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The impact of the COVID-19 pandemic on mental coping and emergency ability of public health emergency in COVID-19 department healthcare workers in ICU nurses of Beijing in China

BMC Nursing volume 24, Article number: 89 (2025) Cite this article

Abstract

Background

The COVID-19 pandemic has brought various opportunities and challenges to critical care nurses, whose emergency abilities in caring for critically ill patients are related to their safety, clinical effectiveness, and improved prognosis. Currently, there is a lack of research on the actual situation and influencing factors of ICU nurses' emergency ability during the COVID-19 pandemic. Although empirical observations from different departments can provide valuable basis for the health system to formulate preventive measures, efficient training programs and future public emergencies.

Design

A cross-sectional descriptive study.

Methods

Data were collected from 486 subjects through electronic surveys from November 8 to 15, 2022, in seven general public hospitals (all tertiary A hospitals) in Beijing, China.

Results

The emergency ability of ICU nurses hover at the intermediate level (145.42 ± 23.29). The variables of work experience, participated in PHE rescue activities, participated in PHE education, cumulative rescue more than 10 times and positive coping were associated with the emergency ability of ICU nurses.

Conclusion

Despite the COVID-19 restrictions, the emergency ability of ICU nurses is acceptable, at a medium level. The ICU nurse of seniority, participated in PHE rescue activities, participated in PHE education, cumulative rescue more than 10 times had excellent emergency ability; The importance of positive coping style was also evident, which means that intervention in psychological is seen as necessary.

Peer Review reports

Background

Public Health Emergency of International Concern (PHEIC) refers to an exceptional event declared by the World Health Organization that constitutes a public health risk to other countries through the international spread of disease and may require a coordinated international response. It is an event that occurs when a serious, sudden, unusual or unexpected situation occurs whose impact on public health goes beyond the borders of the affected countries and may require immediate international action [1, 2]. In recent years, with the frequent occurrence of sudden catastrophes around the world, such as COVID-19, Ebola epidemic and WenChuan earthquake, human health and development are facing enormous challenges [3, 4].

After the outbreak of COVID-19, it spread rapidly to 216 countries until September 9, 2020 [5]. Subsequently, COVID-19 was decidedly determined as a Public Health Emergency of International Concern (PHEIC) by the WHO on 30 January, 2022 [6]. The surge in COVID-19 patients in a short period of time requires access to more timely healthcare services, which overwhelms the healthcare system. Countries have taken active actions, such as establishing designated hospitals, temporary hospitals, and temporary treatment centers. These measures have played an important role in strengthening the capacity of the medical system during the COVID-19 pandemic [7,8,9]. After suffering the epidemic, people have fully realized the importance of medical care services, especially intensive care services, in responding to public health emergencies [4, 10, 11].

The intensive care unit (ICU) is the last line of defense for human health and plays an extremely important role in responding to public health emergencies and crisis events [12]. The outbreak of the COVID-19 epidemic has caused tremendous changes in the hospital's space, manpower, and material resources. Many ordinary wards have been converted into temporary ICUs [7,8,9]. The surge in critically ill patients has brought unprecedented challenges to ICU nurses. On the one hand, the care of critically ill patients includes general and special care, attention to basic needs, and advanced practice in a high-tech environment; on the other hand, ICU nurses need to assume clinical responsibilities, interact with family members, and participate in decision-making [13, 14]. More importantly, in the face of sudden, high-risk and emergency public health events, patients often fall into a state of anxiety, nervousness and even panic. Nurses are also under tremendous psychological pressure when responding to these emergencies. If this pressure cannot be effectively relieved, its work efficiency and capabilities will be greatly reduced [15, 16].

Emergency capacity is a subconscious ability of human beings. It refers to the ability of the human brain to deal with something immediately based on past experience and self-thinking when a person encounters something [17]. The emergency ability of nurses refers to the ability of nurses to observe the changes in the patient's condition in a timely and sensitive manner, make accurate analysis and judgment, master the emergency process, apply skilled skills and techniques, respond calmly, and decisively cooperate with other medical staff in rescue and nursing in clinical nursing practice, especially when facing emergencies [17]. Furthermore, ICU nurses are crucial to the planning, response, and recovery of public health emergencies, and their experience and ability in caring for critically ill patients are related to their safety, clinical effectiveness, and improved prognosis [18]. Therefore, emergency ability of ICU nurses will be one of the determinants of addressing public health emergencies.

Previous studies analyzed the working conditions of ICU nurses during the COVID-19 epidemic, revealing the major challenges they face, such as a surge in workload, frequent safety hazards, heavy emotional stress, and significant professional burnout [19, 20]. At the same time, the study also discovered the positive changes brought about by the epidemic to the nurse group, such as enhancing their resilience and adaptability, improving teamwork effectiveness, and stimulating higher professional enthusiasm and self-improvement awareness [21]. However, it is worth noting that current research is still insufficient in exploring the actual situation and influencing factors of nurses' emergency abilities in public health emergencies during the COVID-19 epidemic. Although empirical observations from different departments can provide valuable basis for the health system to formulate preventive measures and efficient training programs, aiming to strengthen nurses' emergency abilities, thereby optimizing the quality of care for critically ill patients and improving clinical outcomes, there is still a lack of special surveys on the emergency abilities of ICU nurses, and its guiding significance is self-evident. In view of this, this study explored current status and influencing factors of emergency ability of ICU nurses in public health emergency during COVID-19 and public health crises, which will fill the gap in the study on emergency ability of ICU nurses.

Methods

Study design

This study descriptive cross-sectional survey design.

Participants and setting

This study was carried on in November 8th to15th of 2022 in the city of Beijing, which is the capital of China, and the center of politics, economy and culture. Beijing is one of the cities with the highest level of medical care in China, and thus, future research plays an important role by investigating medical staff in the region. Data were collected from seven Grade-A Tertiary Hospitals in Beijing, China; The tertiary hospital is the abbreviation of the tertiary first-class hospital. It is the highest level in the classification of "three grades and six grades" for hospitals in mainland China. The so-called tertiary hospital refers to the hospitals that have more than 501 beds, perform high-class diagnosis and treatment, complete medical services to the region and surrounding radiation areas, provide senior education and scientific research tasks [22]. Refer to Price and Tinsley’s sample size calculation method [23, 24], the quantity of samples is usually more 5 ~ 10 times than those of variables, and 10% of the samples will be dropped when the rate is 5 for the accuracy of the results. So, the minimum required sample size is 389 in this study.

Questionnaire

Demographic information

Basic demographic information included age, gender, job title, educational background, position, work experience, level, nurses were also asked five additional standardized questions whether (1) Participated in public health emergency rescue activities; (2) Participated in public health emergency education; (3) Participated in public health emergency exercises; (4) Cumulative rescue more than 10 times; (5) Willing to participate in rescue.

Public health emergency ability scale

The public health emergency ability scale, which was developed by Zhang et al. [17, 25]. In China and consist of 37 items scored on a 5-point Likert scale (not well at all = 1, very well = 5) that measure the following seven components of the scale: Emergency knowledge, Rescue ability, Critical Thinking, Communication skill, Organization/coordination ability, Professional ethics, Professional development. The total score of the scale is 37 ~ 185 points, with a score of 149 ~ 185, indicating that the nurse's emergency response ability is very strong; a score of 111 ~ 148, indicating that the nurse's emergency-response ability is at a moderate level; a score of 37 ~ 111, indicating that the emergency response ability of nurses is at a low level. This scale has been used in emergency nurses before and has good reliability and validity. The overall Cronbach’s alpha coefficient of this scale was found to be 0.879, and the Cronbach’s alpha coefficients for the individual dimensions ranged from 0.803 to 0.831 [17, 25]. In this study, the Cronbach’s alpha coefficients was 0.918.

Simplified coping style questionnaire

The Simplified Coping Style Questionnaire (SCSQ) was used to estimate the individuals’ coping strategies; This questionnaire has been shown to have satisfactory reliability and validity in China, including two dimensions of negative coping and positive coping [26]. In brief, Item 1 to 12 is used to test individuals' positive coping items, 13 to 20 are used to test the situation of individuals adopting negative coping strategies. The items measure coping style using a four-point Likert scale (0 = never; 1 = occasionally; 2 = sometimes; 3 = frequently). The average score of the active coping dimension and the passive coping dimension were calculated separately. The average score reflects individuals’ coping style preferences, with dimensions with higher scores indicating that individuals are more likely to adopt the relevant coping style.

Data collection

The informed consent was obtained from the nursing department of each hospital when collecting data. Under the coordination of the nursing department and the ICU head nurses of each hospital, the data were collected using the QuestionnaireStar program, Questionnaire Star is a professional online questionnaire survey tool with embedded WeChat program, which has the obvious advantages of being fast, easying to use and low-cost, and has been widely used by a large number of enterprises and individuals in China [27]. Inclusion criteria: On-the-job registered ICU nurses; Nurses who voluntarily participate with informed consent; Exclusion criteria: nursing students that were on clinical attachment. A total of 486 ICU nurses finished the questionnaire effectively.

Ethics approval

This study was approved by the ethics committee of the Xuanwu Hospital Capital Medical University: 2020–064. The first part of the questionnaire is the informed consent part, in which the research object can clarify the purpose, content and risk of the research and keep the research data confidential. Following the ethical procedure, voluntary participation was emphasized in the information and any decline of participation would not lead to negative consequences. The electronic questionnaire skipped to the content section of the questionnaire only after the researcher had consented. In order to protect the confidentiality of the participants, every single returned questionnaire and each unit was coded with a number. The code lists were stored in one password-locked accounts in which only accessible by the first author.

Data analysis

IBM SPSS 26.0 was used for statistical analysis. Measurement data with normal distribution were described by mean ± standard deviation, and comparison between groups was performed by independent sample t test and analysis of variance. The measurement data that did not meet the normal distribution were described by the median and quartile, and the rank sum test was used for comparison between groups. Count data were described by cases and percentages, and chi-square test was used for comparison between groups. Using multiple linear regression (entry method) to analyze influencing factors of emergency ability (P < 0.05).

Results

Demographic information of the participants

A total of 486 participants completed the survey. 410 (84.4%) were female and 76(15.6%) were male. The age of most nurses (74.1%) were in the range of 25 ~ 35. 67.5% of nurses possessed a bachelor degree or above, in terms of seniority, 77% of nurses had nursing experience over five years. 37.9% of the participants had PHE rescue experience ever. Approximately 79% Nurses take part in over 10 rescue surgeries. In the meantime, the majority of the nurses (71.6%) participated in PHE education (see Table 1).

Table 1 Characteristics of the participant, scores on emergency ability, and effect of classified variables on emergency ability (N = 486)
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Emergency ability of ICU nurses in PHE

As shown in Table 2, the emergency ability of ICU nurses hover at the moderate level (145.42 ± 23.29). The level of code of professional ethics (4.33 ± 0.72) is the highest. The level of emergency knowledge (3.28 ± 0.74) is the lowest. The score of item 31 “I can abide by professional ethics, be cautious and honest” (4.41 ± 0.77) is the highest. This is followed by item 33 “I am patient and careful, and take care of each patient with a high degree of responsibility to reduce the occurrence of nursing risks” (4.36 ± 0.80). The score of item 1 “I can judge common public health emergencies” (2.85 ± 1.28) is the lowest. This is followed by item 3 “I can grasp the concept of PHE and related laws, regulations, and ordinances” (2.97 ± 1.02) (see Tables 3 and 4).

Table 2 Mean scores of public health emergency ability scale (N = 486)
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Table 3 5 items with the highest scores of public health emergency ability scale
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Table 4 5 items with the lowest scores of public health emergency ability scale
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Comparison of emergency ability of ICU nurses with different characteristics in PHE

Through univariate analysis (see Table 1), the variables of Work experience, Participated in PHE rescue activities, Participated in PHE education, Cumulative rescue more than 10 times and Positive coping style (see Table 5) were found to be significant (p < 0.05).

Table 5 Correlation between coping style and emergency ability (N = 486)
Full size table

Multiple linear regression analysis of emergency ability

The data with statistical significance in the demographic information (Work experience, Participated in PHE rescue activities et.,) and the Coping style (positive coping) were used as independent variables, fellowly, emergency ability scores were processed as dependent variables, based on which building multiple linear regression analysis. The factor of working experience, PHE rescue activities, PHE education, cumulative rescue times, and positive coping (see Table 6) were associated with the emergency ability of ICU nurses.

Table 6 Multiple linear regression analysis of the influencing factors of the emergency ability
Full size table

Post hoc analysis for power analysis

Power analysis was performed on the five single-factor significant variables and multiple linear regression in the study. The results showed that the efficacy of Work experience was the lowest, 0.83 > 0.8, the efficacy of Cumulative rescue more than 10 times was 0.99, and the efficacy values of Participated in PHE rescue activities, Participated in PHE education, Positive coping and multiple linear regression were all 1, indicating that the sample size of this study had good efficacy for the test results (see Table 7).

Table 7 Power analysis
Full size table

Discussion

Current situation of ICU nurses emergency abilities

In the present study, the emergency ability of ICU nurses in Beijing Grade-A Tertiary Hospitals at the upper-intermediate level (145.42 ± 23.29), which was slightly higher than the results reported in China of 143.45 ± 20.50 [17, 25]. The fact that Beijing is China's medical center, occupying the highest quality medical resources in China. Healthcare professionals are highly skilled, attracting patients from all over the country to seek medical treatment. Besides, they accumulated certain experience in handling all kinds of emergencies, providing patients with high-quality medical services. In addition, due to the complex and diverse diseases of ICU patients, the rapid changes in their conditions, nurses need to make correct decisions in a short time. Under the long-term stressful working environment and the exercise of handling emergencies, the emergency ability of ICU nurses has been improved.

Professional ethics refers to the moral norms and codes of conduct that should be followed in professional activities. It is also one of the key characteristics of the nursing profession and an important tool for dealing with ethical issues, which is of great significance for ensuring professional development, making correct decisions and fulfilling responsibilities [28]. In this study, the highest score was dimension of professional ethics and the score of item 31 “I can abide by professional ethics, be cautious and honest” is the highest. This result is similar to that of Goktas's study [28], and the reason may be that nurses working in the intensive care unit on a daily basis often face various ethical issues related to decision-making, informed consent, limiting or terminating life-support treatment, and fair allocation of resources, which cultivates nurses' professional ethics and ethical decision-making ability. In addition, various departments in our country attach more and more importance to medical services, patients' requirements for clinical care are constantly increasing, and medical institutions pay more and more attention to the cultivation of nurses' awareness of quality service and professional ethics. At the same time, in recent years, hospital management departments have also formulated a number of regulatory measures [29, 30], such as the director's mailbox and the mayor's hotline to provide feedback on patient satisfaction, and promoting nurses to continuously improve themselves and enhance their professional ethics.

However, the emergency knowledge dimension has the lowest score. ICU nurses were lacked in the identification of public health emergencies, reporting and registration procedures, laws and regulations, etc. This result is similar to that of Kayama's and Veenema's study [31, 32], the vast majority of the respondents had not been acquired the training that was benefit to proper response to an emergency in this study, particularly courses in identification, registration procedures, and regulations of public health emergencies were missing. Thus, appropriate interventions are indispensable to improve training program. For example, medical institutions can add a series of disaster nursing courses in the future, including emergency identification, reporting and registration procedures, and relevant laws and regulations, and establish a feedback and evaluation mechanism, set up a feedback link in the training process, collect nurses' opinions and suggestions on the content and format of training, and improve the course design.

There are many factors influencing the emergency ability of ICU nurses in PHE

We discovered that the scores generally have higher emergency abilities in their work more than five years compared to those in their work less than five years. Notably, a majority of respondents who rescued patients more than 10 times were more competent for such events. Previous studies have indicated that abundant work experience can improve the emergency ability of nurses, since they become increasingly skillful and highly effective in their nursing positions [33,34,35]. Therefore, with the accumulation of experience, nurses can make decisions easier when dealing with emergencies. Additionally, the results found that nurses with participated in PHE rescue activities were better emergency abilities than those without prior rescue experience, this result is in consistent with previous study [36, 37]. Rescue experience is an important way for nurses to acquire knowledge and skills of emergency rescue. Nurses can accumulate rescue experience and improve their ability to respond during the rescue process. The knowledge accumulated in responding to public health emergencies will inform a new generation of young nurses to deal with important public crises in the future, and even improve the entire nursing profession to a whole new level. It is worth noting that pre-training nursing educators should use the work experience of nurses with rescue experience to evaluate and update the training content, fully combine theoretical knowledge with rescue experience, and improve the practicality of the training content. When allocating patients with sensitive conditions in different wards, including COVID-19, nurse managers must remember that nurses with more work experiences will be more clinically competent.

This study revealed that the emergency abilities have a significant correlation with PHE education. The results found that nurses with participated in PHE education were better emergency abilities than those without prior PHE education. A majority of respondents in this study considered that the training was carried out after the occurrence of public health emergency and reported that the education content is not targeted and boring. They had not received the training needed for proper response to an event, particularly courses in identification, registration procedures, and regulations of public health emergencies were missing. This study addressed the importance of nursing education to the nursing professions, which focuses on improving previous training programs so that nurses are properly prepared to deal with unforeseen difficulties in a large-scale emergency. Nursing education should concentrate on low-scoring content, including precaution, monitoring, Comprehensive patients’ evaluation and care, recovery, triage, and psycho-health guidance. There are five common types of emergency drills: positioning drills, tabletop drills, drill drills, functional drills, and full-scale simulation drills are recommended according to the World Health Organization's Guidelines for Emergency Drills for Hospitals and Health Facilities [38]. In recent years, scenario simulation has been widely used. It is the reproduction of real events and can take many forms, including computer software, case studies, written clinical scenarios, simulated patients (SPs), role-playing, or using simple or advanced functions to replicate reality [39]. In addition, simulation scenario exercises based on actual emergency situations may help improve the emergency response capabilities of nurses who are not involved in rescue activities [40, 41]. Considering that emergencies are unpredictable and urgent, regular situational simulation activities for emergencies possibly assist nurses to be adequately prepared for various future health crisis.

ICU nurses who utilize positive coping strategies may have better emergency response abilities

During the COVID-19 pandemic, the number of critically ill patients has surged, posing a great threat to the mental and emotional health of ICU nurses around the world. If nurses cannot effectively respond to these challenges, causing greater occupational risk, low morale, intent to leave the profession, therefore, managers need to care about the psychological condition of nurses, help them adapt to various adverse environments, reduce psychological harm, and promote mental health [42]. Coping strategy is a behavioral or cognitive attempt to overcome and mitigate any potential or actual danger to one's well-being [43]. Various individuals, or the identical individual under different stressful circumstance, can utilize positive or passive coping strategies when expose to stressors [44,45,46]. This study showed that ICU nurses showed active coping strategies when facing challenges and stress. In addition, emergency response ability is closely related to coping style. Nurses who actively respond to PHE have better emergency response ability than nurses who respond passively, which has been confirmed in many studies [47, 48]. The reason may that Chinese medical staff believe that working during the COVID-19 pandemic is a noble professional ethical responsibility [49], which is also confirmed by the highest-scoring items in this survey. Therefore, the pressure of the epidemic will be transformed into a positive moral responsibility. Driven by responsibility, nurses may be forced to use their medical and psychological knowledge to make active or passive psychological adjustments, which will motivate nurses to achieve their own psychological growth and may have a beneficial impact on patient care.

Positive coping strategies enable individuals to have active behaviors and positive emotions, which could promote the effective coping to stress [50, 51]. As time flies, they could obtain more valuable experience and resources to deal with difficulties, which will contribute to advancement of personal professional ability. In China, nursing is a stressful profession [52, 53], the mental health of nurses should be paid attention, a positive psychological coping strategy is also help nurses to release enormous psychological pressures in coping to a public health emergency, thereby increasing their ability to overcome threats. Therefore, when facing urgent and unpredictable public events, nursing managers need to be aware that they may be key players in helping nurses cope when their conventional strategies are no longer sufficient to cope effectively [54]. In addition, methods and strategies for nurses to effectively cope with stress can be increased, such as mindfulness interventions, aromatherapy, etc. [55, 56], promotes the physical and mental health of nurses thereby enabling nurses to effectively cope with stress and have a beneficial impact on patient outcomes.

Limitations

The present study has several limitations. First, the samples in this study are from ICU nurses in 7 Grade-A public hospitals in Beijing. The comprehensive level of nurses in Grade-A tertiary hospitals may be better, the representativeness of the samples may be insufficient, so the generalization of the results to other societies should be done with caution due to the cultural and social differences. Second, the inclusion of influencing factors is not comprehensive, in the future, it is necessary to expand the geographical scope, enrich the survey sites, increase the representativeness of the sample, and incorporate more variables to explore the influencing factors of emergency response capacity. Finally, it was found that no relevant studies have examined the public health emergency response capabilities of ICU nurses before and during the COVID-19 outbreak, resulting in a lack of continuous dynamic comparison, so caution should be exercised when interpreting the results.

Conclusion

Despite the COVID-19 restrictions, the emergency ability of ICU nurses is acceptable, at a medium level. The emergency ability of ICU nurses in public health emergency is influenced by various factors. Work experience, participated in PHE rescue activities, participated in PHE education, cumulative rescue more than 10 times and coping style were the dominant predictors of the emergency abilities. The ICU nurse of seniority, participated in PHE rescue activities, participated in PHE education, cumulative rescue more than 10 times had excellent emergency ability; The importance of positive psychological coping style was also evident, which means that intervention in psychological is seen as necessary.

Data availability

The Data that support the findings of this study are available from the corresponding authors upon reasonable request.

Abbreviations

PHE:

Public Health Emergency

ICU:

Intensive care unit

COVID-19:

Coronavirus disease 2019

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Acknowledgements

All participants made important contributions to the conduct of this study by filling out self-reported questionnaires.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China

    Tiantian Gai, Yin He, Ying Yin & Zhenhui Lu

  2. Department of Nursing, Tianjin Cancer Hospital Affiliated, Tianjin Medical University, Tianjin, China

    Yu Cui

  3. Department of Nursing, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China

    Qiuping Li

  4. Department of Nursing, Beijing Jishuitan Hospital, Beijing, China

    Yanzhen Hu

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  1. Tiantian Gai
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Contributions

Tiantian Gai: Conception and design of the research; collection and statistical analysis of date; manuscript writing and revision; Yin He ,Zhenhui Lu,Ying Yin,Qiuping Li: Liaison and management with research related personnel, Monitoring of study quality; Yu Cui and Yanzhen HU: statistical analysis of date; manuscript writing.

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Correspondence to Zhenhui Lu.

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Ethics approval and consent to paticipate

This study was approved by the ethics committee of the Xuanwu Hospital Capital Medical University: 2020–064. The first part of the questionnaire is the informed consent part, in which the research object can clarify the purpose, content and risk of the research and keep the research data confidential. Following the ethical procedure, voluntary participation was emphasized in the information and any decline of participation would not lead to negative consequences. The electronic questionnaire skipped to the content section of the questionnaire only after the researcher had consented. In order to protect the confidentiality of the participants, every single returned questionnaire and each unit was coded with a number. The code lists were stored in one password-locked accounts in which only accessible by the first author.

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Gai, T., He, Y., Yin, Y. et al. The impact of the COVID-19 pandemic on mental coping and emergency ability of public health emergency in COVID-19 department healthcare workers in ICU nurses of Beijing in China. BMC Nurs 24, 89 (2025). https://doi.org/10.1186/s12912-024-02536-1

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BMC Nursing

ISSN: 1472-6955

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