新冠肺炎第一線護理人員心理困擾之系統性文獻回顧

The Psychological Distress of First-Line Nurses Caring for COVID-19 Patients: A Systematic Review

背景世界衛生組織在新冠肺炎（COVID-19）大流行三年後宣佈解除其全球公衛緊急狀態，疫情大流行期間造成全球醫療負荷超載，首當其衝的是第一線護理人員心理健康及離職意向，回顧第一線護理人員在此艱困期間之心理困擾情形，將有助於後疫情時代復原之路。
目的本文旨在系統性回顧第一線照護感染COVID-19病人之護理人員心理困擾狀態。
方法運用Preferred Reporting Items for Systematic Reviews and Meta-Analyses（PRISMA）2020 Statement進行系統性文獻回顧，以英文關鍵字（“COVID-19 first-line nurse”OR“COVID-19 frontline nurse”）AND（“psychological distress”OR“PTSD”OR“depression”OR“anxiety”OR“insomnia”OR“stress”OR“burnout”OR“fear”）；中文關鍵字以（“新冠肺炎第一線護理人員”或“新冠肺炎專責護理人員”及“心理困擾”或“創傷後壓力症候群”或“憂鬱”或“焦慮”或“失眠”或“壓力”或“倦怠”或”恐懼”），搜索2019年12月至2023年3月於「CINAHL」、「PubMed」、「Embase」，及「華藝」發表之中文及英文文獻；且以喬安娜布里格斯學會（Joanna Briggs Institute）出版的評讀工具進行納入研究之品質及證據等級判定。
結果共有20篇文獻符合篩選條件，其中16篇為量性研究，4篇為質性研究。量性研究結果顯示第一線護理人員有高程度心智負荷及中度以上工作倦怠，19.1%–72.3%第一線護理人員有壓力，有三成以上出現失眠問題。焦慮感於疫情高峰後4週及8週隨時間顯著下降，困擾程度則在疫情高峰至8週皆高，未隨時間下降。質性研究訪談第一線照護感染COVID-19病人之護理人員經歷，共同之心理困擾為恐懼。
結論無預期的新興傳染病大流行造成第一線護理人員中度以上心理困擾，仍有待對此議題更進一步之研究，協助第一線維護公眾健康之護理人員得到最好的支持及促進其復原。

Background: The World Health Organization officially declared an end to the COVID-19 Public Health Emergency three years after the initial outbreak of COVID-19. Healthcare providers worldwide were overwhelmed during the pandemic, which greatly affected the mental health and turnover intention of nurses. Conducting a systematic review of psychological distress in first-line nurses during the pandemic may facilitate future research on pandemic-related resilience. Purpose: A systematic review of the literature on psychological distress among first-line nurses caring for patients with COVID-19 was conducted. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. We searched the CINAHL, PubMed, Embase, and Airiti Library databases using the English and Chinese keywords (“COVID-19 first-line nurse”OR“COVID-19 frontline nurse”) AND (“psychological distress”OR“PTSD”OR“depression”OR“anxiety”OR“insomnia”OR“stress”OR“burnout”OR“fear”) to identify Chinese and English articles published between December 2019 and March 2023. The quality of the included studies was assessed using tools from the Joanna Briggs Institute. Results: A total of 20 articles covering 16 quantitative studies and 4 qualitative studies were included in the analysis. The quantitative findings revealed that first-line nurses experienced high task load and moderate or above-average burnout. Between 19.1% and 72.3% of the first-line nurses reported stress, and more than 30% experienced insomnia. At the peak of the pandemic, anxiety and distress levels were high. At 8-week follow-ups, while anxiety had decreased, distress levels had not. Qualitative findings included the identification of fear as a common symptom of psychological distress in first-line nurses. Conclusions/ Implications for Practice: Further research is needed to better support frontline caregivers and facilitate their recovery from the moderate to severe psychological distress associated with pandemics.