RESUMEN
BACKGROUND: The World Health Organization officially declared an end to the COVID-19 Public Health Emergency three years after the initial outbreak of COVID-19. Healthcare providers worldwide were overwhelmed during the pandemic, which greatly affected the mental health and turnover intention of nurses. Conducting a systematic review of psychological distress in first-line nurses during the pandemic may facilitate future research on pandemic-related resilience. PURPOSE: A systematic review of the literature on psychological distress among first-line nurses caring for patients with COVID-19 was conducted. METHODS: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. We searched the CINAHL, PubMed, Embase, and Airiti Library databases using the English and Chinese keywords ("COVID-19 first-line nurse" OR "COVID-19 frontline nurse") AND ("psychological distress" OR "PTSD" OR "depression" OR "anxiety" OR "insomnia" OR "stress" OR "burnout" OR "fear") to identify Chinese and English articles published between December 2019 and March 2023. The quality of the included studies was assessed using tools from the Joanna Briggs Institute. RESULTS: A total of 20 articles covering 16 quantitative studies and 4 qualitative studies were included in the analysis. The quantitative findings revealed that first-line nurses experienced high task load and moderate or above-average burnout. Between 19.1% and 72.3% of the first-line nurses reported stress, and more than 30% experienced insomnia. At the peak of the pandemic, anxiety and distress levels were high. At 8-week follow-ups, while anxiety had decreased, distress levels had not. Qualitative findings included the identification of fear as a common symptom of psychological distress in first-line nurses. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Further research is needed to better support frontline caregivers and facilitate their recovery from the moderate to severe psychological distress associated with pandemics.