Abstract
BACKGROUND: Healthcare workers, especially nurses, were one of the most vulnerable groups for developing posttraumatic stress disorder (PTSD) during the coronavirus disease 2019 (COVID-19) pandemic, which also affected their quality of life. However, only limited research has investigated the individual psychological factors as well as the environmental factors responsible for these effects of the pandemic. Demoralization is a state of loss of meaning and anhedonia, which we thought to be an important mediator between fear and PTSD among frontline nurses during the pandemic. This study aimed to explore the role of demoralization in the mechanisms of posttraumatic stress symptoms of nurses facing different infection risks and influencing factors on their well-being. METHOD: A cross sectional study was conducted from September 16, 2021 to October 8, 2021 in a medical center in Northern Taiwan. Online questionnaires were used to collect data, including age, sex, vaccination status, working years, previous quarantine experiences, psychiatric history, traumatic events and scales for measuring fear of COVID-19, demoralization, symptoms of posttraumatic stress, depression, anxiety and stress, burnout level, teamwork performance and quality of life. Hierarchical regression analysis and mediation analysis were utilized to identify associated risk factors and mechanisms. RESULT: Among 351 included nurses, 148 worked in high-risk areas directly exposed to COVID-19 patients or patients with respiratory symptoms, while 203 nurses worked in low-risk areas. Overall, nurses in the low-risk group had greater fear of COVID-19, and greater demoralization and burnout level, along with poorer teamwork and quality of life. Demoralization was found to have mediating effect in both the high-risk group and low-risk group on the relationships between fear of COVID-19 and posttraumatic stress symptoms. Levels of burnout and teamwork may serve as mediators between depression, anxiety, stress and quality of life. CONCLUSION: Hospital-based nurses appear to be at high risk for developing posttraumatic stress disorder during the COVID-19 pandemic. Study findings demonstrated specific associated factors that should be the focus of nursing administration and hospital management while employing preventive measures, psychological resilience of nurses or systematic managements. Future longitudinal research is needed to improve management in pandemic conditions.