COVID-19 AND STRATEGIES TO REDUCE ANXIETY IN NURSING: SCOPING REVIEW AND META-ANALYSIS

COVID-19 Y LAS ESTRATEGIAS PARA REDUCIR EL NIVEL DE ANSIEDAD EN PROFESIONALES DE ENFERMERÍA: REVISIÓN DE ALCANCE Y META-ANÁLISIS

Caroline Figueira Pereira Divane de Vargas Priscila Araujo Evangelista Victor Daichi Ito Thiago Faustino Aguilar About the authors

ABSTRACT

Objective:

to map the production of knowledge on the strategies used for the management of anxiety, in Nursing professionals, during the fight against COVID-19, Severe Acute Respiratory Syndrome (SARS) and Midlle East Respiratory Syndrome (MERS).

Method:

a scoping review, followed by meta-analysis, conducted in the BVS, EMBASE, PUBMED, CINAHL, PsycINFo, SCOPUS and Web of Science information sources. The review protocol is registered in International Prospective Register of Systematic Reviews under number under number CRD42020192918. Searches in electronic databases were carried out from 22 to 27 July 2020The data were analyzed and synthesized in a narrative fashion.

Results:

a total of 31 studies were included in the review; of these, 12 were included in the meta-analysis. The Nursing professionals presented higher anxiety indexes than the other health professionals. The following stood out in the interventions for the management of anxiety: emotional support, social support, educational campaign, implementation of safety policies, and adoption of a positive coping style.

Conclusion:

the evidence suggests that a considerable proportion of Nursing professionals experienced high anxiety levels, which interfered with COVID-19 prevention and control. Therefore, it becomes necessary to establish intervention protocols to reduce anxiety, with clear and objective language, favoring emotional support, positive coping techniques, and a welcoming work environment, in addition to implementing policies that ensure protective measures against COVID-19.

DESCRIPTORS:
Anxiety; Coronavirus infections; Nursing; Mental health; Severe acute respiratory syndrome; Health staff

RESUMEN

Objetivo:

mapear la producción de conocimiento sobre las estrategias utilizadas para el manejo de la ansiedad en profesionales de Enfermería durante la lucha contra COVID-19, Sindrome Respiratorio Agudo Grave (SARS) y Sindrome Respiratorio de Oriente Medio (MERS).

Método:

revisión de alcance seguida de meta-análisis, realizada en las siguientes fuentes de información: BVS, EMBASE, PUBMED, CINAHL, PsycINFo, SCOPUS y Web of Science. El protocolo de revisión está registrado en International Prospective Register of Systematic Reviews con número CRD42020192918. Los datos se analizaron y sintetizaron en forma narrativa.

Resultados:

se incluyó un total de 31 estudios en esta revisión; de ellos, 12 fueron incluidos en el meta-análisis. Los profesionales de Enfermería presentaron índices de ansiedad más elevados que los demás profesionales de salud. En las intervenciones para el manejo de la ansiedad, se destacan las siguientes: soporte emocional, apoyo social, campaña educativa, implementación de políticas de seguridad y adopción de un estilo de enfrentamiento positivo.

Conclusión:

las evidencias sugieren que una considerable proporción de profesionales de Enfermería experimentó un nivel de ansiedad elevado, lo que interfirió en la prevención y el control de la epidemia de COVID-19. Por lo tanto, resulta necesario establecer protocolos de intervenciones para reducir la ansiedad, con un lenguaje claro y objetivo, propiciando soporte emocional, técnicas de enfrentamiento positivo y un ambiente de trabajo cálido, además de la implementación de políticas que garanticen medidas de protección contra el COVID-19.

DESCRIPTORES:
Ansiedad; Infecciones por coronavirus; Enfermería; Salud mental; Síndrome respiratorio agudo grave; Personal de salud

RESUMO

Objetivo:

mapear a produção do conhecimento sobre as estratégias utilizadas para o manejo da ansiedade, em profissionais de enfermagem, durante o enfrentamento da COVID-19, da Síndrome Respiratória Aguda Grave (SARS)e da Síndrome Respiratória do Oriente Médio (MERS).

Método:

revisão de escopo, seguida de meta-análise, realizada nas fontes de informações BVS, EMBASE, PUBMED, CINAHL, PsycINFo, SCOPUS e Web of Science. O protocolo de revisão está registrado no International Prospective Register of Systematic Reviews sob número CRD42020192918. As buscas em bases eletrônicas de dados foram realizadas no período de 22 a 27 de julho de 2020. Os dados foram analisados e sintetizados de forma narrativa.

Resultados:

31 estudos foram incluídos na revisão, destes, 12 incluídos na metanálise. Os profissionais de enfermagem apresentaram índices de ansiedade maiores do que os demais profissionais de saúde. Nas intervenções para o manejo da ansiedade, destacam-se suporte emocional, apoio social, campanha educacional, implementação de políticas de segurança e adoção de um estilo de enfrentamento positivo.

Conclusão:

as evidências sugerem que considerável proporção de profissionais de enfermagem vivenciou alto nível de ansiedade, interferindo na prevenção e no controle da COVID-19. Portanto, torna-se necessário o estabelecimento de protocolos de intervenções para redução da ansiedade, com linguagem clara e objetiva, propiciando suporte emocional, técnicas de enfrentamento positivo, ambiente de trabalho acolhedor, além de implementação de políticas que assegurem medidas protetivas contra a COVID-19.

DESCRITORES:
Ansiedade; Infecções por coronavírus; Enfermagem; Saúde mental; Síndrome respiratória aguda grave; Pessoal de saúde

INTRODUCTION

Severe Acute Respiratory Syndromes (SARS) are infectious diseases that quickly turn into epidemics. According to the data, there is a major and immediate impact of the virus on the global health system, disease prevention, education and the economy in a short period11. Chen R, Chou KR, Huang YJ, Wang TS, Liu SY, Ho LY. Effects of a SARS prevention programme in Taiwan on nursing staff's anxiety, depression and sleep quality: A longitudinal survey. Int J Nurs Stud [Internet]. 2006 [cited 2020 Aug 14];43(2):215-25. Available from: https://doi.org/10.1016/j.ijnurstu.2005.03.006
https://doi.org/10.1016/j.ijnurstu.2005....
. The new coronavirus (SARS-CoV-2), which was responsible for the COVID-19 outbreak, is causing all these changes and has been generating anxiety in the general population, even in the health professionals. Health professionals are the gear of the health system; therefore, illness in this population has an impact on COVID-19 prevention and control. In view of this, a synthesis of the strategies to reduce anxiety at this critical global moment becomes necessary.

Among the health professions, Nursing stands out, as it is considered the backbone of the health system22. Holland SH. Backbone of the institution. Nurs Manag (Harrow) [Internet]. 2003 [cited 2020 Aug 15];33(2Suppl):26. Available from: https://pubmed.ncbi.nlm.nih.gov/14694864/
https://pubmed.ncbi.nlm.nih.gov/14694864...
,33. Di Censo A, Bryant-Lukosius D. Clinical nurse specialists and nurse practitioners in Canada. Nurs Leadersh (Tor Ont) [Internet]. 2010 [cited 2020 Aug 15];23:189-201. Available from: https://doi.org/10.12927/cjnl.2010.22276
https://doi.org/10.12927/cjnl.2010.22276...
, with professionals who are on the front line of care, staying full time with the patients44. Ko NY, Pan SM, Feng MC, Chang R, Ma HJ, Liou CA. Using focus groups to analyze nurses’ experiences of caring for patients with HIV/AIDS in southern Taiwan. J Nurs [Internet]. 2002 [cited 2020 Aug 15];49(3):37-43. Available from: https://www.airitilibrary.com/Publication/alDetailedMesh?DocID=0047262x-200206-49-3-37-44-a
https://www.airitilibrary.com/Publicatio...
. The workforce represented by these workers stands out in this context and it is important to highlight the possibility of meeting their basic human needs, in order to guarantee their motivation55. Healy K. A Theory of human motivation by Abraham H. Maslow (1942). Br J Psychiatr [Internet]. 2016 [cited 2020 Aug 15];208(4):313. Available from: https://doi:10.1192/bjp.bp.115.179622
https://doi:10.1192/bjp.bp.115.179622...
. However, the anxiety experienced by the professionals makes it difficult to meet such needs.

It is worth noting that Nursing is one of the professions presenting high anxiety levels, which is often related to the following: overwork; high risk of contamination and inadequate protection against coronavirus; concern about the possibility of these professionals transmitting the virus to family members66. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ [Internet]. 2003 [cited 2020 Aug 15];168(10):1245-51. Available from: https://pubmed.ncbi.nlm.nih.gov/12743065/
https://pubmed.ncbi.nlm.nih.gov/12743065...
; and care provided to patients with negative emotions and high anxiety levels77. Kang L, Li Y, Hu S, Chen M, Yang C, Yang B. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatr [Internet]. 2020 [cited 2020 Aug 15];7(3):e14. Available from: https://doi.org/10.1016/s2215-0366(20)30047-x
https://doi.org/10.1016/s2215-0366(20)30...
.

One of the care actions provided by nurses is education in health, conducted by establishing the interpersonal relationship between nurse and patient, which is permeated by the exchange of anxiety between the components of the relationship88. Peplau HE. Interpersonal relations in nursing: a conceptual frame of reference for psychodynamic nursing. New York: Springer Publishing Company; 1991.. Therefore, it is important that the nurse’s anxiety level is low, so that it is possible to convey clear, objective and scientific information about the COVID-19 prevention and control measures, in order to increase acceptability and adherence to these measures.

A number of studies report strategies to reduce nurses’ anxiety, among which the following can be mentioned: reading articles related to COVID-19, implementing a coronavirus prevention program, objective analysis of the real situations, and adoption of strategies to cope with usual reaction patterns to anxiety that generate more anxiety77. Kang L, Li Y, Hu S, Chen M, Yang C, Yang B. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatr [Internet]. 2020 [cited 2020 Aug 15];7(3):e14. Available from: https://doi.org/10.1016/s2215-0366(20)30047-x
https://doi.org/10.1016/s2215-0366(20)30...

8. Peplau HE. Interpersonal relations in nursing: a conceptual frame of reference for psychodynamic nursing. New York: Springer Publishing Company; 1991.
-99. Aguilera DC. Crisis intervention: theory and methodology [Internet]. 6th ed. St. Louis: Mosby;1990 [cited 2020 Aug 14]. Available from: https://doi.org/10.1176/ps.22.1.32-b
https://doi.org/10.1176/ps.22.1.32-b...
.

According to studies, anxiety in the general population, which interferes with COVID-19 prevention and control, can be reduced by providing more information on preventive measures against the coronavirus, grounded on scientific basis, and communicated by health professionals and by the Ministry of Health, conveying trust to the population1010. Al Turki YA. Can we increase public awareness without creating anxiety about corona viruses? Patient Educ Couns [Internet]. 2014 [cited 2020 Aug 14];94(2):286. Available from: https://doi.org/10.1016/j.pec.2013.10.023
https://doi.org/10.1016/j.pec.2013.10.02...
. Trust is one of the main elements to increase the population’s adherence to these measures and can be established through interpersonal relationships (between nurse and patient, nurse and family members, and nurse and the community88. Peplau HE. Interpersonal relations in nursing: a conceptual frame of reference for psychodynamic nursing. New York: Springer Publishing Company; 1991.), as nurses work at all health care levels (primary, secondary and tertiary), thus becoming one of the main actors in prevention and control, so necessary for coping with this disease. In Hong Kong, one of the strategies to reduce anxiety in older adults was the use of telephone calls, made by nurses, with measures for SARS prevention and control1111. Chan SS, So WK, Wong DC, Lee AC, Tiwari A. Improving older adults’ knowledge and practice of preventive measures through a telephone health education during the SARS epidemic in Hong Kong: A pilot study. Int J Nurs Stud [Internet]. 2007 [cited 2020 Aug 15];44(7):1120-27. Available from: https://doi.org/10.1016/j.ijnurstu.2006.04.019
https://doi.org/10.1016/j.ijnurstu.2006....
.

Strategies to reduce anxiety in nurses, such as objectively analyzing real situations, raising awareness about anxiety, and accessing scientific knowledge about COVID-19, are important to cope with this pandemic, since high anxiety levels are related to increased stress at work, loss of emotional control and increased job abandonment11. Chen R, Chou KR, Huang YJ, Wang TS, Liu SY, Ho LY. Effects of a SARS prevention programme in Taiwan on nursing staff's anxiety, depression and sleep quality: A longitudinal survey. Int J Nurs Stud [Internet]. 2006 [cited 2020 Aug 14];43(2):215-25. Available from: https://doi.org/10.1016/j.ijnurstu.2005.03.006
https://doi.org/10.1016/j.ijnurstu.2005....
, affecting adherence to the COVID-19 prevention and control measures in the population, as nurses are responsible for a large part of education in health.

Therefore, this study is important, since it assumes that, through the synthesis of evidence on anxiety management strategies for Nursing professionals, it will be possible to translate scientific knowledge into health practice, enabling greater acceptance and adherence to measures to prevent and control COVID-19 and other acute respiratory syndromes.

The objective of this review is to map the strategies used for the management of anxiety in Nursing professionals, during the fight against COVID-19, SARS and MERS, for the promotion of mental health and, consequently, to contribute to more effective assistance in coping with this pandemic.

METHOD

This systematic review followed the guidelines of the Joanna Briggs Institute (JBI)1212. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping reviews (2020 version). In: Aromataris E, Munn Z, eds. JBI Manual for evidence synthesis. 2020 [cited 2020 Aug 15]. Available from: https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12...
for scoping reviews)1212. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping reviews (2020 version). In: Aromataris E, Munn Z, eds. JBI Manual for evidence synthesis. 2020 [cited 2020 Aug 15]. Available from: https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12...
-1313. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med [Internet]. 2009 [cited 2020 Aug 15];6(7):e1000097. Available from: https://doi.org/10.1371/journal.pmed.1000097
https://doi.org/10.1371/journal.pmed.100...
, which aim at mapping the main concepts that support a given knowledge area; at examining the extent, scope and nature of the research; at summarizing and disseminating the research data; and at identifying existing research gaps; of the PRISMA extension (PRISMA-ScR), specific for scoping reviews, which is ideal for describing in detail the research decision process in view of the method used1414. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med [Internet]. 2018 [cited 2020 Aug 15];169(7):467-73. Available from: https://doi.org/10.7326/M18-0850
https://doi.org/10.7326/M18-0850...
; and of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)1515. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev [Internet]. 2015 [cited 2020 Aug 15];4(1):1. Available from: https://doi.org/10.1186/2046-4053-4-1
https://doi.org/10.1186/2046-4053-4-1...
, to perform the meta-analysis. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42020192918.

The guiding question of the review was the following: “which are the strategies used for the management of anxiety in Nursing professionals for the promotion of mental health during the COVID-19, SARS and MERS pandemics?” The studies included in this scoping review were listed based on the PCC (Population, Concept and Context) mnemonic strategy, according to what is recommended in the JBI protocol. For this review, the Nursing professionals (nurses, nursing assistants and nursing technicians) were defined as population, and the concept of interest was the strategies for the management of anxiety in Nursing professionals, while the context analyzed was the COVID-19 pandemic, in addition to the SARS and MERS epidemics.

The search strategy was conducted in three stages. The first stage of the research was carried out in PUBMED and BSV, to analyze the words contained in the titles and abstracts, using the following keywords: "Anxiety", "SARS Virus", "COVID-19", "Coronavirus Infections", "prevention and control”. In the second stage, the studies were identified by means of the search strategy adapted to each electronic database: BVS, EMBASE, PUBMED, CINAHL, PsycINFo (via APA), SCOPUS and Web of Science. Two search strategies were developed, with the objective of obtaining the greatest possible number of articles on the theme, with the following search terms in PubMed (we adapted the strategy for the other databases): 1) ("Anxiety" [Mesh] OR anxiety OR anxious OR anxieties) AND ("coronavirus disease-19" OR covid-19 OR "COVID-19" OR "corona virus disease 2019" OR "SARS-CoV-2" OR "2019-new coronavirus" OR "2019 novel coronavirus" OR "2019-nCoV" OR coronavirus OR “SARS Virus”); 2) ("Anxiety" [Mesh] OR anxiety OR anxious OR anxieties) AND ("coronavirus disease-19" OR covid-19 OR "COVID-19" OR "corona virus disease 2019" OR "SARS-CoV-2" OR "2019-new coronavirus" OR "2019 novel coronavirus" OR "2019-nCoV" OR coronavirus OR “SARS Virus”) AND (nursing OR nurses). In the third stage, a search was conducted in the references of the selected articles to find the studies that were not retrieved by the search strategy.

After collecting all the references, duplicate articles were excluded by using the Mendeley software. The searches in the electronic databases were conducted from July 22nd to July 27th, 2020.

The inclusion criteria were as follows: quasi-experimental studies; randomized clinical trials; cohort, case-control and cross-sectional studies; and letters to the editor or opinion letters, in addition to qualitative studies addressing strategies to reduce anxiety due to COVID-19 and/or SARS in Nursing professionals. There was no language restriction (consequently, all the articles published in any language and addressing the theme were included) or regarding year of publication. Studies that did not meet the review objectives or did not provide information pertinent to the contribution of the review were excluded.

For the research and data extraction phase, the Covidence© software was used, which is a screening and data extraction tool developed to ease the review process. The selection of studies was performed in phases. In Phase 1, two researchers independently examined the titles and abstracts of the potentially relevant studies and the selected articles that seemed to meet the inclusion criteria, based on their abstracts. In Phase 2, the same reviewers read the full text of all the articles selected, independently, and excluded those studies that did not meet the inclusion criteria. Any disagreement, either in the first or in the second phase, was resolved by means of discussion and agreement between the two reviewers. In case consensus was not reached, a third reviewer was involved to make a final decision.

The assessment of the methodological quality was performed by the two independent evaluators, using “The System for the Unified Management, Assessment and Review of Information” (SUMARI) tool1212. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping reviews (2020 version). In: Aromataris E, Munn Z, eds. JBI Manual for evidence synthesis. 2020 [cited 2020 Aug 15]. Available from: https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12...
, which establishes criteria for the assessment of primary studies. Studies with low methodological quality were excluded from this review.

The authors extracted the following information from each article included in the synthesis: locus (country), year and author; methodology; main results; and quality level. Independently, both authors verified the data extracted and made changes as necessary, in addition to conducting a quality assessment of the studies using MAStARI, the JBI's meta-analysis and review statistical assessment instrument. According to the studies found, all three assessment instruments that make up MAStARI were used: 1) critical assessment checklist for analytical cross-sectional studies, 2) critical assessment checklist for cohort studies, 3) critical assessment checklist for qualitative research studies, and 4) checklist for text and opinion articles.

The general combination of data from the studies included was performed by means of a descriptive synthesis. Statistical grouping of the data was planned with the use of meta-analysis when the articles were considered combinable and relatively homogeneous in relation to the sample design, population and results. The scales were rescheduled between 0 and 1 to be comparable. The model used for conducting the meta-analysis was that of random effects with estimation of Restricted Maximum Likelihood (REML). In relation to the quantitative data, the following were extracted for conducting the meta-analysis: mean, standard deviation and sample size.

RESULTS

Selection of studies

In the eight sources of information surveyed, 445 studies were found: 232 were duplicates, leaving 213 studies for selection; of these, 158 were excluded for not meeting the eligibility criteria, such as: not addressing strategies for the management of anxiety in Nursing professionals and/or not presenting Nursing professionals as study participants. The review final sample consisted in 31 studies. A summary of the literature identified in each stage of the research process can be seen in Figure 1.

Figure 1 -
Flowchart of the study selection process for the systematic review.

Characteristics of the studies

Of the 31 studies included, 27 were published in English, three in Chinese and one in German. The studies addressed strategies to manage anxiety in Nursing professionals during the 2003 SARS outbreak in Canada1616. Lancee WJ, Maunder RG, Goldbloom DS. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv [Internet]. 2008 [cited 2020 Aug 15];59(1):91-5. Available from: https://doi.org/10.1176/ps.2008.59.1.91
https://doi.org/10.1176/ps.2008.59.1.91...
; the 2015 MERS outbreak in South Korea1717. Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital 1workers and quarantined hemodialysis patients. Compr Psychiatry [Internet]. 2018 [cited 2020 Aug 15];87:123-27. Available from: https://doi.org/10.1016/j.comppsych.2018.10.003
https://doi.org/10.1016/j.comppsych.2018...
-1818. Kang J, Kim EJ, Choi JH, Hong HK, Han S, Choi IS, et al. Difficulties in using personal protective equipment: training experiences with the 2015 outbreak of Middle East respiratory syndrome in Korea. Am J Infect Control [Internet]. 2018 [cited 2020 Aug 15];46(2):235-37. Available from: https://doi.org/10.1016/j.ajic.2017.08.041
https://doi.org/10.1016/j.ajic.2017.08.0...
and Saudi Arabia1919. Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy H, Clark A. Perceptions of post outbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open [Internet]. 2019 [cited 2020 Aug 15];9(5):e017476. Available from: https://doi.org/10.1136/bmjopen-2017-017476
https://doi.org/10.1136/bmjopen-2017-017...
-2020. Almutairi AF, Adlan AA, Balkhy HH, Abbas OA, Clark AM. “It feels like I'm the dirtiest person in the world”: exploring the experiences of healthcare providers who survived MERS-CoV in Saudi Arabia. J Infect Public Health [Internet]. 2018 [cited 2020 Aug 15];11(2):187-91. Available from: https://doi.org/10.1016/j.jiph.2017.06.011
https://doi.org/10.1016/j.jiph.2017.06.0...
; and the COVID-19 pandemic in the United States2121. Shingler-Nace A. COVID-19: When leaderships Calls. Nurse Lead [Internet]. 2020 [cited 2020 Aug 15];18(3):202-3. Available from: https://doi.org/10.1016/j.mnl.2020.03.017
https://doi.org/10.1016/j.mnl.2020.03.01...
-2222. Fessell D, Cherniss C. Coronavirus disease 2019 (COVID-19) and beyond: micropractices for burnout prevention and emotional wellness. J Am Coll Radiol [Internet]. 2020 [cited 2020 Aug 15];17(6):746-8. Available from: https://doi.org/10.1016/j.jacr.2020.03.013
https://doi.org/10.1016/j.jacr.2020.03.0...
, China2323. Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry [Internet]. 2020 [cited 2020 Aug 15];7(3):228-9. Available from: https://doi.org/10.1016/S2215-0366(20)30046-8
https://doi.org/10.1016/S2215-0366(20)30...

24. Cai W, Lian B, Song X, Hou T, Deng G, Li H. A cross-sectional study on mental health among health care workers during the outbreak of Coronavirus disease 2019. Asian J Psychiatr [Internet]. 2020 Apr 24 [cited 2020 Aug 15];51:102-11. Available from: https://doi.org/10.1016/j.ajp.2020.102111
https://doi.org/10.1016/j.ajp.2020.10211...

25. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...

26. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. [Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19 ]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi CMA J Cn [Internet]. 2020 [cited 2020 Aug 16];38(3):192-5. Available from: https://doi.org/10.3760/cma.j.cn121094-20200219-00063
https://doi.org/10.3760/cma.j.cn121094-2...

27. Wu J, Rong X, Chen F. Investigation on sleep quality of first-line nurses in fighting against corona virus disease 2019 and its influencing factors. Chin Nurs Res [Internet]. 2020 [cited 2020 Aug 15];34(4):558-62. Available from: https://kns.cnki.net/kcms/detail/detail.aspx?FileName=ZXWS2020081000C&DbName=CAPJ2020
https://kns.cnki.net/kcms/detail/detail....

28. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...

29. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag [Internet]. 2020 [cited 2020 Aug 16];28(5):1002-9. Available from: https://doi.org/10.1111/jonm.13014
https://doi.org/10.1111/jonm.13014...

30. Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. Int J Biol Sci [Internet]. 2020 [cited 2020 Aug 16];16(10):1732-8. Available from: http://www.ijbs.com/v16p1732.htm
http://www.ijbs.com/v16p1732.htm...

31. Zhu J, Sun L, Zhang L, Wang H, Fan A, Yang B, et. al. Prevalence and Influencing Factors of Anxiety and Depression Symptoms in the First-Line Medical Staff Fighting Against COVID-19 in Gansu. Front Psychiatry [Internet]. 2020 2020 [cited 2020 Aug 16];11:386. Available from: https://doi.org/10.3389/fpsyt.2020.00386
https://doi.org/10.3389/fpsyt.2020.00386...

32. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health Outcomes among health care workers exposed to Coronavirus disease 2019. JAMA Netw Open [Internet]. 2020 [cited 2020 Aug 16];3(3):e203976. Available from: https://doi.org/10.1001/jamanetworkopen.2020.3976
https://doi.org/10.1001/jamanetworkopen....

33. Gan X, Shi Z, Chair SY, Cao X, Wang Q. Willingness of Chinese nurses to practice in Hubei combating the coronavirus disease 2019 epidemic: a cross-sectional study. J Adv Nurs [Internet]. 2020 [cited 2020 Aug 16];76:2137-50. Available from: https://doi.org/10.1111/jan.14434
https://doi.org/10.1111/jan.14434...

34. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in hunan between January and March 2020 during the outbreak of Coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci Monit [Internet]. 2020 [cited 2020 Aug 16];26:e924171. Available from: https://doi.org/10.12659/msm.924171
https://doi.org/10.12659/msm.924171...

35. Ni MY, Yang L, Leung CMC, Li N, Yao XI, Wang Y, et al. Mental health, risk factors, and social media use during the COVID-19 epidemic and cordon sanitaire among the community and health professionals in Wuhan, China: cross-sectional survey. JMIR Ment Health [Internet]. 2020 [cited 2020 Aug 16];7(5):e19009. Available from: https://doi.org/10.2196/19009
https://doi.org/10.2196/19009...

36. Sheng X, Liu F, Zhou J, Liao R. Nan Fang Yi Ke Da Xue Xue Bao [Psychological status and sleep quality of nursing interns during the outbreak of COVID-19]. J South Med Univ [Internet]. 2020 [cited 2020 Aug 16];40(3):346-50. Available from: https://doi.org/10.12122/j.issn.1673-4254.2020.03.09
https://doi.org/10.12122/j.issn.1673-425...

37. Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiat [Internet]. 2020 [cited 2020 Aug 16];7(4):15-6. Available from: https://doi.org/10.1016/s2215-0366(20)30078-x
https://doi.org/10.1016/s2215-0366(20)30...

38. Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect [Internet]. 2020 [cited 2020 Aug 16];148:e98. Available from: https://doi.org/10.1017/s0950268820001107
https://doi.org/10.1017/s095026882000110...

39. Liang Y, Chen M, Zheng X, Liu J. Screening for Chinese medical staff mental health by SDS and SAS during the outbreak of COVID-19. J Psychosom Res [Internet]. 2020 [cited 2020 Aug 16];133:110102. Available from: https://doi.org/10.1016/j.jpsychores.2020.110102
https://doi.org/10.1016/j.jpsychores.202...

40. Zhang C, Yang L, Liu S, Ma S, Wang Y, Cai Z, et al. Survey of insomnia and related social psychological factors among medical staff involved in the 2019 novel Coronavirus disease outbreak. Front Psychiat [Internet]. 2020 [cited 2020 Aug 16];11:306. Available from: https://doi.org/10.3389/fpsyt.2020.00306
https://doi.org/10.3389/fpsyt.2020.00306...
-4141. Alsubaie S, Temsah MH, Al-Eyadhy AA, Gossady I, Hasan GM, Al-Rabiaah A, et al. Middle east respiratory syndrome Coronavirus epidemic impact on healthcare workers' risk perceptions, work and personal lives. J Infect Dev Countr [Internet]. 2019 [cited 2020 Aug 16];13(10):920-6. Available from: https://doi.org/10.3855/jidc.11753
https://doi.org/10.3855/jidc.11753...
, Germany4242. Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. COVID-19-Pandemie: belastungen des medizinischen Personals [COVID-19 Pandemic: stress experience of healthcare workers - a short current review]. Psychiatr Prax [Internet]. 2020 [cited 2020 Aug 16];47(4):190-7. Available from: https://doi.org/10.1055/a-1159-5551
https://doi.org/10.1055/a-1159-5551...
, Singapore4343. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:559-65. Available from: https://doi.org/10.1016/j.bbi.2020.04.049
https://doi.org/10.1016/j.bbi.2020.04.04...
, the United Kingdom4444. Black JRM, Bailey C, Przewrocka J, Dijkstra KK, Swanton C. COVID-19: the case for health-care worker screening to prevent hospital transmission. Lancet. 2020 [cited 2020 Aug 16];395(10234):1418-20. Available from: https://doi.org/10.1016/s0140-6736(20)30917-x
https://doi.org/10.1016/s0140-6736(20)30...
-4545. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:901-7. Available from: https://doi.org/10.1016/j.bbi.2020.05.026
https://doi.org/10.1016/j.bbi.2020.05.02...
, and Canada4646. Wu PE, Styra R, Gold WL. Mitigating the psychological effects of COVID-19 on health care workers. CMAJ [Internet]. 2020 [cited 2020 Aug 16];192(17):459-60. Available from: https://doi.org/10.1503/cmaj.200519
https://doi.org/10.1503/cmaj.200519...
. Regarding the population, four studies were conducted with Nursing professionals exclusively, while 27 studies included health professionals, although all contemplated Nursing professionals as participants. Chart 1 summarizes the descriptive characteristics of the studies.

Chart 1 -
Characteristics of the studies included in the review, according to title, author, year of publication, country, methodology and results. Brazil, 2010-2020. (n=31)

Mean of anxiety

The overall combined mean of anxiety in the nurses was 44% (95% CI = 0.31 - 0.57, I2 = 99%) and that of the health professionals was 35% (95% CI = 0.25 - 0.45, I2 = 99%), as shown in Figure 2.

Figure 2 -
Forest graph of the anxiety score. Brazil, 2010-2020.

With regard to the scales used to assess anxiety in the Nursing professionals, one study used the 7-item Generalized Anxiety Disorder scale (GAD 7)3232. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health Outcomes among health care workers exposed to Coronavirus disease 2019. JAMA Netw Open [Internet]. 2020 [cited 2020 Aug 16];3(3):e203976. Available from: https://doi.org/10.1001/jamanetworkopen.2020.3976
https://doi.org/10.1001/jamanetworkopen....
, with a mean of 9.16, scoring between medium and moderate anxiety; four studies used the Self-Rating Anxiety Scale (SAS)2727. Wu J, Rong X, Chen F. Investigation on sleep quality of first-line nurses in fighting against corona virus disease 2019 and its influencing factors. Chin Nurs Res [Internet]. 2020 [cited 2020 Aug 15];34(4):558-62. Available from: https://kns.cnki.net/kcms/detail/detail.aspx?FileName=ZXWS2020081000C&DbName=CAPJ2020
https://kns.cnki.net/kcms/detail/detail....
,2929. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag [Internet]. 2020 [cited 2020 Aug 16];28(5):1002-9. Available from: https://doi.org/10.1111/jonm.13014
https://doi.org/10.1111/jonm.13014...
,3131. Zhu J, Sun L, Zhang L, Wang H, Fan A, Yang B, et. al. Prevalence and Influencing Factors of Anxiety and Depression Symptoms in the First-Line Medical Staff Fighting Against COVID-19 in Gansu. Front Psychiatry [Internet]. 2020 2020 [cited 2020 Aug 16];11:386. Available from: https://doi.org/10.3389/fpsyt.2020.00386
https://doi.org/10.3389/fpsyt.2020.00386...
,3636. Sheng X, Liu F, Zhou J, Liao R. Nan Fang Yi Ke Da Xue Xue Bao [Psychological status and sleep quality of nursing interns during the outbreak of COVID-19]. J South Med Univ [Internet]. 2020 [cited 2020 Aug 16];40(3):346-50. Available from: https://doi.org/10.12122/j.issn.1673-4254.2020.03.09
https://doi.org/10.12122/j.issn.1673-425...
, with a mean of 46.4, scoring from medium to moderate anxiety; and one study used the Visual Analogue Scale (VAS)4545. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:901-7. Available from: https://doi.org/10.1016/j.bbi.2020.05.026
https://doi.org/10.1016/j.bbi.2020.05.02...
, with a mean of 44, scoring from normal to medium anxiety. In the assessment of anxiety in health professionals, one study used the 7-item GAD 73232. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health Outcomes among health care workers exposed to Coronavirus disease 2019. JAMA Netw Open [Internet]. 2020 [cited 2020 Aug 16];3(3):e203976. Available from: https://doi.org/10.1001/jamanetworkopen.2020.3976
https://doi.org/10.1001/jamanetworkopen....
, with a mean of 7.35, scoring medium anxiety; three studies used the SAS2626. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. [Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19 ]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi CMA J Cn [Internet]. 2020 [cited 2020 Aug 16];38(3):192-5. Available from: https://doi.org/10.3760/cma.j.cn121094-20200219-00063
https://doi.org/10.3760/cma.j.cn121094-2...
,3131. Zhu J, Sun L, Zhang L, Wang H, Fan A, Yang B, et. al. Prevalence and Influencing Factors of Anxiety and Depression Symptoms in the First-Line Medical Staff Fighting Against COVID-19 in Gansu. Front Psychiatry [Internet]. 2020 2020 [cited 2020 Aug 16];11:386. Available from: https://doi.org/10.3389/fpsyt.2020.00386
https://doi.org/10.3389/fpsyt.2020.00386...
,3838. Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect [Internet]. 2020 [cited 2020 Aug 16];148:e98. Available from: https://doi.org/10.1017/s0950268820001107
https://doi.org/10.1017/s095026882000110...
, with a mean of 41, scoring normal anxiety; one study used the Symptom Checklist-90 (SCL-90)2424. Cai W, Lian B, Song X, Hou T, Deng G, Li H. A cross-sectional study on mental health among health care workers during the outbreak of Coronavirus disease 2019. Asian J Psychiatr [Internet]. 2020 Apr 24 [cited 2020 Aug 15];51:102-11. Available from: https://doi.org/10.1016/j.ajp.2020.102111
https://doi.org/10.1016/j.ajp.2020.10211...
, with a mean of 1.40, scoring from little to moderate anxiety; another used the Kessler Psychological Distress Scale (K10)1616. Lancee WJ, Maunder RG, Goldbloom DS. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv [Internet]. 2008 [cited 2020 Aug 15];59(1):91-5. Available from: https://doi.org/10.1176/ps.2008.59.1.91
https://doi.org/10.1176/ps.2008.59.1.91...
, with a mean of 24, scoring high anxiety, and one study applied the Depression, Anxiety and Stress Scale (DASS-21)4343. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:559-65. Available from: https://doi.org/10.1016/j.bbi.2020.04.049
https://doi.org/10.1016/j.bbi.2020.04.04...
, with a mean of 7.35, scoring between normal and medium anxiety.

Interventions for the management of anxiety

The interventions were detailed in Chart 1. Four categories emerged during the narrative synthesis of all the interventions used for the management of anxiety, namely: emotional support; strategies to relieve anxiety; welcoming work environment; and implementation of safety policies.

Emotional support

Emotional support was mentioned as an intervention in 12 articles1919. Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy H, Clark A. Perceptions of post outbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open [Internet]. 2019 [cited 2020 Aug 15];9(5):e017476. Available from: https://doi.org/10.1136/bmjopen-2017-017476
https://doi.org/10.1136/bmjopen-2017-017...
-2020. Almutairi AF, Adlan AA, Balkhy HH, Abbas OA, Clark AM. “It feels like I'm the dirtiest person in the world”: exploring the experiences of healthcare providers who survived MERS-CoV in Saudi Arabia. J Infect Public Health [Internet]. 2018 [cited 2020 Aug 15];11(2):187-91. Available from: https://doi.org/10.1016/j.jiph.2017.06.011
https://doi.org/10.1016/j.jiph.2017.06.0...
,2525. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...
-2626. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. [Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19 ]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi CMA J Cn [Internet]. 2020 [cited 2020 Aug 16];38(3):192-5. Available from: https://doi.org/10.3760/cma.j.cn121094-20200219-00063
https://doi.org/10.3760/cma.j.cn121094-2...
,2929. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag [Internet]. 2020 [cited 2020 Aug 16];28(5):1002-9. Available from: https://doi.org/10.1111/jonm.13014
https://doi.org/10.1111/jonm.13014...
-3030. Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. Int J Biol Sci [Internet]. 2020 [cited 2020 Aug 16];16(10):1732-8. Available from: http://www.ijbs.com/v16p1732.htm
http://www.ijbs.com/v16p1732.htm...
,3232. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health Outcomes among health care workers exposed to Coronavirus disease 2019. JAMA Netw Open [Internet]. 2020 [cited 2020 Aug 16];3(3):e203976. Available from: https://doi.org/10.1001/jamanetworkopen.2020.3976
https://doi.org/10.1001/jamanetworkopen....
-3333. Gan X, Shi Z, Chair SY, Cao X, Wang Q. Willingness of Chinese nurses to practice in Hubei combating the coronavirus disease 2019 epidemic: a cross-sectional study. J Adv Nurs [Internet]. 2020 [cited 2020 Aug 16];76:2137-50. Available from: https://doi.org/10.1111/jan.14434
https://doi.org/10.1111/jan.14434...
,3535. Ni MY, Yang L, Leung CMC, Li N, Yao XI, Wang Y, et al. Mental health, risk factors, and social media use during the COVID-19 epidemic and cordon sanitaire among the community and health professionals in Wuhan, China: cross-sectional survey. JMIR Ment Health [Internet]. 2020 [cited 2020 Aug 16];7(5):e19009. Available from: https://doi.org/10.2196/19009
https://doi.org/10.2196/19009...
,3838. Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect [Internet]. 2020 [cited 2020 Aug 16];148:e98. Available from: https://doi.org/10.1017/s0950268820001107
https://doi.org/10.1017/s095026882000110...
,4343. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:559-65. Available from: https://doi.org/10.1016/j.bbi.2020.04.049
https://doi.org/10.1016/j.bbi.2020.04.04...
,4646. Wu PE, Styra R, Gold WL. Mitigating the psychological effects of COVID-19 on health care workers. CMAJ [Internet]. 2020 [cited 2020 Aug 16];192(17):459-60. Available from: https://doi.org/10.1503/cmaj.200519
https://doi.org/10.1503/cmaj.200519...
, encompassing 15 subcategories, which are shown in Figure 3.

Figure 3 -
Organizational chart of the emotional support category. Brazil, 2010-2020.

Strategies to relieve anxiety

The strategies to relieve anxiety, presented in seven articles1919. Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy H, Clark A. Perceptions of post outbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open [Internet]. 2019 [cited 2020 Aug 15];9(5):e017476. Available from: https://doi.org/10.1136/bmjopen-2017-017476
https://doi.org/10.1136/bmjopen-2017-017...
,2222. Fessell D, Cherniss C. Coronavirus disease 2019 (COVID-19) and beyond: micropractices for burnout prevention and emotional wellness. J Am Coll Radiol [Internet]. 2020 [cited 2020 Aug 15];17(6):746-8. Available from: https://doi.org/10.1016/j.jacr.2020.03.013
https://doi.org/10.1016/j.jacr.2020.03.0...
,2525. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...
,3030. Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. Int J Biol Sci [Internet]. 2020 [cited 2020 Aug 16];16(10):1732-8. Available from: http://www.ijbs.com/v16p1732.htm
http://www.ijbs.com/v16p1732.htm...
-3131. Zhu J, Sun L, Zhang L, Wang H, Fan A, Yang B, et. al. Prevalence and Influencing Factors of Anxiety and Depression Symptoms in the First-Line Medical Staff Fighting Against COVID-19 in Gansu. Front Psychiatry [Internet]. 2020 2020 [cited 2020 Aug 16];11:386. Available from: https://doi.org/10.3389/fpsyt.2020.00386
https://doi.org/10.3389/fpsyt.2020.00386...
,3434. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in hunan between January and March 2020 during the outbreak of Coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci Monit [Internet]. 2020 [cited 2020 Aug 16];26:e924171. Available from: https://doi.org/10.12659/msm.924171
https://doi.org/10.12659/msm.924171...
,4646. Wu PE, Styra R, Gold WL. Mitigating the psychological effects of COVID-19 on health care workers. CMAJ [Internet]. 2020 [cited 2020 Aug 16];192(17):459-60. Available from: https://doi.org/10.1503/cmaj.200519
https://doi.org/10.1503/cmaj.200519...
, emphasized the adoption of positive coping styles, which are described in Figure 4.

Figure 4 -
Organization chart of the anxiety relief category. Brazil, 2010-2020.

Welcoming work environment

A welcoming work environment, present in 13 articles1616. Lancee WJ, Maunder RG, Goldbloom DS. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv [Internet]. 2008 [cited 2020 Aug 15];59(1):91-5. Available from: https://doi.org/10.1176/ps.2008.59.1.91
https://doi.org/10.1176/ps.2008.59.1.91...
,1919. Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy H, Clark A. Perceptions of post outbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open [Internet]. 2019 [cited 2020 Aug 15];9(5):e017476. Available from: https://doi.org/10.1136/bmjopen-2017-017476
https://doi.org/10.1136/bmjopen-2017-017...
,2121. Shingler-Nace A. COVID-19: When leaderships Calls. Nurse Lead [Internet]. 2020 [cited 2020 Aug 15];18(3):202-3. Available from: https://doi.org/10.1016/j.mnl.2020.03.017
https://doi.org/10.1016/j.mnl.2020.03.01...
-2222. Fessell D, Cherniss C. Coronavirus disease 2019 (COVID-19) and beyond: micropractices for burnout prevention and emotional wellness. J Am Coll Radiol [Internet]. 2020 [cited 2020 Aug 15];17(6):746-8. Available from: https://doi.org/10.1016/j.jacr.2020.03.013
https://doi.org/10.1016/j.jacr.2020.03.0...
,2525. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...
-2626. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. [Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19 ]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi CMA J Cn [Internet]. 2020 [cited 2020 Aug 16];38(3):192-5. Available from: https://doi.org/10.3760/cma.j.cn121094-20200219-00063
https://doi.org/10.3760/cma.j.cn121094-2...
,2828. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...
-2929. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag [Internet]. 2020 [cited 2020 Aug 16];28(5):1002-9. Available from: https://doi.org/10.1111/jonm.13014
https://doi.org/10.1111/jonm.13014...
,3333. Gan X, Shi Z, Chair SY, Cao X, Wang Q. Willingness of Chinese nurses to practice in Hubei combating the coronavirus disease 2019 epidemic: a cross-sectional study. J Adv Nurs [Internet]. 2020 [cited 2020 Aug 16];76:2137-50. Available from: https://doi.org/10.1111/jan.14434
https://doi.org/10.1111/jan.14434...
,3535. Ni MY, Yang L, Leung CMC, Li N, Yao XI, Wang Y, et al. Mental health, risk factors, and social media use during the COVID-19 epidemic and cordon sanitaire among the community and health professionals in Wuhan, China: cross-sectional survey. JMIR Ment Health [Internet]. 2020 [cited 2020 Aug 16];7(5):e19009. Available from: https://doi.org/10.2196/19009
https://doi.org/10.2196/19009...
,4242. Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. COVID-19-Pandemie: belastungen des medizinischen Personals [COVID-19 Pandemic: stress experience of healthcare workers - a short current review]. Psychiatr Prax [Internet]. 2020 [cited 2020 Aug 16];47(4):190-7. Available from: https://doi.org/10.1055/a-1159-5551
https://doi.org/10.1055/a-1159-5551...
,4646. Wu PE, Styra R, Gold WL. Mitigating the psychological effects of COVID-19 on health care workers. CMAJ [Internet]. 2020 [cited 2020 Aug 16];192(17):459-60. Available from: https://doi.org/10.1503/cmaj.200519
https://doi.org/10.1503/cmaj.200519...
, proved to have strengthening potential for low anxiety levels and grouped important factors that make it possible to achieve this goal, such as: strong leadership4646. Wu PE, Styra R, Gold WL. Mitigating the psychological effects of COVID-19 on health care workers. CMAJ [Internet]. 2020 [cited 2020 Aug 16];192(17):459-60. Available from: https://doi.org/10.1503/cmaj.200519
https://doi.org/10.1503/cmaj.200519...
, with a calm leader who listens to the team2121. Shingler-Nace A. COVID-19: When leaderships Calls. Nurse Lead [Internet]. 2020 [cited 2020 Aug 15];18(3):202-3. Available from: https://doi.org/10.1016/j.mnl.2020.03.017
https://doi.org/10.1016/j.mnl.2020.03.01...
, using their biomedical and psychological knowledge to deal with the team’s and their own psychological status2525. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...
and who coordinates the activities, allocating patients according to the skill of each member of the Nursing team2828. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...
, which indirectly helps to familiarize the team with the procedures and the workplace2828. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...
; communication and regular updates of cases of patients infected by COVID-19, through regular meetings and online platforms2828. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...
; and encouragement of mutual care measures among the team members, through communication between coworkers who present similar feelings and experiences2828. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...
,2929. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag [Internet]. 2020 [cited 2020 Aug 16];28(5):1002-9. Available from: https://doi.org/10.1111/jonm.13014
https://doi.org/10.1111/jonm.13014...
, which will reflect in positive attitudes3434. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in hunan between January and March 2020 during the outbreak of Coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci Monit [Internet]. 2020 [cited 2020 Aug 16];26:e924171. Available from: https://doi.org/10.12659/msm.924171
https://doi.org/10.12659/msm.924171...
and gratitude by the team2222. Fessell D, Cherniss C. Coronavirus disease 2019 (COVID-19) and beyond: micropractices for burnout prevention and emotional wellness. J Am Coll Radiol [Internet]. 2020 [cited 2020 Aug 15];17(6):746-8. Available from: https://doi.org/10.1016/j.jacr.2020.03.013
https://doi.org/10.1016/j.jacr.2020.03.0...
. In addition to the important role of the Nursing team leader, health institutions must carry out educational training and capacity-building campaigns to strengthen COVID-19 knowledge and copying skills1616. Lancee WJ, Maunder RG, Goldbloom DS. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv [Internet]. 2008 [cited 2020 Aug 15];59(1):91-5. Available from: https://doi.org/10.1176/ps.2008.59.1.91
https://doi.org/10.1176/ps.2008.59.1.91...
,1919. Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy H, Clark A. Perceptions of post outbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open [Internet]. 2019 [cited 2020 Aug 15];9(5):e017476. Available from: https://doi.org/10.1136/bmjopen-2017-017476
https://doi.org/10.1136/bmjopen-2017-017...
,2525. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...
,2929. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag [Internet]. 2020 [cited 2020 Aug 16];28(5):1002-9. Available from: https://doi.org/10.1111/jonm.13014
https://doi.org/10.1111/jonm.13014...
,3434. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in hunan between January and March 2020 during the outbreak of Coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci Monit [Internet]. 2020 [cited 2020 Aug 16];26:e924171. Available from: https://doi.org/10.12659/msm.924171
https://doi.org/10.12659/msm.924171...
,4545. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:901-7. Available from: https://doi.org/10.1016/j.bbi.2020.05.026
https://doi.org/10.1016/j.bbi.2020.05.02...
, observing the need to develop programs aimed at each category of health worker1919. Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy H, Clark A. Perceptions of post outbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open [Internet]. 2019 [cited 2020 Aug 15];9(5):e017476. Available from: https://doi.org/10.1136/bmjopen-2017-017476
https://doi.org/10.1136/bmjopen-2017-017...
.

Nursing professionals must be encouraged to seek social support2525. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...
-2626. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. [Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19 ]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi CMA J Cn [Internet]. 2020 [cited 2020 Aug 16];38(3):192-5. Available from: https://doi.org/10.3760/cma.j.cn121094-20200219-00063
https://doi.org/10.3760/cma.j.cn121094-2...
,2929. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag [Internet]. 2020 [cited 2020 Aug 16];28(5):1002-9. Available from: https://doi.org/10.1111/jonm.13014
https://doi.org/10.1111/jonm.13014...
,3535. Ni MY, Yang L, Leung CMC, Li N, Yao XI, Wang Y, et al. Mental health, risk factors, and social media use during the COVID-19 epidemic and cordon sanitaire among the community and health professionals in Wuhan, China: cross-sectional survey. JMIR Ment Health [Internet]. 2020 [cited 2020 Aug 16];7(5):e19009. Available from: https://doi.org/10.2196/19009
https://doi.org/10.2196/19009...
,4242. Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. COVID-19-Pandemie: belastungen des medizinischen Personals [COVID-19 Pandemic: stress experience of healthcare workers - a short current review]. Psychiatr Prax [Internet]. 2020 [cited 2020 Aug 16];47(4):190-7. Available from: https://doi.org/10.1055/a-1159-5551
https://doi.org/10.1055/a-1159-5551...
through video calls and virtual meetings with friends and family members during social isolation4646. Wu PE, Styra R, Gold WL. Mitigating the psychological effects of COVID-19 on health care workers. CMAJ [Internet]. 2020 [cited 2020 Aug 16];192(17):459-60. Available from: https://doi.org/10.1503/cmaj.200519
https://doi.org/10.1503/cmaj.200519...
. In addition, recognition of their work by the community proved to be fundamental in reducing their anxiety during the SARS-CoV-2 pandemic.

Implementation of safety policies

Safety policies are part of a larger strategy plan to reduce anxiety, as they involve the governmental sphere. This category was present in 14 articles1919. Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy H, Clark A. Perceptions of post outbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open [Internet]. 2019 [cited 2020 Aug 15];9(5):e017476. Available from: https://doi.org/10.1136/bmjopen-2017-017476
https://doi.org/10.1136/bmjopen-2017-017...
,2222. Fessell D, Cherniss C. Coronavirus disease 2019 (COVID-19) and beyond: micropractices for burnout prevention and emotional wellness. J Am Coll Radiol [Internet]. 2020 [cited 2020 Aug 15];17(6):746-8. Available from: https://doi.org/10.1016/j.jacr.2020.03.013
https://doi.org/10.1016/j.jacr.2020.03.0...
,2424. Cai W, Lian B, Song X, Hou T, Deng G, Li H. A cross-sectional study on mental health among health care workers during the outbreak of Coronavirus disease 2019. Asian J Psychiatr [Internet]. 2020 Apr 24 [cited 2020 Aug 15];51:102-11. Available from: https://doi.org/10.1016/j.ajp.2020.102111
https://doi.org/10.1016/j.ajp.2020.10211...
-2525. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...
,2727. Wu J, Rong X, Chen F. Investigation on sleep quality of first-line nurses in fighting against corona virus disease 2019 and its influencing factors. Chin Nurs Res [Internet]. 2020 [cited 2020 Aug 15];34(4):558-62. Available from: https://kns.cnki.net/kcms/detail/detail.aspx?FileName=ZXWS2020081000C&DbName=CAPJ2020
https://kns.cnki.net/kcms/detail/detail....

28. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...

29. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag [Internet]. 2020 [cited 2020 Aug 16];28(5):1002-9. Available from: https://doi.org/10.1111/jonm.13014
https://doi.org/10.1111/jonm.13014...
-3030. Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. Int J Biol Sci [Internet]. 2020 [cited 2020 Aug 16];16(10):1732-8. Available from: http://www.ijbs.com/v16p1732.htm
http://www.ijbs.com/v16p1732.htm...
,3333. Gan X, Shi Z, Chair SY, Cao X, Wang Q. Willingness of Chinese nurses to practice in Hubei combating the coronavirus disease 2019 epidemic: a cross-sectional study. J Adv Nurs [Internet]. 2020 [cited 2020 Aug 16];76:2137-50. Available from: https://doi.org/10.1111/jan.14434
https://doi.org/10.1111/jan.14434...

34. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in hunan between January and March 2020 during the outbreak of Coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci Monit [Internet]. 2020 [cited 2020 Aug 16];26:e924171. Available from: https://doi.org/10.12659/msm.924171
https://doi.org/10.12659/msm.924171...

35. Ni MY, Yang L, Leung CMC, Li N, Yao XI, Wang Y, et al. Mental health, risk factors, and social media use during the COVID-19 epidemic and cordon sanitaire among the community and health professionals in Wuhan, China: cross-sectional survey. JMIR Ment Health [Internet]. 2020 [cited 2020 Aug 16];7(5):e19009. Available from: https://doi.org/10.2196/19009
https://doi.org/10.2196/19009...

36. Sheng X, Liu F, Zhou J, Liao R. Nan Fang Yi Ke Da Xue Xue Bao [Psychological status and sleep quality of nursing interns during the outbreak of COVID-19]. J South Med Univ [Internet]. 2020 [cited 2020 Aug 16];40(3):346-50. Available from: https://doi.org/10.12122/j.issn.1673-4254.2020.03.09
https://doi.org/10.12122/j.issn.1673-425...
-3737. Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiat [Internet]. 2020 [cited 2020 Aug 16];7(4):15-6. Available from: https://doi.org/10.1016/s2215-0366(20)30078-x
https://doi.org/10.1016/s2215-0366(20)30...
,4545. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:901-7. Available from: https://doi.org/10.1016/j.bbi.2020.05.026
https://doi.org/10.1016/j.bbi.2020.05.02...
, describing the importance of a comprehensive infectious disease prevention system2727. Wu J, Rong X, Chen F. Investigation on sleep quality of first-line nurses in fighting against corona virus disease 2019 and its influencing factors. Chin Nurs Res [Internet]. 2020 [cited 2020 Aug 15];34(4):558-62. Available from: https://kns.cnki.net/kcms/detail/detail.aspx?FileName=ZXWS2020081000C&DbName=CAPJ2020
https://kns.cnki.net/kcms/detail/detail....
in order to ensure protective measures1919. Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy H, Clark A. Perceptions of post outbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open [Internet]. 2019 [cited 2020 Aug 15];9(5):e017476. Available from: https://doi.org/10.1136/bmjopen-2017-017476
https://doi.org/10.1136/bmjopen-2017-017...
,3434. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in hunan between January and March 2020 during the outbreak of Coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci Monit [Internet]. 2020 [cited 2020 Aug 16];26:e924171. Available from: https://doi.org/10.12659/msm.924171
https://doi.org/10.12659/msm.924171...
-3535. Ni MY, Yang L, Leung CMC, Li N, Yao XI, Wang Y, et al. Mental health, risk factors, and social media use during the COVID-19 epidemic and cordon sanitaire among the community and health professionals in Wuhan, China: cross-sectional survey. JMIR Ment Health [Internet]. 2020 [cited 2020 Aug 16];7(5):e19009. Available from: https://doi.org/10.2196/19009
https://doi.org/10.2196/19009...
,3737. Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiat [Internet]. 2020 [cited 2020 Aug 16];7(4):15-6. Available from: https://doi.org/10.1016/s2215-0366(20)30078-x
https://doi.org/10.1016/s2215-0366(20)30...
,4545. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:901-7. Available from: https://doi.org/10.1016/j.bbi.2020.05.026
https://doi.org/10.1016/j.bbi.2020.05.02...
, and to conduct mass testing2525. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...
and clinical screenings2222. Fessell D, Cherniss C. Coronavirus disease 2019 (COVID-19) and beyond: micropractices for burnout prevention and emotional wellness. J Am Coll Radiol [Internet]. 2020 [cited 2020 Aug 15];17(6):746-8. Available from: https://doi.org/10.1016/j.jacr.2020.03.013
https://doi.org/10.1016/j.jacr.2020.03.0...
,2424. Cai W, Lian B, Song X, Hou T, Deng G, Li H. A cross-sectional study on mental health among health care workers during the outbreak of Coronavirus disease 2019. Asian J Psychiatr [Internet]. 2020 Apr 24 [cited 2020 Aug 15];51:102-11. Available from: https://doi.org/10.1016/j.ajp.2020.102111
https://doi.org/10.1016/j.ajp.2020.10211...
-2525. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...
,2929. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag [Internet]. 2020 [cited 2020 Aug 16];28(5):1002-9. Available from: https://doi.org/10.1111/jonm.13014
https://doi.org/10.1111/jonm.13014...
,3636. Sheng X, Liu F, Zhou J, Liao R. Nan Fang Yi Ke Da Xue Xue Bao [Psychological status and sleep quality of nursing interns during the outbreak of COVID-19]. J South Med Univ [Internet]. 2020 [cited 2020 Aug 16];40(3):346-50. Available from: https://doi.org/10.12122/j.issn.1673-4254.2020.03.09
https://doi.org/10.12122/j.issn.1673-425...
. One of the main points during the implementation of the political plans is the need for clear institutional protocols3030. Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. Int J Biol Sci [Internet]. 2020 [cited 2020 Aug 16];16(10):1732-8. Available from: http://www.ijbs.com/v16p1732.htm
http://www.ijbs.com/v16p1732.htm...
,3434. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in hunan between January and March 2020 during the outbreak of Coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci Monit [Internet]. 2020 [cited 2020 Aug 16];26:e924171. Available from: https://doi.org/10.12659/msm.924171
https://doi.org/10.12659/msm.924171...
to guide the procedures of all the health professionals. It is emphasized that better working conditions2929. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag [Internet]. 2020 [cited 2020 Aug 16];28(5):1002-9. Available from: https://doi.org/10.1111/jonm.13014
https://doi.org/10.1111/jonm.13014...
,3434. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in hunan between January and March 2020 during the outbreak of Coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci Monit [Internet]. 2020 [cited 2020 Aug 16];26:e924171. Available from: https://doi.org/10.12659/msm.924171
https://doi.org/10.12659/msm.924171...
- such as ensuring adequate human resources2525. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...
,2727. Wu J, Rong X, Chen F. Investigation on sleep quality of first-line nurses in fighting against corona virus disease 2019 and its influencing factors. Chin Nurs Res [Internet]. 2020 [cited 2020 Aug 15];34(4):558-62. Available from: https://kns.cnki.net/kcms/detail/detail.aspx?FileName=ZXWS2020081000C&DbName=CAPJ2020
https://kns.cnki.net/kcms/detail/detail....
, offering assistance2525. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
https://doi.org/10.1016/j.ajic.2020.03.0...
,3434. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in hunan between January and March 2020 during the outbreak of Coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci Monit [Internet]. 2020 [cited 2020 Aug 16];26:e924171. Available from: https://doi.org/10.12659/msm.924171
https://doi.org/10.12659/msm.924171...
, adjusting the work shift2828. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...
, and providing reasonable rest2828. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...
and rest areas for the Nursing professionals3333. Gan X, Shi Z, Chair SY, Cao X, Wang Q. Willingness of Chinese nurses to practice in Hubei combating the coronavirus disease 2019 epidemic: a cross-sectional study. J Adv Nurs [Internet]. 2020 [cited 2020 Aug 16];76:2137-50. Available from: https://doi.org/10.1111/jan.14434
https://doi.org/10.1111/jan.14434...
,3737. Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiat [Internet]. 2020 [cited 2020 Aug 16];7(4):15-6. Available from: https://doi.org/10.1016/s2215-0366(20)30078-x
https://doi.org/10.1016/s2215-0366(20)30...
- are the key to reducing anxiety in this category that is at the front line during the pandemic.

DISCUSSION

This systematic review analyzed the mean of anxiety and the interventions proposed to reduce anxiety in Nursing professionals, in the context of outbreaks and pandemics that caused SARS in 31 articles, without time limit or language preference because, in view of the current pandemic by SARS-CoV-2, it becomes urgent to analyze high-quality data on the effects of SARS on the health professionals who are at the front line, especially nurses4747. Townsend E, Nielsen E, Allister R, Cassidy SA. Key ethical questions for research during the COVID-19 pandemic. Lancet Psychiat [Internet]. 2020 [cited 2020 Aug 16];7(5):381-3. Available from: https://dx.doi.org/10.1016%2FS2215-0366(20)30150-4
https://dx.doi.org/10.1016%2FS2215-0366(...
, who are at greater risk due to exposure to COVID-19 patients, to their care activities with more direct contact, and for being in charge of collecting virus detection tests4848. Liu Z, Han B, Jiang R, Huang Y, Ma Chao, Wen J, et al. Mental Health Status of Doctors and Nurses During COVID-19 Epidemic in China. SSRN Electron J [Internet]. 2020 [cited 2020 Aug 16];Preprint. Available from: https://doi.org/10.2139/ssrn.3551329
https://doi.org/10.2139/ssrn.3551329...
.

This systematic review addressed 15 cross-sectional articles, 1 cohort article, 2 review articles, 8 opinion articles, and 4 qualitative studies. The meta-analysis was carried out with 12 articles, evidencing a large proportion of nurses and health professionals with high anxiety levels, although emphasizing that the Nursing professionals present higher anxiety mean values.

Although the different scales and cutoff points adopted by each study have introduced certain heterogeneity in the meta-analysis, it can be observed that, in most cases, the Nursing professionals experienced medium to moderate anxiety levels, while severe levels were less common; however, when compared to the levels of other health professionals, Nursing showed a higher estimated anxiety level4848. Liu Z, Han B, Jiang R, Huang Y, Ma Chao, Wen J, et al. Mental Health Status of Doctors and Nurses During COVID-19 Epidemic in China. SSRN Electron J [Internet]. 2020 [cited 2020 Aug 16];Preprint. Available from: https://doi.org/10.2139/ssrn.3551329
https://doi.org/10.2139/ssrn.3551329...
, which demonstrates the need for clinical anxiety screening as a form of early and preventive intervention in the evolution of anxiety as a symptom for disorders.

Other strategies addressed were the following: better working conditions for the Nursing professionals, which include adjusting the work shift, favoring reasonable rest for this category, as well as providing rest areas in the workplace and offering assistance. This assistance includes the government's benefit strategies in case of contagion, such as workers' compensation insurance2828. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...
; providing equipment to enable online chats between the Nursing professionals and their family members during isolation2828. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
https://doi.org/10.1186/s13054-020-02926...
; and offering online mental health services3030. Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. Int J Biol Sci [Internet]. 2020 [cited 2020 Aug 16];16(10):1732-8. Available from: http://www.ijbs.com/v16p1732.htm
http://www.ijbs.com/v16p1732.htm...
, preferably provided by multidisciplinary mental health teams2222. Fessell D, Cherniss C. Coronavirus disease 2019 (COVID-19) and beyond: micropractices for burnout prevention and emotional wellness. J Am Coll Radiol [Internet]. 2020 [cited 2020 Aug 15];17(6):746-8. Available from: https://doi.org/10.1016/j.jacr.2020.03.013
https://doi.org/10.1016/j.jacr.2020.03.0...
,4343. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:559-65. Available from: https://doi.org/10.1016/j.bbi.2020.04.049
https://doi.org/10.1016/j.bbi.2020.04.04...
,4545. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:901-7. Available from: https://doi.org/10.1016/j.bbi.2020.05.026
https://doi.org/10.1016/j.bbi.2020.05.02...
.

The importance of the Nursing professionals' adherence to the anxiety management interventions is emphasized, especially in the current context of the COVID-19 pandemic, in which time is something rare for this population4949. Moreira WC, Sousa AR, Nóbrega MPSS. Adoecimento mental na população geral e em profissionais de saúde durante a COVID-19: scoping review. Texto Contexto Enferm [Internet]. 2020 [cited 2021 Jan 11];29:e20200215. Available from: https://doi.org/10.1590/1980-265x-tce-2020-0215
https://doi.org/10.1590/1980-265x-tce-20...
. For this reason, a study2222. Fessell D, Cherniss C. Coronavirus disease 2019 (COVID-19) and beyond: micropractices for burnout prevention and emotional wellness. J Am Coll Radiol [Internet]. 2020 [cited 2020 Aug 15];17(6):746-8. Available from: https://doi.org/10.1016/j.jacr.2020.03.013
https://doi.org/10.1016/j.jacr.2020.03.0...
proposed micro-practices for managing anxiety that can be performed during the work routine, such as: practicing breathing techniques to relax, practicing mindfulness, writing three good things and naming emotions. Some of the practices presented were previously addressed by theorist Peplau, a psychiatric nurse, who described the nurses' activities based on interpersonal relationships (IRs) in Nursing, conceptualizing anxiety as the key to IRs. Therefore, during their training, nurses learn to name and manage anxiety.

In view of the above, the synthesis of evidence of interventions for anxiety in front line care professionals during the current pandemic is extremely necessary, as these are the individuals who exert direct and indirect influences on the control of COVID-19, because they take care of infected patients and family members and carry out education in health for the prevention and control of the disease.

The limitations of this study included the methodological heterogeneity of the included studies; the low number of articles included in the meta-analysis; and the fact that the results on anxiety found in the studies are very different so that, when combined, they presented a high degree of heterogeneity. The generalization of the findings should be limited, since most of the studies were conducted in China, and the health systems and the implementation of safety policies are varied worldwide. In addition to that, most of the papers included in the meta-analysis are cross-sectional studies, requiring long-term follow-up studies to enable greater understanding of the prevalence of anxiety in this population.

Despite the limitations, it is worth mentioning that the results observed in this study contribute to the establishment of specific strategies, in addition to more assertive management strategies, in the face of anxiety in the healthcare staff, in order to prevent and treat the professionals affected by this condition, resulting in better care to the patients and family members under their care.

CONCLUSION

The synthesis of evidence of strategies for the management of anxiety in Nursing professionals, key actors in COVID-19 prevention and control, is fundamental to translate scientific knowledge into health practice. From this synthesis, it was possible to identify the main interventions to reduce anxiety, such as emotional support, positive coping techniques, a welcoming work environment, and implementation of policies that ensure protective measures against the disease caused by SARS-CoV-2, considering previous experiences in fighting SARS and MERS. Such knowledge may be applied in the development of a protocol for the management of anxiety for Nursing professionals.

REFERENCES

  • 1. Chen R, Chou KR, Huang YJ, Wang TS, Liu SY, Ho LY. Effects of a SARS prevention programme in Taiwan on nursing staff's anxiety, depression and sleep quality: A longitudinal survey. Int J Nurs Stud [Internet]. 2006 [cited 2020 Aug 14];43(2):215-25. Available from: https://doi.org/10.1016/j.ijnurstu.2005.03.006
    » https://doi.org/10.1016/j.ijnurstu.2005.03.006
  • 2. Holland SH. Backbone of the institution. Nurs Manag (Harrow) [Internet]. 2003 [cited 2020 Aug 15];33(2Suppl):26. Available from: https://pubmed.ncbi.nlm.nih.gov/14694864/
    » https://pubmed.ncbi.nlm.nih.gov/14694864/
  • 3. Di Censo A, Bryant-Lukosius D. Clinical nurse specialists and nurse practitioners in Canada. Nurs Leadersh (Tor Ont) [Internet]. 2010 [cited 2020 Aug 15];23:189-201. Available from: https://doi.org/10.12927/cjnl.2010.22276
    » https://doi.org/10.12927/cjnl.2010.22276
  • 4. Ko NY, Pan SM, Feng MC, Chang R, Ma HJ, Liou CA. Using focus groups to analyze nurses’ experiences of caring for patients with HIV/AIDS in southern Taiwan. J Nurs [Internet]. 2002 [cited 2020 Aug 15];49(3):37-43. Available from: https://www.airitilibrary.com/Publication/alDetailedMesh?DocID=0047262x-200206-49-3-37-44-a
    » https://www.airitilibrary.com/Publication/alDetailedMesh?DocID=0047262x-200206-49-3-37-44-a
  • 5. Healy K. A Theory of human motivation by Abraham H. Maslow (1942). Br J Psychiatr [Internet]. 2016 [cited 2020 Aug 15];208(4):313. Available from: https://doi:10.1192/bjp.bp.115.179622
    » https://doi:10.1192/bjp.bp.115.179622
  • 6. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ [Internet]. 2003 [cited 2020 Aug 15];168(10):1245-51. Available from: https://pubmed.ncbi.nlm.nih.gov/12743065/
    » https://pubmed.ncbi.nlm.nih.gov/12743065/
  • 7. Kang L, Li Y, Hu S, Chen M, Yang C, Yang B. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatr [Internet]. 2020 [cited 2020 Aug 15];7(3):e14. Available from: https://doi.org/10.1016/s2215-0366(20)30047-x
    » https://doi.org/10.1016/s2215-0366(20)30047-x
  • 8. Peplau HE. Interpersonal relations in nursing: a conceptual frame of reference for psychodynamic nursing. New York: Springer Publishing Company; 1991.
  • 9. Aguilera DC. Crisis intervention: theory and methodology [Internet]. 6th ed. St. Louis: Mosby;1990 [cited 2020 Aug 14]. Available from: https://doi.org/10.1176/ps.22.1.32-b
    » https://doi.org/10.1176/ps.22.1.32-b
  • 10. Al Turki YA. Can we increase public awareness without creating anxiety about corona viruses? Patient Educ Couns [Internet]. 2014 [cited 2020 Aug 14];94(2):286. Available from: https://doi.org/10.1016/j.pec.2013.10.023
    » https://doi.org/10.1016/j.pec.2013.10.023
  • 11. Chan SS, So WK, Wong DC, Lee AC, Tiwari A. Improving older adults’ knowledge and practice of preventive measures through a telephone health education during the SARS epidemic in Hong Kong: A pilot study. Int J Nurs Stud [Internet]. 2007 [cited 2020 Aug 15];44(7):1120-27. Available from: https://doi.org/10.1016/j.ijnurstu.2006.04.019
    » https://doi.org/10.1016/j.ijnurstu.2006.04.019
  • 12. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping reviews (2020 version). In: Aromataris E, Munn Z, eds. JBI Manual for evidence synthesis. 2020 [cited 2020 Aug 15]. Available from: https://doi.org/10.46658/JBIMES-20-12
    » https://doi.org/10.46658/JBIMES-20-12
  • 13. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med [Internet]. 2009 [cited 2020 Aug 15];6(7):e1000097. Available from: https://doi.org/10.1371/journal.pmed.1000097
    » https://doi.org/10.1371/journal.pmed.1000097
  • 14. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med [Internet]. 2018 [cited 2020 Aug 15];169(7):467-73. Available from: https://doi.org/10.7326/M18-0850
    » https://doi.org/10.7326/M18-0850
  • 15. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev [Internet]. 2015 [cited 2020 Aug 15];4(1):1. Available from: https://doi.org/10.1186/2046-4053-4-1
    » https://doi.org/10.1186/2046-4053-4-1
  • 16. Lancee WJ, Maunder RG, Goldbloom DS. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv [Internet]. 2008 [cited 2020 Aug 15];59(1):91-5. Available from: https://doi.org/10.1176/ps.2008.59.1.91
    » https://doi.org/10.1176/ps.2008.59.1.91
  • 17. Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital 1workers and quarantined hemodialysis patients. Compr Psychiatry [Internet]. 2018 [cited 2020 Aug 15];87:123-27. Available from: https://doi.org/10.1016/j.comppsych.2018.10.003
    » https://doi.org/10.1016/j.comppsych.2018.10.003
  • 18. Kang J, Kim EJ, Choi JH, Hong HK, Han S, Choi IS, et al. Difficulties in using personal protective equipment: training experiences with the 2015 outbreak of Middle East respiratory syndrome in Korea. Am J Infect Control [Internet]. 2018 [cited 2020 Aug 15];46(2):235-37. Available from: https://doi.org/10.1016/j.ajic.2017.08.041
    » https://doi.org/10.1016/j.ajic.2017.08.041
  • 19. Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy H, Clark A. Perceptions of post outbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open [Internet]. 2019 [cited 2020 Aug 15];9(5):e017476. Available from: https://doi.org/10.1136/bmjopen-2017-017476
    » https://doi.org/10.1136/bmjopen-2017-017476
  • 20. Almutairi AF, Adlan AA, Balkhy HH, Abbas OA, Clark AM. “It feels like I'm the dirtiest person in the world”: exploring the experiences of healthcare providers who survived MERS-CoV in Saudi Arabia. J Infect Public Health [Internet]. 2018 [cited 2020 Aug 15];11(2):187-91. Available from: https://doi.org/10.1016/j.jiph.2017.06.011
    » https://doi.org/10.1016/j.jiph.2017.06.011
  • 21. Shingler-Nace A. COVID-19: When leaderships Calls. Nurse Lead [Internet]. 2020 [cited 2020 Aug 15];18(3):202-3. Available from: https://doi.org/10.1016/j.mnl.2020.03.017
    » https://doi.org/10.1016/j.mnl.2020.03.017
  • 22. Fessell D, Cherniss C. Coronavirus disease 2019 (COVID-19) and beyond: micropractices for burnout prevention and emotional wellness. J Am Coll Radiol [Internet]. 2020 [cited 2020 Aug 15];17(6):746-8. Available from: https://doi.org/10.1016/j.jacr.2020.03.013
    » https://doi.org/10.1016/j.jacr.2020.03.013
  • 23. Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry [Internet]. 2020 [cited 2020 Aug 15];7(3):228-9. Available from: https://doi.org/10.1016/S2215-0366(20)30046-8
    » https://doi.org/10.1016/S2215-0366(20)30046-8
  • 24. Cai W, Lian B, Song X, Hou T, Deng G, Li H. A cross-sectional study on mental health among health care workers during the outbreak of Coronavirus disease 2019. Asian J Psychiatr [Internet]. 2020 Apr 24 [cited 2020 Aug 15];51:102-11. Available from: https://doi.org/10.1016/j.ajp.2020.102111
    » https://doi.org/10.1016/j.ajp.2020.102111
  • 25. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control [Internet]. 2020 [cited 2020 Aug 15];48(6):592-8. Available from: https://doi.org/10.1016/j.ajic.2020.03.018
    » https://doi.org/10.1016/j.ajic.2020.03.018
  • 26. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. [Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19 ]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi CMA J Cn [Internet]. 2020 [cited 2020 Aug 16];38(3):192-5. Available from: https://doi.org/10.3760/cma.j.cn121094-20200219-00063
    » https://doi.org/10.3760/cma.j.cn121094-20200219-00063
  • 27. Wu J, Rong X, Chen F. Investigation on sleep quality of first-line nurses in fighting against corona virus disease 2019 and its influencing factors. Chin Nurs Res [Internet]. 2020 [cited 2020 Aug 15];34(4):558-62. Available from: https://kns.cnki.net/kcms/detail/detail.aspx?FileName=ZXWS2020081000C&DbName=CAPJ2020
    » https://kns.cnki.net/kcms/detail/detail.aspx?FileName=ZXWS2020081000C&DbName=CAPJ2020
  • 28. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care. 2020 [cited 2020 Aug 16];24(1):200. Available from: https://doi.org/10.1186/s13054-020-02926-2
    » https://doi.org/10.1186/s13054-020-02926-2
  • 29. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag [Internet]. 2020 [cited 2020 Aug 16];28(5):1002-9. Available from: https://doi.org/10.1111/jonm.13014
    » https://doi.org/10.1111/jonm.13014
  • 30. Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. Int J Biol Sci [Internet]. 2020 [cited 2020 Aug 16];16(10):1732-8. Available from: http://www.ijbs.com/v16p1732.htm
    » http://www.ijbs.com/v16p1732.htm
  • 31. Zhu J, Sun L, Zhang L, Wang H, Fan A, Yang B, et. al. Prevalence and Influencing Factors of Anxiety and Depression Symptoms in the First-Line Medical Staff Fighting Against COVID-19 in Gansu. Front Psychiatry [Internet]. 2020 2020 [cited 2020 Aug 16];11:386. Available from: https://doi.org/10.3389/fpsyt.2020.00386
    » https://doi.org/10.3389/fpsyt.2020.00386
  • 32. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health Outcomes among health care workers exposed to Coronavirus disease 2019. JAMA Netw Open [Internet]. 2020 [cited 2020 Aug 16];3(3):e203976. Available from: https://doi.org/10.1001/jamanetworkopen.2020.3976
    » https://doi.org/10.1001/jamanetworkopen.2020.3976
  • 33. Gan X, Shi Z, Chair SY, Cao X, Wang Q. Willingness of Chinese nurses to practice in Hubei combating the coronavirus disease 2019 epidemic: a cross-sectional study. J Adv Nurs [Internet]. 2020 [cited 2020 Aug 16];76:2137-50. Available from: https://doi.org/10.1111/jan.14434
    » https://doi.org/10.1111/jan.14434
  • 34. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological impact and coping strategies of frontline medical staff in hunan between January and March 2020 during the outbreak of Coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci Monit [Internet]. 2020 [cited 2020 Aug 16];26:e924171. Available from: https://doi.org/10.12659/msm.924171
    » https://doi.org/10.12659/msm.924171
  • 35. Ni MY, Yang L, Leung CMC, Li N, Yao XI, Wang Y, et al. Mental health, risk factors, and social media use during the COVID-19 epidemic and cordon sanitaire among the community and health professionals in Wuhan, China: cross-sectional survey. JMIR Ment Health [Internet]. 2020 [cited 2020 Aug 16];7(5):e19009. Available from: https://doi.org/10.2196/19009
    » https://doi.org/10.2196/19009
  • 36. Sheng X, Liu F, Zhou J, Liao R. Nan Fang Yi Ke Da Xue Xue Bao [Psychological status and sleep quality of nursing interns during the outbreak of COVID-19]. J South Med Univ [Internet]. 2020 [cited 2020 Aug 16];40(3):346-50. Available from: https://doi.org/10.12122/j.issn.1673-4254.2020.03.09
    » https://doi.org/10.12122/j.issn.1673-4254.2020.03.09
  • 37. Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiat [Internet]. 2020 [cited 2020 Aug 16];7(4):15-6. Available from: https://doi.org/10.1016/s2215-0366(20)30078-x
    » https://doi.org/10.1016/s2215-0366(20)30078-x
  • 38. Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect [Internet]. 2020 [cited 2020 Aug 16];148:e98. Available from: https://doi.org/10.1017/s0950268820001107
    » https://doi.org/10.1017/s0950268820001107
  • 39. Liang Y, Chen M, Zheng X, Liu J. Screening for Chinese medical staff mental health by SDS and SAS during the outbreak of COVID-19. J Psychosom Res [Internet]. 2020 [cited 2020 Aug 16];133:110102. Available from: https://doi.org/10.1016/j.jpsychores.2020.110102
    » https://doi.org/10.1016/j.jpsychores.2020.110102
  • 40. Zhang C, Yang L, Liu S, Ma S, Wang Y, Cai Z, et al. Survey of insomnia and related social psychological factors among medical staff involved in the 2019 novel Coronavirus disease outbreak. Front Psychiat [Internet]. 2020 [cited 2020 Aug 16];11:306. Available from: https://doi.org/10.3389/fpsyt.2020.00306
    » https://doi.org/10.3389/fpsyt.2020.00306
  • 41. Alsubaie S, Temsah MH, Al-Eyadhy AA, Gossady I, Hasan GM, Al-Rabiaah A, et al. Middle east respiratory syndrome Coronavirus epidemic impact on healthcare workers' risk perceptions, work and personal lives. J Infect Dev Countr [Internet]. 2019 [cited 2020 Aug 16];13(10):920-6. Available from: https://doi.org/10.3855/jidc.11753
    » https://doi.org/10.3855/jidc.11753
  • 42. Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. COVID-19-Pandemie: belastungen des medizinischen Personals [COVID-19 Pandemic: stress experience of healthcare workers - a short current review]. Psychiatr Prax [Internet]. 2020 [cited 2020 Aug 16];47(4):190-7. Available from: https://doi.org/10.1055/a-1159-5551
    » https://doi.org/10.1055/a-1159-5551
  • 43. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:559-65. Available from: https://doi.org/10.1016/j.bbi.2020.04.049
    » https://doi.org/10.1016/j.bbi.2020.04.049
  • 44. Black JRM, Bailey C, Przewrocka J, Dijkstra KK, Swanton C. COVID-19: the case for health-care worker screening to prevent hospital transmission. Lancet. 2020 [cited 2020 Aug 16];395(10234):1418-20. Available from: https://doi.org/10.1016/s0140-6736(20)30917-x
    » https://doi.org/10.1016/s0140-6736(20)30917-x
  • 45. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun [Internet]. 2020 [cited 2020 Aug 16];88:901-7. Available from: https://doi.org/10.1016/j.bbi.2020.05.026
    » https://doi.org/10.1016/j.bbi.2020.05.026
  • 46. Wu PE, Styra R, Gold WL. Mitigating the psychological effects of COVID-19 on health care workers. CMAJ [Internet]. 2020 [cited 2020 Aug 16];192(17):459-60. Available from: https://doi.org/10.1503/cmaj.200519
    » https://doi.org/10.1503/cmaj.200519
  • 47. Townsend E, Nielsen E, Allister R, Cassidy SA. Key ethical questions for research during the COVID-19 pandemic. Lancet Psychiat [Internet]. 2020 [cited 2020 Aug 16];7(5):381-3. Available from: https://dx.doi.org/10.1016%2FS2215-0366(20)30150-4
    » https://dx.doi.org/10.1016%2FS2215-0366(20)30150-4
  • 48. Liu Z, Han B, Jiang R, Huang Y, Ma Chao, Wen J, et al. Mental Health Status of Doctors and Nurses During COVID-19 Epidemic in China. SSRN Electron J [Internet]. 2020 [cited 2020 Aug 16];Preprint. Available from: https://doi.org/10.2139/ssrn.3551329
    » https://doi.org/10.2139/ssrn.3551329
  • 49. Moreira WC, Sousa AR, Nóbrega MPSS. Adoecimento mental na população geral e em profissionais de saúde durante a COVID-19: scoping review. Texto Contexto Enferm [Internet]. 2020 [cited 2021 Jan 11];29:e20200215. Available from: https://doi.org/10.1590/1980-265x-tce-2020-0215
    » https://doi.org/10.1590/1980-265x-tce-2020-0215

Publication Dates

  • Publication in this collection
    09 Aug 2021
  • Date of issue
    2021

History

  • Received
    04 Feb 2021
  • Accepted
    01 Apr 2021
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