The coronavirus disease 2019 (COVID-19) is a global public health emergency that started in 2020 [1]. It has affected the global population, especially the mental health, risk perception, and coping strategies of multidisciplinary treatment teams [2, 3]. Furthermore, in 2020, it was the sixth leading cause of public health emergencies worldwide [4, 5]. Stressful life events among nurses are of prime importance, as they affect their performance and the quality of nursing care.
However, COVID-19 has not been the only problem associated with the world recently; in fact, illegal gun ownership and violence [6] are another of many global public health concerns and multifaceted ones. In Thailand, the Mental Health Crisis Assessment and Treatment Team provides care for “proximity” to three groups: Group A, comprising relatives of the deceased, the injured, relatives of the injured, and hostages; Group B, comprising those involved in the incident, including eyewitnesses such as traders/entrepreneurs who were present at the incident, those stranded at the scene, and officers who work on the job site; and Group C, involving general people who receive information on violence through various channels, such as people who may have been psychologically impacted from receiving information on social media. Public mass shootings, albeit unusual and uncommon in the country, caused 57 injuries and 29 deaths in Thailand in 2021 and have had a severe physical, mental, and economic impact on individuals and communities [7]. Moreover, in northeast Thailand, the ex-policeman killed at least 37 people, most children, in a gun and knife attack at a childcare center [8]. In recent events, a 14-year-old boy went on a shooting rampage inside the Siam Paragon shopping mall, killing two people and injuring five others — two of them critically [9].
Public mass shootings are a specific kind of gun violence, defined by the Federal Bureau of Investigation (FBI) as three or more people being killed in a single incident [10, 11] that impacts the daily lives and mental health of people in the community. Another study defined an unpredictable shooting situation as a life-threatening, stressful event that affects lives in multiple ways [12].
During any epidemic, professional nurses act as critical frontline healthcare workers in hospitals and communities, often the most vulnerable to stress-related mental illnesses. Furthermore, researchers show that they play an essential role in minimizing the public’s fear during critical events and in psychological rehabilitation after the events [13–16]. Within the context of the COVID-19 pandemic, nurses are the healthcare workers responsible for providing direct and indirect nursing care to people with COVID-19 24 hours a day in hospitals and community settings. Moreover, in Thailand, nurses in the locales where public mass shootings occur become responsible for simultaneously assisting people with worries about or being infected with COVID-19 and shooting victims.
For this study, stress generation theory [17, 18] and the Neuman systems model [19] were employed to explain the key factors affecting people’s perceptions of stressful life events and how such events affect people differently despite experiencing the same or similar events. We explored how nurses perceived care delivery for public mass shootings during the COVID-19 pandemic.
Along with the exposure to stressors that nurses are subjected to in their course of duty, research shows that these healthcare professionals are at risk of infections and psychological effects such as stress, anxiety, sleep disturbances, maladjustments, relationship issues, and uncertainty [20, 21]. Furthermore, some empirical studies have shown that the mental health effects of mass shootings at the individual level include psychological distress and clinically significant elevations in posttraumatic stress, depression, and anxiety symptoms with an increase in the degree of physical exposure and social proximity to the incident [22–24]. Accordingly, some researchers have praised how professional nurses make society proud as they put their lives at risk every day when going to work to ensure the safety and well-being of others [25]. Therefore, it is necessary to explore nurses’ perceptions in the era of mass shootings during the COVID-19 pandemic to enhance their well-being and work engagement during crises.
Aim of the study
This study explores nurses’ perceptions of nursing careers regarding mass shooting events during the COVID-19 pandemic.
Theoretical perspective
The theories used in this study were chosen to deepen our understanding of nurses’ perceptions in the era of mass shootings and the COVID-19 pandemic. The Neuman Systems Model [26] states that the views of the person, family, and community change constantly in response to the environment and stressors. Additionally, Hammen’s stress generation theory [17, 18] proposes that people perceive stressful life events differently despite facing the same event and that these differences in perception are related to three factors: 1) personality traits—resilience, thought patterns, self-esteem, emotional stability, and perception of social support; 2) personal behaviors—avoiding coping behaviors; and 3) interpersonal relationships—emotional attachment, confidence, conflict, and so on. When a person has poor coping skills and faces severe life events, the person may experience mental health problems and psychiatric disorders. Nevertheless, these stressors can be relieved through support, and professionals may be needed to improve one’s mental health.