The impact of the COVID-19 pandemic on mental coping and emergency ability of public health emergency in COVID-19 department healthcare workers in ICU nurses of Beijing in China

This study descriptive cross-sectional survey design.

This study was carried on in November 8th to15th of 2022 in the city of Beijing, which is the capital of China, and the center of politics, economy and culture. Beijing is one of the cities with the highest level of medical care in China, and thus, future research plays an important role by investigating medical staff in the region. Data were collected from seven Grade-A Tertiary Hospitals in Beijing, China; The tertiary hospital is the abbreviation of the tertiary first-class hospital. It is the highest level in the classification of "three grades and six grades" for hospitals in mainland China. The so-called tertiary hospital refers to the hospitals that have more than 501 beds, perform high-class diagnosis and treatment, complete medical services to the region and surrounding radiation areas, provide senior education and scientific research tasks [22]. Refer to Price and Tinsley’s sample size calculation method [23, 24], the quantity of samples is usually more 5 ~ 10 times than those of variables, and 10% of the samples will be dropped when the rate is 5 for the accuracy of the results. So, the minimum required sample size is 389 in this study.

The informed consent was obtained from the nursing department of each hospital when collecting data. Under the coordination of the nursing department and the ICU head nurses of each hospital, the data were collected using the QuestionnaireStar program, Questionnaire Star is a professional online questionnaire survey tool with embedded WeChat program, which has the obvious advantages of being fast, easying to use and low-cost, and has been widely used by a large number of enterprises and individuals in China [27]. Inclusion criteria: On-the-job registered ICU nurses; Nurses who voluntarily participate with informed consent; Exclusion criteria: nursing students that were on clinical attachment. A total of 486 ICU nurses finished the questionnaire effectively.

This study was approved by the ethics committee of the Xuanwu Hospital Capital Medical University: 2020–064. The first part of the questionnaire is the informed consent part, in which the research object can clarify the purpose, content and risk of the research and keep the research data confidential. Following the ethical procedure, voluntary participation was emphasized in the information and any decline of participation would not lead to negative consequences. The electronic questionnaire skipped to the content section of the questionnaire only after the researcher had consented. In order to protect the confidentiality of the participants, every single returned questionnaire and each unit was coded with a number. The code lists were stored in one password-locked accounts in which only accessible by the first author.

A total of 486 participants completed the survey. 410 (84.4%) were female and 76(15.6%) were male. The age of most nurses (74.1%) were in the range of 25 ~ 35. 67.5% of nurses possessed a bachelor degree or above, in terms of seniority, 77% of nurses had nursing experience over five years. 37.9% of the participants had PHE rescue experience ever. Approximately 79% Nurses take part in over 10 rescue surgeries. In the meantime, the majority of the nurses (71.6%) participated in PHE education (see Table 1).

As shown in Table 2, the emergency ability of ICU nurses hover at the moderate level (145.42 ± 23.29). The level of code of professional ethics (4.33 ± 0.72) is the highest. The level of emergency knowledge (3.28 ± 0.74) is the lowest. The score of item 31 “I can abide by professional ethics, be cautious and honest” (4.41 ± 0.77) is the highest. This is followed by item 33 “I am patient and careful, and take care of each patient with a high degree of responsibility to reduce the occurrence of nursing risks” (4.36 ± 0.80). The score of item 1 “I can judge common public health emergencies” (2.85 ± 1.28) is the lowest. This is followed by item 3 “I can grasp the concept of PHE and related laws, regulations, and ordinances” (2.97 ± 1.02) (see Tables 3 and 4).

Through univariate analysis (see Table 1), the variables of Work experience, Participated in PHE rescue activities, Participated in PHE education, Cumulative rescue more than 10 times and Positive coping style (see Table 5) were found to be significant (p < 0.05).

The data with statistical significance in the demographic information (Work experience, Participated in PHE rescue activities et.,) and the Coping style (positive coping) were used as independent variables, fellowly, emergency ability scores were processed as dependent variables, based on which building multiple linear regression analysis. The factor of working experience, PHE rescue activities, PHE education, cumulative rescue times, and positive coping (see Table 6) were associated with the emergency ability of ICU nurses.

Power analysis was performed on the five single-factor significant variables and multiple linear regression in the study. The results showed that the efficacy of Work experience was the lowest, 0.83 > 0.8, the efficacy of Cumulative rescue more than 10 times was 0.99, and the efficacy values of Participated in PHE rescue activities, Participated in PHE education, Positive coping and multiple linear regression were all 1, indicating that the sample size of this study had good efficacy for the test results (see Table 7).

In the present study, the emergency ability of ICU nurses in Beijing Grade-A Tertiary Hospitals at the upper-intermediate level (145.42 ± 23.29), which was slightly higher than the results reported in China of 143.45 ± 20.50 [17, 25]. The fact that Beijing is China's medical center, occupying the highest quality medical resources in China. Healthcare professionals are highly skilled, attracting patients from all over the country to seek medical treatment. Besides, they accumulated certain experience in handling all kinds of emergencies, providing patients with high-quality medical services. In addition, due to the complex and diverse diseases of ICU patients, the rapid changes in their conditions, nurses need to make correct decisions in a short time. Under the long-term stressful working environment and the exercise of handling emergencies, the emergency ability of ICU nurses has been improved.

Professional ethics refers to the moral norms and codes of conduct that should be followed in professional activities. It is also one of the key characteristics of the nursing profession and an important tool for dealing with ethical issues, which is of great significance for ensuring professional development, making correct decisions and fulfilling responsibilities [28]. In this study, the highest score was dimension of professional ethics and the score of item 31 “I can abide by professional ethics, be cautious and honest” is the highest. This result is similar to that of Goktas's study [28], and the reason may be that nurses working in the intensive care unit on a daily basis often face various ethical issues related to decision-making, informed consent, limiting or terminating life-support treatment, and fair allocation of resources, which cultivates nurses' professional ethics and ethical decision-making ability. In addition, various departments in our country attach more and more importance to medical services, patients' requirements for clinical care are constantly increasing, and medical institutions pay more and more attention to the cultivation of nurses' awareness of quality service and professional ethics. At the same time, in recent years, hospital management departments have also formulated a number of regulatory measures [29, 30], such as the director's mailbox and the mayor's hotline to provide feedback on patient satisfaction, and promoting nurses to continuously improve themselves and enhance their professional ethics.

However, the emergency knowledge dimension has the lowest score. ICU nurses were lacked in the identification of public health emergencies, reporting and registration procedures, laws and regulations, etc. This result is similar to that of Kayama's and Veenema's study [31, 32], the vast majority of the respondents had not been acquired the training that was benefit to proper response to an emergency in this study, particularly courses in identification, registration procedures, and regulations of public health emergencies were missing. Thus, appropriate interventions are indispensable to improve training program. For example, medical institutions can add a series of disaster nursing courses in the future, including emergency identification, reporting and registration procedures, and relevant laws and regulations, and establish a feedback and evaluation mechanism, set up a feedback link in the training process, collect nurses' opinions and suggestions on the content and format of training, and improve the course design.

We discovered that the scores generally have higher emergency abilities in their work more than five years compared to those in their work less than five years. Notably, a majority of respondents who rescued patients more than 10 times were more competent for such events. Previous studies have indicated that abundant work experience can improve the emergency ability of nurses, since they become increasingly skillful and highly effective in their nursing positions [33‐35]. Therefore, with the accumulation of experience, nurses can make decisions easier when dealing with emergencies. Additionally, the results found that nurses with participated in PHE rescue activities were better emergency abilities than those without prior rescue experience, this result is in consistent with previous study [36, 37]. Rescue experience is an important way for nurses to acquire knowledge and skills of emergency rescue. Nurses can accumulate rescue experience and improve their ability to respond during the rescue process. The knowledge accumulated in responding to public health emergencies will inform a new generation of young nurses to deal with important public crises in the future, and even improve the entire nursing profession to a whole new level. It is worth noting that pre-training nursing educators should use the work experience of nurses with rescue experience to evaluate and update the training content, fully combine theoretical knowledge with rescue experience, and improve the practicality of the training content. When allocating patients with sensitive conditions in different wards, including COVID-19, nurse managers must remember that nurses with more work experiences will be more clinically competent.

This study revealed that the emergency abilities have a significant correlation with PHE education. The results found that nurses with participated in PHE education were better emergency abilities than those without prior PHE education. A majority of respondents in this study considered that the training was carried out after the occurrence of public health emergency and reported that the education content is not targeted and boring. They had not received the training needed for proper response to an event, particularly courses in identification, registration procedures, and regulations of public health emergencies were missing. This study addressed the importance of nursing education to the nursing professions, which focuses on improving previous training programs so that nurses are properly prepared to deal with unforeseen difficulties in a large-scale emergency. Nursing education should concentrate on low-scoring content, including precaution, monitoring, Comprehensive patients’ evaluation and care, recovery, triage, and psycho-health guidance. There are five common types of emergency drills: positioning drills, tabletop drills, drill drills, functional drills, and full-scale simulation drills are recommended according to the World Health Organization's Guidelines for Emergency Drills for Hospitals and Health Facilities [38]. In recent years, scenario simulation has been widely used. It is the reproduction of real events and can take many forms, including computer software, case studies, written clinical scenarios, simulated patients (SPs), role-playing, or using simple or advanced functions to replicate reality [39]. In addition, simulation scenario exercises based on actual emergency situations may help improve the emergency response capabilities of nurses who are not involved in rescue activities [40, 41]. Considering that emergencies are unpredictable and urgent, regular situational simulation activities for emergencies possibly assist nurses to be adequately prepared for various future health crisis.

During the COVID-19 pandemic, the number of critically ill patients has surged, posing a great threat to the mental and emotional health of ICU nurses around the world. If nurses cannot effectively respond to these challenges, causing greater occupational risk, low morale, intent to leave the profession, therefore, managers need to care about the psychological condition of nurses, help them adapt to various adverse environments, reduce psychological harm, and promote mental health [42]. Coping strategy is a behavioral or cognitive attempt to overcome and mitigate any potential or actual danger to one's well-being [43]. Various individuals, or the identical individual under different stressful circumstance, can utilize positive or passive coping strategies when expose to stressors [44‐46]. This study showed that ICU nurses showed active coping strategies when facing challenges and stress. In addition, emergency response ability is closely related to coping style. Nurses who actively respond to PHE have better emergency response ability than nurses who respond passively, which has been confirmed in many studies [47, 48]. The reason may that Chinese medical staff believe that working during the COVID-19 pandemic is a noble professional ethical responsibility [49], which is also confirmed by the highest-scoring items in this survey. Therefore, the pressure of the epidemic will be transformed into a positive moral responsibility. Driven by responsibility, nurses may be forced to use their medical and psychological knowledge to make active or passive psychological adjustments, which will motivate nurses to achieve their own psychological growth and may have a beneficial impact on patient care.

Positive coping strategies enable individuals to have active behaviors and positive emotions, which could promote the effective coping to stress [50, 51]. As time flies, they could obtain more valuable experience and resources to deal with difficulties, which will contribute to advancement of personal professional ability. In China, nursing is a stressful profession [52, 53], the mental health of nurses should be paid attention, a positive psychological coping strategy is also help nurses to release enormous psychological pressures in coping to a public health emergency, thereby increasing their ability to overcome threats. Therefore, when facing urgent and unpredictable public events, nursing managers need to be aware that they may be key players in helping nurses cope when their conventional strategies are no longer sufficient to cope effectively [54]. In addition, methods and strategies for nurses to effectively cope with stress can be increased, such as mindfulness interventions, aromatherapy, etc. [55, 56], promotes the physical and mental health of nurses thereby enabling nurses to effectively cope with stress and have a beneficial impact on patient outcomes.

The present study has several limitations. First, the samples in this study are from ICU nurses in 7 Grade-A public hospitals in Beijing. The comprehensive level of nurses in Grade-A tertiary hospitals may be better, the representativeness of the samples may be insufficient, so the generalization of the results to other societies should be done with caution due to the cultural and social differences. Second, the inclusion of influencing factors is not comprehensive, in the future, it is necessary to expand the geographical scope, enrich the survey sites, increase the representativeness of the sample, and incorporate more variables to explore the influencing factors of emergency response capacity. Finally, it was found that no relevant studies have examined the public health emergency response capabilities of ICU nurses before and during the COVID-19 outbreak, resulting in a lack of continuous dynamic comparison, so caution should be exercised when interpreting the results.