key: cord-0922966-92l3z8js authors: Ersin, Fatma; Havlioğlu, Suzan; Gür, Sibel Ceylan title: Mental well‐being and social support perceptions of nurses working in a Covid‐19 pandemic hospital date: 2021-05-05 journal: Perspect Psychiatr Care DOI: 10.1111/ppc.12833 sha: 4f7e179a943ea72d2eef73881b091c43248f93c7 doc_id: 922966 cord_uid: 92l3z8js PURPOSE: This study was conducted to determine the mental well‐being and social support perceptions of nurses working in a Covid‐19 pandemic hospital. DESIGN AND METHODS: This study used a cross sectional design. The sample included 333 volunteer nurses. FINDINGS: Based on the marital and income statuses of the nurses, there was a significant difference between the multidimensional scale of perceived social support family subscale (p < 0.05). There was a positive, weakly significant relationship between the nurses' mental well‐being and their perception of social support (r = 0.381; p < 0.05). PRACTICE IMPLICATIONS: In conclusion, protective measures must be increased and social networks must be promoted to increase the mental well‐being and social support levels of nurses. The novel coronavirus pandemic is an important international public health problem, unprecedented in modern history. 1 Those who are at the highest risk of encountering the infection are health professionals. 2 Among health care professionals, nurses, who are primarily responsible for patient care, are affected the most psychologically and are at the highest risk of becoming ill. 3 Therefore, the mental well-being of nurses may be negatively affected during pandemics. According to the World Health Organization (2004), mental well-being is defined as being aware of one's own abilities, overcoming the stress that occurs throughout life, being productive and beneficial in one's work life, and contributing to the society in line with one's abilities. 4 Studies have shown that individuals with high mental well-being have better psychological and physical health, better quality of life, higher creativity, better relationships with other people, more productive work environments as well as longer lives. [4] [5] [6] Therefore, mental well-being is an important factor at individual, environmental, and social levels 7, 8 and may affect the service provided by nurses. Considering the negative effects during a pandemic, investigating the possible factors necessary for improving the mental health of health care professionals and sustaining their productivity is important. 9 Of the effective factors reported in the literature, social support has been accepted as a protective factor for mental health. 10 Social support refers to the care and support that people perceive as being provided by others. 11 Social support makes individuals feel spiritually better. 12 In addition, studies in different samples have demonstrated a relationship between social support and mental health. [13] [14] [15] [16] There are studies on social support perceptions of nurses during the COVID-19 pandemic. 17 However, to our knowledge, there are no studies examining the social support perceptions and mental well-being levels of nurses. A limited number of studies have focused on social and psychological supports. 17 Determining the mental well-being and social support perceptions of nurses during the pandemic is important to protect or develop health and planning services. Our study will enable the evaluation of mental health and social support perceptions of nurses during the pandemic. In addition, it will guide the planning of interventions that will increase the mental well-being of nurses and their perception of social support. Therefore, this study was conducted to determine the mental wellbeing and social support perceptions of nurses working in a COVID-19 pandemic hospital. This is a cross sectional study. This study was conducted in a pandemic hospital in Turkey between July 30, 2020 and August 25, 2020. The study population consisted of nurses working in a pandemic hospital in Turkey (N = 400). The sample size was aimed to reach at least 197 people with 50% unknown prevalence, 1% absolute deviation and 95% confidence level. A total of 333 nurses participated in the study. This sample size was calculated using OpenEpi, Version 3 (2013) , an open-source calculator. An introductory information form, the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and the multidimensional scale of perceived social support (MSPSS) were used to collect data. This form comprises 19 questions on sociodemographic characteristics and coronavirus. 18, 19 The introductory information form includes questions such as the sociodemographic of nurses, the unit they work in, their quarantine status, their use of personal protective equipment, their status of being diagnosed with COVID-19, the measures adopted to avoid transmitting the virus to their family and the status of following the media on COVID-19. This scale was developed by Tennant et al. 8 to measure the mental well-being levels in individuals living in England. 8 The validity and reliability study in Turkey was conducted by Keldal. 7 After the nurses were informed about the study, those who agreed to participate in the study were provided with data collection forms. The forms were collected after being filled out by the nurses. Filling out the data collection forms took 5 min on average. During the data collection process, necessary measures were adopted to protect against the COVID-19 pandemic. The Statistical Package for the Social Sciences (SPSS) 22.00 package software was used to evaluate the data. In the study, number, percentage, and mean values were used in descriptive statistics. Shapiro-Wilk W test was performed to analyze if the data followed normal distribution. Among the parametric tests, t test and one-way analysis of variance were used to compare the groups with normal distribution. In comparison of the groups without normal distribution, the nonparametric Mann-Whitney U and Kruskal-Wallis H tests were used. Pearson correlation analysis was performed to analyze the relation between the mean scores on the mental wellbeing scale and those on the MSPSS. To conduct the study, permission was obtained from the Republic of A total of 52.6% of the nurses who participated in the study were women, 56.5% were married, 79.4% had an associate degree/undergraduate degree, 60.1% had been working as nurses for 1-5 years, and 73.6% had a middle income status (Table 1 ). In addition, the mean age of the nurses was 29.69 ± 6.28 years. Of the nurses, 31.5% stated that they perceived their health to be good, 61.3% perceived it to be moderate and 7.2% perceived it to be poor. Of the participants, 61.6% stated that they cared for COVID-19 positive patients, 57.7% had storage COVID-19, 56.8% had undergone the COVID-19 test, 11.4% were quarantined, and 95.5% used protective equipment while working. In addition, 82.9% of the nurses stated that they followed the news in the media about COVID-19. Only 39% of the nurses stated that they received support; 79.9% of those who received support stated that they received this support from their families and relatives, 2.4% from the institution and 17.7% from all of them. The WEMWBS mean score of the participating nurses was 48.98 ± 9.99. Their mean score for the MSPSS was 59.55 ± 16.09. The mean score for the MSPSS family subscale was 22.19 ± 5.83, that on the friend subscale was 19.63 ± 5.99 and that on the significant other subscale was 17.72 ± 7.32. There was no significant difference between the mean scores on the WEMWBS and those on the MSPSS according to age, gender, marital status, years of employment, education, and income levels of the nurses (p > 0.05). Based on the marital and income statuses of the nurses, there was a significant difference between the MSPSS family subscale (p < 0.05; Table 2 ). The mental well-being scale and MSPSS mean scores of the nurses who perceived that their health was good and thought that they were supported during the pandemic were significantly higher (p < 0.05). In addition, the mental well-being scale mean scores of nurses who thought they were COVID-19 positive were significantly lower (p < 0.05). The mean scores of the multidimensional social support scale were significantly higher in quarantined nurses (p < 0.05; Table 3 ). In addition, there was a statistically significant difference between receiving support during the pandemic and the mean mental well-being scale and multidimensional perceived social support scale scores of the nurses (p < 0.05). Thus, a positive, weak and significant relationship was observed between the nurses' mental well-being and their perception of social support (r = 0.381; p < 0.05; Table 4 ). During the COVID-19 pandemic, high mental well-being and social support perceptions of nurses are crucial in protecting and improving both their own health and the health of the individuals they care for. Therefore, this study was conducted to determine the mental well-being and social support perceptions of nurses working in a pandemic hospital. This study found that neither the mental well-being scale mean scores nor the multidimensional perceived social support scale mean scores of the nurses were at the desired level. In a study, social T A B L E 1 Socio-demographic characteristics of nurses (n = 333) 25 The mean mental well-being scale scores of the nurses with professional experience ≥6 years were higher than those of nurses with professional experience less than 6 years. In addition, the social support perception of nurses with professional experience ≥6 years was lower than that of nurses with professional experience less than 6 years. Social support is deemed essential in terms of career and well-being in maintaining the nursing profession. 27 reported that nurses with professional experience ≥11 years had higher perceptions of social support. 25 In a different study conducted with intensive care nurses, who are reported to have high critical thinking skills, perceived social support, stress and communication were found to decrease with an increase in the number of working years. 29 Another study has found a significant negative relationship between working years and social support perceptions. 30 As the work experience (years) of nurses increase, their mental well-being levels are expected to be high and their social support perceptions to be low. This may be an indication that nurses cope with problems more efficiently as their experience increases. In addition, imposing more responsibilities on nurses with more working years during the pandemic may have limited social communication. In the study, the mean mental well-being and perceived social support scores of the nurses who perceived their health as good were higher than those of the nurses who perceived their health as moderate or poor. This is an expected result as the perception of health is based on individuals' evaluations of their own health conditions in general and is a simple but powerful indicator reflecting the multidimensionality of health In this study, the mean mental well-being and perceived social support scores of the nurses who cared for patients diagnosed with COVID-19 were lower than those of the nurses who did not. Nurses who thought they had COVID-19 had lower mental well-being and perceived social support scores than those of the nurses who did not. In addition, the mental well-being and perceived social support mean scores of the nurses who took the COVID-19 test were lower than those of the nurses who did not. Based on the literature, the group most likely to be exposed to the virus during the pandemic includes health care professionals 3 and their psychology has been reported to be affected more. 31 The COVID-19 pandemic presents significant challenges for the health care system. In this study, the mean scores of the mental well-being of the nurses who were quarantined were lower than those of the nurses who were not, and their perceived social support mean scores were higher. In a systematic review that investigated the psychosocial effects of quarantine measures in severe coronavirus pandemics before the COVID-19 pandemic and examined 13 studies, it was found that quarantine measures are associated with negative psychosocial outcomes. 32 Mental health of the nurses who are quarantined is expected to be negatively affected due to the negative effects of the disease. In addition, individuals in quarantine are supported by social support sources such as their families, friends, and immediate surroundings. This may explain why nurses in quarantine have a higher perception of social support than those who are not in quarantine. A positive, weakly significant relationship was identified between the nurses' mental well-being and their perception of social support. Studies conducted with different samples have reported a positive relationship between social support and mental health. 12, 15 A meta-analysis study stated that the average effect size between general well-being variables and social support is 0.36, and indicating a positive relationship. 33 In the literature, it was reported that social support reduced anxiety and stress levels in health care professionals and nurses engaging with the treatment and care of patients with COVID-19 11 and prevented the deterioration of both mental and physical health of nurses. 32, 34 In a study of nursing students, regression analysis revealed that resilience, coping, family support, friends support, and significant others support significantly predicted psychological well-being. 35 In another study, there was no significant difference between receiving support and subjective wellbeing. 36 Based on this study, it can be concluded that social support is an important determinant of mental well-being. This study infers that the mental well-being and social support perceptions of nurses are not at the desired level. It is seen that there is a significant relationship between the mental well-being of nurses and their perception of social support. Considering that social support is an important factor in protecting mental health, establishing support systems at both institutional and national levels to strengthen social support networks is necessary. By increasing the number of nurses in clinics, it can be ensured that nurses spend more time for themselves. They will also have more time to communicate more with their families, friends, and colleagues. Most of the nurses work with patients with COVID-19. Therefore, adopting measures to reduce intense working conditions and COVID-19 exposure during effective service provision will positively affect mental health. In addition, effective pandemic management and case control practices will support employees in protecting their psychosocial health. Considering that there is a relationship between the mental wellbeing and social support perceptions of nurses, studies should be conducted covering all health care professionals. The results obtained from this study reveal the current situation of nurses during the pandemic process. For this reason, it is important to provide counseling services to strengthen the mental well-being and social support status of nurses during nursing practices. In addition, qualitative studies can be recommended to determine the factors that affect nurses' mental well-being and social support. The results obtained from these qualitative studies will help nurses to plan interventional nursing studies for the development of mental well-being and social support networks. 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Statement regarding the data availability statement: research data are not shared. https://orcid.org/0000-0001-7851-8625Suzan Havlioğlu https://orcid.org/0000-0001-5593-5688Sibel Ceylan Gür https://orcid.org/0000-0002-8858-4922