MENTAL HEALTH STATUS AND JOB PERFORMANCE DURING COVID-19 PANDEMIC AMONG NURSES WORKING IN SECONDARY HEALTH FACILITIES IN IBADAN, NIGERIA

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E. Isiek, Y.A. Olasunkanmi, F.I. Adeniji, D.A. Adewole, S. Bello

Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan..

Abstract

Background: The impact of the COVID-19 pandemic may not only affect the mental health of nurses but may also affect nurses’ job performance. The study was aimed at assessing the mental health status and job performance among nurses in secondary health facilities in Ibadan.

Methods: A cross-sectional study among 250 nurses in secondary health facilities in Ibadan, Nigeria. Generalized anxiety disorder, insomnia, depression, post-traumatic stress disorder (PTSD) and job performance were assessed using pre-tested standardized tools.

Results: About 34%, 17.2%, and 3.6% had mild, moderate, and severe anxiety, while 31%, 10.4%, and 6% experienced mild, moderate, and severe depression. Additionally, 12%, 2.4%, and 13.6% had mild, probable, and high PTSD. Job performance was significantly associated with marital status, anxiety, insomnia, depression, and PTSD symptoms (p<0.001).

Conclusion: This study highlights the need to prioritize the mental health of nurses in order to promote their efficiency.

Keywords: COVID-19 pandemic, Nurses, Mental health, Job performance, public health emergency.

Introduction

Mental health is defined by the World Health Organization (WHO) as “a state of wellbeing in which every individual realizes his or her own potential, can work productively and fruitfully and is able to make a contribution to his or her community”.¹ Mental ill health is an important and rising burden on public health globally and a key contributor to the overall increase in morbidity and disability.² As a result, the subject of mental health has continued to gain significance around the world. Since the World Health Organization pronounced COVID-19 a global pandemic on March 11, 2020, the focus has been on the disease transmission.³ The impact of the pandemic on other spheres of life such as the psychological impact of the pandemic on affected individuals, the general population, and specific groups such as healthcare workers, may have been neglected.⁴

Evidence from previous pandemics, such as the severe acute respiratory syndrome (SARS) in 2003 and the Middle East Respiratory Syndrome (MERS) in 2009, suggests that disease outbreaks result in varying degrees of mental health disorders in both the general population and healthcare workers, particularly nurses.^5,6 For instance, during the peak of the SARS epidemic in Taiwan in 2003, nurses at a hospital caring for suspected cases had mental health issues.⁷ Fear, anxiety, depression, insomnia, exhaustion, and post-traumatic stress disorders (PTSD) were among the mental problems reported among healthcare workers during the MERS and SARS pandemics, majority of which are known to persist for a sustainable period, long after the pandemic.^6,8

The prevalence of anxiety and depression among nurses during the COVID-19 outbreak has been reportedly high. Nurses were reported to experience the highest anxiety levels ranging from 15% to 92%.^9,10 A study conducted among nurses in an intensive care team reported 50.4% and 30.4% as the prevalence of depression and anxiety respectively.¹¹ Having a high level of anxiety has detrimental consequences, such as a loss of appetite, dizziness, sleep disturbances, and vomiting or nausea.¹² Higher anxiety levels were also linked to physical impairment, poor coping mechanisms (such as increased alcohol or drug consumption), stress and depression, and increased suicidal ideation.¹² Additionally, unmanaged anxiety may have long-term consequences for nurses’ work performance and job satisfaction, resulting in frequent absenteeism and eventual turnover.¹³

Insomnia is currently recognized as one of the most serious public health issues.¹⁴ This disorder has a negative influence on the quality of life of millions of people around the world and leads to a drop-in physical activity.¹⁵ The sleep quality of nurses fighting COVID-19 was observed to be poor, with a prevalence of insomnia as high as 64.7% in Wuhan, China.¹⁶ Nurses with insomnia are more anxious and depressed, and are less productive. ¹⁷ This decrease in nurses’ productivity has irrevocable implications, with severe cases such as fatigue-related errors resulting in a patient’s death.¹⁷ Similarly, the nurses’ roles in infection prevention, infection control, isolation, containment may result in a high degree of stress, which may heighten the risk of developing PTSD.^18,19 PTSD in turn may lead to burnout among nurses which is associated with an increase in sick leave, absenteeism, job withdrawal, and poor work performance,^20,21 thereby affecting the patient’s health outcome and the health sector at large ²².

The mental health disorders experienced by healthcare workers who are working during the COVID-19 pandemic, may have an impact on their job performance, affecting their concentration and decision-making abilities.^{23, 24}. Healthcare workers with poor mental health might decrease the quality and quantity of job performance, resulting in poor clinical outcomes of patients ²⁵. Given the growing global pandemic evidence of nurses’ mental health deterioration, it’s critical to determine the prevalence of these mental health disorders. Hence, this study was aimed at examining the mental health disorders and job performance among nurses and to determine the association between mental health and job performance of nurses during the COVID-19 pandemic.