The relationship between work-family conflict and occupational stress in emergency department nurses: a cross-sectional correlational study.

PPE is a critical barrier for frontline healthcare workers against highly contagious respiratory pathogens like SARS-CoV-2, MERS-CoV, and avian influenza (, ). Level 2 PPE—including N95 respirators, gowns, face shields, gloves, and shoe covers—is the standard base configuration in isolation wards (). While effective at reducing exposure risk through physical isolation, a core infection control principle, the impermeable nature of PPE can cause heat stress, increased breathing resistance, fluid loss, and restricted mobility (, ). Although studies have focused on common PPE-related issues like headaches, dyspnea, and skin injuries (–), digestive symptoms such as nausea, reflux, and vomiting remain a largely overlooked yet critical concern. These symptoms pose significant and multifaceted risks. First, they directly impair physical and mental health, potentially exacerbating anxiety and leading to nutritional deficits and compromised immunity due to reduced food intake (, ). Second, vomiting can cause mask displacement, internal contamination, or even involuntary removal of PPE, substantially increasing exposure risk. The accumulation of vomit within a sealed mask may also lead to hypoxia or aspiration. Furthermore, managing a vomiting incident requires work interruption, ward exit, and PPE re-donning, which disrupts clinical continuity and jeopardizes patient safety. Beyond these immediate dangers, such events can instill psychological fear, undermining long-term morale and staff retention. Notably, the clinical evidence base for PPE is generally weak. A COVID-19 era review highlighted a near-total lack of clinical studies on its effectiveness, fit, and tolerability (). Furthermore, a Cochrane systematic review has graded the evidence in this field as generally low quality (). Current literature lacks data on the specific physiological toll of PPE on the gastrointestinal system, particularly under the extreme conditions characteristic of the initial outbreak phase. This study provides a retrospective analysis of the “shock phase” of the pandemic (March 2020), capturing a unique window of high-intensity stress and prolonged PPE usage. This cross-sectional study was conducted to determine the prevalence of reflux, nausea, and vomiting among nurses in COVID-19 wards during this critical period. Although clinical protocols have since evolved, understanding the physiological limits of healthcare workers during such early-stage crises is essential for future pandemic preparedness. This investigation employed a cross-sectional survey design. The study was conducted in March 2020 at a designated COVID-19 hospital. A total census sampling method was employed, targeting the entire population of 368 nurses working in the isolation wards. The hospital administered a schedule of two consecutive weeks of clinical duty followed by a two-week centralized recovery period. To ensure accurate recall, the survey was distributed during the 1st week of this recovery phase, immediately after the nurses completed their 2-week clinical assignment. Ultimately, 354 nurses completed the survey, yielding a response rate of 96.2%.