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Investigate the uncertain status and influencing factors of COVID-19 patients in mobile shelter hospitals.
In February 2020, 114 COVID-19 patients admitted to a mobile shelter hospital in Wuhan City, Hubei Province were enrolled in the group using convenience sampling. The Chinese version of the Mishel Disease Uncertainty Scale (MUIS) was used to assess the patient’s disease uncertainty, and multiple regression analysis was used to explore its influencing factors.
The average total score of MUIS (Chinese version) is 52.22±12.51, indicating that the disease uncertainty is at a moderate level. The results prove that the average score of dimensional unpredictability is the highest: 2.88 ± 0.90. Multiple stepwise regression analysis showed that females (t = 2.462, p = .015) have a family monthly income of not less than RMB 10,000 (t = -2.095, p = .039), and the course of illness is ≥ 28 days (t = 2.249, p =. 027) is an independent influencing factor of disease uncertainty.
Patients with COVID-19 are at a moderate degree of disease uncertainty. Medical staff should pay more attention to female patients, patients with low monthly family income, and patients with a longer course of disease, and take targeted intervention measures to help them reduce the uncertainty of their disease.
Faced with a new and unknown infectious disease, patients diagnosed with COVID-19 are under tremendous physical and psychological stress, and the uncertainty of the disease is the main source of stress that plagues patients. This study investigated the disease uncertainty of COVID-19 patients in mobile shelter hospitals, and the results showed a moderate level. The results of the study will benefit nurses, public policy makers and future researchers in any environment that provides care for COVID-19 patients.
At the end of 2019, the 2019 Coronavirus Disease (COVID-19) broke out in Wuhan, Hubei Province, China, becoming a major public health problem in China and the world (Huang et al., 2020). The World Health Organization (WHO) lists it as a public health emergency of international concern (PHEIC). In order to limit the spread of the virus, the Wuhan COVID-19 Prevention and Control Command Center decided to build multiple mobile shelter hospitals to treat patients with mild illnesses. Faced with a new and unknown infectious disease, patients diagnosed with COVID-19 suffer huge physical and very serious psychological distress (Wang, Chudzicka-Czupała et al., 2020; Wang et al., 2020c; Xiong et al., 2020). Uncertainty of the disease is the main source of stress that plagues patients. As defined, this happens when the patient loses control over disease-related events and their future, and it may occur at all stages of the disease (for example, At the stage of diagnosis,… at the stage of treatment, or disease-free survival) (Mishel et al., 2018). The uncertainty of disease is related to negative socio-psychological outcomes, and to health-related decline in quality of life and more severe physical symptoms (Kim et al., 2020; Parker et al., 2016; Szulczewski et al., 2017; Yang et al., 2015). This study aims to explore the current status and influencing factors of disease uncertainty in patients with COVID-19, and to provide a basis for future relevant intervention studies.
COVID-19 is a new type B infectious disease that is spread mainly through respiratory droplets and close contact. It is a serious viral epidemic in the 21st century and has an unprecedented global impact on people’s mental health. Since the outbreak of COVID-19 in Wuhan City, Hubei Province at the end of 2019, cases have been detected in 213 countries and regions. On March 11, 2020, the WHO declared the epidemic a global pandemic (Xiong et al., 2020). As the COVIC-19 pandemic spreads and continues, the psychological problems that follow have become more and more important propositions. Many studies have shown that the COVID-19 pandemic is related to high levels of psychological distress. In the face of a pandemic, many people, especially COVID-19 patients, will have a series of negative emotional reactions such as anxiety and panic (Le, Dang, et al., 2020; Tee ML et al., 2020; Wang, Chudzicka -Czupała Et al., 2020; Wang et al., 2020c; Xiong et al., 2020). The pathogenesis, incubation period, and treatment of COVID-19 are still in the exploratory stage, and there are still many issues to be clarified in terms of diagnosis, treatment and scientific cognition. The outbreak and continuation of the pandemic have made people feel uncertain and uncontrollable about the disease. Once diagnosed, the patient is not sure whether there is an effective treatment, whether it can be cured, how to spend the isolation period, and what impact it will have on themselves and their family members. The uncertainty of illness puts the individual in a constant state of stress and produces anxiety, depression and fear (Hao F et al., 2020).
In 1981, Mishel defined disease uncertainty and introduced it into the field of nursing. When the individual lacks the ability to judge disease-related events and the disease causes related stimulus events, the individual cannot make corresponding judgments on the composition and meaning of the stimulus events, and a sense of disease uncertainty will occur. When a patient cannot use his or her educational background, social support, or relationship with a healthcare provider to obtain the information and knowledge he or she needs, the uncertainty of the disease increases. When pain, fatigue, or drug-related events occur, the lack of information will increase, and the uncertainty of the disease will also increase. At the same time, high disease uncertainty is associated with a decline in the ability to process new information, predict results, and adapt to diagnosis (Mishel et al., 2018; Moreland & Santacroce, 2018).
Disease uncertainty has been used in studies of patients with various acute and chronic diseases, and a large number of results show that this cognitive assessment of the disease is related to various negative results of patients. Specifically, mood disorders are associated with a high degree of disease uncertainty (Mullins et al., 2017); disease uncertainty is a predictor of depression (Zhang et al., 2018); in addition, disease uncertainty is considered unanimously It is a malignant event (Hoth et al., 2015; Parker et al., 2016; Sharkey et al., 2018) and is believed to be related to negative psychosocial outcomes such as emotional stress, anxiety, or mental disorders (Kim et al. People, 2020; Szulczewski et al., 2017). It not only interferes with patients’ ability to seek disease information, thereby hindering their choice of treatment and healthcare (Moreland & Santacroce, 2018), but also reduces the patient’s health-related quality of life, and even more serious physical symptoms (Guan et al. People, 2020; Varner et al., 2019).
In view of these negative effects of disease uncertainty, more and more researchers have begun to pay attention to the uncertainty level of patients with different diseases and try to find ways to significantly reduce disease uncertainty. Mishel’s theory explains that the uncertainty of the disease is caused by unclear disease symptoms, complicated treatment and care, lack of information related to the diagnosis and severity of the disease, and unpredictable disease process and prognosis. It is also affected by patients’ cognitive level and social support. Studies have found that the perception of disease uncertainty is affected by many factors. The age, race, cultural concept, educational background, economic status, course of the disease, and whether the disease is complicated by other diseases or symptoms in the demographic and clinical data of the patients are analyzed as factors that affect the perception of disease uncertainty. Many studies (Parker et al., 2016).
Investigate the uncertain status and influencing factors of COVID-19 patients in mobile shelter hospitals.
A cross-sectional study was conducted in the mobile shelter hospital, covering an area of 1385 square meters, divided into three wards, with a total of 678 beds.
Using the convenience sampling method, 114 COVID-19 patients admitted to a mobile shelter hospital in Wuhan, Hubei Province in February 2020 were used as the research objects. Inclusion criteria: 18-65 years old; confirmed COVID-19 infection and clinically classified as mild or moderate cases according to national diagnosis and treatment guidelines; agreed to participate in the study. Exclusion criteria: cognitive impairment or mental or mental illness; severe visual, auditory or language impairment.
In view of the COVID-19 isolation regulations, the survey was conducted in the form of an electronic questionnaire, and logical verification was set up to improve the validity of the questionnaire. In this study, an on-site survey of COVID-19 patients admitted to a mobile shelter hospital was conducted, and the researchers strictly screened the patients according to the inclusion and exclusion criteria. Researchers instruct patients to complete the questionnaire in a unified language. Patients fill out the questionnaire anonymously by scanning the QR code.
The self-designed general information questionnaire includes gender, age, marital status, number of children, place of residence, education level, employment status and monthly family income, as well as the time since the onset of COVID-19, as well as relatives and friends who have been infected.
The Disease Uncertainty Scale was originally formulated by Professor Mishel in 1981, and was revised by Ye Zengjie’s team to form the Chinese version of MUIS (Ye et al., 2018). It includes three dimensions of uncertainty and a total of 20 items: ambiguity (8 items). ), lack of clarity (7 items) and unpredictability (5 items), of which 4 items are reverse scoring items. These items are scored using the Likert 5-point scale, where 1=strongly disagree, 5=strongly agree, and the total score range is 20-100; the higher the score, the greater the uncertainty. The score is divided into three levels: low (20-46.6), intermediate (46.7-73.3) and high (73.3-100). The Cronbach’s α of Chinese MUIS is 0.825, and the Cronbach’s α of each dimension is 0.807-0.864.
Participants were informed of the purpose of the study, and informed consent was obtained when recruiting participants. Then they began to voluntarily fill out and submit questionnaires online.
Use SPSS 16.0 to establish a database and import data for analysis. The count data is expressed as a percentage and analyzed by the chi-square test; the measurement data conforming to the normal distribution is expressed as the mean ± standard deviation, and the t test is used to analyze the factors that affect the uncertainty of the COVID-19 patient’s condition by using multiple stepwise regression. When p <.05, the difference is statistically significant.
A total of 114 questionnaires were distributed in this study, and the effective recovery rate was 100%. Among 114 patients, 51 were males and 63 were females; they were 45.11 ± 11.43 years old. The average number of days since the onset of COVID-19 was 27.69 ± 10.31 days. Most of the patients were married, a total of 93 cases (81.7%). Among them, spouses were diagnosed with COVID-19 accounted for 28.1%, children accounted for 12.3%, parents accounted for 28.1%, and friends accounted for 39.5%. 75.4% of COVID-19 patients are most worried that the disease will affect their family members; 70.2% of patients are worried about the sequelae of the disease; 54.4% of patients are worried that their condition will worsen and affect their normal life; 32.5% of patients are worried that the disease will affect them Work; 21.2% of patients worry that the disease will affect the economic safety of their families.
The total MUIS score of COVID-19 patients is 52.2 ± 12.5, indicating that the disease uncertainty is at a moderate level (Table 1). We sorted the scores of each item of the patient’s disease uncertainty and found that the item with the highest score was “I can’t predict how long my disease (treatment) will last” (Table 2).
The general demographic data of the participants was used as a grouping variable to compare the disease uncertainty of COVID-19 patients. The results showed that gender, family monthly income and time of onset (t = -3.130, 2.276, -2.162, p <.05) were statistically significant (Table 3).
Taking the MUIS total score as the dependent variable, and using the three statistically significant factors (gender, family monthly income, time of onset) in univariate analysis and correlation analysis as independent variables, a multiple stepwise regression analysis was performed. The variables that finally enter the regression equation are gender, family monthly income and time of onset of COVID-19, which are the three main factors that affect the dependent variables (Table 4).
The results of this study show that the total score of MUIS for COVID-19 patients is 52.2±12.5, indicating that the disease uncertainty is at a moderate level, which is consistent with the disease uncertainty research of different diseases such as COPD, congenital heart disease, and blood disease. Pressure dialysis, fever of unknown origin at home and abroad (Hoth et al., 2015; Li et al., 2018; Lyu et al., 2019; Moreland & Santacroce, 2018; Yang et al., 2015). Based on Mishel’s disease uncertainty theory (Mishel, 2018; Zhang, 2017), the familiarity and consistency of COVID-19 events are at a low level, because it is a new, unknown and highly infectious disease, which may The uncertainty that leads to a high level of disease. However, the results of the survey did not indicate the expected results. The possible reasons are as follows: (a) The intensity of symptoms is the main factor of disease uncertainty (Mishel et al., 2018). According to the admission criteria of mobile shelter hospitals, all patients are mild patients. Therefore, the disease uncertainty score has not reached a high level; (b) social support is the main predictor of the disease uncertainty level. With the support of the national response to COVID-19, patients can be admitted to mobile shelter hospitals in time after diagnosis, and receive professional treatment from medical teams from all provinces and cities across the country. In addition, the cost of treatment is borne by the state, so that patients have no worries, and to a certain extent, the uncertainty of these patients’ conditions is reduced; (C). The mobile shelter hospital has gathered a large number of COVID-19 patients with mild symptoms. The exchanges between them strengthened their confidence in overcoming the disease. The active atmosphere helps patients avoid fear, anxiety, depression and other negative emotions caused by isolation, and to a certain extent reduces the patient’s uncertainty about the disease (Parker et al., 2016; Zhang et al., 2018) .
The item with the highest score is “I can’t predict how long my disease (treatment) will last”, which is 3.52±1.09. On the one hand, because COVID-19 is a brand-new infectious disease, patients know almost nothing about it; on the other hand, the course of the disease is long. In this study, 69 cases had an onset of more than 28 days, accounting for 60.53% of the total number of respondents. The average length of stay of 114 patients in the mobile shelter hospital was (13.07±5.84) days. Among them, 39 people stayed for more than 2 weeks (more than 14 days), accounting for 34.21% of the total. Therefore, the patient assigned a higher score to the item.
The second-ranked item “I am not sure whether my disease is good or bad” has a score of 3.20 ± 1.21. COVID-19 is a new, unknown, and highly contagious disease. The occurrence, development and treatment of this disease are still under exploration. The patient is not sure how it will develop and how to treat it, which may result in a higher score for the item.
The third ranked “I have many questions without answers” scored 3.04±1.23. In the face of unknown diseases, medical staff are constantly exploring and optimizing their understanding of diseases and diagnosis and treatment plans. Therefore, some disease-related questions raised by patients may not have been fully answered. Since the ratio of medical staff in mobile shelter hospitals is generally kept within 6:1 and a four-shift system is implemented, each medical staff needs to take care of many patients. In addition, in the process of communicating with medical personnel wearing protective clothing, there may be a certain amount of information attenuation. Although the patient has been provided with instructions and explanations related to disease treatment as much as possible, some personalized questions may not have been fully answered.
At the beginning of this global health crisis, there were differences in the information about COVID-19 received by health care workers, community workers, and the general population. Medical staff and community workers can gain a higher level of awareness and knowledge of epidemic control through diversified training courses. The public has seen a lot of negative information about COVID-19 through the mass media, such as information related to the reduction of the supply of medical equipment, which has increased patient anxiety and illness. This situation illustrates the urgent need to increase the coverage of reliable health information, because misleading information may hinder health agencies from controlling epidemics (Tran et al., 2020). High satisfaction with health information is significantly associated with lower psychological impact, illness, and anxiety or depression scores (Le, Dang, etc., 2020).
The results of current research on COVID-19 patients show that female patients have a higher level of disease uncertainty than male patients. Mishel pointed out that as the core variable of the theory, the individual’s cognitive ability will affect the perception of disease-related stimuli. Studies have shown that there are significant differences in the cognitive abilities of men and women (Hyde, 2014). Women are better at feeling and intuitive thinking, while men are more inclined to rational analysis thinking, which can promote male patients’ understanding of stimuli, thereby reducing their uncertainty about the disease. Men and women also differ in the type and efficiency of emotions. Women prefer emotional and avoidance coping styles, while men tend to use problem-solving and positive thinking strategies to deal with negative emotional events (Schmitt et al., 2017). This also shows that medical staff should appropriately guide patients to help them maintain neutrality when accurately assessing and understanding the uncertainty of the disease itself.
Patients whose monthly household income is more than or equal to RMB 10,000 have a significantly lower MUIS score. This finding is consistent with other studies (Li et al., 2019; Ni et al., 2018), which revealed that lower monthly household income is a positive predictor of patients’ disease uncertainty. The reason behind this speculation is that patients with lower family incomes have relatively few social resources and fewer channels to obtain disease information. Due to unstable work and economic income, they usually have a heavier family burden. Therefore, when faced with an unknown and serious disease, this group of patients is more of doubts and worries, thus showing a high degree of disease uncertainty.
The longer the disease lasts, the lower the patient’s sense of uncertainty (Mishel, 2018). The research results prove this (Tian et al., 2014), claiming that the increase in chronic disease diagnosis, treatment, and hospitalization helps patients to recognize and become familiar with Disease-related events. However, the results of this survey show the opposite argument. Specifically, the disease uncertainty of cases that have passed 28 days or more since the onset of COVID-19 has increased significantly, which is in line with Li (Li et al., 2018) in his study of patients with unknown fever. The result is consistent with the reason. The occurrence, development and treatment of chronic diseases are relatively clear. As a new and unexpected infectious disease, COVID-19 is still being explored. The way to treat the disease is to sail in unknown waters, during which some sudden emergencies occurred. Events, such as patients who relapsed after being discharged from the hospital during the infection period. Due to the uncertainty of the diagnosis, treatment and scientific understanding of the disease, although the onset of COVID-19 has been prolonged, patients with COVID-19 are still uncertain about the development trend and treatment of the disease. In the face of uncertainty, the longer the onset of COVID-19, the more worried the patient will be about the treatment effect of the disease, the stronger the patient’s uncertainty about the characteristics of the disease, and the higher the uncertainty of the disease.
The results suggest that patients with the above characteristics should be disease-centered, and the goal of disease intervention is to find a management method to reduce disease. It includes health education, information support, behavioral therapy, and cognitive behavioral therapy (CBT). For COVID-19 patients, behavioral therapy can help them use relaxation techniques to fight anxiety and prevent depressive episodes by changing the schedule of daily activities. CBT can alleviate maladaptive coping behaviors, such as avoidance, confrontation and self-blame. Improve their ability to manage stress (Ho et al., 2020). Internet Cognitive Behavioral Therapy (I-CBT) interventions can benefit patients who are infected and receiving care in isolation wards, as well as patients who are isolated at home and have no access to mental health professionals (Ho et al., 2020; Soh et al., 2020; Zhang & Ho, 2017).
The MUIS scores of COVID-19 patients in mobile shelter hospitals show a moderate degree of disease uncertainty. The one with the highest score in the three dimensions is unpredictability. It was found that the uncertainty of the disease was positively correlated with the time since the onset of COVID-19, and negatively correlated with the patient’s monthly household income. Males score lower than females. Remind medical staff to pay more attention to female patients, patients with low monthly family income and long course of illness, take active intervention measures to reduce patients’ uncertainty about their condition, guide patients to strengthen their beliefs, face up to the disease with a positive attitude, cooperate with treatment, and improve treatment compliance Sex.
Like any study, this study has some limitations. In this study, only the self-rating scale was used to investigate the disease uncertainty of COVID-19 patients treated in mobile shelter hospitals. There are cultural differences in epidemic prevention and control in different regions (Wang, Chudzicka-Czupała, et al., 2020), which may affect the representativeness of samples and the universality of results. Another problem is that due to the nature of the cross-sectional study, this study did not conduct further studies on the dynamic changes of disease uncertainty and its long-term effects on patients. A study showed that there were no significant longitudinal changes in the levels of stress, anxiety and depression in the general population after 4 weeks (Wang, Chudzicka-Czupała et al., 2020; Wang et al., 2020b). Further longitudinal design is needed to explore the different stages of the disease and its impact on patients.
Made significant contributions to the concept and design, or data acquisition, or data analysis and interpretation; DL, CL participated in drafting manuscripts or critically revised important knowledge content; DL, CL, DS finally approved the version to be released. Each author should fully participate in the work and take public responsibility for the appropriate part of the content; DL, CL, DS agree to be responsible for all aspects of the work to ensure that issues related to the accuracy or completeness of any part of the work are properly investigated and Resolve; DS
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Post time: Jul-16-2021