Nurses more fearful than doctors of contracting COVID-19, but willing to accept risk

Most healthcare workers (HCWs) in Singapore fear contracting COVID-19 but remain committed to accept the risk of viral transmission despite perceiving a moderate-to-high risk of contracting the disease during the course of their work, a recent survey has shown.

Compared to doctors, however, nurses are more anxious of contracting the disease and believe that they should not be caring for COVID-19 patients.

“Overall, there was high confidence in the adequacy of COVID-19 protective measures to prevent healthcare transmission in Singapore,” the researchers said. “The pandemic had a lower degree of psycho-emotional impact on HCWs here as compared to other countries.”

This cross-sectional study was conducted in April 2020. Operating theatre (OT) and intensive care unit (ICU) staff of Sengkang General Hospital, Singapore, received and completed an anonymous electronic survey sent via email.

A total of 358 HCWs were eligible to participate, of whom 292 (81.0 percent) responded to the survey. Majority of the respondents (93.2 percent) felt that precautionary measures in the workplace were sufficient, and 94.9 percent acknowledged that adequate training was provided. [Singapore Med J 2021;doi:10.11622/smedj.2021046]

More than 60 percent of the respondents believed that they were moderately to highly at risk of contracting COVID-19. Female HCWs, nurses, and those with duration of service <10 years were more fearful of contracting the disease. They also appeared to have less control over occupational exposure and have lower perceived need to care for COVID-19 patients. On the other hand, having children at home had no substantial impact on these perceptions.

Notably, nurses were more fearful of contracting COVID-19 compared to doctors. Many nurses also expressed that they should not be caring for COVID-19 patients.

Several reasons for this have been raised by the researchers: inadequate dissemination of correct information regarding the hospital’s situation, public fear and anxiety over the national lockdown, and loss of control of the spread of COVID-19 in other countries such as the US.

Furthermore, the most essential ICU precautions were availability of personal protective equipment outside the rooms of COVID-19 patients (95.3 percent) and having visitor restrictions (95.3 percent). For OT measures, the most important were having a dedicated OT for COVID-19 patients (91.2 percent) and having simulation as part of protocol familiarization (91.7 percent).

“The present study has demonstrated that measures adopted by our hospital has instilled a high level of confidence among ground staff in high-risk patient care areas,” the researchers said.

“This degree of confidence is far higher than those reported in the United Kingdom, possibly because Singapore did not actualize a shortage in PPE supply and had a much smaller percentage of ICU patients (0.09 percent of total COVID-19 cases),” they added. [https://www.who.int/publications-detail/rational-use-of-personal-protective-equipment-for-coronavirus-disease-(covid-19)-and-considerations-during-severe-shortages]

Mental health and psychosocial support have also been made available in Singapore during the pandemic. In addition, government schemes such as the Public Health Preparedness Clinics promoted primary care clinic response to public health emergencies. [Singapore Med J 2020;61:357-362; https://www.primarycarepages.sg/practice-management/moh-national-schemes/public-health-preparedness-clinic-(phpc)]

“[M]aintaining the morale of HCWs cannot be overemphasized during such a large-scale outbreak,” the researchers said. “A safe working environment is an important motivation to continue clinical work and to avoid a vicious cycle from attrition.”