Research Article - (2021) Volume 0, Issue 0
Niki Sadeghipor* and Babak Heidari Aghdam
Health Care Professional, Jam Hospital, Tehran City, Iran
Received Date: May 03, 2021; Accepted Date: May 17, 2021; Published Date: May 21, 2021
Citation: Sadeghipor N, Aghdam BH (2021) Investigating the Effect of Appropriate Personal Protective Equipment on the Stress Level of Care Workers in the Covid19 Epidemic. Health Sci J. Sp. Iss 3: 007.
Importance: Coronavirus disease (COVID-19) is an infectious disease which caused by a newly discovered coronavirus
Objective: The aim of this study was to investigate the effect of access to personal protective equipment on the level of stress of care workers in epidemic conditions.
Design, settings, and participants: This study is hospital - based and which has been donein two stages. The first phase was performed in February 2020, when the disease had justspread and there were insufficient personal protective equipment, and the second phase wasperformed in February 2021, when it was more than 1 year since the outbreak. The disease wasover and personal protective equipment of sufficient quality was provided to the hospital staff.Census method was used to determine the number of participants in the study. In this study,the researchers conducted their research on all people. They gave the questionnaire to allfront-line care worker second-line care worker of Jam Hospital, which was 537 people. In thefirst stage, 472 questionnaires were filled out. In the second stage, 342 questionnaires werefilledout.
Main outcomes and measures: We focused on symptoms of job stress in Jam Hospital staff. The same questionnaire was used in both stages. Data collection tool is a questionnaire (ENSS) Scale is a revised version of the NSS Nursing Stress Scale developed by Gary Taft andAnderson (1981). NSS is the first tool designed to measure nursing stress instead of overall jobstress. Thirty-four items of the NSS questionnaire measure the frequency and main sources ofstressin thepatientcaresituation.
Results: In the first stage of the research, the level of satisfaction with the quality and availability of personal protective equipment Was 2.9%, stress level was high in 69.6% of employees (stress level was high in 65.3% of front line employees and 74% of second line employees).In the second phase of the study, when the level of employee satisfaction with personal protective equipment reached 97.3%, the level of stress was high in 44.1% of employees (the level of stress was high in 57.2% of front line employees and 31.1% of second line employees). That is, it decreased by 25.5%. In both stages of the research, the amount of stress has a significant relationship with the place of work (first stage p valu=0.013 , second stage p valu= 0.01) and there is no significant relationship between the amount of stress, gender, shift work and education
Keywords
Protective Equipment; Care Workers; Covid19 Epidemic
Introduction
As the coronavirus disease 2019 (COVID-19) pandemic accelerates, Preventing spread of infection to and from health care workers (HCWs) and patients relies on effective use of personal protective equipment (PPE). PPE, formerly ubiquitous and disposable in the hospital environment, is now a scarce and precious commodity in many locations when it is needed most to care for highly infectious patients [1]. Limited knowledge of the new disease has been compounded by a lack of emergency preparedness, with healthcare organizations dealing with a lack of proper medical and personal protective equipment (PPE) [2] The sheer volume of patients has necessitated the influx of nurses from non-pulmonary disciplines to help treat patients with this respiratory virus [3,4]. This has resulted in unprecedented stress on an already overburdened nursing corps [4]. Nurses’ primary concern was the lack of adequate PPE followed by concern for the safety of family and friends More than 85% were afraid to go to work [5]. Adequate PPE could attenuate the possible adverse impact of COVID exposure on mental health by helping nurses feel safer in terms of their own health, their patients and their loved one [2]. HCWs face enormous pressure due to work overload, negative emotions, lack of contact with their families, and exhaustion [6]. The extreme preventive practices and the use of whole-body personal protective equipment (PPE) have been linked to many psychological effects [7]. Stress may be compounded when HCWs are shunned because others, including family, fear that they may transmit infection [3,8]. Analysis of survey responses found anxiety levels were associated with the availability of personal protective equipment (PPE): workers who reported more unmet PPE needs also reported higher levels of anxiety [9].
The aim of this study was to investigate the effect of access to personal protective equipment on the level of stress of care workers in epidemic conditions.
Method Study design
This study followed the Institute for work & health (IWH) reporting guideline. Verbal informedconsent was provided by all survey participants prior to their enrollment. Participants wereallowed to terminate the survey at any time they desired. The survey was anonymous, andconfidentialityofinformation was assured.
This study is hospital – based and Which has been done in two stages. The first phase was performed in February 2020, when the disease had just spread and there were insufficient personal protective equipment, and the second phase was performed in February 2021, when it was more than 1 year since the outbreak. The disease was over and personal protective equipment of sufficient quality was provided to the hospital staff. The number of patients in the second phase of the study had reached about 119 million To compare the interregional differences of mental health outcomes among health care workers in Iran, All hospitals in Tehran were involved. We chose Jam Hospital as a sample. Because Tehran was most severely affected. Hospitals equipped with fever clinics or wards for COVID 19 were eligible to participate in this survey. This research is applied research and interms of survey method. The main tool used to collect information in this study is a questionnaire, which was also used to study the evidence to obtain human resource information.
Participant
Census method was used to determine the number of participants in the study. In this study, the researchers conducted their research on all people. They gave the questionnaire to all front-line care worker (nurse, assistant nurse, secretary) second-linecare workers (Services, security, chefs and hostesses, facilities) of Jam Hospital, which were 537 people.In the firststage, 472 questionnaires were filled out. In the second stage, 342 questionnaires were filledout.
Outcomes and Covariates
We focused on symptoms of job stress in Jam Hospital staff. The same questionnaire was usedin both stages. NSS is the first tool designed to measure nursing stress instead of overall jobstress. Thirty-four items of the NSS questionnaire measure the frequency and main sources of stress in the patient care situation [10].
In 2000, French et al., In order to identify stressful situations not mentioned in the NSS, as well as to increase the scope of this scale, renewed it. They initially identified twenty stressful situations that were not assessed on the NSS test by conducting a pilot study of Canadian nurses with experience working in a variety of conditions. In the next stage of the research, five more positions were added to the previous positions and the number of new positions was increased to twenty-five positions. The researchers then re-examined the twenty-five added stressful situations to determine conceptual fit with the seven major NSS scales. Of the twenty- five additional positions identified, fourteen positions with five subscales out of the seven major NSS subscales showed conceptual fit. Three situations were grouped under a new scale that showed discrimination in the workplace. Five other situations were grouped under a new subscale for patients and their families. The researchers then measured fifty positions (ENSS) in a large sample (N = 2.280) and according to the obtained results, two positions were removed from the questionnaire. The final version (ENSS) therefore contains fifty-seven expressions in nine subscales. In the present study, due to the standardization of the questionnaires used, their validity is naturally confirmed. During the research of Sharifian et al. (2005) the content validity of this questionnaire has been reported as very good. Cronbach's alpha criterion was used to estimate the reliability and internal consistency of the questionnaire. Regarding ENSS questionnaire, the results showed that the coefficient of the revised scale of nurses (0.96) is higher than the main scale (0.86). Regarding Osipow questionnaire, its reliability was calculated by satisfactory level and its Cronbach's alpha coefficient was calculated and reported equal to (0.86). Fifty-seven questionnaire items are set on a five-point Likert scale, and the subject should choose one of the following options according to the frequency of experience of the desired situation [11].
Theanswersare:
• I do not have stress at all.
• Sometimes I have stress.
• I often have stress.
• I am verystressed.
• This position does not include my duties.
The Osipow Job Map Questionnaire (1987) by Osipow to assess a person's stress from sixdimensions:
• Role loading,
• Role inadequacy,
• Role duality,
• Role scope,
• Responsibility and
• Physical environment have been prepared and used
This questionnaire consists of 60 questions, each of the six dimensions of which are evaluated by ten phrases, respectively
• The "role role" dimension examined the situation of the person in relation to the demands of the work environment: the first 10 questions
• The dimension of "role inadequacy" evaluates the appropriateness of skills, education and educational and experimental characteristics of the individual with the needs of the work environment: 10 second question.
• The "role duality" dimension assesses an individual's awareness of priorities, workplace perspectives, and evaluation criteria: 10 Third Question.
• The "role range" dimension evaluates the contradictions that a person has in terms of work conscience and the role that is expected of him in the work environment: 10 fourth question.
• The "responsibility" dimension measures a person's sense of responsibility in terms of work efficiency and the wellbeing of others in the workplace: 10 fifth question.
• The dimension of "physical environment" examines the unfavorable physical conditions of the work environment to which the person is exposed: 10 Question
The scoring of the Osipow Job Stress Questionnaire based on the 5 Likert scale is as follows: Foreach phrase 5 options, never equal to 1 point, sometimes = 2, often = 3, usually = 4 and most of the time equal to 5 Points are considered. The range of scores of this questionnaire varies between 60 and 300. The higher scores of the subject in this questionnaire indicate the high level of his stress. Also, the overall stress level in the four categories is described in Table 1.
| Scores | Stress Rate |
|---|---|
| 50-99 | Low stress |
| 100- 149 | Lowtomedium |
| 150- 199 | Moderateto severe |
| 200- 250 | Severestress |
Table 1 Stress Rate Scores.
Statistical Analysis
Data analysis was performed using SPSS statistical software version 26.0 (IBM Corp). The significance level was set at α = .05, and all tests were 2-tailed. The original scores of the 4 measurement tools were not normally distributed and so are presented as medians with interquartile ranges (IQRs). The ranked data, which were derived from the counts of each level for symptoms of job stress, are presented as numbers and percentages.
The nonparametric Mann-Whitney U test and Kruskal-Wallis test were applied to compare the severity of each symptom between 2 or more groups. To determine potential risk factors for symptoms of job stress between risk factors and outcomes are presented as odds ratios (ORs) and 95% CIs, after adjustment for confounders, including sex, age, marital status, educational level, technical title, place of residence, working position (first-line or second-line), and type of section.
Results
Demographic characteristics
This research was conducted in two stages. 472 people participated in the first stage and 342 people participated in the second stage. In the first stage, 373(79%) of the front line, 99 (21%) people of the second line. In the first stage, most participants were women (66.5%), had aneducational level of undergraduate or less (55.7%), were day working (50%) andwere aged 36to 45 (50%). In the second stage most participants were women (68.6%), had an educational level of postgraduate (87.3%), were day working (58.2%) and were aged>46 (34.9%) (Table 2).
| Characteristic | Total | The first stage of research | The second stage of research | |||
|---|---|---|---|---|---|---|
| Overall | first stage | second stage | Front line care worker | second line care worker | Front line | second line |
| care worker | care worker | |||||
| Sex | ||||||
| Men | 127(33.4%) | 109(31.4%) | 81 | 46 | 93 | 16 |
| Women | 253(66.5%) | 238(68.6%) | 191 | 62 | 154 | 84 |
| Education level Under graduate ≤ Post graduate ≥ | 212(55.7%) | 46(12.7%) | ||||
| 168(44.2%) | 316(87.3%) | 126 | 86 | 44 | 2 | |
| 146 | 22 | 218 | 98 | |||
| Shift Day | 189(50%) | 211(58.2%) | ||||
| Night | 189(50%) | 151(41.85) | 122 | 67 | 184 | 27 |
| 148 | 41 | 78 | 73 | |||
| Age | ||||||
| 25-35 | 99(25.3%) | 133(33.4%) | 78 | 21 | 106 | 27 |
| 36-45 | 196(50%) | 126(31.6%) | 138 | 58 | 107 | 19 |
| > 46 | 96(24.5%) | 139(34.9%) | 65 | 31 | 85 | 54 |
Table 2 DemographicandworkingpositionCharacteristicsof Responders.
Severity of measurements and associated factors
In the first stage of the research, the level of satisfaction with the quality and availability ofpersonal protective equipment was 2.9%, stress level was high in 69.6% of employees (stress level was high in 65.3% of front line employees and 74% of second line employees).
In the second phase of the study, when the level of employee satisfaction with personal protective equipment reached 97.3%, the level of stress was high in 44.1% of employees (the level of stress was high in 57.2% of front line employees and 31.1% of second line employees). That is, it decreased by 25.5%. In both stages of the research, the amount of stress has a significant relationship with the place of work (first stage p value=0.013, second stage p value=0.01) and there is no significant relationship between the amount of stress, gender, shift work and education (Table 3).
| First stage | Second stage | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Severity category(%) | Severity category(%) | ||||||||
| Low | Natural | High | P value | Low | Natural | High | P value | ||
| Working position | Front line | 6.6 | 28.1 | 65.6 | 28.6 | 14.2 | 57.2 | ||
| Second line | 12 | 13.8 | 74 | 0.013 | 26.3 | 36.9 | 31.1 | 0.03 | |
| sex | Men | 55 | 22.7 | 22.3 | 58.5 | 20.2 | 21.7 | ||
| Women | 49 | 26.5 | 24.5 | 0.29 | 42.2 | 23.5 | 33.3 | 0.3 | |
| Day | 25 | 35.4 | 39.6 | 39 | 22.7 | 38.3 | |||
| Shift | Night | 18.9 | 39.6 | 41.5 | 0.07 | 49.6 | 17.6 | 32.8 | 0.08 |
| Satisfaction with personal protective equipment | 95.1 | 2 | 2.9 | 1.5 | 1.2 | 97.3 | |||
Table 3 Severity categories of psychosocial factors, stress and satisfaction with personal protective equipment.
Risk factors of mental health outcomes
Risk Factors of Mental Health Outcomes analysis showed that Employees who, in care workers, the level of stress has a significant relationship with the level of satisfaction with personalprotective equipment. It was higher. The amount of stress also depends on the place of work.Those who were in the front line and in direct contact with patients with covid19 had a higherlevel ofstress thanthestaffofthesecondline.
Discussion
This cross-sectional survey enrolled 472 respondents in first stage and 342 respondents in second stage and revealed a high prevalence of mental health symptoms among health workers treating patients with COVID-19 in Iran. Overall, in first stage 69.6% of all participants reported symptoms of job stress and in second stage 44.1% all participants reported symptoms of job stress. In the first phase, when Covid19 disease had just started to spread and the personal protective equipment was not sufficiently available to the medical staff, compared to the second phase of the study, which was one year after the spread of the disease and the personal protective equipment was sufficiently available to the staff, The rate decreased by 25.5%. In both stages of the research, most of the participants were female. In the first stage, most of the participants had Undergraduate education and were equally equal in day and night shifts, and most of the participants were between 36 to 45 years old. In the second stage, most of the participants had a university education, were night shifts, and were over 45 years old. In both stages, there was no significant relationship between age, sex of work shift and employee stress level. At both stages the stress was greater on the secretaries and facilities. In both phases, there was a significant relationship between where employees serve and the amount of stress.
Other studies show Preventing spread of infection to and from health care workers (HCWs) and patients relies on effective use of personal protective equipment (PPE) [12]. We expected to seeheightened anxiety and depression during this pandemic, but we didn’t expect to see levels thishigh. What’s notable is that, if PPE protection and infection control policies and practices areadequate, then this mental health burden can be reduced.” [13]. Limited knowledge of the new disease has been compounded by a lack of emergency preparedness, with healthcare organizations dealing with a lack of proper medical and personal protective equipment (PPE) [14]. The sheer volume of patients has necessitated the influx of nurses from non-pulmonary disciplines to help treat patients with this respiratory virus3. This has resulted in unprecedented stress on an already overburdened nursing corps [15]. Nurses’ primary concern was the lack of adequate PPE followed by concern for the safety of family and friends More than 85% were afraid to go to work [5 Adequate PPE could attenuate the possible adverse impact of COVID exposure on mental health by helping nurses feel safer in terms of their own health, their patients and their loved one [16]. HCWs face enormous pressure due to work overload, negative emotions, lack of contact with their families, and exhaustion [17]. The extreme preventive practices and the use of whole-body personal protective equipment (PPE) have been linked to many psychological effects [16,18]. Stress may be compounded when HCWs are shunned because others, including family, fear that they may transmit infection [1,7,19-21].
It is true that nurses are in direct contact with the patient and the symptoms of stress are high in them, but the present study shows that secretaries and staff of the second line are at high risk of stress which is usually ignored.
Limitations
This study has several limitations. First, it was limited in scope. All participants were from Jam hospital in Tehran. Second, not all employees were interested in completing the questionnaire. Third, due to the large number of questionnaire questions, participants may not have completed a number of questions accurately. Fourth, due to the prolongation of the epidemic period, the psychological symptoms of the employees may have worsened and it is not possible to follow up.
Conclusions
It study showed that the level of stress is significantly associated with satisfaction with personal protective equipment. At the beginning of Corona, when the means of personal protection were low, the level of stress in the treatment staff was high. After 1 year, when the means of personal protection were abundant and of good quality, the level of stress in the staff was significantly reduced. The amount of stress also depends on the place of work. Those who are at the forefront and in direct contact with patients with covid19 have higher levels of stress.
Support for front-line and second-line staff seems necessary.
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