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MENTAL WELL-BEING OF EMERGENCY ROOM NURSES IN HOSPITALS OF HAIL REGION, SAUDI ARABIA DURING COVID 19 PANDEMIC

AWAD EID NADAA ALSHAMMARI

MASTER OF ARTS IN NURSING

GRADUATE SCHOOL, UNIVERSITY OF HAIL

April 14, 2022

APPROVAL SHEET

Approved by the Committee on Oral Examination with a grade of __________ on _______________________.

______________________

Chairman

____________________ ____________________

Panel Member Panel Member

___________________________________________________________________________

This is to certify further that AWAD EID NADAA AL-SHAMMARI, have satisfactorily completed all academic requirements in the MASTER’S DEGREE IN NURSING.

______________________________

Dean, Graduate Studies

Hail University

Date Signed: __________

Dedication

This study is primarily dedicated to Allah. Peace be unto Him!

To my parents, siblings, and relatives.

To my colleagues in the profession.

To my Hail University family.

TABLE OF CONTENTS

Title Page……………………………………………………………………………………………………………. 1 Approval Sheet …………………………………………………………………………………………………… 2

Dedication ………………………………………………………………………………. 3

Table of Contents…………………………………………………………………………………………………. 4

List of Tables and Figures ………………………………………………………………. 7

List of Appendices ……………………………………………………………………… 8

Abstract …………………………………………………………………………………. 9

Chapter 1 – Introduction

Introduction to the Research Project ……………………………………………. 10

Statement of the Research Problem …………………………………………….. 11

Background of the Problem …………………………………………………….. 11

Purpose of the Project …………………………………………………………… 14

Definition of Terms …………………………………………………………….. 14

Significance to Nursing ………………………………………………………… 15

Summary ……………………………………………………………………….. 15

Chapter 2 – Review of Evidence

Introduction ……………………………………………………………………. 16

Conceptual Model/ Theoretical Framework …………………………………… 16

Evaluation of Evidences ………………………………………………………. 18

Summary ……………………………………………………………………… 28

Chapter 3 – Project Methodology

Introduction …………………………………………………………………… 30

Research Design ………………………………………………………………. 30

Target Population, Subjects, Sample, and Setting ……………………………. 30

Instrument …………………………………………………………………….. 31

Plan and Implementation Process …………………………………………….. 32

Data Analysis …………………………………………………………………. 33

Ethical Consideration …………………………………………………………. 35

Summary ……………………………………………………………………… 36

Chapter 4 – Project Outcome

Introduction …………………………………………………………………… 37

Findings ………………………………………………………………………. 37

Chapter 5 – Discussion

Introduction ……………………………………………………………………. 41

Discussion ……………………………………………………………………… 41

Conclusions ……………………………………………………………………. 43

Implications to Nursing …………………………………………………… 43

Recommendations for further research …………………………………… 43

References …………………………………………………………………………. 45

Lists of Tables and Figures

Table 1 Statistical Limits and Descriptive Equivalence ……………………………… 34

Table 2 Profile of Respondents ………………………………………………………. 38

Table 3 Extent of Mental Wellbeing of Emergency Room Nurses ……………………39

Table 3 Correlation Analysis …………………………………………………………. 40

List of Appendices

Appendix A Sample Informed Consent ……………………………………………… 51

Appendix B sample Questionnaire …………………………………………………… 53

Abstract

Background Health care professionals including nurses experienced increase in their workload, psychological suffering, shortage of protective equipment and gears, social discrimination like stigmatization, absence of incentives or proper compensation, and management system approach during the course of their duty in times of pandemic. Therefore, it is significant to protect the wellbeing of nurses during Covid-19 pandemic in order to continuously provide good, effective, quality services to patients and maintain a mental health status needed during crises.

Results The response rate as of percentage is 95% which composed of 114 respondents out of 120 nurses. Majority of the respondents are female, Non-Saudi Employees, and having 3-5 years of experience in the Emergency room. The extent of mental well-being of emergency room nurses in different government hospitals of Hail Region, Kingdom of Saudi Arabia is generally often. the correlation analysis of the moderating variables in the study. The extent of mental well-being of emergency nurses has significant relationship with nationality (Correlation = 0.808, p-value= 0.000), and, year of ER experience (Correlation=0.872, p-value=0.087). However, extent of mental well-being of ER nurses has no significant relationship to gender (Correlation = 0.151, p = 0.095).

Conclusion Therefore, it is concluded based on the findings and results that Emergency Room nurses are greatly affected with the occurrence of Covid-19 crisis in fulfilling their duties and responsibilities. The impact of the health crisis influenced their mental wellbeing which affects their physical, psychological, emotional, and social aspects. Mental wellbeing of emergency room nurses is not related to gender however the nationality and years of experiences of nurses have an influence.

Keywords Mental Wellbeing, Emergency Room Nurses, Covid-19 crisis

CHAPTER 1

BACKGROUND OF THE STUDY

This chapter discusses the background of the study that explains the importance of the formulating the study. It also involves the statement of the problem, purpose of the study and its main objective, definition of the important concepts used in the study, and elaboration of the significance of the study to the nursing profession.

Introduction

The world was shaken with an unprecedent advent of one of the deadliest viruses in the history of mankind happened towards the end days of 2019. Corona virus was named SARS Cov-2 after an outbreak happened in Wuhan China. The spread was too rapid which was seen to be contagiously outrageous in its effect to the people (https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19/basics-covid-19.html). This infectious and transmissible disease was branded as one of the most concentrated health diseases happened in the history mankind (Dos Santos, 2020). It was declared a pandemic in March 2020 by the World Health Organization which was due to its rapid and speedy scale of transmission.

The Covid-19 pandemic manifested many changes and vulnerabilities in the different sectors in the society around the globe. This includes economic sector, educational sectors, government sectors, and most especially the health sectors (https://www.oecd.org/social/covid-19.htm). As it rapidly affecting the lives of many people around the world, it is bringing along considerable fear, anxiety, stress, and worries which affects individual in all walks of life. According to World health Organization-Europe (2020) this phenomenon is felt tremendously by specific group of people which includes elderlies, immune-compromised individuals and most especially health care providers. This gave rise to the public issue of psychological to health care providers affecting their performances and productivity in the field of health care. Furthermore, research has shown an increase in the number of health care professionals showing high levels of anxiety and depression having a percentage rate of 13% and 12.2% respectively (https://apps.who.int/iris/bitstream/handle/10665/340220/WHO-EURO-2021-2150-41905-57496-eng.pdf).

Statements of the Problem

Generally, the study identified mental well-being status of emergency room nurses during COVID 19 pandemic. Specifically, it sought the answers of the following queries:

1. In what extent do emergency room nurses’ mental well-being status during COVID 19 pandemic?

2. What is the relationship on the extent of mental well-being status of emergency room nurses when the following variables are considered?

a. Nationality

b. Years of Service

c. Gender

Background of the Study

Nurses as members of the healthcare team have been showing up to their work shifts and working hard to provide the best care to patients with various acuity levels during the COVID-19 pandemic (Fernandez, et al., 2020). Generally, nurses respond in different time situation may either be in a daily routine of their regular work and even during disasters like pandemic. In fact, nurses constitute the majority number of the entire health care team in different set up and they are required to function critically in order to respond to the different cases confronting the (Powers, 2020, Al Thobaity, Alamri, Plummer, and Williams, 2019).

Emergency room nurses are mostly involved in assigning and sorting cases of patients according to the degree of urgency of care and also involved in detecting cases with infections with extra precautionary measures. They are also responsible in the process of refinement and synchronization with other health care providers. Moreover, as part of their duties to provide holistic management of care to numerous types of infection concurrently dealing not only to the patients directly but even to their families as well (Xie, Tong, Guan, Qiu, and Slutsky 2020).

During crises, they are tasked to assist patients and their respective families in a high degree of satisfaction as being demanded at all times. Therefore, emergency room nurses are required to be fully equipped with indispensable knowledge, skills, and right attitude in managing catastrophes or emergencies which involves clinical treatment, isolation, communication, sorting or triaging, psychological support, and palliative care if it is needed and necessary (Bosario, Gamondi, Obrist, & Jox 2020, Corless, Nardi, Milstead, Nokes, Orsega et al 2018, Al Thobaity, Williams, & Plummer 2016, Al Thobaity, Plummer, Innes, & Copnell 2015).

A qualitative report in a study on the challenges faced by health care professionals in Bangladesh revealed that health care professionals including nurses experienced increase in their workload, psychological suffering, shortage of protective equipment and gears, social discrimination like stigmatization, absence of incentives or proper compensation, and management system approach during the course of their duty in times of pandemic (Razu et al, 2021).

Numerous health care professionals also suffered other types of encounters which includes insomnia, sadness, sleep disturbances and difficulties, and to the extent of having mental depression which was observed to be related to their increased workload and other related stress (Su, Lien, Yang, Su, Wang, Tsai et al, 2007). Moreover, these professionals including nurses have been observed to experience attacks of anxiety and frustrations as well which is related to their ignorance, changes happening in their environment, and feeling of dread of acquiring the disease extending to their family members (Sun, Wei, Shi, Jiao, Song, Ma, et al, 2020). In addition to their emotional burden is the practice of being socially distant to their families when they got home after work as a precautionary measure to mitigate possibilities of infection which aggravates their psychological distress (WHO, 2020).

One of the key challenges that nurses face during Covid-19 pandemic is the provision of psychological and even social support (Chen et al, 2020). Based on the claims of Abadi et al, low level of job satisfaction of nurses was significantly observed as caused by having a higher psychological and physical demands from their jobs. Therefore, the quality of performances of nurses during pandemic is influenced by the degree and level of their job satisfaction.

Reconnoitering the matters that nurses face when caring for patients with COVID-19 will help upsurge nurse and hospital flexibility in reply to the crisis, as well as improve readiness and regaining from the crisis. Additionally, understanding these issues will help sustain nurses by enlightening leaders and decision-makers about these problems and providing commendations and insinuations. Hence, with provision of information of the presented literatures, it is then therefore significant to protect the well being of nurses during Covid-19 pandemic in order to continuously provide good, effective, quality services to patients and maintain a mental health status needed during crises. Therefore, this study will be highlighting the determination of the mental well-being of emergency nurses in the field while unanimously fighting the dreadful effect of the COVID-19 virus not only to healthcare professionals but to the entire humanity as a whole.

Purpose of the Study

The proposed study would be able to provide useful information to encourage Emergency Room nurses to be aware of their mental well-being amidst their experiences during COVID-19 pandemic. It will also bridge the knowledge gap on nurses’ mental well-being and identify strategies and interventions that have been proven to address these potential concerns especially among the members of the nursing community. It might be a stepping stone in developing or improving active and responsive interventions or programs that can help support their professional morale and raise awareness on measures to decrease mental challenges while promoting workplace diversity and safety.

Definition of Terms

The following terms were operationally defined based on their use in the study.

Mental Health. It is a state of nurses’ health when he/she comprehends his/her abilities, able to manage normal life stresses and events, can display potential at work, and able to provide contributions to his/her community.

Mental Well-being. The status of emergency room nurses to respond ups and down or challenges while performing their professional jobs. It is an integral part of the over all health of emergency room nurses.

Emergency Room Nurses. Licensed registered nurses working in the emergency room of the hospital.

COVID 19 Pandemic. The occurrence of health crisis brought by COVID 19 virus affecting worldwide population.

Significance to Nursing

This study will serve as an eye opener to nursing authorities to consider possible solutions that prompts the nursing profession in terms of mental health promotion and other related issues specifically those that affects the delivery of quality care to patients. Furthermore, the development of different programs by authorities will help our emergency room nurses in the field to remain steadfast and resilient at all times. Programs that could provide professional assistance and growth holistically to promote high level of mental well-being and support systems.

Summary

Health related crisis brought about by COVID 19 virus affected our lives multidimensionally. Health care providers who play vital role in caring people afflicted with disease due to their vulnerability are the most concerned individuals in these times. However, so much so with studies that focused on the promotion of health, prevention of the disease, rehabilitation of the cured patients, and prolonging lives of individuals, emergency room nurses were not given that much attention in terms of their mental well-being while caring during uncertainties. The level of anxiety and stress brought by the current situation is affecting their job performances which will eventually affects their job satisfaction in the end. Hence, the mental health status of these emergency room nurses affects the quality of nursing care given to their patients.

It is very important that nurses’ mental well-being must be given attention by assessing their current situations. This will provide information on how they are providing the quality services while being confronted with different anxieties and stresses brought about the pandemic

CHAPTER 2

REVIEW OF EVIDENCE

Introduction

This chapter introduces the different literatures that explores knowledge of the world in terms of professional quality of life of emergency room nurses. It also presents the theoretical framework that is believed to support the future findings of the study.

Theoretical Framework

As it was observed by many authorities that health care workers including nurses are always confronted with the different demands and levels of toxicity in their field of work. Most of them were trained to put patients on the priority list before themselves and this is one of the most important and essential quality of being a nurse – selflessness. Others before self.

However, it has been seen that this practice if abused and neglected could lead to physical and psychological breakdown which yields to a more disruptive effect to their health and performances of their jobs. Therefore, it is being suggested that practicing self-care would solve issues that confronts nurses stress and improve their coping abilities to their workloads, duty demands, and other obligations they have.

This study is rooting in the theory of Self-care by Dorothea Orem. Self-care theory is a nursing theory that was developed between 1959 and 2001 (American Sintenel, 2011). This theory focuses on the concept that every individual has the capacity to practice and perform activities that an individual will perform on their behalf. In addition, this theory explains that a certain individual is able to initiate a behavior that will maintain his life, health, and well-being.

One of the major assumptions of this theory is that an individual must be independent and responsible for their own care and also including the care for other involving their families. This independence entails the ability of an individual to initiate actions that will promote and maintain well-being in all situations. These initiatives shall include different activities and programs that will promote and enhance health status.

Moreover, this theory also assumes that if a certain individual has the knowledge of potential health problems that may occur based on situations upholding a certain person, this would help him promote self-care behaviors. Nurses are well knowledgeable on this matter in regards to health problems, so therefore they are capable also of designing their potentials in order to build defenses for them to fight stress and emotional disturbances that tries to affect them internally and externally.

Research had shown that activities that are needed in order to promote self-care includes self-awareness, self-compassion, the practice of unselfishness and the employment of different variations of approaches that will affect physical, social, and inner self or mental aspects. In this manner, nurses will be able to obtain balanced work life which will improve their health and mental well-being.

Practicing self-care among nurses is significant especially in times of crises and uncertain times. This could be accomplished by always assessing mental well-being status in order to become aware to one’s emotional level and stress level as needed. Upon examining these factors, nurses would the be given numerous strategies and measures in order to mitigate or lessen the effect of stress and emotional disturbances that affects their mental health status as they perform their duties and responsibilities as nurses.

This theory is significantly providing a framework that nurses as individuals also needs proper practice of self-care. This practice will be a beneficial too in order to improve their physical, emotional, and mental well-being which will give their way in providing quality and sustaining care to their patients. Moreover, practicing self-care will try to lead them to become more resilient in times of uncertainties thus enabling to endure and give them the power to handle harder situations.

Evaluation of Evidences

Emergency nurses are health care professionals who are the first to face close contact with patients and their families while caring for infected patients and provide first care to patients.

The pressures of working in an emergency department are real. There are high expectations of staff – from their managers, their colleagues and themselves. They need to perform to a high standard

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