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TABLE OF CONTENT

Table of Contents

TABLE OF CONTENT..............................................................................................................i

CHAPTER ONE........................................................................................................................1

INTRODUCTION......................................................................................................................1

Background.............................................................................................................................1

Problem Statement..................................................................................................................2

Purpose of the Study...............................................................................................................4

The purpose of the study is to investigate the psychological impacts of Covid-19 pandemic

on nurses at Ankaful Psychiatric Hospital..............................................................................4

Specific Objectives.................................................................................................................4

Research questions.................................................................................................................4

Significance of the Study........................................................................................................4

Delimitations..........................................................................................................................5

Limitations..............................................................................................................................6

Definition of terms.................................................................................................................6

Organization of the Study.......................................................................................................7

CHAPTER TWO.......................................................................................................................8

LITERATURE REVIEW...........................................................................................................8

Introduction............................................................................................................................8

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 Overview of Covid 19............................................................................................................8

Assessing Nurses' Knowledge of the COVID-19 Pandemic................................................10

Exploring the Psychological Effects of the COVID-19 Pandemic on Nurses.....................12

Coping Measures of Nurses in Dealing with the Psychological Consequences of the

COVID-19 Pandemic...........................................................................................................14

METHODOLOGY...................................................................................................................17

Introduction..........................................................................................................................17

Study Area............................................................................................................................17

Study Type and Design........................................................................................................17

Study Population..................................................................................................................17

Sampling...............................................................................................................................17

Pre-testing.............................................................................................................................18

Method of Data Collection...................................................................................................18

Data Processing and Analysis..............................................................................................18

Ethical Consideration...........................................................................................................18

CHAPTER FOUR....................................................................................................................19

RESULTS AND DISCUSSION..............................................................................................19

Introduction..........................................................................................................................19

DISCUSSION.......................................................................................................................35

Assessing nurses' knowledge of the covid-19 pandemic......................................................35

Psychological effects of the covid-19 pandemic on nurses..................................................37

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 Coping measures of nurses in dealing with the psychological consequences of the covid-19

pandemic...............................................................................................................................41

CHAPTER FIVE......................................................................................................................45

CONCLUSION AND RECOMMENDATION.......................................................................45

Conclusion............................................................................................................................45

Recommendation..................................................................................................................47

References............................................................................................................................50

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 CHAPTER ONE

INTRODUCTION

Background

The increasing number of confirmed COVID-19 cases and related deaths has thrust the global

healthcare system into an unprecedented crisis (Catton, 2020). Local healthcare systems

worldwide are grappling with the overwhelming challenge posed by the pandemic, especially

as they contend with limited resources. One group of individuals that has borne the brunt of

this crisis, both physically and emotionally, is healthcare workers, and among them, nurses

have faced a unique set of challenges.

Nurses, as front-line healthcare providers, are at the forefront of the battle against the novel

coronavirus. Their daily experiences have become increasingly daunting due to a multitude of

factors. Firstly, the availability and accessibility of Personal Protective Equipment (PPE)

have become constant concerns, leaving nurses worried about their own safety as they care

for COVID-19 patients. Secondly, many nurses are grappling with inadequate staffing levels,

resulting in heavier workloads and longer shifts. The sheer demand for their services, coupled

with the need to isolate themselves from family and friends to prevent transmission, has

caused immense distress. Additionally, nurses constantly face the emotional toll of

witnessing the suffering of ill patients, which can take a significant toll on their mental

health. Furthermore, they are exposed to a substantial risk of contracting the virus

themselves, further compounding their anxiety and stress (Kupferschmidt & Cohen, 2020).

Nurses constitute the largest professional group within the global healthcare workforce,

making them a vital component of coordinated responses to public health emergencies like

pandemics (Jordan, Adab & Cheng, 2020). Historically, nurses have consistently played a

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pivotal role in infection prevention and control, as well as caring for individuals during times

of crisis (Corless et al., 2018). During the COVID-19 pandemic, nurses have once again

demonstrated their essential role. They are not only responsible for identifying, isolating, and

managing COVID-19 cases but also for supporting patients with non-COVID-19 related

health needs. This multifaceted role places them in a high-stress environment, where the

cumulative effects of repeated exposure to stressors can lead to significant mental health

challenges.

The toll on nurses' mental health is a matter of increasing concern. The persistent stressors

they face can result in poorer mental health and functioning (Cavanaugh, Campbell &

Messing, 2014). Nurses are experiencing symptoms of posttraumatic stress disorder (PTSD),

depression, and anxiety more frequently than the general population (Mealer, Burnham,

Goode, Rothbaum & Moss, 2009). These mental health challenges not only affect nurses'

personal well-being but also have the potential to impact the quality of care they provide to

patients.

In conclusion, the COVID-19 pandemic has placed an immense burden on healthcare systems

globally, and nurses, as the largest professional group within healthcare, have faced

extraordinary challenges. The combination of increased workload, concerns about safety and

PPE, inadequate staffing, isolation, and the emotional toll of caring for patients has taken a

toll on their mental health. Recognizing and addressing these challenges is crucial not only

for the well-being of nurses but also for the effectiveness of the healthcare system's response

to the ongoing pandemic.

Problem Statement

The COVID-19 pandemic has had a profound impact on healthcare systems worldwide, with

nurses serving as the backbone of patient care in hospitals. This research seeks to address the

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pressing problem of understanding the multifaceted impact of the COVID-19 pandemic on

nurses working in a hospital setting. Specifically, it aims to investigate the physical and

psychological well-being of nurses, the increased workload and stress they face, the risk of

burnout, and the coping strategies employed by nurses in response to these challenges.

The COVID-19 pandemic has placed unprecedented stress on nurses, who are at the forefront

of patient care (Catton, 2020). As healthcare workers deal with the novel coronavirus, nurses

have been grappling with a myriad of stressors, including concerns about the availability and

access to Personal Protective Equipment (PPE), inadequate staffing, long working hours,

isolation from family and friends, worry for the health of their patients, and a substantial risk

of contracting the virus (Kupferschmidt & Cohen, 2020).

Nurses constitute the largest professional group within healthcare globally and have

historically played pivotal roles in infection prevention, crisis management, and patient care

(Jordan, Adab & Cheng, 2020; Corless et al., 2018). However, the COVID-19 pandemic has

placed them under immense strain, necessitating a deeper understanding of the challenges

they face.

The cumulative effects of repeated exposure to these stressors may result in poorer mental

health and functioning among nurses, leading to symptoms of posttraumatic stress disorder

(PTSD), depression, and anxiety more frequently than the general population (Cavanaugh,

Campbell & Messing, 2014; Mealer, Burnham, Goode, Rothbaum & Moss, 2009).

This research problem is significant as it not only sheds light on the well-being of nurses who

have been instrumental in the pandemic response but also has implications for healthcare

systems' preparedness to support and protect the mental and physical health of nurses during

public health crises like the COVID-19 pandemic.

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Purpose of the Study

The purpose of the study is to investigate the psychological impacts of Covid-19 pandemic on

nurses at Ankaful Psychiatric Hospital.

Specific Objectives

1. To assess the level knowledge of nurses on Covid-19 pandemic.

2. To explore the psychological effects of the pandemic of Covid-19 on nurses

3. To examine the coping measures of nurses in dealing with the psychological

consequences of the pandemic of Covid-19.

Research questions

1. What is the level of knowledge of nurses on Covid-19 pandemic?

2. How are the psychological effects of the Covid-19 affecting nurses?

3. What are the coping measures of nurses in dealing with the psychological

consequences of the pandemic of Covid-19?

Significance of the Study

The study on the impact of the COVID-19 pandemic on nurses in hospital holds immense

significance for several reasons, including its potential to inform healthcare policy, improve

the well-being of healthcare workers, and enhance overall patient care.

Understanding the profound impact of the COVID-19 pandemic on nurses provides critical

insights for healthcare systems and policymakers. This knowledge can inform future

preparedness efforts, helping hospitals and healthcare organizations develop more effective

strategies for responding to public health emergencies and ensuring the availability of

necessary resources such as Personal Protective Equipment (PPE).

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Nurses, as front-line healthcare providers, have experienced unprecedented physical and

psychological challenges during the pandemic. Investigating these challenges and their

effects on nurses' mental and emotional well-being can guide the development of targeted

support systems, including mental health services and interventions, to mitigate the adverse

impact on healthcare workers.

Recognizing the impact of the pandemic on nurses is essential for maintaining high-quality

patient care. Burnout, stress, and mental health issues among nurses can compromise patient

safety and the quality of care provided. Addressing these challenges can lead to better patient

outcomes and overall healthcare system effectiveness.

Findings from this research can inform nursing education and training programs to better

prepare future nurses for dealing with crisis situations. Incorporating lessons learned from the

pandemic can enhance the resilience and adaptability of nursing professionals.

This study contributes to the growing body of nursing research on the impact of pandemics

and public health emergencies. It adds valuable insights to the field, advancing our

understanding of the unique challenges nurses face during such crises and their coping

mechanisms.

Delimitations

While researching the impact of the COVID-19 pandemic on nurses in hospital is essential, it

is important to acknowledge and define the delimitations of the study to provide a clear scope

and context for the research.

This research focuses on a specific hospital, Ankaful Psychiatric Hospital within a defined

geographic area, Central Region of Ghana. The findings may not be fully representative of

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nurses' experiences in different regions or healthcare settings, both nationally and

internationally.

The study does not delve deeply into the broader government policies and responses to the

pandemic, which can significantly impact nurses' experiences and resources available to

them.

Limitations

The study's sample may be subject to selection bias, as it relies on voluntary participation

from nurses who may have experienced the pandemic differently or are more inclined to

participate due to their particular experiences or motivations.

The data collected through surveys may be influenced by response bias, as participants may

underreport or overreport their experiences or emotions due to social desirability or recall

inaccuracies.

The research design is primarily cross-sectional, capturing a snapshot of nurses' experiences

at a specific point in time. This design may not capture changes and developments over time

or provide insights into the dynamic nature of the pandemic.

Resource constraints, such as time and budget limitations, may affect the comprehensiveness

of the study, including the number of participants, and the scope of data collection.

Definition of terms

COVID-19 Pandemic: The COVID-19 pandemic refers to the global outbreak of the novel

coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2). It encompasses the widespread transmission of the virus,

leading to significant public health and healthcare system challenges

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Impact: In the context of this research, "impact" refers to the effects, consequences, or

changes resulting from the COVID-19 pandemic on nurses in a hospital setting. These effects

may encompass physical, psychological, and professional dimensions, among others.

Nurses: "Nurses" refers to registered nurses (RNs) who provide direct patient care in a

hospital setting. They are healthcare professionals responsible for various aspects of patient

care, including assessment, treatment, and patient education.

Physical Well-being: "Physical well-being" refers to the overall physical health and safety of

nurses. It encompasses considerations such as exposure to infectious agents, availability and

use of Personal Protective Equipment (PPE), and occupational health concerns.

Psychological Well-being: "Psychological well-being" pertains to the mental and emotional

health of nurses. It encompasses factors like stress, anxiety, depression, and posttraumatic

stress symptoms resulting from the pandemic.

Organization of the Study

Chapter one presented a background to the study, problems statement, objectives,

significance and organization of the study.

Chapter Two focused on relevant literature related to the Covid-19 pandemic and empirical

review of the study was discussed in this chapter.

Chapter Three described the research methodology, including the research design, the

population, sampling procedures for the study, as well as the research instrument, pre-testing

procedure, data collection procedure and analysis of data.

Chapter Four presented the research results and discussion of the findings in relation to the

reviewed literature.

Chapter Five summarized the study, provide relevant conclusions and recommendations base

on research findings.
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 CHAPTER TWO

LITERATURE REVIEW

Introduction

This chapter reviews relevant literature concerning Covid-19 and its impact on psychiatric

nurses at the Ankaful Psychiatric Hospital. A search of electronic databases was conducted

using keywords such as Covid-19 pandemic and impact on nurses. The literature searched

included the following data bases: EBScohost, CINAHL, MEDLINE, Wiley online library,

Science direct, PubMed and Google scholar.

Overview of Covid 19

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has had a

profound and far-reaching impact on global health, economies, and daily life.

The COVID-19 pandemic is believed to have originated in a seafood market in Wuhan,

China, in late 2019, where live animals were also sold. The zoonotic spillover event likely

involved bats and an intermediate host, although the exact source has not been definitively

identified (Zhou et al., 2020). The virus rapidly spread to humans, leading to a global health

crisis.

The epidemiology of COVID-19 has been characterized by its rapid transmission. It is

primarily transmitted through respiratory droplets from infected individuals, and

asymptomatic carriers can also spread the virus. The virus has exhibited a wide range of

clinical presentations, from mild or asymptomatic cases to severe respiratory distress and

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death. The pandemic has followed waves of infection in various regions, with periodic surges

in cases and associated public health challenges (Anderson et al., 2020).

COVID-19 manifests with a spectrum of clinical symptoms. Common symptoms include

fever, cough, and shortness of breath, but it can also lead to pneumonia, acute respiratory

distress syndrome (ARDS), and multi-organ failure. Notably, COVID-19 has been associated

with a heightened risk of blood clotting and thromboembolic events (Connors & Levy, 2020).

The disease's variability in severity has posed challenges for healthcare systems in managing

patient care.

Governments and public health agencies worldwide have implemented a range of measures to

mitigate the spread of COVID-19. These measures include lockdowns, travel restrictions,

social distancing, mask mandates, and widespread testing and contact tracing. The success of

these measures has varied by region, with some countries achieving significant control of the

virus, while others have faced ongoing challenges (Chin et al., 2020).

The global response to the COVID-19 pandemic has involved unprecedented cooperation

between countries, scientists, and healthcare organizations. International collaborations have

led to the rapid development of multiple vaccines through various platforms, such as mRNA

and viral vector vaccines (Voysey et al., 2021). Vaccination campaigns, though faced with

distribution challenges, have played a crucial role in reducing the severity of the disease and

preventing hospitalizations and deaths.

The COVID-19 pandemic has exposed vulnerabilities in healthcare systems, supply chains,

and public health infrastructures worldwide. It has highlighted disparities in access to

healthcare, with marginalized communities disproportionately affected (Yaya et al., 2020).

Additionally, misinformation and vaccine hesitancy have posed challenges to achieving

widespread vaccination coverage.

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The COVID-19 pandemic represents one of the most significant global health crises in

modern history. Its origins, rapid transmission, variable clinical manifestations, and the

complex web of public health measures and interventions make it a multifaceted challenge.

While vaccines offer hope for controlling the pandemic, addressing the long-term

consequences and lessons learned from COVID-19 will remain a critical focus of research

and public health efforts.

Assessing Nurses' Knowledge of the COVID-19 Pandemic

Understanding the level of knowledge that nurses possess regarding the COVID-19 pandemic

is essential for ensuring their effectiveness in managing and responding to this global health

crisis.

Several studies have been conducted worldwide to assess nurses' knowledge of COVID-19.

These assessments often involve the administration of surveys or questionnaires to gauge

their understanding of various aspects of the virus, including transmission, symptoms,

preventive measures, and management. In general, these studies have revealed a range of

knowledge levels among nurses, with some demonstrating a strong understanding of COVID-

19, while others exhibit gaps in knowledge (Elhadi et al., 2020; Ilesanmi et al., 2020).

Several factors contribute to nurses' knowledge of COVID-19. One of the most critical

factors is education and training. Nurses who have received specific COVID-19 training or

have access to educational resources tend to have higher knowledge levels (Giao et al., 2020).

Additionally, nurses who work in COVID-19 dedicated units or have direct exposure to

COVID-19 patients tend to have more comprehensive knowledge due to their firsthand

experience (Fernandez et al., 2020).

Furthermore, demographic factors, such as age, years of experience, and level of education,

can influence nurses' knowledge. Studies have shown that younger nurses and those with
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more years of experience may have a better understanding of COVID-19 due to exposure to

recent educational materials (Ghazawy et al., 2021; Xiong et al., 2020).

Nurses' knowledge of COVID-19 directly impacts patient care and infection control

measures. Adequate knowledge enables nurses to identify potential cases promptly,

implement appropriate isolation and infection prevention measures, and provide accurate

information and support to patients and their families (Ilesanmi et al., 2020). Conversely,

insufficient knowledge may lead to misdiagnosis, delayed care, or the inadvertent spread of

the virus within healthcare settings (Elhadi et al., 2020).

In addition to patient care, nurses' knowledge also influences their own safety and well-being.

Proper understanding of infection control protocols and the proper use of personal protective

equipment (PPE) are critical for nurses' protection (Fernandez et al., 2020). Knowledge

deficits can put healthcare workers at increased risk of contracting COVID-19.

Several research studies have also been conducted in Ghana to assess nurses' knowledge of

the COVID-19 pandemic and its implications. In one study conducted in the country,

researchers found that a significant proportion of nurses demonstrated good knowledge of

COVID-19, especially regarding its clinical presentation, transmission routes, and preventive

measures (Gyimah et al., 2021). However, there were variations in knowledge levels among

different nursing categories, with registered nurses exhibiting higher levels of knowledge

compared to auxiliary nurses. These findings emphasize the need for targeted educational

interventions to ensure uniform knowledge levels among all nursing staff in Ghana's

healthcare system.

Another study in Ghana highlighted the impact of COVID-19 knowledge on nurses' practices

and attitudes (Donkor et al., 2021). The research revealed that nurses with better knowledge

of the virus were more likely to adhere to infection prevention and control protocols, use

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personal protective equipment correctly, and provide effective patient care. This underscores

the importance of improving nurses' knowledge through continuous training and education to

enhance their capacity to manage and respond to the pandemic effectively.

Assessing nurses' knowledge of the COVID-19 pandemic is essential for ensuring effective

patient care and infection control. Studies have shown variability in knowledge levels among

nurses, with factors such as education, training, and direct exposure to COVID-19 patients

influencing their knowledge. Adequate knowledge is crucial not only for the safety of nurses

but also for the proper management of COVID-19 cases and the prevention of further

transmission within healthcare settings.

Exploring the Psychological Effects of the COVID-19 Pandemic on Nurses

The COVID-19 pandemic has had profound psychological effects on healthcare workers

worldwide, including nurses who are at the frontline of patient care.

Nurses have experienced a wide range of emotional responses during the COVID-19

pandemic. While dedication to patient care remains a driving force, many nurses have

reported increased levels of anxiety, fear, and uncertainty (Hu et al., 2020). Witnessing the

suffering and loss of patients, coupled with concerns about personal safety and the well-being

of their families, has taken a toll on their emotional well-being.

The pandemic has introduced numerous stressors for nurses, contributing to burnout. Factors

such as long working hours, inadequate staffing, increased patient loads, and the constant fear

of contracting the virus have exacerbated stress levels (Emmett et al., 2021). Burnout among

nurses has been reported at alarming rates, with symptoms including emotional exhaustion,

depersonalization, and a reduced sense of personal accomplishment (Emmett et al., 2021).

High levels of burnout can negatively impact patient care and the mental health of nurses.

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Nurses exposed to traumatic events during the pandemic, such as patient deaths and

overwhelming patient volumes, have reported posttraumatic stress symptoms (Spoorthy et al.,

2020). Symptoms may include intrusive thoughts, nightmares, hyperarousal, and avoidance

behaviors. Nurses who experience these symptoms are at risk of developing posttraumatic

stress disorder (PTSD) and require mental health support and intervention (Mealer et al.,

2009).

Studies have shown that nurses are at an increased risk of experiencing symptoms of

depression and anxiety due to the pandemic (Hu et al., 2020). The constant exposure to

suffering and the uncertainty surrounding the virus's trajectory have contributed to these

mental health challenges. These symptoms can hinder nurses' ability to provide high-quality

patient care and negatively impact their own well-being.

Despite the psychological challenges, many nurses have demonstrated remarkable resilience

and adaptive coping strategies during the pandemic. Social support from colleagues, access to

mental health resources, and self-care practices have been identified as protective factors

(Spoorthy et al., 2020). Recognizing and promoting effective coping mechanisms is essential

to mitigating the psychological impact of the pandemic on nurses.

In Ghana, studies have also been conducted to investigate the psychological effects of the

COVID-19 pandemic on nurses. A study conducted in the Greater Accra Region of Ghana

revealed that nurses experienced significant psychological distress during the pandemic, with

symptoms of anxiety, depression, and posttraumatic stress (Addo-Boateng et al., 2021).

Factors such as the fear of infection, increased workload, and witnessing the suffering of

patients contributed to their psychological distress. This research underscores the importance

of addressing the mental health needs of nurses in Ghana to ensure their well-being and the

quality of patient care.

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Furthermore, a study conducted in Kumasi, Ghana, assessed nurses' coping strategies and

resilience in the face of the pandemic's psychological challenges (Kusi et al., 2021). The

research found that nurses employed various coping mechanisms, including seeking social

support from colleagues and family, engaging in relaxation exercises, and accessing mental

health resources. Their resilience and ability to adapt to the psychological stressors were

crucial in maintaining their mental well-being. These findings highlight the importance of

recognizing and promoting effective coping strategies among nurses in Ghana to enhance

their psychological resilience during the ongoing pandemic.

The COVID-19 pandemic has imposed significant psychological burdens on nurses,

impacting their emotional well-being, increasing stress levels, and contributing to mental

health challenges such as burnout, posttraumatic stress symptoms, depression, and anxiety.

Recognizing these psychological effects is crucial for healthcare organizations to provide

appropriate support and resources to nurses. Efforts to promote resilience and effective

coping strategies can help nurses navigate the ongoing challenges posed by the pandemic.

Coping Measures of Nurses in Dealing with the Psychological Consequences of the

COVID-19 Pandemic

The COVID-19 pandemic has placed immense psychological stress on nurses, necessitating

the development and utilization of coping measures to navigate the challenges they face.

One of the primary coping strategies adopted by nurses during the pandemic is seeking social

support. Nurses often turn to their colleagues, friends, and family members for emotional

support and to share their experiences (Al Maqbali et al., 2020). Peer support allows nurses to

discuss their concerns, process their emotions, and reduce feelings of isolation. Furthermore,

the sense of camaraderie among healthcare workers can foster resilience and a sense of unity

in facing the challenges posed by COVID-19.

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Self-care has become a critical aspect of nurses' coping measures during the pandemic.

Nurses recognize the importance of taking care of their physical and mental well-being to

sustain their ability to provide quality patient care (Labrague & de Los Santos, 2020). Self-

care practices may include exercise, mindfulness, relaxation techniques, and maintaining a

healthy work-life balance. Engaging in these practices helps nurses reduce stress levels and

enhance their resilience.

Many healthcare organizations have implemented mental health resources and support

services to assist nurses in coping with the psychological consequences of the pandemic.

These resources include counseling services, crisis helplines, and mental health programs

(Serrão et al., 2021). Nurses are encouraged to seek professional help when experiencing

severe psychological distress or symptoms of mental health conditions. The availability of

mental health resources plays a crucial role in addressing nurses' needs.

Some nurses have participated in mindfulness and resilience training programs to enhance

their coping skills (Chan et al., 2020). These programs teach nurses techniques to manage

stress, increase emotional resilience, and improve their ability to adapt to challenging

situations. Mindfulness practices, such as meditation and deep breathing exercises, have been

particularly effective in reducing anxiety and enhancing nurses' well-being.

Effective communication and collaboration within healthcare teams have been instrumental

in nurses' coping measures. Open and transparent communication channels allow nurses to

express their concerns, share experiences, and collectively problem-solve (Al Maqbali et al.,

2020). Team collaboration fosters a supportive work environment and can mitigate the

psychological impact of the pandemic.

Ghana again has experienced several research studies that investigated the coping measures

adopted by nurses to deal with the psychological consequences of the COVID-19 pandemic.

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A study conducted in Ghana's Ashanti Region found that nurses often relied on their faith and

spirituality as a coping mechanism during the pandemic (Kusi et al., 2021). The research

revealed that engaging in religious practices and seeking solace in their faith helped nurses

manage stress, anxiety, and emotional distress. This coping strategy highlights the cultural

and spiritual dimensions of resilience among Ghanaian nurses.

Another study conducted in Ghana explored the role of social support networks in nurses'

coping mechanisms (Amegah et al., 2021). The research emphasized the significance of

family and community support for nurses facing the psychological challenges of the

pandemic. The extended family system and close-knit communities in Ghana provided

emotional and practical support, including childcare and assistance with daily chores,

allowing nurses to focus on their duties and mental well-being. These findings underscore the

importance of social and community support structures in enhancing nurses' coping during

the COVID-19 crisis in Ghana.

Nurses have employed a range of coping measures to address the psychological consequences

of the COVID-19 pandemic. Seeking social support, engaging in self-care practices,

accessing mental health resources, participating in mindfulness and resilience training, and

promoting team collaboration and communication have all played crucial roles in helping

nurses navigate the challenges they face. These coping measures are essential not only for

nurses' well-being but also for ensuring the continued provision of high-quality patient care

during the ongoing pandemic.

CHAPTER THREE

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 METHODOLOGY

Introduction

This chapter of the study talks about the methods and procedures which was used in

conducting the study. It specifically took into consideration, the profile of the study area,

study type and design, study population, sampling, pre-test, method of data collection, data

processing and analysis, ethical consideration.

Study Area

The study area is Ankaful Psychiatric Hospital. It one on the three psychiatric hospitals in

Ghana. It is located in the Central Region.

Study Type and Design

The study will employ a cross-sectional research design. The design is chosen because it

allows for the collection of data at a single point in time, providing a snapshot of the impact

of Covid-19 on nurses at Ankaful Psychiatric Hospital.

Study Population

The study population is registered nurses. The total population of the registered nurses is 263.

Sampling

The population for this study is registered nurses. An estimation of sample size was

determined using Yamane’s formula for sample size. This gave a good representation of the

entire targeted population of the nurses.

N
n= 2
1+ N ( e )

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Where n = sample size, N = population and e = level of precision or confident level

263
n= 2 = 158.67
1+ 263 ( 0.05 )

The sample size is 159 nurses as we cannot have decimal of humans.

Pre-testing

Pre-testing of the questionnaire will be conducted at the Cape Coast Teaching Hospital. This

will be done to determine the consistency and the accuracy of the questionnaire.

Method of Data Collection

A structured questionnaire was developed based on the research objectives. Respondents

were approached, purpose of the study explained, informed consent obtained and

questionnaires subsequently administered.

Data Processing and Analysis

Data collected was analyzed using descriptive statistics such as frequencies and percentages.

Ethical Consideration

Permission was obtained from the academic office of the college before research was carried

out. Privacy and confidentiality were ensured by anonymizing data and securely storing.

Informed consent was obtained from respondents, explanation of the purpose of the study,

voluntary participation, and their rights were duly given them.

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 CHAPTER FOUR

RESULTS AND DISCUSSION

Introduction

This chapter presents the results and discussions of the study. The main issues covered

included the socio-demographic characteristics of the respondents, assessment of the level

knowledge, the psychological effects and coping measures of nurses in dealing with the

psychological consequences of the pandemic of Covid-19.

Table 1: DEMOGRAPHIC INFORMATION OF RESPONDENTS

Question Response Option Frequency (Count) Percentage (%)

What is your age group? 18-23 years 25 17.5%
24-29 years 35 24.5%
30-35 years 30 21.0%
36-41 years 25 17.5%
42 and above 28 19.5%
What is your gender? Male 45 31.5%
Female 98 68.5%
What is your marital status? Single 32 22.4%
Co-habiting 15 10.5%
Married 96 67.1%
What is your religion? Christian 120 83.9%
Islam 10 7.0%
African Traditional 13 9.1%
How long have you been working? 1-3 years 50 35.0%
4-6 years 38 26.6%
7-9 years 30 21.0%
10 years and above 25 17.5%
Total 143 100.0%
Source fieldwork (2023)

The results from Table 1, which presents the demographic information of the respondents,

provide valuable insights into the characteristics of the survey participants. Regarding the

respondents' age groups, the data shows a fairly balanced distribution. The largest age group

19
was individuals aged 24-29 years, comprising 24.5% of the sample. The age group of 18-23

years accounted for 17.5%, while the age groups of 30-35 years and 42 and above both had

21.0% and 19.5% representation, respectively. This indicates a diverse age range among the

survey participants, with no single age group dominating the sample. In terms of gender

distribution, the majority of respondents identified as female, constituting 68.5% of the

sample, while 31.5% identified as male. This gender breakdown reflects a higher

participation of females in the survey compared to males. The marital status of the

respondents varied considerably. The most common marital status was "Married," with

67.1% of the respondents falling into this category. "Single" respondents accounted for

22.4%, and "Co-habiting" respondents made up 10.5% of the sample. These findings suggest

a diverse mix of marital statuses within the surveyed population. Religious affiliation among

the respondents was predominantly Christian, with 83.9% of the sample identifying as such.

A smaller proportion of respondents, 7.0%, reported being of the Islamic faith, while 9.1%

identified with African Traditional religions. This data underscores the prevalence of

Christianity among the survey participants. The duration of respondents' work experience

varied, with a range of experience levels represented. The largest group, 35.0%, reported

having 1-3 years of work experience. The group with 4-6 years of experience accounted for

26.6%, while 21.0% had 7-9 years of experience. A significant 17.5% had been working for

10 years or more. This indicates a diversity of work experience levels among the respondents.

Table 2: ASSESSING NURSES' KNOWLEDGE OF THE COVID-19 PANDEMIC

Response Frequency Percentage

Question Option (Count) (%)
Have you received specific training or education on Yes 115 80.4%

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 Response Frequency Percentage
Question Option (Count) (%)
COVID-19?
No 28 19.6%
Are you currently working in a COVID-19
dedicated unit or have you had direct exposure to
COVID-19 patients? Yes 0 0%
No 143 100%
What is your highest level of education? Diploma 53 37.0%
Bachelor’s
degree 84 58.7%
Master's degree
(MSN) 5 3.5%
Doctoral degree
(Ph.D.) 1 0.7%
Have you ever attended any COVID-19-related
workshops or seminars? Yes 92 64.3%
No 51 35.7%
In your opinion, how confident are you in Not confident
identifying potential COVID-19 cases? at all 15 10.5%
Slightly
confident 30 21.0%
Moderately
confident 40 28.0%
Very confident 35 24.5%
Extremely
confident 23 16.1%
How often do you update your knowledge about
COVID-19? Daily 40 28.0%
Weekly 45 31.5%
Monthly 30 21.0%
Rarely 18 12.5%
Never 10 7.0%
Do you believe that your knowledge of COVID-19
has a direct impact on patient care and infection
control in your healthcare setting? Strongly Agree 60 42.0%
Agree 50 35.0%
Neutral 20 14.0%
Disagree 10 7.0%
Strongly
Disagree 3 2.0%

21
 Response Frequency Percentage
Question Option (Count) (%)
How familiar are you with the proper use of
personal protective equipment (PPE) for COVID- Not familiar at
19? all 5 3.5%
Slightly
familiar 15 10.5%
Moderately
familiar 30 21.0%
Very familiar 60 42.0%
Extremely
familiar 33 23.0%
How would you rate your overall knowledge of
COVID-19? Very Low 5 3.5%
Low 12 8.4%
Moderate 30 21.0%
High 60 42.0%
Very High 36 25.1%
Total 143 100.0%
Source fieldwork (2023)

The results presented in Table 2 provide valuable insights into the knowledge and

experiences of healthcare professionals, specifically nurses, regarding the COVID-19

pandemic. The first question inquired about whether the respondents had received specific

training or education on COVID-19. The majority of the nurses, accounting for 80.4% of the

sample, indicated that they had received such training, while 19.6% reported not having

received training. This suggests that a significant portion of the nursing staff had been

formally educated about COVID-19. In response to the question about whether the nurses

were currently working in a COVID-19 dedicated unit or had direct exposure to COVID-19

patients, none of the respondents reported direct exposure, indicating that all the participants

in the study were not currently working in high-risk COVID-19 patient care environments.

The respondents' highest level of education was also surveyed. A substantial percentage held

a bachelor's degree (58.7%), while 37.0% had a diploma. A smaller proportion had a master's

22
degree (MSN) (3.5%), and an even smaller group possessed a doctoral degree (Ph.D.) (0.7%).

These education levels provide insights into the educational backgrounds of the surveyed

nurses. The nurses were also asked if they had attended any COVID-19-related workshops or

seminars. The responses revealed that 64.3% had attended such events, while 35.7% had not,

indicating a significant level of interest and engagement in educational opportunities related

to the pandemic. In terms of confidence in identifying potential COVID-19 cases, the

majority of nurses expressed varying degrees of confidence. Notably, 24.5% reported feeling

"Very confident," while 28.0% felt "Moderately confident." A smaller percentage was

"Slightly confident" (21.0%), and 16.1% felt "Extremely confident." A minority expressed

they were "Not confident at all" (10.5%). These results indicate a range of self-assessed

confidence levels in identifying potential COVID-19 cases. Regarding the frequency of

updating knowledge about COVID-19, 31.5% of the respondents reported updating their

knowledge on a weekly basis, followed by 28.0% who did so daily. 21.0% updated their

knowledge monthly, 12.5% rarely updated, and 7.0% reported never updating. This suggests

a proactive approach among a significant proportion of nurses in staying informed about the

pandemic. The nurses were also asked about their beliefs regarding the impact of their

knowledge of COVID-19 on patient care and infection control. A majority either "Strongly

Agree" (42.0%) or "Agree" (35.0%) that their knowledge has a direct impact, while a smaller

percentage felt "Neutral" (14.0%), "Disagree" (7.0%), or "Strongly Disagree" (2.0%). This

highlights the perceived significance of knowledge in patient care among the majority of

respondents. In terms of familiarity with the proper use of personal protective equipment

(PPE) for COVID-19, a notable percentage of nurses indicated being "Very familiar" (42.0%)

or "Extremely familiar" (23.0%). Smaller proportions reported being "Moderately familiar"

(21.0%), "Slightly familiar" (10.5%), or "Not familiar at all" (3.5%). These findings indicate

a varying level of expertise in PPE usage among the surveyed nurses. Lastly, when asked to

23
rate their overall knowledge of COVID-19, a significant portion assessed their knowledge as

either "High" (42.0%) or "Very High" (25.1%). Smaller percentages rated their knowledge as

"Moderate" (21.0%), "Low" (8.4%), or "Very Low" (3.5%). This suggests that the majority

of respondents had a favorable view of their knowledge level regarding the COVID-19

pandemic.

TABLE 3: PSYCHOLOGICAL EFFECTS OF THE COVID-19 PANDEMIC ON

NURSES

Question Response Frequency Percentage

Increased levels of anxiety, fear, or uncertainty Yes 89 62.2%
during the COVID-19 pandemic No 54 37.8%
Witnessed suffering or loss of patients due to Yes 0 0%
COVID-19 during your work as a nurse No 143 100%
Concerns about personal safety and well-being Yes 119 83.2%
affecting emotional well-being during the No 24 16.8%
Pandemic
Long working hours contributing to stress
during Strongly Agree 27 18.9%
the pandemic Agree 46 32.2%
Neutral 14 9.8%
Disagree 30 21.0%
Strongly
Disagree 26 18.2%
Inadequate staffing levels increasing stress Yes 102 71.3%
Levels No 41 28.7%
Increased patient loads negatively impacting Strongly Agree 35 24.5%
mental well-being during the pandemic Agree 52 36.4%
Neutral 20 14.0%
Disagree 26 18.2%
Strongly
Disagree 10 7.0%
Experienced symptoms of emotional
exhaustion, Yes 75 52.4%
depersonalization, or reduced personal No 68 47.6%
accomplishment (burnout) during the
pandemic

24
Question Response Frequency Percentage
Symptoms such as intrusive thoughts,
nightmares, Yes 59 41.3%
hyperarousal, or avoidance behaviors related
to No 84 58.7%
experiences during the pandemic
Uncertainty surrounding the COVID-19
pandemic Strongly Agree 22 15.4%
contributing to feelings of depression or
anxiety Agree 48 33.6%
Neutral 30 21.0%
Disagree 28 19.6%
Strongly
Disagree 15 10.5%
Actively engaged in coping mechanisms or
self- Yes 102 71.3%
care practices to manage psychological
challenges No 41 28.7%
Total 143 100%
Source fieldwork (2023)

The data presented in Table 3 focuses on the psychological effects of the COVID-19

pandemic on nurses.

The first question inquired about increased levels of anxiety, fear, or uncertainty during the

COVID-19 pandemic. A majority of nurses, accounting for 62.2% of the sample, reported

experiencing these heightened emotions, while 37.8% stated that they did not. This indicates

that a significant proportion of nurses have been psychologically impacted by the pandemic.

Nurses were also asked if they had witnessed suffering or the loss of patients due to COVID-

19 during their work. Surprisingly, none of the respondents reported witnessing such

experiences, suggesting that the sample consisted of nurses who had not directly encountered

such situations in their healthcare settings. The survey assessed concerns about personal

safety and well-being affecting emotional well-being during the pandemic. A substantial

percentage of nurses, 83.2%, expressed such concerns, while 16.8% reported not being

25
significantly affected in this regard. The impact of long working hours on stress during the

pandemic was examined. Responses varied, with 18.9% "Strongly Agreeing," 32.2%

"Agreeing," 9.8% expressing "Neutral" sentiments, 21.0% "Disagreeing," and 18.2%

"Strongly Disagreeing." These findings highlight the diverse range of perspectives on the role

of working hours in contributing to stress. Concerning inadequate staffing levels and stress,

71.3% of nurses indicated that they experienced increased stress due to staffing inadequacies,

while 28.7% reported not being significantly affected. The impact of increased patient loads

on mental well-being during the pandemic was assessed. A notable percentage either

"Strongly Agreed" (24.5%) or "Agreed" (36.4%) that increased patient loads negatively

impacted their mental well-being. Smaller percentages expressed "Neutral" (14.0%),

"Disagreed" (18.2%), or "Strongly Disagreed" (7.0%). The survey also asked about

experiencing symptoms of emotional exhaustion, depersonalization, or reduced personal

accomplishment, often referred to as burnout, during the pandemic. A majority of

respondents, 52.4%, reported experiencing these symptoms, while 47.6% did not. In terms of

symptoms related to post-traumatic stress, such as intrusive thoughts, nightmares,

hyperarousal, or avoidance behaviors, 41.3% of nurses reported experiencing these

symptoms, while 58.7% did not. The nurses were questioned about whether uncertainty

surrounding the COVID-19 pandemic contributed to feelings of depression or anxiety.

Responses varied, with 15.4% "Strongly Agreeing," 33.6% "Agreeing," 21.0% expressing

"Neutral" sentiments, 19.6% "Disagreeing," and 10.5% "Strongly Disagreeing." Finally, the

survey assessed whether nurses were actively engaged in coping mechanisms or self-care

practices to manage psychological challenges during the pandemic. A significant portion,

71.3%, reported engaging in such practices, while 28.7% indicated that they were not actively

involved in coping mechanisms.

26
TABLE 4: COPING MEASURES OF NURSES IN DEALING WITH THE

PSYCHOLOGICAL CONSEQUENCES OF THE COVID-19 PANDEMIC

Question Response Frequency Percentage

Sought social support to cope with
psychological Yes 118 82.5%
challenges of the COVID-19 pandemic No 25 17.5%
Frequency of engagement in self-care
practices to Daily 38 26.6%
manage stress during the pandemic Weekly 45 31.5%
Monthly 28 19.6%
Rarely 20 14.0%
Never 12 8.4%
Availability of mental health resources and Yes 100 69.9%
support services in healthcare organization No 43 30.1%
Participation in mindfulness or resilience Yes 58 40.6%
training programs to enhance coping skills No 85 59.4%
Belief in the effectiveness of mindfulness Strongly Agree 32 22.4%
practices in reducing anxiety and enhancing Agree 50 35.0%
well-being during the pandemic Neutral 20 14.0%
Disagree 25 17.5%
Strongly
Disagree 16 11.2%
Frequency of open and transparent
communication Daily 42 29.4%
with healthcare team to discuss concerns and Weekly 51 35.7%
share experiences related to the pandemic Monthly 20 14.0%
Rarely 15 10.5%
Never 15 10.5%
Effect of collaborative problem-solving and
team Strongly Agree 34 23.8%
communication on mitigating the
psychological Agree 52 36.4%
impact of the pandemic on well-being Neutral 20 14.0%
Disagree 24 16.8%
Strongly
Disagree 13 9.1%
Effectiveness of coping measures and
resources Very Effective 26 18.2%
provided by healthcare organization in Effective 60 42.0%

27
Question Response Frequency Percentage
managing
psychological consequences of the pandemic Neutral 20 14.0%
Ineffective 27 18.9%
Very Ineffective 10 7.0%
Belief in the essential nature of coping
measures Strongly Agree 39 27.3%
for well-being and quality of patient care
during Agree 55 38.5%
the pandemic Neutral 20 14.0%
Disagree 21 14.7%
Strongly
Disagree 8 5.6%
Experienced challenges or barriers in
accessing Yes 57 39.9%
coping resources and programs provided by No 86 60.1%
Total 143 100%
Source fieldwork (2023)

Table 4 presents the results of the survey focused on how nurses coped with the

psychological challenges of the COVID-19 pandemic, their use of support systems, and their

perceptions of available resources.

One key aspect of coping strategies was seeking social support to manage psychological

challenges during the pandemic. A significant proportion, 82.5% of nurses, reported seeking

social support, emphasizing the importance of this form of coping in their experiences. The

frequency of engagement in self-care practices to manage stress during the pandemic varied.

Daily engagement was reported by 26.6% of nurses, while 31.5% engaged in self-care

practices on a weekly basis. Monthly engagement was reported by 19.6%, and 14.0%

engaged rarely, while 8.4% never engaged in self-care practices. This indicates that nurses

employed a range of self-care routines to manage their stress. The availability of mental

health resources and support services within healthcare organizations was also evaluated. A

substantial 69.9% of nurses reported having access to these resources, underscoring the

28
importance of mental health support within healthcare settings. Participation in mindfulness

or resilience training programs to enhance coping skills was reported by 40.6% of nurses,

while 59.4% had not participated in such programs. This suggests that a significant

proportion of nurses actively sought training to improve their coping abilities. Belief in the

effectiveness of mindfulness practices in reducing anxiety and enhancing well-being during

the pandemic varied. A considerable percentage either "Strongly Agreed" (22.4%) or

"Agreed" (35.0%) with the effectiveness of these practices, while 14.0% expressed "Neutral"

sentiments. A smaller proportion "Disagreed" (17.5%) or "Strongly Disagreed" (11.2%). This

illustrates diverse perspectives on the usefulness of mindfulness practices. The frequency of

open and transparent communication with the healthcare team to discuss concerns and share

experiences related to the pandemic varied. Daily communication was reported by 29.4% of

nurses, while 35.7% communicated weekly. Monthly communication was reported by 14.0%,

while 10.5% communicated rarely, and 10.5% never engaged in such discussions. The impact

of collaborative problem-solving and team communication on mitigating the psychological

impact of the pandemic on well-being was examined. A significant proportion either

"Strongly Agreed" (23.8%) or "Agreed" (36.4%) with the positive impact of collaboration,

while 14.0% expressed "Neutral" sentiments. A smaller percentage "Disagreed" (16.8%) or

"Strongly Disagreed" (9.1%). The effectiveness of coping measures and resources provided

by healthcare organizations in managing the psychological consequences of the pandemic

was assessed. Responses varied, with 18.2% finding these measures "Very Effective," 42.0%

"Effective," 14.0% "Neutral," 18.9% "Ineffective," and 7.0% "Very Ineffective." Regarding

the belief in the essential nature of coping measures for well-being and quality of patient care

during the pandemic, 27.3% "Strongly Agreed," while 38.5% "Agreed." A notable 14.0%

expressed "Neutral" sentiments, while 14.7% "Disagreed," and 5.6% "Strongly Disagreed."

These results reflect the varying views on the necessity of coping measures. Experienced

29
challenges or barriers in accessing coping resources and programs provided by healthcare

organizations was reported by 39.9% of nurses, while 60.1% had not encountered such

barriers. This underscores the importance of facilitating access to coping resources for

healthcare workers.

DISCUSSION

Assessing nurses' knowledge of the covid-19 pandemic

Most nurses (80.4%) had received specific training or education on COVID-19,

demonstrating a commitment to staying informed and prepared for the pandemic. None of the

surveyed nurses reported currently working in high-risk COVID-19 patient care

environments, indicating limited direct exposure to COVID-19 patients. Educational

backgrounds varied, with a majority holding bachelor's degrees (58.7%). A significant

percentage of nurses (64.3%) attended COVID-19-related workshops and seminars,

underlining their interest in ongoing education and staying up-to-date with pandemic-related

information. Nurses displayed a range of confidence levels in identifying potential COVID-

19 cases, with varying degrees of self-assessed confidence. Many nurses demonstrated a

proactive approach to staying informed about COVID-19, with a substantial percentage

updating their knowledge on a weekly (31.5%) or daily (28.0%) basis. A majority of nurses

believed that their knowledge of COVID-19 directly impacted patient care and infection

control, with 42.0% strongly agreeing and 35.0% agreeing with this statement. Nurses had

varying levels of familiarity with the proper use of personal protective equipment (PPE), with

a notable portion feeling very or extremely familiar. Most nurses had a positive self-

assessment of their overall knowledge of COVID-19, with 42.0% rating it as "High" and

25.1% as "Very High."

30
Several studies conducted worldwide have assessed nurses' knowledge of COVID-19, often

through the use of surveys or questionnaires. These studies consistently reveal varying

knowledge levels among nurses, with some demonstrating a strong understanding of COVID-

19, while others exhibit gaps in knowledge (Elhadi et al., 2020; Ilesanmi et al., 2020). In the

present survey, it was found that a substantial percentage of nurses (80.4%) had received

specific training or education on COVID-19. This result aligns with the literature, which

emphasizes the role of education and training in influencing nurses' knowledge. Nurses who

have received specific training tend to have higher knowledge levels (Giao et al., 2020).

The literature suggests that several factors influence nurses' knowledge of COVID-19. For

instance, nurses who work in COVID-19 dedicated units or have direct exposure to COVID-

19 patients tend to have more comprehensive knowledge due to their firsthand experience

(Fernandez et al., 2020). In contrast, the surveyed nurses in the current study reported no

direct exposure to COVID-19 patients, indicating a potential limitation in their exposure to

the virus. Demographic factors, such as age, years of experience, and level of education, have

also been shown to influence nurses' knowledge. Younger nurses and those with more years

of experience may have a better understanding of COVID-19 due to exposure to recent

educational materials (Ghazawy et al., 2021; Xiong et al., 2020). In the current survey,

educational backgrounds varied, with a majority holding bachelor's degrees (58.7%),

reflecting the diversity in educational qualifications among nurses.

Nurses' knowledge of COVID-19 directly impacts patient care and infection control

measures. Adequate knowledge enables nurses to identify potential cases promptly,

implement appropriate isolation and infection prevention measures, and provide accurate

information and support to patients and their families (Ilesanmi et al., 2020). The survey

results corroborate these findings, as the majority of nurses believed that their knowledge of

31
COVID-19 directly impacted patient care and infection control, with 42.0% strongly agreeing

and 35.0% agreeing with this statement.

In addition to patient care, nurses' knowledge also influences their own safety and well-being.

Proper understanding of infection control protocols and the proper use of personal protective

equipment (PPE) are critical for nurses' protection (Fernandez et al., 2020). Inadequate

knowledge can put healthcare workers at increased risk of contracting COVID-19. Notably,

in the survey, a notable portion of nurses reported being "very" or "extremely familiar" with

the proper use of PPE.

Psychological effects of the covid-19 pandemic on nurses

A majority of nurses (62.2%) reported experiencing increased levels of anxiety, fear, or

uncertainty during the COVID-19 pandemic. This finding underscores the psychological toll

the pandemic has taken on healthcare professionals, with more than half of the sample

reporting heightened emotional distress. Surprisingly, none of the surveyed nurses reported

witnessing suffering or the loss of patients due to COVID-19 during their work. This suggests

that the sample primarily consisted of nurses who had not directly encountered such

distressing situations in their healthcare settings. The survey assessed concerns about

personal safety and well-being affecting emotional well-being during the pandemic. A

substantial percentage of nurses (83.2%) expressed such concerns, highlighting the

significant impact of the pandemic on their emotional state. Responses regarding the impact

of long working hours on stress varied. While 18.9% "Strongly Agreed" that long hours were

stressful, 32.2% "Agreed," 9.8% were "Neutral," 21.0% "Disagreed," and 18.2% "Strongly

Disagreed." These diverse perspectives indicate that the role of working hours in contributing

to stress is a subject of varying opinions among nurses. Inadequate Staffing Levels and

Stress: A significant percentage of nurses (71.3%) reported experiencing increased stress due

32
to inadequate staffing levels, while 28.7% reported not being significantly affected. This

suggests that staffing issues have a notable impact on the well-being of nurses. Many nurses

either "Strongly Agreed" (24.5%) or "Agreed" (36.4%) that increased patient loads negatively

impacted their mental well-being. Smaller percentages expressed differing sentiments, with

14.0% "Neutral," 18.2% "Disagreed," and 7.0% "Strongly Disagreed." In terms of

experiencing symptoms of emotional exhaustion, depersonalization, or reduced personal

accomplishment (burnout), 52.4% of respondents reported experiencing these symptoms,

while 47.6% did not. Regarding symptoms related to post-traumatic stress, such as intrusive

thoughts, nightmares, hyperarousal, or avoidance behaviors, 41.3% of nurses reported

experiencing these symptoms, while 58.7% did not. Nurses were questioned about whether

uncertainty surrounding the COVID-19 pandemic contributed to feelings of depression or

anxiety. Responses varied, with 15.4% "Strongly Agreeing," 33.6% "Agreeing," 21.0%

expressing "Neutral" sentiments, 19.6% "Disagreeing," and 10.5% "Strongly Disagreeing."

Finally, the survey assessed whether nurses were actively engaged in coping mechanisms or

self-care practices to manage psychological challenges during the pandemic. A significant

portion (71.3%) reported engaging in such practices, while 28.7% indicated that they were

not actively involved in coping mechanisms.

The results of the survey depict a range of psychological challenges faced by nurses during

the COVID-19 pandemic. A significant majority (62.2%) reported experiencing heightened

levels of anxiety, fear, or uncertainty. This finding corroborates the literature, which

highlights the emotional toll that the pandemic has taken on healthcare workers (Hu et al.,

2020).

It is intriguing to note that none of the surveyed nurses reported witnessing patient suffering

or loss due to COVID-19 during their work. This could be attributed to the composition of

the sample, which may consist of nurses working in settings where such experiences were

33
less frequent. The absence of direct exposure to these distressing situations might have

contributed to the variation in their psychological responses.

The survey uncovered substantial concerns about personal safety and well-being affecting

nurses' emotional states, with 83.2% expressing such concerns. This aligns with the

literature's findings, which suggest that concerns about personal safety and family well-being

have been paramount stressors for nurses (Hu et al., 2020). These concerns are exacerbated

by the constant exposure to the virus in healthcare settings.

The impact of long working hours on stress was met with varying responses, reflecting

diverse opinions among nurses. This diversity in perspectives on the role of working hours in

contributing to stress corresponds to the literature's acknowledgment of long hours as a

potential stressor (Emmett et al., 2021). It is essential to recognize that nurses' experiences

with working hours may differ, contributing to the variance in responses.

Inadequate staffing levels were a significant source of stress for 71.3% of nurses, highlighting

the pivotal role of adequate staffing in ensuring the well-being of healthcare professionals.

The literature has similarly emphasized how inadequate staffing contributes to stress and

burnout (Emmett et al., 2021). Staffing levels play a critical role in providing a safe and

supportive work environment.

Increased patient loads were perceived as detrimental to the mental well-being of a

considerable proportion of nurses, with 60.9% either "Strongly Agreeing" or "Agreeing" that

this had a negative impact. This finding aligns with the literature, which recognizes the effect

of increased patient loads on stress and well-being (Emmett et al., 2021). The importance of

managing patient loads effectively to prevent nurse burnout and maintain patient care quality

is evident.

34
The survey revealed that 52.4% of nurses reported experiencing symptoms of burnout. This

aligns with the literature's findings, which have reported alarming rates of burnout among

healthcare workers, including nurses (Emmett et al., 2021). Burnout can have adverse effects

on patient care and the mental health of nurses, emphasizing the importance of addressing

this issue.

Concerning symptoms of post-traumatic stress, 41.3% of nurses reported experiencing such

symptoms, highlighting the need for mental health support. The literature acknowledges that

exposure to traumatic events, such as patient deaths, can lead to post-traumatic stress

symptoms (Spoorthy et al., 2020). Identifying and providing appropriate support to nurses

with these symptoms is vital.

The survey's exploration of the impact of uncertainty surrounding the pandemic on feelings

of depression or anxiety generated diverse responses. This resonates with the literature, which

acknowledges the uncertainty and constant exposure to suffering as contributors to mental

health challenges (Hu et al., 2020). Addressing these concerns is crucial for the well-being of

nurses.

Encouragingly, the survey found that a significant proportion of nurses (71.3%) were actively

engaged in coping mechanisms or self-care practices to manage psychological challenges

during the pandemic. This aligns with the literature's recognition of the importance of coping

mechanisms and self-care practices in mitigating the psychological impact of the pandemic

on nurses (Spoorthy et al., 2020).

Coping measures of nurses in dealing with the psychological consequences of the covid-
19 pandemic.

An impressive 82.5% of nurses reported seeking social support to manage psychological

challenges during the pandemic, underscoring the vital role of social support in helping

35
nurses cope effectively with the stress and emotional toll. Nurses employed a variety of self-

care practices to manage stress, with 31.5% engaging in self-care practices on a weekly basis

and 26.6% engaging daily. This emphasizes that a significant portion of nurses actively

practiced self-care to address the challenges posed by the pandemic. The availability of

mental health resources and support services within healthcare organizations was reported by

69.9% of nurses. This highlights the importance of ensuring that healthcare settings offer

mental health support to their staff, demonstrating the commitment of organizations to the

well-being of their nursing workforce. Notably, 40.6% of nurses had participated in

mindfulness or resilience training programs to enhance coping skills. This indicates a

substantial interest in and active pursuit of training to bolster coping abilities during the

pandemic. A considerable percentage of nurses either "Strongly Agreed" (22.4%) or

"Agreed" (35.0%) with the effectiveness of mindfulness practices in reducing anxiety and

enhancing well-being, while 17.5% expressed disagreement. This diverse perspective

highlights varying beliefs in the usefulness of mindfulness practices. The frequency of open

and transparent communication with the healthcare team to discuss pandemic-related

concerns and experiences was quite varied. This demonstrates that some nurses engaged in

daily (29.4%) and weekly (35.7%) discussions, while others participated less frequently. A

significant proportion either "Strongly Agreed" (23.8%) or "Agreed" (36.4%) with the

positive impact of collaborative problem-solving and team communication on mitigating the

psychological impact of the pandemic. This reflects the recognition of teamwork in

alleviating psychological challenges. Responses regarding the effectiveness of coping

measures and resources provided by healthcare organizations were diverse, with 42.0%

finding these measures "Effective." This suggests that while many considered them effective,

others expressed varying opinions about their usefulness. The belief in the essential nature of

coping measures for well-being and quality of patient care varied, with 38.5% "Agreeing"

36
and 27.3% "Strongly Agreeing." This reflects the value placed on coping measures by a

majority of respondents, although some had differing views. 39.9% of nurses reported

experiencing challenges or barriers in accessing coping resources and programs provided by

healthcare organizations, emphasizing the need for improving accessibility and removing

barriers to support resources.

An impressive 82.5% of nurses reported seeking social support to manage psychological

challenges during the pandemic. This aligns with existing research emphasizing the

significance of peer support and social networks as critical coping strategies (Al Maqbali et

al., 2020). Nurses often rely on their colleagues and friends to share their concerns, emotions,

and experiences. This support network reduces feelings of isolation and fosters resilience,

which is crucial when navigating the challenging landscape of COVID-19 patient care.

The survey results reveal that a substantial proportion of nurses engaged in self-care

practices, with 31.5% practicing self-care weekly and 26.6% engaging daily. These findings

are consistent with the literature, which underscores the importance of self-care in sustaining

nurses' physical and mental well-being (Labrague & de Los Santos, 2020). Maintaining

practices such as exercise, mindfulness, and maintaining a healthy work-life balance is

crucial in reducing stress levels and enhancing resilience, ultimately benefiting patient care.

The data indicating that 69.9% of nurses had access to mental health resources and support

services within their healthcare organizations is a positive finding. It reflects the commitment

of healthcare institutions to the well-being of their nursing workforce (Serrão et al., 2021).

These resources, which may include counseling services and crisis helplines, are crucial in

addressing the psychological consequences of the pandemic, providing nurses with

professional assistance when needed.

37
Approximately 40.6% of nurses participated in mindfulness or resilience training programs to

enhance their coping skills. This highlights a significant interest and active pursuit of training

to bolster coping abilities during the pandemic (Chan et al., 2020). These programs equip

nurses with techniques to manage stress, increase emotional resilience, and adapt to

challenging situations. The finding aligns with the effectiveness of mindfulness practices in

reducing anxiety and enhancing well-being, though it's noteworthy that opinions on their

usefulness were diverse (Chan et al., 2020).

The diverse responses regarding the frequency of open and transparent communication within

healthcare teams emphasize the varying approaches taken by nurses. Effective

communication channels allow nurses to express their concerns, share experiences, and

collectively problem-solve (Al Maqbali et al., 2020). This collaborative approach is

instrumental in mitigating the psychological impact of the pandemic, and the varying

engagement levels reflect different team dynamics within healthcare settings.

The survey results demonstrate diverse opinions about the effectiveness of coping measures

and resources provided by healthcare organizations. While 42.0% found these measures

"Effective," the perceptions of others were more varied. This divergence of views

underscores the complexity of evaluating the impact of coping measures and suggests the

need for tailored support that considers individual preferences and needs.

The data indicating that 38.5% "Agreed" and 27.3% "Strongly Agreed" with the essential

nature of coping measures for well-being and quality of patient care highlight the value

placed on these measures. However, the 14.7% who "Disagreed" and 5.6% who "Strongly

Disagreed" indicate varying perspectives regarding the necessity of coping strategies.

The fact that 39.9% of nurses reported encountering challenges or barriers in accessing

coping resources emphasizes the need for improving accessibility and removing barriers to

38
support resources. This corresponds to the critical importance of making these resources

readily available to healthcare workers, especially during crises (Serrão et al., 2021).

39
 CHAPTER FIVE

CONCLUSION AND RECOMMENDATION

Conclusion

The culmination of this research provides valuable insights into nurses' knowledge,

psychological well-being, and coping measures during the COVID-19 pandemic.

Understanding the dynamics within the nursing workforce in such unprecedented times is

essential for addressing challenges and ensuring the welfare of healthcare professionals.

The majority of nurses in this study had received specific training or education on COVID-

19, reflecting their commitment to staying informed and prepared for the pandemic. This

underscores the role of education in influencing nurses' knowledge levels. However, none of

the surveyed nurses reported currently working in high-risk COVID-19 patient care

environments, which might limit their direct exposure to COVID-19 patients. The results

align with the existing literature, which shows that exposure to high-risk settings significantly

influences nurses' knowledge of the virus. Moreover, nurses with diverse educational

backgrounds participated, emphasizing the varied qualifications among healthcare

professionals. A significant proportion of nurses displayed a proactive approach to updating

their knowledge about COVID-19, with many engaging in regular knowledge enhancement,

reflecting their dedication to patient care.

The research revealed that a substantial majority of nurses experienced heightened levels of

anxiety, fear, or uncertainty during the COVID-19 pandemic. While none of the surveyed

nurses reported witnessing suffering or patient loss due to COVID-19, the wide variance in

emotional responses could be due to the sample's composition and their limited exposure to

distressing situations. Concerns about personal safety and well-being significantly affected

nurses' emotional states, underscoring the emotional impact of the pandemic. The research

40
highlights the significance of addressing healthcare workers' psychological well-being, as

personal safety concerns continue to be a major stressor for healthcare professionals. The

findings demonstrate the diverse perspectives regarding the influence of working hours on

stress and the substantial impact of inadequate staffing levels, which adds to the mounting

evidence that these factors contribute to the stress and burnout experienced by nurses.

Nurses employed various coping measures to manage the psychological consequences of the

pandemic. Seeking social support was a dominant strategy, with an impressive 82.5%

actively seeking support from colleagues, friends, and family. The adoption of self-care

practices was also significant, with 31.5% engaging in self-care weekly and 26.6% practicing

self-care daily. The availability of mental health resources and support services within

healthcare organizations is commendable, with 69.9% of nurses having access to these

resources. This illustrates the commitment of healthcare institutions to the well-being of their

nursing workforce. Participation in mindfulness and resilience training programs was noted in

40.6% of nurses, suggesting substantial interest in enhancing coping skills. A varying belief

in the effectiveness of mindfulness practices to reduce anxiety and enhance well-being

underlines the importance of recognizing individual preferences. Open and transparent

communication with healthcare teams was diverse, and while the majority recognized the

positive impact of collaboration in mitigating psychological challenges, some participated

less frequently. Opinions regarding the effectiveness and necessity of coping measures and

resources varied among nurses, illustrating the multifaceted nature of support and suggesting

a need for tailored approaches. Significantly, 39.9% of nurses reported challenges in

accessing coping resources, emphasizing the need to improve accessibility and eliminate

barriers to support resources for healthcare workers.

41
Recommendation

The insights gained from this research offer significant implications for healthcare

institutions, policymakers, and stakeholders interested in enhancing the well-being of nurses

and the quality of patient care, particularly in the context of a global pandemic. The following

recommendations are based on the findings:

1. Tailored Training Programs: Healthcare institutions and educational organizations

should consider the diverse educational backgrounds of nurses and develop tailored

training programs to ensure that healthcare professionals are well-equipped to handle

unprecedented situations like a pandemic. These programs should not only focus on

theoretical knowledge but also practical skills to enhance nurses' preparedness.

2. Mental Health Support: The research findings emphasize the critical importance of

addressing nurses' psychological well-being. Healthcare institutions should prioritize

the provision of psychological support services, including counseling, mental health

programs, and crisis helplines. Creating a supportive environment that encourages

nurses to seek help when needed is vital.

3. Emphasis on Personal Safety: Acknowledging the significant impact of personal

safety concerns on nurses' emotional states, healthcare institutions and policymakers

should prioritize measures to enhance the safety of healthcare professionals. Adequate

provision of personal protective equipment (PPE) and a safe working environment are

essential components.

4. Addressing Staffing and Working Hours: Addressing the concerns raised by nurses

regarding inadequate staffing levels and the impact of long working hours is

paramount. Healthcare organizations should ensure adequate staffing levels and

42
 implement strategies to manage nurse workloads effectively. This includes measures

to prevent nurse burnout and maintain the quality of patient care.

5. Support for Coping Measures: Healthcare institutions should encourage and support

the coping mechanisms employed by nurses. This includes fostering a work

environment that allows nurses to seek social support and actively engage in self-care

practices. Organizations should consider offering structured programs like

mindfulness and resilience training, recognizing the diverse beliefs about their

effectiveness.

6. Communication and Collaboration: Promote open and transparent communication

within healthcare teams. The benefits of collaborative problem-solving and team

communication in mitigating the psychological impact of the pandemic should be

emphasized. Providing avenues for healthcare workers to discuss their concerns and

experiences can enhance teamwork and emotional well-being.

7. Assess Effectiveness and Accessibility: Continuously assess the effectiveness of

coping measures and resources provided by healthcare organizations, considering the

varying perspectives of nurses. Regular feedback mechanisms can help tailor support

systems to meet the specific needs of healthcare professionals. Additionally, focus on

improving the accessibility of these resources and eliminating any barriers that may

hinder access.

8. Resilience-Building Initiatives: Encourage and invest in resilience-building initiatives

for healthcare professionals. These initiatives can include training in stress

management, emotional resilience, and adaptive coping strategies. By equipping

nurses with the skills to cope with stress and adversity, healthcare institutions can

better support their well-being.

43
9. Research and Data Collection: Encourage ongoing research and data collection on the

well-being of healthcare professionals, especially during times of crisis. The evolving

nature of healthcare challenges necessitates a continuous understanding of the

experiences and needs of nurses. This data can inform evidence-based policies and

interventions.

10. Public Awareness and Advocacy: Raise public awareness about the challenges faced

by nurses and healthcare workers, including their mental and emotional well-being.

Advocate for policies that prioritize the welfare of healthcare professionals, both in

times of crisis and during routine healthcare delivery.

44
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48
Questionnaire Preamble: Impact of COVID-19 on Hospital Nurses

Dear Participant,

Your input is crucial in understanding how COVID-19 has affected nurses in hospitals.

Please answer honestly; there are no right or wrong responses. Your feedback will remain

confidential and take about 15 minutes to complete.

Thank you for your participation and dedication to healthcare.

DEMOGRAPHIC CHARACTERISTICS

1. What is your age group?

a. 18-23 years Yes [ ] No [ ]

b. 24-29 years Yes [ ] No [ ]

c. 30-35 years Yes [ ] No [ ]

d. 36-41 years Yes [ ] No [ ]

e. 42 and above Yes [ ] No [ ]

2. What is your gender?

a. Male Yes [ ] No [ ]

b. Female Yes [ ] No [ ]

3. What is your marital status?

a. Single Yes [ ] No [ ]

49
 b. Co-habiting Yes [ ] No [ ]

c. Married Yes [ ] No [ ]

4. What is your religion?

a. Christian Yes [ ] No [ ]

b. Islam Yes [ ] No [ ]

c. Africa Traditional Yes [ ] No [ ]

5. How long have you been working?

a. 1-3 years Yes [ ] No [ ]

b. 4-6 years Yes [ ] No [ ]

c. 7-9 years Yes [ ] No [ ]

d. 10 years and above Yes [ ] No [ ]

ASSESSING NURSES' KNOWLEDGE OF THE COVID-19 PANDEMIC

6. Have you received specific training or education on COVID-19?

Yes [ ] No [ ]

7. Are you currently working in a COVID-19 dedicated unit or have you had direct

exposure to COVID-19 patients?

Yes [ ] No [ ]

8. What is your highest level of education?

a. Diploma []

b. Bachelor’s degree []

c. Master's degree (MSN) []

d. Doctoral degree (Ph.D.) [ ]

9. Have you ever attended any COVID-19-related workshops or seminars?

Yes [ ] No [ ]

50
10. In your opinion, how confident are you in identifying potential COVID-19 cases?

a. Not confident at all []

b. Slightly confident []

c. Moderately confident []

d. Very confident []

e. Extremely confident []

11. How often do you update your knowledge about COVID-19?

a. Daily []

b. Weekly []

c. Monthly []

d. Rarely []

e. Never []

12. Do you believe that your knowledge of COVID-19 has a direct impact on patient care

and infection control in your healthcare setting?

a. Strongly Agree []

b. Agree []

c. Neutral []

d. Disagree []

e. Strongly Disagree [ ]

13. How familiar are you with the proper use of personal protective equipment (PPE) for

COVID-19?

a. Not familiar at all []

b. Slightly familiar []

c. Moderately familiar []

d. Very familiar []

51
 e. Extremely familiar []

14. How would you rate your overall knowledge of COVID-19?

a. Very Low []

b. Low []

c. Moderate []

d. High []

e. Very High []

EXPLORING THE PSYCHOLOGICAL EFFECTS OF THE COVID-19 PANDEMIC

ON NURSES

15. Have you experienced increased levels of anxiety, fear, or uncertainty during the

COVID-19 pandemic?

Yes [ ] No [ ]

16. Have you witnessed the suffering or loss of patients due to COVID-19 during your

work as a nurse?

Yes [ ] No [ ]

17. Have concerns about personal safety and the well-being of your family affected your

emotional well-being during the pandemic?

Yes [ ] No [ ]

18. Do you believe that long working hours have contributed to your stress during the

pandemic?

a. Strongly Agree []

b. Agree []

c. Neutral []

d. Disagree []

e. Strongly Disagree []

52
19. Have inadequate staffing levels at your workplace increased your stress levels?

Yes [ ] No [ ]

20. Do you feel that increased patient loads have negatively impacted your mental well-

being during the pandemic?

a. Strongly Agree []

b. Agree []

c. Neutral []

d. Disagree []

e. Strongly Disagree []

21. Have you experienced symptoms of emotional exhaustion, depersonalization, or

reduced personal accomplishment (burnout) during the pandemic?

Yes [ ] No [ ]

22. Have you ever had symptoms such as intrusive thoughts, nightmares, hyperarousal, or

avoidance behaviors related to your experiences during the pandemic?

Yes [ ] No [ ]

23. Do you believe that the uncertainty surrounding the COVID-19 pandemic has

contributed to your feelings of depression or anxiety?

a. Strongly Agree []

b. Agree []

c. Neutral []

d. Disagree []

e. Strongly Disagree []

24. Have you actively engaged in coping mechanisms or self-care practices to manage the

psychological challenges of the pandemic?

Yes [ ] No [ ]

53
COPING MEASURES OF NURSES IN DEALING WITH THE PSYCHOLOGICAL

CONSEQUENCES OF THE COVID-19 PANDEMIC

25. Have you sought social support from colleagues, friends, or family members to cope

with the psychological challenges of the COVID-19 pandemic?

Yes [ ] No [ ]

26. How frequently do you engage in self-care practices, such as exercise, mindfulness, or

relaxation techniques, to manage stress during the pandemic?

a. Daily []

b. Weekly []

c. Monthly []

d. Rarely []

e. Never []

27. Are mental health resources and support services readily available to you in your

healthcare organization to assist in coping with pandemic-related psychological

consequences?

Yes [ ] No [ ]

28. Have you participated in mindfulness or resilience training programs to enhance your

coping skills during the COVID-19 pandemic?

Yes [ ] No [ ]

29. Do you believe that mindfulness practices, such as meditation and deep breathing

exercises, have helped reduce your anxiety and enhance your well-being?

a. Strongly Agree []

b. Agree []

c. Neutral []

d. Disagree []

54
 e. Strongly Disagree []

30. How often do you engage in open and transparent communication with your

healthcare team to discuss your concerns and share experiences related to the

pandemic?

a. Daily []

b. Weekly []

c. Monthly []

d. Rarely []

e. Never []

31. Have collaborative problem-solving and team communication within your healthcare

team helped mitigate the psychological impact of the pandemic on your well-being?

a. Strongly Agree []

b. Agree []

c. Neutral []

d. Disagree []

e. Strongly Disagree []

32. In your opinion, how effective have the coping measures and resources provided by

your healthcare organization been in helping you manage the psychological

consequences of the pandemic?

a. Very Effective []

b. Effective []

c. Neutral []

d. Ineffective []

e. Very Ineffective []

55
33. Do you believe that these coping measures are essential for maintaining not only your

well-being but also the quality of patient care during the pandemic?

a. Strongly Agree []

b. Agree []

c. Neutral []

d. Disagree []

e. Strongly Disagree []

34. Have you experienced any specific challenges or barriers in accessing the coping

resources and programs provided by your healthcare organization?

Yes [ ] No [ ]

56