Self-Care Behaviors as a Mediator of Health Anxiety for Nurses during COVID-19 Pandemic

By Christopher McGuire

 

                      Chris McGuire at the Eastern Psychological 
                            Association’s Research Conference

Introduction

The COVID-19 pandemic has lead to many adverse psychological outcomes, especially in healthcare workers. For example, nurses working with COVID patients report higher symptoms of PTSD, anxiety, and insomnia (Li, 2021; Schierber-Scherr et al., 2021). Health anxiety, another negative outcome, is defined as the preoccupation or obsession with thinking an individual has a serious physiological disease when there are no apparent physical symptoms (Weck & Höfling, 2015). This can develop into a serious mental disorder that overtakes one’s thoughts and emotions if symptoms get out of control, thus interrupting their daily life. To mitigate such adverse outcomes, self-care behaviors are essential to maintain physiological health (Riegel, et al., 2009). In this study, differences in health anxiety levels will be measured in nurses who have worked with COVID-19 patients and nurses who have not, and self-care behaviors will be tested as a moderator of those two variables.

Methods

Participants

For four weeks in October and November, 2021, nurses were invited to participate in our study by taking online surveys promoted through social media and the American Association of Critical Care Nurses Participate in Research Studies webpage. A total of 271 responses were recorded, but only 148 responses were used in the analysis due to missing data. Participants were asked demographic information, including number of years worked as a nurse, age, average number of hours worked per week, and whether or not they have worked directly with patients who had contracted COVID-19.

Measures

Health Anxiety: Participants were asked to complete the Health Anxiety Questionnaire (HAQ) (Lucock & Morley 1996) to measure their levels of health anxiety. The survey consists of 21 questions asking participants about their attitudes towards their own physical health, and health symptomologies. The items can be categorized into four subscales (health worry & preoccupation, fear of illness & death, reassurance seeking behavior, and interference with life) or scored as a full scale. The HAQ uses a 4-point Likert scale (scored 0-3) ranging from “not at all or rarely” to “most of the time” to measure how often the participants feel concern, anxiety, or stress about their own physical health. The average scores were used in the current analyses, with higher scores indicating higher health anxiety.

Self-care: A self-care measure was developed by the researchers for the study to assess  15 self-care activities, including sleep, exercise, diet, stress management, and body monitoring. Items on the self-care measure were loosely based off the Self-care of Heart Failure Index (SCHFI) (Riegel, et al., 2009) which asks a variety of self-care questions using various Likert scales. Higher scores indicate an increased frequency in engaging these behaviors.

Results

Data were analyzed in two steps. The first step was to examine differences in health anxiety. Specifically, a t-test found that nurses who reported treating patients with COVID-19 had significantly higher health anxiety scores (M = 2.77, SD = 0.67) than nurses who did not (M = 2.39, SD = 0.50), t(147) = 3.04, p = .003). The second step was to examine if self-care behaviors moderated the relationship between treating patients with COVID-19 and health anxiety. We tested this using a hierarchical regression controlling for age, number of years working as a nurse, and education. The first step, which included the control variables, if they treated patients with COVID-19, and scores on the self-care scale, accounted for 21.7% of the variance, F(5, 142) = 7.88, p < .001. The second step, which included the interaction term of if they treated patients with COVID-19 and self-care, accounted for an additional 2.2% of the variance, ΔF(1, 141) = 4.07, p = .04. Overall, the model accounted for 23.9% of the variance in health anxiety, F(6, 141) = 7.83, p < .001. Follow-up analyses of the interaction found that the difference in health anxiety between nurses who treated patients with COVID-19 and those who did not decreased as self-care behaviors increased.

Discussion

Working closely with patients with COVID-19 during a national pandemic is significantly related to increased levels of health anxiety in nurses. This finding emphasizes the vulnerability of nurses working with COVID patients to adverse psychological outcomes. Self-care behaviors may be an effective way to lower these levels of health anxiety. Self-care behaviors accounted for a significant amount of variance of health anxiety in nurses that worked with COVID patients. This suggests that engaging in healthy self-care acts can help reduce feelings of health anxiety in nurses working with COVID patients. Lastly, as self-care behaviors increased, the differences in health anxiety decreased between nurses who treated COVID patients and nurses who did not. This suggests self-care behaviors are essential to maintain lower health anxiety levels for all nurses, but that they might be particularly important for nurses who treat patients with COVID-19.

The current study emphasizes the need for nurses to engage in self-care behaviors, especially those working with patients with COVID-19. Limitations of this study include the use of self-report, that the sample is not representative (e.g., geographical area, sample was overwhelmingly White and female), and that it is possible that nurses who were more affected by the COVID-19 pandemic may have been more likely to respond. Future research is needed for more in-depth knowledge of the adverse effects of health anxiety on nurses working with COVID patients.

Presentation at the Eastern Psychological Association’s research conference: A Fulfilling Experience

Walking into the Eastern Psychological Association’s research conference, I was unsure what to expect as this was my first time ever at a conference. I was walking through Times Square to my hotel in Manhattan, a city I have never been before, wondering what kind of experience I would have. Outside, the typical hustle and bustle of New York City was going on in the streets, but on the inside, a solemn sharing of knowledge was taking place. It was a very unique sight, as students, professors, and researchers from around the US met in this somewhat chaotic city to share research, ask questions, and speak with like-minded people.

I had the pleasure of listening to some great speakers and speaking with dedicated students during the two full days of the conference before my own presentation. I particularly enjoyed walking around the poster presentations and seeing what other students were researching. I was truly amazed at the number of undergraduates who were attending their first conference, like myself. Listening to keynote speakers with decades of experience was also fascinating as these researchers are at the top of their field and show me what I can become with dedication and hard work. The highlight of my conference experience was presenting. I was a bit concerned while setting up my poster, but once I started speaking to the viewers, the nerves melted away and it truly felt like having a conversation rather than a “presentation.” Overall, my first conference was a memorable experience and something I will take with me the rest of my career. I learned a lot, was amazed by the environment and amount of knowledge, and was very proud to show my project I have been working on for over a year to viewers. I thank my mentor, Dr. Brian Ayotte, my committee members, Dr. Anna Shierberl Scherr and Dr. Marni Kellogg, the Office of Undergraduate Research, and my family for their support to make this experience happen.