Journal of Education and Health Promotion

Perceived stress and quality of life among frontline nurses fighting against COVID‑19: A web‑based cross‑sectional study

Document Type : Original Article

Authors

. Sajedeh Amjadi
. Sepideh Mohammadi
. Ali Khojastehrad

Department of Nursing, Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

Abstract
BACKGROUND: The coronavirus disease‑2019 (COVID‑19) crisis has changed many aspects of 
frontline nurses’ lives. Nurses caring for patients with COVID‑19 reported experiencing significant 
psychological distress and work‑related anxiety. This study aimed to assess the perceived stress 
and quality of life among frontline nurses fighting against COVID‑19.
MATERIALS AND METHODS: This web‑based cross‑sectional study was conducted on 322 
frontline nurses fighting against COVID‑19 in hospitals affiliated to Mazandaran University of Medical 
Sciences. Data were collected using the two following online questionnaires: the Perceived Stress 
Scale and World Health Organization Quality of Life-Brief. Data were compiled from October 23, 
2020, to November 25, 2020. Data were analyzed using the independent sample t‑test, Pearson’s 
correlation test, and regression analysis test in the SPSS‑21.
RESULTS: Average perceived stress scores was 30.27 (standard deviation [SD] = 7.01). Average 
quality of life subscale scores consist of physical health, psychological health, social relationships, and 
environment were 57.71 (SD = 12.74), 44.3 (SD = 15.58), 45.61 (SD = 16.99), and 47.6 (SD = 18.11), 
respectively. There was an inverse significant association between all the subscales of quality of life 
and perceived stress (P = 0.008). Based on the multiple linear regression analysis, the variables 
of age, gender, marital status, and perceived stress were the significant predictors of quality of life 
subscales.
CONCLUSIONS: Paying serious attention to addressing the concerns of frontline nurses, especially 
those who are at high risk, is necessary. It is recommended to take action as soon as possible to 
reduce the perceived stress and improve quality of life on nurses who care for patients with COVID‑19.

Keywords

Coronavirus disease‑2019
nurse
perceived stress
psychological distress
quality of life
stress
  1. Bulut C, Kato Y. Epidemiology of COVID‑19. Turk J Med Sci 
    2020;50:563‑70.
    2. Kumar R, Singh V, Mohanty A, Bahurupi Y, Gupta PK. Corona 
    health‑care warriors in India: Knowledge, attitude, and practices 
    during COVID‑19 outbreak. J Educ Health Promot 2021;10:44.
    3. Tola HH. Risk communication during novel corona‑virus disease 
    2019 pandemic in low health service coverage setup: The case 
    of Ethiopia. J Educ Health Promot 2020;9(1):143. 10.4103/jehp.
    jehp_346_20.
    4. Shamsalinia, A., Mohammadi, S., Ghaffari, F., and Arazi, T. (2020). 
    Changes in Preventive Behavior During the First 3 Months of the 
    COVID‑19 Outbreak in Iran. Disaster Medicine and Public Health 
    Preparedness, 1‑8. doi: 10.1017/dmp.2020.378.
    5. Saghafipour A, Abolkheirian S, Khazaei S. COVID‑19: What 
    approach should people take to prevent it? J Educ Health Promot 
    2021;10:1.
    6. Tandon T, Dubey AK, Dubey S, Arora E, Hasan MN. Effects of 
    COVID‑19 pandemic lockdown on medical advice seeking and 
    medication practices of home‑bound non‑COVID patients. J Educ 
    Health Promot 2021;10:28.
    7. Sharma D, Sharma N, Sharma P, Subramaniam G. Review of 
    investigational drugs for coronavirus disease 2019. J Educ Health 
    Promot 2021;10:31.
    8. Meena SP, Jhirwal M, Puranik AK, Sharma N, Rodha MS, 
    Lodha M, et al. Awareness and experience of health‑care workers 
    during coronavirus disease 2019 pandemic. J Educ Health Promot 
    2021;10:110.
    9. Catton H. Nursing in the COVID‑19 pandemic and beyond: 
    Protecting, saving, supporting and honouring nurses. Int Nurs 
    Rev 2020;67:157‑9.
    10. Singh KK, Jyotirmay, Kumar A, Goel A, Gulati S, Nayak BB. 
    Prevalence of anxiety, stress, and depression among health care 
    and nonhealth‑care professionals in India. J Educ Health Promot 
    2021;10:83.
    11. Mohammadi S, Nakhaeizadeh A, Arazi T. Assessment of 
    Covid‑19‑related anxiety and its physical and psychological 
    symptoms in the Iranian adult. J Mil Med 2021;23:142‑50.
    12. Purba AK. How should the role of the nurse change in response 
    to Covid‑19? Nurs Times 2020;116:25‑8.
    13. Tu Zh, He Jw, Zhou N. Sleep quality and moodsymptoms in 
    conscripted frontline nurse in Wuhan, China during COVID‑19 
    outbreak: A cross‑sectional study. Medicine 2020;99:26(e20769).
    14. Abdi M. Coronavirus disease 2019 (COVID‑19) outbreak in 
    Iran: Actions and problems. Infect Control Hosp Epidemiol 
    2020;41:754‑5.
    15. Raurell‑Torredà M. Management of ICU nursing teams 
    during the COVID‑19 pandemic. Enferm Intensiva (Engl Ed) 
    2020;31:49‑51.
    16. KarimiZ, FereidouniZ, BehnammoghadamM, Alimohammadi N, 
    Mousavizadeh A, Salehi T, et al. The lived experience of nurses 
    caring for patients with COVID‑19 in Iran: A phenomenological 
    study. Risk Manag Healthc Policy 2020;13:1271‑8.
    17. Labrague LJ, de Los Santos JA. Fear of Covid-19, psychological 
    distress, work satisfaction and turnover intention among frontline 
    nurses. J Nurs Manag 2020, 29(3):395‑403.
    18. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated 
    with mental health outcomes among health care workers exposed 
    to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976.
    19. Gharebaghi R, Heidary F. COVID‑19 and Iran: Swimming with 
    hands tied! Swiss Med Wkly 2020;150:w20242, doi: 10.4414/
    smw.2020.20242.
    20. Chuan CL, Penyelidikan J. Sample size estimation using Krejcie 
    and Morgan and Cohen statistical power analysis: A comparison. 
    Jurnal Penyelidikan IPBL 2006;7:78‑86.
    21. Skevington SM, Lotfy M, O’Connell KA, WHOQOL Group. 
    The World Health Organization’s WHOQOL‑BREF quality 
    of life assessment: Psychometric properties and results of the 
    international field trial. A report from the WHOQOL group. Qual 
    Life Res 2004;13:299‑310.
  2. 22. Lee EH. Review of the psychometric evidence of the perceived 
    stress scale. Asian Nurs Res (Korean Soc Nurs Sci) 2012;6:121‑7.
    23. Ruiz‑Fernández MD, Ramos‑Pichardo JD, Ibáñez‑Masero O, 
    Cabrera‑TroyaJ, Carmona‑RegaMI, Ortega‑Galán ÁM. Compassion 
    fatigue, burnout, compassion satisfaction and perceived stress in 
    healthcare professionals during the COVID-19 health crisis in 
    Spain. J Clin Nurs. 2020;29:4321‑30. https://doi.org/10.1111
    /jocn.15469
    24. Leng M, Wei L, Shi X, Cao G, Wei Y, Hong Xu et al. Mental 
    distress and influencing factors in nurses caring for patients with 
    COVID-19. Nurs Crit Care. 2021 Mar; 26 (2):94‑101. doi: 10.1111/
    nicc.12528.
    25. Shahrokhi A, Elikaei N, Yekefallah L, Barikani A. Relationship 
    between spiritual intelligence and perceived stress among critical 
    care nurses. Journal of Inflammatory Diseases. 2018; 22(3):40‑49.
    26. Aslan H, Pekince H. Nursing students’ views on the COVID‑19 
    pandemic and their percieved stress levels. Perspect Psychiatr Care. 
    2021;57(2):695‑701. doi: 10.1111/ppc.12597.
    27. Stojanov J, Malobabic M, Stanojevic G, Stevic M, Milosevic V, 
    Stojanov A. Quality of sleep and health‑related quality of 
    life among health care professionals treating patients with 
    coronavirus disease‑19. Int J Soc Psychiatry 2021;67:175‑81.
    28. Hong S, Ai M, Xu X, Wang W, Chen J, Zhang Q, et al.
    Immediate psychological impact on nurses working at 42 
    government‑designated hospitals during COVID‑19 outbreak 
    in China: A cross‑sectional study. Nurs Outlook 2021;69:6‑12.
    29. Vafaei H, Roozmeh S, Hessami K, Kasraeian M, Asadi N, Faraji A,
    et al. Obstetrics healthcare providers’ mental health and quality 
    of life during COVID‑19 pandemic: Multicenter study from eight 
    cities in Iran. Psychol Res Behav Manag 2020;13:563‑71.
    30. Nie A, Su X, Zhang S, Guan V, Li J, Psychological impact of 
    COVID-19 outbreak on frontline nurses: A cross-sectional survey 
    study. J Clin Nurs 2020;29:4217‑26.
    31. Sarafis P, Rousaki E, Tsounis A, Malliarou M, Lahana L, 
    Bamidis P, et al. The impact of occupational stress on nurses’ 
    caring behaviors and their health related quality of life. BMC 
    Nurs 2016;15:56.
    32. Mira JJ, Carrillo I, Guilabert M, Mula A, Martin‑Delgado J, 
    Pérez‑Jover MV, et al. Acute stress of the healthcare workforce 
    during the COVID‑19 pandemic evolution: A cross‑sectional 
    study in Spain. BMJ Open 2020;10:e042555.
    33. Mohammadi S, Nakhaeizadeh A. Assessing the level of 
    engagement in preventive behaviors and COVID‑19 related 
    anxiety in Iranian adults. Avicenna J Nurs Midwifery Care 
    2021;29:160‑70.
    34. Singh C, Cross W, Munro I, Jackson D. Occupational stress facing 
    nurse academics – A mixed-methods systematic review. J Clin 
    Nurs 2020;29:720‑35.
    35. Babore A, Lombardi L, Viceconti ML, Pignataro S, Marino V, 
    Crudele M, et al. Psychological effects of the COVID‑2019 
    pandemic: Perceived stress and coping strategies among 
    healthcare professionals. Psychiatry Res 2020;293:113366.
    36. Folkman S. Stress, coping, and hope. In: Psychological Aspects of 
    Cancer. Wiley Online Library: Springer; 2013. p. 119‑27.
    37. Wu W, Zhang Y, Wang P, Zhang L, Wang G, Lei G et al.
    Psychological stress of medical staffs during outbreak of 
    COVID-19 and adjustment strategy. J Med Virol 2020;92:1962‑70.
    38. Hernández Padilla JM, Ruiz‑Fernández MD, Granero‑Molina J, 
    Ortíz‑Amo R, Rodríguez MML, Fernández‑Sola C. Perceived 
    health, caregiver overload and perceived social support in family 
    caregivers of patients with Alzheimer’s: Gender differences. 
    Health Soc Care Community 2020; 29(4), P. 1001‑1009.
    39. Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, et al. Depression 
    after exposure to stressful events: Lessons learned from the 
    severe acute respiratory syndrome epidemic. Compr Psychiatry 
    2012;53:15‑23.
    40. Vyas KJ, EM Delaney, JA Webb‑Murphy, Johnston SL.
    Psychological impact of deploying in support of the US response 
    to Ebola: A systematic review and meta‑analysis of past outbreaks. 
    Mil Med 2016;181:e1515‑31.
    41. Hendy A, Abozeid A, Sallam G, Abboud AbdelFattah H, 
    Ahmed Abdelkader Reshia F. Predictive factors affecting stress 
    among nurses providing care at COVID-19 isolation hospitals at 
    Egypt. Nurs Open 2021;8:498‑505.
    42. Moghanibashi‑Mansourieh A. Assessing the anxiety level of 
    Iranian general population during COVID‑19 outbreak. Asian J 
    Psychiatr 2020;51:102076.
Journal of Education and Health Promotion
Volume 12, Issue 4
April 2022
Pages 1-7

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