Brazilian nursing professionals’ quality of life during the COVID-19 pandemic and associated factors

INTRODUCTION

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV-2),1 the rapid spread of the virus and the increase in the number of cases in several regions of the world has become a major public health crisis in several countries, including Brazil.

In this context, healthcare professionals, especially nurses, who in Brazil account for approximately 60% of the health workforce in hospitals,2 played a fundamental role in facing this crisis. Despite this, they faced numerous factors that are associated with a decrease in their quality of life (QoL), especially when exposed to physical and mental exhaustion. Therefore, challenges were and are experienced in caring for themselves and, consequently, for others in light of the quality of care provided.3

For instance, a systematic review showed a correlation between the decrease in QoL of healthcare professionals and the COVID-19 pandemic, which led to direct and indirect impacts on QoL. Furthermore, among these professionals, nurses were the most affected category, with considerably high scores for anxiety, depression and insomnia. These impacts were caused by several previous risk factors such as disorders in physical and mental health conditions, including depression, anxiety, fear of transmission, concerns, reduced social interactions, linked to an unhealthy lifestyle, combined with the stress generated by the pandemic, which resulted in an overload on mental health.4

A survey carried out in India with 197 healthcare professionals during the COVID-19 pandemic showed that 92.47% reported symptoms of depression, 98.50%, anxiety, and 89.45%, low QoL.5 Another study conducted in Brazil with nursing professionals demonstrated that the perception of QoL had the worst score in the social domain, indicating difficulties related to personal relationships, sexual activity and support network. Scores related to the overall QoL domain, and the physical, psychological and environmental domains had similar results.3

It is worth noting that, according to the World Health Organization (WHO), through the World Health Organization Quality of Life Assessment (WHOQOL GROUP), QoL is defined as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”. It also encompasses individuals’ physical health, psychological status, level of independence, relationships, personal beliefs and their relationships with characteristics of the environment.6-7

Given the above, carrying out this research will enable a greater understanding of how nursing professionals assess their QoL in the pandemic context as well as the factors associated with the improvement or worsening of this QoL in this scenario. Such findings will enable collaboration in the construction of management plans and guidelines and, consequently, improvements in the work environment.

OBJECTIVE

To analyze nursing professionals’ QoL in Brazilian regions during the COVID-19 pandemic and its associated factors.

METHOD

This is a quantitative, cross-sectional and analytical study, developed using an online survey, from October 1 to December 31, 2020, in all regions of Brazil. The research followed the Strengthening the Reporting of Observational studies in Epidemiology for RDS Studies (STROBE-RDS)8 recommendations and was guided by the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).9

For sample calculation, information on the number of healthcare professionals by region of Brazil was considered as a reference, according to data provided by the Ministry of Health, base year 2010.10 A 95% confidence interval was adopted, with a margin of error equal to 1%, either way, obtaining a minimum sample of 5,079 individuals. Thus, a total of 12,086 healthcare professionals who worked in direct patient care at different levels of healthcare services were obtained.

Nursing professionals who worked in direct care for patients, whether or not affected by COVID-19, in different healthcare settings in public and/or private services, for at least the last six months prior to the start of data collection, were considered eligible for this study. Professionals who did not respond to the research instrument completely were excluded.

Professionals were recruited using an adaptation of the Respondent Driven Sampling (RDS)11 method to the virtual environment. In this method, participants are encouraged to recruit other individuals in the same category as their own through social networks.

The RDS adaptation for this research was carried out as follows: 47 research leaders were selected, nominated by the research team, with at least one from each state in Brazil. They nominated ten recruiters, called “seeds”, to form a data collection team in each state. All of them (leaders and recruiters) underwent four hours of online training on “How to collect data through social media during the COVID-19 pandemic,” the questionnaire to be applied later, and how to manage participants in a Microsoft Excel® spreadsheet, which included fields for ten nominations that each seed was eligible to nominte for participation. At the end of this process, 280 collectors were recruited, and 45 training sessions were held.

For the data collection itself, each collector initially nominated ten professionals to respond to the survey and, at the end of the survey, asked participants for new nominations. The number of indications was limited in these circumstances to ensure that the recruiters could make a number of indications that had the greatest possible reach within their contact networks.

Potential participants were contacted and invited to participate in the survey using social media applications. Upon acceptance, the form was sent via a link with access to the Informed Consent Form (ICF) and the survey form (created and validated – face and content, by 15 experts12). The completed instruments were hosted on a software, Survey Monkey, which allowed a single submission of the form via internet protocol (IP), aiming at the security of the information collected.

The instrument included closed-ended, multiple-choice questions, divided according to sociodemographic variables, related to sex, marital status and religion, labor variables, related to the professional category, performance in the Intensive Care Unit (ICU) sector, availability of Personal Protective Equipment (PPE) in adequate quantity and quality, and variables related to professionals’ personal experience, related to COVID-19 diagnosis, family isolation and sleep loss.

In this study, the outcome variable was QoL. To collect this variable, the question “During the COVID-19 pandemic, how do you assess your QoL?” was used, with the response options being “improved” and “worsened”.

It is worth noting that a pilot study was previously conducted with 47 respondents, who were invited to send feedback or comments about the survey via WhatsApp®. All suggested changes were considered, in addition to minor adaptations to the terminology. These respondents did not make up the study sample.

The collected data were exported and analyzed in the statistical software R version 4.0.4. Descriptive analysis was performed using frequency distribution and standard deviation. Prevalence rates were calculated with a 95% Confidence Interval (95%CI). The chi-square test and Fisher’s exact test were used to test differences between proportions. Statistically significant associations were considered with p-values ​​<0.05. To estimate the Odds Ratio, a logistic regression model was initially adjusted, and from this adjustment, the variables that presented a p-value <0.20 were included in a new adjustment, and in this adjustment, the stepwise method was considered.

The project was approved by the Research Ethics Committee (REC), under Opinion 4,258,366. All ethical aspects were considered for its implementation according to Resolution 466/2012.

RESULTS

A total of 9,039 nursing professionals from all regions of Brazil participated in the study. From the Northeast region, 2,728 professionals participated. The majority were female (2,325; 85.2%), single/divorced (1,434; 52.6%) and had some type of religion (2,437; 89.3%). Due to the COVID-19 pandemic, 1,279 (46.9%) indicated a worsening of their QoL.

An association was observed between QoL and marital status (p = 0.002), religion (p = 0.021), professional category (p < 0.001), ICU as the sector of activity (p = 0.010), provision of quality and sufficient PPE by the work institution (p < 0.001), family isolation (p < 0.001) and sleep loss due to concerns (p < 0.001) (Table 1).

In the Southeast region, 2,524 nursing professionals participated, the majority of whom were female (2,162; 85.7%), married or in a common-law marriage (1,370; 54.3%) and with some type of religion (2,211; 87.6%). Regarding their QoL, during the COVID-19 pandemic, the majority indicated a worsening (1,429; 56.6%). QoL was associated with marital status (p<0.021), professional category (p<0.001), COVID-19 diagnosis (p = 0.003), provision of sufficient and quality PPE by the work institution (p<0.001), family isolation (p<0.001) and sleep loss due to concerns (p<0.001).

In the Central-West region, 1,609 nursing professionals participated. The majority were female (1,358; 84.4%), married or in a common-law marriage (935; 58.1%) and with some religion (1,430; 88.9%). As for their QoL, the majority reported worsening (917; 57.0%) during the COVID-19 pandemic. The results indicated an association between QoL and marital status (p=0.002), professional category (p<0.001), provision of sufficient and quality PPE by the work institution (p<0.001), family isolation (p<0.001) and sleep loss due to concerns (p<0.001).

In the North region, 1,376 nursing professionals participated. The majority were female (1,079; 78.4%), single or divorced (705; 51.2%) and had some religion (1,229; 89.3%). Regarding their QoL, 763 (55.5%) nursing professionals indicated an improvement during the COVID-19 pandemic. QoL was associated with professional category (p<0.001), provision of quality (p<0.001) and sufficient (p = 0.014) PPE by the work institution, family isolation (p<0.001) and sleep loss due to concerns (p<0.001).

In the South region, 802 nursing professionals participated. The majority were female (710; 88.5%), married or in a common-law marriage (473; 59.0%), followed by single/divorced (327; 40.8%) and with some religion (706; 88.0%). Most nursing professionals reported a worsening of their QoL (410; 51.1%) due to the COVID-19 pandemic. This QoL was associated with the professional category (p < 0.001), provision of quality (p < 0.001) and sufficient (p = 0.003) PPE by the work institution, family isolation (p < 0.001) and sleep loss due to concerns (p < 0.001).

Table 1. Bivariate analysis of factors associated with nursing professionals’ quality of life by region during the COVID-19 pandemic (n = 9,039). Ribeirão Preto (SP), Brazil, 2020.

Variables

Quality of life

Northeast region

(n = 2,728)

Southeast region

(n = 2,524)

Improved

n = 1,279

(46.9%)

Worsened

n = 1,279

(46.9%)

p-value*

Improved n = 1,095

(43.4%)

Worsened

n = 1,429

(56.6%)

p-value*

Marital status

 

 

0.002

 

 

0.021

Single/divorced

724 (50.5)

710 (49.5)

 

464 (40.9)

671 (59.1)

 

Married/common-law marriage

712 (55.7)

566 (44.3)

 

619 (45.2)

751 (54.8)

 

Widowed

13 (81.2)

3 (18.8)

 

12 (63.2)

7 (36.8)

 

Professional category

 

 

< 0.001

 

 

< 0.001

Nurse

908 (47.6)

1.000 (52.4)

 

558 (38.0)

912 (62.0)

 

Nursing technician

524 (66.3)

266 (33.7)

 

467 (49.8)

470 (50.2)

 

Nursing assistant

17 (56.7)

13 (43.3)

 

70 (59.8)

47 (40.2)

 

Works in ICU

 

 

0.010

 

 

0.070

Yes

296 (48.5)

314 (51.5)

 

275 (40.4)

405 (59.6)

 

No

1.153 (54.4)

965 (45.6)

 

820 (44.5)

1.024 (55.5)

 

COVID-19 diagnosis

 

 

0.507

 

 

0.003

Yes

535 (52.3)

488 (47.7)

 

250 (38.5)

400 (61.5)

 

No

914 (53.6)

791 (46.4)

 

845 (45.1)

1.029 (54.9)

 

Provision of sufficient PPE

 

 

< 0.001

 

 

< 0.001

Yes

1.076 (56.3)

834 (43.7)

 

873 (45.6)

1.041 (54.4)

 

No

64 (42.1)

88 (57.9)

 

39 (37.1)

66 (62.9)

 

In part

309 (46.4)

357 (56.6)

 

183 (36.2)

322 (63.8)

 

Provision of good quality PPE

 

 

< 0.001

 

 

< 0.001

Yes

819 (57.7)

601 (42.3)

 

661 (48.0)

717 (52.0)

 

No

116 (44.6)

144 (55.4)

 

96 (36.4)

168 (63.6)

 

In part

514 (49.0)

534 (51.0)

 

338 (38.3)

544 (61.7)

 

Family isolation

 

 

< 0.001

 

 

< 0.001

Yes

441 (46.9)

499 (53.1)

 

227 (29.1)

552 (70.9)

 

No

1.008 (56.5)

780 (43.6)

 

868 (49.7)

877 (50.3)

 

Sleep loss

 

 

< 0.001

 

 

< 0.001

Not at all

343 (73.9)

121 (26.1)

 

319 (67.4)

154 (32.6)

 

No more than usual

509 (63.2)

296 (36.8)

 

364 (54.7)

301 (45.3)

 

Much more than usual

597 (40.9)

862 (59.1)

 

412 (29.7)

974 (70.3)

 

Variables

Central-West region

(n = 1,609)

North region

(n = 1,376)

Improved

n = 692

(43.0%)

Worsened

n =917

(57.0%)

p-value *

Improved

n = 763

(55.5%)

Worsened

n = 613

(44.5%)

p-value *

Marital status

 

 

0.002†

 

 

0.693†

Single/divorced

256 (38.4)

411 (61.6)

 

392 (55.6)

313 (44.4)

 

Married/common-law marriage

431 (46.1)

504 (53.9)

 

364 (55.1)

297 (44.9)

 

Widowed

5 (71.4)

2 (28.6)

 

7 (70.0)

3 (30.0)

 

Professional category

 

 

< 0.001†

 

 

< 0.001

Nurse

414 (37.4)

694 (62.6)

 

437 (49.8)

441 (50.2)

 

Nursing technician

275 (55.3)

222 (44.7)

 

315 (65.4)

167 (34.6)

 

Nursing assistant

3 (75.0)

1 (25.0)

 

11 (68.8)

5 (31.2)

 

Works in ICU

 

 

0.549

 

 

0.054

Yes

135 (41.5)

190 (58.5)

 

134 (50.2)

133 (49.8)

 

No

557 (43.4)

727 (56.6)

 

629 (56.7)

480 (43.3)

 

COVID-19 diagnosis

 

 

0.508

 

 

0.516

Yes

238 (41.9)

330 (58.1)

 

355 (54.5)

296 (45.5)

 

No

454 (43.6)

587 (56.4)

 

408 (56.3)

317 (43.7)

 

Provision of sufficient PPE

 

 

< 0.001

 

 

0.014

Yes

552 (45.9)

651 (54.1)

 

501 (58.4)

357 (41.6)

 

No

20 (31.7)

43 (68.3)

 

66 (53.7)

57 (46.3)

 

In part

120 (35.0)

223 (65.0)

 

196 (49.6)

199 (50.4)

 

Provision of good

quality PPE

 

 

< 0.001

 

 

< 0.001

Yes

414 (49.0)

431 (51.0)

 

398 (60.8)

257 (39.2)

 

No

53 (27.7)

138 (72.3)

 

103 (47.2)

115 (52.8)

 

In part

225 (39.3)

348 (60.7)

 

262 (52.1)

241 (47.9)

 

Family isolation

 

 

< 0.001

 

 

< 0.001

Yes

161 (35.5)

293 (64.5)

 

234 (47.5)

259 (52.5)

 

No

531 (46.0)

624 (54.0)

 

529 (59.9)

354 (40.1)

 

Sleep loss

 

 

< 0.001

 

 

< 0.001

Not at all

198 (65.1)

106 (34.9)

 

194 (78.2)

54 (21.8)

 

No more than usual

242 (53.2)

213 (46.8)

 

269 (66.7)

134 (33.3)

 

Much more than usual

252 (29.6)

598 (70.4)

 

300 (41.4)

425 (58.6)

 

Variables

South region (n = 802)

Improved

n = 392

(48.9%)

Worsened

n = 410

(51.1%)

p-value*

Professional category

 

 

< 0.001

Nurse

229 (43.5)

297 (56.5)

 

Nursing technician

145 (57.3)

108 (42.7)

 

Nursing assistant

18 (78.3)

5 (21.7)

 

Works in ICU

 

 

0.822

Yes

92 (48.2)

99 (51.8)

 

No

300 (49.1)

311 (50.9)

 

COVID-19 diagnosis

 

 

0.883

Yes

81 (49.4)

83 (50.6)

 

No

311 (48.7)

327 (51.3)

 

Provision of sufficient PPE

 

 

0.003

Yes

341 (51.3)

324 (48.7)

 

 

 

No

8 (57.1)

6 (42.9)

 

In part

43 (35.0)

80 (65.0)

 

Provision of good quality PPE

 

 

0.001

Yes

274 (53.7)

236 (46.3)

 

No

19 (47.5)

21 (52.5)

 

In part

99 (39.3)

153 (60.7)

 

Family isolation

 

 

< 0.001

Yes

76 (38.0)

124 (62.0)

 

No

316 (52.5)

286 (47.5)

 

Sleep loss

 

 

< 0.001

Not at all

114 (77.0)

34 (23.0)

 

No more than usual

152 (57.4)

113 (42.6)

 

Much more than usual

126 (32.4)

263 (67.6)

 

Note: PPE - Personal Protective Equipment; ICU - Intensive Care Unit; *Chi-square test; †Fisher’s exact test.

Table 2 shows the logistic regression model performed to assess the variables that were associated with nursing professionals’ QoL by region of Brazil.

Table 2. Odds Ratios by logistic regression for improving nursing professionals’ quality of life according to Brazilian regions during the COVID-19 pandemic (n = 9,039). Ribeirão Preto (SP), Brazil, 2020

Variables

Unadjusted OR*

(95%CI)†

p-value

Adjusted OR‡ (95%CI)†

p-value

Northeast region

 

 

 

 

Marital status

 

 

 

 

Single/divorced

0.23 (0.06-0.82)

0.024

0.19 (0.04-0.80)

0.023§

Married/common-law marriage

0.29 (0.08-1.02)

0.054

0.23 (0.05-0.96)

0.044§

Works in ICU (yes)

0.78 (0.65-0.94)

0.010

0.75 (0.62-0.91)

0.004§

Provision of sufficient PPE by the institution where they work

 

 

 

 

No

0.56 (0.40-0.78)

0.001

0.67 (0.46-0.96)

0.032§

In part

0.67 (0.56-0.80)

< 0.001

0.71 (0.59-0.87)

0.001§

Family isolation (yes)

0.68 (0.58-0.80)

< 0.001

0.13 (0.10-0.16)

< 0.001§

Sleep loss due to concerns

 

 

 

 

No more than usual

0.60 (0.47-0.78)

< 0.001

0.63 (0.49-0.82)

0.001§

Much more than usual

0.24 (0.19-0.30)

< 0.001

0.26 (0.20-0.33)

< 0.001§

Southeast region

 

 

 

 

Professional category

 

 

 

 

Nurse

0.41 (0.28-0.60)

< 0.001

0.42 (0.28-0.61)

< 0.001§

Nursing technician

0.66 (0.45-0.98)

0.043

0.68 (0.46-1.01)

0.061

Positive diagnosis for COVID-19

0.76 (0.63-0.91)

0.003

0.79 (0.65-0.97)

0.027§

Provision of good quality PPE by the institution where they work

 

 

 

 

No

0.62 (0.47-0.81)

0.001

0.81 (0.60-1.10)

0.193

In part

0.67 (0.56-0.80)

< 0.001

0.78 (0.65-0.94)

0.012§

Family isolation (yes)

0.41 (0.34-0.49)

< 0.001

0.56 (0.46-0.68)

< 0.001§

Sleep loss due to concerns

 

 

 

 

No more than usual

0.58 (0.45-0.74)

< 0.001

0.68 (0.53-0.88)

0.004§

Much more than usual

0.20 (0.16-0.25)

< 0.001

0.29 (0.22-0.36)

< 0.001§

Central-West region

 

 

 

 

Marital status

 

 

 

 

Single/divorced

0.24 (0.04-1.29)

0.098

0.16 (0.02-0.90)

0.038§

Married/common-law marriage

0.34 (0.06-1.77)

0.201

0.21 (0.03-1.18)

0.077

Provision of good quality PPE by the institution where they work

 

 

 

 

No

0.40 (0.28-0.56)

< 0.001

0.48 (0.33-0.69)

< 0.001§

In part

0.67 (0.54-0.83)

< 0.001

0.81 (0.65-1.02)

0.080

Sleep loss due to concerns

 

 

 

 

No more than usual

0.60 (0.45-0.82)

0.001

0.62 (0.46-0.84)

0.002§

Much more than usual

0.22 (0.17-0.29)

< 0.001

0.24 (0.18-0.31)

< 0.001§

North region

 

 

 

 

Provision of good quality PPE by the institution where they work

 

 

 

 

No

0.57 (0.42-0.78)

0.001

0.67 (0.48-0.94)

0.020§

In part

0.70 (0.55-0.88)

0.003

0.78 (0.61-1.01)

0.060

Family isolation (yes)

0.60 (0.48-0.75)

< 0.001

0.70 (0.56-0.89)

0.004§

Sleep loss due to concerns

 

 

 

 

No more than usual

0.55 (0.38-0.80)

0.002

0.57 (0.39-0.83)

0.003§

Much more than usual

0.19 (0.14-0.27)

< 0.001

0.21 (0.15-0.30)

< 0.001§

South region

 

 

 

 

Professional category

 

 

 

 

Nurse

0.21 (0.07-0.58)

0.003

0.21 (0.07-0.60)

0.003§

Nursing technician

0.37 (0.13-1.03)

0.058

0.39 (0.14-1.09)

0.074

Provision of sufficient PPE by the institution where they work

 

 

 

 

No

1.26 (0.43-3.69)

0.665

1.60 (0.46-5.55)

0.459

In part

0.51 (0.34-0.76)

0.001

0.59 (0.37-0.96)

0.034§

Provision of good quality PPE by the institution where they work

 

 

 

 

No

0.77 (0.40-1.48)

0.448

0.80 (0.37-1.70)

0.569

In part

0.55 (0.41-0.75)

< 0.001

0.65 (0.45-0.93)

0.020§

Family isolation (yes)

0.55 (0.40-0.76)

< 0.001

0.69 (0.48-0.98)

0.040§

Sleep loss due to concerns

 

 

 

 

No more than usual

0.40 (0.25-0.63)

< 0.001

0.41 (0.26-0.65)

< 0.001§

Much more than usual

0.14 (0.09-0.22)

< 0.001

0.14 (0.09-0.22)

< 0.001§

Note: PPE - Personal Protective Equipment; ICU - Intensive Care Unit; *Unadjusted OR - Unadjusted Odds Ratio; †Adjusted OR - Adjusted Odds Ratio; ‡95%CI - 95% Confidence Interval; §p-value ≤ 0.05.

In all regions of Brazil, it was observed that nursing professionals who had sleep disorders due to concerns during the pandemic had reduced chances of improving their QoL.

In the Northeast, nursing professionals who are single or divorced, married or living in a common-law marriage, who work in the ICU, who did not receive or received sufficient PPE in part from the institution where they work and who needed to isolate themselves from their family to practice their profession had reduced chances of improving their QoL.

In the Southeast, nurses and nursing professionals who tested positive for COVID-19 and who did not receive (in part) good quality PPE from the institution where they work had reduced chances of improving their QoL.

In the Central-West, nursing professionals who are single or divorced and who did not receive good quality PPE from the institution where they work had reduced chances of improving their QoL.

In the North, nursing professionals who did not receive good quality PPE from the institution where they work and who had to isolate themselves from their families to practice their profession had reduced chances of improving their QoL.

In the South, nurses, nursing professionals who received in part sufficient and good quality PPE and who needed to isolate themselves from their families to practice their profession had reduced chances of improving their QoL.

DISCUSSION

The COVID-19 pandemic has significantly changed the daily lives of the entire population, especially nursing professionals, given numerous factors that have been associated with reduced chances of improving QoL.

Regarding sociodemographic variables, marital status and religion were associated with QoL, unlike the study developed by Askin et al. (2021), in which no sociodemographic variable was associated with QoL.13

A study with nursing professionals from all regions of Brazil, who worked in care, presented a mean total QoL score of 56.79, considering a low QoL score, supporting the data of this research. The cited study associated the worsening of QoL with professional performance (being a nurse), the number of employment contracts (two or more), the weekly workload (more than 50 hours), the increase in patients and care (mentioned by 80.80% of participants), tension, stress and use of sleeping pills (mentioned by 25.90% of participants).3

Regarding sleep loss due to concerns, it was observed that it was associated with a worsening of QoL. A study carried out in Serbia with the aim of assessing QoL, sleep, anxiety, depression and other factors among healthcare professionals observed that impaired QoL correlated with poor sleep quality, female sex, marital status (married) and having children.14

 The increase in physical and emotional overload has repercussions on relationships between the team, in addition to harming professionals’ health, the quality of sleep and rest, which, consequently, leads to an increase in sleeping pill consumption.3 This last finding is in line with the findings of participants in this research, in which nursing professionals, from all regions of Brazil, mostly had sleep changes due to concerns about the pandemic and thus presented reduced chances of improving their QoL.

Family isolation also had an impact on the reduction of professionals’ QoL in the Northeast, North and South regions. It is known that isolation and/or physical distancing, along with other preventive actions, are the main preventive measures recommended and adopted by all countries in the world during the pandemic, therefore constituting the main changes in the population’s habits during this period. However, although isolation and/or physical distancing are intended to benefit the population’s physical health, this guideline can be detrimental to social and emotional health, since, in itself, it represents a risk factor for health problems in the general population, as it can drastically increase feelings of isolation and loneliness during the pandemic.15

It is noteworthy that, among nursing professionals, this measure has become even more intensified due to frequent exposure to the disease, in addition to the concern for protecting themselves (nursing professionals) and others (co-workers, family members and patients), being covered by fear and concern of contagion of the disease.16 Therefore, actions aimed at stress related to COVID-19 and the isolation imposed by it are necessary, in order to reduce the repercussions on these professionals’ psychological distress, such as depression and anxiety disorders, which negatively impact QoL.

The lack of PPE, associated with reduced chances for improving QoL, was found in all regions of this study, whether in quality or quantity sufficient by the work institution. This crisis related to the supply of essential and quality materials for preventing and coping with the disease was also found in other studies.16-17 Therefore, reflections are needed on the need for management guidelines for the allocation of these resources in a contextualized manner to care scenarios, ensuring that professionals do not need to make isolated and emotionally traumatic decisions,16-17 providing an improvement in the nursing team’s QoL and the care provided.

Concerning the sector of activity, only the ICU in the Northeast showed an association with reduced chances for improving QoL. The nursing team, which was on the front line in facing the COVID-19 pandemic, was affected in different ways in the physical, psychological and social spheres, which becomes more intensified in the ICU sector, since it is an environment with a great psychological burden, extremely controlled, requiring skill, high preparation and effective management.18-19

Linked to the stress of this scenario, studies raised in an integrative review(17) point out factors that contribute to physical and mental exhaustion, such as precarious working conditions, long working hours and work overload, exposure to risk factors, professional demotivation, low pay and double shifts, implying negative results in the QoL of this class of workers, also contributing significantly to their greater exposure to burnout syndrome(18) and other physical and psychological problems.

QoL among healthcare professionals working in ICUs and emergency units in five cities in Saudi Arabia during the COVID-19 pandemic was low. The mean overall QoL score was 3.37 ± 0.97, with the overtime variable being a determining factor in this reduction.20 Another study, conducted prior to the pandemic, in the intensive care sector, showed that sleep deprivation and a sedentary lifestyle negatively influence perceived QoL in different domains. Furthermore, insufficient remuneration also reduced QoL in the environment domain, proving to be a relevant factor for professionals in this sector.21

A study that assessed the QoL of healthcare professionals who tested positive for COVID-19 in the state of Rio de Janeiro showed that 52.7% (252) considered their QoL to be good, of which 145 (57.5%) had the disease. Furthermore, men had better QoL when compared to women, and nurses and nursing technicians had a lower QoL score when compared to physicians, with the environment domain being the most compromised, which may be related to insecurity and uncertainty in the work environment, financial resources, leisure, home environment, among others.22 In contrast, in this study, in the Southeast, a positive diagnosis implied reduced chances for improving QoL.

The main limitation of this study concerns participant recruitment, since, as the research was developed online, there may have been an overrepresentation of professionals who have skills in using computers and social networks. However, it is considered that this limitation did not interfere with the results, due to the high number of participants.

Based on the findings, with the identification of the QoL experienced by nursing professionals in Brazilian regions during the COVID-19 pandemic, the study presents advances for the fields of health and nursing, by allowing collaboration in the construction of management plans and guidelines. Thus, it allows improvements in the work environment, given the real factors associated with the reduced chances of improving their QoL identified in the study, such as the provision and forecast of resources, thus ensuring the reduction of the negative impacts of these on professionals’ QoL and the care provided. Finally, it is expected that this study will stimulate new investigations on the subject, in order to fill the gaps found in the preparation of this study.

CONCLUSION

Regarding QoL, most participants indicated improvement in the Northeast and North, whereas in the Southeast, Central-West and South, there was a worsening. However, it is worth noting that the regions that showed improvement in QoL (above 50%) are still far from being considered of good quality.

Different factors were associated with reduced chances of improving Brazilian professionals’ QoL. Among them, sleep disorders and the lack of sufficient or quality PPE by the institution where they worked stood out in all regions of Brazil. QoL was impacted by family isolation in three regions, Northeast, North and South, and among single and divorced individuals in the Northeast and Central-West. The ICU sector and positive COVID-19 diagnosis were evidenced in the Northeast and Southeast, respectively.

 CONTRIBUTIONS

All authors contributed to article design, data collection, data analysis and/or interpretation, manuscript writing and/or critical review. All authors approved the final version of the manuscript.

CONFLICTS OF INTERESTS

Nothing to declare.

FUNDING

Brazilian National Council for Scientific and Technological Development (CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico). Process number 401708/2020-9.

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Correspondence:

Elucir Gir

Email: egir@usp.br

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