Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic
Authors: Hoedl Manuela , Eglseer Doris , Bauer Silvia 
Published: August 2020

AbstractBackgroundThe results of several projects on the effects of personal protective equipment (PPE) have been published since the outbreak of COVID-19. It is known that wearing PPE, and specifically face masks, has physcial consequences like headache and pain, which can Increase stress among nursing staff. However, none of these studies placed a focus on PPE and nursing staff, although nurses are the only members of the health care profession who are at the patients’ bedsides 24/7, and PPE is the only way to protect them from a COVID-19 infection. Therefore, this study was carried out to investigate the association between the use of PPE and stress among nursing staff during the COVID-19 pandemic.MethodsAn online, cross-sectional survey was conducted, which we distributed using snowball sampling techniques. The questionnaire was developed on the basis of (inter-)national recommendations as well as the international literature. We used the perceived level of stress scale to measure the nursing staff members’ stress levels.ResultsWe included data collected from 2600 nurses in this analysis. Nearly all nursing staff wore face masks. We showed that more than two-thirds of the nurses had moderate to high levels of stress. No statistically significant association between the use of PPE and stress was detected. However, we show a statistically significant association between the duration of mask usage and stress.Discussion and conclusionsNearly all participating nurses wore face masks or FFP masks to protect themselves from COVID-19 infection. This observation might indicate that Austrian nurses display a high level of compliance with national and international regulations and play a key role in such pandemics. Our results also show that increased mask-wearing time led to increased stress levels. These results suggest that (international regulations on how and when to use PPE should include a maximum duration of time for wearing each type of mask. Such regulations could help to prevent work-related stress, particularly in the case of future epidemics, and avoid burnout among nursing staff or even nurses leaving their jobs. The consequences of both of these negative outcomes should be considered in light of the predicted expected future shortage of health care workers.“Contribution of the Paper”“What is already known about the topic?”Associations between headache and pain experienced when wearing personal protective equipment (PPE), and specifically face masks, has already been investigated.Nurses are at patients’ bedsides 24/7, and PPE is the only way to protect them from a COVID-19 infection.“What this paper adds”These study results show that the stress level among nursing staff during the COVID-19 pandemic ranged from moderate to high, stress levels in general, stress levels.We did not find a statistically significant association between the use of PPE and the nurses’ stress levels in general.This study identified an association between the duration of wearing PPE and the nurses’ stress levels.