Asploro Journal of Biomedical and Clinical Case Reports

Asploro Journal of Biomedical and Clinical Case Reports

Ying Su^1*
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

Corresponding Author: Ying Su
Address: Department of Anaesthesiology, West China Hospital, Sichuan University, 37 Guo Xue St, Chengdu, Sichuan 610041, China.
Received date: 01 July 2025; Accepted date: 16 July 2025; Published date: 25 July 2025

Citation: Su Y. Anxiety: The Major Challenges Faced by PACU Nurses During the COVID-19 Pandemic. Asp Biomed Clin Case Rep. 2025 Jul 25;8(2):161-67.

Copyright © 2025 Su Y. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Post-Anesthesia Care Unit Nurses, Anxiety, The Depression -Anxiety – Stress Scale (DASS – 21), COVID-19 Pandemic, Occupational Stress, Perioperative Care

Abstract

Background: The coronavirus disease 2019 (COVID – 19) pandemic has been recognized by the World Health Organization (WHO) as a global public health emergency. Its sustained impact has exerted profound influence on the global healthcare system, manifested in aspects such as the strain on medical resources and the exacerbation of the workloads of healthcare professionals. As a pivotal component of perioperative nursing, the nursing team in the Post – Anesthesia Care Unit (PACU) is confronted with multiple pressures. Despite the fact that mental health issues triggered by COVID – 19 are prevalent among healthcare workers, the anxiety situation of PACU nurses has yet to receive adequate attention. Thus, this study is designed to analyze the current anxiety status of PACU nurses in China and the associated influencing factors, aiming to provide data – driven support for the optimization of anesthesia nursing strategies.
Methods: This study was a cross-sectional study conducted on PACU nurses from six Grade-III Class-A hospitals in Western China between May and June 2021. The anxiety status of the subjects was evaluated using the DASS-21. Statistical analyses were then performed to explore the inter-group differences. All statistical tests were two – tailed, with a significance level set at α = 0.05.
Results: According to our study, five nurses had mild anxiety, and two nurses had moderate anxiety. (1) Physical health: There are differences in the anxiety levels of PACU nurses under different states of physical health. (P=0.031). (2) Attitude to the prospect of PACU nurse: There are significant differences in anxiety levels among PACU nurses who hold different attitudes towards their career prospects in different working conditions. (P=0.026). (3) Hospital’s attention to PACU nurse: The anxiety levels of PACU nurses exhibit context-dependent variations based on hospitals’ attention. (P=0.002). (4) Patient’s respect for PACU nurse: PACU nurses exhibit significant differences in anxiety levels depending on patients’ degree of respect under clinical conditions. (P=0.000).
Conclusion: The results of our study suggest that anxiety is correlated with several modifiable factors, such as Attitude to the prospect of PACU nurses, physical health condition, Hospital’s attention to PACU nurse, Patient’s respect for PACU nurse. These findings contribute to the dissemination of adaptive strategies. These strategies can be implemented in the nursing practice of the Post – Anesthesia Care Unit (PACU) to resolve and mitigate the issues explored in this study.

Introduction

As a global public health emergency, the coronavirus disease 2019 (COVID-19) pandemic has imposed a persistent impact on the healthcare system [1]. As a crucial component of the perioperative period, the Post-Anesthesia Care Unit (PACU) subjects its nursing team to numerous pressures.

With the increase in the patient turnover rate in the PACU during the COVID-19 pandemic, there are concerns regarding the metabolism of anesthetic drugs in perioperative children [2,3]. The unfamiliar environment, combined with their inherently fragile state due to illness, makes them feel extremely fearful and uneasy in the hospital. Emotions such as anxiety and nervousness are prevalent among them, and these emotions are often vented through incessant crying [4].

Patients experiencing restlessness due to the incomplete metabolism of anesthetic agents impose a substantial workload on anesthesia recovery nurses. During the COVID-19 pandemic, in line with the hospital’s epidemic prevention and control requirements, postoperative patients are mandated to wear masks. This may impede the PACU nursing staff’s observation of patients’ facial complexion and lip conditions.

For patients and children presenting with restlessness and communication impairments, family accompaniment has been suspended. At the same time, during the anesthesia recovery phase, these patients may experience restlessness and show complete non-cooperation with medical staff. This is attributable to various factors, including mental panic, irritation from the tracheal catheter, wound pain, and irritation caused by the urinary catheter.

Under such circumstances, when nursing personnel are engaged in the restraint and consolation of patients, they frequently endure physical injuries inflicted by patients’ inadvertent scratches and assaults [5].

Furthermore, noise is highly prevalent in hospitals, especially within the operating room and the PACU. It represents a physiological risk factor that exerts detrimental effects not only on patients but also on the physiological and psychological well-being of medical professionals. When the noise generated by equipment and patients remains unregulated, it can trigger the autonomic nervous system, giving rise to a series of adverse physiological and psychological consequences, ultimately impinging on work performance [6].

Against the current backdrop, anesthesia recovery nurses in China may be experiencing anxiety. Nevertheless, the anxiety situation among anesthesia recovery nurses in China has not yet drawn sufficient attention. Thus, this investigation was carried out with the aim of gaining an understanding of the current anxiety status of anesthesia recovery nurses in the country. Moreover, by exploring the factors contributing to this phenomenon, we seek to provide data-based support for enhancing the current state of anesthesia care.

Methods

Ethical Approval:

Ethics approval was obtained from the Ethics Review Board of West China Hospital, Sichuan University (Reference Number 2021/786).

Study Design and Study Setting:

This was a cross-sectional study conducted on PACU nurses from six Grade-III Class-A hospitals in Western China (West China Hospital, Sichuan University; The First People’s Hospital of Lanzhou City; Traditional Chinese Medicine Hospital Dianjiang Chongqing; Cheng Du Shang Jin Nan Fu Hospital; AVIC 363 Hospital) between May and June 2021.

Patients:

A total of 131 nurses were included in the survey after excluding those who did not complete the questionnaire or were deemed ineligible. The final analysis comprised responses from all 131 participants.

The inclusion criteria are as follows:
(1) Effective registration time of nurses with Chinese nurse qualification certificates;
(2) Anesthesia resuscitation nurse.

The exclusion criteria are as follows:
(1) Nurses who rotate, visit, or study in the anesthesiology department;
(2) Nurses who were unable to fill out the questionnaire for various reasons during the survey;
(3) Refusal to participate.

Measurement and Data Collection:

In this study, an electronic survey entailing online questionnaire filling was adopted. Initially, the research team meticulously designed a paper-based questionnaire. Through iterative refinement and adjustment, this was then transformed into an electronic version. The generated link was subsequently disseminated to six hospitals in Sichuan Province.

Concurrently, the anesthesiology department nurses in these hospitals were comprehensively briefed on the details regarding questionnaire completion. To guarantee the authenticity of the data, specific measures were implemented to restrict each user to submitting only one questionnaire. Moreover, to ensure data integrity, every item within the questionnaire was designated as a “mandatory question.”

Upon completion of the data collection phase, a rigorous screening process was carried out. Questionnaires that were completed in less than 90 seconds and those where the same option was selected for all items were excluded from further analysis. Notably, both the response rate and the valid response rate of the questionnaire reached 100%. The estimated number of potential participants was around 170, and 131 individuals successfully completed the survey, resulting in a response rate of approximately 81.1%.

In this study, the Depression Anxiety and Stress Scale (DASS-21) was utilized to evaluate the anxiety states of the research participants [7]. The Depression-Anxiety-Stress Scale (DASS-21) is a self-assessment scale developed by Lovibond et al. to measure the severity of negative emotional symptoms [8].

The original version consisted of 42 items. After modification, it was compiled into the abbreviated version of the DASS-21. The scale is composed of three sub-scales: depression, anxiety, and stress, encompassing a total of 21 items [9]. Each sub-scale contains 7 items and adopts a four-level scoring system from 0 to 3. Specifically, “0” represents “not at all in line,” “1” represents “partially in line,” “2” represents “largely in line,” and “3” represents “highly in line.” This scale is used to evaluate an individual’s negative emotional symptoms over the past week. A higher score indicates more severe symptoms.

Regarding the anxiety sub-scale, a score of ≤7 is regarded as normal, 8 – 9 points indicates mild anxiety, 10 – 14 points represents moderate anxiety, 15 – 19 points suggest severe anxiety, and a score > 20 points implies extremely severe anxiety.

Statistical Analysis:

The data were analyzed using SPSS 22.0 statistical software. Measurement data were presented as X ± SD, and count data were presented by frequency and percentage. Measurements showing a non-normal distribution were expressed in median and quartiles. Intergroup comparisons were determined by t-test or ANOVA. Statistical significance was set at P < 0.05.

Results

In this study, the data were collected online. Anesthesia nurses from six tertiary hospitals in Sichuan Province participated in the study. A total of 131 questionnaires were distributed, and the effective response rate of the questionnaires was 100%. The mean age of the participants was 31.53 ± 6.97 years. Females accounted for 95% of the participants, the majority of whom were married (57.2%). Moreover, 78.6% of the participants had a bachelor’s degree or higher. The detailed general information is presented in Table-1.

Table-1: General Information of PACU nurses (N=131)

In this study, the DASS-21 was used to evaluate the anxiety status of the subjects. According to the score rules, five nurses had mild anxiety, and two nurses had moderate anxiety.
(1) Physical health: There are differences in the anxiety levels of PACU nurses under different states of physical health (P = 0.031).
(2) Attitude to the prospect of PACU nurse: There are significant differences in anxiety levels among PACU nurses who hold different attitudes towards their career prospects in different working conditions (P = 0.026).
(3) Hospital’s attention to PACU nurse: The anxiety levels of PACU nurses exhibit context-dependent variations based on hospitals’ attention (P = 0.002).
(4) Patient’s respect for PACU nurse: PACU nurses exhibit significant differences in anxiety levels depending on patients’ degree of respect under clinical conditions (P = 0.000).

The univariate analysis of the depression-anxiety-stress scale data is detailed in Table-2.

Table-2: Univariate Analysis of Anxiety (total score= 63) in PACU nurses(N=131)

Discussions

During the COVID-19 pandemic, PACU (Post-Anesthesia Care Unit) nurses are in close contact with airway management on a daily basis, thus facing a high risk of occupational exposure. In the face of these risks and a series of changes in professional procedures, to varying extents, physical and psychological impacts have been imposed on our PACU nurses [10].

Previous research has indicated that there exists a significant negative correlation between the attitudes of PACU nurses towards their career prospects and their anxiety levels [11]. Our study identified significant differences in anxiety levels among PACU nurses with divergent attitudes toward their career prospects across varying working conditions (P = 0.026). This finding is in accordance with previous studies.

There were some researches that indicated that poor physical condition is more prone to induce an anxious state among nurses [12,13]. Our study revealed that the better the physical condition of PACU nurses, the lower the likelihood of experiencing anxiety. This implies that while engaged in our work, it is of utmost importance to ensure our physical well-being. Consequently, the hospital conducts annual medical check-ups for its employees each year to protect the physical and mental health of PACU nurses. This enables us to provide better services to patients.

Some studies have put forward the view that the hospital’s attention to PACU nurses is related to the anxiety state of the nurses [14,15]. Our findings in this study are congruent with the aforementioned conclusion. Notably, our findings indicate that under clinical settings, the anxiety levels of PACU nurses demonstrate significant variations contingent upon the extent of respect accorded to them by patients.

As is well known, patients’ respect is directly related to nurses’ professional sense of achievement. Research shows that nurses who receive positive feedback have higher empathy satisfaction and a lower incidence of anxiety [15]. The findings of this study are largely congruent with this perspective. This suggests that by means of health education to guide patients to recognize the professionalism of nursing, it may contribute to fostering harmonious doctor-patient relationships and decreasing the incidence of anxiety among PACU nurses.

Conclusions

The results of our study suggest that anxiety is correlated with several modifiable factors, such as attitude to the prospect of PACU nurse, physical health condition, hospital’s attention to PACU nurse, and patient’s respect for PACU nurse. Against the backdrop of the pandemic, implementing relevant management strategies to tackle psychosocial risks is of paramount importance for boosting productivity, preventing accidents, and advancing the welfare of Post-Anesthesia Care Unit (PACU) nurses. This knowledge can contribute to the dissemination of adaptive strategies, which can be applied in PACU nursing practice to resolve and mitigate the issues investigated in this study.

Acknowledgments

The authors would like to thank all of the participants of this study.

Conflict of Interest

The author has read and approved the final version of the manuscript. The author has no conflicts of interest to declare.

Funding

No funding for this research has been received.

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