Journal of Health And Care
Volume 27, Issue 3 (Autumn 2025)
JHC 2025, 27(3): 252-268 |
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Azad M, Shamshiri M, Dashti-Kalantar R. Explaining Strategies for Coping with Anxiety during the COVID-19 Pandemic in Pre-hospital Emergency Nurses: A Qualitative Content Analysis. JHC 2025; 27 (3) :252-268
URL: http://hcjournal.arums.ac.ir/article-1-1652-en.html
URL: http://hcjournal.arums.ac.ir/article-1-1652-en.html
Department of Critical Care Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
Abstract: (225 Views)
Background and Objective: Nurses are considered vulnerable groups and frontline caregivers against viral pandemics, and they are usually neglected. This study aimed to explain methods of coping with anxiety in nurses working in the prehospital emergency department of Ardabil City during the COVID-19 pandemic.
Methods: This qualitative study involved 12 emergency nurses working on the frontline of the fight against COVID-19 in the Ardabil Emergency Medical Center. Participants were interviewed in semi-structured individual interviews, which lasted 30 to 100 minutes. The data were converted to text and analyzed using the method introduced by Granheim and Landman.
Findings: The participants' experiences were summarized in 8 main themes, which are attention to and compliance with health protocols, solidarity and comprehensive support, understanding, and professional and occupational responsibility, strengthening the sense of adaptation to the disease, strengthening the immune system for adaptation, strengthening the spiritual sense, managing emotions and relaxation techniques.
Conclusion: The present study revealed that nurses use various methods such as self-control, positive thinking, relying on spirituality, and receiving support from family, colleagues, experts, and others to manage their anxiety caused by the COVID-19 viral pandemic. It is necessary to strengthen and shape the existing adaptation mechanism and take adequate measures to care for themselves and control anxiety in critical situations such as COVID-19.
Methods: This qualitative study involved 12 emergency nurses working on the frontline of the fight against COVID-19 in the Ardabil Emergency Medical Center. Participants were interviewed in semi-structured individual interviews, which lasted 30 to 100 minutes. The data were converted to text and analyzed using the method introduced by Granheim and Landman.
Findings: The participants' experiences were summarized in 8 main themes, which are attention to and compliance with health protocols, solidarity and comprehensive support, understanding, and professional and occupational responsibility, strengthening the sense of adaptation to the disease, strengthening the immune system for adaptation, strengthening the spiritual sense, managing emotions and relaxation techniques.
Conclusion: The present study revealed that nurses use various methods such as self-control, positive thinking, relying on spirituality, and receiving support from family, colleagues, experts, and others to manage their anxiety caused by the COVID-19 viral pandemic. It is necessary to strengthen and shape the existing adaptation mechanism and take adequate measures to care for themselves and control anxiety in critical situations such as COVID-19.
References
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17. Rony MKK, Rahman MM, Saki MAA, Parvin MR, Alamgir HM. Coping strategies adopted by frontline nurses in dealing with COVID‐19 patients in a developing country during the pandemic: a qualitative study. Nursing Open. 2023;10(6):3646-58. [DOI:10.1002/nop2.1614] [PMID] []
18. Su T-P, Lien T-C, Yang C-Y, Su YL, Wang J-H, Tsai S-L, et al. Prevalence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak: a prospective and periodic assessment study in Taiwan. Journal of Psychiatric Research. 2007;41(1-2):119-30. [DOI:10.1016/j.jpsychires.2005.12.006] [PMID] []
19. Lee N, Lee H-J. South Korean nurses' experiences with patient care at a COVID-19-designated hospital: growth after the frontline battle against an infectious disease pandemic. International Journal of Environmental Research and Public Health. 2020;17(23):9015. [DOI:10.3390/ijerph17239015] [PMID] []
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21. Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice: Lippincott Williams & Wilkins; 2008.
22. Graneheim UH, Lindgren B-M, Lundman B. Methodological challenges in qualitative content analysis: a discussion paper. Nurse Education Today. 2017;56:29-34. [DOI:10.1016/j.nedt.2017.06.002] [PMID]
23. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24(2):105-12. [DOI:10.1016/j.nedt.2003.10.001] [PMID]
24. Souri S, Amerzadeh M, Kalhor R, Rafiei S. The relationship between anxiety, stress and protective behavior in nurses during COVID-19 pandemic. Journal of Health & Safety at Work. 2022;12(3);664-79.
25. Demir G, Şahin S, editors. Experiences of nurses providing care to patients with COVID‐19 in intensive care units: a qualitative study. Nursing Forum. 2022;57(4):650-57. [DOI:10.1111/nuf.12716] [PMID] []
26. Abdulah DM, Mohammedsadiq HA, Liamputtong P. Experiences of nurses amidst giving care to COVID‐19 patients in clinical settings in Iraqi Kurdistan: a qualitative descriptive study. Journal of Clinical Nursing. 2022;31(1-2):294-308. [DOI:10.1111/jocn.15909] [PMID] []
27. Sierakowska M, Doroszkiewicz H. Stress coping strategies used by nurses during the COVID-19 pandemic. PeerJ. 2022;10:e13288. [DOI:10.7717/peerj.13288] [PMID] []
28. Peng C, Chen Y, Zeng T, Wu M, Yuan M, Zhang K. Relationship between perceived organizational support and professional values of nurses: mediating effect of emotional labor. BMC Nursing. 2022;21(1):142. [DOI:10.1186/s12912-022-00927-w] [PMID] []
29. Kagan I, Lancman N, Weisbord I. Experiences and psychosocial predictors of professional function among intensive care nurses under the shadow of Covid‐19: a mixed‐methods study. Journal of Nursing Scholarship. 2022;54(6):787-98. [DOI:10.1111/jnu.12796] [PMID] []
30. Shahoei R, Nemati SM, Valiee S. Exploring the experience of nurses in providing care to patients with COVID-19: a qualitative study. The Journal of Nursing Research. 2022;30(4):e217. [DOI:10.1097/jnr.0000000000000498] [PMID] []
31. Fernandez R, Lord H, Halcomb E, Moxham L, Middleton R, Alananzeh I, et al. Implications for COVID-19: a systematic review of nurses' experiences of working in acute care hospital settings during a respiratory pandemic. International Journal of Nursing Studies. 2020;111:103637. [DOI:10.1016/j.ijnurstu.2020.103637] [PMID] []
32. Atashi V, Abolhasani S, Afshari A. Health-care workers' experience of stressors and adaptation strategies for COVID-19: a qualitative research. Journal of Education and Health Promotion. 2022;11:34. [DOI:10.4103/jehp.jehp_314_21] [PMID] []
33. Neuman B, Fawcett J. The Neuman Systems Model. 5th edition. Pearson Publisher; 2011.
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35. Shabbir MA, Mehak F, Khan ZM, Ahmed W, Haq SMAU, Khan MR, et al. Delving the role of nutritional psychiatry to mitigate the COVID-19 pandemic induced stress, anxiety and depression. Trends in Food Science & Technology. 2022;120:25-35. [DOI:10.1016/j.tifs.2021.12.035] [PMID] []
36. Muhammad F. COVID-19 pandemic: the role of traditional medicine. International Journal of Infection. 2020;7(3):e107090. [DOI:10.5812/iji.107090]
37. Rahman A. A scoping review of COVID-19-related stress coping resources among nurses. International Journal of Nursing Sciences. 2022;9(2):259-67. [DOI:10.1016/j.ijnss.2022.02.008] [PMID] []
38. Bagheri Sheykhangafshe F, Rezaeinasab F, Arianipour M, Jalili P, Fathi-Ashtiani A. The role of psychological distress and difficulties in emotion regulation in predicting post-traumatic stress nurses during the COVID-19 pandemic. Razavi International Journal of Medicine. 2022;10(4):e1180.
39. Sharour LA, Salameh AB, Suleiman K, Subih M, Mahmoud A-H, Al Dameery K, et al. Nurses' self-efficacy, confidence and interaction with patients with COVID-19: a cross-sectional study. Disaster Medicine and Public Health Preparedness. 2022;16(4):1393-97. [DOI:10.1017/dmp.2021.1] [PMID] []
40. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. Journal of the American College of Cardiology. 2020;75(18):2352-71. [DOI:10.1016/j.jacc.2020.03.031] [PMID] []
41. Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019‐nCoV) in Japan: mental health consequences and target populations. Psychiatry and Clinical Neurosciences. 2020;74(4):281. [DOI:10.1111/pcn.12988] [PMID] []
42. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7(3):e14. [DOI:10.1016/S2215-0366(20)30047-X] [PMID]
43. Mohammadi M, Abdollahimohammad A, Firouzkouhi M, Shivanpour M. Challenges of prehospital emergency staff in the COVID-19 pandemic: a phenomenological research. Journal of Emergency Practice and Trauma. 2022;8(2):99-103. [DOI:10.34172/jept.2021.35]
44. Mahmoudi H, Ebadi A, Salimi SH, Najafi Mehri S, Mokhtari Noori J, Shokrollahi F. Effect of nurse communication with patients on anxiety, depression and stress level of emergency ward patients. Journal of Critical Care Nursing. 2010;3(1):3-4. [Persian]
45. Barati F, Nasiri A, Akbari N, Sharifzadeh G. The effect of aromatherapy on anxiety in patients. Nephro-urology Monthly. 2016;8(5):e38347. [DOI:10.5812/numonthly.38347] [PMID] []
46. Rahimian Boogar E, Nouri A, Oreizy H, Molavi H, Foroughi Mobarake A. Relationship between adult attachment styles with job satisfaction and job stress in nurses. Iranian Journal of Psychiatry and Clinical Psychology. 2007;13(2):148-57. [Persian]
47. Sam ML. Effectiveness of progressive muscle relaxation technique on anxiety. Sinhgad e-Journal of Nursing. 2014;17(1):23-25. [DOI:10.4103/2231-1505.262290]
48. Azad Marzabady E, Salimi S. Study on job stress in a military unit. Journal of Military Medicine. 2004;6(4):279-84. [Persian]
49. Sepahvand E, Khankeh HR, Ebadi A. Psychometric properties of the Persian version of readiness for events with psychological emergencies assessment tool. Health in Emergencies and Disasters. 2017;2(4):207-16. [Persian] [DOI:10.29252/nrip.hdq.2.4.207]
50. Tabatabaei S, Maleki A, Mataji M, Nurian R, Karimi M. Investigation of depression, anxiety, and musculoskeletal disorders in emergency staff of hospitals supervised by Shahid Beheshti University of Medical Sciences. Iran Occupational Health. 2015;12(1):56-65.[Persian]
51. Hancock KM, Swain J, Hainsworth CJ, Dixon AL, Koo S, Munro K. Acceptance and commitment therapy versus cognitive behavior therapy for children with anxiety: outcomes of a randomized controlled trial. Journal of Clinical Child & Adolescent Psychology. 2018;47(2):296-311. [DOI:10.1080/15374416.2015.1110822] [PMID]
52. Schwartz J, King C-C, Yen M-Y. Protecting healthcare workers during the coronavirus disease 2019 (COVID-19) outbreak: lessons from Taiwan's severe acute respiratory syndrome response. Clinical Infectious Diseases. 2020;71(15):858-60. [DOI:10.1093/cid/ciaa255] [PMID] []
53. Huang L, Lei W, Xu F, Liu H, Yu L. Emotional responses and coping strategies in nurses and nursing students during Covid-19 outbreak: a comparative study. PloS One. 2020;15(8):e0237303. [DOI:10.1371/journal.pone.0237303] [PMID] []
54. Seccia R. The nurse rostering problem in COVID-19 emergency scenario. Tech-nical Report. 2020.
55. Mahdizadeh M, Yaghobipoor M, Khoshab M. Implementation of enforcement productivity law and performance-based payment and nurses' job satisfaction. Quarterly Journal of Nursing Management. 2017;6(2):31-40. [Persian] [DOI:10.29252/ijnv.6.2.31]
56. Rony MKK, Rahman MM, Saki MAA, Parvin MR, Alamgir HM. Coping strategies adopted by frontline nurses in dealing with COVID‐19 patients in a developing country during the pandemic: a qualitative study. Nursing Open. 2023;10(6):3646-58. [DOI:10.1002/nop2.1614] [PMID] []
57. Su T-P, Lien T-C, Yang C-Y, Su YL, Wang J-H, Tsai S-L, et al. Prevalence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak: a prospective and periodic assessment study in Taiwan. Journal of Psychiatric Research. 2007;41(1-2):119-30. [DOI:10.1016/j.jpsychires.2005.12.006] [PMID] []
58. Lee N, Lee H-J. South Korean nurses' experiences with patient care at a COVID-19-designated hospital: growth after the frontline battle against an infectious disease pandemic. International Journal of Environmental Research and Public Health. 2020;17(23):9015. [DOI:10.3390/ijerph17239015] [PMID] []
59. Habibpour Z. Determining nurses understanding of psychological factors at workplace: a qualitative study. Scientific Journal of Nursing, Midwifery and Paramedical Faculty. 2020;5(4):49-61.
60. Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice: Lippincott Williams & Wilkins; 2008.
61. Graneheim UH, Lindgren B-M, Lundman B. Methodological challenges in qualitative content analysis: a discussion paper. Nurse Education Today. 2017;56:29-34. [DOI:10.1016/j.nedt.2017.06.002] [PMID]
62. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24(2):105-12. [DOI:10.1016/j.nedt.2003.10.001] [PMID]
63. Souri S, Amerzadeh M, Kalhor R, Rafiei S. The relationship between anxiety, stress and protective behavior in nurses during COVID-19 pandemic. Journal of Health & Safety at Work. 2022;12(3);664-79.
64. Demir G, Şahin S, editors. Experiences of nurses providing care to patients with COVID‐19 in intensive care units: a qualitative study. Nursing Forum. 2022;57(4):650-57. [DOI:10.1111/nuf.12716] [PMID] []
65. Abdulah DM, Mohammedsadiq HA, Liamputtong P. Experiences of nurses amidst giving care to COVID‐19 patients in clinical settings in Iraqi Kurdistan: a qualitative descriptive study. Journal of Clinical Nursing. 2022;31(1-2):294-308. [DOI:10.1111/jocn.15909] [PMID] []
66. Sierakowska M, Doroszkiewicz H. Stress coping strategies used by nurses during the COVID-19 pandemic. PeerJ. 2022;10:e13288. [DOI:10.7717/peerj.13288] [PMID] []
67. Peng C, Chen Y, Zeng T, Wu M, Yuan M, Zhang K. Relationship between perceived organizational support and professional values of nurses: mediating effect of emotional labor. BMC Nursing. 2022;21(1):142. [DOI:10.1186/s12912-022-00927-w] [PMID] []
68. Kagan I, Lancman N, Weisbord I. Experiences and psychosocial predictors of professional function among intensive care nurses under the shadow of Covid‐19: a mixed‐methods study. Journal of Nursing Scholarship. 2022;54(6):787-98. [DOI:10.1111/jnu.12796] [PMID] []
69. Shahoei R, Nemati SM, Valiee S. Exploring the experience of nurses in providing care to patients with COVID-19: a qualitative study. The Journal of Nursing Research. 2022;30(4):e217. [DOI:10.1097/jnr.0000000000000498] [PMID] []
70. Fernandez R, Lord H, Halcomb E, Moxham L, Middleton R, Alananzeh I, et al. Implications for COVID-19: a systematic review of nurses' experiences of working in acute care hospital settings during a respiratory pandemic. International Journal of Nursing Studies. 2020;111:103637. [DOI:10.1016/j.ijnurstu.2020.103637] [PMID] []
71. Atashi V, Abolhasani S, Afshari A. Health-care workers' experience of stressors and adaptation strategies for COVID-19: a qualitative research. Journal of Education and Health Promotion. 2022;11:34. [DOI:10.4103/jehp.jehp_314_21] [PMID] []
72. Neuman B, Fawcett J. The Neuman Systems Model. 5th edition. Pearson Publisher; 2011.
73. Taati B, Paydar Ardakani SM, Suzuki K, Sadat Modaresi M, Taati Moghadam M, Roozbeh B. Protective roles of exercise and nutritional factors for immune system during Delta variant-COVID-19 outbreaks: evidence review and practical recommendations. Iranian Journal of Medical Microbiology. 2022;16(3):178-85. [DOI:10.30699/ijmm.16.3.178]
74. Shabbir MA, Mehak F, Khan ZM, Ahmed W, Haq SMAU, Khan MR, et al. Delving the role of nutritional psychiatry to mitigate the COVID-19 pandemic induced stress, anxiety and depression. Trends in Food Science & Technology. 2022;120:25-35. [DOI:10.1016/j.tifs.2021.12.035] [PMID] []
75. Muhammad F. COVID-19 pandemic: the role of traditional medicine. International Journal of Infection. 2020;7(3):e107090. [DOI:10.5812/iji.107090]
76. Rahman A. A scoping review of COVID-19-related stress coping resources among nurses. International Journal of Nursing Sciences. 2022;9(2):259-67. [DOI:10.1016/j.ijnss.2022.02.008] [PMID] []
77. Bagheri Sheykhangafshe F, Rezaeinasab F, Arianipour M, Jalili P, Fathi-Ashtiani A. The role of psychological distress and difficulties in emotion regulation in predicting post-traumatic stress nurses during the COVID-19 pandemic. Razavi International Journal of Medicine. 2022;10(4):e1180.
78. Sharour LA, Salameh AB, Suleiman K, Subih M, Mahmoud A-H, Al Dameery K, et al. Nurses' self-efficacy, confidence and interaction with patients with COVID-19: a cross-sectional study. Disaster Medicine and Public Health Preparedness. 2022;16(4):1393-97. [DOI:10.1017/dmp.2021.1] [PMID] []
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