key: cord-288022-xh10ccki
authors: Wu, Dongmei; Jiang, Chunyan; He, Changjiu; Li, Chao; Yang, Lei; Yue, Yuchuan
title: Stressors of nurses in psychiatric hospitals during the COVID-19 outbreak
date: 2020-04-14
journal: Psychiatry Res
DOI: 10.1016/j.psychres.2020.112956
sha: 
doc_id: 288022
cord_uid: xh10ccki

nan

In early February 2020, novel coronavirus infection occurred in the Wuhan Mental Health Center, and a total of about 80 patients and medical staff were diagnosed. This was the first novel coronavirus epidemic in psychiatric hospitals in China. As of February 18, 2020, novel coronavirus pneumonia was diagnosed in 323 patients with severe mental disorders, covering 17 provinces in the country (China, 2020) .

The epidemic makes it hard for psychiatric nurses to work. Through phenomenological research, 18 psychiatric nurses were interviewed. The male to female ratio of the study subjects was 6:12, whose age ranges from 25 to 54 years old. In addition, most of them have married and possessed their own family. Furthermore, their lever of nursing education ranges from junior college degree to graduate degree. The majority of nurses have a bachelor's degree. The average years of nursing in psychiatric hospitals are 14.5 years. They are equipped with extensive clinical experiences. The participants worked in a psychiatric hospital with more than 1200 inpatients during the COVID-19 outbreak located in Chengdu city, Sichuan Province, in the west of China. Five stressors were identified from the interview data.

First, higher exposure risks than peers in general hospitals. To begin with, the patients often lived in crowded wards. In addition, although general clinics were closed, 3 to 5 psychiatric patients with severe symptoms, especially aggressive behaviors, were admitted from the emergency room every day. Most of them could not provide accurate epidemiological histories under the symptoms. Moreover, patients also had various risk behaviors to the medical staff, such as tearing safety goggles and masks of medical staff, and even spitting to them.

Second, inadequate preparedness for the outbreak. Psychiatric nurses tended to lack knowledge about coping with infectious diseases (Zhu et al., 2020) . They had to process large volumes of information in a short time, such as COVID-19 prevalence, viral pathogens, symptoms and signs of patients, protection level. The lack of contingency plans for public health emergencies in the psychiatric hospital also brought big challenges to nurses' daily work.

Third, conflict with the original professional value. During the outbreak, some psychiatric nurses suddenly found that they were not as good as a novice nurse who worked in the respiratory department or ICU. "I have been working in the psychiatric hospital for 14 years, but recently I feel so sorry for being a psychiatry nurse. When I saw those nurses working in the front line of anti epidemic in Wuhan on TV, I began to blame myself for not being a nurse in the respiratory department or ICU. " Fourth, the role conflict between family and work. Traditional Chinese families usually live together with three generations. Adults are responsible for the care of elderly parents and young children (Liu et al., 2020) . During the outbreak, the daily care of the elderly parents, especially with various chronic diseases, become a major problem. In addition, due to the full suspension of school, nurses also needed to provide homework tutoring after work for their own children receiving online school education at home. Nurses were struggling with these responsibilities. Nurses were also worried about themselves to be carriers of new coronavirus, causing cross infection between patients and family members.

Finally, the delay of personal life and career planning. Due to the epidemic, nurses had to postpone their original personal life plans, such as marriage, childbirth, or traveling abroad. The original plan to go abroad for vocational training or further study also fell apart.

The results of the study could draw the world's attention to the stressors of psychiatric nurses during the COVID-19outbreak, help solve their problems and reduce the turnover of psychiatric nurses during the outbreak and afterwards. 

The authors declare that they have no conflicting interests.

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