MENTAL WELL-BEING OF EMERGENCY ROOM NURSES IN HOSPITALS OF HAIL RE

MENTAL WELL-BEING OF EMERGENCY ROOM NURSES
IN HOSPITALS OF HAIL REGION, SAUDI ARABIA DURING
COVID 19 PANDEMIC
AWAD EID NADAA ALSHAMMARI
MASTER OF ARTS IN NURSING
GRADUATE SCHOOL, UNIVERSITY OF HAIL
April 14, 2022
APPROVAL SHEET
Approved by the Committee on Oral Examination with a grade
of __________ on _______________________.

______________________
Chairman
____________________
____________________
Panel Member Panel Member
_____________________________________________________
______________________
This is to certify further that AWAD EID NADAA AL-
SHAMMARI, have satisfactorily completed all academic
requirements in the MASTER’S DEGREE IN NURSING.
______________________________
Dean, Graduate Studies
Hail University
Date Signed: __________
Dedication
This study is primarily dedicated to Allah. Peace be unto Him!
To my parents, siblings, and relatives.
To my colleagues in the profession.
To my Hail University family.

TABLE OF CONTENTS
Title
Page........................................................................................
.................................... 1 Approval Sheet
...............................................................................................
................... 2
Dedication
…………………………………………………………………………
……. 3
Table of
Contents..................................................................................
.............................. 4
List of Tables and Figures
………………………………………………………………. 7
List of Appendices
……………………………………………………………………… 8
Abstract
…………………………………………………………………………

………. 9
Chapter 1 – Introduction
Introduction to the Research Project
……………………………………………. 10
Statement of the Research Problem
…………………………………………….. 11
Background of the Problem
…………………………………………………….. 11
Purpose of the Project
…………………………………………………………... 14
Definition of Terms
…………………………………………………………….. 14
Significance to Nursing
………………………………………………………… 15
Summary
………………………………………………………………………..
15
Chapter 2 – Review of Evidence
Introduction
……………………………………………………………………. 16
Conceptual Model/ Theoretical Framework
…………………………………… 16
Evaluation of Evidences
………………………………………………………. 18
Summary
………………………………………………………………………
28
Chapter 3 – Project Methodology
Introduction
…………………………………………………………………… 30
Research Design
………………………………………………………………. 30
Target Population, Subjects, Sample, and Setting
……………………………. 30
Instrument
…………………………………………………………………….. 31

Plan and Implementation Process
…………………………………………….. 32
Data Analysis
…………………………………………………………………. 33
Ethical Consideration
…………………………………………………………. 35
Summary
………………………………………………………………………
36
Chapter 4 – Project Outcome
Introduction
…………………………………………………………………… 37
Findings
……………………………………………………………………….
37
Chapter 5 – Discussion
Introduction
……………………………………………………………………. 41
Discussion
………………………………………………………………………
41
Conclusions
……………………………………………………………………. 43
Implications to Nursing
…………………………………………………… 43
Recommendations for further research
…………………………………… 43
References
…………………………………………………………………………
. 45

Lists of Tables and Figures
Table 1 Statistical Limits and Descriptive Equivalence
……………………………… 34
Table 2 Profile of Respondents
………………………………………………………. 38
Table 3 Extent of Mental Wellbeing of Emergency Room Nurses
…………………...39
Table 3 Correlation Analysis
…………………………………………………………. 40
List of Appendices
Appendix A Sample Informed Consent
……………………………………………… 51
Appendix B sample Questionnaire
…………………………………………………… 53

Abstract
Background Health care professionals including nurses
experienced increase in their workload, psychological suffering,
shortage of protective equipment and gears, social
discrimination like stigmatization, absence of incentives or
proper compensation, and management system approach during
the course of their duty in times of pandemic. Therefore, it is
significant to protect the wellbeing of nurses during Covid-19
pandemic in order to continuously provide good, effective,
quality services to patients and maintain a mental health status
needed during crises.
Results The response rate as of percentage is 95% which
composed of 114 respondents out of 120 nurses. Majority of the
respondents are female, Non-Saudi Employees, and having 3-5
years of experience in the Emergency room. The extent of
mental well-being of emergency room nurses in different
government hospitals of Hail Region, Kingdom of Saudi Arabia
is generally often. the correlation analysis of the moderating
variables in the study. The extent of mental well-being of
emergency nurses has significant relationship with nationality
(Correlation = 0.808, p-value= 0.000), and, year of ER

experience (Correlation=0.872, p-value=0.087). However,
extent of mental well-being of ER nurses has no significant
relationship to gender (Correlation = 0.151, p = 0.095).
Conclusion Therefore, it is concluded based on the findings and
results that Emergency Room nurses are greatly affected with
the occurrence of Covid-19 crisis in fulfilling their duties and
responsibilities. The impact of the health crisis influenced their
mental wellbeing which affects their physical, psychological,
emotional, and social aspects. Mental wellbeing of emergency
room nurses is not related to gender however the nationality and
years of experiences of nurses have an influence.
Keywords Mental Wellbeing, Emergency Room Nurses, Covid-
19 crisis
CHAPTER 1
BACKGROUND OF THE STUDY
This chapter discusses the background of the study that
explains the importance of the formulating the study. It also
involves the statement of the problem, purpose of the study and
its main objective, definition of the important concepts used in
the study, and elaboration of the significance of the study to the
nursing profession.
Introduction
The world was shaken with an unprecedent advent of one
of the deadliest viruses in the history of mankind happened
towards the end days of 2019. Corona virus was named SARS
Cov-2 after an outbreak happened in Wuhan China. The spread
was too rapid which was seen to be contagiously outrageous in
its effect to the people (https://www.cdc.gov/coronavirus/2019-
ncov/your-health/about-covid-19/basics-covid-19.html). This
infectious and transmissible disease was branded as one of the
most concentrated health diseases happened in the history

mankind (Dos Santos, 2020). It was declared a pandemic in
March 2020 by the World Health Organization which was due to
its rapid and speedy scale of transmission.
The Covid-19 pandemic manifested many changes and
vulnerabilities in the different sectors in the society around the
globe. This includes economic sector, educational sectors,
government sectors, and most especially the health sectors
(https://www.oecd.org/social/covid-19.htm). As it rapidly
affecting the lives of many people around the world, it is
bringing along considerable fear, anxiety, stress, and worries
which affects individual in all walks of life. According to World
health Organization-Europe (2020) this phenomenon is felt
tremendously by specific group of people which includes
elderlies, immune-compromised individuals and most especially
health care providers. This gave rise to the public issue of
psychological to health care providers affecting their
performances and productivity in the field of health care.
Furthermore, research has shown an increase in the number of
health care professionals showing high levels of anxiety and
depression having a percentage rate of 13% and 12.2%
respectively
(https://apps.who.int/iris/bitstream/handle/10665/340220/WHO-
EURO-2021-2150-41905-57496-eng.pdf).
Statements of the Problem
Generally, the study identified mental well-being status of
emergency room nurses during COVID 19 pandemic.
Specifically, it sought the answers of the following queries:
1. In what extent do emergency room nurses’ mental well-being
status during COVID 19 pandemic?
2. What is the relationship on the extent of mental well-being
status of emergency room nurses when the following variables
are considered?
a. Nationality
b. Years of Service
c. Gender
Background of the Study

Nurses as members of the healthcare team have been showing
up to their work shifts and working hard to provide the best care
to patients with various acuity levels during the COVID-19
pandemic (Fernandez, et al., 2020). Generally, nurses respond
in different time situation may either be in a daily routine of
their regular work and even during disasters like pandemic. In
fact, nurses constitute the majority number of the entire health
care team in different set up and they are required to function
critically in order to respond to the different cases confronting
the (Powers, 2020, Al Thobaity, Alamri, Plummer, and
Williams, 2019).
Emergency room nurses are mostly involved in assigning and
sorting cases of patients according to the degree of urgency of
care and also involved in detecting cases with infections with
extra precautionary measures. They are also responsible in the
process of refinement and synchronization with other health
care providers. Moreover, as part of their duties to provide
holistic management of care to numerous types of infection
concurrently dealing not only to the patients directly but even to
their families as well (Xie, Tong, Guan, Qiu, and Slutsky 2020).
During crises, they are tasked to assist patients and their
respective families in a high degree of satisfaction as being
demanded at all times. Therefore, emergency room nurses are
required to be fully equipped with indispensable knowledge,
skills, and right attitude in managing catastrophes or
emergencies which involves clinical treatment, isolation,
communication, sorting or triaging, psychological support, and
palliative care if it is needed and necessary (Bosario, Gamondi,
Obrist, & Jox 2020, Corless, Nardi, Milstead, Nokes, Orsega et
al 2018, Al Thobaity, Williams, & Plummer 2016, Al Thobaity,
Plummer, Innes, & Copnell 2015).
A qualitative report in a study on the challenges faced by health
care professionals in Bangladesh revealed that health care
professionals including nurses experienced increase in their
workload, psychological suffering, shortage of protective
equipment and gears, social discrimination like stigmatization,

absence of incentives or proper compensation, and management
system approach during the course of their duty in times of
pandemic (Razu et al, 2021).
Numerous health care professionals also suffered other types of
encounters which includes insomnia, sadness, sleep disturbances
and difficulties, and to the extent of having mental depression
which was observed to be related to their increased workload
and other related stress (Su, Lien, Yang, Su, Wang, Tsai et al,
2007). Moreover, these professionals including nurses have
been observed to experience attacks of anxiety and frustrations
as well which is related to their ignorance, changes happening
in their environment, and feeling of dread of acquiring the
disease extending to their family members (Sun, Wei, Shi, Jiao,
Song, Ma, et al, 2020). In addition to their emotional burden is
the practice of being socially distant to their families when they
got home after work as a precautionary measure to mitigate
possibilities of infection which aggravates their psychological
distress (WHO, 2020).
One of the key challenges that nurses face during Covid-19
pandemic is the provision of psychological and even social
support (Chen et al, 2020). Based on the claims of Abadi et al,
low level of job satisfaction of nurses was significantly
observed as caused by having a higher psychological and
physical demands from their jobs. Therefore, the quality of
performances of nurses during pandemic is influenced by the
degree and level of their job satisfaction.
Reconnoitering the matters that nurses face when caring for
patients with COVID-19 will help upsurge nurse and hospital
flexibility in reply to the crisis, as well as improve readiness
and regaining from the crisis. Additionally, understanding these
issues will help sustain nurses by enlightening leaders and
decision-makers about these problems and providing
commendations and insinuations. Hence, with provision of
information of the presented literatures, it is then therefore
significant to protect the well being of nurses during Covid-19
pandemic in order to continuously provide good, effective,

quality services to patients and maintain a mental health status
needed during crises. Therefore, this study will be highli ghting
the determination of the mental well-being of emergency nurses
in the field while unanimously fighting the dreadful effect of
the COVID-19 virus not only to healthcare professionals but to
the entire humanity as a whole.
Purpose of the Study
The proposed study would be able to provide useful
information to encourage Emergency Room nurses to be aware
of their mental well-being amidst their experiences during
COVID-19 pandemic. It will also bridge the knowledge gap on
nurses’ mental well-being and identify strategies and
interventions that have been proven to address these potential
concerns especially among the members of the nursing
community. It might be a stepping stone in developing or
improving active and responsive interventions or programs that
can help support their professional morale and raise awareness
on measures to decrease mental challenges while promoting
workplace diversity and safety.
Definition of Terms
The following terms were operationally defined based on
their use in the study.
Mental Health. It is a state of nurses’ health when he/she
comprehends his/her abilities, able to manage normal life
stresses and events, can display potential at work, and able to
provide contributions to his/her community.
Mental Well-being. The status of emergency room nurses to
respond ups and down or challenges while performing their
professional jobs. It is an integral part of the over all health of
emergency room nurses.
Emergency Room Nurses. Licensed registered nurses working in
the emergency room of the hospital.
COVID 19 Pandemic. The occurrence of health crisis brought
by COVID 19 virus affecting worldwide population.

Significance to Nursing
This study will serve as an eye opener to nursing authorities to
consider possible solutions that prompts the nursing profession
in terms of mental health promotion and other related issues
specifically those that affects the delivery of quality care to
patients. Furthermore, the development of different programs by
authorities will help our emergency room nurses in the field to
remain steadfast and resilient at all times. Programs that could
provide professional assistance and growth holistically to
promote high level of mental well-being and support systems.
Summary
Health related crisis brought about by COVID 19 virus
affected our lives multidimensionally. Health care providers
who play vital role in caring people afflicted with disease due to
their vulnerability are the most concerned individuals in these
times. However, so much so with studies that focused on the
promotion of health, prevention of the disease, rehabilitation of
the cured patients, and prolonging lives of individuals,
emergency room nurses were not given that much attention in
terms of their mental well-being while caring during
uncertainties. The level of anxiety and stress brought by the
current situation is affecting their job performances which will
eventually affects their job satisfaction in the end. Hence, the
mental health status of these emergency room nurses affects the
quality of nursing care given to their patients.
It is very important that nurses’ mental well-being must be
given attention by assessing their current situations. This will
provide information on how they are providing the quality
services while being confronted with different anxieties and
stresses brought about the pandemic
CHAPTER 2
REVIEW OF EVIDENCE
Introduction

This chapter introduces the different literatures that
explores knowledge of the world in terms of professional
quality of life of emergency room nurses. It also presents the
theoretical framework that is believed to support the future
findings of the study.
Theoretical Framework
As it was observed by many authorities that health care
workers including nurses are always confronted with the
different demands and levels of toxicity in their field of work.
Most of them were trained to put patients on the priority list
before themselves and this is one of the most important and
essential quality of being a nurse – selflessness. Others before
self.
However, it has been seen that this practice if abused and
neglected could lead to physical and psychological breakdown
which yields to a more disruptive effect to their health and
performances of their jobs. Therefore, it is being suggested that
practicing self-care would solve issues that confronts nurses
stress and improve their coping abilities to their workloads,
duty demands, and other obligations they have.
This study is rooting in the theory of Self-care by
Dorothea Orem. Self-care theory is a nursing theory that was
developed between 1959 and 2001 (American Sintenel, 2011).
This theory focuses on the concept that every individual has the
capacity to practice and perform activities that an individual
will perform on their behalf. In addition, this theory explains
that a certain individual is able to initiate a behavior that will
maintain his life, health, and well-being.
One of the major assumptions of this theory is that an
individual must be independent and responsible for their own
care and also including the care for other involving their
families. This independence entails the ability of an individual
to initiate actions that will promote and maintain well-being in
all situations. These initiatives shall include different activities
and programs that will promote and enhance health status.

Moreover, this theory also assumes that if a certain
individual has the knowledge of potential health problems that
may occur based on situations upholding a certain person, this
would help him promote self-care behaviors. Nurses are well
knowledgeable on this matter in regards to health problems, so
therefore they are capable also of designing their potentials in
order to build defenses for them to fight stress and emotional
disturbances that tries to affect them internally and externally.
Research had shown that activities that are needed in order
to promote self-care includes self-awareness, self-compassion,
the practice of unselfishness and the employment of different
variations of approaches that will affect physical, social, and
inner self or mental aspects. In this manner, nurses will be able
to obtain balanced work life which will improve their health and
mental well-being.
Practicing self-care among nurses is significant especially
in times of crises and uncertain times. This could be
accomplished by always assessing mental well-being status in
order to become aware to one’s emotional level and stress level
as needed. Upon examining these factors, nurses would the be
given numerous strategies and measures in order to mitigate or
lessen the effect of stress and emotional disturbances that
affects their mental health status as they perform their duties
and responsibilities as nurses.
This theory is significantly providing a framework that
nurses as individuals also needs proper practice of self-care.
This practice will be a beneficial too in order to improve their
physical, emotional, and mental well-being which will give
their way in providing quality and sustaining care to their
patients. Moreover, practicing self-care will try to lead them to
become more resilient in times of uncertainties thus enabling to
endure and give them the power to handle harder situations.
Evaluation of Evidences
Emergency nurses are health care professionals who are the first
to face close contact with patients and their families while

caring for infected patients and provide first care to patients.
The pressures of working in an emergency department are real.
There are high expectations of staff – from their managers, their
colleagues and themselves. They need to perform to a high
standard. Staff are constantly in high adrenaline, ‘reaction’
mode Staff across a range of roles described the ED
environment as unpredictable and intense. It was hard for them
to predict what their working day would be like or to plan their
schedules. They needed to be alert and on guard throughout
their shift, to react and adapt to the circumstances and perform
at the best of their abilities. While many staff complained about
the pressures of working in the emergency department, most
were conscious that the adrenalin-fueled atmosphere, the
unpredictability, the variety of challenges and the opportunities
to contribute to saving lives were a huge part of the appeal and
kept them working there. Both clinical and non-clinical staff
loved the intensity and thrived on the pressure, even if it at
times it could feel overwhelming (Shepard, 2021).
As the world becomes increasingly interconnected, so do the
risks it faces. The COVID-19 has affected day to day life and is
slowing down the global economy. Its impact is extensive and
have far reaching consequences. Not only has it cost a million
lives but it has also burdened the existing medical system,
disrupted the supply chain of products and services, shattered
livelihoods, travel became a luxury, and almost all social events
were disrupted (Haleem & Javaid, 2020). The COVID-19
pandemic has had an unprecedented impact on health systems in
most countries, and in particular, on the mental health and well -
being of health workers on the frontlines of pandemic response
efforts. Though they described themselves as resilient, many
Emergency Department staff describe experiencing poor mental
health.
Further, the COVID-19 pandemic has taken a toll on the mental
health of emergency department staff, both clinical and non-
clinical. Front line health care workers in hospital emergency
departments are at increased risk for anxiety, burnout,

depression and post-traumatic stress disorder while coping with
the COVID-19 pandemic, according to research published in
Annals of Emergency Medicine in February. The study, done in
20 emergency departments at hospitals in the United States,
found that symptoms of anxiety and burnout were prevalent
across the full spectrum of emergency department staff during
the pandemic, and as many as one-fifth of health care
employees were at risk for PTSD. (Shepard, 2021). There are
considerable opportunities to provide support and significant
benefits to doing so. But initiatives and interventio ns need to
take account of the culture within the Emergency Department,
the performance mentality of most of its staff and the prevailing
narratives around putting the patient first. Mind developed the
‘Taking care of you’ toolkit and champions program as a pilot
intervention to help ED staff prioritize self-care and develop
coping strategies to manage the challenges of their workplace.
The struggle to balance literal survival with all the things that
make surviving worthwhile has never been so clear, with the
COVID-19 pandemic forcing many to sacrifice social
connections, and therefore quality of life, for life itself. Being
socially connected in meaningful ways is actually key to human
health and survival. The COVID-19 pandemic and the need to
slow the virus’ spread have highlighted the pervasiveness of
social contact within, and social relevance of, nearly every
sector of our lives, including employment, education,
entertainment, travel, transportation, recreation and health.
(Holt-Lunstad, 2020). As such, COVID-19 has underscored the
necessity of strengthening organizational systems to rebuild and
sustain not only the physical but also the psychological, social
and emotional needs of the population – a task that will be
critical to a nation’s public health recovery from the pandemic.
With the exception of “essential workers,” the pandemic has
meant limiting physical proximity to those with whom one lives.
The extreme stress, uncertainty, and often difficult medical
nature of global infectious disease outbreaks, such as
Coronavirus (COVID-19), require special attention to the needs

of healthcare personnel. Taking care of yourself and
encouraging others to practice self-care sustains the ability to
care for those in need. Sustaining the Mental-Well-Being of
Healthcare Personnel during Coronavirus and other Infectious
Disease Outbreaks. Numerous factors contribute to elevated
stress among healthcare workers, including heavy workloads,
long shifts, a high pace, lack of physical or psychological
safety, chronicity of care, moral conflicts, perceived job
security, and workplace related bullying or lack of social
support. The resulting psychological distress can lead to
burnout, depression, anxiety disorders, sleeping disorders, and
other illnesses. Work related stress can have a negative impact
on health care providers' professionalism, quality of care
delivery, efficiency, and overall quality of life (Pedrosa,2020).
Therefore, it is critical to identify and mitigate these work-
related risk factors to protect the mental health and well-being
of healthcare workers.
According to a study published by Brown University, 32.8% of
people who were directly exposed to Covid-19 stressors
experienced elevated depressive symptoms compared to only
8.5% before the pandemic. The findings underscore the
inextricable link between the pandemic and its short- and long-
term impacts on mental health. Typically, a few months after a
traumatic event, depression peaks and lowers over time. But for
this pandemic, 18 months after its onset, levels of depression
still remained high and the burden to the overall mental well -
being is still prevalent. Columbia University analyzed data from
different sources like PubMed, Medlin, Web of Science about
depression and anxiety prevalence.
The global rate is between 21 to 24%, Asia has an overall rate
of 18 percent with China registering the lowest at 16% while the
rest of the world had 29% depression and anxiety rate. Closure
of public transportation, job loss, closure of schools, closure of
work and restriction or cancellation of public events are the
main sources of the anxiety aside from the virus. Rates of
anxiety in Asia prior to the pandemic was only about 2.1 to

4.1% (Henderson, 2020). These results have important
implications to policy makers to delve into the urgency of
support for the prevention and early intervention of depression
and anxiety.
According to Munter et.al. (2021), the challenges for health
systems, further complicated by the emergence of new more
infectious variants of the virus, are likely to persist—even
though infection rates have decreased in many parts of the
world and the vaccine roll out progresses at a rapid pace at the
time of writing this article—because we are now facing a
second and equally serious pandemic of mental health
challenges. The threats to mental health run deep within
communities and are far reaching, affecting the millions of
individuals who have been traumatized during national or
regional lockdowns, left vulnerable to substance use or
loneliness, those who have lost loved ones to the virus or face
heightened anxieties of getting sick, or among those facing the
dire economic consequences of the pandemic. In this
challenging recovery phase of the pandemic, the mental health
needs of healthcare workers and those on the frontlines such of
the pandemic response cannot be overlooked.
Working in a stressful or challenging environment for long
periods with little recovery time is a risk factor for burnout.
Burnout is defined as an occupational phenomenon in ICD-11:
Maslach et. al. describe burnout as that point at which
important, meaningful, and challenging work becomes
unpleasant, unfulfilling, and meaningless. Energy turns into
exhaustion, involvement (also referred to as engagement)
becomes cynicism and efficacy is replaced by ineffectiveness.
Grobler.
In a recent research study by Naslund (2021) healthcare systems
in many countries have been overwhelmed by the coronavirus
disease (COVID-19) pandemic, with increasing demands to
contain and respond to the virus. The result has been increased
pressure on frontline health workers. As the pandemic unfolds,
the impact on health systems in low-income and middle-income

countries (LMICs) is becoming apparent. In lower resource
settings, the detrimental effects on frontline health workers will
likely be significant due to fragmented infrastructure, low
compensation, and significant shortages of necessary resources
such as personal protective equipment. These high stress
conditions, coupled with risk of infection and fears and
anxieties among patients, can result in grave psychosocial
consequences for frontline health workers, who play a vital role
in delivering the bulk of primary care services in LMICs. In this
narrative review, we consider the psychological impact of the
COVID-19 pandemic on frontline health workers in LMICs.
The important role of frontline health workers, summarize
existing literature on burnout and risks to mental health in this
essential workforce, and consider how public health
emergencies exacerbate these concerns to showcase their
vulnerability to mental health impacts of COVID-19. The study
explores emerging research on the detrimental effects of the
COVID-19 pandemic on health workers and consider possible
approaches to mitigate these consequences. This review draws
from existing studies and emerging evidence to highlight the
critical need to consider the wellbeing of frontline health
workers, and to address these challenges as health systems
respond to the pandemic (Naslund, 2021).
Researchers are increasingly examining the experiences of
healthcare workers (HCWs), yet there is a dearth of research
considering how gender shapes frontlines Health care workers
(HCWs) personal experiences. As the majority of HCWs in the
UK and worldwide are women, research that investigates gender
and focuses on women’s experiences is urgently needed. We
conducted an analysis of 41 qualitative interviews with HCWs
in the British NHS during the first peak of the COVID-19
pandemic in the Spring of 2020. Our findings demonstrate that
gender is significant when understanding the experiences of
HCWs during COVID-19 as it illuminates ingrained inequalities
and asymmetrical power relations, gendered organizational
structures and norms, and individual gendered bodies that

interact to shape experiences of healthcare workers. These
findings point to important steps to improve gender equality,
the wellbeing of healthcare workers, and the overall strength of
the NHS (Fernandez et. al., 2021).
In a recent study by Gold JA. (2020) indicates that COVID-19
has a considerable impact on the psychological wellbeing of
front-line hospital staff. Results suggest that nurses may be at
higher risk of adverse mental health outcomes during this
pandemic, but no studies compare this group with the primary
care workforce. Furthermore, no studies investigated the
psychological impact of the COVID-19 pandemic on social care
staff. Other risk factors identified were underlying organic
illness, gender (female), concern about family, fear of infection,
lack of personal protective equipment (PPE) and close contact
with COVID-19. Systemic support, adequate knowledge and
resilience were identified as factors protecting against adverse
mental health outcomes. Health and social care workers
(HSCWs) have carried a heavy burden during the COVID-19
crisis and, in the challenge to control the virus, have directly
faced its consequences. Supporting their psychological
wellbeing continues, therefore, to be a priority. This rapid
review was carried out to establish whether there are any
identifiable risk factors for adverse mental health outcomes
amongst HSCWs during the COVID-19 crisis.
Nearly half of the emergency nurses perceived stress above
average during pandemic, and their working conditions affected
this situation. The factors that significantly affect the perceived
stress score of emergency nurses during the COVID-19
pandemic included applying respiratory isolation, changing the
way of life, not being able to access protective equipment,
insufficient nurses in the unit and thinking that COVID-19 will
be transmitted to oneself. Hence, an implication that meeting
physiological needs and applying psychological guidance and
counselling interventions in the stress management of
emergency nurses may contribute to the reduction of their stress
levels. Effective infection control, reducing workload,

increasing the number of nurses and strengthening the coping
mechanisms can minimize the perceived stress level of
emergency nurses. Some studies reported that in previous
epidemics, psychological problems such as stress, anxiety and
depression were observed in emergency nurses (Muktar, 2020).
During the pandemic process, health professionals have been
reported to experience physical and mental fatigue, affective
disorders and sleep problems due to the stress experienced
(Ohayon et. al, 2021). If emergency nurses are not provided
with timely, effective support and training during the COVID-
19 pandemic process, stress-related health problems may
develop (Mukhtar, 2020). WHO had identified these risks for
health care professionals and had reported a greater need to
prevent depression and exhaustion, and manage stress and
anxiety (Bethesda, 2020).
The COVID-19 pandemic has increased stress factors in health
care professionals. Emergency nurses are the first group to
encounter infected patients. For nursing managers to find
solutions to the individual and workplace stressors of
emergency nurses working at the front line of the pandemic
process, it became necessary to determine the stress factors and
basic needs. Our research is the first and original study
conducted with emergency nurses in Turkey at the first stage of
the pandemic process in terms of providing a basis for future
studies (Anglim, J. & Horwood, S. (2021)).
This study aimed to examine the stress levels and factors
affecting the stress level of nurses working in the emergency
department related to the COVID-19 pandemic. The population
of the study was formed by all nurses working in the emergency
services of hospitals during the COVID-19 pandemic process in
Turkey and actively registered with the Emergency Nurses
Association. It had been determined that there were 250 nurses
actively registered with the Emergency Nurses Association in
Turkey.
Emergency Nurses Association data are collected through the
sole association where the emergency nurses are actively

registered in Turkey. In the sample of the study, no sample
selection was made, and an online questionnaire form was sent
to 250 nurses actively registered with the Emergency Nurses
Association between April and August 2020. The sample of the
study consisted of 169 (67.6%) emergency service nurses who
completed the questionnaire completely and returned. The
professional characteristics of emergency nurses are given in
Table 1. According to this, it was determined that of the
emergency nurses, 74.4% were female, 42.9% were between the
ages of 25 and 34, 56.5% were single, 68.5% had no children,
94.6% lived with elementary families, and 10.7% had a chronic
disease. When the professional characteristics of emergency
nurses were evaluated, it was found that 92.9% of them were
clinical nurses, 46.4% of them worked in emergency care and
follow-up, 75.0% of them had vocational training at the
undergraduate level, and 42.5% had 10 years or more
professional experience (Çınar et. al, 2021).
It was determined that the perceived stress score of the
emergency nurses was 29.57 ± 7.65 (13–51) and they
experienced moderate stress. However, it was determined that
44.6% of the emergency nurses experienced stress above
average (30 points and above). It was found that the stress
levels of female emergency nurses were significantly higher
than male nurses (p < .05) and that the stress levels of
emergency nurses under the age of 25 who have just started
their profession were significantly higher than those of other
age group nurses (p < .05) (Table 1). When we look at the
requirements most needed by emergency nurses during the
COVID-19 pandemic, they were observed to be psychological
support (67.9%), quality sleep (67.3%), hygiene (66.7%),
reduced working hours (65.5%) and healthy nutrition (60.1%),
respectively.
The factors that significantly affect the perceived stress score of
emergency nurses during the COVID-19 pandemic with the
regression analysis performed included applying respiratory
isolation, changing the way of life, not being able to access

protective equipment, insufficient nurses in the unit and
thinking that COVID-19 will be transmitted to oneself. These
variables explain 26% of the perceived stress level of
emergency nurses during the COVID-19 pandemic (Çınar et. al,
2021).
Emergency nurse managers’ planning regarding pandemic
management is important in terms of reducing the perceived
stress in employees. Study findings showed that the COVID-19
pandemic affected the stress levels of emergency nurses. In our
study, it was determined that emergency nurses experienced
moderate perceived stress during the pandemic process, and
nearly half (44.6%) of them had a perceived stress level above
the average. There is no study encountered showing the stress
levels of emergency nurses in the literature. However,
according to the United Nations COVID-19 and mental health
action report published by WHO, it has been stated that
approximately half of the health care professionals (47%) in
Canada need psychological support. In a study conducted with
health professionals in Pakistan, it has been reported that
approximately half of the participants (42%) experienced
moderate psychological distress (United Nations, 2020). In
other studies, with health care professionals, it has been stated
that more than half of the participants experienced intense stress
or stress-related symptoms (Shuai et al., 2020; Lai et al., 2020).
Studies conducted during pandemics such as severe acute
respiratory syndrome (SARS) and Middle East respiratory
syndrome (MERS) have shown that emergency room workers
have a higher development of post-pandemic stress disorder
(Min et al., 2018).
In this study, perceived stress levels of female nurses were
found to be higher than male nurses (p < .05). In a study
conducted in Turkey, it has been reported that female health
professionals have higher anxiety and stress levels than males
(Polat, 2020). A study conducted in Wuhan has shown that
females, nurses and front-line health care professionals
experienced more severe psychological symptoms than others

(Lai et al., 2020). Finding was similar to other studies,
suggesting that female nurses' concern for the risk of infecting
their families and staying away from their families to protect
them from infection negatively affect their stress levels. Among
the participants in the study, it was found that the stress levels
of the emergency nurses who were 25 years old and younger
were higher than the nurses of other age groups (p < .05).
According to a review conducted during the pandemic process,
it has been stated that there was a relationship between the age
of health professionals and their stress levels. It has been
reported that health care professionals aged 30 and younger had
higher depression scores (Spoorthy et al., 2020). The fact that
young emergency nurses started their profession recently and
had less professional experience compared with other nurses
was also predicted to have an effect on stress levels. In the light
of these findings, the nursing management should plan the
emergency care services in order to prevent the interruption of
emergency care services, while personnel planning should be
made by considering the socio-demographic characteristics such
as gender and age in the nurses who will work in the
emergency.
According to our research findings, the most needed
requirements of emergency nurses during the COVID-19
pandemic were psychological support (67.9%), quality sleep
(67.3%) and hygiene (66.7%). It was seen that the needs of the
emergency nurses involved in the study during the pandemic
process were mostly psychological and physiological needs.
Various practices have been reported in many countries to meet
the needs of health care professionals during the pandemic
process. In Wuhan, China, in order to relieve the health
professionals working in the front line, the number of personnel
was increased, the shift system was arranged, the information to
reduce the risk of transmission was provided on online
platforms, and psychological counselling and guidance support
services by phone were provided (Zang et al., 2020; Shuai et al.,
2020).

Summary
It is in this light that the researcher sought to understand the
extent of effect of mental well-being of Emergency Room
Nurses in Hail, Kingdom of Saudi Arabia with the intent to
prevent mental health problems and come up with a mental
health program to address the results of this research. There is
no perfect policy response to a pandemic, but acknowledging
tradeoffs, examining consequences over time, and advocating
for a more voluntary, decentralized approach can minimize
human costs and maximize overall health and well-being of
these academic stakeholders. The COVID-19 pandemic has had
an unprecedented impact on health systems in most countries,
and in particular, on the mental health and well-being of health
workers on the frontlines of pandemic response efforts. Hence,
Prioritizing the Mental Health and Well-Being of Frontlines
Healthcare Workers is an urgent global public health priority.
CHAPTER 3
PROJECT METHODOLOGY AND IMPLEMENTATION PLAN
Introduction
This chapter will delineate the research design and
methods to be used to conduct the study. The researcher shall

explain how the necessary data will address the research
objectives. Responses from questionnaires shall be collected,
tabulated, treated, and analyzed. This will also include the
justifications as to how data shall be gathered, the process of
selecting the respondents, and the features of the instruments to
be used.
Research Design
A cross-sectional correlational design was utilized in this study.
Correlational studies do not necessarily imply cause and effect
bonds but could provide a sound basis to incur relationships
while descriptive design provides an overview of collated data
and simple representation of differences among variables or
categories (Polit & Beck, 2017). Having a cross-sectional
design is a representation of the duration of the measurement
phase (Lavrakas, 2008). For this study, the data will be
collected while the COVID-19 pandemic is still ongoing. The
variables that will be correlated are extent of mental well -being
as well as their correlation when grouped according to profile
variables- gender, nationality, and years of experiences.
Target Groups
The study involved Emergency room nurses from the
different government hospitals situated in Hail Region Kingdom
of Saudi Arabia. Based from the statistical profile of the
different hospitals, there are around 120 ER nurses currently
employed in the area working in the government hospitals.
Respondents were recruited through total purposive
sampling. They were selected based on the inclusion and
exclusion criteria set by the researcher. This study involved the
following inclusion criteria – currently working as ER nurse in
a government hospital, with Saudi Council License or registered
nurse, in any position in the emergency department, and
belonging to any nationality. However, this study did not
include the nurse assistants and other paramedical profession
working in the Emergency room. It will be exclusively to

emergency room nurses working in a government hospital in
Hail region, Kingdom of Saudi Arabia.
Instrument
This study adapted the Warwick-Edinburgh Mental Well-
Being Scale which was developed by expert panels which was
led by Professor Sarah Stewart-Brown together with his
colleagues in 2005. This instrument aimed to capture a wide
conception of well-being to general population and it is
intended to come up with mental health promotion activities and
programs. It is consisting of 14 items worded all in positive
statement and it is answered in 5 response categories.
The instrument was previously tested based on the report
of Tennant et al (2007) for its internal consistency yielding a
standard Cronbach’s alpha to 0.91 score for the general
population sample. Furthermore, the confirmatory factor
analysis of the instrument was administered to 17489
respondent population sample which showed good content
validity. And lastly, test-retest was also administered to the said
population and yielded to a high score (0.83).
However, this instrument shall be tested in its reliability to
the population that is intended in this research study. It wil l be
administered to 30 respondents whereas the data that will be
gathered will be computed still with Cronbach’s alpha statistical
formula.
Plan and Implementation Process
The researcher observed the research process in a strict
manner. The initiation of data gathering started after the
pronouncement of the approval of the proposed study
unanimously decided by the designated panel members.
After which, the researcher obtained approval from the
different ethical board/committees involved in the process . An
ethical approval shall be obtained from the Ethical Board of the
University of Hail noted by the Dean of the Graduate Schools.
A letter of request and permission was forwarded to the

different hospital’s ethical board which included King Salman
Specialist Hospital, King Khalid Hospital, Hail General
Hospital, and Erada Complex and Mental Health Hospital. The
researcher will be attending personal meetings to the different
ethical Boards in order to explain the full nature of the research
study and importantly the significance and purpose of the study.
Data were gathered through an electronic questionnaire
which will be designed in Google Form. The respondents’
answers were stored and collectively tallied and analyzed
through SPSS statistical treatment. The respondents’ voluntary
participation is implied once they accomplished the
questionnaire.
Results were inferentially analyzed and processed in order
to formulate significant findings and conclusions. The
researcher carefully examined the findings which is in linked
with the raw results from the statistical treatment. The
recommendations were based on the conclusion exclusively. A
concrete output shall be drafted once the conclusions and
recommendation are finally developed and a checked by the
panel members.
Data Analysis
The obtained data after data gathering was treated by SPSS
version 23 and specifically applied the descriptive and
inferential formula.
For specific problem number 1, it was treated by
frequency, percentage and ranking. Frequency is defined as the
absolute occurrence of all events and or the number of times a
data appeared as it occurred. Percentage is the proportion times
100.
For specific number 2, it was treated with person product
moment correlation formula. Pearson product moment
correlation is a measure of the strength and direction of
association that exists between two variables measure on an
interval scale.

Where
The gender variable and its correlation to the extent of
professional quality life were treated with Chi-square tests-of-
independence. Chi-square used to assess relationships between
two independent nominal variables.
Formula:
χ2 = ∑(Oi – Ei)2/Ei
where
· Oi = observed value (actual value)
· Ei = expected value.
Table 1. Descriptive Equivalence and Statistical Limits
1.00 – 1.80
None of the Time
1.81 – 2.60
Rarely
2.61 – 3.40
Some of the Time
3.41 – 4.20
Often
4.21 – 5.00
All of the Time
Ethical Consideration
For the ethical consideration, this study sought ethical

approval from the Ethical Board of the University of Hail and to
the different hospitals involved in the study. If other
institutional research ethics committee is also present from
other target facilities, approvals were sought. The online
questionnaire will provide the necessary informatio n to inform
the eligible participants particularly with the aim, benefits, and
possible risks associated with the study. To enhance veracity
and focus in answering the questionnaire, the participants were
flagged online through a reminder in the online form to answer
it during their rest period and not during their work.
Furthermore, alphanumeric coding was used to preserve
anonymity among the respondents while serving as a tracker for
the researcher. Participation in this study is voluntary.
Respondents may choose not to participate and may withdraw
their consent to participate at any time. Participation in this
research study is completely voluntary and refusal to participate
will involve no penalty or loss of benefits to which the subject
is otherwise entitled. All responses remain ed anonymous and
confidential.
Limitations
This study is limited in its scope as to the population
characteristics. The population of the study includes emergency
room nurses all with Saudi Council registration, belong to any
position or rank in the emergency department, any nationality,
currently working and employed to any government hospitals in
Hail region, Kingdom of Saudi Arabia.
Moreover, variables of interest which includes gender,
nationality, and years of experience in the emergency were the
focus of the study and its correlation the extent of mental well -
being status of the emergency room nurses. Further and
additional variables and other analysis shall be suggested for
the improvement of the study.
Summary
The research methodology of the study enlightened the analysis

process of the study. It also explains the data gathering process
and the use of the appropriate instrument for the sake of getting
the relevant information which will eventually affect the
conclusions of the study. Ethical approvals are important to
obtain prior to the administration of the data gathering tool.
Statistical formula that is indicative per sub problem will give
better ways of solution that will yield to clearer findings and
better conclusions.
CHAPTER 4
Project Outcomes
Introduction
This chapter exhibits the analyzed results from the data
gathered. Data were computed using both descriptive and
inferential statistical treatment based on the problem presented.
The treatment used in the computation include frequency,
percentage, chi-square, and person-product moment correlation.
The variables that were used to analyzed includes extent of
mental well-being, gender, nationality, and years of experience
in emergency room.
Findings
Data gathered were collated and tallied by the researcher
in order to figure out the results. Data were analyzed using the
SPSS version 27 applying inferential statistics and descriptive

statistics accordingly.
Table 2 shows the distribution of respondents according
age, nationality, and years of experience in the emergency
room. The response rate as of percentage is 95% which
composed of 114 respondents out of 120 nurses. Majority of the
respondents are female, Non-Saudi Employees, and having 3-5
years of experience in the Emergency room. Specifically, as to
gender of the respondents, there are 27% are males and 73% are
females. Moreover, as to the nationality of the respondents,
37% were Saudi nationals and 63% are non-Saudi nurses.
Finally, as to the number of years of experience incurred by the
respondents, 14% belongs to ER nurse with 0-2 years of
experience, 46% have 3-5 years of experience, and 40% have
the longest experience of staying in the Emergency room with 6
years and above.
Table 2. Profile of Respondents
n=114
Hospital Affiliation
No. of Respondents
Gender
Nationality
Years of Experience
King Salman Specialist Hospital
34
(29.82%)
Male= 12
Female= 22
Saudi = 14
Non-Saudi = 20
0-2 = 4
3-5 = 18
6-above = 12
King Khalid Hospital,
32
(28%)
Male = 8

Female =24
Saudi = 10
Non-Saudi = 22
0-2 = 3
3-5 = 15
6-above = 14
Hail General Hospital
26
(23%)
Male = 10
Female = 16
Saudi = 8
Non-Saudi =18
0-2 = 5
3-5 = 11
6-above =10
Erada Complex and Mental Health Hospital
22
(20%)
Male = 9
Female = 13
Saudi = 10
Non-Saudi = 12
0-2 = 3
3-5 = 8
6-above = 11
Table 3 shows the extent of mental well-being of
emergency room nurses in different government hospitals of
Hail Region, Kingdom of Saudi Arabia. It is well gleaned from
the table that generally have “Often” extent of mental well
being of Emergency room nurses working from different
government hospitals in Hail region.
Among all the mental wellness items, item number 13
which states that “I’ve been interested in new things” got the
highest mean of 4.89 interpreted as all the time. On the other

hand, the lowest mean reflected is item number 9 which states
“I’ve been feeling close to everyone” having a weighted mean
of 2.00 interpreted as rarely.
Table 3. Extent of Mental Well-being
n=114
Statements
Mean
Interpretation
1
I’ve been feeling optimistic about the future
4.26
All the Time
2
I’ve been feeling useful
4.82
All the Time
3
I’ve been feeling relaxed
2.73
Some of the time
4
I’ve been feeling interested in other people
2.62
Some of the time
5
I’ve had energy to spare
3.03
Some of the time
6
I’ve been dealing with problems well
2.77
Some of the time
7

I’ve been thinking clearly
3.01
Some of the time
8
I’ve been feeling good about myself
2.03
Rarely
9
I’ve been feeling close to other people
2.00
Rarely
10
I’ve been feeling confident
3.76
Some of the time
11
I’ve been able to make up my own mind about things
3.01
Some of the time
12
I’ve been feeling loved
3.25
Some of the time
13
I’ve been interested in new things
4.89
All the Time
14
I’ve been feeling cheerful
2.33
Rarely
WEIGHTED MEAN
3.18
Some of the Time
Table 3 shows the correlation analysis of the moderating

variables in the study. The extent of mental well-being of
emergency nurses has significant relationship with nationality
(Correlation = 0.808, p-value= 0.000), and, year of ER
experience (Correlation=0.872, p-value=0.087).
However, extent of mental well-being of ER nurses has no
significant relationship to gender (Correlation = 0.151, p =
0.095)
Table 4: Correlation Analysis
Mental Health and
Correlation
p-value
Interpretation
Gender
0.09
0.095
Weak
Nationality
0.808
0.000
High
F-value
p-value
Interpretation
Year of ER experience
0.872
0.087
High

CHAPTER V
DISCUSSION
Introduction
This chapter explores thoroughly the results based on the
analysis of the data gathered. The implications of each result
will bring evidence to the different insights that was driven out
of the data. The corroboration to the implication suggests a
significant proof to the consumers of the study that this study is
supremely needed to be undertaken.
This chapter will present the discussion of each of the results,
conclusions derived from the analysis of the data, its
implications to the nursing profession, and the recommendations
for future researches.
Discussion
The results on the extent of mental well-being of
Emergency Room Nurses appeared to be generally some of the
time. It only means that mental well being of the respondents
are deeply affected during Covid-19 crisis. A some of the time
results would imply that occasionally they are in good condition
of their mind. In the study of Ghaleb et al in 2021, most of the
health care workers experiencing depression, stress, and anxiety
during Covid-19 pandemic. Frontline workers reported having
mild to moderate signs and symptoms of depression, distress,
and burn out (Ali, Sha, and Thalib 2021). Furthermore, in the
study of De Kock et al in 2021, the emergence of Covid-19
produces a substantial impact in the psychological well -being of

many health care workers especially the front-liners. Thus, this
appears to be evident that the result of this study is congruently
the same with other researchers had found out.
Moreover, the extent of mental well-being of Emergency
nurses is significantly related with nationality. This only
implies that respondents’ cultural background affects the way
they exercise their mental capacities during Covid-19 crisis.
The mental health status of every individual is unique. Mental
health or well-being is displayed differently by people around
the world. According to Mental Health Foundation in UK
(2021), there are some nationalities that high level of mental
wellbeing like people of India, Pakistan, and African-Caribbean
compared to other nationalities
(https://www.mentalhealth.org.uk/a-to-z/b/black-asian-and-
minority-ethnic-bame-communities). In addition, according to
the result of the study of Oliveira, Pankalla, and Cabechinas
(2012) found out that there is an association positive attitude
and sense of ethnic belonging which was seen among European
students. Hence, nationality is considered as one predictor of
mental well-being based on studies presented.
Furthermore, relationship also exist between extent of
mental well-being and years of experience of the respondents. A
good mental wellbeing exists when an individual learns to
thrive in his job thus giving the manifestation of job
satisfaction. Job satisfaction is the sense of contentment of
workers or an individual brought by his skills of adapting
properly himself to his job. This is manifested when a certain
worker has a good state of mental wellbeing. Nadinloyi,
Sadeghi, and Hajloo in 2013 found out that the longer the
history of an individual to his job, the higher job satisfaction
rate he got. Hence, applying this finding to the study,
Emergency Room nurses with more years of experiences
precisely displays job satisfaction which is one of the
manifestations of possessing good level of mental wellbeing.
Lastly, gender has no significant relationship as correlated
to the extent of mental wellbeing of emergency room nurses.

This only implies that whatever gender a person has, his state of
mental wellbeing is remained the same.
Conclusion
Therefore, it is concluded based on the findings and results
that Emergency Room nurses are greatly affected with the
occurrence of Covid-19 crisis in fulfilling their duties and
responsibilities. The impact of the health crisis influenced their
mental wellbeing which affects their physical, psychological,
emotional, and social aspects. Mental wellbeing of emergency
room nurses is not related to gender however the nationality and
years of experiences of nurses have an influence.
Implication to Nursing
The findings of the study suggest on the importance of
providing mental wellbeing programs that are timely needed for
our Emergency Room nurses especially during disruptive times.
Emergency room nurses must be given attention in their
physical, psychological, and emotional welfare in order to be
assisted in their mental health needs during health crisis. It is
then time for nurse administrators to start formulating these
programs in order to promote better mental wellbeing of
emergency room nurses thus promoting better and satisfactory
nursing services to patients.
Recommendations for Future Research
The researcher humble recommends researches that will
explore further other related variables that affects the mental
wellbeing of nurses. This could also be done by including other
group of nurses who are greatly affected with the health crisis
that everybody is facing now. Furthermore, a qualitative inquiry
is suggested in order to explore further experiences of
Emergency room nurses in terms of their mental wellbeing
during health crisis.

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Appendix A
Sample Informed Consent
Dear Respondent,

I, Awad Eid Nadaa Alshammari, a graduate student of Master of
Arts in Nursing of the University of Hail is currently
conducting a study on Mental Well-being Status of Emergency
Room Nurses of Hospitals in Hail Region Kingdom of Saudi
Arabia During COVID-19 Pandemic. In cases of ambiguity, you
may address questions or concerns to the principal investigator
through the following contact details: +966561999155
Awad Eid Nadaa Alshammari
Graduate Student – Master of Science in Nursing
University of Hail
INFORMATION SHEET
PURPOSE OF THE RESEARCH: This study aims to understand
the extent of mental well-being of emergency room nurses in the
different government hospitals in Hail region Kingdom of Saudi
Arabia with its primary goal of identifying which aspects and
profile of these nurses are significant factors
PROCEDURES: You will be asked to accomplish an online
form after this information sheet where you will tick the
appropriate answers to the items asked or fill-up short
responses.
DURATION: This online-based questionnaire can only take up
approximately 3-5 minutes to accomplish.
RISKS: This study involves no risks and/or discomfort on the
part of the respondents.
BENEFITS: Potential benefits might recommendations to
improve the mental well-being of emergency room nurses
despite pandemic.
CONFIDENTIALITY: No names will be mentioned during and

after the course of the study including any publication that
might result from this study. Furthermore, alphanumeric coding
will be used to preserve anonymity among the respondents
while serving as a tracker for the researchers.
SHARING THE RESULTS: The general findings of this study
will be communicated to the nursing leaders and professional
organizations. The study may also be presented to local or
international publications, posters, or oral presentations but
there’ll be no way that any personal information of the
participants will be exposed.
RIGHT TO REFUSE OR WITHDRAW: Your participation is
voluntary and includes your right to withdraw. You also have
the opportunity to review your responses and make necessary
corrections as necessary.
Note: Since this is an online form, your completion of this
online survey indicates your affirmation that you have read and
understood the information regarding the study and indicates
your full consent for participation. A copy of your response will
be sent through e-mail.
Appendix B
Sample Questionnaire
PART 1 – Respondent’s Characteristics
RESPONDENT’S BACKGROUND INFORMATION: Put a
checkmarkor fill in the necessary spaces. Please do not leave
any blank entries.
Name (optional): _____________________________ Date:
______________
Gender: ( ) Male ( ) Female
Nationality: ( ) Saudi ( ) Non saudi
Years of Service in ER: ( ) 0-2 years ( ) 3-5 years ( ) 6
years and more

PART 2 – The Extent of Mental Well-being
Below are some statements about feelings and thoughts. Please
tick the box that best describes your experience of each over the
last 2 weeks.
1 – None of the Time 2- Rarely 3- Some of the Time
4- Often 5- All the Time
Statements
1
2
3
4
5
I’ve been feeling optimistic about the future
I’ve been feeling useful
I’ve been feeling relaxed
I’ve been feeling interested in other people

I’ve had energy to spare
I’ve been dealing with problems well
I’ve been thinking clearly
I’ve been feeling good about myself
I’ve been feeling close to other people
I’ve been feeling confident

I’ve been able to make up my own mind about things
I’ve been feeling loved
I’ve been interested in new things
I’ve been feeling cheerful
Adapted from Warwick–Edinburgh Mental Well-being Scale
(WEMWBS) © NHS Health Scotland, University of Warwick
and University of Edinburgh, 2006, all rights reserved.
Accessed @
https://www2.uwe.ac.uk/services/Marketing/students/pdf/Wellb
eing-resources/well-being-scale-wemwbs.pdf
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