A Study to Assess the Social Stigma among Nursing Officers working in Covid-19 Wards in selected Hospitals at Puducherry

 

Ancy Sylvia. S¹, Arunkumar. S¹*, Bharathi. S¹, Dharshini Laniyon. K¹, Dhivya. M¹, Maria Therese. A²

¹B.Sc Nursing Students, College of Nursing,

Mother Theresa Post Graduate and Research Institute of Health Sciences, Gorimedu, Puducherry-605006, India.

²Professor in Nursing, Department of Medical Surgical Nursing, College of Nursing,

Mother Theresa Post Graduate and Research Institute Of Health Sciences, Gorimedu, Puducherry-605006, India.

 

ABSTRACT:

Background and Objectives: Sudden onset of COVID-19 pandemic situation which brings many changes in each and every individuals life. Likewise in our healthcare setting also. This pandemic leads to death of many peoples. Healthcare Professionals (HCPs) works 24 X 7 in emergency, In-patient and out-patient areas. There was increased fear among public which leads to discrimination of Health care professionals who works in COVID-19 wards and their family due to misinformation in social medias.   Because of this discrimination HCPs undergoes stress and depressions. A Descriptive Study was conducted to assess social stigma among Nursing Officers working covid-19 ward in selected hospitals, Puducherry. The Objectives of the Study were, to assess the level of social stigma faced by Nursing Officers working in COVID-19 wards, to assess the nurse's attitude towards social stigma. to correlate the level of stigma with the level of attitude of the Nursing Officers. Methodology: A quantitative research approach with descriptive research design was adopted in this study. The study was conducted in selected hospitals at Puducherry among Nursing Officers working in covid-19 wards. Quantitative research approach and descriptive survey research design was adopted by using snowball sampling technique (Google form) for the study to select 50 samples from selected hospitals at Puducherry. Once received the concern from the participants after explaining the purpose of study, data were collected by using self-structured questionnaire which comprised of demographic variables and questionnaire to assess the level of social stigma and self-structured attitude scale was given to the participants. The data was analyzed by using frequency distribution and percentage, correlation and chi-square test. Result: Research findings revealed that 20% of Nursing Officers mildly faced social stigma, 64% of Nursing Officers moderately faced social stigma, 16% of Nursing Officers severely faced social stigma. The findings show that Positive attitude showed by the Nursing Officers facing social stigma was 24%, Neutral attitude showed by the Nursing Officers facing social stigma was 42% and Negative attitude showed by them was 34%. There was a moderately negative correlation coefficient r = -0.44 ( -1< r <1) between attitude and social stigma faced by the Nursing Officers. Conclusion: The study result shows that the level of social stigma among the Nursing Officers working in COVID-19 wards in Puducherry is at the moderate level and shown neutral attitude during stigma.

 

INTRODUCTION:

Stigma is the personnel experience faced by an individual such as negligence, rejection, discrimination and blame when the individual is identified with a particular health issues or other problems. Social stigma is the negligence, rejection, discrimination and blame faced by an individual from other individuals, group of people or society because of specific social characteristic and attitude.

 

On December 31, 2019 the current outbreak of COVID-19 was reported in Wuhan, China.¹ COVID-19 was declared as global pandemic on march 11, 2020 by the World Health Organization (WHO). COVID-19 virus cause respiratory infections.^2,3,4 Almost most of the countries like Mexico, India and Malawi Health care professionals (HCPs) has experienced social stigma. There was a heightened fear among public which leads to the discrimination of health care workers by the neighbours, society and colleagues. Because of this discrimination, the HCPs has a increased risk of developing stress and trauma.⁵ As a result, these HCPs may get bullied, isolated, loss of status which will directly or indirectly influence their families and friends. In India cause of social stigma among health care due to misinformation spreads on social media, uneducated people can’t recognize or differentiate the fake and real news and information. This will leads to discrimination, negligence, rejection of the Nursing Officers and their family. 

 

A study conducted by Dr Ananya Ray Laskar, et.al on “ A study on stigma and apprehensions related to COVID-19  among HCPs in Delhi” revealed that some kind of stigma is perceived by 70% of the participants, stigma in residential society is perceived by 50.9%  of participants, change in behavior of neighbors  is perceived 46% of participants. Hence this study is conducted to assess social stigma among nursing officers working in Covid-19 ward in selected hospitals.⁵

 

A study conducted by Melanie Schubert et.al(2021) on “systemic review on stigmatization from COVID-19 work related exposure by meta analysis” revealed that relavent problem and increased risk for depression (95% confidence interval 1.29-2.36) and anxiety(95% confidence interval 1.29-3.27)⁶  Mostafa A et.al(2020) conducted a cross sectional study on “ COVID-19 related stigma among Egyptian Health Care Workers” revealed that severe level of stigma reported by 31.2% participants.⁷ A study conducted by Timothy D Dye et.al (2020) on “ study on risk of COVID-19 related bullying a Harassment and stigma among HCWs” showed that 21.9% of HCWs feels that they loss status and respect in society.⁸

 

Nirav Bhupendrabhas et.al (2020) conducted a study on stigma and discrimination toward health care staffs working in COVID-19 ward. this study revealed that 51.39% participants feels that it is necessary to avoid person contact and 30.6%  participant have problem if a person eats in hospital canteen working in COVID-19.⁹ TizianaRamaci, et.al(2020) conducted “a cross sectional study on social stigma during COVID-19  and its impact on Healthcare workers outcome” the study shows that fear level was increased during COVID-19, 24% participant feels fatigue and 19% of them feels burnout. It bring negative outcome on result of their work. Therefore, strengthening of human resource for COVID-19 which will brings reduced level of stigma.¹⁰

 

A stress and stigmatization among health care workers during COVID-19 pandemic conducted by Mkhailyu.Sarokin, et. al (2020) this study shows that direct contact with COVID-19 patient will increases the stress level among healthcare workers. However stigma is not directly associate with risk of infection from infected patient, it present among nurses who worker COVID-19 wards and other paramedical worker.¹¹

 

Maria Teresa Gonzalez- Gil, et al (2020) found that out of 557 nurses, 37.5% participant feels that they have fear of getting infection while working with infected patient and 28.2% participant feels that they have increased workloads.¹²

 

A study conducted on mental health impact on Health care worker during COVID-19 in less human resources setting by Pratik Khanal, et. al (2020). The study shows that 41.9% participants had anxiety, 37.5% participants had depression and 33.9% participants had sleeplessness and also concluded that considerate proportion of anxiety, depression and insomnia among HCPs.⁽¹³⁾ the psychological characteristics of nursing officers changes in overtime shifts, overload of work and stigma. Changes such as ambivalence and emotional exhaust etc.¹⁴

 

Vishakantamurthy D G et.al conducted a study on Nursing Officers knowledge, attitude and practice regarding COVID-19 at Covid Care Center. This study shows that out of 50 participants 85.5% had good knowledge, 83.66% had positive attitude and 79.8% had good practice during COVID-19.¹⁵ A study conducted in Maharashtra. this study shows that 23.31% participants had good knowledge, 38% had positive attitude and 99% had good practice during COVID-19.¹⁶ A study conducted on Knowledge and attitude of staff nurses regarding nursing informatics shows that 64% participants had average knowledge and 80% participants had positive attitude.¹⁷ So positive attitude will leads to good mental health that will reduce stress and depression.¹⁸ A study conducted on Obstacles among Nurses during COVID-19 shows that Nurses not only facing COVID-19 infected patient but also management problems, risk of cross infection to family members, excess workload and mental stress during their work.¹⁹ Nursing students had average knowledge regarding COVID-19.²⁰

 

NEED FOR STUDY:

The spread of COVID-19 cases have let to serious of violent incidents against health care workers accused of spreading infection to neighbors and society. As a result HCPs and their family also are being isolated and neglected from their society. Many factors influence stigma and psychological distress such as age, gender, medical and surgical history and suspected case of COVID-19 present in their family.

 

Poor human resources among Healthcare Professionals in COVID-19 wards and separation of their children, needy parents and family will increase stress and depression that will cause emotional disturbance and social stigma such as negligence, discrimination and blame will leads to emotional exhaust and anger.

 

Even after quarantine and lockdown has ended stigma continue to persist. Therefore, it is important know that stigma and its consequences on Nursing Officers. So support from family and colleague can help HCPs to overcome their feelings. To prevent the stigma and trauma among HCP’s we need to provide emotional and psychological support. In the view of this, the study was conducted with an objective to assess the social stigma faced and attitude shown by the Nursing Officers working in COVID-19 wards in selected hospitals, Puducherry. The statistical death rate of Health care workers in COVID-19 globally was 1,15,000 cases and nationally was 489 cases. Which arise need for this study.

 

STATEMENT OF THE PROBLEM:

A descriptive study to assess the level of social stigma among the Nursing Officers working in COVID-19 wards in Puducherry.

 

OBJECTIVES OF THE STUDY:

1.     To assess the level of social stigma faced by Nursing Officers working in COVID-19 wards.

2.     To assess the nurse’s attitude towards social stigma.

3.     To correlate the level of stigma with the level of attitude of the Nursing Officers.

4.     To associate the level of social stigma with the demographic variables.

5.     To associate the level of Attitude with the demographic variables.

 

MATERIALS AND METHODS:

Research approach:

Quantitative research approach was adopted for this study in order to achieve the objectives of the study.

Research design:

This design used for the study is descriptive research design (non experimental research design).

Research study setting:

The present study among Nursing Officers working in COVID- 19 wards. The research was conducted in 5 selected hospitals (bed strength 500)  in Puducherry.

 

Population:

In this study, population comprises of the Nursing Officers those were working in COVID-19 wards in selected hospitals at Puducherry.

Sample size:

In this study, sample size was 50.

Sampling technique:

The sampling technique used was snowball sampling technique.

 

Criteria for sample selection :

Inclusion criteria:

·       Nursing Officers who were working in COVID-19 ward

·       Nursing Officers who were interest to participate in the study

·       Nursing Officers who were able to understand Tamil or English

Exclusion criteria:

·       Nursing Officers who were working in COVID-19 OPD and screening

·       Those who were not available at the time of data collection

 

Development of data collection tool:

A Semi-structured questionnaire was prepared. The tool consists of three sections.

Section A:

It consists of socio demographic variables such as age, gender, educational level, working experience, type of house, place of stay during quarantine, number of times posted in covid-19 ward and number of days quarantined after each posting in covid-19 wards.

Section B:

It consists of self-administered closed ended questionnaires comprised of 20 items to assess social stigma among Nursing Officers working in covid-19 ward.

Section C:

It consists of self-administered attitude scale comprised of 20 items to assess the attitude of Nursing Officers towards social stigma.

 

Data collection procedure:

After getting concern from the participants, the data was collected by online mode through Google form using snowball sampling technique. Instruction was given in the questionnaire form which consist of 50 items.

 

Plan for data analysis:

The demographical data was analyzed by Descriptive and inferential statistics. The frequency and percentage distribution were used to assess the level of social stigma and the attitude of nursing officers working in COVID-19 wards. Chi-square test was used to associate the level of social stigma with demographical variables and level of attitude with demographical variables. Correlation between the level of social stigma and the level of attitude was made.

 

ETHICAL CONSIDERATION:

The ethical clearance was obtained from our college (MTPG and RIHS) and the consent from college of nursing. Before the collection of data formal permission was obtained from the principal. The selection of sample was based on inclusion criteria. The samples has the freedom to withdraw from the study at any time.

 

RESULT AND DISCUSSION:

SECTION-A: Frequency and percentage distribution of demographic variables among sample:

Most of (82%) Nursing Officer belongs to 21-30 years, Most of them (92%)  are female, Most of them (84%) are B.sc Nursing, Most of them (76%) had 1-5 years of experience, Majority of them (44%) were from urban, Most of them (74%) belongs to Nuclear family, Most of them (72%) had own house, Majority of them (58%) have been posted in COVID-19 ward for 1 time, Majority of them (44%) had quarantined 1-3 days after posting, Most of them (78%) had stayed in home during quarantine period.

 

SECTION-B: Level of social stigma with the demographic variables:

·       AGE:

21-30 years: 9 members had mild stigma, 25 members had moderate stigma, 7 members had severe stigma; 31-40 years: 1 members had mild stigma, 6 members had moderate stigma, 1 members had severe stigma; 41-50 years: 1 members had mild stigma; 51-60 years: no one participate in this study.

·       GENDER:

Male: no one  had mild stigma, 3 members had moderate stigma,1 members had severe stigma; Female: 10 members had mild stigma, 29 members had moderate stigma,7 members had severe stigma are participate in this study.

·       EDUCATION:

ANM : no one had mild stigma,1 members had moderate stigma, no one had severe stigma; DGNM : no one mild stigma, 2 members had moderate stigma,1 members had severe stigma; B.sc (Nursing): 10 members had mild stigma, 27 members had moderate stigma, 5 members had severe stigma; M.sc (Nursing): no one  had mild stigma, 3 members had moderate stigma, 1 members had severe stigma are participate in this study.

·       EXPERIENCE:

1- 5 years experience: 8 members had mild stigma,24 members had moderate stigma, 6 members had severe stigma; 6-10 years experience: no one  had mild stigma, 5 members had moderate stigma,1 members had severe stigma; 11-15 years experience: no one  had mild stigma, 5 members had moderate stigma,1 members had severe stigma; more than 15 years experience : no one  had mild stigma, moderate stigma, severe stigma are participate in this study.

·       PLACE OF RESIDENCE:

Rural: 6 members had mild stigma,12 members had moderate stigma,4 members had severe stigma; Urban : 4 members had mild stigma,20 members had moderate stigma,2 members had severe stigma; Semi urban : no one had mild and moderate stigma,2 members had severe stigma participate in this study.

·       TYPE OF FAMILY:

Joint family: 2 members had mild stigma,10 members had moderate stigma,1 members had severe stigma; Nuclear family: 8 members had mild stigma,22 members had moderate stigma, 7 members had severe stigma participate in this study.

·       TYPE OF HOUSE:

Rented house: 2 members had mild stigma,9 members had moderate stigma,1 members had severe stigma; Own house: 9 members had mild stigma,22 members had moderate stigma,5 members had severe stigma; Rented apartment: no one had mild stigma, 1 members had moderate stigma, no one had severe stigma; Own apartment: no one  had mild stigma, no one had moderate stigma, 1 members had severe stigma are participate in this study.

·       NO. OF. TIMES POSTED:

1- times: 5 members had mild stigma, 19 members had moderate stigma, 5 members had severe stigma; 4-7 times: 2 members had mild stigma, 11 members had moderate stigma, 4 members had severe stigma; 8-10 times: no one had mild stigma, 1 members had moderate stigma, 1 members had severe stigma; more than 10 times: no one had mild stigma, 2 members had moderate stigma, no one had severe stigma are participate in this study.

·       NO. OF DAYS QUARANTINED:

1-3 days: 7 members had mild stigma, 14 members had moderate stigma,1 members had severe stigma; 4-6 days: no one had mild stigma, 6 members had moderate stigma, 1 members had severe stigma; 7-10 days:  2 members had mild stigma, 3 members had moderate stigma, 1 members had severe stigma; 10-14 days: 1 members had mild stigma, 9 members had moderate stigma, 5 members had severe stigma are participate in this study.

·       PLACE OF STAY DURING QUARANTINE:

Home: 9 members had mild stigma, 26 members had moderate stigma, 4 members had severe stigma; Hospital: no one had mild stigma, 4 members had moderate stigma, 3 members had severe stigma; Hotel Rooms: no one had mild stigma, 1 members had moderate stigma, no one had severe stigma; Hostel: 1 members had mild stigma, 1 members had moderate stigma, 1 members had severe stigma are participate in this study.

 

OVERALL STIGMA:

Out of 50 Nursing Officers 20% of Nursing Officers mildly faced social stigma, 64% of Nursing Officers moderately faced social stigma, 16% of Nursing Officers severely faced social stigma during working in COVID-19 wards. 

 

SECTION-C: Frequency and percentage description of level of Attitude of the Nursing Officers OVERALL ATTITUDE: Out of 50 Nursing Officers 24% of Nursing Officers showed positive attitude, 42% of Nursing Officers showed neutral attitude, 34% of Nursing Officers showed negative attitude during stigma.

 

SECTION D: Correlation of the level of social stigma with the level of attitude of Nursing Officers

Table: 1 Correlation of the level of social stigma with the level of attitude of Nursing Officers           N=50

 

From the Table 1 and figure 1 shows that the mean score of social stigma was 10.68 ± 3.19 and the mean score of attitude was 61.18±7.69. the calculated Karl Pearson’s correlation value of r=-0.44 shows a moderately negative correlation but was found to be statistically significant. It indicates attitude decreases when the social stigma increases.

 

Figure:1 Correlation of the level of social stigma with the level of attitude of Nursing Officers

 

SECTION-E: Association of the level of attitude with their demographic variables of the nursing officers

TABLE:2 Association of the level of attitude with their demographic variables of the nursing officer                                  N=50

 

Table :2 shows that there was statistically significant association of demographic variables (age, gender, education, experience, place of residence, type of family, no of times posted, no of days quarantined, place of quarantine) with level of attitude of nursing officers. Type of house shows non-significant association with level of attitude of nursing officers at P<0.05 level.

 

DISCUSSION:

The first objective of the study to assess the common social stigma faced by Nursing Officers working in COVID-19 wards. The findings showed that out of 50 Nursing Officers 20% of Nursing Officers mildly faced social stigma, 64% of Nursing Officers moderately faced social stigma, 16% of Nursing Officers severely faced social stigma during working in COVID-19 wards whereas the study conducted by Kartikeyyadav, et.al on stigma and apprehensions related COVID-19 among HCP’s in Delhi revealed 50% of study participants faced some form of stigma in their residential colony,46% observed changes in behavior of neighbours and 20% participant experienced harassment from neighbours.⁽¹⁾

 

CONCLUSION:

The study result shows that the level of social stigma among the Nursing Officers working in COVID-19 wards in Puducherry is at the moderate level.

 

CONFLICT OF INTEREST:

The authors declare that they have no conflict of interest related to the publication of the article.

 

IMPLICATION OF THE STUDY:

The Nursing implication includes the specific suggestion for Nursing education, Nursing administration and Nursing research.

 

NURSING EDUCATION:

Nursing curriculum should include more content in the area of social stigma among Nursing Officers in COID-19 ward. They was necessary to train skills to the Nursing Officers by simulation, conference, workshops, seminars can be given for Nursing Officers to impact education towards social stigma among Nursing Officers working in COVID-19 wards.

 

NURSING ADMINISTRATION:

Nursing administration should have a special focus to the aspect of handling social stigma among Nursing Officers working in COVID-19 wards. They play vital role in planning, organizing, supervising and implementing conference, workshops, seminars related to COVID-19 stigma. Frequent in-service training and pre service training program should be arranged. The Nursing administrator should arrange for proper hands on training for the Nursing Officers in aspect of handling COVID-19 stigma.

 

NURSING RESEARCH:

In Nursing, there is scare literature and research done on knowledge about social stigma among Nursing Officers working in COVID-19 ward.

 

RECOMMENDATION:

·       Human resource management can support to decrease the level of stigma among  Nursing Officer by reducing workload stress and depression.

·       Avoiding overtime duties and maintain either 6 hours or 8 hours duty in three shifts (morning, evening and night) with atleast 2 day-off per week.

·       A similar study can be conducted to assess the prevalence of social stigma among Nursing students posted in COVID-19 wards.

·       This study can be replicated on a larger samples for generalizing the findings.

 

ACKNOWLEDGEMENT:

We would like to express our sincere gratitude to our college senior librarian Mr. C.Kumaravel who helped us in our statistics work.

 

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Received on 28.09.2021           Modified on 22.06.2022

Accepted on 01.12.2022          © A&V Publications all right reserved