[68]	Canal Rivero M, Montes García C, Garrido Torres N, et al. (2023) The impact of the COVID-19 pandemic on the psychological well-being of healthcare workers: A 6-month longitudinal cohort study. Rev Psiquiatr Salud Ment 16: 25-37. https://doi.org/10.1016/j.rpsm.2022.08.001
[69]	Kells M, Jennings Mathis K (2023) Impact of COVID-19 on the next generation of nurses in the United States. Jay Kline Nour 32: 359-367. https://doi.org/10.1111/jocn.16202
[70]	Sampaio F, Sequeira C, Teixeira L (2021) Impact of the COVID-19 outbreak on nurses' mental health: A prospective cohort study. Environment Res 194: 110620. https://doi.org/10.1016/j.envres.2020.110620
[71]	Hendy A, Abozeid A, Sallam G, et al. (2021) Prognostic factors influencing stress among nurses providing care in COVID-19 isolation hospitals in Egypt. Nurs Open 8: 498-505. https://doi.org/10.1002/nop2.652
[72]	Saifullah, Ma Z, Li M, et al. (2023) Impact of the COVID-19 pandemic on healthcare workers (HCW) in Sindh province, Pakistan. Health Res Policy Sy 21: 78. https://doi.org/10.1186/s12961-023-01022-5
[73]	Soto Rubio A, Giménez Espert MDC, Prado Gascó V (2020) Impact of emotional intelligence and psychosocial risks on nurses' burnout, job satisfaction, and health during the COVID-19 pandemic. Int J Environ Res Public Health 17: 7998. https://doi.org/10.3390/ijerph17217998
[74]	Franco J A, Leví P L Á (2020) Feelings, Stress, and Adaptation Strategies of Nurses against COVID-19 in Guayaquil. Invest Educ Enferm 18: e07. https://doi.org/10.17533/udea.iee.v38n3e07
[75]	Nowicki GJ, Ślusarska B, Tucholska K, et al. (2020) The severity of traumatic stress associated with the COVID-19 pandemic, perception of support, sense of security, and sense of meaning in life among nurses: Research protocol and preliminary results from Poland. Int J Environ Res Public Health 17: 6491. https://doi.org/10.3390/ijerph17186491
[76]	Letvak S, Ruhm C, Lane S (2011) The impact of nurses' health on productivity and quality of care. J Nurs Adm 41: 162-167. https://doi.org/10.1097/NNA.0b013e3182118516
[77]	Janeway D (2020) The Role of Psychiatry in Treating Burnout Among Nurses During the Covid-19 Pandemic. J Radiol Nurs 39: 176-178. https://doi.org/10.1016/j.jradnu.2020.06.004
[78]	Labrague LJ, De Los Santos JAA (2021) Prevalence and prognostic factors of coronaphobia among frontline hospital and public health nurses. Public Health Nurses 38: 382-389. https://doi.org/10.1111/phn.12841
[79]	Kim MY, Yang YY (2021) Mental health status and factors affecting it: the case of nurses working in COVID-19 hospitals in South Korea. Int J Environ Res Public Health 18: 6531. https://doi.org/10.3390/ijerph18126531
[80]	Al Dossary R, Alamri M, Albaqawi H, et al. (2020) Awareness, attitudes, prevention, and perceptions of the COVID-19 epidemic among nurses in Saudi Arabia. Int J Environ Res Public Health 17: 8269. https://doi.org/10.3390/ijerph17218269
[81]	Turale S, Meechamnan C, Kunaviktikul W (2020) Hard times: Ethics, nursing, and the COVID-19 pandemic. Int Nurs Rev 67: 164-167. https://doi.org/10.1111/inr.12598
[82]	Hofmeyer A, Taylor R (2021) Strategies and resources that nurse leaders can use to lead with empathy and prudence to understand and address the sources of stress among practicing nurses in the COVID-19 era. J Clin Nurs 30: 298-305. https://doi.org/10.1111/jocn.15520
[83]	Dimino K, Learmonth AE, Fajardo CC (2021) Nursing managers lead the way: they reimagine stress to maintain a healthy work environment. Nurse Crit Care 41: 52-58. https://doi.org/10.4037/ccn2021463
[84]	White JH (2021) A phenomenological study of the experiences of nursing managers and assistant nursing managers during the COVID-19 pandemic in the United States. J Nurs Manag 29: 1525-1534. https://doi.org/10.1111/jonm.13304
[85]	Lin CH, Siao SF, Lin YJ, et al. (2023) Cognitive assessments and coping strategies of enrolled nurses in the emergency department to combat COVID-19: A delineation review. J Nurs Scholarsh 55: 79-96. https://doi.org/10.1111/jnu.12815
[86]	Lim S, Park H, Kim S (2023) Psychological experiences of nurses caring for COVID-19 patients: A comprehensive review based on qualitative research. Nurs Open 10: 4919-4931. https://doi.org/10.1002/nop2.1813
[87]	Xu Y, Zheng QX, Jiang XM, et al. (2023) Effects of coping on nurses' mental health during the COVID-19 pandemic: Mediating role of social support and psychological resilience. Nurs Open 10: 4619-4629. https://doi.org/10.1002/nop2.1709

Reader Comments

Your name:*

Email:*
© 2024 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)