The Psychological Responses of Nurses Caring for COVID-19 Patients: A Q Methodological Approach
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Process and Procedure
2.2. Building the Q-Population (Concourse)
2.2.1. Q-Population
2.2.2. Q-Sampling
2.2.3. Reliability Test
2.2.4. P-Sample
2.2.5. Q-Sorting
2.3. Data Processing and Analysis Method
2.4. Ethical Considerations
3. Results
3.1. Forming the Q-Types
3.2. The Types of Psychological Responses from Nurses with Experience Caring for COVID-19 Patients
3.2.1. Type 1: Fear of Social Stigma
3.2.2. Type 2: Anxiety about the Risk of Infection
3.2.3. Type 3: Burden of Infection Prevention and Control Nursing
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- World Health Organization. World Health Organization Coronavirus Disease (COVID-19) Dashboard. Available online: https://covid19.who.int/ (accessed on 20 October 2020).
- Disaster and Safety Management law. National Legal Information Center. Available online: http://www.law.go.kr/main.html (accessed on 20 October 2020).
- 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, 4217–4226. [Google Scholar] [CrossRef] [PubMed]
- Hwang, S.W.; Kim, S.H. Health care professional’s duty of care in a public health emergency. Bioethics 2019, 20, 29–43. [Google Scholar]
- Sperling, D. Ethical dilemmas, perceived risk, and motivation among nurses during the COVID-19 pandemic. Nurs. Ethics 2020, 28, 9–22. [Google Scholar] [CrossRef]
- The Korean Nurses Association News. Available online: http://www.nursenews.co.kr/main/main.asp (accessed on 21 October 2020).
- Korean Nurses Association. Available online: http://www.koreanurse.or.kr (accessed on 20 December 2020).
- Hong, S.; Ai, M.; Xu, X.; Wang, W.; Chen, J.; Zhang, Q.; Kuang, L. Immediate psychological impact on nurses working at 42 government-designated hospitals during COVID-19 outbreak in China: A cross-sectional study. Nurs. Outlook 2020, 69, 6–12. [Google Scholar] [CrossRef]
- Kwon, D.H.; Hwang, J.H.; Hong, J.H. Impression of a neurologist who experienced hub-hospital for coronavirus disease 2019 and Middle East Respiratory Syndrome. J. Korean Neurol. Assoc. 2020, 38, 183–187. [Google Scholar] [CrossRef]
- Kim, S.; Kim, K.; Kang, M.; Go, M.; Kwon, Y.; Kim, B.; Kim, E.; Park, M.; Park, H.; Lee, S.; et al. Psychiatric Mental Health Nursing; Hyeonmunsa: Seoul, Korea, 2016. [Google Scholar]
- Lehmann, M.; Bruenahl, C.A.; Löwe, B.; Addo, M.M.; Schmiedel, S.; Lohse, A.W.; Schramm, C. Ebola and psychological stress of health care professionals. Emerg. Infect. Dis. 2015, 21, 913. [Google Scholar] [CrossRef]
- Micale, M.S.; Lerner, P.F. Trauma, psychiatry, and history: A conceptual and historiographical introduction. In Traumatic Pasts: History, Psychiatry, and Trauma in the Modern Age, 1870–1930; Cambridge University Press: Cambridge, UK, 2001; pp. 1–27. [Google Scholar]
- Kim, J.N.; Jung, S.H. Types of perception toward ethical issues in perioperative nurses: Q-methodological approach. J. Korean Acad. Nurs. 2018, 48, 679–691. [Google Scholar] [CrossRef] [PubMed]
- Oh, T.S.; Choi, H.C. Social Science Data Analysis Method; NaNam: Seoul, Korea, 2004. [Google Scholar]
- Kim, H. Understanding the Q methodology for subjectivity studies. Perspect. Nurs. Sci. 1992, 6, 1–12. [Google Scholar]
- Lee, D.H.; Kim, J.Y.; Kang, H.S. The emotional distress and fear of contagion related to Middle East Respiratory Syndrome (MERS) on general public in Korea. J. Korean Psych. Assoc. 2016, 35, 355–383. [Google Scholar] [CrossRef]
- Kim, J. Nurses’ experience of Middle East Respiratory Syndrome patients care. J. Korea Acad. Ind. Coop. Soc. 2017, 18, 185–196. [Google Scholar]
- Jung, H.; Choi, A.; Lee, G.; Kim, J.; Jung, S. Turnover intention of nurses that were cohort quarantined during the Middle East Respiratory Syndrome (MERS) outbreak. J. Korea Acad. Ind. Coop. Soc. 2017, 18, 175–184. [Google Scholar]
- Lee, D.; Na, j.; Sim, M. Psychological reactions and physical trauma by types of disasters: View from man-made disaster. J. Korean Neuropsychiatr. Assoc. 2015, 54, 261–268. [Google Scholar] [CrossRef]
- Song, J.H.; Lee, H.S.; Park, J.H.; Kim, K.H. The validation of Korean Version of the Psychological Well Being-Post Traumatic Changes Questionnaire(PWB-PTCQ). Kor. J. Psychol. 2009, 14, 193–214. [Google Scholar]
- Ministry of Health & Welfare. Available online: http://www.mohw.go.kr/react/index.jsp (accessed on 21 December 2020).
- National Center for Disaster Trauma. Guidelines for Psychological support related to COVID-19. Available online: https://www.nct.go.kr (accessed on 21 December 2020).
- Lee, K.H.; Sin, S.J. Validity of instrument development research in Korean nursing research. J. Korean Acad. Nurs. 2013, 43, 697–703. [Google Scholar] [CrossRef] [PubMed]
- Lee, E.; Im, N.; Part, H.; Lee, I.; Kim, J.; Bae, J.; Lee, S. Nursing Research and Statistical Analysis; Somoonsa: Seoul, Korea, 2009. [Google Scholar]
- Halcomb, E.; McInnes, S.; Williams, A.; Ashley, C.; James, S.; Fernandez, R.; Calma, K. The experiences of primary healthcare nurses during the COVID-19 pandemic in Australia. J. Nurs. Scholarsh. 2020, 52, 553–563. [Google Scholar] [CrossRef] [PubMed]
- Khanal, P.; Devkota, N.; Dahal, M.; Paudel, K.; Joshi, D. Mental health impacts among health workers during COVID-19 in a low resource setting: A cross-sectional survey from Nepal. Glob. Health 2020, 16, 1–12. [Google Scholar] [CrossRef] [PubMed]
- Labrague, L.J.; De los Santos, J.A.A. COVID-19 anxiety among front-line nurses: Predictive role of organisational support, personal resilience and social support. J. Nurs. Manag. 2020, 28, 1653–1661. [Google Scholar] [CrossRef]
- Wu, W.; Zhang, Y.; Wang, P.; Zhang, L.; Wang, G.; Lei, G.; Huang, F. Psychological stress of medical staffs during outbreak of COVID-19 and adjustment strategy. J. Med. Virol. 2020, 92, 1962–1970. [Google Scholar] [CrossRef]
- Kim, H.; Park, H. Factors affecting post-traumatic stress of general hospital nurses after the epidemic of Middle East Respiratory Syndrome infection. J. Korean Clin. Nurs. Res. 2017, 23, 179–188. [Google Scholar]
- Ratner, P.A.; Sawatzky, R. Health status, preventive behaviour and risk factors among female nurses. Health Rep. 2009, 20, 53. [Google Scholar]
- Ko, D.W. What Makes People Overcome COVID-19 Pandemic? Vulnerable or tolerable characteristics. Korean J. Consum. Advert. Psychol. 2020, 21, 399–424. [Google Scholar] [CrossRef]
- Lee, E.H. The 19 generation of Corona, how are you mental health? Issue Diagn. 2020, 414, 1–25. [Google Scholar]
- Choi, S.; Kim, M. Health Psychological Services during the COVID-19 Pandemic: Effects and Issues of Teletherapy. J. Korean of Health Psych. 2021, 26, 1–20. [Google Scholar]
Type | P-Sample | Factor Weight | Gender | Age | Marital Status | Clinical Experience | Current Position | Clinic Work |
---|---|---|---|---|---|---|---|---|
Type 1 (n = 12) | p4 | 0.45 | F | 32 | Married | 11 years, 10 months | General nurse | ICU |
p6 | 0.43 | F | 23 | Single | 8 months | General nurse | General ward | |
p8 | 1.28 | F | 38 | Married | 15 years, 8 months | General nurse | ICU | |
p9 | 0.90 | F | 46 | Married | 23 years, 6 months | Head nurse | Outpatient department | |
p10 | 1.00 | F | 38 | Married | 15 years | General nurse | Outpatient department | |
p11 | 1.35 | F | 42 | Married | 17 years, 2 months | Charge nurse | General ward | |
p12 * | 4.42 | F | 48 | Married | 24 years | Head nurse | Outpatient department | |
p13 | 3.43 | F | 36 | Married | 9 years, 9 months | General nurse | Outpatient department | |
p14 | 3.10 | F | 41 | Married | 15 years, 10 months | General nurse | Outpatient department | |
p15 | 2.06 | F | 40 | Married | 12 years, 4 months | General nurse | Outpatient department | |
p16 | 3.19 | F | 40 | Married | 18 years | Head nurse | ER | |
p22 | 1.04 | F | 37 | Married | 10 years | General nurse | Outpatient department | |
Type 2 (n = 7) | p1 * | 1.95 | F | 50 | Married | 28 years, 7 months | Head nurse | ICU |
p2 | 0.83 | F | 49 | Married | 20 years | General nurse | Outpatient department | |
p7 | 0.91 | F | 28 | Single | 6 years, 6 months | General nurse | Outpatient department | |
p17 | 0.94 | F | 44 | Married | 22 years | Other | ER | |
p18 | 1.07 | F | 44 | Married | 18 years | Head nurse | ER | |
p19 | 0.92 | F | 35 | Married | 8 years, 2 months | General nurse | General ward | |
p21 | 1.05 | F | 35 | Married | 13 years, 8 months | Head nurse | ICU | |
Type 3 (n = 3) | p3 | 0.66 | F | 26 | Single | 3 years, 10 months | General nurse | ICU |
p5 * | 1.13 | F | 25 | Single | 3 years, 7 months | General nurse | ICU | |
p20 | 0.86 | F | 59 | Married | 30 years | Other | Outpatient department |
No. | Q-Statements | Type 1 | Type 2 | Type 3 |
---|---|---|---|---|
1 | I am confused because it is my first time experiencing COVID-19. | 1.9 | 1.1 | 0.5 |
2 | I am worried that I might contract COVID-19. | 1.5 | 1.8 | −2.5 |
3 | I am worried that COVID-19 might spread in my family because of my work environment. | 2.0 | 2.5 | −0.2 |
4 | I am more afraid of what other people will think if I contract COVID-19, as a nurse. | 1.2 | 1.8 | 1.5 |
5 | I feel sorry for my family because I have to work at a COVID-19 screening hospital. | 1.6 | 0.4 | −2.5 |
6 | I feel bored because COVID-19 is not going away any time soon. | 0.0 | −0.9 | 0.6 |
7 | I am sad because confirmed patients die without feeling the warmth of their family at the end of their lives. | 0.1 | −0.8 | 0.7 |
8 | I am always worried about whether the protective suits and N95 masks are really safe. | 0.3 | −0.8 | −0.8 |
9 | I am worried that wearing goggles will leave a scar on my forehead. | −0.4 | −1.5 | 0.0 |
10 | I am always nervous because I might contract the virus while taking off my protective suit and equipment. | 0 | 0.2 | 0.0 |
11 | I feel irritated because of the moisture and sweat caused by wearing protective suits and goggles. | 0.1 | −0.3 | 2.2 |
12 | I feel dizzy due to wearing Level-D protective suits for a long time. | 0.9 | −0.1 | 1.2 |
13 | My whole body ached, and I struggled with headaches and muscle pain after taking care of patients while wearing a Level-D protective suit. | 0.6 | −0.7 | 0.2 |
14 | I am hurt because my husband and children are treated unfairly because I work at a designated COVID-19 treatment hospital. | 1.0 | −0.4 | −0.2 |
15 | I am burdened by the reality that my work as a nurse comes before the health of my family during the current pandemic. | 0.8 | 0.2 | 0.8 |
16 | I feel the pressure of protecting myself due to the COVID-19 guidelines. | 0.4 | 0.1 | 0.7 |
17 | If another type of infectious disease crisis occurs, I have the confidence to deal with it through my past experience. | 0.5 | −0.8 | −0.1 |
18 | I realized that I am stronger than I thought during this crisis. | 0.8 | −0.8 | 0.6 |
19 | I try to avoid uncomfortable situations. | −1.1 | −0.9 | −0.1 |
20 | I would rather take care of general patients instead of COVID-19 patients during my working hours. | −0.8 | −0.1 | −0.1 |
21 | Currently, I regret becoming a nurse. | −1.5 | −0.9 | −1.1 |
22 | I think I can never go back to my life before COVID-19. | −0.4 | −1.3 | −0.9 |
23 | I don’t think anywhere in the world is safe from COVID-19. | −0.7 | 0.0 | 0.1 |
24 | I get upset and angry when I see suspected and confirmed cases not following self-quarantine measures. | 0.1 | 2.0 | 1.4 |
25 | I feel distant or disconnected from the people around me. | −0.5 | −0.7 | −1.3 |
26 | I don’t have the time or luxury to heal my psychological wounds. | −1 | −1.3 | −0.9 |
27 | I had a valuable and helpful experience because of the COVID-19 pandemic. | 0.0 | 0.3 | 0.4 |
28 | I think warm supportive messages give us strength. | −0.4 | 0.4 | 1.2 |
29 | My family respects and recognizes my job as a dedicated nurse for COVID-19 patients. | −0.2 | 1.0 | 0.4 |
30 | I became overly wary of my environment, fearing that I may have crossed paths with confirmed cases. | −1.4 | 0.8 | −0.2 |
31 | I avoid personal relationships because I am a nurse working at a screening center. | −1.4 | −0.1 | −0.6 |
32 | I suspect even close acquaintances because of the fear of crossing paths with confirmed cases. | −1.2 | 0.0 | −0.6 |
33 | I have anorexia and indigestion because of my heavy workload of caring for COVID-19 patients. | −1.7 | −1.0 | −0.9 |
34 | I do my best to care for COVID-19 patients, but my self-esteem decreases when patients demand unfair or inappropriate care. | −1.2 | 1.1 | 0.3 |
Type | Type 1 | Type 2 | Type 3 |
---|---|---|---|
Type 1 | 1 | ||
Type 2 | 0.44 | 1 | |
Type 3 | 0.10 | 0.14 | 1 |
Eigenvalue | 8.54 | 2.27 | 1.41 |
Variance (%) | 38.82 | 10.34 | 6.39 |
Cumulative | 38.82 | 49.15 | 55.55 |
Type | Q-Statements * | Z-Scores |
---|---|---|
1 | 3. I am worried that COVID-19 might spread in my family because of my work environment. | 2.01 |
1. I am confused because it is my first time experiencing COVID-19. | 1.91 | |
5. I feel sorry for my family because I have to work at a COVID-19 screening hospital. | 1.58 | |
2. I am worried that I might contract COVID-19. | 1.52 | |
4. I am more afraid of what other people will think if I contract COVID-19, as a nurse. | 1.23 | |
14. I am hurt because my husband and children are treated unfairly because I work at a designated COVID-19 treatment hospital. | 1.01 | |
19. I try to avoid uncomfortable situations. | −1.08 | |
34. I do my best to care for COVID-19 patients, but my self-esteem decreases when patients demand unfair or inappropriate care. | −1.17 | |
32. I suspect even close acquaintances because of the fear of crossing paths with confirmed cases. | −1.19 | |
31. I avoid personal relationships because I am a nurse working at a screening center. | −1.42 | |
30. I became overly wary of my environment, fearing that I may have crossed paths with confirmed cases. | −1.42 | |
21. Currently, I regret becoming a nurse. | −1.46 | |
33. I have anorexia and indigestion because of my heavy workload of caring for COVID-19 patients. | −1.68 | |
2 | 3. I am worried that COVID-19 might spread in my family because of my work environment. | 2.46 |
24. I get upset and angry when I see suspected and confirmed cases not following self-quarantine measures. | 1.97 | |
2. I am worried that I might contract COVID-19. | 1.82 | |
4. I am more afraid of what other people will think if I contract COVID-19, as a nurse. | 1.75 | |
1. I am confused because it is my first time experiencing COVID-19. | 1.07 | |
34. I do my best to care for COVID-19 patients, but my self-esteem decreases when patients demand unfair or inappropriate care. | 1.05 | |
22. I think I can never go back to my life before COVID-19. | −1.30 | |
26. I don’t have the time or luxury to heal my psychological wounds. | −1.35 | |
9. I am worried that wearing goggles will leave a scar on my forehead. | −1.53 | |
3 | 11. I feel irritated because of the moisture and sweat caused by wearing protective suits and goggles. | 2.16 |
4. I am more afraid of what other people will think if I contract COVID-19, as a nurse. | 1.55 | |
24. I get upset and angry when I see suspected and confirmed cases not following self-quarantine measures. | 1.37 | |
12. I feel dizzy due to wearing Level-D protective suits for a long time. | 1.24 | |
28. I think warm supportive messages give us strength. | 1.23 | |
21. Currently, I regret becoming a nurse. | −1.05 | |
25. I feel distant or disconnected from the people around me. | −1.30 | |
2. I am worried that I might contract COVID-19. | −2.47 | |
5. I feel sorry for my family because I have to work at a COVID-19 screening hospital. | −2.48 |
Type | Q Statements | Z-Score Difference * |
---|---|---|
1 | 5. I feel sorry for my family because I have to work at a COVID-19 screening hospital. | 2.61 |
14. I am hurt because my husband and children are treated unfairly because I work at a designated COVID-19 treatment hospital. | 1.32 | |
1. I am confused because it is my first time experiencing COVID-19. | 1.13 | |
8. I am always worried about whether the protective suits and N95 masks are really safe. | 1.05 | |
31. I avoid personal relationships because I am a nurse working at a screening center. | −1.07 | |
28. I think warm supportive messages give us strength. | −1.16 | |
24. I get upset and angry when I see suspected and confirmed cases not following self-quarantine measures. | −1.58 | |
30. I became overly wary of my environment, fearing that I may have crossed paths with confirmed cases. | −1.73 | |
34. I do my best to care for COVID-19 patients, but my self-esteem decreases when patients demand unfair or inappropriate care. | −1.85 | |
2 | 2. I am worried that I might contract COVID-19. | 2.30 |
30. I became overly wary of my environment, fearing that I may have crossed paths with confirmed cases. | 1.61 | |
3. I am worried that COVID-19 might spread in my family because of my work environment. | 1.57 | |
34. I do my best to care for COVID-19 patients, but my self-esteem decreases when patients demand unfair or inappropriate care. | 1.48 | |
24. I get upset and angry when I see suspected and confirmed cases not following self-quarantine measures. | 1.24 | |
13. My whole body ached, and I struggled with headaches and muscle pain after taking care of patients while wearing a Level-D protective suit. | −1.13 | |
12. I feel dizzy due to wearing Level-D protective suits for a long time. | −1.16 | |
7. I am sad because confirmed patients die without feeling the warmth of their family at the end of their lives. | −1.20 | |
6. I feel bored because COVID-19 is not going away any time soon. | −1.22 | |
9. I am worried that wearing goggles will leave a scar on my forehead. | −1.34 | |
3 | 11. I feel irritated because of the moisture and sweat caused by wearing protective suits and goggles. | 2.27 |
28. I think warm supportive messages give us strength. | 1.23 | |
7. I am sad because confirmed patients die without feeling the warmth of their family at the end of their lives. | 1.11 | |
6. I feel bored because COVID-19 is not going away any time soon. | 1.04 | |
3. I am worried that COVID-19 might spread in my family because of my work environment. | −2.48 | |
5. I feel sorry for my family because I have to work at a COVID-19 screening hospital. | −3.48 | |
2. I am worried that I might contract COVID-19. | −4.15 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Cho, K.H.; Kim, B. The Psychological Responses of Nurses Caring for COVID-19 Patients: A Q Methodological Approach. Int. J. Environ. Res. Public Health 2021, 18, 3605. https://doi.org/10.3390/ijerph18073605
Cho KH, Kim B. The Psychological Responses of Nurses Caring for COVID-19 Patients: A Q Methodological Approach. International Journal of Environmental Research and Public Health. 2021; 18(7):3605. https://doi.org/10.3390/ijerph18073605
Chicago/Turabian StyleCho, Kyung Hyeon, and Boyoung Kim. 2021. "The Psychological Responses of Nurses Caring for COVID-19 Patients: A Q Methodological Approach" International Journal of Environmental Research and Public Health 18, no. 7: 3605. https://doi.org/10.3390/ijerph18073605