Abstract

This aim of this study was to analyze levels of resilience, depression and self-efficacy among Brazilian nursing professionals during the COVID-19 pandemic. We conducted an analytical cross-sectional study between October and December 2020. Student’s t test, analysis of variance and multiple linear regression were used to investigate the impact of two main factors (Resilience and Self-efficacy) on depression. A total of 8,792 nursing professionals participated in the study; 5,124 (58.8%) had low levels of resilience. The mean overall score for Depression was 0.74, ranging from 0.59 to 0.80, while the mean overall score for Self-efficacy was 0.68, ranging from 0.56 to 0.80. The variable that had the strongest impact on depression levels was Resilience, explaining 6.6% of the outcome (p < 0.001, AdjustedR2 = 0.066). In general, respondents had low levels of resilience and self-efficacy and showed high mean depression scores. Level of resilience had an impact on depression. The findings reveal an urgent need for actions to promote the psychological health of nursing professionals working in crisis situations such as pandemics.

Key words:
Psychological resilience; Depression; Self-efficacy; Nursing professionals; COVID-19

Introduction

High job stress levels can lead to job dissatisfaction, anxiety, depression and burnout among clinical nurses, affecting the sustainability of nursing teams and the physical and mental health of nurses¹1 Van Bogaert P, Adriaenssens J, Dilles T, Martens D, Van Rompaey B, Timmermans O. Impact of role-, joband organizational characteristics on nursing unit managers' work related stress and well-being. J Adv Nurs 2014; 70(11):2622-2633.

2 Hayes B, Douglas C, Bonner A. Work environment, job satisfaction, stress and burnout among haemodialysis nurses. J Nurs Manag 2015; 23(5):588-598.^-33 Guo YF, Cross W, Plummer V, Lam L, Luo YH, Zhang JP. Exploring resilience in Chinese nurses: a cross-sectional study. J Nurs Manag 2017; 25(3):223-230.. Resilience is key to dealing with adversity in the workplace.

Resilience is the interaction between individual and environmental attributes (family, social, cultural) that determine an individual’s ability to cope with adverse conditions⁴4 Gurgel LEA, Gonçalves PLENTZ, Méa RD, Joly MCRA, Reppo CT. Avaliação da resiliência em adultos e idosos: revisão de instrumento. Estud Psicol 2013; 30(4):487-496.. Several different disciplines (psychology, psychopathology, sociology and psychiatry, among others) have contributed to the development of the concept of resilience, meaning that it requires a multisectoral approach, which has become increasingly important in contexts of social, political and economic adversities, like those experienced during the COVID-19 pandemic.

Various studies have shown that the mental and psychological health of health professionals deteriorated during the pandemic, with high rates of prevalence of anxiety, burnout, depression and psychological distress⁵5 Chew QH, Chia FA, Ng WK, Lee WCI, Tan PLL, Wong CS, Puah SH, Shelat VG, Seah ED, Huey CWT, Phua EJ, Sim K. Perceived stress, stigma, traumatic stress levels and coping responses amongst residents in training across multiple specialties during COVID-19 pandemic - a longitudinal study. Int J Environ Res Public Health 2020; 17(18):6572.^,66 Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, Birk JL, Brodie D, Cannone DE, Chang B, Claassen J, Cornelius T, Derby L, Dong M, Givens RC, Hochman B, Homma S, Kronish IM, Lee SAJ, Manzano W, Mayer LES, McMurry CL, Moitra V, Pham P, Rabbani L, Rivera RR, Schwartz A, Schwartz JE, Shapiro PA, Shaw K, Sullivan AM, Vose C, Wasson L, Edmondson D, Abdalla M. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry 2020; 66:1-8.. Studies conducted during outbreaks of other diseases, such as SARS, Ebola and MERS-CoV, have emphasized that psychological resilience, coping behaviors and social support play a protective role against the stress of caring for infected patients, especially among nursing staff⁷7 Baduge MSP, Morphet J, Moss C. Emergency nurses' and department preparedness for an ebola outbreak: a (narrative) literature review. Int Emerg Nurs 2018; 38:41-49.^,88 De Brier N, Stroobants S, Vandekerckhove P, De Buck, E. Factors affecting mental health of health care workers during coronavirus disease outbreaks (SARS, MERS & COVID-19): a rapid systematic review. PLoS One 2020; 15(12):e0244052..

Resilience is therefore a protective factor for the physical and mental well-being of nursing professionals. Nursing can be a stressful profession, especially when dealing with the pressures of social and ethical contexts in constant transformation, which can have a negative effect on both nursing professionals and patients⁹9 Hegney D, Rees CS, Eley R, Osseiran-Morrison R, Francis K. The contribution of individual psychological resilience in determining the professional quality of life of Australian nurses. Front Psychol 2015; 6:1613.^,1010 Rushton CH, Batcheller J, Schroeder K, Donohue P. Burnout and resilience among nurses practicing in high-intensity settings. Am J Crit Care 2015; 24(5):412-420..

Understanding resilience among nursing professionals is therefore extremely important. Despite the large number of studies on the topic, there is no broadly accepted definition of resilience in the nursing literature, only agreement that it is vital in enabling nurses to cope with workplace stress and pressures⁹9 Hegney D, Rees CS, Eley R, Osseiran-Morrison R, Francis K. The contribution of individual psychological resilience in determining the professional quality of life of Australian nurses. Front Psychol 2015; 6:1613.^,1111 Hart PL, Brannan JD, De Chesnay M. Resilience in nurses: an integrative review. J Nurs Manag 2014; 22(6):720-734..

Resilience encompasses different modes of resistance to stress, while coping refers to the ability to deal with stress and promote positive adaptation. Coping therefore occurs at a given moment and resilience takes place over time¹²12 Sinclair VG, Wallston KA. The development and psychometric evaluation of brief resilient coping scale. Assessment 2004; 11(1):94-101.. Self-efficacy is the belief in one’s capacity to organize and carry out a given course of action and is a central element of an individual’s motivation and resistance to pressures from the surrounding environment. Hence the concepts of resilience and self-efficacy are related to coping with economic, social and job changes involving context, culture and collective responsibility¹³13 Barreira DD, Nakamura AP. Resiliência e a autoeficácia percebida: articulação entre conceitos. Aletheia 2006; 23:75-80.^,1414 Fontes AP, Azzi RG. Crenças de autoeficácia e resiliência: apontamentos da literatura sociocognitiva. Estud Psicol 2012; 29(1):105-114..

Nursing professionals with high levels of self-efficacy and resilience are less likely to develop mental disorders such as depression and burnout. In addition, more resilient nursing professionals have higher levels of well-being in the workplace and everyday life. The aim of this study was to analyze levels of resilience, depression and self-efficacy among nursing professionals in Brazil during the COVID-19 pandemic.

Method

Study design

We conducted a cross-sectional analytical study with nursing professionals working in all regions of Brazil. The data were collected between October and December 2020 using an online questionnaire.

Population

The following individuals were considered eligible: nursing professionals (nurses, nursing technicians and auxiliary nurses) working directly in care delivery during the six months prior to data collection in different public and private care settings across all states and regions in Brazil.

Data collection

The data were collected using an online questionnaire created on SurveyMonkey. The link was made available on social media platforms, including Facebook, Twitter, Instagram, WhatsApp, and via email. The form containing the questionnaire was made up of two parts: an informed consent form and survey form.

Data collection instruments

Three instruments were used for data collection: a sociodemographic questionnaire; the Brief Resilient Coping Scale; and the General Health Questionnaire (GHQ-12). The sociodemographic variables were as follows: profession (nurse/nursing technician/auxiliary nurse); sex (male/female); age group (18-30 years, 31-50 years and 51 and over); region (Northeast, North, Midwest, Southeast and South); skin color (white, black, brown, yellow); marital status (married/stable union, single/divorced and widowed); COVID-19 diagnosis (yes/no); and worked in a campaign hospital during the pandemic (yes/no).

The Portuguese version of the Brief Resilient Coping Scale consists of four items with a 5-point Likert response scale: 5) Almost always, 4) Very often, 3) Often, 2) Occasionally, 1) Almost never. A score of less than 13 indicates low resilience and a score of more than 17 indicates strong resilience¹⁵15 Ribeiro JLP, Morais R. Adaptação portuguesa da escala breve de coping resiliente. Psicol Saude Doenças 2010; 11(1):5-13..

The General Health Questionnaire (GHQ-12) is used to assess health-related factors. Applied to different populations and contexts, the questionnaire originated from a 60-item instrument¹⁶16 Goldberg DP. The detection of psychiatric illness by questionnaire. Londres: Oxford University Press; 1972.. The 12-item version of the instrument is widely used today¹⁷17 Damásio BF, Machado WL, Silva JP. Estrutura fatorial do Questionário de Saúde Geral (QSG-12) em uma amostra de professores escolares. Aval Psicol 2011; 10(1):99-105.. For the purposes of the present study, we explored the factorial structure of the GHQ-12, extracting two oblique factors: depression and self-efficacy. The items are answered using the following 4-point Likert scale: 0) Not at all; 1) No more than usual; 2) More than usual; and 3) Much more than usual. Factor 1 (depression) comprised items 2, 5, 6, 9, 10 and 11, while Factor 2 (self-efficacy) consisted of items 1, 3, 4, 7, 8 and 12. The factorial structure identified for the present study is similar to that extracted from a sample of school teachers¹⁷17 Damásio BF, Machado WL, Silva JP. Estrutura fatorial do Questionário de Saúde Geral (QSG-12) em uma amostra de professores escolares. Aval Psicol 2011; 10(1):99-105..

Data analysis

The data were analyzed using descriptive statistics. The scores of the depression and self-efficacy scales were assessed using exploratory factor analysis of the GHQ-12 to calculate weighted means. The score of the resilience scale was calculated using the simple means of the scale items.

Student’s t-test and analysis of variance (ANOVA) were used to compare resilience, depression and anxiety scores with sociodemographic variables, COVID-19 diagnosis and working in a campaign hospital during the pandemic. The data were analyzed using SPSS version 20.0.

A multiple linear regression analysis (forward method) was performed to determine the impact of the two main factors (resilience and self-efficacy) on depression. Resilience and self-efficacy were the independent variables and depression was the dependent variable. We also calculated R²2 Hayes B, Douglas C, Bonner A. Work environment, job satisfaction, stress and burnout among haemodialysis nurses. J Nurs Manag 2015; 23(5):588-598., adjusted R²2 Hayes B, Douglas C, Bonner A. Work environment, job satisfaction, stress and burnout among haemodialysis nurses. J Nurs Manag 2015; 23(5):588-598. and change in R²2 Hayes B, Douglas C, Bonner A. Work environment, job satisfaction, stress and burnout among haemodialysis nurses. J Nurs Manag 2015; 23(5):588-598.. A 95% confidence interval was adopted for all analyses.

Ethical aspects

The project was approved by the ethics committee of the Ribeirão Preto Nursing School, University of São Paulo (code number 4.258.366). The study was conducted in accordance with the ethical norms and standards for research involving human subjects set out in resolutions 466/2012 and 510/2016. All participants signed an online informed consent form.

Results

A total of 8,792 nursing professionals participated in the study, including 5,767 nurses (65.6%). Most of the respondents (7,437 or 84.6%) were female and from the Northeast (2,643 or 30.1%), as shown in Table 1.

Over half of the respondents (5,124 or 58.8%) obtained low overall scores for resilience. The mean overall score for “depression” was 0.74, with scores ranging from 0.59 to 0.80. The mean overall score for “self-efficacy” was 0.68, with scores ranging from 0.56 to 0.80.

The results show statistically significant differences in resilience scores for the following variables: profession (p <0.001); sex (p = 0.003); age group (p<0.001); region (p < 0.001); marital status (p = 0.029); and worked in a campaign hospital (p < 0.001).

Statistically significant differences in depression scores were found for the following variables: profession (p <0.001); sex (p < 0.001); age group (p = 0.01); region (p = 0.012); and marital status (p < 0.001).

Statistically significant differences in self-efficacy scores were observed for the following variables: profession (p < 0.001); marital status (p < 0.001); and worked in a campaign hospital (p = 0.01).

The findings also show that men obtained a higher resilience score than women (M = 12.43; SD = 3.25 versus M = 12.11; SD = 3.30; t(8790) = 3.28, p < 0.001). Depression scores were also higher among men than in women (M = 0.748; SD = 0.021 versus M = 0.746; SD = 0.019; t(8813) = 3.10, p = 0.002), as shown in Table 2.

Statistically significant differences in resilience scores were found between professions (nurse, nursing technician and auxiliary nurse, p < 0.001). The difference between nurses (M = 12.06; SD = 3.27) and nursing technicians (M = 12.33; SD =3.33) was statistically significant (p = 0.002); however, the differences in means between auxiliary nurses and nurses and nursing technicians were not statistically significant. Statistically significant differences in depression scores were found between professions (nurse, nursing technician and auxiliary nurse, p < 0.001). The differences between nurses (M = 0.745; SD = 0.019) and nursing technicians (M = 0.749; SD = 0.020) and between nurses and auxiliary nurses (M = 0.748; SD = 0.021) were statistically significant (p < 0.001). Statistically significant differences in self-efficacy scores were found between professions (nurse, nursing technician and auxiliary nurse, p < 0.001). The differences between nurses (M = 0.683; SD = 0.023) and nursing technicians (M = 0.680; SD = 0.021) and nurses and auxiliary nurses (M = 0.678; SD = 0.024) were statistically significant (p < 0.001).

The results show statistically significant differences in resilience scores between ages and across regions (18-30 years, 31-60 years, 61 years and over, p < 0.001; North, Northeast, Midwest, Southeast and South, p < 0.001). The differences in means between the Northeast (M = 12.27; SD = 3.33) and Southeast (M = 11.98; SD = 3,29) (p = 0.01), North and Southeast (p = 0.003) and North and Southeast (p = 0.001) were statistically significant. Statistically significant differences in resilience scores were also found between marital status groups (married/stable union, single/divorced, widowed, p = 0.029).

Nursing professionals who worked in a campaign hospital during the pandemic obtained higher resilience and self-efficacy scores than those who did not (M = 12.32; SD = 3.30 versus M = 12.07; SD = 3.29; t(8813) = 3.29, p < 0.001 and M = 0.683; SD = 0.023 versus M = 0.681; SD = 0.022; t(8813) = 2.56, p = 0.01), as shown in Table 2.

The findings show that the two main factors (resilience and self-efficacy) had a statistically significant impact on depression (F(2.8789) = 317.031, p < 0.001; _adjustedR²2 Hayes B, Douglas C, Bonner A. Work environment, job satisfaction, stress and burnout among haemodialysis nurses. J Nurs Manag 2015; 23(5):588-598. = 0.067). Table 3 shows the coefficients of the significant predictors, revealing that the variable with the strongest impact on depression was Resilience, explaining 6.6% of the outcome.

Discussion

In general, the respondents had low levels of resilience and self-efficacy and high mean depression scores. Men obtained significantly higher mean resilience scores than women, while nurses showed higher levels of resilience than nursing technicians. Finally, nursing professionals who worked in a campaign hospital during the COVID-19 pandemic obtained significantly higher Resilience scores than those who did not.

To speak of the positive impacts of the COVID-19 pandemic would be to disregard the deaths that occurred¹⁸18 Hallal PC. Resistência e resiliência em tempos de pandemia. Cien Saude Colet 2020; 25(9):3342.. However, despite the chaotic situations experienced during the pandemic, such as the shortage of ICU beds, personal protective equipment and qualified professionals, nursing professionals in Brazil were committed to tackling the crisis, especially those working on the frontline.

The international literature presents evidence of the general relationship between level of resilience and gender. A study with Spanish university students using the Connor-Davidson Resilience Scale showed that male students obtained higher scores for the factors optimism and adaptation to stressful situations¹⁹19 Mata SR, Martínez AM, Ortega FZ, Cuberos RC, Molero PP, Valero GG. Capacidad de resiliencia según tendencia religiosa y género en universitarios. REDIE 2019; 21:e15.. Other studies have also reported significant differences between genders²⁰20 Fínez MJ, Morán MC. La resiliencia y su relación con salud y ansiedad en Estudiantes españoles. Una nueva visión de la Psicología: Psicología Positiva. Int J Develop Educ Psychol 2015; 1(1):409-416.

21 Gil I, Orbea JM, Axpe I. Aproximación al perfil resiliente de los/as futuros/as educadores/as sociales. Rev Int Cien Soci 2012; 1(1):1-15.^-2222 Zurita Y, Castro M, Linares M, Chacón R. Resiliencia un elemento de prevención en actividad física. Sportis 2017; 3(1):564-576.. With regard to profession, the present study revealed that nurses obtained higher resilience scores than nursing technicians. A study investigating psychosocial stress and resilience among nursing professionals in the South of Brazil did not find any statistically significant differences in resilience scores between professions²³23 Macedo ABT, Antoniolli L, Dornelles TM, Hansel LA, Tavares JP, Souza SBCD. Estresse psicossocial e resiliência: um estudo em profissionais da enfermagem. Rev Enferm UFSM 2020; 10(25):e25.. Further research should be conducted to elucidate this question, because both professionals with secondary education level and higher education qualifications may have low levels of resilience.

Nursing professionals in Brazil are divided into categories and poorer working conditions in lower-skilled categories may influence the mental health of workers. A study with nursing technicians in three of Brazil’s regions showed that poor working conditions, such as low pay, overwork and psychic burdens, are frequent among this category²⁴24 Scherer MDDA, Oliveira NAD, Pires DEPD, Trindade LDL, Gonçalves ASR, Vieira M. Aumento das cargas de trabalho em técnicos de enfermagem na atenção primária à saúde no Brasil. Trab Educ Saude 2016, 14(Supl. 1):89-104.. Another study found that approximately half of nursing technicians had mental disorders associated with financial and work issues²⁵25 Santos FFD, Brito MFSF, Pinho LD, Cunha FO, Rodrigues Neto JF, Fonseca ADG, Silva CSDO. Transtornos mentais comuns em técnicos de Enfermagem de um hospital universitário. Rev Bras Enferm 2020; 73(1):e20180513.. These issues were aggravated by the pandemic, which led to changes in the dynamics of everyday work.

Our findings regarding professionals working in campaign hospitals are inconsistent with the literature, with a study investigating resilience showing that health professionals working with the diagnosis and treatment of people with COVID-19 were more vulnerable to mental illness²⁶26 Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Hu S. Factors associated with mental health outcomes among health care workers exposed to Coronavirus Disease 2019. JAMA Netw Open 2020; 3(3):e203976.. Adverse situations involving exposure to health risks can trigger high levels of stress and symptoms of mental illness. However, it is important to consider that campaign hospitals were better equipped than other health facilities during the first months of the pandemic, which may have influenced nursing professionals’ perceptions of the safety of working on the frontline.

Our findings reveal statistically significant differences in self-efficacy for the variables profession and working in a campaign hospital during the COVID-19 pandemic, with nurses obtaining higher scores than nursing technicians and auxiliary nurses and nursing professionals who worked in campaign hospitals obtaining higher scores than those who did not. Nursing professionals obtained generally low overall scores for self-efficacy. Similar results were found in a study in Italy, which showed that nurses had low self-efficacy and that female nurses were more likely to have low self-efficacy than male nurses²⁷27 Simonetti V, Durante A, Ambrosca R, Arcadi P, Graziano G, Pucciarelli G, Simeone S, Vellone E, Alvaro R, Cicolini. Anxiety, sleep disorders and self-efficacy among nurses during COVID-19 pandemic: a large cross-sectional study. J Clin Nurs 2021; 30(9-10):1360-1371.. A study with nurses in Wuhan showed that self-efficacy was one of the main factors affecting anxiety among nurses²⁸28 Mo Y, Deng L, Zhang L, Lang Q, Pang H, Liao C, Wang N, Tao P, Huang H. Anxiety of Nurses to support Wuhan in fighting against COVID-19 Epidemic and its Correlation With Work Stress and Self-efficacy. J Clin Nurs 2021; 30(3-4):397-405..

Studies investigating self-efficacy among nursing teams during the COVID-19 pandemic are scarce in both the national and international literature. However, based on Bandura’s²⁹29 Bandura A. A teoria da aprendizagem social de Bandura. In: Bandura A. Teorias do desenvolvimento: conceitos e aplicações. [s.l.]:[s.n]; 1992. p. 175-192. definition of self-efficacy - a person’s belief in their ability to perform a task - it is possible that the differences between nurses, nursing technicians and auxiliary nurses may be partially related to the activities performed by nurses, such as leading nursing staff and the management of nursing and health services. In addition, authors have suggested that a belief in one’s own ability can influence other indicators such as resilience³⁰30 Ibiapina ISM, Santos Junior RD, Grandizoli MV, Garcia VCB. Autoeficácia e indicadores de ansiedade e depressão em pacientes com câncer. Psicol Hosp 2018; 16(1):2-17..

It is important to implement interventions designed to develop and maintain high levels of self-efficacy among nursing professionals, especially during times of pandemic. A study with Jordanian nurses showed that coping self-efficacy was a protective factor against psychological distress during the COVID-19 pandemic³¹31 Shahrour G, Dardas LA. Acute stress disorder, coping self-efficacy and subsequent psychological distress among nurses amid COVID-19. J Nurs Manag 2020; 28(7):1686-1695.. The authors suggested the implementation of stress-reduction strategies and referral to psychological services aimed at reducing mental distress among nursing professionals experiencing stress due to the pressure of a heavy workload or exposure to risk.

The data presented show that nurses had a significantly higher mean depression score than nursing technicians and auxiliary nurses and that resilience and self-efficacy had a significant influence on depression, with the former explaining 6.6% of the outcome.

Clinical nurses face situations that negatively affect their physical and mental health on a daily basis. They face high levels of workplace stress, which negatively affect care delivery⁹9 Hegney D, Rees CS, Eley R, Osseiran-Morrison R, Francis K. The contribution of individual psychological resilience in determining the professional quality of life of Australian nurses. Front Psychol 2015; 6:1613.^,1010 Rushton CH, Batcheller J, Schroeder K, Donohue P. Burnout and resilience among nurses practicing in high-intensity settings. Am J Crit Care 2015; 24(5):412-420.. The low levels of resilience observed in the present study influence the mental health of nursing professionals. The pandemic aggravated obstacles to care, negatively impacting nursing professionals. Actions are therefore needed to promote the physical and psychological well-being of professionals working in exceptional situations. Studies have shown that resilience plays an important role in promoting the mental health of people in times of pandemic³²32 Gonçalves MP, Freires LA, Tavares JET, Vilar R, Gouveia VV. Fear of COVID and trait anxiety: mediation of resilience in university students. Psicol Teor Prat 2021; 23(1):1-16..

Resilience plays a fundamental role in coping with unexpected situations among nursing professionals. However, these factors should not be analyzed in an isolated manner. It is important to understand the circumstances under which these professionals work and think critically beyond the pandemic as an isolated conditioning factor. From this perspective, an international review covering four countries highlighted that organizational support and participation in policy and procedure development resulted in higher resilience scores among nurses³³33 Jo S, Kurt S, Bennett JA, Mayer K, Pituch KA, Simpson V, Reifsnider E. Nurses' resilience in the face of coronavirus (COVID-19): an international view. Nurs Health Sci 2021; 23(3):646-657.. Further research with nursing professionals in Brazil is therefore needed to investigate factors related to the involvement of nursing teams in management decision-making and the formulation of nursing care policies.

Our findings regarding symptoms of mental disorders are similar to those of a study conducted in the Northeast of Brazil, which found that symptoms of depression and anxiety were more frequent among professionals working in services with inadequate working conditions³⁴34 Santos KMRD, Galvão MHR, Gomes SM, Souza TAD, Medeiros ADA, Barbosa IR. Depressão e ansiedade em profissionais de enfermagem durante a pandemia da covid-19. Esc Anna Nery 2021; 25(esp.):e20200370.. The international literature has documented high levels of depression among health professionals who worked in care services during the COVID-19 pandemic³⁵35 Aly HM, Nemr NA, Kishk RM, bakr Elsaid NMA. Stress, anxiety and depression among healthcare workers facing COVID-19 pandemic in Egypt: a cross-sectional online-based study. BMJ Open 2021; 11(4):e045281.^,3636 Sahebi A, Nejati B, Moayedi S, Yousefi K, Torres M, Golitaleb M. The prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic: an umbrella review of meta-analyses. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110247..

A systematic literature review found that the pooled prevalence of depression among nurses working during the COVID-19 pandemic was 35%, which is consistent with the results of the present study³⁷37 Al Maqbali M, Al Sinani M, Al-Lenjawi B. Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: a systematic review and meta-analysis. J Psychosom Res 2020; 141:110343.. The findings in the literature and the results of the present study suggest an urgent need for actions to address the difficulties experienced by nursing professionals during crisis situations like pandemics. Urgent measures are needed to promote self-care focusing on protective factors for the mental and physical health of nursing professionals.

Good occupational protection practices and the provision of personal protective equipment were found to be protective factors against depression among pediatric nurses in China³⁸38 Zheng R, Zhou Y, Qiu M, Yan Y, Yue J, Yu L, Lei X, Tu D, Hu Y. Prevalence and associated factors of depression, anxiety, and stress among Hubei pediatric nurses during COVID-19 pandemic. Compr Psychiatry 2021; 104:152217.. The COVID-19 pandemic has brought the academic and public discussion of the psychological problems faced by nursing professionals when subjected to unexpected care situations center stage.

The promotion of the psychological and physical health of nursing professionals is increasingly urgent in the face of crisis situations such as pandemics. The government and professional bodies should develop actions to better equip workers to cope with similar situations in the future. Under adequate working conditions, nurses should be prepared to lead a multiprofessional team without adversely affecting their own general health.

The main contributions of this study can be summarized as follows: 1) Low levels of resilience contribute to higher levels of depression, which is important for discussions about the elaboration of public policies designed to improve levels of resilience among nursing professionals, especially those working during unexpected events such as pandemics; and 2) the results encompass the three categories of nursing professionals (nurses, nursing technicians and auxiliary nurses) working during the pandemic in all of Brazil’s regions, contributing to a better understanding of issues related to the mental health of nurses in Brazil.

Conclusion

Our findings show that the COVID-19 pandemic had psychological impacts on nursing professionals working in health services during the crisis. The respondents obtained generally low scores for resilience and self-efficacy, aspects that are considered protective factors against depression, and level of resilience had an impact on depression. In general, respondents showed low levels of resilience and self-efficacy and high scores for depression. These findings reveal an urgent need for actions to promote the psychological health of nursing professionals working in crisis situations such as pandemics.

References

Publication Dates

History