Wellbeing and Coping Strategies of Emergency Department Nurses and Paramedics during the Coronavirus (COVID-19) Pandemic in Northern Region Hospitals of the Kingdom of Saudi Arabia: A Mixed-methods Study

Abstract

Background: Healthcare workers (HCWs) on the frontline carried significant responsibilities during the COVID-19 pandemic and confronted its direct consequences in efforts to manage the virus. Prioritizing their psychological wellbeing remained essential. Nevertheless, there was a scarcity of published studies focusing on HCWs in the emergency department (ED), especially in the Northern Region of the Kingdom of Saudi Arabia (KSA). Objective: This study explored the experiences of ED nurses and paramedics impacting their mental health and coping related to the COVID-19 pandemic in selected hospitals in the Northern Region of the KSA. Methods: This sequential mixed methods research (MMR) study was carried out in two phases. Phase One utilised semi-structured interviews in a purposive sample of 21 emergency nurses and paramedics in two selected hospitals in the Northern Border Zone and Al Jouf Region of the KSA. Interview data were analysed using thematic analysis and findings were used to inform Phase Two. The second phase employed an online cross-sectional survey in which a total convenience sample of 134 emergency nurses and paramedics participated, exploring the scale of topics emerging from Phase One, namely COVID-19 fear, general wellbeing, coping strategies, social and self-stigma, and mental health support and services. The survey was distributed across ten hospitals in the Northern Border Zone and Al Jouf Region of KSA. Survey data were analysed using SPSS version 28. Key Findings: Phase One interview findings identified two primary themes: (1) Working on the emergency frontline and (2) Wellbeing of self and associated sub-themes. Participants articulated significant changes in their work settings in the ED and team dynamics throughout the pandemic, 19 accompanied by considerable psychological challenges. They noted increased workloads, shortages of staff, anxiety regarding potential infection, and emotional turmoil, frequently without sufficient organisational support. The Phase Two survey validated the interview findings. Results revealed that fear of COVID-19 was moderate to high at the peak of the pandemic, and overall wellbeing was markedly diminished during this peak, compared to the later data collection period. Coping strategies reported by the emergency nurses and paramedics were revealed to be maladaptive on average, and exhibited stigmatising views towards mental health issues, with moderate levels of stigma reported. Expatriate nurses faced unique challenges. Conclusions: Overall study findings indicate that the experience of working during the pandemic subjected emergency nurses and paramedics to intense stress, adversely impacting their mental health and leading them to depend on personal coping strategies in the absence of organisational mental health support and services.