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Nursing performance in COVID-19 and non-COVID-19 units: Implications for occupational health

Abstract

Objective:

to analyze the implications of the pandemic on the Nursing team’s occupational health according to its performance in COVID-19 and non-COVID-19 units.

Method:

a multicenter and mixed-methods study, with a sequential explanatory strategy. A total of 845 professionals took part in the first stage, answering an electronic form which contained sociodemographic and work-related variables, as well as about the pandemic and their health, in addition to the Self-Reporting Questionnaire. 19 professionals were interviewed in the second stage. The quantitative data were submitted to statistical analysis and the qualitative ones to thematic content analysis, with integration by connection.

Results:

the pandemic exerted impacts on the professionals’ health, both in the COVID-19 and non-COVID-19 areas. However, composition of the teams presented different characteristics between the areas, as well as the risk perceptions and the work demands.

Conclusion:

the professionals working in areas COVID-19 and non-COVID-19 areas are equally affected, although with different work exposure regarding the requirements at work in the COVID-19 units and the fear of contamination in non-COVID-19 units.

Descriptors:
Nursing; COVID-19; Occupational Health; Mental Health; Occupational Exposure; Working Conditions

Resumo

Objetivo:

analisar as implicações da pandemia sobre a saúde ocupacional da equipe de enfermagem conforme a atuação em unidades dedicadas e não dedicadas à COVID-19.

Método:

estudo multicêntrico, de método misto, estratégia explanatória sequencial. Participaram 845 profissionais na primeira etapa, respondendo a um formulário eletrônico contendo variáveis sociodemográficas, laborais, sobre a pandemia e sua saúde e o Self-Reporting Questionnaire. Na segunda etapa, 19 profissionais foram entrevistados. Os dados quantitativos foram submetidos à estatística analítica e os qualitativos à análise temática de conteúdo, sendo integrados por conexão.

Resultados:

os impactos da pandemia sobre a saúde dos profissionais ocorreram tanto nas áreas dedicadas como nas não dedicadas à COVID-19. Contudo, a composição das equipes apresentou características distintas entre as áreas, bem como as percepções de risco e das exigências no trabalho.

Conclusão:

os profissionais que atuam em áreas dedicadas e não dedicadas à COVID-19 estão igualmente adoecidos, mas com exposição laboral distinta quanto às exigências no trabalho nas unidades dedicadas e o medo da contaminação nas unidades não dedicadas.

Descritores:
Enfermagem; COVID-19; Saúde do Trabalhador; Saúde Mental; Exposição Ocupacional; Condições de Trabalho

Resumen

Objetivo:

analizar las consecuencias que tuvo la pandemia en la salud ocupacional de los enfermeros según si se desempeñaban en unidades dedicadas y no dedicadas al COVID-19.

Método:

estudio multicéntrico, método mixto, estrategia explicativa secuencial. En la primera etapa participaron en total 845 profesionales que respondieron un formulario electrónico que contenía variables sociodemográficas, ocupacionales, sobre la pandemia y la salud y el Self-Reporting Questionnaire. En la segunda etapa, fueron entrevistados 19 profesionales. Los datos cuantitativos fueron sometidos a estadística analítica y los datos cualitativos al análisis de contenido temático, posteriormente, ambos fueron integrados por conexión.

Resultados:

los impactos de la pandemia en la salud de los profesionales se produjeron tanto en las áreas dedicadas como en las no dedicadas al COVID-19. Sin embargo, la composición de los equipos presentó distintas características entre las áreas, así como también diferentes percepciones de riesgo y exigencias en el trabajo.

Conclusión:

los profesionales que trabajan en áreas dedicadas y no dedicadas al COVID-19 se enfermaron por igual, pero tuvieron diferente exposición ocupacional debido a las exigencias que presentaba el trabajo en las unidades dedicadas y al miedo al contagio en las unidades no dedicadas.

Descriptores:
Enfermería; COVID-19; Salud Laboral; Salud Mental; Exposición Ocupacional; Condiciones de Trabajo

Highlights

(1) The COVID-19 pandemic exerted an impact on Nursing workers’ health.

(2) Composition of the teams differed in the COVID-19 and non-COVID-19 units.

(3) Working in COVID-19 units intensified work pace and complexity.

(4) Working in non-COVID-19 units increased the fear of contracting the infection.

(5) The suspicion of Minor Psychological Disorders is high, with no difference regarding the units

Introduction

Among the challenges imposed by the coronavirus pandemic, health services faced rapid and important adaptations given the impact of morbidity and mortality due to COVID-19 on the population, which was aggravated by the global scarcity of inputs to protect health professionals11. Pan American Health Organization. Time is of the essence - Countries of the Americas must act now to slow the spread of COVID-19 (Internet). Washington, D.C.: PAHO; 2020 (cited 2021 Sep 6). Available from: https://bityli.com/Hi49u.
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-22. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report - 68. Geneva: WHO; 2020 (cited 2021 Sep 6). Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200328-sitrep-68-covid-19.pdf?sfvrsn=384bc74c_8
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. Therefore, the Nursing team, which works in the most varied health services, stands out with regard to exposure to illness risk and vulnerability, either because its work requires physical and close contact with the patients or even in relation to care provided in long working hours33. Fernández MD, Ortega-Galán AM, Fernández-Sola C, Hernandéz-Padilla JM, Granera-Molina J, Pichardo JD. Occupational Factors Associated with Health-Related Quality of Life in Nursing Professionals: A Multi-Centre Study. Int J Environ Res Public Health. 2020;17(3):982. Doi: 10.3390/ijerph17030982
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-44. World Health Organization. WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic. Geneva: WHO; 2020 (cited 2021 Sep 6). Available from: https://www.who.int/news/item/28-04-2020-who-calls-for-healthy-safe-and-decent-working-conditions-for-all-health-workers-amidst-covid-19-pandemic
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.

In order to control spread of the infection in the health services, hospital institutions have designated units devoted to the care of patients infected with the coronavirus, seeking to keep them separate from other hospitalizations due to causes other than COVID-1955. Kenanidis E, Anagnostis P, Arvaniti K, Potoupnis ME, Tsiridis E. Organizing an Orthopaedic Department During COVID-19 Pandemic to Mitigate In-Hospital Transmission: Experience From Greece. Cureus. 2020;12(6):e8676. Doi: 10.7759/cureus.8676
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. Considering performance in these units, the intensity of the requirements related to the adaptations of the flows and processes for the assistance to the victims of the disease stands out, including clinical management of the symptoms and elaboration of work protocols, as well as the need to use Personal Protective Equipment (PPE) for extended periods of time and for paramentation and de-paramentation training sessions since, in the COVID-19 units, high exposure to aerosols increases contact with the virus55. Kenanidis E, Anagnostis P, Arvaniti K, Potoupnis ME, Tsiridis E. Organizing an Orthopaedic Department During COVID-19 Pandemic to Mitigate In-Hospital Transmission: Experience From Greece. Cureus. 2020;12(6):e8676. Doi: 10.7759/cureus.8676
https://doi.org/10.7759/cureus.8676...

6. Zeneli A, Altini M, Bragagni M, Gentil N, Prati S, et al. Mitigating strategies and nursing response for cancer care management during the COVID-19 pandemic: an Italian experience. Int Nurs Rev. 2020;67(4):543-53. Doi: 10.1111/inr.12625
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7. Atay S, Cura SU. Problems encountered by nurses due to the use of personal protective equipment during the coronavirus pandemic: Results of a survey. Wound Manag Prev. 2020;66(10):12-6. Doi: 10.25270/wmp.2020.10.1216
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-88. Li X, Qu X. Establishment of an effective nursing team against COVID-19-a COVID-19 treatment center experience. Ann Palliat Med. 2021;10(6):6661-8. Doi: 10.21037/apm-21-1255
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.

The increased exposure risk in these workers, added to the requirement of technical improvement and adaptations in the schedules, routines and work protocols, increased the professionals’ workload88. Li X, Qu X. Establishment of an effective nursing team against COVID-19-a COVID-19 treatment center experience. Ann Palliat Med. 2021;10(6):6661-8. Doi: 10.21037/apm-21-1255
https://doi.org/10.21037/apm-21-1255...

9. Ingram C, Downey V, Roe M, Chen Y, Archibald M, Kallas K, et al. COVID-19 Prevention and Control Measures in Workplace Settings: A Rapid Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18(15):7847. Doi: 10.3390/ijerph18157847
https://doi.org/10.3390/ijerph18157847...
-1010. Zaghini F, Fiorini J, Livigni L, Carrabs G, Sili A. A mixed methods study of an organization's approach to the COVID-19 health care crisis. Nurs Outlook. 2021;69(5):793-804. Doi: 10.1016/j.outlook.2021.05.008
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, also added to the social restrictions imposed by the pandemic on domestic life and cessation of essential leisure activities in the mediation of pressures and work-related stress1111. Ramírez-Ortiz J, Castro-Quintero D, Lerma-Córdoba C, Yela-Ceballos F, Escobar-Córdoba F. Mental health consequences of the COVID-19 pandemic associated with social isolation. Colomb J Anesthesiol. 2020;48(4). Doi: 10.5554/22562087.e930
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-1212. Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci. 2020;18:Doc05. Doi: 10.3205/000281
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.

In this context, workers working in non-COVID-19 units have not undergone the same organizational changes, which could immediately represent a lower impact on them. However, as they do not enjoy the same precautions offered in the COVID-19 units, they faced insecurity due to the unidentified presence of the virus, either due to absence/ineffectiveness of tests to detect the infection, to asymptomatic cases, to nonspecific symptoms or to symptoms that become suspicious during hospitalization1313. Ximenes RG Neto, Machado MH, Freire NP, Silva MCN, Santos MP, Wermelinger MW. Complaints of Brazilian Nursing about exposure to occupational risks during the COVID-19 pandemic. Nursing. 2021;6191-4. Doi: 10.36489/nursing.2021v24i280p6191-6198
https://doi.org/10.36489/nursing.2021v24...
.

These situations caused by the COVID-19 pandemic favor tiring and detrimental work environments and relationships for Nursing professionals, which become even more susceptible to developing stress, wear out, insomnia, anxiety and depression, among other symptoms that cause distress, illness and leaves of absence, as already shown in studies conducted with Indian and Chinese workers through Minor Psychological Disorders (MPD)1414. Uvais NA, Nalakath MJ, Jose K. Facing COVID-19: psychological impacts on hospital staff in a tertiary care private hospital in India. Prim Care Companion CNS Disord. 2021;23(2):20m02843. Doi: 10.4088/PCC.20m02843
https://doi.org/10.4088/PCC.20m02843...

15. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. Doi: 10.1001/jamanetworkopen.2020.3976
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-1616. Zhan Y, Liu Y, Liu H, Li M, Shen Y, Gui L, et al. Factors associated with insomnia among Chinese front-line nurses fighting against COVID-19 in Wuhan: A cross-sectional survey. J Nurs Manag. 2020;28(7):1525-35. Doi: 10.1111/jonm.13094
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.

MPD consist of depression, anxiety, fatigue, irritability, insomnia and memory and concentration deficit1717. Harding TW, Arango V, Baltazar J, Climent CE, Ibrahim HHA, Ladrigo-Ignacio L, et al. Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychol Med. 1980;231-41. Doi: 10.1017/S0033291700043993
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symptoms and have been identified in Brazilian Nursing and in other countries1818. Sagherian K, Steege LM, Cobb SJ, Cho H. Insomnia, fatigue and psychosocial well-being during COVID-19 pandemic: A cross-sectional survey of hospital nursing staff in the United States. J Clin Nurs. 2020;00:1-14. Doi: 10.1111/jocn.15566
https://doi.org/10.1111/jocn.15566...

19. Oliveira EB, Silva SRCS, Sora AB, Oliveira TS, Valério RL, Dias LBS. Minor psychic disorders in nursing workers at a psychiatric hospital. Rev Esc Enferm USP. 2020;54:e03543. Doi: 10.1590/S1980-220X2018031903543
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-2020. Du ML, Deng WX, Sun W, Chien CW, Tung TH, Zou XC. Assessment of mental health among nursing staff at different levels. Medicine (Baltimore). 2020;99(6):e19049. Doi: 10.1097/MD.0000000000019049
https://doi.org/10.1097/MD.0000000000019...
. In addition to the harms to workers’ health, MPD can negatively interfere on the work process and on patient safety.

In the international context, there are studies1515. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. Doi: 10.1001/jamanetworkopen.2020.3976
https://doi.org/10.1001/jamanetworkopen....
,2121. Que J, Shi L, Deng J, Liu J, Zhang L, Wu S, et al. Psychological impact of the COVID-19 pandemic on healthcare workers: a cross-sectional study in China. General Psychiatry. 2020;33:e100259. Doi: 10.1136/gpsych-2020-100259
https://doi.org/10.1136/gpsych-2020-1002...
-2222. Miljeteig I, Forthun I, Hufthammer KO, Engelund I, Schanche E, Schaufel M, et al. Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway. Nurs Ethics. 2021;28(1):66-81. Doi: 10.1177/0969733020981748
https://doi.org/10.1177/0969733020981748...
pointing out to the greater vulnerability of the professionals who worked directly with patients infected with the coronavirus, although another does not corroborate this result2323. Wu Y, Wang J, Luo C, Hu S, Lin X, Anderson AE, et al. A comparison of burnout frequency among oncology physicians and nurses working on the front lines and usual wards during the COVID-19 epidemic in Wuhan, China. J Pain Symp Manag. 2020;60:e60-e65. Doi: 10.1016/j.jpainsymman.2020.04.008
https://doi.org/10.1016/j.jpainsymman.20...
. In the Brazilian context, no studies were found that compared the impacts of coping with the pandemic between areas of professional activity devoted and not devoted to the care of coronavirus-infected patients.

The importance of this study is justified by the need to gather subsidies to more assertively direct the efforts in the protection, prevention and promotion of Nursing professionals’ health, who have been protagonists at this moment of facing the pandemic. Although workers in COVID-19 units were permanently exposed to the virus, this study hypothesized that the impact of the pandemic on the professionals’ health affected both workers in COVIC-19 and non-COVID-19 units, as all faced new and/or increased demands due to the pandemic context, as well as exposure to the virus even before confirmation of the diagnosis. Therefore, the objective was to analyze the implications of the pandemic on the Nursing team’s occupational health according to its performance in COVID-19 and non-COVID-19 units.

Method

Study design

This is a multicenter study with a mixed-methods approach and a sequential explanatory strategy. This strategy uses greater weight assignment in collection of quantitative data (QUAN) to elaborate the qualitative stage, whose weight assignment is lower (qual), both stages being combined by connection2424. Creswell JW, Creswell JD. Projeto de Pesquisa: métodos qualitativo, quantitativo e misto. 5. ed. Porto Alegre: Penso; 2021.. A cross-sectional designed was used in the quantitative stage and the qualitative stage was descriptive, with content analysis methodological guidance2525. Minayo CS, organizator. Pesquisa Social. Teoria, método e criatividade. 29. ed. Petrópolis: Vozes; 2010.. This study was guided by the STROBE (Strengthening the Reporting of Observational Studies Epidemiology) guideline, which is used to describe observational studies2626. Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies (Internet). Oxford: The UK Equator Centre; 2007 (cited 2022 Jun 23). Available from: https://www.equatornetwork.org/reporting-guidelines/strobe
https://www.equatornetwork.org/reporting...
.

Data collection locus (city, state acronym and country)

The study was conducted in units intended and not intended to the care of COVID-19 patients, from four hospital institutions, located in the central and eastern regions of Rio Grande do Sul (RS) state, in Brazil. The hospitals are tertiary-level or references in care by the Unified Health System and are referred to as HA, HB, HC and HD, with 784, 237, 919 and 403 beds, respectively.

Period

The first stage (QUAN) was conducted from August to October 2020 and the second, from January to May 2021.

Population

The study population consisted of 2,962 Nursing professionals from hospital HA, 707 from HB, 2,278 from HC and 952 from HD, totaling 6,899 Nursing workers (nurses, technicians and nursing assistants).

Selection criteria

In the “QUAN” stage, all the workers from the four institutions were invited by means of institutional email messages, with inclusion of those who answered the electronic form. A sample of these respondents was included in the “qual” stage selected from the statements written in the open question, providing contact to talk more about the subject matter. The professionals excluded were those that were away from their work functions during the data collection period and who refused to be interviewed.

Sample definition

The “QUAN” stage consisted of a sample of 845 participants from the Nursing team, selected by convenience, exceeding the minimum number (534) statistically estimated with the aid of the statistical PSS Health software (Power and Sample Size for Health Researchers)2727. Borges RB, Mancuso AC, Camey SA, Leotti VB, Hirakata VN, Azambuja GS, et al. Power and Sample Size for Health Researchers: a tool for calculating sample size and statistical power designed for health researchers. Clin Biomed Res. 2021;40(4):247-53. Doi: 10.22491/2357-9730.109542
https://doi.org/10.22491/2357-9730.10954...
, with a 96% confidence level and a 4% estimate of absolute error, assuming 33.7% prevalence2828. Magnago TSBS, Prochnow A, Urbanetto JS, Greco PBT, Beltrame M, Luz EMF. Relationship between work ability in nursing and minor psychological disorders. Texto Contexto Enferm. 2015;24(2):362-70. Doi: 10.1590/0104-07072015002580013
https://doi.org/10.1590/0104-07072015002...
. The “qual” stage sample was intentionally obtained among the 353 individuals who answered the open question and defined at 19 participants through data saturation. Intentionality of the selection of interviewees occurred by choosing the best informants, through identification the answers that revealed interest in discussing their work experiences during the pandemic.

Study variables

The sociodemographic data were collected through dichotomous categorical variables such as sex (female or male), race/skin color (white or brown/black/others), marital status (single/without a partner or married/with a partner) and numerical variables such as number of children. The work-related data were categorical polytomous variables such as institution (HA, HB, HC or HD), work shift (day, night or no fixed turn/relief staff), dichotomous variables such as position (nurse or nursing technician/assistant), employment contract [Consolidation of Labor Laws (CLT-Consolidação das Leis do Trabalho)]/statutory or temporary] and if they had another contract (yes or no). The numerical variables were “time working in the institution”, “time working in the profession” and “time working in the unit” (in years).

MPD suspicion, as well as data on life and health habits related to the pandemic (has a chronic disease, practices physical activity, increased alcohol consumption, works in a unit devoted to infected patients, assisted infected patients, started using medication, had a medical leave, due to suspected or confirmed COVID-19, belongs to the risk group, lives with people who belong to the risk group) were obtained through dichotomous categorical variables (yes or no), in addition to the “time away” numerical variable (in days). A five-point Likert scale was used for the following variables: sleep quality (from poor: “1” to excellent: “5”), increased level of demand at work (from nothing changed: “1” to intensely changed: “5”), fear felt in the face of exposure to being contaminated at work (from not afraid: “1” to very much afraid: “5”) and impact on physical health (from no impact: “1” to intense impact: “5”).

The study considered the sectors that devoted their physical area and care process exclusively to patients infected by the coronavirus as “COVID-19 units”. The other sectors were understood as “non-COVID-19 units”, intended to care for other causes (such as outpatient services and hospitalizations of any specialties) and/or that were adapted to carry out eventual care of patients infected with the coronavirus, their permanence being temporary in the area (such as emergencies and areas for exams).

Instruments used for data collection

For collecting quantitative data, an online form prepared by the authors of the manuscript and submitted to a pilot test was used, containing sociodemographic, work-related, pandemic and health questions, in addition to the Self-Reporting Questionnaire (SRQ-20) that investigates MPD. SRQ-20, validated in Brazil in 19862929. Mari JJ, Williams P. A validity study of a psychiatric screening questionnaire (SQR-20) in primary care in the city of São Paulo. Br J Psychol. 1986;148:23-6. Doi: 10.1192/bjp.148.1.23
https://doi.org/10.1192/bjp.148.1.23...
, consists of 20 dichotomized questions (yes/no), divided into symptoms characteristic of depressive-anxious mood, somatic mood, decreased vital energy and depressive thoughts. Results equal to or higher than 7 were used as cutoff point to define suspected MPD, without resulting in diagnosis.

The open question available in the electronic form, to freely discuss their experiences during care performance in the pandemic, was used to guide the development of semi-structured questions that comprised the interview script of the second stage, as well as the results of the previous analysis of the data from the first stage of the study. The interview script, prepared by the authors of the study, consisted of six questions that dealt with daily work in the pandemic, organization of teams and processes, perceived changes, exposure to risk and impact on health.

Data collection

Quantitative data collection was conducted by means of an electronic form (Google Forms), sent via institutional email, provided and authorized by the institutions. The qualitative stage was conducted by the researcher, first author of this manuscript, in the remote modality and through the Google Meet videocall platform, with recording of the interviews. Access to the participants who answered the interview was through the email address provided in form from the first stage. The interviews were scheduled according to the participants’ availability.

Data treatment and analysis

The “QUAN” stage data were entered into an Excel spreadsheet and analyzed in SPSS, version 20. The categorical variables were presented as absolute and relative frequencies and the continuous ones, as central tendency and dispersion measures. The Chi-Square or Fisher’s Exact tests were employed for the association between the categorical variables, according to the cell’s frequency. The Shapiro-Wilk normality test resulted in the identification of the asymmetric distribution of the continuous variables, which had their analysis performed using the non-parametric Mann-Whitney test in the comparison of the groups. “Works in a unit devoted to infected patients” was the dependent variable of this study, which was crossed with the independent ones. The data with two-tailed “p”-values below 0.05, or with a 95% confidence interval, were considered as statistically significant differences.

In the “qual” stage, the data were transcribed and submitted to thematic content analysis2929. Mari JJ, Williams P. A validity study of a psychiatric screening questionnaire (SQR-20) in primary care in the city of São Paulo. Br J Psychol. 1986;148:23-6. Doi: 10.1192/bjp.148.1.23
https://doi.org/10.1192/bjp.148.1.23...
, permeating the pre-analysis phases, represented by intense floating reading until impregnation of the material, where the first impressions that emerge in the researcher are allowed to flow; exploration of the material, to understand the findings, where elaboration of the categories begins, reducing the material to words and speeches and inference and interpretation of the results, the final phase of the analysis.

After the quantitative and qualitative analyses, a joint data analysis was performed, combined from the connection, so that the results could be integrated, improving and expanding understanding of the theme. Joint-display was used to allow for better data visualization3030. Guetterman TC, Fetters MD, Creswell JW. Integrating quantitative and qualitative results in health science mixed methods research through joint displays. Ann Fam Med. 2015;13(6)554-61. Doi: 10.1370/afm.1865
https://doi.org/10.1370/afm.1865...
, favoring the emergence of new ideas3131. Fetters MD, Curry LA, Creswell JW. Achieving Integration in Mixed Methods Designs - Principles and Practices. Health Serv Res. 2013;48(6pt2):2134-56. Doi: 10.1111/1475-6773.12117
https://doi.org/10.1111/1475-6773.12117...
.

Ethical aspects

This study was approved by the National Commission on Research Ethics under opinion number 4,152,027 and CAAE record 33105820200000008. The ethical principles were followed as provided in Resolution No. 466 of December 12th, 2012, by the National Health Council of the Ministry of Health, as well as the norms applicable for research in Human and Social Sciences provided in Resolution No. 510/16. The Free and Informed Consent From was sent together with the online form, informing about both stages. In the interviews, the professionals’ names were substituted by the acronyms NT for Nursing Technician/Assistant and NUR for Nurse.

Results

The study first stage included 845 Nursing team professionals from all four hospitals: 155 participants from HA, 90 from HB, 367 from HC and 233 from HD. The participants included 470 (55.6%) nursing technicians/assistants and 375 (44.4%) nurses.

There was predominance of the female sex (84.9%), with a median age of 41 (36-48) years old and self-declared as white race/skin color (83.1%) and 625 (74%) were married or had partners. Regarding the participants’ health, 580 (68.6%) answered that they were not practicing physical activity, 200 (23.7%) increased alcohol consumption in the pandemic, 205 (24.3%) started using medication in this period and the prevalence of suspected MPD was 49.3% (417).

Regarding the work-related data, 762 (90.2) participants were statutory or CLT-contracted, 112 (13.3%) had another employment contract, 566 (67%) were from the day shift and 64 (7.6) had a management position. The sample consisted of 155 professionals working in COVID-19 units and of 690 from non-COVID-19 units. However, regarding the experience of the care provided to infected patients, it was found that 575 (83.3%) had these experiences working in non-COVID-19 units.

Table 1 shows the distribution of participants according to their sociodemographic and work-related characteristics according to the work unit in coping with the COVID-19 pandemic. Table 2 defines the changes in life and health habits and in the work context due to the pandemic.

Table 1
Distribution of the Nursing professionals from all four institutions (n=845) according to COVID-19 or non-COVID-19 work unit. Rio Grande do Sul, RS, Brazil, 2020-2021
Table 2
Repercussions of the pandemic according to COVID-19 or non-COVID-19 work unit (n=845). Rio Grande Sul, RS, Brazil, 2020-2021

Regarding the MPD, there were no statistically significant differences between the COVID-19 and non-COVID-19 areas. Figure 1 illustrates the high prevalence of suspected MPD in the Nursing professionals from both teams.

Figure 1
Prevalence of Minor Psychological Disorders in the COVID-19 (n=155) and non-COVID-19 (n=690) areas. Rio Grande do Sul, RS, Brazil, 2020-2021

In the “qual” stage, 19 professionals were interviewed, of which 9 were nurses and 10 were nursing technicians, 10 of whom were from COVID-19 units and 9 from non-COVID-19 units and distributed across all four hospitals as follows: 5 in HA, 3 in HB, 5 in HC and 6 in HD. Three categories emerged from analyzing these interviews: (1) Restructuring the work teams; (2) Understanding risk and work demands; and (3) Impact on workers’ health.

The “Restructuring the work teams” category includes adjustments faced by the professionals to adapt the work teams. The workers interviewed revealed experiences with greater impact regarding distancing/reallocation of the professionals belonging to the risk group who had to leave their work groups and places in order to assemble the COVID-19 units, as well as regarding establishment of new routines and protocols. In the non-COVID units, concern was evidenced about PPE availability and the constant changes in the care flows in order to maintain distancing of uncontaminated patients from the suspected cases, which was a generator of many uncertainties due to the care rules.

[...] for us it was all uncertain, we didn’t know if we’d have the staff reallocated to other areas and if the patients would continue to be cared here with us [...] it was a very volatile scenario [...] it was all very unknown and the guidelines were changing every day. [...] it demanded a lot from our team [...] (NUR 2 - Non-COVID-19).

At first we had a lot of suffering related to all these changes, of so many people, of a complete restructuring in the service, this change was very intense, it required an adaptation like never before in our life. (NUR 3 - COVID-19).

[...] enough people with temporary contracts were hired to work in the COVID units, because there were a lot of sick leaves. [...] these units were given differentiated attention [...] the colleagues who replace us [sick leaves] are normally the same [...] the technicians when they came to help us, also had experience in isolation, so this made it all much easier because they were more used to the routines. (NUR 5 - COVID-19).

The “Understanding risk and work demands” category addressed the professionals’ perception in view of the increased work demands, with experiences more emphasized by the workers of the COVID-19 units, who were subjected to increased complexity of the work tasks, as well as described themselves as victims of prejudice within the institution. The fear of exposure to the virus and the disease was present in the statements of the interviewees, especially those from the non-COVID-19 units, as they felt less privileged in PPE distribution by the institution.

[...] when me and my colleagues from the ICC (Intensive Care Center) came down to change clothes in the locker room, peers from the other units screamed and told us to go away, because we weren’t allowed to change clothes in the same place. Even though we were exhausted and with no protection equipment and sanitized [...] this moment was very shocking for us, because they didn’t want to get in the elevators with us. (NUR 3 - COVID-19).

Too afraid of having the disease, of taking it home, [fear of caring] when the patient arrives with a suspicion, or knowing that such peer died and that I had worked with him. Another one [colleague] who had children of the same age as mine, died, another two hospital peers died, about 10 people from the institution died, I said “my God in Heaven”. In late March and April there was one death after another, a horror. I’m powerless, panicked and people are dying around me. (NUR 9 - Non-COVID-19).

In the “Impact on workers’ health” category, the professionals talked about the symptoms experienced and/or worsening in the pre-existing clinical conditions due to their performance in the pandemic. Anxiety and depressive symptoms, insomnia and their somatization were the most found in the statements of the participants interviewed.

[...] everything had to be hastily remanaged and restructured because of the situation and because the hospital is a reference for the care of COVID-19 patients [...] Walking into the hospital and seeing your peers not getting in the same elevator. So it was panic. Afraid of putting on the PPE in the wrong way before entering the room, of becoming contaminated, panic before leaving the room. [...] for me it was difficult to see my peers suffering [...] no one is ready to experience that [...] I haven’t stopped crying, I’m still recovering from last week. I have an appointment now, maybe I have to start with a medication, because I’m not getting it, it’s being too much for me, just to think that I’m going back to COVID. I think that the people who are working on the front line, they’re all going to get emotional sequelae, there’s no way they’re not getting them. (NT 5 - COVID-19).

I had enough contact with a lot of COVID patients without any warning. It also causes a little anxiety. I was afraid I had contracted COVID because I had a headache three days in a row, took medication and was no good, also tachycardia and shortness of breath. I was scared to death “I’m going to put an oximeter on to see if I’m saturating well” because I was thinking “my God, I’m going to die.” But I think it was tension, pure tension. (NT 2 - Non-COVID-19).

The interviews expressed many feelings and symptoms of distress and illness, both in the professionals who worked in the COVID-19 and non-COVID-19 units. However, the relationship of these reports with the work experiences showed that the triggering factors did not have the same similarities, as professionals from the COVID-19 units had their causes in death, in the suffering of patients who did not respond to the treatment and in the urgency for new learning and definitions of care processes. In the non-COVID-19 units, the reports about health repercussions were related to the fear of having to deal with suspected COVID-19 patients or even approaching colleagues who worked directly with infected patients. The perception that PPE availability was different in the performance areas was the justification mentioned for these professionals’ fear.

Figure 2 shows the integration of the “QUAN” and “qual” results, combined by data connection and distributed across the units devoted and not devoted to the care of COVID-19 patients.

Figure 2
Joint-display of the connection between the QUAN (n=845) and qual (n=19) results about the implications of the Nursing team’s performance in units devoted and not devoted to the care of COVID-19 patients. Rio Grande do Sul, RS, Brazil, 2020-2021

Discussion

Composition of the teams that worked in the COVID-19-and non-COVID-19 units revealed a number of differences, even with regard to sex. Although Nursing is a mostly and historically female profession, both in this study and in another one carried out during the pandemic, there was a significant number of male professionals comprising the teams of units devoted to the care of patients infected with COVID-193232. Hoseinabadi TS, Kakhki S, Teimori G, Nayyeri S. Burnout and its influencing factors between frontline nurses and nurses from other wards during the outbreak of Coronavirus Disease -COVID-19- in Iran. Invest Educ Enferm. 2020;38(2):e3. Doi: 10.17533/udea.iee.v38n2e03
https://doi.org/10.17533/udea.iee.v38n2e...
. This fact can be due to the role socially attributed to men in the culture, linked to virility and courage, which often consolidates denial of vulnerability and fear3333. Medrado B, Lyra J, Nascimento M, Beiras A, Corrêa AC, Alvarenga EC, et al. Men and masculinities and the new coronavirus: sharing gender issues in the first phase of the pandemic. Ciênc Saúde Colet. 2021;26(1):179-83. Doi: 10.1590/1413-81232020261.35122020
https://doi.org/10.1590/1413-81232020261...
. On the other hand, the result found can be related to the female attribute of household activities, with responsibilities for the care of frail individuals such as older adults and children3434. Garcia CC. Notes on the History of Women's Work in Western Society: from differences to gender labor inequalities. RG&PP. 2019;9(1):123-40. Doi: 10.11606/rgpp.v9i1.175097
https://doi.org/10.11606/rgpp.v9i1.17509...
, thus preferring to work in non-COVID-19 areas.

In addition, mixed race, black and others was prevalent in the composition of teams from COVID-19 units, as well as temporary employment contracts in the institution, more than one job and less time of experience in the profession, in the institution and in the unit. Afro-American people represent a significant number of workers in Nursing and their predominance in COVID-19 units can be understood in view of the temporary employment contracts and their relationship with unemployment and the double working hours already described in the literature, vulnerabilities that were increased in the pandemic for the less favored groups3535. Machado MH, coord. Perfil da enfermagem no Brasil: relatório final (Internet). Rio de Janeiro: NERHUS/DAPS/ENSP/Fiocruz; 2017 (cited 2022 Jun 23). Available from: http://www.cofen.gov.br/perfilenfermagem/pdfs/relatoriofinal.pdf
http://www.cofen.gov.br/perfilenfermagem...
.

Many changes were necessary and inevitable in order to prepare health services to face the pandemic. The expansion of beds for the creation of new sectors, the increase of night teams in the COVID-19 units due to the patients’ severity and the relocations of professionals that belonged to the risk group resulted in many emergency hires and also in dissolution of teams. Breaking of the work teams’ bonds to the detriment of the new dimensioning and distribution of professionals was mentioned by the interviewees as a difficult moment, which may have affected the social support that already existed in the work groups, requiring the construction of new bonds and work organization with new colleagues, even causing psychological illness3636. Rossi S, Cosentino C, Bettinaglio GC, Giovanelli F, Prandi C, Pedrotti P, et al. Nurse's identity role during Covid-19. Acta Biomed. 2021;29(S2):e2021036. Doi: 10.23750/abm.v92iS2.11959
https://doi.org/10.23750/abm.v92iS2.1195...
-3737. Hou T, Zhang T, Cai W, Song X, Chen A, Deng G, et al. Social support and mental health among health care workers during Coronavirus Disease 2019 outbreak: A moderated mediation model. PloS One. 2020;15(5):e0233831. Doi: 10.1371/journal.pone.0233831
https://doi.org/10.1371/journal.pone.023...
.

The training of new colleagues, sometimes recent graduates or without experience in hospital and/or intensive care, was reported by the interviewees of this study as an increase in workload. A number of studies have disclosed special attention to inexperienced nurses, who had fewer skills to deal with work-related difficulties, as revealed by a Chinese study on psychological manifestations of decreased appetite, fatigue, insomnia, nervousness, frequent crying and even suicidal thoughts in inexperienced professionals who worked in COVID-19 units1010. Zaghini F, Fiorini J, Livigni L, Carrabs G, Sili A. A mixed methods study of an organization's approach to the COVID-19 health care crisis. Nurs Outlook. 2021;69(5):793-804. Doi: 10.1016/j.outlook.2021.05.008
https://doi.org/10.1016/j.outlook.2021.0...
,3838. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020;24(1):200. Doi: 10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...
.

A study that disclosed greater severity in the development of trauma secondary to the pandemic in nurses working in the units that did not deal directly with patients infected with COVID-19 suggests that this was due to the fact that the professionals from COVID-19 units volunteered for this service because they were more experienced3939. Li Z, Ge J, Yang M, Feng J, Qiao M, Jiang R, et al. Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain Behav Immun. 2020;88:916-9. Doi: 10.1016/j.bbi.2020.03.007
https://doi.org/10.1016/j.bbi.2020.03.00...
. However, this result differs from the current research, considering that the professionals from COVID-19 units had less experience in the profession, in the institution and also in the unit.

This study identified that the inexperience of the Nursing professionals who worked in the COVID-19 units represented an additional burden for the experienced ones, as they had to take on training and supervision to perform their duties. A number of studies were conducted on this support to inexperienced workers and nurses from Turkey pointed out the following among the difficulties dealing with the new working conditions: concern with possible errors by new colleagues, referring to the experience of anxiety by those who were already in the service by assuming adaptation of these professionals to the new sector4040. García-Martín M, Roman P, Rodriguez-Arrastia M, Diaz-Cortes M, Soriano-Martin PJ, Ropero-Padilla C. Novice nurse's transitioning to emergency nurse during COVID-19 pandemic: A qualitative study. J Nurs Manag. 2020;29(2):258-67. Doi: 10.1111/jonm.13148
https://doi.org/10.1111/jonm.13148...
-4141. Demirci AD, Oruc M, Kabukcuoglu,K. It was difficult, but our struggle to touch lives gave us strength: The experience of nurses working on COVID-19 wards. J Clin Nurs. 2020;30(5-6):732-41. Doi: 10.1111/jocn.15602
https://doi.org/10.1111/jocn.15602...
.

This constant concern for the possibility of incorrect actions by colleagues possibly ends up burdening the work of the most experienced, as there was an increase in work demands in the COVID-19 units1010. Zaghini F, Fiorini J, Livigni L, Carrabs G, Sili A. A mixed methods study of an organization's approach to the COVID-19 health care crisis. Nurs Outlook. 2021;69(5):793-804. Doi: 10.1016/j.outlook.2021.05.008
https://doi.org/10.1016/j.outlook.2021.0...
,4242. Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Health. 2020;8(6):e790-e798. Doi: 10.1016/S2214-109X(20)30204-7
https://doi.org/10.1016/S2214-109X(20)30...
also due to the rigor in PPE use, such as paramentation and de-paramentation and its prolonged use, as well as the change in the profile of the patients, who were distributed by specialties across the units, such as Oncology and Hematology, and had their particularities added to the coronavirus infection1010. Zaghini F, Fiorini J, Livigni L, Carrabs G, Sili A. A mixed methods study of an organization's approach to the COVID-19 health care crisis. Nurs Outlook. 2021;69(5):793-804. Doi: 10.1016/j.outlook.2021.05.008
https://doi.org/10.1016/j.outlook.2021.0...
,4343. Arnetz JE, Goetz CM, Arnetz BB, Arble E. Nurse reports of stressful situations during the COVID-19 pandemic: qualitative analysis of survey responses. Int J Environ Res Public Health. 2020;17(21):8126. Doi: 10.3390/ijerph17218126.
https://doi.org/10.3390/ijerph17218126...
.

The change in the patient profile was due to the need to create units devoted to the care of patients infected with the coronavirus, in order to control its dissemination. However, in addition to also manifesting severe forms of the disease, becoming critical care patients3838. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020;24(1):200. Doi: 10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...
, people affected by the virus also had other diseases such as cancer or diabetes, patients who had undergone surgeries, in the terminal phase of life and a wide variety of other comorbidities and situations, with the need for the professionals who were in these dedicated units to be trained to treat them4343. Arnetz JE, Goetz CM, Arnetz BB, Arble E. Nurse reports of stressful situations during the COVID-19 pandemic: qualitative analysis of survey responses. Int J Environ Res Public Health. 2020;17(21):8126. Doi: 10.3390/ijerph17218126.
https://doi.org/10.3390/ijerph17218126...
.

Another difficulty faced by the health services and that put Nursing professionals at risk was lack of PPE, which was a worldwide problem at the beginning of the pandemic, as well as the lack of training for its proper and prolonged use4343. Arnetz JE, Goetz CM, Arnetz BB, Arble E. Nurse reports of stressful situations during the COVID-19 pandemic: qualitative analysis of survey responses. Int J Environ Res Public Health. 2020;17(21):8126. Doi: 10.3390/ijerph17218126.
https://doi.org/10.3390/ijerph17218126...
-4444. Yuan L, Chen S, Xu Y. Donning and doffing of personal protective equipment protocol and key points of nursing care for patients with COVID-19 in ICU. Stroke Vasc Neurol. 2020;5(3):302-7. Doi: 10.1136/svn-2020-000456
https://doi.org/10.1136/svn-2020-000456...
, which caused pressure injuries4545. Jiang Q, Song S, Zhou J, Liu Y, Chen A, Bai Y, et al. The Prevalence, Characteristics, and Prevention Status of Skin Injury Caused by Personal Protective Equipment Among Medical Staff in Fighting COVID-19: A Multicenter, Cross-Sectional Study. Adv Wound Care. 2020;9(7):357-64. Doi: 10.1089/wound.2020.1212
https://doi.org/10.1089/wound.2020.1212...
. In Italy, nurses in COVID-19 units linked these situations to the large number of contamination cases in the professionals, requiring the development of several protocols such as training for the proper use of PPE4646. Catania G, Zanini M, Hayter M, Timmins F, Dasso N, Ottonello G, et al. Lessons from Italian front-line nurses' experiences during the COVID-19 pandemic: A qualitative descriptive study. J Nurs Manag. 2021;29:404-11. Doi: 10.1111/jonm.13194
https://doi.org/10.1111/jonm.13194...
.

For the professionals who were not working directly with infected patients, lack of adequate protection and the uncertainty of the fact that a given patient was not infected with coronavirus generated greater fear in the face of exposure to the risk for contamination during work. Diverging from this result, studies carried out with nurses showed greater fear felt by those who worked directly with infected patients, who also felt more unprotected3434. Garcia CC. Notes on the History of Women's Work in Western Society: from differences to gender labor inequalities. RG&PP. 2019;9(1):123-40. Doi: 10.11606/rgpp.v9i1.175097
https://doi.org/10.11606/rgpp.v9i1.17509...
,4747. Montes-Berges B, Ortúñez Fernández ME. Efectos psicológicos de la pandemia covid-19 en el personal del ámbito sanitario. Enfermería Global. 2021;20(2)254-82. Doi: 10.6018/eglobal.427161
https://doi.org/10.6018/eglobal.427161...
. Non-protection of health professionals, such as PPE scarcity, misuse and inadequacy, generated fear in those who worked during the pandemic, regardless of the performance unit.

The fear felt by the professionals of both types of unit in relation to being contaminated and transmitting the virus to their family members and friends was linked to the experiences of prejudice suffered by the professionals of the non-COVID-19 units, practiced by people in social spaces, who showed fear even if the protocols regarding distancing and use of masks were respected4848. Javed B, Sarwer A, Soto EB, Mashwani Z. The coronavirus (COVID-19) pandemic's impact on mental health. Int J Health Plann Manage. 2020;35(5):993-6. Doi: 10.1002/hpm.3008
https://doi.org/10.1002/hpm.3008...
. During the pandemic, stigmatization and prejudice brought about concerns to Nursing professionals, who sometimes face problems regarding the family and social support network that can negatively affect their mental health1515. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. Doi: 10.1001/jamanetworkopen.2020.3976
https://doi.org/10.1001/jamanetworkopen....
,4848. Javed B, Sarwer A, Soto EB, Mashwani Z. The coronavirus (COVID-19) pandemic's impact on mental health. Int J Health Plann Manage. 2020;35(5):993-6. Doi: 10.1002/hpm.3008
https://doi.org/10.1002/hpm.3008...
.

On the other hand, the professionals from COVID-19 units had the same feeling, but in relation to the colleagues of the institution who did not work directly with infected patients, when they shared changing rooms, corridors and elevators, even when they were no longer wearing contaminated uniforms. Both felt the need to isolate themselves from people in general life in order not to be held responsible for contaminating anybody The professionals who dealt directly with COVID-19 also distanced from colleagues from other sectors, both because of the prejudice suffered and because they were not considered contamination means within the institutions4343. Arnetz JE, Goetz CM, Arnetz BB, Arble E. Nurse reports of stressful situations during the COVID-19 pandemic: qualitative analysis of survey responses. Int J Environ Res Public Health. 2020;17(21):8126. Doi: 10.3390/ijerph17218126.
https://doi.org/10.3390/ijerph17218126...
,4949. Pfefferbaum B, North CS. Mental Health and the Covid-19 Pandemic. N Engl J Med. 2020;383:510-2. Doi: 10.1056/NEJMp2008017
https://doi.org/10.1056/NEJMp2008017...
.

There were no statistically significant differences in sick leave, impact on physical health and suspicion of MPDs among Nursing professionals in COVID-19 and non-COVID-19 units and this differs from the findings of studies carried out with nurses from China, in which the professionals who did not work directly with infected patients presented higher levels of professional illness when compared to those who were in the COVID-19 ward2323. Wu Y, Wang J, Luo C, Hu S, Lin X, Anderson AE, et al. A comparison of burnout frequency among oncology physicians and nurses working on the front lines and usual wards during the COVID-19 epidemic in Wuhan, China. J Pain Symp Manag. 2020;60:e60-e65. Doi: 10.1016/j.jpainsymman.2020.04.008
https://doi.org/10.1016/j.jpainsymman.20...
.

Among the possible explanations provided by the authors2323. Wu Y, Wang J, Luo C, Hu S, Lin X, Anderson AE, et al. A comparison of burnout frequency among oncology physicians and nurses working on the front lines and usual wards during the COVID-19 epidemic in Wuhan, China. J Pain Symp Manag. 2020;60:e60-e65. Doi: 10.1016/j.jpainsymman.2020.04.008
https://doi.org/10.1016/j.jpainsymman.20...
, there is the fact that the professionals who worked directly with patients infected with COVID-19 feel better able to control the situation. This corroborates the current study, as the workers from the non-COVID-19 units reported not having felt prioritized to the detriment of the established flows and the materials provided at the first moment of the pandemic, generating a sensation of helplessness and non-protection, as they also ended up dealing with infected patients and also unsuspectingly, because many infected people were asymptomatic, which can increase exposure to the risk of infection and the fear felt4343. Arnetz JE, Goetz CM, Arnetz BB, Arble E. Nurse reports of stressful situations during the COVID-19 pandemic: qualitative analysis of survey responses. Int J Environ Res Public Health. 2020;17(21):8126. Doi: 10.3390/ijerph17218126.
https://doi.org/10.3390/ijerph17218126...
.

Regarding the finding about the feeling of fear in the face of the contamination risk experienced with higher prevalence by the professionals from non-COVID-19 areas, it is worth relating this to the study5050. Escudero DV, Fram DS, Coelho WE, Matias LO, Meira ES, Ferreira DB, et al. Prevalência de SARS-COV-2 entre profissionais da saúde de um hospital terciário de ensino. Braz J Infect Dis. 2021;25:101105. Doi: 10.1016/j.bjid.2020.101105
https://doi.org/10.1016/j.bjid.2020.1011...
found more contaminated professionals in non-COVID-19 areas when compared to professionals from COVID-19 areas. In addition to weighing the negative experience of the feeling of fear found in the current study, a number of authors1212. Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci. 2020;18:Doc05. Doi: 10.3205/000281
https://doi.org/10.3205/000281...
,5151. Sampaio F, Sequeira C, Teixeira L. Impact of COVID-19 outbreak on nurses' mental health: A prospective cohort study. Environ Res. 2021;194:110620. Doi: 10.1016/j.envres.2020.110620
https://doi.org/10.1016/j.envres.2020.11...
showed that the fear of being contaminated was a predictive factor for the development of depression among Nursing workers.

The studies developed with nurses showed higher levels of illness among those who work directly with infected patients1212. Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci. 2020;18:Doc05. Doi: 10.3205/000281
https://doi.org/10.3205/000281...
,1515. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. Doi: 10.1001/jamanetworkopen.2020.3976
https://doi.org/10.1001/jamanetworkopen....
,3434. Garcia CC. Notes on the History of Women's Work in Western Society: from differences to gender labor inequalities. RG&PP. 2019;9(1):123-40. Doi: 10.11606/rgpp.v9i1.175097
https://doi.org/10.11606/rgpp.v9i1.17509...
,5252. Ali SK, Shah J, Talib Z. COVID-19 and mental well-being of nurses in a tertiary facility in Kenya. PloS One. 2021;16(7):e0254074. Doi: 10.1371/journal.pone.0254074
https://doi.org/10.1371/journal.pone.025...
. In China1515. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. Doi: 10.1001/jamanetworkopen.2020.3976
https://doi.org/10.1001/jamanetworkopen....
, they showed more severe degrees of depression, anxiety, insomnia and anguish; in Germany1212. Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci. 2020;18:Doc05. Doi: 10.3205/000281
https://doi.org/10.3205/000281...
they had more depression, exhaustion and stress, when compared with professionals from the non-COVID-19 units, as well as in Iran3434. Garcia CC. Notes on the History of Women's Work in Western Society: from differences to gender labor inequalities. RG&PP. 2019;9(1):123-40. Doi: 10.11606/rgpp.v9i1.175097
https://doi.org/10.11606/rgpp.v9i1.17509...
, where exhaustion and stress prevailed in these professionals. In the current study there was no difference regarding the psychological health of the professionals from different areas.

Although this study did not identify differences between the performance units with regard to MPD, their high prevalence among the participants stands out, as well as in a study carried out during the pandemic in Brazil5353. Santos KMR, Galvão MHR, Gomes SM, Souza TA, Medeiros AA, Barbosa IR. Depression and anxiety in nursing professionals during the covid-19 pandemic. Esc Anna Nery. 2021;25(spe):e20200370. Doi: 10.1590/2177-9465-EAN-2020-0370
https://doi.org/10.1590/2177-9465-EAN-20...
with 490 professionals from a Nursing team, revealing that 30.4% of the participants had some mental disorder diagnosed, with moderately severe or severe anxiety as the most prevalent diagnosis, followed by moderately severe or severe depression. In Canada5454. Crowe S, Howard AF, Vanderspank-Wright B, Gillis P, McLeod F, Penner C, et al. The effect of COVID-19 pandemic on the mental health of Canadian critical care nurses providing patient care during the early phase pandemic: A mixed method study. Intensive Crit Care Nurs. 2021;63:102999. Doi: 10.1016/j.iccn.2020.102999
https://doi.org/10.1016/j.iccn.2020.1029...
, more than 50% of the participants in a study presented depression symptoms, with 42% moderate, serious or severe and more than 65% of the professionals had anxiety, with 22% serious or severe.

This study was developed entirely online, which may be one of the largest limitations to be considered, as the demands for remote interactions began to overwhelm the professionals in the pandemic, who often were not willing to stay in front of the computer or other digital medium for this reason, as well as the fact that the quality of the interviews was impacted by virtuality. The fact that the research was developed by nurses, who somehow also worked during the pandemic, facilitated the study logistics but generated negative emotions due to the impact of the pandemic on all life instances.

Another limitation was found in relation to time, a factor inherent to cross-sectional research, as it is a clipping of a given moment and resulting from the constant changes in the pandemic, such as daily changes in institutional flows, illness of professionals, increase in the number of contaminated people and individuals in need of care, which makes these results reflect a certain period of the pandemic.

This research contributed to the advancement of scientific knowledge, as it portrays a reality that was unexpected by Nursing and society. The results provided knowledge for health managers about the situations experienced by Nursing professionals and the need for improvements in their health and working conditions.

Conclusion

The integrated data analysis allowed concluding that Nursing professionals who worked in COVID-19 and non-COVID-19 units suffered harms to health to the same extent, although with different occupational exposure regarding the requirements of work pace and complexity in COVID-19 units and the fear of contamination in non-COVID-19 units. Therefore, the hypothesis that the health impacts of the pandemic had affected professionals from different sectors of the Nursing practice was proved in this study.

There is an emphasis on the urgent need for improvements in the working conditions, in support and reception of the mental health demands of the professionals, who work/worked in coping with the pandemic, both in COVID-19 and in non-COVID-19 units. Measures to promote health and prevent illness and/or the complications of the distress already established should envision professionals from different Nursing care areas, considering the vulnerability to the coronavirus infection, as well as the psychosocial implications of working during the pandemic.

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  • Associated academic work

    Paper extracted from master’s thesis “Trabalho e saúde da enfermagem no enfrentamento à pandemia: estudo multicêntrico sobre áreas dedicadas e não dedicadas à COVID-19”, presented to Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil.

Edited by

Associate Editor

Maria Lúcia do Carmo Cruz Robazzi

Publication Dates

  • Publication in this collection
    30 Jan 2023
  • Date of issue
    Jan-Dec 2023

History

  • Received
    29 Apr 2022
  • Accepted
    15 July 2022
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