Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic

Hoedl, Manuela; Eglseer, Doris; Bauer, Silvia

Background: The results of several projects on the effects of personal protective equipment (PPE) have been published since the outbreak of COVID-19. It is known that wearing PPE, and specifically face masks, has physcial consequences like headache and pain, which can increase stress among nursing staff. However, none of these studies placed a focus on PPE and nursing staff, although nurses are the only members of the health care profession who are at the patients bedsides 24/7, and PPE is the only way to protect them from a COVID-19 infection. Therefore, this study was carried out to investigate the association between the use of PPE and stress among nursing staff during the COVID-19 pandemic. Methods An online, cross-sectional survey was conducted, which we distributed using snowball sampling techniques. The questionnaire was developed on the basis of (inter-)national recommendations as well as the international literature. We used the perceived level of stress scale to measure the nursing staff members stress levels. Results We included data collected from 2600 nurses in this analysis. Nearly all nursing staff wore face masks. We showed that more than two-thirds of the nurses had moderate to high levels of stress. No statistically significant association between the use of PPE and stress was detected. However, we show a statistically significant association between the duration of mask usage and stress. Discussion and conclusions Nearly all participating nurses wore face masks or FFP masks to protect themselves from COVID-19 infection. This observation might indicate that Austrian nurses display a high level of compliance with national and international regulations and play a key role in such pandemics. Our results also show that increased mask-wearing time led to increased stress levels. These results suggest that (inter-)national regulations on how and when to use PPE should include a maximum duration of time for wearing each type of mask. Such regulations could help to prevent work-related stress, particularly in the case of future epidemics, and avoid burnout among nursing staff or even nurses leaving their jobs. The consequences of both of these negative outcomes should be considered in light of the predicted expected future shortage of health care workers.