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Table of Contents
Year : 2022  |  Volume : 19  |  Issue : 2  |  Page : 104-108

COVID-19-related anxiety and coping strategies among nursing professionals working in COVID intensive care unit: A Cross-sectional survey

1 Tutor, College of Nursing, AIIMS, New Delhi, India
2 Associate Professor, College of Nursing, AIIMS, New Delhi, India
3 Nursing Officer, Cardiology and CTVS department, AIIMS, New Delhi, India

Date of Submission17-Jul-2021
Date of Decision03-Nov-2021
Date of Acceptance04-Jan-2022
Date of Web Publication27-Dec-2022

Correspondence Address:
Ms. K P Jyotishana
AIIMS, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/iopn.iopn_71_21

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Background: During the COVID-19 pandemic, nursing professionals along with other health-care workers worked as the pillars of the health-care system. There have been difficult times when nursing professionals have overworked despite shortage of resources, continuously wearing PPE over hours, and overfilled intensive care units (ICUs). Thus, while confronting the numerous COVID-19-related challenges, nursing professionals might have experienced anxiety and utilized various coping strategies to reduce their anxiety. Methods: The cross-sectional survey was conducted using a web-based questionnaire. Information was collected from 200 nursing personnel's working in the COVID ICU of a selected tertiary care hospital. The questionnaire used for data collection comprised three sections: the first section focused on sociodemographic profile of subjects, the second section included the Self-Rating Anxiety Scale, and the third included Brief COPE. Results: The result revealed that majority, 61%, of the subjects had no COVID-19-related anxiety, whereas 33.5% of subjects had mild-to-moderate COVID-19-related anxiety. However, only 5.5% of the subject reported marked-to-severe form of COVID-19-related anxiety. The highest anxiety scores were identified for items: (1) I get feelings of numbness and tingling in my fingers and toes, (2) I feel weak and get tired easily, and (3) I have nightmares. To cope up with anxiety, majority of nursing professionals' approach “praying or meditating” coping style mechanism followed by positive reframing and planning. Conclusions: COVID-19 is causing mild-to-moderate anxiety in a significant number of nursing professionals. Thus, the hospital administration and nurse managers should focus on early screening for anxiety, providing psychological support to nurses, and training ineffective coping strategies.

Keywords: Anxiety, coping strategy, COVID-19, highly infectious respiratory disease, nursing professionals

How to cite this article:
Choudhary M, Gopichandran L, Jyotishana K P. COVID-19-related anxiety and coping strategies among nursing professionals working in COVID intensive care unit: A Cross-sectional survey. Indian J Psy Nsg 2022;19:104-8

How to cite this URL:
Choudhary M, Gopichandran L, Jyotishana K P. COVID-19-related anxiety and coping strategies among nursing professionals working in COVID intensive care unit: A Cross-sectional survey. Indian J Psy Nsg [serial online] 2022 [cited 2023 May 28];19:104-8. Available from: https://www.ijpn.in/text.asp?2022/19/2/104/365473

  Introduction Top

The novel coronavirus (COVID-19) is a new disease caused by severe acute respiratory syndrome coronavirus-2 that is not previously seen in humans which is known to impact all groups of people of different ages. On January 13, 2020, the first case of infection outside of China was reported thereafter by March 11, 2020, there were over 120,000 cases with 4300 deaths reported of COVID-19, and so it was declared a pandemic by the World Health Organization, and still, the number continues to rise.[1]

The cases of COVID-19 are still increasing dramatically, which can overwhelm the health-care system and escalate nurse anxiety levels. With this high surge in cases and widespread infection, there is a shortage of public health officials. The rapid spread of COVID-19 has increased the burden and posed a great challenge to nursing professionals across the world. With an increasing ratio of patients to nurses, they are susceptible to psychological hazards of working with a COVID-19 patient due to their routine of monitoring and handling infectious patients. Higher workload, psychological stress, fatigue, occupational burnout, lack of knowledge of the pathogen, and physical and psychological violence have deeply compromised the quality of health care given by nurses and amplified the severity of infection in their health-care system.[2],[3],[4],[5]

The nurses have to struggle to maintain their mental and emotional health while providing care to severely ill and infectious patients and create a compromising position which is difficult to cope with. Continuous exposure to high-level stress and long hours of continuous work without a break during an outbreak of various infectious diseases has been linked to substance abuse as well as increase in anxiety, depression, and suicidal tendencies among health-care workers.[6],[7]

The frontline nurses reported to have a high risk of psychological distress, such as sleep disturbance, loss of self-confidence, and inability to make decisions, as well as physical health problems which hinder professional performance and, in turn, the quality of care to patients.[4],[5],[6],[7] Due to the severity and rapid progression of the disease and since there is no effective treatment for the disease so far, although many supportive measures have been given, many patients rapidly deteriorate and succumb to critical conditions and die. This might increase anxiety, decrease nurses' confidence, and reduce personal accomplishment. In turn, effective use of coping strategies is needed to help nursing professionals to manage their anxiety levels.[6],[7],[8],[9]

Several morale supportive interventions for nurses working in highly stressful areas have been identified in previous studies, including positive attitude in the workplace and acknowledgment of their efforts, social and family support, clear communication of directives, and support from supervisors.[10] In the Indian setting, limited researches were conducted for studying psychological health during the times of pandemic for nurses and efficacies of various coping strategies. Thus, the invigilators conducted this survey to assess COVID-19-related anxiety levels and coping strategies among nursing professionals while working in COVID intensive care unit (ICU).

  Materials and Methods Top

The cross-sectional survey was conducted from September 2020 to December 2020, using a web-based questionnaire. Information was collected from 200 nursing personnel's working in COVID ICU of selected tertiary care hospital. Eligibility criteria for inclusion included nursing professionals working in COVID ICU since the beginning of pandemic, who can understand or read the English language, and who were willing to participate in the study. New recruits, contractual employees, and outsourced nursing professions were excluded from the study. Details of the survey website were provided to 212 nursing professionals recruited in the study using a consecutive sampling technique. Information received from 200 nursing professionals who completed the survey questionnaire, depicting a response rate of 94%, was compiled for analysis.

The questionnaire used for data collection comprised three sections: the first section focused on sociodemographic profile of subjects which included age, gender, marital status, educational level, and years of experience; the second section included Self-Rating Anxiety Scale (SAS); and the third section included Brief COPE scale. SAS developed by Zung was used to assess anxiety among nursing professionals. SAS is a self-report Likert scale with 20 items. Scoring for each item ranged from 1 to 4, with a total score of scale ranging from 20 to 80. The score of 20–44 indicated normal range, i.e., no anxiety, score of 45–59 depicted mild-to-moderate anxiety, 60–74 score showed marked-to-severe anxiety levels, and 75 and above represented extreme anxiety levels.

Coping strategies used by nursing professions were assessed using Brief COPE developed by Carver, 1997. The brief cope scale comprised 14 subscales and 28 items, with 2 items in each subscale. This subscale included active coping, planning, positive reframing, acceptance, humor, religion, using instrumental support, self-distraction, denial, using emotional support, venting, substance use, behavioral disengagement, and self-blame. The score for each item ranged from 1 to 4, and for each subscale, it ranged from 1 to 8. Higher scores depicted increased utilization of that particular coping strategy.

  Results Top

Information collected from a web-based survey was compiled and analyzed using SPSS (IBM Corp; Version 21. Armonk, New York, US). Sociodemographic variables were analyzed using descriptive analysis and are presented in [Table 1]. Majority, 63.5% of the subjects, were of the age group from 25 to 30 years and more than half of the subjects were females. Majority, 83% of subjects, were postgraduate in nursing, and a maximum of 58% had experience of more than 2 years to 5 years. More than half, 52%, of subjects were unmarried or single. Majority, 61% of nursing professionals, had no anxiety, with their anxiety scale score lying in the normal range [Table 2]. However, 33.5% of nursing professionals depicted mild-to-moderate COVID-19-related anxiety, and 5.5% had marked-to-severe anxiety [Table 3]. None of the subjects had extreme COVID-19-related anxiety.
Table 1: Socio-demographic profile of participants n=200

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Table 2: Level of COVID-19 related anxiety among nursing professionals n=200

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Table 3: Association of Anxiety among nursing professionals with selected sociodemographic variable n=200

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The five items with the highest anxiety score were (1) I get feelings of numbness and tingling in my fingers and toes, (2) I feel weak and get tired easily, (3) I have nightmares, (4) I am bothered by dizzy spells, and (5) I feel afraid for no reason at all. However, I feel like I am falling apart and going to pieces and my hands are usually dry and warm were the least rated anxiety-related items [Table 3].

The highest mean anxiety score of 37.0 ± 11.7 was in the age group of >30–40 years. The mean anxiety score was comparatively more in female participants (36.4 ± 11.9) as compared to their counterparts. Married nursing professionals reported a slightly higher mean anxiety score of 37.10 ± 11.72 as compared to unmarried/single study participants. Subjects with educational qualifications of a diploma in nursing, i.e., general nursing and midwifery, had more mean stress score of 37.87 ± 16.48 as compared to other groups. Subjects with professional experience of >5–10 years reported a higher mean stress score of 39.3 ± 13.05. However, correlation of COVID-19-related stress with selected sociodemographic variables was found to be nonsignificant at P < 0.05 [Table 4].
Table 4: Coping styles employed by Nursing Professional

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Coping strategy

Religion items of approach coping including “I've been trying to find comfort in my religion or spiritual beliefs” and “I've been praying or meditating” were the highest-rated coping style employed by nursing professionals, followed by positive reframing and planning [Table 4]. However, denial and substance use items of avoidance coping were the least rated used coping strategies to deal with COVID-19-related anxiety.

  Discussion Top

The study was conducted among nursing professionals to investigate the COVID-19-related anxiety and coping strategy used while working in COVID ICU, using a web-based survey. The study observed that the majority of participants (61%) in this study experienced no COVID-19-related anxiety, whereas, 33.5% of participants had mild-to-moderate levels of anxiety. Salari et al.[8] in their study found anxiety among 25.8% and stress among 45% of the hospital staff caring for COVID-19 patients. This may be due to the fact that nurses have a wider knowledge of the nature of COVID-19, its transmission, and symptoms and measures to prevent the disease which could contribute to lower anxiety levels.

In the present study, the high levels of anxiety were associated with physical symptoms such as nightmares, feeling of weakness, numbness and tingling in fingers and toes, and easily tiredness. “Tingling” and “sleep disturbance” were reported to be the most pronounced symptoms in a study conducted by Skalski et al., 2020,[11] while in a study conducted by Shevlin et al., 2020,[12] high levels of anxiety were linked to somatic symptoms such as fatigue and gastrointestinal manifestations.

Majority of participants were female (57.5%) and relatively young in this study. Higher anxiety levels were reported in females, which suggests that there might be gender differences in terms of expressing their emotions as they are more sensitive and more vulnerable to anxiety.[13] Our study shows that older participants expressed less anxiety than younger which suggests that higher age participants usually have more working experience and confidence in dealing and managing with a pandemic crisis.[3]

This study found that majority of the nursing professionals approached religious ways of coping style followed by positive reframing and planning. A similar study by Eslami Akbar et al.,[6] 2015, and Ali et al.,[2] 2020, found that majority of nurses practised religious or spiritual activities and relaxation activities to deal with anxiety. Gurvich et al.,[7] 2020, reported that majority of participants (50.55%) responded positively to stress, whereas (49.45%) were more likely to utilize negative coping behaviors such as fantasy, avoidance, and self-blame.

This study has various limitations as the survey was conducted online due to this ongoing pandemic. Therefore, the sampling was web based, creating the possibility of selection bias. Second, the survey was conducted only in one tertiary care hospital in Delhi, which could not reflect the whole situation of nursing professional stress level while working in COVID ICU.

  Conclusion Top

The results showed that almost one-quarter of the nursing professionals had a mild-to-moderate level of anxiety. The unprecedented demand on nursing professionals during the pandemic had a huge impact on anxiety levels. Majority of the nursing professionals approached religious ways of coping style. The hospital administration and nurse managers need to focus on early screening for anxiety, providing psychological support to nurses, and training ineffective coping strategies.

Ethical approval

The study was approved by the Institutional Ethical Committee of selected tertiary care hospital.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Sharma A, Tiwari S, Deb MK, Marty JL. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2): A global pandemic and treatment strategies. Int J Antimicrob Agents 2020;56:106054.  Back to cited text no. 1
Ali H, Cole A, Ahmed A, Hamasha S, Panos G. Major stressors and coping strategies of frontline nursing staff during the outbreak of coronavirus disease 2020 (COVID-19) in Alabama. J Multidiscip Healthc 2020;13:2057-68.  Back to cited text no. 2
Elbay RY, Kurtulmuş A, Arpacıoğlu S, Karadere E. Depression, anxiety, stress levels of physicians and associated factors in COVID-19 pandemics. Psychiatry Res 2020;290:113130.  Back to cited text no. 3
Nickell LA, Crighton EJ, Tracy CS, Al-Enazy H, Bolaji Y, Hanjrah S, et al. Psychosocial effects of SARS on hospital staff: Survey of a large tertiary care institution. CMAJ 2004;170:793-8.  Back to cited text no. 4
Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of COVID-19 outbreak on frontline nurses: A cross-sectional survey study. J Clin Nurs 2020;29:4217-26.  Back to cited text no. 5
Eslami Akbar R, Elahi N, Mohammadi E, Fallahi Khoshknab M. What strategies do the nurses apply to cope with job stress? A qualitative study. Glob J Health Sci 2015;8:55-64.  Back to cited text no. 6
Gurvich C, Thomas N, Thomas EH, Hudaib AR, Sood L, Fabiatos K, et al. Coping styles and mental health in response to societal changes during the COVID-19 pandemic. Int J Soc Psychiatry 2021;67:540-9.  Back to cited text no. 7
Salari N, Khazaie H, Hosseinian-Far A, Khaledi-Paveh B, Kazeminia M, Mohammadi M, et al. The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: A systematic review and meta-regression. Hum Resour Health 2020;18:100.  Back to cited text no. 8
Cabarkapa S, Nadjidai SE, Murgier J, Ng CH. The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review. Brain Behav Immun Health 2020;8:100144.  Back to cited text no. 9
Tahara M, Mashizume Y, Takahashi K. Coping mechanisms: Exploring strategies utilized by Japanese Healthcare workers to reduce stress and improve mental health during the COVID-19 pandemic. Int J Environ Res Public Health 2020;18:131.  Back to cited text no. 10
Skalski S, Uram P, Dobrakowski P, Kwiatkowska A. The link between ego-resiliency, social support, SARS-CoV-2 anxiety and trauma effects. Polish adaptation of the Coronavirus Anxiety Scale. Pers Individ Dif 2021;171:110540.  Back to cited text no. 11
Shevlin M, McBride O, Murphy J, Miller JG, Hartman TK, Levita L, et al. Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open 2020;6:e125.  Back to cited text no. 12
Xu Q, Mao Z, Wei D, Liu P, Fan K, Wang J, et al. Prevalence and risk factors for anxiety symptoms during the outbreak of COVID-19: A large survey among 373216 junior and senior high school students in China. J Affect Disord 2021;288:17-22.  Back to cited text no. 13


  [Table 1], [Table 2], [Table 3], [Table 4]


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