Nepal Intensive Care Research Foundation, Kathmandu, Nepal.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
BMC Health Serv Res. 2024 Apr 10;24(1):450. doi: 10.1186/s12913-024-10724-7.
The COVID-19 pandemic resulted in significant physical and psychological impacts for survivors, and for the healthcare professionals caring for patients. Nurses and doctors in critical care faced longer working hours, increased burden of patients, and limited resources, all in the context of personal social isolation and uncertainties regarding cross-infection. We evaluated the burden of anxiety, depression, stress, post-traumatic stress disorder (PTSD), and alcohol dependence among doctors and nurses working in intensive care units (ICUs) in Nepal and explored the individual and social drivers for these impacts.
We conducted a mixed-methods study in Nepal, using an online survey to assess psychological well-being and semi-structured interviews to explore perceptions as to the drivers of anxiety, stress, and depression. Participants were recruited from existing national critical care professional organisations in Nepal and using a snowball technique. The online survey comprised of validated assessment tools for anxiety, depression, stress, PTSD, and alcohol dependence; all tools were analysed using published guidelines. Interviews were analysed using rapid appraisal techniques, and themes regarding the drivers for psychological distress were explored.
134 respondents (113 nurses, 21 doctors) completed the online survey. Twenty-eight (21%) participants experienced moderate to severe symptoms of depression; 67 (50%) experienced moderate or severe symptoms of anxiety; 114 (85%) had scores indicative of moderate to high levels of stress; 46 out of 100 reported symptoms of PTSD. Compared to doctors, nurses experienced more severe symptoms of depression, anxiety, and PTSD, whereas doctors experienced higher levels of stress than nurses. Most (95%) participants had scores indicative of low risk of alcohol dependence. Twenty participants were followed up in interviews. Social stigmatism, physical and emotional safety, enforced role change and the absence of organisational support were perceived drivers for poor psychological well-being.
Nurses and doctors working in ICU during the COVID-19 pandemic sustained psychological impacts, manifesting as stress, anxiety, and for some, symptoms of PTSD. Nurses were more vulnerable. Individual characteristics and professional inequalities in healthcare may be potential modifiable factors for policy makers seeking to mitigate risks for healthcare providers.
COVID-19 大流行给幸存者带来了重大的身心影响，也给照顾患者的医护人员带来了影响。重症监护病房的护士和医生面临着更长的工作时间、患者负担增加以及资源有限的情况，所有这些都伴随着个人社会隔离和对交叉感染的不确定性。我们评估了尼泊尔重症监护病房（ICU）医护人员的焦虑、抑郁、压力、创伤后应激障碍（PTSD）和酒精依赖的负担，并探讨了这些影响的个体和社会驱动因素。
我们在尼泊尔进行了一项混合方法研究，使用在线调查评估心理健康状况，并进行半结构化访谈以探讨焦虑、压力和抑郁的驱动因素。参与者是从尼泊尔现有的国家重症监护专业组织中招募的，并采用滚雪球技术招募。在线调查包括用于评估焦虑、抑郁、压力、PTSD 和酒精依赖的经过验证的评估工具；所有工具均根据已发表的指南进行分析。访谈采用快速评估技术进行分析，并探讨了导致心理困扰的主题。
共有 134 名（113 名护士，21 名医生）参与者完成了在线调查。28 名（21%）参与者出现中度至重度抑郁症状；67 名（50%）出现中度或重度焦虑症状；114 名（85%）有中度至高度压力水平的分数；46 名（占 100 名）报告有 PTSD 症状。与医生相比，护士经历了更严重的抑郁、焦虑和 PTSD 症状，而医生经历了比护士更高的压力水平。大多数（95%）参与者的酒精依赖风险评分较低。对 20 名参与者进行了后续访谈。社会污名化、身体和情绪安全、强制角色转变以及缺乏组织支持被认为是心理健康不佳的驱动因素。
在 COVID-19 大流行期间在 ICU 工作的护士和医生承受了心理影响，表现为压力、焦虑，对于一些人来说，还表现出 PTSD 症状。护士更容易受到影响。个人特征和医疗保健中的职业不平等可能是政策制定者寻求减轻医疗保健提供者风险的潜在可改变因素。
