Nurses’ Psychospiritual Coping Strategy Instruments (STDPs) in Handling Psychological Impact during Treatment for COVID-19 Patients

Instruments related to the nurses’ psychospiritual coping strategy evaluation in handling their psychological impact during the treatment of COVID 19 patients are still deficient. Bearing this in mind, this current study aims to develop the psychospiritual coping strategy instrument (STDPs) of nurses in dealing with the psychological impacts when treating COVID 19 patients. Thus, the focus of this article rests on the evaluation of the constructs and items of both the validity and reliability tests developed in this instrument. The questionnaire instrument developed comprises of three main sections, which is the factors that induce stress among nurses, the psychological impact and the psychospiritual coping strategy. 59 nurses in four (4) departments in Tuanku Mukhriz Chancelor Hospital, Universiti Kebangsaan Malaysia (HCTM UKM), Cheras were involved as respondents in this study. In the construction of items, several previous instruments were chosen as guidance namely the Nursing Stress Scale (1981), Depression, Anxiety, Stress Scales-21 (DASS-21


Introduction
The chronology of the COVID-19 pandemic began when it was first detected in Huanan Coban et al. (2015) adapted from Tiew & Creedy (2012); (8) The Spirituality Index Of Well Being oleh Daaleman & Frey (2004); (9) The Daily Spiritual Experience by Underwood & Teresi (2002) (Underwood & Teresi, 2002); (10) Islamic Psychospiritual Scale (ZATIP) by Sa'ari et al., (2020); (11) Nursing student's spirituality and spiritual care-giving by Pesut (2002); and the study Spiritual Approach To Address The Stress Among Nurses in Tuanku Muhriz Chancelor Hospital, University Kebangsaan Malaysia Medical Center by Mohd Abdul (2016).The construction of the instrument is also based on the literature review from the latest articles for the purpose of adaptation to the needs of the study, which is surrounding nurses and the time of the COVID-19 pandemic.

Literature Studies
The Concept of Stress Linguistically, stress is pressure.The word originates from Greek "stringere" which means tight, restless, anxious, and so on (Adam et al., 2021;Aisha & Ruslan, 2020).The study by Mat Lazin et al. (2021) portrays stress as a form of hardship and suffering.This is due to the fact that stress is seen as a tension emerging from a response change towards human body and mental reaction caused by the demand or request that exceeds self-capability (Mohd Zawawi et al., 2019).This view is consistent with that of Sidi & Shaharom (2020) that stress gives a different perspective to every individual and situation.Physically, stress means tension or pressure.Meanwhile, in the context of body cell, it is the process of pressure change that happens externally causing a chemical reaction to take place in the human body.In terms of mental health, it refers to the system manifestation (mind and body), which impact from both external and internal pressures can be predicted.Next, as the pressure continues, this can lead to self-destruction and diseases.

Nurses' stress motivating factor
The issue of stress among nurses is important to be emphasized to warrant the stability of health, security and success of a healthcare organization.Several studies have been conducted within and outside the country proving that the COVID-19 pandemic has escalated the stress among nurses, so every indicator developed has its basis and significance in forming the construct of nurses' stress motivating factor.The indicators used are as follows a) Self The concept of self is a level of evaluation of one's health, appearance, and thought process in unraveling himself or herself, and the people's perceptions of himself or herself (Sidi & Shaharom, 2020;Syahraeni, 2019;Tus, 2020); Self-concept is a continuous experience to the point that it invites the perceptions about self-existence and social interactions suitable with the surroundings that can leave an impact on the physical, psychology and experience of one's social life (Hashim, 2020;Syahraeni, 2019;Xu et al., 2023) states that the pandemic can make an individual feel negatively about themselves until emotional effects like sadness, anger, fear, disappointment, demotivation, anxiety, neglect, tension, worry and confusion might surface.b) Job scope Kamus Dewan Bahasa -the Fourth Edition (2005) explains that job scope is a field or a job coverage that needs to be implemented by the student, employee and so on.The job scope for nurses is the responsibility that needs to be borne by nurses in assisting individuals who are incapable of taking care of themselves and facilitating the doctors' job in treating patients (KKM, 2011;Nik Mansor, 2020); Job scope encompasses the workload, also the need to have a close contact with the patients infected to the point that the nurses would feel uncomfortable when using the Personal Protective Equipment (PPE) (Salcha & Arni, 2021) and that they also have to work over-time (Fariza Md Sham, 2021).c) Work Ecosystem An ecosystem is an entity that is naturally complex and has a lot of inter-related components (Mustaffa & Ku Saud, Ku Azhar Hashim, 2015).Ecosystem also refers to a human interaction system with the environment or organization that has become part of the populace.Work ecosystem covers the supervision support, good relationships with employees, the environment and the equipment.Furthermore, work ecosystem is also depicted as a process, system, structure or situation at work that gives an impact on the labour productivity (Ismail & Ahmad, 2020).Therefore, the work ecosystem is very influential towards the psychology and achievement of individuals at the workplace.

d) Family Factor
The factor of family and stress based on Rani et al. (2018) has a specific relationship between an individual and their surroundings, and this is thought of as exceeding the capability and giving a bad implication in the whole aspect of life of an individual especially his or her emotions, and which further spreads to his or her family institution.Referring to Zur Raffar et al. ( 2023) parents are not exempted from experiencing stress during the pandemic, as they are pressured in managing their children, dealing with their affected family economy, tending to the need to monitor their children's learning and having to balance work, family and parents-caretaking.Also, stress happens due to the self-isolation from family members when they are at work, as to avoid the contagion of the COVID-19 pandemic (Ayad et al., 2021;Di Tella et al., 2020) Coping Strategy Lazarus & Folkman (1984) state that the coping strategy is a combination of one's cognitive and behavior when facing external and internal pressures.Next, it is defined as the efforts to resolve an issue using appropriate thinking and behavior (Abd. Razak & Mydin Kutty, 2021;Abdullah et al., 2011).Based on the literature studies, two (2) coping strategy approaches of nurses during stress are given below: a) Psychology Psychology is a scientific study that focuses on humans' mental process and behavior.
Behavior is regarded as an individual attitude that can be monitored and observed.Meanwhile, the mental process is an individual's internal component that cannot be observed and studied, such as the thought patterns, beliefs and feelings (Utz, 2011).Wilhem Wundt is a member of Structuralism (1879) stating that psychology is a field of knowledge that is characteristically empirist-realistic as it has to undergo process that are systematic, academic and scientific.Thus, empowering the psychology is one of the coping strategies in addressing the stress experienced.

b) Spiritual
Spiritual is associated with the heart and the mind that can make one closer to God (Mohamad Jodi et al., 2014).Spiritual is the basis within oneself that can connect himself or herself with God, oneself, other humans and the environment.Meanwhile, according to Yakub (1998) spiritual has four important elements in oneself namely: (i) qalb or heart, (2) alruh or spirit, (3) nafs or soul and (iv) 'aql or the mind (Hamjah, 2016;Fariza Md Sham et al., 2013;Sudi et al., 2017).Thus, it is concluded that spirituality is an entity that is complex, an ever-changing entity that also touches on the life of an individual.An individual is spiritual through his or her quest for the meaning of life by integrating the element of purity and the holiness of the heart by way of observation.Thus, a strong spiritual construction can be achieved by getting closer to God through acts of worship, religious beliefs, thinking positively about life and believing that there are blessings and meaning to everything that happens.

Respondents
This study is conducted on 59 study participants from the Tuanku Muhriz Chancelor Hospital (HCTM UKM) through the distribution of questionnaires (pilot study) for 13 days from 11 August 2022 to 23 August 2022.Respondents are nurses, who have been selected for giving treatment to COVID-19 patients for at least one (1) month, and the samples are segregated from those who have taken sick leave, study leave and not in charge of COVID-19 patients.

Validity of Instruments
The instrument's validity test uses the exploratory factor analysis (EFA) through the SPSS software version 26.0.According to Awang (2010Awang ( , 2012)), EFA aims to evaluate the division of the item dimension to measure every construct that has been determined.He also stresses that every researcher needs to conduct the EFA procedure for every construct to identify if there exists the difference in the item dimension with that in the previous studies.
According to Chua (2009) if the KMO value is greater than 0.50 this shows that the data does not have any serious multicollinearity, thus the items are thought to be appropriate to be the factor analysis.Meanwhile, in the study done by Tan et al. (2020) the minimum KMO value is 0.60, whereas Chua (2009) state that the KMO value of 0.80 and above is a great value.Other than that, the significant correlation value for the items in the factor analysis for Bartlett's Test of Sphericity is (p<.05) (Chua, 2009).Additionally, if the communality value is (0.0) it will offer no contribution in a factor, and if the value is (1.0) it shows that there is a contribution in a factor (Chua, 2009).Finally, during the process of elaborating the factor through the SPSS software version 26.0, the size for an item accommodated in one (1) factor must fulfill a general requirement where the items must have a round value ±0.33 to be included in the factor (component) respectively (Chua, 2009).

Reliability Test
The reliability test adopts the Cronbach's Alpha analysis method to measure if the reliability of the instrument used in this study fits every construct (Ramli, 2020).Table 1.1 is the Cronbach's Alpha index classification according to (Brymen & Cramer, 1999).

Finding And Discussion
Table 1.2 shows the outcome obtained based on the EFA procedure where the Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) value is 0.818 and it is a great value as the number is greater than 0.80.Other than that, the outcome of the Bartlett's Test of Sphericity is significant with (approx.chi-square= 20282.756,df= 5050, p= .000)as the value is smaller than (p<0.05).This shows that the correlation of items is sufficient to conduct the factor analysis.Then, the value of communalities is between 0.103 and 0.812, and the value is within the number proposed by Chua (2009).Next, the Exploratory Factor Analysis (EFA) acquisition finds three (3) factors included in the stress motivating factor, psychological impacts and the psychospiritual coping strategy are not overlapped in the same factor (Table 1.3).The first factor has combined seven (7) factors for the variables of the items under stress motivating factor which is (3,4,8,17,18,5,15).Next, the second factor is the variable for the items under psychological impacts that combines three (3) factors, (2,13,14).Meanwhile, the third factor for the psychospiritual coping strategy items combines ten (10) factors which is (1,6,7,9,10,11,12,16,19,20).Finally, with reference to Table 1.3 it is found that the questionnaire items have fulfilled the general requirements with the round value of ±0.33 (Chua, 2009).

BIII(4)
The labour shortage in dealing with patients in the unit or ward.1.4 shows that the coefficient value of the Cronbach's Alpha for every construct is "High" and "Very High" and the overall reliability value for the items in the Motivating Factor instrument, psychological impacts and the psychospiritual coping strategy is "Very High" which is 0.957.

Conclusion
This study is conducted to test the validity and reliability of the items in the instrument for the Motivating Factor construct to nurses' stress, their psychological impacts and their psychospiritual coping strategy (STDPs).The finding for the validity test is proven from the Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) which is 0.818 and this is a great value as it is more than 0.80, making the value accepted.Next, the overall Cronbach's Alpha for the reliability test also obtains the best value which is 0.957.From the analysis, one (1) item was removed from the construct of Stress Impact.

Table 1
Based on the reliability test, one (1) item in the construct of Psychological Impacts is removed as it has low reliability value which is 0.293* and if the item is removed the Cronbach's Alpha will increase to 0.954 (Table1.5).