Self-efficacy as a psychological resource in the management of stress suffered by ICU nurses during the COVID-19 pandemic: A prospective study on emotional exhaustion.

Abstract

Background: Intensive care unit (ICU) nurses have experienced a high degree of stress during the COVID-19 pandemic. While the literature on the consequences on emotional symptomatology is abundant, studies on the protective psychosocial variables that have contributed to buffering these consequences are scarcer.

Aim: This study analyses the role of self-efficacy as a protective personality trait in ICU nurses during the COVID-19 pandemic, using a moderated mediation model that begins with the stress and anxiety experienced at the onset of the pandemic and concludes with the emotional exhaustion experienced 6 months later.

Study design: Prospective longitudinal study with two data collection periods during the COVID-19 pandemic: (1) from 5 May to 21 June 2020 and (2) a follow-up 6 months after the state of alarm finalized (January-April 2021). These were both very stressful periods for ICU staff because of the COVID-19 pandemic. This study was conducted with 129 ICU nurses (a non-probabilistic convenience sample in the Spanish health care system). Socio-demographic, occupational and psychosocial variables (i.e. stress, anxiety, self-efficacy and emotional exhaustion) were assessed. Descriptive analyses, Pearson correlations, covariate analyses (i.e. Student's t-test, one-factor ANOVA) and moderated mediation analyses were carried out (SPSS PROCESS macro, model 7). STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) reporting guidelines were followed.

Results: It shows that the higher the self-efficacy score, the lower the effect of stress on anxiety (p < .001); likewise, the moderating role of self-efficacy was equally valid for the whole final model (F = 8.790, p < .001), showing self-efficacy to be a good buffer for emotional exhaustion derived from the stress suffered in the ICU.

Conclusions: Self-efficacy (i.e. the belief of being able to do certain tasks successfully) is shown to be a highly relevant trait to enhance among ICU nurses during the COVID-19 pandemic, allowing them to manage work stress effectively and thus buffering the development of anxiety in the short term and emotional exhaustion in the long term.

Relevance to clinical practice: Our results point to the need to assess and take action on self-efficacy in ICU nurses in highly stressful situations such as the COVID-19 pandemic. As a psychological variable, self-efficacy refers to beliefs and therefore has to be trained by evidence-based psychological techniques, such as cognitive behavioural therapy. In addition, previous literature has pointed out that previous experience or specific training is an influential (although not a determining) factor in self-efficacy, so specialization for ICU nurses could also be considered.