Abstract
The domestic health care system has been facing a difficult task, especially in medical care, and Chinese nurses are under tremendous psychological pressure. Psychological support is a protective factor to relieve stress. This study examined the stress level and characteristics of Chinese nurses with different psychological support-seeking behaviours. Data from online questionnaires for this cross-sectional study were collected between January 2020 and February 2020 and yielded 2248 valid questionnaires for analysis with a response rate of 99.8%. General information of the respondents was also collected. The nurses’ stress levels were assessed using the Perceived Stress Scale (PSS-10). T tests, chi-square tests, and linear regression were used to examine the relationships among the factors. The results of this survey showed that between January and February 2020, 26.9% of nurses received psychological counselling, and the proportion was higher among men and nurses with lower education. The PSS-10 was related to gender, age group, provincial severity, and confidence in the control of the epidemic. The results showed that psychological support can effectively improve the confidence of domestic nurses in the face of arduous work and effectively relieve the psychological pressure caused by a heavy workload.
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Introduction
In 2020, China and the world were facing a serious public health event, during which medical workers were engaged in the dual tasks of disease prevention and treatment [1]. Serious public health events lead to heavy workloads and mental burdens among nurses, and these negative impacts influence their work performance [2]. However, very few studies have unveiled the effects of the COVID pandemic with its repeated and ongoing stressors and traumatization among nurses.
Stress refers to a psychological state of tension that happens when an individual’s adaptive capacity does not meet the perceived environmental demands. Robbins’s stress model divides stressors into environmental, organizational, and personal factors that interact with individual differences to produce stressful experiences [3]. Compared with other occupations, nursing is considered to be a profession with a moderate stress level [2, 4]. Clinical registered nurses were the subjects of this study and were facing a greater than normal workload during a public health event outbreak. An increased workload and dangerous working environment can lead to negative emotions, increased psychological stress, and impaired physical health among nurses. These problems can prevent nurses from providing high-quality care, and their work efficiency can be greatly reduced. A study in China found that mental stress among nurses has increased while mental health has declined over the past 19 years, with work and family stress as the main stressors [31, 32]. The gender difference regarding dealing with stress may be related to negative interpersonal relationships, demanding jobs, a high degree of competition, gender discrimination, and biological differences [33,34,35,36,37,38].
The biological mechanisms of stress have been widely studied. In men, stress is associated with the right prefrontal cortex and the left orbitofrontal cortex, while in women, stress activates the limbic system. Studies have also indicated that there are sex differences in the core components of the HPA axis stress response. Serum corticosterone concentration and brain-derived neurotrophic factor methylation also show gender differences. Under controlled stress, it was found that 5-hydroxytryptamine (5-HT) in men’ dorsal raphe nucleus (DRN) was effectively inhibited, while 5-HT in women’s DRN was not involved in behavioural control [39,40,41,42]. Thus, men tend to seek psychological intervention when they are aware that stress has influenced their mental status and work performance. In addition, controllable stress can protect against uncontrollable stress in the future, which explains why nurses who accessed psychological support experienced less stress and had a more positive co** attitude [37, 39,40,41,42,43,44,45].
Other common factors that influence stress
Our study found that age, professional title, and marital status affected the nurses’ stress level and stress perception; this finding is similar to previous research results.
The results of the mental health survey that Fan et al. (2019) administered to clinical nurses aged 20 to 49 showed that nurses under 30 years old experienced the greatest psychological stress, followed by nurses over 40 years old [46]. In contrast, Cohen et al. (2012) found that younger and older people were less stressed, while middle-aged people were more stressed [47].
In social and family life, the status, quality, and interaction of marital and professional titles symbolizing social status are closely related to stress. In general, nurses who hold supervisory positions experience the highest levels of work stress and the lowest levels of work satisfaction. Married nurses experienced lower levels of stress and physical discomfort and better social adjustment than unmarried nurses. Our results are in line with previous studies’ findings [38, 48,49,50].
Strengths and limitations
This study focused on the psychological stress and psychological support of nurses dealing with public events during the peak period of public health events in China. This study used a self-designed scale to measure the source of stress, which includes three factors: work, family, and society. In the future, we will expand the use of this questionnaire. This study had the following limitations: a) a convenience sampling method was employed, which might affect the generalizability of the conclusion. In the future, more rigorous sampling methods should be adopted to control the sampling deviation; b) other sources of stress might not be included, and more potentially influential stressors should be included in the future; and c) although this questionnaire has passed the reliability and validity tests, the use of this questionnaire is low at present; thus, further examination of the external validity of this questionnaire is needed.
Conclusion
During a public health event outbreak, nurses experienced high work, family, and social stress, among which gender, age, education level, the severity of public health incidents in the region, confidence in the authorities’ ability to control the epidemic, and psychological support were shown to be different. Psychological support has a benign regulatory effect on nurses, with the potential to improve their confidence and reduce stress. Therefore, it can be concluded that psychological support interventions for nurses during the epidemic is necessary and beneficial. Our findings suggest that society should pay attention to the mental health of nursing staff in addition to their physical health during public health events.
Availability of data and materials
The datasets generated and/or analysed in the current study are not publicly available due to the provisions of the policy document but are available from the corresponding author on reasonable request.
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Acknowledgements
We thank the units and friends who helped distribute this questionnaire.
Funding
This study was supported by the National Natural Science Foundation of China (81503475, 82004226), the Natural Science Foundation of Guangdong Province (2016A030313491), the Administration of Traditional Chinese and Tibetan Medicine of Qinghai Province (2016104), and the Science and Technology Project of Guangzhou Integrating Traditional Chinese Medicine and Western Medicine (20192A010014).
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Junrong Ye, Aixiang **ao and Lin Yu were responsible for the research design and manuscript preparation. Junrong Ye, Chen Wang, Chenxin Wu, Haoyun Wang, Ting Wang and Yuanxin Pan were responsible for the recruitment of respondents. Yufang Zhou and Shengwei Wu conducted the calculations and statistical analysis of the questionnaire results. Yufang Zhou, Junrong Ye, Youtian Wang, and Meilian Huang were involved in the drafting and editing of the manuscript. Lin Yu and Aixiang **ao performed critical revision of the paper for important intellectual content. All authors contributed to the paper, and all authors approved the final manuscript. All authors read and approved the final manuscript.
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This study obtained ethical approval from the IRB of the Affiliated Brain Hospital of Guangzhou Medical University (approval number: 2020–009). Informed consent was obtained from all participants before inclusion. The entire study was carried out in accordance with the Declaration of Helsinki.
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Additional file 1.
Medical staff respond to the investigation of the current situation of nCoV.
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Zhou, Y., Wang, Y., Huang, M. et al. Psychological stress and psychological support of Chinese nurses during severe public health events. BMC Psychiatry 22, 800 (2022). https://doi.org/10.1186/s12888-022-04451-8
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DOI: https://doi.org/10.1186/s12888-022-04451-8