Problems Facing Healthcare Providers When Caring for COVID-19 Patients: An Integrative Review

Figures & data

Figure 1 Flowchart describing article search and selection.

Notes: RAdapted from: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and MetaAnalyses: The PRISMA Statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed1000097.⁵⁰ © 2009 Moher et al. Creative Commons Attribution (CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/legalcode).

Table 1 Summary of Reviewed Articles

Authors/Year of Citation/Country	Purpose of Study	Research Design	Sample Size	Instruments	Key Findings	Critical Appraisal
Sun et al (2020) China^Citation23	Investigate the psychology associated with nurses’ ability to care for COVID-19 patients.	Qualitative phenomenology study	22 nurses	In-depth interview	Facing stress and anxiety. Lack of self-coping styles. Feeling under pressure. Heavy workloads. Lack of communication with colleagues and authority. Lack of support from organization.	9/10
Yin and Zeng (2020)^Citation24 China	Investigate the psychological requirements of nurses ability to care for COVID-19 patients and suggest reciprocal interventions.	Qualitative study	Ten nurses	In-depth interviews	Facing stress. Lack of PPE. Feeling insecure of COVID-19. Lack of support. The needs of health and security. The needs of supports from organization especially facilities of PPE. 9/10
Guo et al (2020) China^Citation25	Analyze the psychological effect of the virus outbreak on medical staff in China.	Cross-sectional survey	3351 physicians; 5900 nurses; 757 medical students, 464 clinical medical assistants, 450 clinical Administration staff.	Self-rating anxiety scale (SAS) and Self-Rating Depression Scale (SDS).	4.98% of medical staffs have middle and high level of anxiety. 13.47% respondents have middle and high levels of depression. Nurses, younger medical and frontline medical staff were more anxious and depressed than the physicians, older and non-frontline medical staff, respectively.	10/12
Liu et al (2020) China^Citation26	Recognize the factors influencing medical workers’ nervousness in China during the outbreak.	Cross-sectional study	512 medical staff; 164 healthcare workers.	Zung Self-rating Anxiety Scale (ZAS).	Respondents’ anxiety is minimal. However, the medical staff that came in direct contact with infected patients had an increase in anxiety rate than others.	10/12
Lu et al (2020) China^Citation27	Determine the psychological state of the medical workforce.	Cross-sectional survey	2042 medical staff (doctors and nurses); 257 non-medical staff.	Numeric Rating Scale (NRS) on fear, Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD).	The medical staff possesses significant anxiety, fear, and depression than non-medical staff. The HCPs working in emergency, ICU, and infectious disease, were twice more anxious and depressed than the non-clinical staff.	11/12
Tan et al (2020) Singapore^Citation28	Analyze the psychological distress, stress, depression, and anxiety experienced by health care workers in Singapore during the pandemic.	Cross-sectional study	296 health care workers (physician, nurses) and 174 on medical” personnel (allied health professional, pharmacists, technicians, administrator, clerical staff, and maintenance workers.	Depression, Anxiety and Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IESR) instrument.	The HCPs and Non-medical staff experience the most significant risk for psychological distress during the pandemic.	11/12
Kang et al (2020) China^Citation29	Assessed the mental health status of nursing staff and medical personnel to determine their psychological needs.	Quantitative study	183 doctors and 811 nurses staff working in Wuhan.	Mental health assessment using: 9 items (PHQ-9), the 7- item Generalized Anxiety Disorder (GAD-7), the 7-item Insomnia Severity Index (ISI), and the 22-item Impact of Event Scale-Revised (IESR) Questioners.	36.9% of doctors, and nurses had subthreshold mental disturbances, 22.4% and 6.2% had moderate and severe disturbances, respectively.	10/12
Simone and Gangnarella (2020) Italy^Citation30	Examine the risk of being infected with the pandemic both in healthcare workers and the general population in Italy.	Quantitative study	353 health care workers: 167 medical, doctors, nurses, paramedics, students in medicine as MED group and 186 participants in control group.	4-item Perceived Stress Scale (PSS) 6-item version of State-Trait Anxiety Inventory (STAI) Death anxiety scale of the Existential Concerns Questionnaire (ECQ) Marlowe & Crowne social desirability scale (M&C) Questionnaire about SARS CoV-2 and COVID-19-related experience and personal opinion.	HCWs reported increased risk perception, inadequate knowledge of the virus and higher levels of anxiety, compared to the overall population.	10/12
Zhu et al (2020) China^Citation31	Examine the psychological impaction of health workers at Tongji Hospital in Wuhan, China.	Cross-sectional survey	5062 participants (doctors, nurses, and clinical technicians) in all clinical departments of Tongji Hospital.	Online Questionnaire of perceptions of the threat of COVID-19 By using Revised Questionnaire (IES-R), Patient Health Questionnaire −9 (PHQ-9), and Generalized Anxiety Disorder 7 item (GAD-7).	29.8% of HCPs reported distress, depression, and anxiety symptoms.	10/12
Dai et al (2020) China^Citation32	Analyze the risk perception and psychological state of workers.	Cross-sectional survey	4357 health care workers in China.	General Health Questionnaire 6 questions\Designed to examine the participants’ perception of risk to COVID-19.	HCWs were worried about the increase in the infection of their colleagues (72.5%), family members (63.9%), measures (52.3%), and Medical violence (48.5%). However, only 34.7% were worried about the risk of self-infection.	10/12
Huang et al (2020)^Citation33 China	Examine the present state of emotional and coping strategies of nurses and college students in Anhui Province.	Quantitative study	Population comprises 202 males and 602 females of which, 298 live in rural areas and 506 in urban. Furthermore, 374 are nurses with 430 in nursing school, 377 from cities with uncompromising epidemics, 17 from cities with moderate epidemic levels, 257 from prefecture-level cities.	Modified Brief COPE(Carver, 1997 and an emotional responses scale.	The HCWs faced psychological burdens and a lack of coping strategies.	10/12
Zerbini et al (2020) German^Citation34	Examine the psychosocial problems of physicians and nurses in accordance with their degree of contact with affected patients.	Cross-sectional study (Survey)	The survey consists of a total of 75 nurses and 35 physicians, working either in a special COVID-19 ward or in a regular ward.	The Patient Health Questionnaire, PHQ; and the Maslach Burnout Inventory, MBI.	Nurses in ICU had higher stress, depression and exhaustion, stress levels compared to those of their colleagues in other wards. Similar independent scores were reported by physicians that came in contact with COVID-19 patients.	10/12
Lai et al (2020) China^Citation35	Investigate the magnitude of mental health outcomes as well as its factors among health care workers exposed to the virus in China.	Cross-sectional, survey-based, region-stratified study	1257 health care workers in 34 hospitals in China. 764 (60.8%) were nurses.	The Chinese versions of the 9-item Patient Health Questionnaire in addition to the 7-item both of Generalized Anxiety Disorder scale and Insomnia Severity Index as well as the 22-item Impact of Event Scale–Revised.	The nurses had more significant risk of symptoms, anxiety, depression, insomnia, anxiety, and distress than other healthcare providers.	11/12
Xiaoa et al (2020) China^Citation36	Analyze the trappings of social support associated with sleep quality and function of medical staff responsible for COVID-19 patients in Wuhan China from January to February 2020.	Cross-sectional study	180 medical staff (Doctors or nurses) in Wuhan.	Self-Rating Anxiety Scale, the General Self-Efficacy Scale, the Stanford Acute Stress Reaction Questionnaire, the Pittsburgh Sleep Quality Index, and the Social Support Rate Scale.	The various levels of social support were associated with sleep quality, self-efficacy and adverse degree of stress and anxiety.	10/12
Liang et al (2020) China^Citation37	Identify medical staff mental health Using SDS and SAS to identify personnel’s mental health during the pandemic.	Cross-sectional study	A total of 59 doctors and nurses in addition to 180 medical staff from COVID-19 associated departments and in Guangdong and Wuhan.	Zung’s self-rating depression scale (SDS), Zung’s self-rating anxiety scale (SAS).	Several staff experienced clinical significant depressive symptoms.	10/12
Roy et al (2020) India^Citation38	Analyze the attitude, knowledge, anxiety and perceived experience of mental healthcare needed by the adult Indian population during the pandemic	Cross-sectional study	662 health care professionals were involved in this study.	An online survey was carried out using a semi-structured questionnaire.	The anxiety levels in this study is high because approximately more than 80% of the people were occupied with the thoughts of the pandemic. 72% stated the importance for adequate PPE.	11/12
Li et al (2020) China^Citation39	Examining the psychological emphasis of sympathetic nurses caused by the pandemic.	A mobile phone app-based questionnaire survey	740 individuals (ie, 214 general public, 234 frontline nurses, and 292 non-front-line nurses) were enrolled in the study	The vicarious traumatization questionnaire was used in the study.	The sympathetic traumatization of front-line medical staff is less serious than their non-frontline counterpart.	11/12
Razu et al (2021) Bangladesh^Citation40	Analyze the difficulties faced by doctors and nurses during the pandemic.	A qualitative study	15 participants (doctors and nurses)	Telephone- in-depth interview.	Psychological Distress. Feeling powerless. Lack of Facilities (PPE). Heavy workload. Lack of incentives. Lack of Coordination. Lack of support. Lack of nurses and medical doctors.	9/10

Figure 2 Themes.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and MetaAnalyses: The PRISMA Statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed1000097

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Sun N, Shi S, Jiao D, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control. 2020;48:592–598. doi:10.1016/j.ajic.2020.03.018

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Yin X, Zeng L. A study on the psychological needs of nurses caring for patients with coronavirus disease 2019 from the perspective of the existence, relatedness, and growth theory. Int J Nurs Sci. 2020;7:157–160. doi:10.1016/j.ijnss.2020.04.002

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Guo J, Liao L, Wang B, et al. Psychological effects of COVID-19 on hospital staff: a national cross-sectional survey of China Mainland. Lancet Psychiatry. 2020;7:e15–e16.

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