INTRODUCTION

The COVID-19 pandemic affected various aspects of human life: social, economic, educational, cultural, and spiritual, and it impacts individual and collective health from all perspectives due to its rapid spread and increased mortality ¹. According to epidemiological reports, as of July 2024, more than seven million deaths and over 775 million infections have been recorded worldwide ². It should be noted that since 2021, its variants and subvariants have continued to spread in all countries ³. In Peru, around 111,000 deaths were reported, making it the South American country with the highest mortality rate globally. However, it is estimated that the real numbers are two to three times higher than the official figures ⁴.

In this context, since the first confirmed cases in March 2020, Peruvian healthcare personnel have taken on the task of reducing morbidity and mortality in the most vulnerable populations while also protecting themselves from infection, alongside the risk of illness and death from the disease. Nevertheless, in Peru, more than 2,200 healthcare workers were reported to have died from COVID-19 ⁵.

Despite the sharp rise in infections and deaths, healthcare personnel had to cope with the health emergency in a scenario characterized by a lack of hospital capacity in terms of available intensive care unit beds, a shortage of specialized personnel, limited material resources, and insufficient personal protective equipment. Additionally, there was a reduced availability of oxygen support and ventilation systems. This was compounded by the intense pressure on emergency services, triage, the overflow of patients, attending to relatives, family isolation, and witnessing the loss of colleagues, patients, and family members. All of this led to physical and mental exhaustion, as documented by various studies, which showed healthcare teams experiencing signs of stress, anxiety, depression, and fatalism, as well as sleep disturbances, feelings of anger, fear, frustration, and denial ^6-9. This physical and mental fatigue among healthcare professionals affected the quality of patient care, their decision-making capacity, and even their clinical skills, which were sufficient reasons to intensify efforts to protect the physical and mental health of healthcare workers ¹⁰.

In this context, nursing professionals who worked on the frontlines, especially in emergency services, were also affected. For instance, by early 2021 in Peru, 7,780 cases of COVID-19 and 90 nurse deaths were reported ¹¹. This situation generated fear of COVID-19 infection, and concern was likely constant. However, empirical studies show some discrepancies regarding fear of COVID-19. In this way, a study conducted at a hospital in Lima reported high levels of fear, as well as in the dimensions of emotional fear reactions (EFR) and somatic expressions of fear (SEF), which also reached a high level ¹². In contrast, another study in Lima found moderate levels of fear of COVID-19 (74.3%) ¹. Lastly, another study concluded that Peruvian nurses had low concern about contracting COVID-19 ⁹. Internationally, an important study conducted in Wuhan, China, showed that nurses exhibited a high level of fear of COVID-19 (91.2%) ¹³. Despite these differences, the literature considers fear to be a good predictor of anxiety ¹⁴ and fatalism ⁹.

Therefore, it is relevant to study the concern and fear of nursing staff during the COVID-19 pandemic. Furthermore, reports suggest that these professionals were likely the most subject to pressure, fear, and constant concern about becoming infected. This is understandable, given the complexity of stabilizing patients and the psychological impact associated with potential infection ^(15,16). In this line, it is worth noting that empirical evidence is still scarce regarding these professionals and their concern and fear of infection, among other constructs that need further investigation. Therefore, the objective was to characterize the concern about infection and fear of COVID-19 in Peruvian nurses working in emergency services.

MATERIALS AND METHODS

RESULTS

DISCUSSION

Among the main findings of the study, it was shown that emergency nurses exhibited a moderate level of fear of COVID-19. Additionally, most of them reported experiencing significant fear, discomfort when thinking about the coronavirus, and fear of losing their life due to the virus. These results reveal the intensity of fear as the primary emotional reaction faced by nurses during direct patient care in the emergency department.

Regarding the findings, similar results have been reported in recent studies, where participants also reached a moderate level of fear, with an average score of 16.79 points ²¹. Likewise, a 2020 multicenter study revealed that the fear of COVID-19 scale had an average score of 16.7 points ²². In 2021, in the city of Lima, a predominance of moderate-level fear (74.3%) was found; similarly, regarding the dimension of somatic expressions of fear, participants also exhibited a moderate level (65.7%) ¹.

However, differences have been discovered in the findings of another study, also conducted in Lima, which examined fear of COVID-19 in nursing staff working at a national public hospital. The study found that most participants (58%) scored above 25 points. Regarding the dimensions of the scale, both emotional fear reactions and somatic fear expressions reached high levels (59.5% and 53.4%, respectively) ¹². Similarly, a study conducted in Wuhan, China, recorded that participants exhibited a high level of fear of COVID-19 (91.2%) ¹³. It is worth noting that all these studies were conducted among nursing professionals working in COVID-19 areas, an environment exclusively for patients with this diagnosis, where close contact with such personnel is frequent.

In terms of indicators from the COVID-19 fear scale, similar findings were reported in Colombia in three indicators: significant fear of the coronavirus (82.3%), discomfort when thinking about the virus (78.5%), and fear of losing one’s life (71%). However, opposite results were found for the remaining indicators ⁸.

Some authors suggest that fear is a disturbance of the mind caused by a threat or danger, which can increase or decrease in each person. As it is a socially created or represented condition, fear is also a social state, not just a physiological one ²³. Additionally, there is broad consensus in describing fear as a defensive reaction to danger, which has, to some extent, a protective function ²⁴.

In this sense, the COVID-19 pandemic was considered a public health emergency in all countries, causing thousands of deaths in short periods, which significantly impacted social aspects ²⁵. This health crisis poses a threat or danger due to its high transmissibility, particularly in 2020 and 2021, and various forms of contagion constitute a high occupational risk for nursing professionals and healthcare workers in general ²⁶. As a result, situations of fear, uncertainty, and high concern are understandable, particularly regarding the possibility of contracting or transmitting the virus to family members. If we add inadequate working conditions, fear would significantly increase, along with other states such as stress, anxiety, and psycho-emotional exhaustion ²⁷.

However, there are not enough studies to fully understand the phenomenon of concern regarding COVID-19. Nevertheless, one study with similar results to the present report found that nurses in a Peruvian sample had an average score of 13.23 points, placing it in the medium range ¹⁴. More extensive, possibly cross-cultural, studies are needed to understand how cultural, social, and working conditions might influence the concern and fear of contracting COVID-19.

It is important to note that concern involves the persistence of one or more recurring topics in people's thoughts and conversations, which are related to anxiety and depression due to future uncertainty regarding how to carry out actions, potentially leading to a loss of control in decision-making ²⁸. In this context, the ongoing and prolonged state of emergency due to COVID-19, the possibility of contracting the virus, the lack of human resources, the scarcity of protective materials and biosecurity equipment, and the increase in patients, among other factors, constitute recurring issues and a constant manifestation in healthcare personnel and nursing management, causing concern in daily tasks.

Strictly speaking, and knowing that we are addressing a new thematic field, the findings on the concern of nurses are consistent with the intensity of fear they exhibit. Here, it is worth noting that while fear is a response that drives immediate action, concern fosters anticipation or preparation for future protective actions in response to danger ²⁹.

The timing of this global health crisis is also important in understanding our findings. It is likely that the fear and concern of the subjects in this sample were greater in 2020 than in 2021, when the instruments were applied. This is because, by 2021, nurses had partially overcome their concerns due to improvements in hospital response capacity, resource allocation, and a decrease in COVID-19 cases in the weeks leading up to our study. Additionally, mass vaccination of healthcare personnel and scientific knowledge about the disease, which was not available in 2020, likely played a significant role.

Some limitations of this study should be highlighted. First, for ethical reasons, we applied the instruments to volunteers. Second, the fact that we did not consider questions about working conditions or the perceptions of nurses reduced the possibility of including potentially relevant intervening variables for the study of these two constructs. Lastly, during data analysis, it may have been pertinent to incorporate questions regarding the reasons for getting vaccinated or not; this could help understand why people with one dose are more concerned than those with two doses or no vaccination against COVID-19.

CONCLUSION

The findings of this study highlight the predominant levels of concern and fear of COVID-19 among nursing staff working in emergency services. Although most participants exhibit moderate levels of these emotions, differences were identified based on characteristics such as sex, vaccination status, and work modality, particularly in emotional and somatic reactions associated with fear. These differences underscore the importance of considering targeted interventions to support the mental health of nurses, who face a constant risk of infection due to their direct work with critical patients. In this regard, ensuring an adequate work environment, promoting access to vaccination, and providing continuous psychological support are essential strategies to mitigate the negative effects of concern and fear, which could compromise both their personal well-being and professional performance.