The Invisible Face of ECMO: Anxiety Levels and Challenges Among Intensive Care Nurses

The Invisible Face of ECMO: Anxiety Levels and Challenges Among Intensive Care Nurses | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Invisible Face of ECMO: Anxiety Levels and Challenges Among Intensive Care Nurses Ercan ÖZPOLAT, Hülya BULUT, Ayda KEBAPÇI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7068232/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Apr, 2026 Read the published version in BMC Psychology → Version 1 posted 18 You are reading this latest preprint version Abstract Background Extracorporeal membrane oxygenation (ECMO) is a technology that provides temporary life support to critically ill patients with heart and/or lung failure. However, the complexity of the care involved presents significant challenges for nurses. This study was conducted to determine the difficulties and anxiety levels experienced by nurses caring for patients undergoing ECMO support. Methods This study is a descriptive and cross-sectional research. It was conducted in Turkey. In this study included 137 nurses working in third level intensive care units and caring for patients with ECMO support. Anxiety levels of nurses caring for ECMO patients were examined with the ‘State and Trait Anxiety Inventory (STAI)’. Results The mean state anxiety score of nurses was found to be 44.82 ± 10.89, while the mean trait anxiety score was 43.66 ± 8.58. A statistically significant negative correlation was found between the duration of ECMO patient care and both state and trait anxiety scores (p < 0.05). Nurses perceived ECMO patients as complex, experienced a high rate of complications, and consequently reported anxiety in patient care. Additionally, they faced various challenges in the care of ECMO patients, including the risk of COVID-19 transmission, increased workload, organizational issues among team members, and the risk of bleeding at the cannulation site. Conclusions The development of standardized protocols for the treatment and care of patients receiving ECMO plays a role in improving care quality. In addition, implementing regular training programs for nurses may help reduce the challenges and anxiety they experience. Involving experienced nurses in ECMO care may further help alleviate these difficulties. Anxiety Difficulties ECMO Nursing Intensive Care Background Extracorporeal membrane oxygenation (ECMO) is a temporary life support method applied for patients with the potential to survive in treatable cardiopulmonary disorders such as severe life-threatening advanced cardiac and/or pulmonary failure [ 1 ]. ECMO circuit is applied in two ways: veno-venous (VV) and veno-arterial (VA). VV-ECMO is preferred in isolated respiratory failure cases that do not respond to mechanical ventilation, while VA-ECMO is used in cases where cardiac dysfunction is accompanied or dominant [ 2 ]. The treatment and care of patients receiving ECMO support —a complex and high-risk intervention—are managed by a multidisciplinary team consisting of a nurse, cardiac surgeon, perfusionist, respiratory therapist, and auxiliary personnel. Delivering safe and high-quality care to these patients requires healthcare professionals who are specifically trained and experienced in ECMO management [ 3 ]. Within this team, nurses play a vital role and assume significant responsibilities. In the ECMO care setting, nurses are responsible for monitoring hemodynamic parameters, circuit rotation speed (RPM), pump flow rate (LPM), and the oxygenator, as well as observing circuit color changes, clot formation, and air emboli. In addition, they evaluate the distal perfusion catheter, monitor for bleeding or signs of infection at cannula insertion sites, evaluate limb circulation, and provide both routine nursing care and overall patient management [ 4 , 5 ]. Nurses face several challenges during the treatment and care of patients with ECMO due to the risk of developing many complications, the high mortality rate, and the need for effective teamwork and co-operation. Therefore, nurses experience anxiety [ 3 , 6 – 9 ]. Nurses involved in the care of patients receiving ECMO have been reported in the literature to experience high levels of anxiety and workload. Especially inexperienced nurses have been reported to experience anxiety due to the complex structure of patients and the dynamics of the intensive care environment (Alshammari et al., 2022a; Wellman et al., 2017). Since ECMO applications require additional responsibilities such as prone positioning, mobilization, oxygenator and circuit monitoring in addition to standard intensive care, a nurse-patient ratio of 1:1 is recommended (Lucchini et al., 2019; 2020). Complications, organizational deficiencies and staff shortages increase the emotional burden of nurses, which may lead to burnout and tendency to quit the profession (Knistey et al., 2019; Salloum et al., 2023; Asgari et al., 2022). During the pandemic period, the risk of infection, isolation practices and prolonged patient hospitalisation periods have further increased the difficulties experienced by nurses (Honey & Wang, 2012; Umeda & Sugiki, 2020). Furthermore, psychological and physiological feelings of exhaustion, role confusion due to lack of standardization, emotional difficulties, and anxieties caused by facing patients in critical condition are stated among the difficulties experienced by Intensive Care Unit (ICU) nurses [ 7 , 11 , 12 ]. Therefore, this study aimed to determine the difficulties and anxiety levels experienced by nurses who care for patients with ECMO support. In the literature, there is limited study on the difficulties experienced by nurses who care for patients receiving ECMO treatment in Turkey. This study provided important aspects in determining the difficulties experienced by nurses caring for patients with ECMO to resolve these difficulties and take the necessary precautions. Materials and Methods Research Design This descriptive and cross-sectional study was conducted to determine the difficulties and anxiety levels experienced by nurses caring for patients receiving ECMO support. It was conducted between June 1, 2021, and February 1, 2022, among nurses working in the ICU and caring for patients with ECMO support at private, state, and foundation hospitals in Turkey. Study Population The study population consists of intensive care nurses caring for patients with ECMO. There is no current data on the total number of nurses caring for patients with ECMO in Turkey. Therefore, snowball sampling method, which is a non-random sampling method, was used as a sampling method. In snowball sampling method, reference persons related to the study subject are selected and other persons are reached through these persons [ 16 ]. Sample In the calculation of the sample size, it was calculated that at least 125 participants should be included in the study with an effect size of 0.31 obtained from the pilot study, 95% confidence interval and 0.05 Type I margin of error. The study included 137 participants with the idea that there might be 10% data loss in the study. The inclusion criteria were nurses who have been working in the ICU for at least six months and have experience in caring for patients receiving ECMO support. Nurses with less than six months of experience working in the intensive care unit and those with no experience in caring for patients on ECMO support were excluded from the study. Measurement This descriptive and cross-sectional study was conducted to determine the difficulties and anxiety levels of nurses caring for patients receiving ECMO support. In this descriptive and cross-sectional study, the "Descriptive Information Form" prepared by the researchers and the "State and Trait Anxiety Inventory (STAI)" were used to determine the anxiety levels experienced by the nurses. Descriptive Information Form The descriptive information form was developed by the researchers by making use of the studies in the literature and consisted of a total of 25 questions including the age, gender, education level, duration of professional experience, duration of intensive care unit experience, the number of patients with ECMO cared by a nurse in a shift, previous training on ECMO, frequency of training, the presence of a protocol for the care of patients receiving ECMO in the ICU where the nurse works, and the difficulties experienced by nurses while caring for patients with ECMO. In the questions asked to determine the difficulties experienced by nurses providing ECMO care, nurses were asked to give a score from 0 to 10. The State and Trait Anxiety Inventory (STAI) This scale, developed by Spielberger et al. (1985) and adapted into Turkish by Öner and Le Compte (1985), describes how the individual feels in general. The scale consists of two separate scales with a total of 40 items and 4-point Likert-type statements. The total score obtained from the scale can vary between 20 and 80. Cronbach's alpha values of the scale are 0.942 and 0.890 for state and trait anxiety scores, respectively [ 16 ]. In this study, Cronbach's alpha values for state and trait anxiety sub-dimensions were 0,942 and 0,890, respectively. Data Collection Data were collected between June 1, 2021, and February 1, 2022, with the online data collection link created via Google form. Reference persons were created from the nurses reached via the WhatsApp application, and the survey link was delivered to other nurses through them and social media (Facebook, Twitter, etc.). All nurses who met the research criteria and agreed to participate in the study participated in the survey. Firstly, a pilot study was conducted on 20 nurses who agreed to participate before the study was implemented. As a result of the pilot study, no changes were required in the data collection tools, and all participants were included in the sample. Data Analysis The data were analyzed using the IBM SPSS (Statistical Package for Social Sciences) for Windows 23.0 program. Frequency distribution (number, percentage) was used for categorical variables; descriptive statistics (mean, standard deviation, minimum, maximum) were used for numerical variables. Data normality was assessed using the Kolmogorow-Smirnow, histograms, and Levene test. Independent sample t-test was used for two groups, and one-way analysis of variance (One-way ANOVA) was used for more than two groups. As a result of the one-way analysis of variance (ANOVA), the Bonferroni test was used to examine the difference between the groups in variables that provided variance homogeneity, and Tamhane's T2 test was used to examine the difference between the groups in variables that did not provide variance homogeneity. Pearson Correlation analysis examined the relationship between the State anxiety inventory and STAI scale sub-scales. Cronbach's alpha value was used for scale reliability. The findings were evaluated at a 95% confidence interval and a significance level of 5% p < 0.05 was considered as significant. Results The mean age of the participants was 28.96±5.34 years. Of the participants, 75.9% were female and 75.9% were undergraduate graduates. The total working time of the nurses in the intensive care unit was 5.08±4.79 years and the duration of caring for the patient with ECMO was 2.64±2.73 years. Table 1. Nurses sociodemographic characteristics (n=137) n % Gender Male 33 24.1 Female 104 75.9 Education level High school 5 3.6 Associate degree 6 4.4 Bachelor degree 104 75.9 Postgraduate 22 16.1 Types of intensive care unit (ICU) Cardiovascular surgery ICU 71 51.8 Adult ICU 37 27 COVID ICU 10 7.3 Pediatrics KVC ICU 12 8.8 Cardiology ICU 5 3.6 Neonatal ICU 2 1.5 Number of patients with ECMO that a nurse care for in a shift ≥ 2 patients 128 93.5 < 2 patients 9 6.5 X̄ SD Age 28.96 5.34 Length of experience in ICU (year) 5.08 4.79 Length of experience in caring for patients with ECMO (year) 2.64 2.73 X̄: Mean, n: Number, %: Percentage,SD: Standard deviation, Min.: Minimum, Max : Maximum, ECMO: Extracorporeal membrane oxygenation It was found that the average level of difficulties that nurses experienced was between 4.12±2.56 at the lowest and 6.31±3.23 at the highest (Table 2). Table 2. The difficulties that Nurses experience while caring for patients with (n=137) Difficulties n (%)* X̄ SD Min - Max D1. Experiencing anxiety in caring for patients with ECMO 137 (100) 5.51 2.85 0-10 D2. Being experienced and uneducated in caring for patients with ECMO 133 (97.09) 5.29 2.88 0-10 D3. Having increased workload due to sending nurses to other units for support 120 (87.6) 5.55 3.23 0-10 D4. Difficulty in caring of cannula areas due to bleeding risk 136 (99.28) 6.42 2.86 0-10 D5. Increased workload and anxiety due to psychosocial factors related to family members and caregivers. 135 (98.55) 5.56 2.65 0-10 D6. Monitorization of the ECMO cycle and complications addition to intensive care procedures 136 (99.28) 5.63 2.63 0-10 D7. Decreased the quality of patient care due to caring more than two patients with ECMO 135 (98.55) 6.23 2.91 0-10 D8. Experiencing transmission anxiety due to caring for patients with ECMO and contagious infections such as COVID-19 and H1N1 134 (97.82) 5.89 2.95 0-10 D9. Increased working hours and workload due to caring for patients with ECMO and contagious infections such as COVID-19 and H1N1 133 (97.09) 6.11 2.93 0-10 D10. Working with protective equipment at all times due to caring for patients with ECMO and contagious infections such as COVID-19 and H1N1 133(97.09) 6.09 3.02 0-10 D11. Experiencing organizational problems in providing supplies used for the care and safety of patients with ECMO 131 (97.82) 5.14 2.87 0-10 D12. having organizational problems within the team members who care for patients with ECMO 134 (97.82) 4.95 2.56 0-10 D13. Patients with ECMO isolated and in separate rooms 115 (83.95) 4.12 2.76 0-10 D14. Patients with ECMO have a higher complication rate 135 (98.55) 6.31 2.93 0-10 SD: Standard deviation, *Nurses responded more then one item, X̄: mean, Min.: Minimum, Max : Maximum, %: Percentage, n: Number It was found that the average state anxiety score of all participants was 44.82±10.89, and the average trait anxiety score was 43.66±8.58. There was no significant relationship between age and total intensive care working time and state and trait anxiety scores (p>0.05). A negative statistically significant relationship was found between the time spent caring for a patient with ECMO and the state and trait anxiety scale scores (p<0.05) (Table 3). Accordingly, as the time spent caring for a patient with ECMO increased, a decrease in state and trait anxiety scores was observed. Table 3. The relationship between descriptive variables and State and Trait Anxiety Inventory (STAI) scores State and Trait Anxiety Inventory X̄ ± SD Min.- Max. Age Length of experience in ICU Length of experience in caring for patients with ECMO State anxiety score 44.82 ± 10.89 20-74 r - 0.090 - 0.112 - 0.272 p 0.296 0.192 0.001* Trait anxiety score 43.66 ± 8.58 20-70 r - 0.112 -0.147 -0.216 p 0.193 0.086 0.011* X̄: Mean, SD: Standard deviation, Min.: Minimum, Max : Maximum, r: Pearson correlation coefficient, *p<0.05, ICU: Intensive Care Unit, ECMO: Extracorporeal membrane oxygenation A positive statistically significant relationship was found between nurses' state anxiety score and difficulties (D) such as D1, D8, D9, G12 and trait anxiety score and D1, D4, D8, D12, D13, D14 difficulty participation levels (p<0.05) (Table 4). Table 4. The relationship between difficulties and State and Trait Anxiety Inventory (STAI) scores Difficulties State anxiety score Trait anxiety score State anxiety score r 1 0.640 p 0,000* Trait anxiety score r 0.640 1 p 0,000* D1 r 0.216 0.219 p 0.011* 0.010* D2 r 0.070 0.090 p 0.418 0.296 D3 r 0.120 0.071 p 0.161 0.408 D4 r 0.131 0.169 p 0.128 0.048* D5 r 0.074 0.140 p 0.389 0.104 D6 r 0.109 0.160 p 0.204 0.062 D7 r 0.157 0.131 p 0.067 0.128 D8 r 0.226 0.222 p 0.008* 0.009* D9 r 0.169 0.167 p 0.049* 0.051 D10 r 0.129 0.129 p 0.132 0.134 D11 r 0.090 0.045 p 0.294 0.601 D12 r 0.211 0.190 p 0.013* 0.026* D13 r 0.166 0.238 p 0.052 0.005 D14 r 0.115 0.200 p 0.183 0.019* r:Pearson correlation coefficient, *:p<0.05, D:Difficulty Discussion In this study, the mean state anxiety score of nurses was found to be 44.8 ± 10.89, and the mean trait anxiety score was found to be 43.6 ± 8.58 (Table 3 ). In addition, the study found that the shortness of experience, the complexity of caring for patients with ECMO, the possible risk of infection due to infected patients, the high risk of bleeding, the high workload, working in isolation rooms, and the problems experienced in supplying materials affected the mean state and trait anxiety scores (Table 4 ). It was also estimated that the increase in ECMO use and the risk of infection during the COVID-19 period also affected the anxiety experienced by nurses (Table 4 ). Similar results were found in studies conducted in the literature. Asgari et al. (2022) reported that nurses experienced role confusion and fatigue while caring for complex and risky ECMO patients. In addition, it was emphasized that nurses caring for these patients with high mortality rates tend to experience psychological and physiological burnout [ 12 ]. In a qualitative study conducted by Salloum et al. (2023), it was reported that nurses caring for patients with ECMO experienced difficulties such as emotional difficulties and role confusion in addition to the standard workload of intensive care [ 11 ]. In the study, Knistey et al. (2019) found that complications developing in patients with ECMO increased the anxiety level of nurses [ 7 ]. Alshammari et al. (2022) reported that less experienced nurses caring for patients with ECMO experienced anxiety due to the patients being very complex [ 3 ]. In this study, the average length of experience of nurses in providing care to patients on ECMO was found to be 2.64 ± 2.73 (Table 1 ), and there was a significant relationship between the length of time nurses provided care to patients on ECMO and state and trait anxiety levels (p < 0.05; Table 2 ). As the length of time nurses provided care to patients on ECMO increased, a decrease in state and trait anxiety scores was observed. Honey et al. (2012) reported that having nurses experienced in ECMO increased job satisfaction in the management of ECMO support used during the H1N1 pandemic and increased the quality of care of patients in ECMO [ 13 ]. Similarly, it was reported that inexperienced nurses experienced anxiety and stress in the face of the heavy workload and the responsibility of caring for patients on ECMO during the H1N1 pandemic [ 17 ]. It is thought that the increased length of experience nurses in ICU in providing care to patients on ECMO provided them with skills and, therefore, reduced their anxiety. The study found that almost all nurses experienced difficulties (Table 2 ). Many studies indicated that nurses who care for patients with ECMO experience several difficulties [ 3 , 6 , 7 , 9 ]. Alshammari et al. (2022) found that nurses experienced difficulties such as workload, high ECMO patient: nurse ratio, problems in supplying materials, transferring nurses skilled in caring for patients with ECMO to other units, not having several healthcare professionals who could affect patient care, insufficient appreciation and lack of knowledge regarding the ECMO [ 3 ]. Honey and Wang (2012) determined that nurses who provide care to patients with ECMO experienced difficulties such as long working hours, heavy workload, and concern about infection due to some non-compliance with infection rules during the H1N1 period [ 13 ]. In the study by Peig et al. (2021), it was stated that nurses had difficulties in informing the family members of the patients and managing the patients and their relatives to see each other due to the hospital's limited visitation policy during the COVID-19 pandemic [ 18 ]. In this study, similar to the previous studies, showed that the difficulties experienced by ICU nurses caring for patients with ECMO are universal and become even more difficult, especially during epidemic periods such as COVID-19. In addition, it was thought that the lack of a protocol in hospitals regarding the care of patients with ECMO and the lack of training of nurses on ECMO brought difficulties (Appendix-1). In this study, a significant relationship was found between nurses’ state anxiety levels and their exposure to certain clinical challenges. Specifically, contamination concerns while caring for patients with infectious diseases such as H1N1 and COVID-19, increased workload, and organizational issues within the healthcare team were associated with higher state anxiety levels (p < 0.05, Table 4 ). Furthermore, trait anxiety levels were found to be elevated in response to more persistent and structural challenges. These included the complex clinical condition of ECMO patients, the risk of bleeding at cannulation sites, ongoing concerns about contamination, the need for patient isolation, high complication rates, and organizational difficulties within the team (p < 0.05, Table 4 ). Although the number of studies in the literature examining the problems and anxiety levels encountered by ICU nurses in the care of patients with ECMO is very limited, there are some studies investigating the anxiety and difficulties experienced by nurses [ 3 , 6 , 8 , 9 , 13 ]. Alshammari et al. (2022) stated that the 1:1 patient-nurse ratio was not adhered to when caring for patients with ECMO. Furthermore, since patients require a workforce and their care requires a lot of attention, communication problems occur within the team, and nurses experience anxiety [ 3 ]. Wrigley et al. (2018) emphasized that nurses are challenged because patients are complex, which causes them to experience professional burnout and tension [ 19 ]. Wellman et al. (2018) found that nurses experience fear and fatigue due to heavy workloads due to the complexity of ECMO patients, and it was stated that this situation can negatively affect clinical results. In the study conducted by Besey and Dağcı (2020), the first five problems experienced by nurses in the ICU were determined as insufficient staff, workload, job description problems, hazardous situations, and stress caused by critical patient care [ 20 ]. Braus et al. (2018) stated that nurses feel tired due to providing continuous care support to ECMO patients and suffering from heavy workloads. This situation causes low motivation, hopelessness, and anxiety [ 21 ]. Due to the stress experienced by nurses, the care they provide to patients can be negatively affected [ 22 , 23 ]. Atashzadeh et al. (2011) emphasize that nurses' roles as team members during the care of patients with ECMO require them to have high mental and emotional endurance and to be prepared to work with sufficient knowledge about possible complications [ 24 ]. In this study, nurses stated that difficulties such as experiencing anxiety, excessive workload, teamwork problems, and high risk of complications and bleeding in patients during the care of patients with ECMO increased their anxiety. Especially during the COVID-19 pandemic, ECMO devices were frequently used to support heart and lung functions [ 25 – 27 ]. In this study examining the effects of ECMO interventions on burnout levels in physicians and nurses during the COVID-19 pandemic, it was found that having COVID-19 infection, knowing other healthcare professionals infected with COVID-19, salary dissatisfaction, and excessive workload were among the important determinants of burnout [ 28 ]. Fregene et al. (2020) determined that the use of personal protective equipment required for COVID-19 patients in the ICU caused additional anxiety and discomfort in healthcare workers due to the risk of infection [ 29 ]. In this study, it was thought that the increase in the number of patients requiring ECMO during the COVID-19 pandemic, the fear of infection among nurses, as well as the increase in workload and working hours, and the additional difficulty in nursing care and communication between team members due to the frequent use of personal protective equipment caused nurses to experience more anxiety. Limitations This study has some limitations. The research was conducted while the COVID-19 pandemic was ongoing. Since anxiety is a dynamic emotional state that can be easily affected by environmental factors, the pandemic process can directly affect the mental state of nurses. Therefore, the anxiety levels of nurses involved in the care of ECMO patients during the COVID-19 pandemic may have been affected by unusual conditions. However, pandemic-specific anxiety levels were not evaluated separately in this study. Since the anxiety level is a dynamic parameter that can be affected by the COVID-19 pandemic process and fluctuate as the pandemic continues, different results may be obtained in similar studies in the future. The increased workload and psychological states of nurses working in the ICU during the pandemic may have reduced the participation rate in the study. Conclusion The results of this study showed that nurses caring for patients with ECMO experienced difficulties and that state and trait anxiety scores were associated with various difficulties encountered by nurses. Since this study was conducted during the COVID-19 period, which may affect the results, it is recommended that further studies be conducted on the difficulties experienced by nurses caring for patients with ECMO. Abbreviations ECMO: Extracorporeal membrane oxygenation STAI: State and Trait Anxiety Inventory VV: Veno-venous VA: Veno-arterial RPM: Revolutions per minute LPM: Pump blood flow rate IBM SPSS: Statistical Package for Social Sciences ICU: Intensive Care Unit H1N1: Hemagglutinin 1 – Neuraminidase 1 ICU: Intensive Care Unit Declarations Ethics approval and consent to participate Ethical approval was obtained from Gazi University Ethics Committee (Number: E-77082166-302.08.01-142880, date: 10.08.2021). In the implementation phase of the study, the purpose and details of the study were explained to the participants on the first page opened through the link sent to them. After the participants read this information text, they were asked whether they wanted to participate in the study and were asked to answer ‘Yes/No’. Informed consent for participation was obtained from the participants. After the consent of those who agreed to participate was obtained, it was allowed to proceed to the questionnaire part of the study. All stages of this study were conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials Data and materials are available. Competing interests None. Funding None. Authors' contributions E.O: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. H.B: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. A.K: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. Acknowledgments We sincerely thank all the nurses who participated in this study for their valuable time, effort, and contributions. Their dedication and insights have been instrumental in the completion of this research. Clinical trial number: Not applicable. Note: This study was presented as an oral presentation at the 17th Turkish Society of Cardiovascular Surgery Congress in Antalya, Turkey. References Özsoy SD, Ak HY. Extracorporeal membrane oxygenation. 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Anxiety and related factors in frontline clinical nurses fighting COVID-19 in Wuhan. Medicine (Baltimore). 2020;99(30):e21262. https://doi.org/10.1097/MD.0000000000021413 Extracorporeal Life Support Organization (ELSO). Risks and complications [Internet]. 2022 [cited 2022 Feb 2]. Available from: https://www.elso.org/Resources/RisksandComplications.aspx Omar AS, Labib A, Hanoura SE, et al. Impact of extracorporeal membrane oxygenation service on burnout development in eight intensive care units: A national cross-sectional study. J Cardiothorac Vasc Anesth. 2022;36(8):2891–2899. https://doi.org/10.1053/j.jvca.2022.02.018 Fregene TE, Nadarajah P, Buckley JF, Bigham S, Nangalia V. Use of in situ simulation to evaluate the operational readiness of a high-consequence infectious disease intensive care unit. Anaesthesia. 2020;75:733–738. https://doi.org/10.1111/anae.15048 Additional Declarations No competing interests reported. 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ECMO circuit is applied in two ways: veno-venous (VV) and veno-arterial (VA). VV-ECMO is preferred in isolated respiratory failure cases that do not respond to mechanical ventilation, while VA-ECMO is used in cases where cardiac dysfunction is accompanied or dominant [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The treatment and care of patients receiving ECMO support \u0026mdash;a complex and high-risk intervention\u0026mdash;are managed by a multidisciplinary team consisting of a nurse, cardiac surgeon, perfusionist, respiratory therapist, and auxiliary personnel. Delivering safe and high-quality care to these patients requires healthcare professionals who are specifically trained and experienced in ECMO management [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Within this team, nurses play a vital role and assume significant responsibilities.\u003c/p\u003e\u003cp\u003eIn the ECMO care setting, nurses are responsible for monitoring hemodynamic parameters, circuit rotation speed (RPM), pump flow rate (LPM), and the oxygenator, as well as observing circuit color changes, clot formation, and air emboli. In addition, they evaluate the distal perfusion catheter, monitor for bleeding or signs of infection at cannula insertion sites, evaluate limb circulation, and provide both routine nursing care and overall patient management [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Nurses face several challenges during the treatment and care of patients with ECMO due to the risk of developing many complications, the high mortality rate, and the need for effective teamwork and co-operation. Therefore, nurses experience anxiety [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNurses involved in the care of patients receiving ECMO have been reported in the literature to experience high levels of anxiety and workload. Especially inexperienced nurses have been reported to experience anxiety due to the complex structure of patients and the dynamics of the intensive care environment (Alshammari et al., 2022a; Wellman et al., 2017). Since ECMO applications require additional responsibilities such as prone positioning, mobilization, oxygenator and circuit monitoring in addition to standard intensive care, a nurse-patient ratio of 1:1 is recommended (Lucchini et al., 2019; 2020). Complications, organizational deficiencies and staff shortages increase the emotional burden of nurses, which may lead to burnout and tendency to quit the profession (Knistey et al., 2019; Salloum et al., 2023; Asgari et al., 2022). During the pandemic period, the risk of infection, isolation practices and prolonged patient hospitalisation periods have further increased the difficulties experienced by nurses (Honey \u0026amp; Wang, 2012; Umeda \u0026amp; Sugiki, 2020).\u003c/p\u003e\u003cp\u003eFurthermore, psychological and physiological feelings of exhaustion, role confusion due to lack of standardization, emotional difficulties, and anxieties caused by facing patients in critical condition are stated among the difficulties experienced by Intensive Care Unit (ICU) nurses [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, this study aimed to determine the difficulties and anxiety levels experienced by nurses who care for patients with ECMO support. In the literature, there is limited study on the difficulties experienced by nurses who care for patients receiving ECMO treatment in Turkey. This study provided important aspects in determining the difficulties experienced by nurses caring for patients with ECMO to resolve these difficulties and take the necessary precautions.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003eResearch Design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis descriptive and cross-sectional study was conducted to determine the difficulties and anxiety levels experienced by nurses caring for patients receiving ECMO support. It was conducted between June 1, 2021, and February 1, 2022, among nurses working in the ICU and caring for patients with ECMO support at private, state, and foundation hospitals in Turkey.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Population\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study population consists of intensive care nurses caring for patients with ECMO. There is no current data on the total number of nurses caring for patients with ECMO in Turkey. Therefore, snowball sampling method, which is a non-random sampling method, was used as a sampling method. In snowball sampling method, reference persons related to the study subject are selected and other persons are reached through these persons [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn the calculation of the sample size, it was calculated that at least 125 participants should be included in the study with an effect size of 0.31 obtained from the pilot study, 95% confidence interval and 0.05 Type I margin of error. The study included 137 participants with the idea that there might be 10% data loss in the study. The inclusion criteria were nurses who have been working in the ICU for at least six months and have experience in caring for patients receiving ECMO support. Nurses with less than six months of experience working in the intensive care unit and those with no experience in caring for patients on ECMO support were excluded from the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasurement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis descriptive and cross-sectional study was conducted to determine the difficulties and anxiety levels of nurses caring for patients receiving ECMO support. In this descriptive and cross-sectional study, the \"Descriptive Information Form\" prepared by the researchers and the \"State and Trait Anxiety Inventory (STAI)\" were used to determine the anxiety levels experienced by the nurses.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDescriptive Information Form\u003c/strong\u003e\u003cp\u003eThe descriptive information form was developed by the researchers by making use of the studies in the literature and consisted of a total of 25 questions including the age, gender, education level, duration of professional experience, duration of intensive care unit experience, the number of patients with ECMO cared by a nurse in a shift, previous training on ECMO, frequency of training, the presence of a protocol for the care of patients receiving ECMO in the ICU where the nurse works, and the difficulties experienced by nurses while caring for patients with ECMO. In the questions asked to determine the difficulties experienced by nurses providing ECMO care, nurses were asked to give a score from 0 to 10.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eThe State and Trait Anxiety Inventory (STAI)\u003c/strong\u003e\u003cp\u003eThis scale, developed by Spielberger et al. (1985) and adapted into Turkish by \u0026Ouml;ner and Le Compte (1985), describes how the individual feels in general. The scale consists of two separate scales with a total of 40 items and 4-point Likert-type statements. The total score obtained from the scale can vary between 20 and 80. Cronbach's alpha values of the scale are 0.942 and 0.890 for state and trait anxiety scores, respectively [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In this study, Cronbach's alpha values for state and trait anxiety sub-dimensions were 0,942 and 0,890, respectively.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData were collected between June 1, 2021, and February 1, 2022, with the online data collection link created via Google form. Reference persons were created from the nurses reached via the WhatsApp application, and the survey link was delivered to other nurses through them and social media (Facebook, Twitter, etc.). All nurses who met the research criteria and agreed to participate in the study participated in the survey. Firstly, a pilot study was conducted on 20 nurses who agreed to participate before the study was implemented. As a result of the pilot study, no changes were required in the data collection tools, and all participants were included in the sample.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe data were analyzed using the IBM SPSS (Statistical Package for Social Sciences) for Windows 23.0 program. Frequency distribution (number, percentage) was used for categorical variables; descriptive statistics (mean, standard deviation, minimum, maximum) were used for numerical variables. Data normality was assessed using the Kolmogorow-Smirnow, histograms, and Levene test. Independent sample t-test was used for two groups, and one-way analysis of variance (One-way ANOVA) was used for more than two groups. As a result of the one-way analysis of variance (ANOVA), the Bonferroni test was used to examine the difference between the groups in variables that provided variance homogeneity, and Tamhane's T2 test was used to examine the difference between the groups in variables that did not provide variance homogeneity. Pearson Correlation analysis examined the relationship between the State anxiety inventory and STAI scale sub-scales. Cronbach's alpha value was used for scale reliability. The findings were evaluated at a 95% confidence interval and a significance level of 5% p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered as significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the participants was 28.96\u0026plusmn;5.34 years. Of the participants, 75.9% were female and 75.9% were undergraduate graduates. The total working time of the nurses in the intensive care unit was 5.08\u0026plusmn;4.79 years and the duration of caring for the patient with ECMO was 2.64\u0026plusmn;2.73 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Nurses sociodemographic characteristics (n=137)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e75.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eAssociate degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eBachelor degree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e75.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTypes of intensive care\u0026nbsp;unit (ICU)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eCardiovascular\u0026nbsp;surgery ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e51.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eAdult ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eCOVID ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003ePediatrics\u0026nbsp;KVC ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eCardiology ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eNeonatal ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eNumber of patients with ECMO that a nurse care for in a shift\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026ge;\u0026nbsp;2 patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e93.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026lt; 2\u0026nbsp;patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eX̄\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e28.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e5.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 453px;\"\u003e\n \u003cp\u003eLength of experience in ICU (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e5.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e4.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 453px;\"\u003e\n \u003cp\u003eLength of experience in caring for patients with ECMO\u0026nbsp;(year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e2.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eX̄: Mean, n: Number, %: Percentage,SD: Standard deviation, Min.: Minimum, Max : Maximum, ECMO: Extracorporeal membrane oxygenation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt was found that the average level of difficulties that nurses experienced was between 4.12\u0026plusmn;2.56 at the lowest and 6.31\u0026plusmn;3.23 at the highest (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e The difficulties that Nurses experience while caring for patients with (n=137)\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDifficulties\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eX̄\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin\u003c/strong\u003e\u003cstrong\u003e- Max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD1. Experiencing anxiety in caring for patients\u0026nbsp;with ECMO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 137 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD2. Being experienced and uneducated in caring for patients\u0026nbsp;with ECMO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e133\u0026nbsp;(97.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD3. Having increased workload due to sending nurses to other units for support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e120 (87.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD4. Difficulty in caring of cannula areas due to bleeding risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e136\u0026nbsp;(99.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e6.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD5. Increased workload and anxiety due to psychosocial factors related to family members and caregivers.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e135\u0026nbsp;(98.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD6. Monitorization of the ECMO cycle and complications addition to intensive care procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e136\u0026nbsp;(99.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD7. Decreased the quality of patient care due to caring more than two patients with ECMO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e135\u0026nbsp;(98.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e6.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD8. Experiencing transmission anxiety due to caring for patients with ECMO and contagious infections such as COVID-19 and H1N1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e134\u0026nbsp;(97.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD9.\u0026nbsp;Increased working hours and workload\u0026nbsp;due to caring for patients with ECMO and contagious infections such as COVID-19 and H1N1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e133\u0026nbsp;(97.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e6.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD10. Working with protective equipment at all times due to caring for patients with ECMO and contagious infections such as COVID-19 and H1N1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e133(97.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e6.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD11. Experiencing organizational problems in providing supplies used for the care and safety of patients with ECMO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e131\u0026nbsp;(97.82)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD12. having organizational problems within the team members who care for patients with ECMO\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e134\u0026nbsp;(97.82)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD13. Patients with ECMO isolated and in separate rooms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e115\u0026nbsp;(83.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e4.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eD14.\u0026nbsp;Patients with ECMO have a higher complication rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e135\u0026nbsp;(98.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e6.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSD: Standard deviation, *Nurses responded more then one item, X̄: mean, Min.: Minimum, Max : Maximum, %: Percentage, n: Number\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt was found that the average state anxiety score of all participants was 44.82\u0026plusmn;10.89, and the average trait anxiety score was 43.66\u0026plusmn;8.58. There was no significant relationship between age and total intensive care working time and state and trait anxiety scores (p\u0026gt;0.05). A negative statistically significant relationship was found between the time spent caring for a patient with ECMO and the state and trait anxiety scale scores (p\u0026lt;0.05) (Table 3). Accordingly, as the time spent caring for a patient with ECMO increased, a decrease in state and trait anxiety scores was observed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eThe relationship between descriptive variables and State and Trait Anxiety Inventory (STAI) scores\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"625\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eState and Trait Anxiety Inventory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eX̄\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMin.- Max.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of experience in ICU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of experience in caring for patients with ECMO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eState anxiety score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e44.82 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e10.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e20-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e- 0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e- 0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e- 0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrait\u0026nbsp;anxiety score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e43.66 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e8.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e20-70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e- 0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e-0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eX̄: Mean, SD: Standard deviation, Min.: Minimum, Max : Maximum, r: Pearson correlation coefficient, *p\u0026lt;0.05, ICU: Intensive Care Unit, ECMO: Extracorporeal membrane oxygenation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA positive statistically significant relationship was found between nurses\u0026apos; state anxiety score and difficulties (D) such as D1, D8, D9, G12 and trait anxiety score and D1, D4, D8, D12, D13, D14 difficulty participation levels (p\u0026lt;0.05) (Table 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e The relationship between difficulties and State and Trait Anxiety Inventory (STAI) scores\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDifficulties\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 45.9481%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eState\u0026nbsp;anxiety score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrait\u0026nbsp;anxiety score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eState\u0026nbsp;anxiety score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.640\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrait\u0026nbsp;anxiety score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.219\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.048*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.5363%;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6769%;\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6769%;\"\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6769%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.026*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6769%;\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6769%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 24.9293%;\"\u003e\n \u003cp\u003eD14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6769%;\"\u003e\n \u003cp\u003e0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.479%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4692%;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6769%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003er:Pearson correlation coefficient, *:p\u0026lt;0.05, D:Difficulty\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, the mean state anxiety score of nurses was found to be 44.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.89, and the mean trait anxiety score was found to be 43.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.58 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In addition, the study found that the shortness of experience, the complexity of caring for patients with ECMO, the possible risk of infection due to infected patients, the high risk of bleeding, the high workload, working in isolation rooms, and the problems experienced in supplying materials affected the mean state and trait anxiety scores (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). It was also estimated that the increase in ECMO use and the risk of infection during the COVID-19 period also affected the anxiety experienced by nurses (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSimilar results were found in studies conducted in the literature. Asgari et al. (2022) reported that nurses experienced role confusion and fatigue while caring for complex and risky ECMO patients. In addition, it was emphasized that nurses caring for these patients with high mortality rates tend to experience psychological and physiological burnout [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In a qualitative study conducted by Salloum et al. (2023), it was reported that nurses caring for patients with ECMO experienced difficulties such as emotional difficulties and role confusion in addition to the standard workload of intensive care [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In the study, Knistey et al. (2019) found that complications developing in patients with ECMO increased the anxiety level of nurses [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Alshammari et al. (2022) reported that less experienced nurses caring for patients with ECMO experienced anxiety due to the patients being very complex [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, the average length of experience of nurses in providing care to patients on ECMO was found to be 2.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), and there was a significant relationship between the length of time nurses provided care to patients on ECMO and state and trait anxiety levels (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). As the length of time nurses provided care to patients on ECMO increased, a decrease in state and trait anxiety scores was observed. Honey et al. (2012) reported that having nurses experienced in ECMO increased job satisfaction in the management of ECMO support used during the H1N1 pandemic and increased the quality of care of patients in ECMO [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similarly, it was reported that inexperienced nurses experienced anxiety and stress in the face of the heavy workload and the responsibility of caring for patients on ECMO during the H1N1 pandemic [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It is thought that the increased length of experience nurses in ICU in providing care to patients on ECMO provided them with skills and, therefore, reduced their anxiety.\u003c/p\u003e\u003cp\u003eThe study found that almost all nurses experienced difficulties (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Many studies indicated that nurses who care for patients with ECMO experience several difficulties [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Alshammari et al. (2022) found that nurses experienced difficulties such as workload, high ECMO patient: nurse ratio, problems in supplying materials, transferring nurses skilled in caring for patients with ECMO to other units, not having several healthcare professionals who could affect patient care, insufficient appreciation and lack of knowledge regarding the ECMO [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Honey and Wang (2012) determined that nurses who provide care to patients with ECMO experienced difficulties such as long working hours, heavy workload, and concern about infection due to some non-compliance with infection rules during the H1N1 period [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In the study by Peig et al. (2021), it was stated that nurses had difficulties in informing the family members of the patients and managing the patients and their relatives to see each other due to the hospital's limited visitation policy during the COVID-19 pandemic [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In this study, similar to the previous studies, showed that the difficulties experienced by ICU nurses caring for patients with ECMO are universal and become even more difficult, especially during epidemic periods such as COVID-19. In addition, it was thought that the lack of a protocol in hospitals regarding the care of patients with ECMO and the lack of training of nurses on ECMO brought difficulties (Appendix-1).\u003c/p\u003e\u003cp\u003eIn this study, a significant relationship was found between nurses\u0026rsquo; state anxiety levels and their exposure to certain clinical challenges. Specifically, contamination concerns while caring for patients with infectious diseases such as H1N1 and COVID-19, increased workload, and organizational issues within the healthcare team were associated with higher state anxiety levels (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Furthermore, trait anxiety levels were found to be elevated in response to more persistent and structural challenges. These included the complex clinical condition of ECMO patients, the risk of bleeding at cannulation sites, ongoing concerns about contamination, the need for patient isolation, high complication rates, and organizational difficulties within the team (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Although the number of studies in the literature examining the problems and anxiety levels encountered by ICU nurses in the care of patients with ECMO is very limited, there are some studies investigating the anxiety and difficulties experienced by nurses [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Alshammari et al. (2022) stated that the 1:1 patient-nurse ratio was not adhered to when caring for patients with ECMO. Furthermore, since patients require a workforce and their care requires a lot of attention, communication problems occur within the team, and nurses experience anxiety [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Wrigley et al. (2018) emphasized that nurses are challenged because patients are complex, which causes them to experience professional burnout and tension [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Wellman et al. (2018) found that nurses experience fear and fatigue due to heavy workloads due to the complexity of ECMO patients, and it was stated that this situation can negatively affect clinical results. In the study conducted by Besey and Dağcı (2020), the first five problems experienced by nurses in the ICU were determined as insufficient staff, workload, job description problems, hazardous situations, and stress caused by critical patient care [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Braus et al. (2018) stated that nurses feel tired due to providing continuous care support to ECMO patients and suffering from heavy workloads. This situation causes low motivation, hopelessness, and anxiety [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDue to the stress experienced by nurses, the care they provide to patients can be negatively affected [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Atashzadeh et al. (2011) emphasize that nurses' roles as team members during the care of patients with ECMO require them to have high mental and emotional endurance and to be prepared to work with sufficient knowledge about possible complications [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In this study, nurses stated that difficulties such as experiencing anxiety, excessive workload, teamwork problems, and high risk of complications and bleeding in patients during the care of patients with ECMO increased their anxiety. Especially during the COVID-19 pandemic, ECMO devices were frequently used to support heart and lung functions [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In this study examining the effects of ECMO interventions on burnout levels in physicians and nurses during the COVID-19 pandemic, it was found that having COVID-19 infection, knowing other healthcare professionals infected with COVID-19, salary dissatisfaction, and excessive workload were among the important determinants of burnout [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Fregene et al. (2020) determined that the use of personal protective equipment required for COVID-19 patients in the ICU caused additional anxiety and discomfort in healthcare workers due to the risk of infection [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In this study, it was thought that the increase in the number of patients requiring ECMO during the COVID-19 pandemic, the fear of infection among nurses, as well as the increase in workload and working hours, and the additional difficulty in nursing care and communication between team members due to the frequent use of personal protective equipment caused nurses to experience more anxiety.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has some limitations. The research was conducted while the COVID-19 pandemic was ongoing. Since anxiety is a dynamic emotional state that can be easily affected by environmental factors, the pandemic process can directly affect the mental state of nurses. Therefore, the anxiety levels of nurses involved in the care of ECMO patients during the COVID-19 pandemic may have been affected by unusual conditions. However, pandemic-specific anxiety levels were not evaluated separately in this study. Since the anxiety level is a dynamic parameter that can be affected by the COVID-19 pandemic process and fluctuate as the pandemic continues, different results may be obtained in similar studies in the future. The increased workload and psychological states of nurses working in the ICU during the pandemic may have reduced the participation rate in the study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study showed that nurses caring for patients with ECMO experienced difficulties and that state and trait anxiety scores were associated with various difficulties encountered by nurses. Since this study was conducted during the COVID-19 period, which may affect the results, it is recommended that further studies be conducted on the difficulties experienced by nurses caring for patients with ECMO.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eECMO: Extracorporeal membrane oxygenation\u003c/p\u003e\n\u003cp\u003eSTAI:\u0026nbsp;State and Trait Anxiety Inventory\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVV: Veno-venous\u003c/p\u003e\n\u003cp\u003eVA: Veno-arterial\u003c/p\u003e\n\u003cp\u003eRPM: Revolutions per minute\u003c/p\u003e\n\u003cp\u003eLPM: Pump blood flow rate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIBM SPSS: Statistical Package for Social Sciences\u003c/p\u003e\n\u003cp\u003eICU: Intensive Care Unit\u003c/p\u003e\n\u003cp\u003eH1N1:\u0026nbsp;Hemagglutinin 1 \u0026ndash; Neuraminidase 1\u003c/p\u003e\n\u003cp\u003eICU: Intensive Care Unit\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from Gazi University Ethics Committee (Number: E-77082166-302.08.01-142880, date: 10.08.2021). In the implementation phase of the study, the purpose and details of the study were explained to the participants on the first page opened through the link sent to them. After the participants read this information text, they were asked whether they wanted to participate in the study and were asked to answer \u0026lsquo;Yes/No\u0026rsquo;. Informed consent for participation was obtained from the participants. After the consent of those who agreed to participate was obtained, it was allowed to proceed to the questionnaire part of the study. All stages of this study were conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and materials are available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eE.O:\u003c/strong\u003e Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH.B:\u003c/strong\u003e Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA.K:\u003c/strong\u003e Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank all the nurses who participated in this study for their valuable time, effort, and contributions. Their dedication and insights have been instrumental in the completion of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e This study was presented as an oral presentation at the 17th Turkish Society of Cardiovascular Surgery Congress in Antalya, Turkey.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u0026Ouml;zsoy SD, Ak HY. Extracorporeal membrane oxygenation. Koşuyolu Heart J. 2018;21(3):236\u0026ndash;44.\u0026nbsp;https//doi.org/10.5578/khj.59769 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSeen OG, Nancy HS, Lim CA, Clement CKH, Guim GS. Extracorporeal life support. In: Hei F, Guan Y, Yu K, editors. Types of Extracorporeal Life Support and Evolution of Extracorporeal Oxygenators. Springer; 2023.\u0026nbsp;https://doi.org/10.1007/978-981-19-9275-9_3.\u003c/li\u003e\n \u003cli\u003eAlshammari MA, Vellolikalam C, Alfeeli S. Nurses\u0026rsquo; perception of their role in extracorporeal membrane oxygenation care: A qualitative assessment. Nurs Crit Care. 2022;27(2):251\u0026ndash;7. \u0026nbsp;https://doi.org/10.1111/nicc.12538\u003c/li\u003e\n \u003cli\u003eChai\u0026ccedil;a V, Pont\u0026iacute;fice-Sousa P, Marques R. Nursing approach to the person in critical situation submitted to extracorporeal membrane oxygenation: Scoping review. Enferm Glob. 2020;19:536\u0026ndash;46. https://doi.org/10.6018/eglobal.395701\u003c/li\u003e\n \u003cli\u003eBergeron A, Holifield L. Extracorporeal membrane oxygenation: The nurse\u0026rsquo;s role in patient care\u003cem\u003e.\u0026nbsp;\u003c/em\u003eNurs Crit Care. 2020;15(3):6\u0026ndash;14. https//doi.org/\u0026nbsp;10.1097/01.CCN.0000660384.56911.cf\u003c/li\u003e\n \u003cli\u003eWellman J. An exploration of staff experiences of extracorporeal membrane oxygenation (ECMO) [dissertation]. London: University of East London; 2017. p. 20\u0026ndash;9. https://doi.org/10.15123/PUB.6732\u003c/li\u003e\n \u003cli\u003eKnisley J, DeBruyn E, Weaver M. Management of extracorporeal membrane oxygenation for obstetric patients: Concerns for critical care nurses. Crit Care Nurse. 2019;39(2):e8\u0026ndash;e17. https://doi.org/10.4037/ccn2019620\u003c/li\u003e\n \u003cli\u003eBotsch A, Protain E, Smith AR, Szilagyi R. Nursing implications in the ECMO patient. In: Advances in Extracorporeal Membrane Oxygenation-Volume 3. IntechOpen; 2019. p. 1\u0026ndash;14.\u003c/li\u003e\n \u003cli\u003eLucchini A, Elli S, De Felippis C, et al. The evaluation of nursing workload within an Italian ECMO Centre: A retrospective observational study. Intensive Crit Care Nurs. 2019;55:102749. https://doi.org/10.1016/j.iccn.2019.07.008\u003c/li\u003e\n \u003cli\u003eLucchini A, Giani M, Elli S, et al. Nursing Activities Score is increased in COVID-19 patients. Intensive Crit Care Nurs. 2020;59:102876. https://doi.org/10.1016/j.iccn.2020.102876\u003c/li\u003e\n \u003cli\u003eSalloum A, Fawaz M, Rayan A, et al. Extracorporeal membrane oxygenation and Lebanese critical care nurses\u0026rsquo; perceptions: A qualitative phenomenological study. SAGE Open Nurs. 2023;9:23779608231216797. https://doi.org/10.1177/23779608231216797\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAsgari P, Jackson AC, Esmaeili M, Hosseini A, Bahramnezhad F. Nurses\u0026rsquo; experience of patient care using extracorporeal membrane oxygenation. Nurs Crit Care. 2022;27(2):258\u0026ndash;66. https://doi.org/10.1111/nicc.12684\u003c/li\u003e\n \u003cli\u003eHoney M, Wang WY. New Zealand nurses\u0026rsquo; perceptions of caring for patients with influenza A (H1N1). Nurs Crit Care. 2012;18(2):63\u0026ndash;69. https://doi.org/10.1111/j.1478-5153.2012.00520.x\u003c/li\u003e\n \u003cli\u003eUmeda A, Sugiki Y. Nursing care for patients with COVID-19 on extracorporeal membrane oxygenation (ECMO) support. Glob Health Med. 2020;30(2):127\u0026ndash;130.\u0026nbsp;https://doi.org/10.35772/ghm.2020.01018\u003c/li\u003e\n \u003cli\u003eKılı\u0026ccedil; S. Sampling methods. J Mood Disord. 2013;3(1):44\u0026ndash;46.\u0026nbsp;https://doi.org/10.5455/jmood.20130325011730\u003c/li\u003e\n \u003cli\u003e\u0026Ouml;ner N, Le Compte A. State-Trait Anxiety Inventory Handbook. Istanbul: Boğazi\u0026ccedil;i University Press; 1985.\u003c/li\u003e\n \u003cli\u003eCorley A, Hammond NE, Fraser JF. The experiences of health care workers employed in an Australian intensive care unit during the H1N1 influenza pandemic of 2009: A phenomenological study. Int J Nurs Stud. 2010;47(5):577\u0026ndash;585. https://doi.org/10.1016/j.ijnurstu.2009.11.015\u003c/li\u003e\n \u003cli\u003ePeig NNA, Djen E, Garalza M, et al. Nursing management of a patient with COVID-19 receiving ECMO: A case report. Crit Care Nurse. 2021;41(6):12\u0026ndash;21. https://doi.org/10.4037/ccn2021929\u003c/li\u003e\n \u003cli\u003eWrigley C, Straker K, Nusem E, Fraser JF, Gregory SD. Nursing challenges in interactions with patients receiving mechanical circulatory and respiratory support. J Cardiovasc Nurs. 2018; 33 (5): E10\u0026ndash;E15. https://doi.org/10.1097/JCN.0000000000000494\u003c/li\u003e\n \u003cli\u003eBesey \u0026Ouml;, Dağcı S. Problems faced by nurses working in intensive care units. J Intensive Care Nurs. 2020;24(3):170\u0026ndash;83.\u003c/li\u003e\n \u003cli\u003eBraus NA, Jaramillo C, Curtis SH, et al. Multidisciplinary perspectives on the withdrawal of ECMO in anticipation of death: A qualitative study. Am Thorac Soc. 2018;A4583\u0026ndash;A4583.\u003c/li\u003e\n \u003cli\u003eBitek DE, Akyol A. Examination of the relationship between intensive care nurses\u0026rsquo; perceptions of their work environment and job satisfaction. J Intensive Care Nurs. 2017;21(1):1\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eYılmaz M, Yaman Z, Erdoğan S. Stress-inducing situations and coping methods among nursing students. Mersin Univ J Health Sci. 2017;10(2):88\u0026ndash;99.\u003c/li\u003e\n \u003cli\u003eAtashzadeh SF, Ashktorab T, Yaghmaei F. The experience of moral distress in ICU nurses: A qualitative study. Knowl Health. 2011;6:16\u0026ndash;23.\u003c/li\u003e\n \u003cli\u003eWang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus\u0026ndash;infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061\u0026ndash;1069. https://doi.org/10.1001/jama.2020.1585\u003c/li\u003e\n \u003cli\u003eLi R, Chen Y, Lv J, et al. Anxiety and related factors in frontline clinical nurses fighting COVID-19 in Wuhan. Medicine (Baltimore). 2020;99(30):e21262. https://doi.org/10.1097/MD.0000000000021413\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eExtracorporeal Life Support Organization (ELSO). Risks and complications [Internet]. 2022 [cited 2022 Feb 2]. Available from: https://www.elso.org/Resources/RisksandComplications.aspx\u003c/li\u003e\n \u003cli\u003eOmar AS, Labib A, Hanoura SE, et al. Impact of extracorporeal membrane oxygenation service on burnout development in eight intensive care units: A national cross-sectional study. J Cardiothorac Vasc Anesth. 2022;36(8):2891\u0026ndash;2899.\u0026nbsp;\u0026nbsp;https://doi.org/10.1053/j.jvca.2022.02.018\u003c/li\u003e\n \u003cli\u003eFregene TE, Nadarajah P, Buckley JF, Bigham S, Nangalia V. Use of in situ simulation to evaluate the operational readiness of a high-consequence infectious disease intensive care unit. Anaesthesia. 2020;75:733\u0026ndash;738. https://doi.org/10.1111/anae.15048\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Anxiety, Difficulties, ECMO, Nursing, Intensive Care","lastPublishedDoi":"10.21203/rs.3.rs-7068232/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7068232/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eExtracorporeal membrane oxygenation (ECMO) is a technology that provides temporary life support to critically ill patients with heart and/or lung failure. However, the complexity of the care involved presents significant challenges for nurses. This study was conducted to determine the difficulties and anxiety levels experienced by nurses caring for patients undergoing ECMO support.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study is a descriptive and cross-sectional research. It was conducted in Turkey. In this study included 137 nurses working in third level intensive care units and caring for patients with ECMO support. Anxiety levels of nurses caring for ECMO patients were examined with the \u0026lsquo;State and Trait Anxiety Inventory (STAI)\u0026rsquo;.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean state anxiety score of nurses was found to be 44.82\u0026thinsp;\u0026plusmn;\u0026thinsp;10.89, while the mean trait anxiety score was 43.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.58. A statistically significant negative correlation was found between the duration of ECMO patient care and both state and trait anxiety scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Nurses perceived ECMO patients as complex, experienced a high rate of complications, and consequently reported anxiety in patient care. Additionally, they faced various challenges in the care of ECMO patients, including the risk of COVID-19 transmission, increased workload, organizational issues among team members, and the risk of bleeding at the cannulation site.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe development of standardized protocols for the treatment and care of patients receiving ECMO plays a role in improving care quality. In addition, implementing regular training programs for nurses may help reduce the challenges and anxiety they experience. Involving experienced nurses in ECMO care may further help alleviate these difficulties.\u003c/p\u003e","manuscriptTitle":"The Invisible Face of ECMO: Anxiety Levels and Challenges Among Intensive Care Nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 13:47:48","doi":"10.21203/rs.3.rs-7068232/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-25T10:01:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-25T09:55:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-26T10:14:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-21T20:25:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T18:45:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T06:06:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318198211034146227953179829512411207140","date":"2025-08-14T18:00:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"104660467070333351285598104660854374580","date":"2025-08-12T21:50:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"259493169717996960070152588688457078421","date":"2025-08-11T19:25:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120611309400114732745564957033844909203","date":"2025-08-11T14:40:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246493654631358610464883271615660807216","date":"2025-08-05T18:07:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-04T21:15:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290915312693852058613592958194300557014","date":"2025-08-04T10:57:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-04T08:06:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-10T06:48:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-08T06:48:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-08T06:47:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-07-07T18:48:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"92e51bad-9ef1-47a9-978f-6b23e913aaad","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T16:05:43+00:00","versionOfRecord":{"articleIdentity":"rs-7068232","link":"https://doi.org/10.1186/s40359-026-04468-8","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2026-04-10 15:58:20","publishedOnDateReadable":"April 10th, 2026"},"versionCreatedAt":"2025-08-06 13:47:48","video":"","vorDoi":"10.1186/s40359-026-04468-8","vorDoiUrl":"https://doi.org/10.1186/s40359-026-04468-8","workflowStages":[]},"version":"v1","identity":"rs-7068232","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7068232","identity":"rs-7068232","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}