During the covid-19 pandemic, many people worldwide were at a high risk of developing mental health issues, especially healthcare providers like nurses (Spoorthy et al., 2020). This systematic review will summarize evidence concerning the self-efficacy of psychological aid interventions in promoting mental healthcare among nurses during the coronavirus pandemic.
The research used databases such as Google Scholar, PubMed, Scopus, and PsycINFO to source relevant articles. The quality of the methodology of selected articles was assessed using the Quality evaluation Tool for Quantitative research.
A search of electronic databases containing peer-reviewed articles identified seven articles based on exclusion and inclusion criteria. All the studies digitally delivered psychological aid interventions for nurses. Even though the selected articles demonstrated high heterogeneity, the findings supported the effectiveness of psychological interventions in decreasing anxiety, depression, and distress while promoting self-efficiency in nurses.
Since mental health issues are expected to rise due to Covid-19, digital tools are in a position to provide a wide range of support and treatment for the issues (Inkster et al., 2020). This is because the treatment can uniquely and immediately meet the needs of the nurses. However, further research must be conducted to assess the cost-effectiveness of digital interventions.
The recent growing pandemic of Covid-19 caused by coronavirus has posed a significant threat to many people throughout the world. Even though there have been various pandemics in the past, such as Ebola, Asian flu, and MERS, Covid-19 has caused the most psychological impact on individuals, especially the healthcare workers like nurses (Dubey, 2020). Since the beginning of the pandemic, studies have shown that adverse effects result from social isolation, like adapting maladaptive behaviors such as a sedentary lifestyle and consumption of alcohol and drugs (Robb et al., 2020).
According to studies, another effect of social isolation is increased levels of depression, anxiety, distress, and PTSD. Nurses being the frontline workers during the pandemic, are vulnerable to psychological effects (Robb et al., 2020). According to studies, about 35% of nurses have reported symptoms of depression, and about 44% have reported levels of anxiety (Spoorthy et al., 2020). Therefore, offering healthcare during the pandemic has already proven to be a stressful task with psychological impacts on the nurses.
During the pandemic, nurses experience long working hours, fear of contracting coronavirus, fear of infecting family and friends, isolation, and stress due to the death of workmates and patients. Therefore, to curb the psychological impacts, psychological interventions have been put in place to offer support to nurses during the pandemic. However, there is no systematic assessment of the existing interventions, which limits the conceptualization of the effectiveness of the care. To fill the gap, this systematic review will offer an outline of the evidence on the existing mental health support interventions and their effects on the mental health of nurses during the pandemic.
Is digital psychological support intervention more efficient than face-to-face intervention in preventing mental health issues in nurses during the Covid-19 pandemic?
Protocol and Registration
The engagement of this systematic review was recorded with PROSPERO, and its registration number is yet to be formulated. The review follows the PRISMA statement, and after receiving the registration number, it can be viewed on Google Scholar and PubMed.
This systematic was performed in line with the PICOS elements. The articles selected during the search strategy were those published since the beginning of the pandemic and were only those published in English.
Searches to determine relevant articles were run in the following databases: Google Scholar, PubMed, and Scopus, and Psych INFO. The search strategy combined medical search titles and binding terms based on participants, intervention, comparison, outcomes, and study design. The strategy was in accordance with the PICOS element as follows:
- (“psychological support” OR “mental well-being” OR “emotional support”);
- (“anxiety” OR “self- efficacy” OR “depression” OR “distress”).
Criteria of Exclusion and Inclusion
The articles that were chosen met the following exclusion and inclusion criteria. Articles were included if, first, they were the initial study articles. Secondly, the study utilized those articles that employed quantitative methods. Thirdly, the study also employed articles that tested the effect of psychological intervention established during the coronavirus pandemic. Also, the articles that were included in the study are those that reported a minimum of one psychological basic outcome. The last criteria of inclusion were those articles that focused on nurses with or without mental illness issues. Articles were contraindicated if they only reported biomedical data and were not the initial research articles.
Selection of Study
Following the probe and exclusion of articles, the studies that were selected for the study were screened for eligibility based on their title, abstract, and full text. Searches of databases identified 6,345 reports and of which 100 were duplicates. Of the remaining 6,245 searches, 6 235 of them were excluded because they were not initial articles and gave only biomedical results. The remaining ten articles were assessed for inclusion by examining their full text. Following the review, three articles were excluded because their psychological intervention was not availed during the coronavirus pandemic. Therefore, after the selection process, only seven articles qualified for the systematic review.
Data were independently collected from the final seven chosen articles. The data that was collected from the articles include the year of publication, first author, country, aim and design of the study, type of psychological intervention, the format of delivery, age, gender and sample size, points on follow-ups, results and measures and lastly, the main results. The collected data was then used to come up with the outline of research features to address the review’s objective. The studies explored during this review were heterogeneous, and therefore, a meta-analysis could not be performed.
Data collection for each of the studies was characterized by PICOS. It was also characterized by a follow-up period and the study sample.
During the research, the Quality Assessment Tool for Quantitative Studies Dictionary was used to assess the methodology of each chosen study. The standardized tool was established to offer high-quality systematic reviews (Mokkink et al., 2017). The final result of the quality assessment rated the methodology as strong, weak, or moderate in several sections. The sections include selection bias, study design, blinding, withdrawals, confounders, and data collection methods. Of the seven chosen articles, four articles had moderate quality, two had poor quality, and the remaining had a strong methodology quality.
The chosen studies were conducted in the United States, China, and Italy. In each study, the sample size scaled from a minimum of 30 to a maximum of 600 participants. All the studies featured nurses of both genders, with the mean age varying from 25 to 72 years. The duration of intervention ranged from four weeks to 16 weeks. The recipients of the interventions were nurses who were giving healthcare to patients with Covid-19.
Most of the interventions were in digital form but two of the studies involved face-to-face interact actions. The face-to-face interactions were made up of self-feedback training, after-work activities, peer-group psychological education and discussions, and measurement of mood. The nurses maintained a generally positive outcome for almost six weeks of working, and substantial treatment effects on gains and a decrease in the presented issues were observed.
Summary of Main Findings and Relevance of the Main Outcome to Nurses
Findings from this systematic review show that there are different psychological interventions that have been established during the coronavirus pandemic for nurses. However, the digital interventions were the most effective for most of the nurses. The effectiveness of digital interventions is due to the significant progress in technology within the context of therapy (Bucci et al., 2019).
The utilization of digital interventions to promote and improve nurses’ self-efficacy and mental health has been proven to be important during emergencies (Bucci et al., 2019), such as the ones experienced during the coronavirus pandemic. The psychological interventions were established with the aim of promoting positive emotions, preventing depression, decreasing distress, improving mental well-being, and maintaining the effectiveness of teamwork. The main outcome of this research was the efficiency of the digital psychological intervention. The strength of this outcome to the nurses was its ability to promote and prevent mental health issues among the healthcare providers.
Limitations at the Review Level
Although extensive research was performed, only seven studies qualified to be used in this review. Of the seven, four studies had a moderate quality of methodology, and two had a poor quality while only one had a strong quality of methodology. Consequently, among the seven studies, none of them made follow-ups for more than three months. This short period of follow-ups prevented the illustration of valid deductions over the short and long-term effects of the psychological interventions. Moreover, the featured researches were only performed in the United States, Italy, and China, which also limited the generalization of the results of the research.
Limitations at the Study and Outcome Level
Furthermore, the results of the interventions were biased because the outcomes varied across the selected studies preventing this study from deducting meaningful conclusions. The other limitation is that each intervention had different terms of treatment, duration of treatment, and tools of treatment. Nevertheless, the results of this study support the viability and flexibility of digital tools when offering psychological aid intervention.
Existing studies have shown the advantages of digital psychological aid interventions like reduced geographical limitations, cost-effectiveness, reduced waiting time, and contributing towards the disclosure of nurses while in their offices or homes (Hollis et al., 2018). However, there should be a few considerations in terms of establishing and assessing the effectiveness of digital psychological interventions. To begin with, it is essential to carry out a usability test to assess whether nurses find the intervention platform used during treatment usable and functional. The assessment is because the usability issues may affect the treatment process (Lattle et al., 2019).
In addition to usability, the participant of the intervention should be adequately vetted and assessed before they begin the intervention. Therefore, further studies should be done to assess and review the results of the digital psychological treatments for nurses to allow for shared treatment decisions so as to reduce or prevent the mental health challenges faced by the caregivers. The digital interventions are efficient and effective, but some of them have domain-specific impacts instead of global impacts on the nurses.
Due to the Coronavirus pandemic and social isolation, there have been reports of adverse health issues across the world. Particularly, nurses have been greatly affected by the pandemic (Pancani et al., 2021). The finding of this systematic review shed light on the mental effects and the treatment or interventions that the nurses might utilize to prevent or treat the psychological effects during the pandemic. Moreover, the findings of the review also provide a valuable understanding of the digital interventions that nurses may use to deal with their mental issues. Furthermore, further studies should be conducted to assess the outcome of the digital psychological interventions for nurses so as to allow for shared decision-making with consideration to the prevention of mental health issues.
This review received funding from the local union of nurses in the form of a grant. The grant was used to hire extra manpower to help during the article reviewing process.
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