Study of blood exposure-related mental health illness among clinical nurses

Abstract

Nurses are subjected to high amount of stress in the medical setting, and work-related stress often leads to mental problems. This study aims to investigate the mental health status of nurses exposed to blood through needlestick injuries. A total of 302 nurses working in the hospital of Guangdong, China, participated in this study. Out of the 302 nurses, 140 did not experience any needlestick injuries during the previous week, whereas 162 nurses experienced needlestick injuries. The General Health Questionnaire (GHQ)-28 Standardized Questionnaire, which uses physical, anxiety, social function, and depression subscales, was used in this study. No significant difference between nurses exposed to blood and nurses not exposed to blood was found in terms of gender, age, length of employment, and civil status (P>0.05). Results from the GHQ-28 Standardized Questionnaire showed that 75.9% (123/162) of nurses exposed to blood were suspected to suffer from mental disorders, whereas 40% (56/140) of nurses not exposed to blood were suspected to suffer from mental disorders. The mean mental health scores of nurses exposed to blood and those not exposed were 8.73±7.32 and 5.69±5.70, respectively. From these results, we can conclude that blood exposure from needlestick injuries leads to higher prevalence of depression, anxiety, and stress symptoms in nurses. This finding highlights the importance of providing efficient, adequate, and appropriate support services after nurses are exposed to blood from needlestick injuries.

Keywords

blood exposure / needlestick injuries / mental health / nurses

Introduction

Mental health can also be defined as a mental disorder or mental illness. The World Health Organization estimates that nearly half of the world’s population is affected by mental illness [ 1]. Most mental disorders stem from chronic diseases with disability and have high economic costs. Emotional health can also impact physical health [ 2], making mental health a significant element of social well-being. Preventing mental disorders is one of the most important programs worldwide. Prevention is beginning to appear in mental health strategies, such as the 2004 WHO report “Prevention of Mental Disorder.” However, 76% to 85% of people with severe mental disorders are left untreated in low- and middle-income countries, whereas in high-income countries, 35% up to 50% are left untreated [ 3, 4].

Occupational mental health has considerably been growing in recent years. Over the last years, researchers have focused on various work settings in relation to mental illness, such as hospitals and banks [ 5, 6]. Studies have shown that the incidence of mental health problems in individuals with occupational burnout was significantly higher. Nurses experience stressful conditions that can induce mental problems, such as anxiety and depression. Study results showing the high prevalence of mental problems among nurses is alarming [ 7– 9]. Nurses working at the burn wards, CCU, and ICU were particularly more vulnerable to mental threats than others [ 10]. In the hospital, nurses play a vital role in promoting and upholding the standards for the quality of care. Nurses put patient needs before theirs, which leads to burnout and even mental problems. Given that physical and mental health are directly related to work efficiency, providing efficient, adequate, and appropriate support services for nurses results in healthier and more competent nurses as well as the promotion of public health [ 11].

Nurses are more prone to infections from blood-borne pathogens, such as hepatitis B and C and human immunodeficiency virus. Several studies have focused on assessing nurse exposure to blood-borne pathogens and shown nurses are more frequently exposed to blood compared with other healthcare practitioners [ 12– 14].

Clinical observation showed that the risk of blood exposure from needlestick injuries seriously influences the life of nurses. Minimal attention has been given to nurses with regard to the correlation between mental health and blood exposure. This study aims to assess blood-exposure-related mental health among clinical nurse practitioners.

Materials and methods

This descriptive cross-sectional study had 302 nurse participants that answered the General Health Questionnaire (GHQ)-28 Standardized Questionnaires. All the participants were a purposeful sample of full-time qualified nurses of Peking University Shenzhen Hospital in Guangdong, China. The ethics committee of Peking University Shenzhen Hospital has approved this study. Out of the 302 participants, 162 nurses (53.6%) were given the questionnaire after experiencing needlestick injury from the past week. In the same period, 140 nurses (46.4%) who were not exposed to blood through needlestick injuries from the previous week were enrolled. Majority of the participants worked in the same department of the hospital. The information included two parts, namely, personal information and the GHQ-28. A validated Chinese version of the GHQ-28 was used. The GHQ-28 was developed by Goldberg to screen those who are and are not likely at risk of developing psychiatric disorders. GHQ-28 has been divided into four sections: somatic symptoms (items 1–7); anxiety/insomnia (items 8–14); social dysfunction (items 15–21), and severe depression (items 22–28). The questionnaire assesses current state and asks if that differs from the person’s usual state. GHQ-28 is therefore sensitive to short-term distress or psychiatric disorders. This test has been translated into 38 languages and demonstrated adequate sensitivity and specificity consistent across language. A modified Likert method (0, 0, 1, 2) was used for this study, which involves Not at all and No more than usual score 0 and Rather more than usual score 1 and Much more than usual score 2. A high score (≥5) indicates a psychiatric disorder. Numerous studies have investigated reliability and validity of the GHQ-28 in various clinical populations. Test–retest reliability has been reported to be high (0.78 to 0.9), and interrater and intrarater reliability have both been shown to be excellent. The GHQ-28 correlates well with the Hospital Depression and Anxiety Scale (HADS) and other measures of depression [ 15, 16].

Statistical analysis

Descriptive statistics were summarized as mean score and standard deviation. t-test analysis was used to compare the difference of mean±SD of age and mental health scores between nurses exposed to blood and nurses not exposed to blood from needlestick injury. The difference of percentage of gender, length of employment, civil status, history of psychiatric conditions, and variable of mental health status was compared between nurses exposed to blood and nurses not exposed to blood using Chi-square test. Linear regression was used to calculate OR. A P value of 0.05 was considered as statistically significant. All analyses were performed with SPSS 16 Software.

Results

Majority of the participants were females (89.4% vs. 10.6%) aged 20 to 50 years old. A total of 80.1% of the participants were married, 38.1% had worked for less than 5 years, 33.1% with 5–10 years, and 28.8% had worked for more than 10 years. No significant difference was found between nurses exposed to blood and nurses not exposed to blood in terms of gender, age, length of employment, and civil status (P>0.05). Participant characteristics are shown in Table 1.

The analysis of GHQ-28 results showed that 75.9% (123/162) of nurses exposed to blood were suspected to suffer from mental disorders, whereas 40% (56/140) of nurses not exposed to blood were suspected to suffer from mental illness. Compared with nurses not exposed to blood, nurses who were exposed to blood were almost twice as likely to be diagnosed to have a psychiatric condition, and this finding was significant (P<0.01) (Fig. 1).

Comparison of mean mental health scores between the nurses revealed that nurses exposed to blood had a significantly higher score that that of nurses not exposed to blood (Table 2).

Of all the participants suspected to have mental illness in the blood-exposed nurse group, 51 (31.5%) exhibited physical symptoms, 64 (39.5%) showed anxiety symptoms, 63 (39.0%) showed social dysfunction symptoms, and 14 (8.6%) showed symptoms of depression. Meanwhile, in the nurse group not exposed to blood, of all the participants suspected to have mental illness, 20 (14.3%) exhibited physical symptoms, 25 (17.9%) showed anxiety symptoms, 27 (19.3%) had social dysfunction symptoms, and 5 (3.6%) showed symptoms of depression (Fig. 2).

Chi-square test results showed significant difference in mental health status related to different lengths of employment between nurses exposed to blood and nurses not exposed to blood (Table 3). No significant difference was found between nurses exposed to blood and nurses not exposed to blood in terms of gender, age, and civil status in each work record. Nurses exposed to blood had a higher percentage of diagnosed psychiatric cases compared with that of nurses not exposed to blood. No significant difference in mental health with regard to length of employment was found between the two nurse groups (P>0.05).

Discussion

Identifying psychiatric disorders and its influencing factors in nurses is particularly important not only to maintain the quality of life of nurses, but also to preserve their competence, which in turn leads to the promotion of the patient’s quality of life. Studies have found that mental health and sleep disorders were associated with occupational accidents, such as needlestick injuries [ 17, 18]. Needlestick injuries were correlated with various aspects of hospital safety [ 19]. Blood exposure from needlestick injuries and mental disorder were more frequent among clinical nurses compared with the general population. In this study, we investigated whether needlestick injuries influence the development of mental disorder. Results of GHQ-28 questionnaire were significantly different in nurses exposed to blood compared with nurses not exposed to blood exposure in terms of whether the nurses were diagnosed as a psychiatric case. Both the percentage and scores were higher in nurses exposed to blood who were diagnosed to have a psychiatric condition than nurses not exposed to blood.

Studies found that psychiatric disorders are more prevalent in women and married people [ 20, 21]. In our study, no significant difference was found between nurses exposed to blood and nurses not exposed to blood in terms of gender, age, length of employment, and civil status (Table 1).

In this study, 75.9% were suspected of having mental disorders in the nurse group exposed to blood from needlestick injuries during the previous week, which is significantly higher compared with that of the nurses not exposed to blood. The mean mental health score was 8.73 in nurses exposed to blood, whereas mean mental health score was 5.69 in nurses not exposed to blood. This finding indicates that clinical nurses experience significantly higher mental stress after being exposed to blood from needlestick injuries.

The percentage of nurses diagnosed with psychiatric disorders was significantly higher among nurses exposed to blood compared with that of nurses not exposed to blood. In terms of length of employment, no significant difference was noted in the percentage of nurses diagnosed with a psychiatric disorder. No significant difference was also found among nurses exposed to blood based on their length of work in the hospitals. Nurses working more than 10 years in the hospital were still facing the same amount of mental stress after blood exposure from needlestick injury.

Therefore, increasing the education on occupational risks and operating procedures among junior nurses is essential. Many researchers believe that the use of safer needle devices, sharps collection boxes, gloves and personal protective gear, and universal precautions are necessary to prevent needlestick injuries [ 22]. Adequate vaccination coverage reduces the stress of worrying about being infected. Providing more efficient and appropriate support services after blood exposure from needlestick injuries lead to more healthy nurses and in health promotion. Psychological interventions to reduce stress and enforcement of adjustment should be done after needlestick injuries.

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