شناسایی عوامل تنش زا در پرستاران درگیر مراقبت از بیماران مبتلا به کووید 19

زمینه و هدف: همه گیری کووید 19، تنش زیادی را بر پرسنل و سیستم مراقبت بهداشتی وارد کرد. هدف این مطالعه تعیین عوامل تنش زا در پرستاران درگیر مراقبت از بیماران کروناویروس در بیمارستانهای دانشگاه علوم پزشکی بابل بود.                 روش بررسی: این مطالعه توصیفی تحلیلی از نوع مقطعی بر روی پرستاران درگیر مراقبت از بیماران کرونایی شاغل (بیمارستانهای روحانی و یحیی نژاد) در دانشگاه علوم پزشکی بابل در سال 1399 انجام شد. تعداد نمونه با استفاده از فرمول آماری کوکران (224 نفر) برآورد گردید. سپس به نسبت پرستاران درگیر کرونا در هر بیمارستان، نمونه گیری به روش طبقه ای از بخشهای کرونایی انجام شد. ابزار گردآوری داده ها پرسشنامه محقق ساخت استفاده گردید. پرسشنامه عوامل تنش زا در پرستاران در پنج حیطه (بین فردی، مراقبت از بیمار، فیزیکی و محیطی، فردی و مدیریتی) و پرسشنامه ویژگیهای دموگرافیک بود. تجزیه و تحلیل داده های جمع آوری شده با استفاده از نرم افزار آماری spss نسخه 23 و آزمونهای آماری پارامتریک تحلیل واریانس یکطرفه و تی مستقل همچنین در صورت برقرار نبودن فرض ناپارامتری از آزمون های کروسکال والیس و من ویتنی صورت گرفت.  یافته ها: عوامل تنش زا فیزیکی و محیطی با میانگین 10.12± 29 و عوامل تنش زای مراقبت از بیمار5.02 ±13.38 به ترتیب بیشترین و کمترین شدت تنش زایی را داشتند. مهمترین عوامل تنش زا در پرستاران حمایت ناکافی(68.2%)، حجم زیاد کار(63.9%)، فشردگی برنامه کاری ماهانه(63.5%)، سنگینی و راحت نبودن پرستار با لباس و چکمه محافظ(63.3%)، کمبود پرستار (61.5%)، نبود فضای مناسب جهت تعویض لباس محافظ (60.2%) و ... بودند. عوامل تنش زای شغلی پرستاران با متغیرهای جنس، سابقه کار و نوع بیمارستان، عوامل تنش زای فیزیکی و محیطی با شیفت کاری، عوامل تنش زای بین فردی با تحصیلات و عوامل تنش زای مراقبت از بیمار با اضافه کار ارتباط معنی دار داشتند(0.05>p).نتیجه گیری: از آنجایی که عوامل فیزیکی و محیطی به عنوان مهمترین منبع عوامل تنش زا شناخته شدند، با تمهیدات مناسب می توان جهت حذف یا اصلاح این عوامل، به کاهش تنش و ارتقاء سلامتی پرستاران کمک کرد.

identification of stressors in nurses involved in caring for patients with covid 19

introduction: the covid 19 pandemic put a lot of strain on staff and the health care system. nurses who have a high risk prolonged close contact with patients are at a great risk for infection. recent research has shown that health care providers suffer from psychological distress due to the covid 19 pandemic. they experience social isolation, role conflicts, fear, anxiety, and psychological distress when they work with these patients. understanding the stressors in nurses during the caring for covid 19 patients is essential for health care managers. therefore, the present study aimed at identifying stressors in nurses involved in taking care of covid 19 patients in hospitals affiliated to babol university of medical sciences.stress factors of patient care:mean (sd)interpersonal stressors:mean (sd)                              stressors  variable25.96(7.57)25.93(6.88)median=2728.7(9.19)13.06(4.68)24.2(7.91)median=2430=>age25.29(7.60)25.09(7.97)median=2629.15(10.64)13.5(5.18)26.3(8.5)median=26<30p value =.536p value =.491p value =.750p value =.539p value =.115test22.56(7.01)22.71(6.79)25.16(8.58)11.58(4.77)23.58(8.25)malesex27.25(7.42)26.93(7.64)31.14(10.31)14.38(4.89)26.75(8.20)femalet (221) = 4.62p value =.000*t (221)= 4.1p value =.000*t (222)= 4.4p value =.000*t (222 )= 4.13p value =.000*t (222)= 2.67p value =.006*test27.25(7.54)median=2926.45(7.56)median=2731.24(10.56)median=3114.19(5.07)median=1526.06(8.65)median=271 10work experience23.25(7.27)median=2324.16(7.67)median=2326.36(8.83)median=2512.26(4.75)median=1224.92(7.99)median=2411 2025.50(4.88)median=24.522.66(3.88)median=2222.50(7.52)median=2213.66(5.60)median=1528(7.09)medin=29.521 30χ2=16.10p value=.000*χ2=5.53p value=.063*χ2=15.43p value=.000*χ2=9.89p value=.007* χ2=2.66p value=.263test21.11(8.02)median=2020.33(7.31) median=1920.33(7.84) median=2211.44(5.19)median=1225.55(10.08) median=27morningwork shift24.24(8.78) median=2524.44(6.80)median=2528.08(11.21) median=2812.8(6.34)median=1124.88(11.24) median=22evening25.95(7.39) median=2725.76(7.67)median=2729.55(9.94) median=2913.57(4.82)median=1425.75(7.86) median=26circulationχ2=4.27p value=.118χ2=3.83p value=.147χ2=7.69p value=.021*χ2=2.34p value=.309χ2=1.19p value=.55test25.76(7.39) median=2625.64(7.57) median=26.529.04(9.9) median=2813.36(4.84)median=1325.97(7.97) median=26bacheloreducation23.52(9.57) median=2623(7.82) median=2328.63(12.61) median=2913.63(6.79)median=1221.89(11.19) median=20mastert (221)= 1.22p value =.221z= 1.387 p value =.166z= .165 p value =.869t (222)= .224p value =.823t (222)= 2.05p value =.041*test25.58(7.80)24.25(8.09)26.56(9.90)11.91(4.74)23.37(7.81)rouhanihospital59.67(5.20)27.80(5.87)34.05(8.66)16.42(4.1530.28(7.46)yahyanejadt (221 )= 6.04p value =.000*t (221)= 3.34p value =.000*t (222 )= 5.51p value =.000*t (222 )= 6.93p value =.000*t (222)= 6.29p value =.000*testdiscussion: the aim of this study was to identify stressors in nurses involved in caring for coronavirus patients in hospitals of babol university of medical sciences. in determining the areas of stressors in nurses, the mean scores of physical and environmental stressors with 29±10.12 and patient care stressors 13.38±5.02 were the highest and lowest, respectively. the mean scores of interpersonal, managerial and individual stressors were 25.62±8.34, 25.57±7.60 and 25.41±7.61, respectively. that is, the average score of physical and environmental stress areas was higher than other stress areas in nurses.the average score of physical and environmental stress was higher than other areas. the most important stressors in nurses are: inadequate support provided by the medical system for nurses involved in caring for covid 19 patients, high workload, tight nursing schedule, heaviness and inconvenience of protective clothing and boots, inappropriate nurse to patient ration, lack of adequate space to change protective clothing, lack of protective equipment, lack of adequate resting opportunities for staff, nurses' thirst resulted from excessive sweating due to wearing protective clothing, unavailability of doctors in emergency situations, contact with contaminated equipment and objects, nurse's fear of getting infected by corona virus, caring for a sick and dying patient and the density of patients referred to the covid 19 ward.a study conducted by ong et al showed that one of the main concerns and tensions of nurses when caring for patients with contagious infectious diseases such as covid 19 is how to take care of themselves against the disease and prevent it. a study in china also showed that nurses were worried about the risk of transmitting the disease to their families. the study of kuo et al. (2020) in taiwan showed that the discomfort caused by wearing protective equipment and responsibility of patient care were the first and the second major causes of stress in nurses. in other studies, dry, cracked hands caused by frequent hand washing and use of disinfectants, inconvenience to go to the toilet at work, restrictions on eating and drinking at work, fear of getting infected by coronavirus and fear of transmitting the virus to relatives and friends were reported as the most important stressors in nurses. in terms of physical and environmental stressors (discomfort due to the use of protective equipment such as heavy clothing and protective boots, nurse feeling thirsty due to excessive sweating due to wearing protective clothing, fear of nurse and family becoming infected with covid 19 are consistent with our study. liu et al. (2020) also reported that in addition to caring for patients, wearing protective equipment for a long time led to physical discomfort for nurses, especially the ones who had to stay in isolated wards for all shifts. in terms of stressors, heavy clothing and protective boots, high workload and tightness of nurses' work schedule are consistent with our study. the above mentioned studies indicated that nurses are required to wear protective equipment (goggles, protective clothing, masks and gloves) for a long time to effectively prevent the source of infection from entering into the hospital, which makes eating, drinking and using the toilet unpleasant for them. based on the results of the present study, interpersonal factors were assigned as the second stressors factor among nurses involved in the care of coronavirus patients. when the interpersonal relationships in nurses are weak, it ultimately leads to low trust, lack of interest, and the feeling of insecurity and dissatisfaction of patients, as well as increasing the level of occupational stress in nurses. the results of the present study showed that the third of stressors factor among nurses involved in the care of coronavirus patients was management factors. in the study of faremi et al. (2019) in southwestern nigeria, the most stressful aspects of nurses' work were: insufficient staff cover workload, lack of medication and equipment needed for nursing care, and seeing patients die. in our study, the factors of lack of nurses compared to patients, lack of protective equipment, care of the sick and dying patient are among the most important stressors in nurses involved in the care of coronavirus patients, so this study is consistent with our study. the results of the present study showed that personal factors and care of covid 19 patients constitute the fourth and fifth stressors, respectively, among nurses involved in the care of covid 19 patients. among the most important individual factors in the covid 19 ward that can lead to an increase in the stress level of nurses is the critical condition of patients and the need to make momentary decisions regarding care. frontline medical workers in the covid 19 pandemic due to unpredictable conditions and high work pressure, excessive fatigue and exposure to sick patients and high patient mortality, lack of protective equipment against the transmission of the virus, concern about the transmission of the virus to family members, in addition to being at risk of viral infection, they also suffer from many psychological problems. in terms of stress factors, caring for a sick and dying patient is one of the most important stress factors in nurses involved in caring for coronavirus patients, so it is consistent with our study.the female gender and work experience of 1 10 years are significantly associated with stressors in nurses involved in caring for coronavirus patients. findings from maphangela (2015) in line with our study showed that women experienced more stress than their male counterparts. nurses with less work experience were more stressed, however, in the study of faremi et al. (2019) there was no significant difference between the stress experienced by young and senior nurses. this research is not in line with our study. in the interpretation of the contradiction of this finding with the current research, it can be pointed out that most nurses with experience expect less presence in the care department of covid 19 patients from hospital officials. the nurses at yahyanejad hospital experienced more stressors than the ones at rouhani hospital. this may be due to the fact that this hospital is the primary treatment and care center for covid 19 patients in the city of babol, and its nurses have been involved in caring for covid 19 patients for a longer period than the nurses at rouhani hospital. there was no significant relationship between different stressors and the variables including age, marital status, having children, employment status, overtime and interest in the nursing profession. likewise, in the study of hebrani et al., there was no significant relationship between nurses' job stressors and any of the variables including age, sex, marital status, year of work, shift work and finally employment in different hospital wards. however, in the study of eriksen et al., it showed a significant inverse relationship between work experience and the level of occupational stress in nurses. the discrepancy between the findings of the present research and the mentioned studies can be due to the difference in the research environment and critical conditions during the corona pandemic, as well as the pervasive anxiety of this disease on all nurses. regarding the relationship between employment status and stressors, our study, like shojaei et al.'s study, showed that employment status has no significant relationship with stressors.conclusions: the most stressful area in nurses employed in hospitals is related to physical and environmental stress. the most important stressors in nurses include: inadequate support provided by the medical system for nurses involved in caring for covid 19 patients, high workload, tight nursing schedule, heaviness and inconvenience of protective clothing and boots, inappropriate nurse to patient ratio, lack of suitable space for changing protective clothing and lack of protective equipment. undoubtedly, the authorities can be of a great help in reducing stress in nurses involved in caring for coronavirus patients. therefore, it is recommended that they eliminate or modify the factors that cause or increase stress in nurses, which can improve their health status and ultimately lead to faster recovery of patients.among the limitations of this study, nurses with master's and bachelor's degrees were selected. therefore, the results can not be generalized to other categories of nursing, such as post diploma, nurse, assistant nurse and managers and head nurses of departments.on the other hand, the mental state and fatigue of nurses working in corona wards could also affect the way the questionnaire was answered, so we tried to provide full questionnaires to nurses at the appropriate time, but complete control was beyond the researcher.acknowledgment: we would like to thank the vice chancellor for research and technology of babol university of medical sciences for supporting the implementation of the project and also all the nurses who have participated in this study.conflict of interest: the authors declare that there are no conflicts of interest regarding the publication of this manuscript.