Document Type



Doctor of Philosophy



Date of Defense


Graduate Advisor

Anne F. Fish, College of Nursing


Umit Tokac, PhD

Alicia Hutchings, PhD

Nancy Magnuson, DSN



The purpose is to examine health care providers’ psychosocial responses to COVID-19 in China and the US via exploring relationships among psychological responses and describing experiences of working at the epicenter during the pandemic.


In manuscript one, a cross-sectional study was conducted in nurse and physician volunteers who provided direct care to COVID-19 patients in Wuhan (volunteers) and those with no COVID-19 contact outside of Wuhan (non-volunteers). A path analysis theoretical model was developed to illustrate the relationships among psychosocial variables and was separately applied to volunteer and non-volunteer groups.

In manuscript two, a cross-sectional study was conducted to examine the psychological wellbeing of nurses in the US. Network analysis was used to model the data and analyze the centrality indices.

In manuscript three, a qualitative descriptive study using content analysis was completed to explore experiences of Chinese nurse and physician volunteers at the epicenter.


In manuscript one, no significant difference was found in the structure of the models between volunteers and non-volunteers. In volunteers, potential key early indicators to prevent PTSD were compassion satisfaction, general health, attitude toward life, and perceived stress. In non-volunteers, indicators were general health and attitude toward life.

In manuscript two, one out of five US nurses had probable PTSD. Life satisfaction was a potential inflection point for intervention to reduce perceived stress and mitigate PTSD symptomatology. Perceived stress was a potential inflection point for intervention to mitigate PTSD symptomatology. Attitude toward life was a potential inflection point for intervention to improve compassion satisfaction.

In manuscript three, emerging themes were: (a) the manifestation of a strong sense of national need and a call to serve, (b) family support in a national crisis, (c) an understanding that collaboration was needed, (d) a commitment to protect oneself properly to avoid infection, (e) a necessary and varying degree of self-dependency, (f) the importance of coping strategies amidst the tension of the pandemic, and (g) a recognition that challenges and opportunities were present side-by-side.


Findings point to the need for implementing scalable, system-level interventions to reduce the psychological burden during the pandemic.

Available for download on Tuesday, July 25, 2023

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