Feelings, Stress, and Coping of Nurses Amidst COVID-19 Outbreak in Saudi Arabia
Background: A year after the COVID-19 pandemic spread around the world, the pandemic is still affecting healthcare systems with an increasing number of infected healthcare workers. Such a unique situation may often result in emotional turmoil, anxiety, depression, and fear, which could lead to resignation and burnout. The study intended to assess the feelings of nurses toward the COVID-19 outbreak; ascertain the factors that cause stress; and determine their coping strategies and factors contributing to coping.
Methods: A descriptive cross-sectional design was utilized to recruit 313 nurses working in the Ministry of Health (Saudi Arabia) hospitals that accommodate COVID-19 patients. The study instrument was adapted and modified from the ”MERS-CoV Staff Questionnaire” and the Brief COPE.
Results: The results showed that female, married, those with a bachelor’s degree, and aged 25–34 years had higher significant coping strategies. On the other hand, Filipino nurses assigned in the Outpatient Department and COVID-19 Isolation Ward had more negative feelings and encountered several factors causing stress but were coping in a better way than others.
Conclusion: Nurses’ commitment to their profession appears to be an intrinsic motivation to continue caring for COVID-19 patients despite the risk of infection. Comfort with religion, spiritual beliefs, and the presence of a support system were the coping strategies used by nurses to ameliorate the stress and negative feelings during the COVID-19 outbreak.
COVID-19, Saudi Arabia, nurses, feelings, factors causing stress, coping strategies
 World Health Organization. (February 27, 2020). A Joint Statement on Tourism and COVID-19 – UNWTO and WHO Call for Responsibility and Coordination. WHO.
 Al-Mandhari, A., Samhouri, D., Abubakar, A., et al. (2020). Coronavirus disease 2019: preparedness and readiness of countries in the eastern Mediterranean region. Eastern Mediterranean Health Journal, vol. 26, no. 2, pp. 136–137.
 Jiang, X., Rayner, S., and Luo, M.-H. (2020). Does SARS-Cov-2 have a Longer Incubation Period than SARS and MERS. Journal of Medical Virology, vol. 92, no. 5, pp. 476–478.
 Patel, A. and Jernigan D. (2020). Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak-United States, December 31, 2019–February 4, 2020. Morbidity and Mortality Weekly Report, vol. 69, no. 5, pp. 140–146.
 Diaconu, C. (2020). A novel coronavirus threatens the world. Archives of the Balkan Medical Union, vol. 55, no. 1.
 Windarwati, H. D., Ati, N. A. L., Paraswati, M. D., et al. (2020). Stressor, coping mechanism, and motivation among health care workers in dealing with stress due to the COVID-19 pandemic in Indonesia. Asian Journal of Psychiatry, vol. 56, p. 102470.
 Kisely, S., Warren, N., McMahon, L., et al. (2020). Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and metaanalysis. BMJ, vol. 369, p. m1642.
 Barello, S. and Graffigna, G. (2020). Caring for health professionals in the COVID-19 pandemic emergency: toward an “epidemic of empathy” in healthcare. Frontiers in Psychology, vol. 11, p. 1431.
 Marton, G., Vergani, L., Mazzocco, K., et al. (2020). 2020s heroes are not fearless: the impact of the COVID-19 pandemic on wellbeing and emotions of Italian health care workers during Italy Phase 1. Frontiers in Psychology, vol. 11, p. 2781.
 World Health Organization. (April 28, 2020). WHO Calls for Healthy, Safe, and Decent Working Conditions for All Health Workers Amidst COVID-19 Pandemic. WHO.
 Babore, A., Lombardi, L., Viceconti, M. L., et al. (2020). Psychological effects of the COVID2019 pandemic: perceived stress and coping strategies among healthcare professionals. Psychiatry Research, vol. 293, p. 113366.
 Cai, H., Tu, B., Ma, J., et al. (2020). Psychological impact and coping strategies of frontline medical staff in Hunan between January and March 2020 during the outbreak of coronavirus disease 2019 (COVID-19) in Hubei, China. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, vol. 26, pp. e924171-1.
 World Health Organization. (March 18, 2020). Coronavirus Disease (COVID-19) Outbreak: Rights, Roles and Responsibilities of Health Workers, Including Key Considerations for Occupational Safety and Health. Retrieved from: https://www.who.int/docs/default-source/coronaviruse/who-rights-rolesrespon-hw-covid-19.pdf?sfvrsn=bcabd401_0
 Khalid, I., Khalid, T. J., Qabajah, M. R., et al. (2016). Healthcare workers’ emotions, perceived stressors, and coping strategies during a MERS-CoV outbreak. Clinical Medicine & Research, vol. 14, no. 1, pp. 7–14.
 Kim, Y. (2018). Nurses’ experiences of care for patients with the Middle East respiratory syndromecoronavirus in South Korea. American Journal of Infection Control, vol. 46, no. 7, pp. 781–787.
 Lima, C., Carvalho, P., and Neto, M. (2020). The emotional impact of coronavirus 2019-nCoV (new Coronavirus disease). Psychiatry Research, vol. 287, p. 112915.
 Huang, L., Lei, W., Xu, F., et al. (2020). Emotional responses and coping strategies in nurses and nursing students during Covid-19 outbreak: a comparative study. PLoS ONE, vol. 15, no. 8, p. e0237303.
 Chen, Q., Liang, M., Li, Y., et al. (2020).Mental health care for medical staff in China during the COVID-19 outbreak. The Lancet Psychiatry, vol. 7, no. 4, pp. e15–e16.
 Raosoft. Sample Size Calculator 2004. Retrieved from http://www.raosoft.com/samplesize.html
 Abdo, M. S., Hammad, M. A., Harun, S. N., et al. (2020). Evaluation of knowledge, attitude and practice of healthcare providers towards life-threatening drug-drug interactions in Penang General Hospital, Malaysia. Clinical Epidemiology and Global Health, vol. 8, no. 4, pp. 1253–1258.
 Zaidi, S. F., Mgarry, R., Alsanea, A., et al. (2021). A questionnaire-based survey to assess the level of knowledge and awareness about drug–food interactions among general public in western Saudi Arabia. Pharmacy, vol. 9, no. 2, p. 76.
 NovoPsych. (2018). Brief-COPE. Retrieved from: https://novopsych.com.au/assessments/brief-cope/
 Bonnie, R. J., Stroud, C., and Breiner, H., et al. (Eds.). (2015). Young adults in the 21st century. In Investing in the Health and Well-Being of Young Adults. National Academies Press (US).
 Borghuis, J., Denissen, J. J. A., Oberski, D., et al. (2017). Big five personality stability, change, and codevelopment across adolescence and early adulthood. Journal of Personality and Social Psychology, vol. 113, no. 4, pp. 641–657.
 Shek, D. T. L., Dou, D., and Cheng. M. N. S. (Eds.) (2020). Transition from adolescence to emerging adulthood. In The Encyclopedia of Child and Adolescent Development (pp. 1–10). Wiley. Retrieved from: https://doi.org/10.1002/9781119171492.wecad325
 Huremović, D. (Ed.) (2019). Quarantine and isolation: effects on healthcare workers. In Psychiatry of Pandemics. Springer, Cham. Retrieved from: https://doi.org/10.1007/978-3-030-15346-5_10
 Gao, X., Jiang, L., Hu, Y., et al. (2020). Nurses’ experiences regarding shift patterns in isolation wards during the COVID−19 pandemic in China: a qualitative study. Journal of Clinical Nursing, vol. 29, no. 21–22, pp. 4270–4280.
 Vagni, M., Maiorano, T., Giostra, V., et al. (2020). Coping with COVID-19: emergency stress, secondary trauma and self-efficacy in healthcare and emergency workers in Italy. Frontiers in Psychology, vol. 11, p. 566912.
 Zhang, Y., Wang, C., Pan, W., et al. (2020). Stress, burnout, and coping strategies of frontline nurses during the COVID-19 epidemic in Wuhan and Shanghai, China. Frontiers in Psychiatry, vol. 11, p. 1154.
 Al-Dossary, R., Alamri, M., Albaqawi, H., et al. (2020). Awareness, attitudes, prevention, and perceptions of COVID-19 outbreak among nurses in Saudi Arabia. International Journal of Environmental Research and Public Health, vol. 17, no. 21, p. 8269.
 Ahn, M. H., Shin, Y. W., Suh, S., et al. (2020). High Work-related Stress and Anxiety Response to COVID19 among Healthcare Workers in South Korea: SAVE Study. Retrieved from: https://doi.org/10.31234/ osf.io/9nxth
 Bettinsoli, M. L., Di Riso, D., Napier, J. L., et al. (2020). Mental health conditions of Italian healthcare professionals during the COVID−19 disease outbreak. Applied Psychology: Health and Well−Being, vol. 12, no. 4, pp. 1054–1073.
 Salman, M., Raza, M. H., Mustafa, Z. U., et al. (2020). The psychological effects of COVID-19 on frontline healthcare workers and how they are coping: a web-based, cross-sectional study from Pakistan. medRxiv. Retrieved from: https://doi.org/10.1101/2020.06.03.20119867
 Jones, S., Sam, B., Bull, F., et al. (2017). Even when you are afraid, you stay: provision of maternity care during the Ebola virus epidemic: a qualitative study. Midwifery, vol. 52, pp. 19–26.
 Duncan, D. L. (2021). What the COVID-19 pandemic tells us about the need to develop resilience in the nursing workforce. Nursing Management, vol. 28, no. 2.
 Labrague, L. J., and De los Santos, J. A. A. (2020). COVID−19 anxiety among front−line nurses: predictive role of organisational support, personal resilience and social support. Journal of Nursing Management, vol. 28, no. 7, pp. 1653–1661.
 Yu, F., Raphael, D., Mackay, L., et al. (2019). Personal and work-related factors associated with nurse resilience: a systematic review. International Journal of Nursing Studies, vol. 93, pp. 129–140.
 Yuan, N., Yang, W. X., Lu, J. L., et al. (2020). Investigation of adverse reactions in healthcare personnel working in Level 3 barrier protection PPE to treat COVID-19. Postgraduate Medical Journal, vol. 97, pp. 351–354.
 Onyeaka, H., Zahid, S., and Patel, R. (2020). The unaddressed behavioral health aspect during the coronavirus. Cureus, vol. 12, no. 3, p. e7351.
 Park, J. S., Lee, E. H., Park, N. R., et al. (2018). Mental health of nurses working at a governmentdesignated hospital during a MERS-CoV outbreak: a cross-sectional study. Archives of Psychiatric Nursing, vol. 32, no. 1, pp. 2–6.
 Li, J., Xu, J., Zhou, H., et al. (2021). Working conditions and health status of 6,317 front-line public health workers during the COVID-19 epidemic across5 provinces in China: a cross-sectional study. BMC Public Health, vol. 21, article 106.