Abstract
Workplace stress among American nurses became a problem during the peak of the coronavirus pandemic. This systematic review aimed to discuss workplace stress among American nurses during the period and to suggest measures that should be taken when addressing a similar problem in the future. Data were obtained from specific peer-reviewed journals available in medical research databases. Study eligibility criteria, participants, and interventions, study appraisal and synthesis methods, results, and limitations are discussed in the paper. The study shows that the stress was caused by excess work and the constant threat of contracting the deadly disease.
Introduction
Rationale
When the Coronavirus (COVID-19) pandemic struck, the United States relied on its health care providers to combat it. Nurses played a major role in offering care to those who contracted the virus. They also had to continue caring for their patients suffering from other conditions. Arnetz et al. (2020) explain that nurses had to work for longer hours than before because of the crisis. Cases of burnout and workplace stress became normal during the period. The government was unable to recruit additional nurses to address the emerging needs. Although some nurses considered quitting the job, making an already bad situation worse, most of them were able to overcome the challenge (Hines et al., 2021). In this systematic review paper, the researcher seeks to discuss workplace stress among American nurses during the peak of the coronavirus pandemic in the country.
Objectives
It is necessary to develop PICOS research questions to facilitate the collection of data from various sources. The following are the questions used to collect data for the study;
- P: Who were the most affected nurses during the peak of the COVID-19 pandemic in the United States?
- I: What can be done to ensure that the affected population is protected from similar future pandemics?
- C: Which country handled the pandemic in the best way to protect their nurses?
- O: What would be the outcome of the new measures in case there is a similar pandemic in the country?
- S: What is the most appropriate study design that can facilitate effective collection and analysis of data on this topic?
Methods
Protocol and Registration
In this systematic literature review, there was a review protocol used to collect and process data. First, the researcher developed PICOS questions to define the nature of data needed from the field. The inclusion criteria used to gather data from the field were then defined. All the source materials must have been published within the period that the country experienced the pandemic (2020-2021). The search strategy involved using keywords to identify journal articles that met the set criteria. Most of the data were obtained from specific nursing journal databases, especially CINAHL, MEDLINE, and PsycINFO.
Eligibility Criteria
It was necessary to define the eligibility criteria for the materials used in this study. Based on the PICOS questions developed above, one of the important characteristics of the materials included in the study was the place of publication. The materials must have been published in the United States and at least one of the authors had to be a practicing nurse during the period of the COVID-19 pandemic. The material had to be at least 5 pages, published in English, in the 2020 or 2021 timeframe. It had to be a peer-reviewed journal to meet inclusion criteria. These characteristics had to be met to ensure that the material was credible.
Information Sources
As mentioned above, the study involved the use of peer-reviewed articles on nursing. The sources had to be from specific databases, which included CINAHL, MEDLINE, and PsycINFO. All the sources were published either in 2020 or 2021. The research did not have any contact with the authors of these articles.
Search
The researcher conducted a simple search in the databases selected. The questions above were keyed into the databases and specific articles selected based on how well they answered those questions. The keywords used include ‘workplace stress’, ‘American nurses’, and ‘coronavirus pandemic’.
Study Selection
When the search was conducted, it was important to screen the materials to determine their eligibility before they could be included in the systematic review. Each of the articles had to meet the criteria explained above in terms of their year of publication, authors involved, the area of focus/topic, length of the material, and if they are peer-reviewed.
Data Collection Process
Once a journal article was selected for the review, the next step was to collect data from them. The researcher used piloted forms to extract data from the reports. It involved defining the name of authors, the country of the population (which had to be the United States), and year of publication (2020-2021). Other factors include study design (cohort study, case report, or clinical trial), the sample size, the affected individuals, vaccination, efficacy of interventions, the safety of nurses, and adverse effects after vaccinations
Data Items
Based on the PICOS question above, the dependent variable was workplace stress among nurses. The independent variable included long hours of work, the constant threat of contracting the deadly virus, the inability to help dying patients, lack of counseling, and inability to spend time with family members. The assumption made was that all the nurses were exposed to similar risks and challenges.
Risk of Bias in Individual Studies
The risk of bias in the study was assessed by determining the authors of the report. Articles with all the authors being nurses affected by the pandemic were likely to be biased. Priority was given to articles published by nurses and other professionals to reduce the level of bias.
Summary Measures
The researcher was keen on assessing the risk ratio (by determining the authors of the articles) as a measure of addressing the problem of individual bias in the reports used.
Synthesis of Results
Data were analyzed qualitatively to help achieve the research aim. It involves identifying themes that explained the causes of workplace stress, how it affected the population, how it was managed, and the way forward.
Risk of Bias across Studies
There was a possible risk of bias across studies that could affect the cumulative evidence. The researcher was keen to identify and eliminate journals with selective reporting, especially those that underscore the burden and threat that other healthcare professionals such as doctors and clinical officers faced.
Additional Analyses
The researcher also used statistical analysis in this study based on the nature of the research question.
Results
Study Selection
The table below shows the selection criteria used to screen the studies in the report. It provides numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage.
Table 1: Flow Diagram of Screening and Selection
Study Characteristics
Each of the studies met the inclusion criteria discussed above. As Choi et al. (2020) observe, the researcher ensured that data characteristics in the articles focused on the problem the nurses faced based on actual data collection. Each of them had a sample size of more than 50 practicing nurses.
Risk of Bias within Studies
The risk of bias, as discussed in item 12, was a major concern that had to be addressed. The authors in the selected articles did not statistically present the information.
Results of Individual Studies
A study by Arnetz et al. (2020) reports that over 96% of nurses in the United States were highly stressed during the period. The common causes of stress included long hours at work, the threat of contracting coronavirus, constant deaths at the hospitals, and limited resources (Choi et al., 2020). A study by Hines et al. (2021) recommends the need for the government to enhance the capacity of healthcare institutions to avoid similar challenges in the future. Counseling for the affected nurses is also encouraged to help them overcome stress.
Synthesis of Results
All the selected materials used in this study had a confidence level of 95% and a measure of consistency was also taken into consideration to ensure that the data was reliable and valid. They reaffirmed the massive workplace stress that American nurses endured during the period.
Risk of Bias across Studies
As explained in item 15, the researcher made an effort to eliminate bias across studies. As such, the articles selected addressed this risk factor effectively.
Additional Analysis
Besides the primary analysis method used (thematic analysis), the researcher also used statistical analysis in presenting the percentage of those who were affected by the problem,
Discussion
Summary of Evidence
The findings of the review show that an overwhelming majority of nurses in the United States were stressed by various factors during the pandemic. Some of them lost their lives in their line of duty. The screening method conducted meant that the evidence presented in each of the articles was as credible as possible. The outcome of the study is relevant to nursing administrators, healthcare management teams, policy-makers, and government officials keen on improving the workplace environment for nurses. Future scholars will also find the document essential in their future studies.
Limitations
The main limitation of this study is that, as a systematic review, data were obtained only from secondary sources. It would have been appropriate to interview nurses who were affected by the problem. Although the risk of bias was managed, it could not be eliminated because some of the participants are nurses.
Conclusions
Results from this systematic review show that the majority of American nurses were overwhelmed with the work during the peak of the COVID-19 pandemic. Although they were all concerned about the threat of contracting the deadly virus and the burden, the fact that they had to watch helplessly as many died was even more stressful. Future research should focus on investigating how nurses can cope with such traumatizing events.
Funding
In this systematic review, there was no need for external funding for the study. The researcher only needed to pay a subscription fee to have access to specific databases discussed above. As such, the study was fully self-funded by the researcher.
References
Arnetz, J. E., Goetz, C. M., Arnetz, B. B., & Arble, E. (2020). Nurse reports of stressful situations during the COVID-19 pandemic: Qualitative analysis of survey responses. International Journal of Environmental Research and Public Health, 17(21), 1-6.
Choi, K., Heilemann, M., Fauer, A., & Mead, M. (2020). A second pandemic: Mental health spillover from the novel coronavirus (COVID-19). Journal of the American Psychiatric Nurses Association, 26(4), 340-345.
Hines, E., Chin, H., Glick, D., & Wickwire, M. (2021). Trends in moral injury, distress, and resilience factors among healthcare workers at the beginning of the COVID-19 Pandemic.International Journal of Environmental Research and Public Health, 18(2), 488-493.