新冠肺炎第一線護理人員心理困擾之系統性文獻回顧

The Psychological Distress of First-Line Nurses Caring for COVID-19 Patients: A Systematic Review

10.6224/JN.202312_70(6).08

楊婷淯(Tin-Yu YANG)；徐茂棠(Mao-Tang HSU)；劉英妹(Ying-Mei LIU)

心理困擾 ； 系統性回顧 ； 第一線 ； 新冠肺炎 ； 護理人員 ； psychological distress ； systematic review ； first-line ； COVID-19 ； nurse

護理雜誌

70卷6期（2023 / 12 / 01）

58 - 73

繁體中文;英文

背景：世界衛生組織在新冠肺炎（COVID-19）大流行三年後宣佈解除其全球公衛緊急狀態，疫情大流行期間造成全球醫療負荷超載，首當其衝的是第一線護理人員心理健康及離職意向，回顧第一線護理人員在此艱困期間之心理困擾情形，將有助於後疫情時代復原之路。目的：本文旨在系統性回顧第一線照護感染COVID-19病人之護理人員心理困擾狀態。方法：運用Preferred Reporting Items for Systematic Reviews and Meta-Analyses（PRISMA）2020 Statement進行系統性文獻回顧，以英文關鍵字（"COVID-19 first-linenurse"OR"COVID-19 frontline nurse"）AND（"psychological distress" OR "PTSD" OR "depression" OR "anxiety" OR "insomnia" OR "stress" OR "burnout" OR "fear"）；中文關鍵字以（“新冠肺炎第一線護理人員”或“新冠肺炎專責護理人員”及“心理困擾”或“創傷後壓力症候群”或“憂鬱”或“焦慮”或“失眠”或“壓力”或“倦怠”或“恐懼”），搜索2019年12月至2023年3月於「CINAHL」、「PubMed」、「Embase」，及「華藝」發表之中文及英文文獻；且以喬安娜布里格斯學會（Joanna Briggs Institute）出版的評讀工具進行納入研究之品質及證據等級判定。結果：共有20篇文獻符合篩選條件，其中16篇為量性研究，4篇為質性研究。量性研究結果顯示第一線護理人員有高程度心智負荷及中度以上工作倦怠，19.1%－72.3%第一線護理人員有壓力，有三成以上出現失眠問題。焦慮感於疫情高峰後4週及8週隨時間顯著下降，困擾程度則在疫情高峰至8週皆高，未隨時間下降。質性研究訪談第一線照護感染COVID-19病人之護理人員經歷，共同之心理困擾為恐懼。結論：無預期的新興傳染病大流行造成第一線護理人員中度以上心理困擾，仍有待對此議題更進一步之研究，協助第一線維護公眾健康之護理人員得到最好的支持及促進其復原。

Background: The World Health Organization officially declared an end to the COVID-19 Public Health Emergency three years after the initial outbreak of COVID-19. Healthcare providers worldwide were overwhelmed during the pandemic, which greatly affected the mental health and turnover intention of nurses. Conducting a systematic review of psychological distress in first-line nurses during the pandemic may facilitate future research on pandemic-related resilience. Purpose: A systematic review of the literature on psychological distress among first-line nurses caring for patients with COVID-19 was conducted. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. We searched the CINAHL, PubMed, Embase, and Airiti Library databases using the English and Chinese keywords ("COVID-19 first-line nurse" OR "COVID-19 frontline nurse") AND ("psychological distress" OR "PTSD" OR "depression" OR "anxiety" OR "insomnia" OR "stress" OR "burnout" OR "fear") to identify Chinese and English articles published between December 2019 and March 2023. The quality of the included studies was assessed using tools from the Joanna Briggs Institute. Results: A total of 20 articles covering 16 quantitative studies and 4 qualitative studies were included in the analysis. The quantitative findings revealed that first-line nurses experienced high task load and moderate or above-average burnout. Between 19.1% and 72.3% of the first-line nurses reported stress, and more than 30% experienced insomnia. At the peak of the pandemic, anxiety and distress levels were high. At 8-week follow-ups, while anxiety had decreased, distress levels had not. Qualitative findings included the identification of fear as a common symptom of psychological distress in first-line nurses. Conclusions/ Implications for Practice: Further research is needed to better support frontline caregivers and facilitate their recovery from the moderate to severe psychological distress associated with pandemics.

1. 陳淑純, S.-C.,陳美華, M.-H.,張倩蜜, C.-M.,康美玉, M.-Y.,謝孟蓁, M.-C.,張翠芬, T.-F.,粘沛琳Nien, P.-L.,錢美容, M.-J.,李雅文, Y.-W.(2022)。探討護理人員照顧COVID-19病人的工作壓力與復原力。榮總護理，39(4)，400-411。
   連結：
2. Asa, G. A.,Fauk, N. K.,Ratu, M.,Ward, P. R.(2022).The impact of working in COVID-19 hospital on Indonesian nurses’ mental health and wellbeing: A qualitative study.BMC Nursing,21(1),345.
3. Chong, M.-Y.,Wang, W.-C.,Hsieh, W.-C.,Lee, C.-Y.,Chiu, N.-M.,Yeh, W.-C.,Huang, T.-L.,Wen, J.-K.,Chen, C.-L.(2004).Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital.The British Journal of Psychiatry,185(2),127-133.
4. Chung, S.,Kim, H. J.,Ahn, M. H.,Yeo, S.,Lee, J.,Kim, K.,Kang, S.,Suh, S.,Shin, Y.-W.(2020).Development of the stress and anxiety to viral epidemics-9 (SAVE-9) scale for assessing work-related stress and anxiety in healthcare workers in response to viral epidemics.Journal of Korean Medical Science,36(47),e319.
5. Connor, K. M.,Davidson, J. R. T.(2003).Development of a new resilience scale: The Connor-Davidson resilience scale (CD-RISC).Depression and Anxiety,18(2),76-82.
6. Delassalle, N.,Cavaciuti, M.(2023).Psychological distress and COVID-19: Evidence-based interventions for frontline health care workers—A literature review.Dimensions of Critical Care Nursing,42(2),53-62.
7. Fateminia, A.,Hasanvand, S.,Goudarzi, F.,Mohammadi, R.(2022).Post-traumatic stress disorder among frontline nurses during the COVID-19 pandemic and its relationship with occupational burnout.Iranian Journal of Psychiatry,17(4),436-445.
8. Galehdar, N.,Kamran, A.,Toulabi, T.,Heydari, H.(2020).Exploring nurses’ experiences of psychological distress during care of patients with COVID-19: A qualitative study.BMC Psychiatry,20(1),489.
9. Jiménez-Fernández, R.,Corral-Liria, I.,Trevissón-Redondo, B.,Lopez-Lopez, D.,Losa-Iglesias, M.,Becerro-de-Bengoa-Vallejo, R.(2022).Burnout, resilience and psychological flexibility in frontline nurses during the acute phase of the COVID-19 pandemic (2020) in Madrid, Spain.Journal of Nursing Management,30(7),2549-2556.
10. Joanna Briggs Institute. (2013, October). JBI levels of evidence. https://jbi.global/sites/default/files/2019-05/JBI-Levels-of-evidence_2014_0.pdf
11. Joanna Briggs Institute. (n.d.). Critical appraisal tools. Retrieved March 24, 2023, from https://jbi.global/critical-appraisal-tools
12. Jose, S.,Cyriac, M. C.,Dhandapani, M.,Mehra, A.,Sharma, N.(2022).Mental health outcomes of perceived stress, anxiety, fear and insomnia, and the resilience among frontline nurses caring for critical COVID-19 patients in intensive care units.Indian Journal of Critical Care Medicine,26(2),174-178.
13. Kandemir, D.,Temiz, Z.,Ozhanli, Y.,Erdogan, H.,Kanbay, Y.(2022).Analysis of mental health symptoms and insomnia levels of intensive care nurses during the COVID-19 pandemic with a structural equation model.Journal of Clinical Nursing,31(5-6),601-611.
14. Kim, S. C.,Rankin, L.,Ferguson, J.(2022).Nurses’ mental health from early COVID-19 pandemic to vaccination.Journal of Nursing Scholarship,54(4),485-492.
15. L’Abate, L.(Ed.)(2011).Mental illnesses-Understanding, prediction and control.InTech.
16. Labrague, L. J.,De los Santos, J. A. A.,Fronda, D. C.(2021).Perceived COVID-19-associated discrimination, mental health and professional-turnover intention among frontline clinical nurses: The mediating role of resilience.International Journal of Mental Health Nursing,30(6),1674-1683.
17. Lai, J.,Ma, S.,Wang, Y.,Cai, Z.,Hu, J.,Wei, N.,Wu, J.,Du, H.,Chen, T.,Li, R.,Tan, H.,Kang, L.,Yao, L.,Huang, M.,Wang, H.,Wang, G.,Liu, Z.,Hu, S.(2020).Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019.JAMA Network Open,3(3),e203976.
18. Lavoie-Tremblay, M.,Gélinas, C.,Aubé, T.,Tchouaket, E.,Tremblay, D.,Gagnon, M.-P.,Côté, J.(2022).Influence of caring for COVID-19 patients on nurse’s turnover, work satisfaction and quality of care.Journal of Nursing Management,30(1),33-43.
19. Li, T.,Qiu, X.,Gong, X.,Zhan, R.,Zheng, X.(2022).Mental health status of frontline clinical nurses fighting the Omicron variant of COVID-19 – A cross-sectional survey in China.Annals of Agricultural and Environmental Medicine,29(3),375-382.
20. Li, X.,Zhou, Y.,Xu, X.(2021).Factors associated with the psychological well-being among front-line nurses exposed to COVID-2019 in China: A predictive study.Journal of Nursing Management,29(2),240-249.
21. Li, Z.,Ge, J.,Yang, M.,Feng, J.,Qiao, M.,Jiang, R.,Bi, J.,Zhan, G.,Xu, X.,Wang, L.,Zhou, Q.,Zhou, C.,Pan, Y.,Liu, S.,Zhang, H.,Yang, J.,Zhu, B.,Hu, Y.,Hashimoto, K.,Yang, C.(2020).Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control.Brain, Behavior, and Immunity,88,916-919.
22. Liu, Y.-E.,Zhai, Z.-C.,Han, Y.-H.,Liu, Y.-L.,Liu, F.-P.,Hu, D.-Y.(2020).Experiences of front-line nurses combating coronavirus disease-2019 in China: A qualitative analysis.Public Health Nursing,37(5),757-763.
23. Manila, P. (2020, April 7). Urgent need for investment in nursing. World Health Organization. https://www.who.int/westernpacific/news/item/07-04-2020-urgent-need-for-investment-in-nursing
24. McAlonan, G. M.,Lee, A. M.,Cheung, V.,Cheung, C.,Tsang, K. W.,Sham, P. C.,Chua, S. E.,Wong, J. G. W. S.(2007).Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers.The Canadian Journal of Psychiatry,52(4),241-247.
25. Mesri, M.,Safara, M.,Koohestani, H. R.,Baghcheghi, N.(2022).Examining the predictive role of spiritual health and resilience in mental distress of nurses in COVID-19 wards in Iran.Mental Health, Religion & Culture,25(4),435-447.
26. Narita, Z.,Okubo, R.,Sasaki, Y.,Takeda, K.,Takao, M.,Komaki, H.,Oi, H.,Mizoue, T.,Miyama, T.,Kim, Y.(2023).COVID-19-related discrimination, PTSD symptoms, and psychological distress in healthcare workers.International Journal of Mental Health Nursing,32(1),139-146.
27. Nishihara, T.,Yoshihara, K.,Ohashi, A.,Kuroiwa, M.,Sudo, N.(2022).Occupational stress, psychological distress, physical symptoms, and their interrelationships among frontline nurses caring for COVID-19 patients in Japan.Medicine,101(48),e31687.
28. Pourteimour, S.,Yaghmaei, S.,Babamohamadi, H.(2021).The relationship between mental workload and job performance among Iranian nurses providing care to COVID-19 patients: A cross-sectional study.Journal of Nursing Management,29(6),1723-1732.
29. Ridner, S. H.(2004).Psychological distress: Concept analysis.Journal of Advanced Nursing,45(5),536-545.
30. Rodríguez-Martín, B.,Ramírez-Moreno, J. M.,Caro-Alonso, P. Á.,Novo, A.,Martínez-Andrés, M.,Clavijo-Chamorro, M. Z.,Rodríguez-Almagro, J.,López-Espuela, F.(2022).The psychological impact on frontline nurses in Spain of caring for people with COVID-19.Archives of Psychiatric Nursing,41,27-34.
31. Roney, J. K.,Mihandoust, S.,Bazan, G. N.,Patterson, T.,Dunkle, S.,Whitley, B. E.,Long, J. D.(2022).Caring for COVID-19 infected patients admitted to redesignated coronavirus ICUs: Impact on nurse stress and burnout.Nursing Forum,57(6),1321-1329.
32. Salari, N.,Khazaie, H.,Hosseinian-Far, A.,Khaledi-Paveh, B.,Kazeminia, M.,Mohammadi, M.,Shohaimi, S.,Daneshkhah, A.,Eskandari, S.(2020).The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: A systematic review and meta-regression.Human Resources for Health,18(1),100.
33. Van Steenkiste, E.,Schoofs, J.,Gilis, S.,Messiaen, P.(2022).Mental health impact of COVID-19 in frontline healthcare workers in a Belgian tertiary care hospital: A prospective longitudinal study.Acta Clinica Belgica,77(3),533-540.
34. World Health Organization. (2023, May 5). Statement on the fifteenth meeting of the IHR (2005) Emergency Committee on the COVID-19 pandemic. https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic
35. Xia, W.,Defang, W.,Xiaoli, G.,Jinrui, C.,Weidi, W.,Junya, L.,Luhong, H.,Hui, W.(2022).Compassion satisfaction and compassion fatigue in frontline nurses during the COVID-19 pandemic in Wuhan, China.Journal of Nursing Management,30(7),2537-2548.
36. Zhang, M.,Zhang, P.,Liu, Y.,Wang, H.,Hu, K.,Du, M.(2021).Influence of perceived stress and workload on work engagement in front-line nurses during COVID-19 pandemic.Journal of Clinical Nursing,30(11-12),1584-1595.
37. 財團法人國家實驗研究院高速網路與計算中心（2023，3月5日）．COVID-19全球疫情圖。[National Center for High-Performance Computing. (2023, March 5). COVID-19 global dashboard.] https://covid-19.nchc.org.tw/index.php
38. 潘玫燕, M.-Y.,葉乙臻, Y.-C.,洪儀珍, I.-C.,林宣妤, H.-Y.,劉嘉琪, C.-C.,楊美嬌, M.-C.,黃雯芳, W.-F.,汪倢西, C.-H.,洪燕慧, Y.-H.,林綉珠, S.-J.,蔡明叡, M.-J.,郭柏賢, P.-H.,劉旺, W.-D.,王振泰, J.-T.,陳宜君, Y.-C.,劉秀雲, H. Y.(2021)。新冠肺炎疫病專責病房之滾動式調整。台灣醫學，25(2)，277-285。
39. 羅文惠, W.-H.,游麗瑾, L.-C.,李金霙, C.-Y.,游淑敏, S.-M.(2021)。護理人員照護嚴重特殊傳染性肺炎（COVID-19）病人之心理壓力。北市醫學雜誌，18(4)，432-444。