Factors Associated with Anxiety Towards Omicron (Corona Virus

Variant) Among Nurses in Bangli Regency of Bali

I Made Agus Budi Wijaya

, I Gusti Ayu Rai Rahayuni

and I Nyoman Arya Mahaputra

Master of Nursing Program, Faculty of Health, Institute of Technology and Health Bali, Indonesia

Bachelor of Nursing Program, Faculty of Health, Institute of Technology and Health Bali, Indonesia

Keywords: COVID-19, Anxiety, Nurses, Indonesia.

Abstract: The COVID-19 pandemic gives massive negative impacts on human life, especially on the economic and

health aspects. One COVID-19 variant, Omicron, makes the health situation more severe. Nurses who work

at the forefront are prone to experiencing anxiety because of dealing patients with Omicron infections. This

study aimed to identify factors associated with nurses' anxiety about the Omicron cases. This study was

conducted in the Bangli Regency of Bali, Indonesia. Using a snowball sampling technique, the respondents

were selected to participate in this study. Data were collected using a Google Form questionnaire. Univariate,

bivariate (Chi-square test), and multivariate anayses (multiple logistic regression) were performed to study

the data. This study found that 25.7% of the respondents experienced anxiety about how to handle Omicron

cases. Perception and completeness of Personal Protective Equipment (PPE) were significantly associated

with nurse anxiety. Nurses need to pay attention to their health safety in serving patients with COVID-19

infections.

1 INTRODUCTION

The outbreak of Coronavirus Disease 2019 (COVID-

19) has become a threat all over the world. COVID-

19 is an infectious disease caused by Severe Acute

Respiratory Syndrome Coronavirus 2 (SARS-CoV-

2). SARS-CoV-2 is a new type of coronavirus which

has never been previously identified in humans

(WHO, 2022b), (Swarjana, Suyasa, & Nuryanto,

2022).

Since the SARS-CoV-2 virus variant was

identified in many countries around the world, the

World Health Organization (WHO) named the virus

as Omicron using the Greek alphabet in May 2021.

The virus’ name makes it easier for people to track

corona virus variants. Omicron or variant B.1.1.529

was first reported to the WHO on November 24,

2021. It was classified as an outbreak on November

26, 2021 under the Technical Advisory Group on

Virus Evolution, primarily based on information from

South Africa. Omicron has a large number of

mutations, causing detrimental changes in the

epidemiology of COVID-19 infection and acting

https://orcid.org/0000-0002-8463-8911

https://orcid.org/0000-0001-7135-4859

differently from other circulating variants (WHO,

2022a).

Anxiety about COVID-19 has been widely

studied in various journals. However, research is

limited to study anxiety about variants in general.

Very few studies specifically point to specific anxiety

about Omicron although a previous study has

addressed anxiety about Delta variant (Swarjana,

Suyasa, et al., 2022).

Health workers are responsible for handling

COVID-19 patients either through preventive or

curative measures. With a high demanding situation,

they might develop negative psychological response,

namely anxiety. Several factors affecting anxiety are

gender, work unit, risk perception, age, marital status,

years of service, workload, information and training,

availability of PPE, and level of education (Uktutias

& Drastyanaa, 2022), (Swarjana, Suarmayasa, et al.,

2022). Previous studies have also found that age,

family status, patient honesty, availability of personal

protective equipment, and knowledge of staff anxiety

are related to anxiety (Ifdil, Fadli, Suranata, Zola, &

Ardi, 2020).

Wijaya, I., Rahayuni, I. and Mahaputra, I.

Factors Associated with Anxiety Towards Omicron (Corona Virus Variant) Among Nurses in Bangli Regency of Bali.

DOI: 10.5220/0011939100003576

In Proceedings of the 2nd Bali Biennial International Conference on Health Sciences (Bali BICHS 2022), pages 59-63

ISBN: 978-989-758-625-5

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

Health service facilities such as hospitals, health

centers, clinics, and others provide health services to

people who are at risk of contracting with COVID-

19. Being in contact with infected patients, health

workers might develop anxiety. With that said, this

study aimed to research factors that affect nurse

anxiety in the Bangli district of Bali province.

2 METHODS

This study used a quantitative cross-sectional design,

and it was conducted among nurses in Bangli district

of Bali province, Indonesia. The research population

involved all nurses working in Bangli Regency or 998

nurses in total. This study gathered 311 nurses as

research samples. The sample size was calculated

using the Daniel formula (Swarjana, 2022). After

that, a snowball sampling technique was performed to

select the samples. The inclusion criteria of the

respondents were 1) nurses who worked in Bangli

district; 2) had a smartphone; and 3) were willing to

be a respondent. Meanwhile, nurses who were sick,

on leave, or in quarantine at the time of data collection

were excluded from the sample.

Data were collected through a questionnaire

consisting of 1) demographic data of respondents

(age, gender, education, marital status, and place of

work; 2) anxiety using The Hamilton Anxiety Rating

Scale (HARS) that consists of 14 components with

five options (No symptoms, Mild, Moderate and

Severe, and Very Severe). 3) Questionnaire on

perception consists of 16 items with four options

(Strongly Agree, Agree, Disagree, and Strongly

Disagree); 4) Questionaire related to work

environment consists of four questions with four

options (Strongly Supporting, Supporting, Not

Supporting, and Strongly Not Supporting); 5)

Questionnaire on completeness of standard PPE

consists of “Yes” and “No” options; 6) questionnaire

on PPE levels consists of one question with three

options: “Level 1”, “Level 2”, “Level 3”; 7) last

questionnaire on co-morbidities history consists of

one question with "Yes" and "No" options.

Data were analyzed using univariate, bivariate,

and multivariate analyses. Univariate analysis was

used to find the frequency, mean, and proportion of

each research variable. Bivariate analysis (Chi-square

test) was performed to idenitfy the association

between dependent and independent variables.

Furthermore, multivariate analysis (multiple logistic

regression) was used to determine factors associated

with anxiety. This study was granted an ethical

approval from the Research Ethics Commission of the

Institute of Technology and Health Bali (No:

04.0560/KEPITEKES-BALI/III/2022).

3 RESULTS

Data were gathered from 311 nurses in Bangli district.

This study presents five tables related to respodnents’

characteristics, anxiety, perceptions, work

environment, completeness of PPE, comorbid

history, as well as bivariate and multivariate

analyeses.

Table 1: Characteristics of respondents (n = 311).

Characteristics f (%)

Sex

Male

Female

102

209

(32,8)

(67.2)

Age (years old)

24- 30

31-40

41-50

51-60

135

(28.6)

(43.4)

(22.5)

(5.5)

Education

Diploma 3 of Nursing

Bachelor of Nursing

Master of Nursing

223

(27.7)

(71.7)

(0.6)

Marital status

Married

Unmarried

285

(91.6)

(8.4)

Wark place

Hospital

Health center

Clinic

241

(77.5)

(20.9)

(1.6)

Table 1 shows that the majority of respondents are

women (67.2%) and are aged 31-40 years (43.4%).

Respondents mostly have a Bachelor of Nursing

degree (71.7%). Most of the respondents were

married (91.6%), and they mostly worked at hospitals

(77.5%).

Table 2: Categories of Anxiety (n = 311).

Categories f (%)

Normal 231 (74.3)

Mild anxiety 78 (25.1)

Moderate anxiety 2 (0.6)

Table 2 describes that the majority of respondents

did not experience anxiety (74.3%) about Omicron

variant cases, and neither did others (25.7%). In

addition, some respondents experienced mild anxiety

(25.1%).

Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences

Table 3: Perception, work environment, completeness and

levels of PPE, and co-morbidities factors (n = 311).

Variable f (%)

Perception

Fair

Goo

271

(87.1)

(

12.9

Work environment

Poor

Fai

255

(82.0)

(

18.0

)

Completeness of PPE

Complete

Incomplete

Levels of PPE

Level 1

Level 2

Level 3

307

157

53.5

(98.7)

(1.3)

(81.7)

(93.5)

(22.2)

Co-morbidities

Yes

306

(98.4)

(1.6)

Table 3 explains that out of 311 respondents,

respondents mostly have fair perceptions (87.1%).

From the aspect of the work environment, most of the

respondents had fair work environment (82.0%).

Respondents mostly use complete PPE (93.5%) and

mostly had no comorbid history (98.4%).

Table 4: Bivariate analysis results between sex, education,

marital status, place of work, age, perception, work

environment, completeness of PPE, comorbid history, and

nurse anxiety towards Omicron variant (n = 311).

Variables Anxiety Status

p-values

Not

Anxious

Anxio

Total

(

)

(

)

Sex

Male

77 (75.5)

(24.5)

102

0.732

Female 154

(73.7)

(26.3)

209

Age (years old)

24- 30

65 (73.0)

(27)

0.003

31-40

97 (71.9)

(

28.1

)

135

41-50

55 (78.6)

(

21.4

)

51-60

14 (82.4)

(17.6)

Education

Diploma 3

of Nursin

68 (79.1)

(

20.9

)

0.002

Bachelor of

Nursing

161

(72.2)

(27.8)

233

Master of

Nursin

2 (100) 0 2

Marital status

Married

215

(75.4)

(24.6)

285

0.121

Unmarried

16 (61.5)

(

38.5

)

Workplace

Hospital

177

(73.4)

(26.6)

241

0.002

Health

cente

49 (75.4)

(

24.6

)

Clinic 5 (100) 0 5

Perception

Fair 208

(76.8)

(23.2)

271

0.009

Good

23 (57.5)

(

42.5

)

Work environment

Poor

191(74.9)

(25.1)

255

0.590

Fair

40 (71.4)

(28.6)

Completeness of PPE

Complete 230

(

74.9

)

(

25.1

)

307

0.023

Incomplete

1 (25) 3 (75) 4

Levels of PPE

Level 1

58 (81.7)

(

18.3

)

0.001

Level 2 157

(93.5)

(6.5)

168

Level 3

16 (22.2)

(

77.8

)

Co-morbidities

No 299

(

74.8

)

(

25.2

)

306

0.077

Yes 2 (40) 3 (60) 5

In Table 4, this study shows that both male and

female respondents mostly did not feel anxious about

Omicron. No significant association was found

between sex and anxiety about Omicron variant (p =

0.732). The proportion of anxiety and education

levels varied between age groups. Age and education

were significantly related to anxiety about Omicron

variant (p = 0.003; p = 0.002, respectively). However,

marital status had no significant relationship with

anxiety about Omicron variant (p = 0.121).

Respondents who experienced anxiety mostly

worked at hospitals. A significant association was

found between the workplace and anxiety (p = 0.002).

Furthermore, anxiety levels varied according to

perceptions. A significant association was discovered

between perception and anxiety about Omicron (p =

0.009). Although workspace was related to anxiety,

Factors Associated with Anxiety Towards Omicron (Corona Virus Variant) Among Nurses in Bangli Regency of Bali

work environment was not (p = 0.590). A different

number of patients feeling anxious were found in

relation to incomplete and complete PPE. A

significant association was found between the

completeness of PPE and anxiety about Omicron

variant (p = 0.023). Anxiety issues were different

between the respondents based on the level of PPE;

anxiety and the level of PPE were related to each

other (p < 0.001). Furthermore, from the co-

morbidities aspect, the proportion of anxiety was

higher in co-morbid respondents, but statistically,

there was no association between co-morbid history

and respondents' anxiety towards the Omicron

Variant of COVID-19 (p 0.077).

Table: 5 Multivariate analysis of factors associated with

anxiety about Omicron variant in Bangli (n = 311).

Variables B S. E OR 95% CI p-

values

Perception 0.892 0.351 2.440 1.227-

4.852

0.011

Completeness

of PPE

0.936 0.352 2.550 1.280-

5.082

0.008

Constanta 5.448 1.444 14.223 0.001

Table 5 presents that a significant assiociation

between two variables and anxiety about Omicron

variant. The related variables were perception (OR:

2.440; 95% CI: 1.227-4.852; p = 0.011), and

completeness of PPE (OR: 2.55; 95% CI 1.280-5.082;

p = 0.008).

4 DISCUSSION

Every human being tends to experience anxiety when

faced with situations in the form of threats, problems,

and others (Swarjana, 2021), including the COVID-

19 pandemic (Temsah et al., 2022), (Shan, Liu, Li, &

Zheng, 2022). The anxiety levels of nurses in Bangli

district of Bali province were not frequent.

Respondents mostly did not feel anxious (74.3%)

about Omicron variant, and 25.7% of them did. Most

respondents experienced mild anxiety (25.1%).

The results of previous studies state that Omicron

variant cause fear in the community because it has an

extraordinary ability to mutate, causing a high

transmission rate (Ren, Wang, Gao, & Zhou, 2022).

Anxiety levels in this study involve (1) normal, (2)

mild, (3) moderate, (4) severe, and (5) panic levels.

(Louise, 2012). However, previous research divides

anxiety levels into four: (1) mild, (2) moderate, (3)

severe, and (4) paniclevels (Videbeck, 2019).

The results of previous research show 22% of

health worker respondents who experienced anxiety

about Delta variant had various anxiety levels: 52%

of mild anxiety, 34% of moderate anxiety, and only

14% of severe anxiety (Swarjana, Suyasa, et al.,

2022). Meanwhile, research at the Mangusada

Hospital, Badung Regency found different

proportions of health workers (nurses and midwives)

with anxiety: 14.7% mild anxiety, 4.2% moderate

anxiety, and only 3.2% severe anxiety (Swarjana,

Suarmayasa, et al., 2022). Another study found that

only 8.6% of respondents experienced anxiety (Hou

et al., 2022). The other found that 14% of respondents

from East Java, Indonesia experienced anxiety

(Lusida et al., 2022).

The current results show that perception and

completeness of PPE were related to anxiety toward

the Omicron variant. Meanwhile, previous study

reports that age and health workers are related to

anxiety during the COVID-19 pandemic (Lusida et

al., 2022). Other studies have also found slightly

different findings in which age and gender are related

to anxiety (Turna et al., 2021). Other than those

variables, marital status, social isolation, employment

status, education, income, lifestyle, clinical risk, and

personality are likely associated with anxiety

(Santabárbara et al., 2021), (Ferré et al., 2022).

4.1 Limitations of Study

This study was conducted at one point in time in one

district of Bali. Such small scope of research may not

be able to explain the causes and effects in the general

population of nurses.

5 CONCLUSION

This current study found that 25.7% of respondents

experienced anxiety toward Omicron variant. Of this

percentage, respondents generally experienced mild

anxiety. The bivariate analysis found no relationship

between sex and marital status with anxiety about

Omicron variant experienced by the nurses.

Meanwhile, age, education, workplace, perception,

completeness of PPE, and levels of PPE were

associated with nurse anxiety. The last idea to point

is that the multivariate analysis shows that perception

and completeness of PPE were significantly

associated with nurse anxiety toward Omicron

variant.

Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences

RECOMMENDATION

Nurses are expected to pay close attention to two

main aspects: perception of Omicron variant and

completeness of PPE. To prevent excessive anxiety,

nurses need comfortable and safe workplace. Nurses'

perceptions of Omicron variant can be improved

through socialization and training on the standard

operating procedures of PPE by levels and work unit.

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Factors Associated with Anxiety Towards Omicron (Corona Virus Variant) Among Nurses in Bangli Regency of Bali