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.