The psychological effects of the COVID-19 pandemic on ITU nurses in Malta

Abstract

Background: The COVID-19 pandemic brought about unprecedented challenges for many countries. Since the beginning of the pandemic, many studies have attempted to begin the process of understanding the true impacts on health care systems and their staff members. This study aims to explore the psychological effects of the COVID-19 pandemic on ITU nurses in terms of burnout, stress, depression and anxiety. The findings can assist policy makers to develop strategies to support nurses and ensure a healthy workforce today and in the future.

Methodology: The study made use of both quantitative and qualitative methodologies. It consisted of paper-based questionnaires distributed to ITU nurses which included the use of the DASS-21 and OLBI tools to measure depression, anxiety, stress and burnout. The questionnaires obtained a response rate of 60%.

Findings: The percentage of participants recalling having mild to severe symptoms include depression (37%), anxiety (43%) and stress (23%) during the pandemic. In all three of these scores, nurses who contemplated leaving the department (57%) scored statistically significantly higher in all scales. Scores relating to burnout showed that 85% of participants currently have signs of burnout, with 90% showing signs of exhaustion and 67% having signs of disengagement. Participants who contemplated leaving the department also scored significantly higher in the three burnout scores. Additionally, a statistically significant difference was observed in the age group of 31-40 years who scored higher for disengagement than their older colleagues. A multiple linear regression carried out also showed a significant positive relationship between depression and burnout as well as a significant negative relationship between anxiety and burnout. The qualitative methodology included eight semi-structured interviews in which participants were asked about their work and coping mechanisms throughout the COVID-19 pandemic along with their recommendations for similar future scenarios. The interviews provided an insight into what the nurses experienced while working in the pandemic. The main themes which emerged included changing work dynamics, emotional times, coping strategies, organisational support, external factors and the current situation. Most participants contributed to almost all of these themes. The main issue where participants’ answers differed was about the current state of the unit.

Conclusion: This research is the first to locally explore the effects of the pandemic on ITU nurses. It provided insight into their experience and difficulties faced. These effects can still be felt by some of the nurses, mainly in their levels of burnout and belief that the unit has not yet reached its state of ‘normality’. Recommendations which emerged from this study include future research regarding manager’s perspectives, reasons for leaving the department and the impact of major decisions taken by the hospital. Recommendations for practice consist of a plan of action for emergency expansion and reallocation of nurses. The latter includes leadership training, exposure opportunities for nurses who do not work in the unit as well as methods for improving communication of updated protocols and support services available.