Healthcare Workers Emotions, Perceived Stressors and Coping Strategies During a MERS-CoV Outbreak

Mental health status of healthcare providers during the Covid-19 pandemic: A cross-sectional study across India

Background

From the beginning of the Covid-19 pandemic, studies have observed an increased prevalence of psychological symptoms in the general population and healthcare providers. We studied the prevalence of psychological symptoms among the latter.

Methods

We did this study using a self-administered questionnaire among healthcare providers across India who were involved in caring/treating patients. The questionnaire collected information on demographics, Depression, Anxiety and Stress Scales (DASS-21) and semi-structured questions related to the Covid-19 pandemic.

Results

A total of 612 healthcare providers participated in the study; 254 were doctors of various specialties and 358 were nursing care-providers. According to the DASS-21 assessment, the prevalence of depression was 12.4%, anxiety was 19.1% and stress was 10.8%. The prevalence of psychological problems was more among nursing staff compared to doctors (depression risk ratio [RR] 2.4, anxiety RR 1.73 and stress RR 2.93) and they were equal among both genders (depression RR 1.05, anxiety RR 1.06 and stress RR 1.21).

Conclusions

Our study shows that there is a higher prevalence of depression, anxiety and stress among healthcare providers, particularly among nursing care-providers. We suggest psychological interventions to nursing care-providers and also those who are vulnerable among doctors, to improve their mental health status.

Evaluation of psychological impact of COVID-19 on anesthesiology residents in the United States

The aim of our study was to evaluate the impact of COVID-19 on the mental health of in-training anesthesiology residents in the United States. A link containing validated survey tools including the Depression-Anxiety-Stress-Scale (DASS-21), the Abbreviated Maslach Burnout Inventory (aMBI), and the Brief Resilient Coping Scale (BRCS) along with questions related to work environment, and additional personal factors were emailed to 159 Anesthesiology residency programs across the US. 143 responses were received of which 111 were complete. The prevalence of depression, anxiety, stress and burnout was 42%, 24%, 31% and 71% respectively. Emotional exhaustion, depersonalization, and reduced feelings of personal accomplishment were experienced by 80%, 53%, and 65% of respondents, respectively. The BRCS scale showed 33% of respondents with low, 44% with moderate and 22% with high coping scales. Logistic regression analyses indicated those with a prior mental health diagnosis were 3 times more likely to have a non-normal DASS depression score, 4 times more likely to have a non-normal DASS anxiety score, and 11.74 times more prone to emotional exhaustion. Increased work hours and higher training levels were associated with increased levels of stress. In our survey, prior mental health illness, gender and increased work hours were the main drivers of increased risk .

The impact of rumination on life satisfaction of hotel employees during the COVID-19 pandemic: the mediating role of fear of COVID-19 and the moderating role of sedentary lifestyle

BACKGROUND

It is important to determine the individual factors that cause the differentiation of negative reactions of individuals due to epidemics. The purpose of this study is to investigate the moderating role of a sedentary lifestyle and the mediating role of fear of COVID-19 on the relationship between rumination and life satisfaction. Intense rumination is known to have a negative impact on individuals' life satisfaction levels. Very little is known about variables that may mediate and moderate this relationship.

PARTICIPANTS AND PROCEDURE

The study was conducted with staff members of five-star accommodation establishments in Turkey. Data were collected with a quantitative research method via questionnaires, completed by 386 full-time employees.

RESULTS

The results show that rumination negatively affects life satisfaction, and fear of COVID-19 has a mediating role between rumination and life satisfaction. In addition, the study concluded that a sedentary lifestyle moderated the indirect effect of rumination on life satisfaction through fear of COVID-19. This finding indicates that the negative impact of rumination on life satisfaction, mediated by fear of COVID-19, decreased, as the active lifestyle level of employees increased.

CONCLUSIONS

The results indicate the importance of active lifestyles in reducing negative impacts of the fear of being infected with a disease during times of crisis such as outbreaks and ruminative thoughts on lifestyle. The findings of this study provide substantial contributions with respect to how outbreak-related negative reactions occur and differ.

Nurses' recovery experiences during the COVID-19 pandemic in Isfahan, Iran: A qualitative study

AIM

The aim of this study is to explore and describe the recovery experiences of nurses working in COVID-19 wards.

BACKGROUND

The global outbreak of coronavirus in 2020 has extracted job stress for nurses. Job stress has impacts on physical and mental health and performance, so recovery is essential to restore the lost energy resources.

METHOD

Semi-structured interviews were conducted with 12 nurses in Isfahan city of Iran.

RESULTS

The research results were extracted as 5 main themes, 14 subthemes and 54 items. The main themes are detachment from work, relaxation, non-work activities, affiliation and meaning. The combination of these themes led to the clear statement that using recovery experiences is a major step toward relieving the nurses' COVID-19-related stress and their physical and mental resuscitation.

CONCLUSION

The use of recovery experiences, including detachment from work, relaxation, non-work activities, affiliation and meaning by nurses, helps them cope with job stressors and regain their resources.

IMPLICATIONS FOR NURSING MANAGEMENT

It is the responsibility of health system policy makers, hospital managers and nurse managers to design and implement training programmes for nurses to use recovery experiences as stress management techniques in their profession.

Inequality in the middle of a crisis: an analysis of health workers during the COVID-19 pandemic from the profession, race, and gender perspectives

Abstract Studies show that people in vulnerable conditions and some social groups such as women and black people have suffered more intensely from the COVID-19 pandemic impacts. This expression of inequality also manifests itself among healthcare workers, with greater exposure of some specific groups. This paper analyzes the effect of COVID-19 on health care workers and the working conditions in the Brazilian public health system, analyzed from professional, gender, and race perspectives. Data were collected from an online survey of 1,829 health workers conducted in March 2021. Indeed, we identified inequalities in health workers’ experiences during the health crisis generated by COVID-19, which are marked by the profession of each worker and are traversed by their gender and race traits.

Desigualdade em meio à crise: uma análise dos profissionais de saúde que atuam na pandemia de COVID-19 a partir das perspectivas de profissão, raça e gênero

Resumo Estudos mostram que pessoas em condições de vulnerabilidade têm sofrido de forma mais intensa os impactos da pandemia de COVID-19, assim como alguns grupos sociais, como mulheres e negros. Essa expressão de desigualdade também se manifesta entre os trabalhadores da saúde, com maior exposição de alguns grupos específicos. Este artigo analisa a incidência da COVID-19 sobre os trabalhadores da saúde a partir das perspectivas de profissão, gênero e raça. Os dados foram coletados por uma survey online com 1.829 trabalhadores da saúde, realizada no mês de março de 2021. Encontramos que, efetivamente, há desigualdades nas experiências dos trabalhadores da saúde durante a crise sanitária gerada pela COVID-19. Essas desigualdades estão marcadas pela profissão de cada trabalhador e são atravessadas por suas características de gênero e raça.

Comparing the Mental Wellbeing and Quality of Working Life among Nurses and Social Care Workers in the UK and Japan in Older Adults’ Care Services during the COVID-19 Pandemic

This study explored and compared the psychological wellbeing, burnout, coping strategies and work-related quality of life amongst health and social care workers in older adults’ care homes and community settings during the COVID-19 pandemic in the United Kingdom (UK) and Japan. A cross-sectional online survey was conducted in the UK (May–July 2021) and a postal survey conducted in Japan (September–October 2021). Participants recruited were health and social care professionals within nursing, social care and social work occupations working in care home or community settings in the UK and Japan during the pandemic. Data were analysed using SPSS. 1327 respondents across the UK and Japan completed the survey. Respondents’ psychological wellbeing was significantly lower in Japan compared to the UK (p ≤ 0.001). UK respondents had significantly higher personal burnout (p < 0.05) and work-related burnout (p < 0.05) while those in Japan had significantly higher client-related burnout (p < 0.001). The novelty of this study relates to exploring mental wellbeing and quality of working life in two culturally contrasting countries. The overall psychological wellbeing and work-related quality of life of staff who work with older adults in the UK and Japan during the COVID-19 pandemic were lower than the population norm. Greater support and flexible working conditions for this workforce are needed to reduce burnout by improving wellbeing and work-related quality of life.

Future public health emergencies and disasters: sustainability and insights into support programs for healthcare providers

BACKGROUND

The mental health of healthcare workers (HCWs) has been at the forefront throughout the COVID-19 pandemic. While workplace-based support programs have been developed in hospitals globally, few systematically collected data. While critical to their success, information on these programs and the experience of mental healthcare providers (MHP) who support colleagues is limited. The objective of this study was to explore the experiences of MHP caring for HCW colleagues within a novel workplace-based mental health support program during the COVID-19 pandemic, to provide insights on facilitators, areas for improvement and barriers to program sustainability.

METHODS

This qualitative study used semi-structured interviews conducted by videoconference between September 2020 to October 2021. UHN CARES (University Health Network Coping and Resilience for Employees and Staff) Program was developed during the first wave of the COVID-19 pandemic in March 2020. It supports over 21,000 staff members within the UHN, Canada's largest academic health research institution, in Toronto, Canada. Purposive sampling was used to select 10 of the 22 MHP in the UHN CARES Program (n = 10). Using a critical realism framework, key components required to sustain a successful workplace-based mental health support program for HCWs and balance the needs of MHP were determined.

RESULTS

Six psychiatrists and four psychologists (n = 10) with varying roles at UHN participated in 17 interviews, including seven repeat interviews exploring changes over time within the pandemic and program. Components which facilitated the success of the program included flexibility in scheduling, confidential health record storage, comprehensive administrative support, availability of resources and adaptive quality improvement approach. Recommendations for improvement included opportunities for peer supervision, triaging of cases, and managing HCW expectations. MHP found caring for HCWs to be meaningful and they utilized existing clinical skills during sessions. Challenges included working in a virtual setting, navigating boundaries when caring for colleagues, and managing the range of service users and their needs.

CONCLUSIONS

These findings suggest how support programs can be structured for HCWs, how to provide support, and how to sustain this support, allowing health systems to balance the needs of HCWs and MHPs in preparation for future public health emergencies.

Psychological impact, coping behaviors, and traumatic stress among healthcare workers during COVID-19 in Taiwan: An early stage experience

OBJECTIVE

This study investigated the psychological impact on, coping behaviors of, and traumatic stress experienced by healthcare workers during the early stage of the COVID-19 pandemic and formulated effective support strategies that can be implemented by hospitals and government policymakers to help healthcare staff overcome the pandemic.

METHODS

This cross-sectional study recruited clinical healthcare workers at a regional hospital in Nantou County, Taiwan. The questionnaire collected personal characteristics, data on the impact and coping behaviors of the pandemic, and Impact of Event Scale-Revised (IES-R). A total of 354 valid questionnaires were collected. The statistical methods employed were univariate and multivariate stepwise regression, and logistic regression.

RESULTS

Perceived impact and coping behaviors were found to be moderate in degree, and traumatic stress was lower than that in other countries. However, our data identified the following subgroups that require special attention: those with young age, those living with minor children, nurses, those with self-rated poor mental health, and those with insufficient COVID-19-related training.

CONCLUSION

Managers should pay particular attention to helping healthcare workers in high-risk groups, strengthen COVID-19 training, provide adequate protective equipment and shelter, and offer psychological counseling.

Stress and the Psychological Impact of the COVID-19 Pandemic on Frontline Obstetrics and Gynecology Providers

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic rapidly overwhelmed global health care systems in 2020, with New York City (NYC) marking the first epicenter in the United States. High levels of stress amongst health care workers have been reported in pandemics, but less is known about stress amongst Obstetrics and Gynecology (OB/GYN) providers. We sought to describe levels of stress, anxiety, depression, and other aspects of mental health among OB/GYN health care workers during the first wave of the COVID-19 pandemic.

STUDY DESIGN

We conducted an anonymous cross-sectional electronic survey of a wide range of OB/GYN clinicians in a large NYC hospital system in the spring of 2020. We used both original survey questions and validated screening tools to assess stress, anxiety, depression, and burnout. We calculated median scores for these tools and compared median score between provider types. We also adapted questions on pandemic-related stressors from the MERS and SARS pandemics to fit the context of the COVID-19 pandemic and OB/GYN providers.

RESULTS

A total of 464 providers met study inclusion criteria, and 163 providers completed the survey (response rate = 35.1%). Approximately 35% of providers screened positive for anxiety and 21% for depression. Scores for depression, burnout, and fulfillment varied by provider type, with nurses scoring higher than physicians (p <0.05). The majority of respondents reported stress from pandemic and OB-specific stressors, including the possibility of transmitting COVID-19 to friends and family (83.9%, [95% confidence interval or CI 78.0-89.8%]), uncertainty regarding the pandemic's trajectory (91.3% [86.7-95.8%]), and frequent policy changes on labor and delivery (72.7% [65.1-80.3%]).

CONCLUSION

OB/GYN providers reported high levels of stress during the COVID-19 pandemic. The stress of caring for laboring patients during a pandemic may disproportionately affect nurses and trainees and highlights the need to provide interventions to ameliorate the negative impact of a pandemic on the mental health of our OB/GYN health care workers.

KEY POINTS

· COVID-19 led to stress amongst OB/GYN providers.. · Some stressors were unique to providing obstetric care.. · Nurses and trainees were more affected by this stress..

Lived Experience of Nurses in COVID-19 Units - A Phenomenological Study from Eastern India

Introduction: Nurses are the frontline workers who had to play multiple functions like in acute care, community, etc. but, it was stated that COVID-19 has caused immense trauma to nurses globally. Methods: A descriptive phenomenological study to explore the lived experience of nurses working in COVID-19 units was conducted among nine senior nursing officers recruited by purposive homogenous sampling and interviewed with an open-ended interview guide by ensuring data saturation. COREQ guideline were adopted for this qualitative study. Results: Qualitative data were analysed using Giorgi's framework, and themes and sub-themes were derived. The major themes that emerged in the present study were "Reactions and preparation", "Feelings and satisfaction in active duty", "Role of a helping hand", "Working experience in PPE", and "Pandemic and socialization". Each theme had further sub-themes to classify the verbatims. Conclusion: Most of the nurses had anxiety and prepared themselves to play with fire, had unrealistic hope, and mixed emotions, kept their family away and intentionally concealed information to reduce family's fear, were satisfied with training and preparation, and had unpleasant experiences with PPE, had to restrict their social activities and felt social stigma. It also concludes with the recommendation that warrants the need to improve their professional quality of life and working conditions by safeguarding nurses' physical and mental health.

Nurses' Experiences of Caring for Patients with COVID-19: A Qualitative Study

The purpose of this study was to explore nurses' experiences, abilities, and willingness to care for patients with Coronavirus Disease 2019 (COVID-19). A descriptive qualitative study was conducted among 12 nurses working with patients with COVID-19. Purposive sampling was used to recruit participants from two national hospitals in Jordan. Semi-structured interviews (45-90 minutes each) with open-ended questions were held via Zoom to collect data. Four major themes emerged from the data analysis. The first theme, uncertainty, consisted of two subthemes: new experience and lack of training. The second theme was related to social stigma by society and other staff members. The third theme of front-line fighters consisted of two subthemes: empowering the main health caregiver and community acknowledgment. The fourth theme was related to challenges and consisted of two subthemes: physical and psychological challenges. At the beginning of the outbreak of COVID-19, the nurses had experienced a lack of certainty, physical and psychological challenges, and social stigmatization, which had negatively affected their willingness and ability to fight the outbreak. However, the nurses reported growing professionally and psychologically with time and becoming more knowledgeable, skillful, powerful, and confident care providers during the pandemic. Being able to fulfill their responsibilities and being acknowledged by others gave the nurses a sense of achievement. Early education and training about COVID-19, clear infection control protocols and guidelines, psychological counseling, and adequate social support are essential steps for enhancing nurses' mental well-being and willingness and ability to fight COVID-19.

Occupational Stress and Stress Busters Used Among Saudi Dental Practitioners During the COVID-19 Pandemic Outbreak

OBJECTIVE

This study aims to assess the stress levels, stress busters (stress relievers), and coping mechanisms among Saudi dental practitioners (SDPs) during the coronavirus disease (COVID-19) pandemic outbreak.

METHOD

A self-administered questionnaire was sent to SDPs via Google Forms. Cohen's stress score scale was used for stress evaluation, and the mean scores were compared based on age, gender, qualification, and occupation. In addition, comparisons of the utilization of stress coping mechanisms and stress busters based on gender, age, and occupation were evaluated. Descriptive statistics were carried out using SPSS Version 21.0 (IBM Corp, Armonk, NY).

RESULTS

A total of 206 SDPs (69% males and 31% females) participated in the study. Male SDPs showed a higher score than females (P > 0.05). SDPs around age 50 years and above obtained high stress scores (25 ± 7.4) as compared with other age groups (P < 0.05). The occupational level showed higher stress scores (22.6 ± 4.6 than the other occupation groups (P < 0.05). The majority of the SDPs used watching TV/mobile/computer (80%) as a stress buster, followed by binge eating (64%), exercise (44%), smoking (32%), do-it-yourself (DIY; 23%), and meditation (17%).

CONCLUSION

SDPs are experiencing stress levels during the COVID-19 pandemic. Male SDPs above age 50 years and private practitioners showed higher levels of stress scores. An overall commonly used stress buster was smoking in males and meditation in females.

Determinants of emotional distress in neonatal healthcare professionals: An exploratory analysis

Background

High levels of mental health problems have been consistently reported among neonatal healthcare professionals. While studies suggest that personality, coping strategies and safety culture might contribute to the psychological wellbeing of healthcare professionals, they have not been systematically investigated in low-risk (i.e., neonatal wards; NWs) and high-risk (i.e., neonatal intensive care units; NICUs) neonatal contexts. The current study investigated potential predictors of professionals' emotional distress and whether they differ according to the work setting (i.e., NICUs vs. NWs).

Methods

Healthcare professionals (N = 314) from 7 level-3 (i.e., NICUs) and 6 level-2 (i.e., NWs) neonatal units in Tuscany were included. Emotional distress (i.e., anxiety, depression, psychosomatic, post-traumatic stress symptoms and emotional exhaustion), Behavioral Inhibition System (BIS) and Behavioral Approach System (BAS) sensitivity, coping strategies and safety culture were assessed through well-validated, self-reported questionnaires.

Results

Greater BIS/BAS sensitivity, avoidance coping strategies and a sub-dimension of safety culture (i.e., stress recognition) were significantly associated with greater risk of emotional distress, whereas job satisfaction emerged as a protective factor. Three specific profiles of professionals in term of personality, coping and safety culture were identified and further predicted emotional distress. Neonatal wards and NICUs personnel presented different associations between personality, coping and safety culture.

Conclusion

These findings highlighted significant modifiable contributors of neonatal mental healthcare professionals' wellbeing. Institutional initiatives that target these factors and, particularly, job satisfaction may promote professionals' emotional wellbeing and thus improve caring processes.

Narratives of hospital health care professionals during the pandemic in the Northern Philippines: A phenomenological study

Hospital health care professionals (HCPs) play a vital and crucial role in saving the lives of patients afflicted with the coronavirus disease 2019 (COVID-19). As the incidence of the disease keeps increasing, health care workers in hospitals face difficulties in discharging their duties. This study aimed to describe the lived experiences of HCPs. Particularly, it determined their challenges, motivations and coping strategies to craft grassroots policies for the enhancement of health care delivery in the Northern Philippines. Employing a phenomenological study design, 24 study participants were purposively selected and their narratives were elicited through focus group discussion. Responses were transcribed verbatim. After data analyses, the challenges, coping strategies and motivations of HCPs were identified. Results revealed that HCPs experienced a lot of challenges. Some of these were brought by the rapid changes in their environment as HCPs. Moreover, there was lack of comprehensive strategies that made them unprepared along with a lack of human and material resources. Furthermore, they experienced physical fatigue because of overwhelming workload, anxiety, fear and discrimination that led to depression. Despite these difficulties, they remain resilient because of religious coping, being true to their duty as HCPs and the support they receive from their fellows. Thus, the study recommends that protocols to ensue should centre on adequate pandemic preparedness and capacitation of HCPs.

Healthcare Workers' Emotions, Perceived Stressors, and Coping Strategies at Workplace during the COVID-19 Pandemic in Palestine

Evidence about the impact of the COVID-19 pandemic on the mental health of Palestinian healthcare professionals is lacking and has been disregarded during the COVID-19 pandemic. This study aims to describe Palestinian healthcare workers (HCWs) emotions and factors causing stress, and factors used to reduce the stress experienced at the workplace and to examine the relationships between HCWs level of stress and their coping strategies and motivational factors during the COVID-19 pandemic. A self-reported online survey was completed by 506 doctors and nurses working in healthcare facilities that provide COVID-19 care. Descriptive statistics, bivariate, and multivariate regression models were developed to adjust for the association between HCWs coping and motivation factors with HCWs' perceived stressors. The findings showed that 24.1% of the participants had a high-stress level, and 25.7% had a low level of stress. The participant's main coping strategy was avoidance and the key emotional factor was the ethical and professional obligation to continue working. Additionally, a major cause of their stress was their personal safety and having the COVID-19 infection. Findings showed a positive association between stress and the younger age of participants, with physicians being less stressed than nurses. In addition, receiving no training on the treatment of COVID-19 was strongly associated with stress levels. Furthermore, there was a significant positive correlation between stress scoring and coping strategies scoring but not with motivation score. In conclusion, this study shows that Palestinian healthcare workers experienced emotional turmoil during the COVID-19 pandemic. These results indicate the necessity of providing supervision, psychological counseling and intervention to professional healthcare workers who work directly with COVID-19 patients in health settings during the current pandemic or in the event of future outbreaks. Policymakers and managers must also conduct training and provide interventions on how to cope with stress in pandemics, in order to assist HCWs in developing their adaptive coping strategies and increase their motivation.

Post-traumatic stress disorder symptoms among nursing staff who provided direct care to COVID-19 patients: a cross-sectional study

Background

The coronavirus disease 2019 (COVID-19) pandemic has led to a major physical and psychological burden on nursing staff who provide patient care in difficult circumstances with persistent exposure to infected patients. This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) symptoms among nursing staff working during the COVID-19 pandemic and its relationship with different work-related variables. It was designed as a cross-sectional comparative study in which 102 nurses on duty during the past 6 months were enrolled and divided into two groups. The first group included fifty-one COVID-dealing nurses who provided direct patient care to COVID-19 patients (emergency department, isolation zone, and intensive care unit (ICU)), while the second group included fifty-one non-COVID-dealing nurses on duty during the same period but in other hospital units and not providing direct care to COVID-19 patients (inpatient and outpatient wards).

Sociodemographic data, work-related variables, PTSD symptom severity, and diagnosis were all assessed.

Results

The COVID-dealing nurses had significantly less frequent short breaks (P = 0.007), inadequate organizational support and compensation (P = 0.024), and inadequate time off work (P = 0.004) compared to non-COVID-dealing nursing staff. They were also significantly suffering from PTSD compared to second-line staff (P = 0.025).

Conclusions

COVID-dealing nurses providing direct care to COVID-19 patients suffered significantly from PTSD with a variety of contributing work-related variables.

The anxiety levels of midwives and nurses working for filiation during COVID-19: A sample of Turkey

This study examines the anxiety levels of midwives and nurses working for filiation during management of the COVID-19 pandemic(n = 205) The cross-sectional data were collected using State-Trait Anxiety Inventory (STAI-I and II). Having COVID-19 test done and provision of protective equipment affected their STAI-I and II. High anxiety status was found to be those who did not experience fear of carrying the coronavirus to their families (O.R: 1.128), who had diagnosis tests done (O.R:0.888), who had good feeling states before COVID-19 process (O.R:1.076). Information about infection spreads, required equipment and providing social support will lead to a reduction in their anxiety levels in working filiation.

The impact of the COVID-19 pandemic on nursing care and nurses' work in a neonatal intensive care unit

PURPOSE

This study was conducted to determine the effects of the COVID-19 pandemic process on nursing care and nurses' work in neonatal intensive care units.

DESIGN AND METHODS

The study was conducted using a qualitative method. The data were collected by voice recording with a one-on-one in-depth interview technique, and a semi-structured question form was used in the interviews. The data obtained from voice recordings were evaluated using the qualitative content analysis method.

RESULTS

The main themes and subthemes of the study were as follows: (1) decrease in physical contact with newborns due to fear of transmitting Covid-19 (decrease in physical contact between neonatal nurses and newborns, decrease in physical contact between mothers and newborns, decrease in physical contact between fathers and newborns), (2) communication problems between healthcare professionals and parents (3) changes in the working conditions for neonatal nurses (increase in the frequency and duration of work intense working speed, exhaustion and decreased motivation due to use of protective equipment).

CONCLUSION

The COVID-19 pandemic process led to a decrease in nurses' and parents' touching newborns, nurses' experiencing problems with parents due to measures taken, heavier working conditions and a decrease in motivation for nurses.

PRACTICE IMPLICATIONS

This study will inform future research to be directed to nursing care and the work of nursing who work on the front line in the COVID-19 pandemic process.

Perceptions, Coping Strategies, and Mental Health of Residents during COVID-19

We explored perceptions, coping strategies, and levels of depression, anxiety, and stress among residents during the coronavirus disease 2019 pandemic and administered a multiple-choice online anonymous survey to assess residents’ perceptions of the virus, coping strategies, and self-reported levels of depression, anxiety, and stress. We received completed information from 59/143 (41.3%) residents in a single southern community-based graduate medical education program with academic affiliation.

Objectives

Since the inception of the coronavirus disease 2019 (COVID-19) pandemic, the United States has been the leader in cases and deaths. Healthcare workers treating these severely ill patients are at risk of many deleterious consequences. Residents, in particular, may be affected by physical as well as psychological consequences. Because data are sparse on perceptions, coping strategies, and the mental health of residents during COVID-19, we explored these issues in survey data from a community-based academic program in the southeastern United States.

Methods

In May 2020, when US deaths from COVID-19 reached 100,000, we administered multiple-choice online anonymous surveys to assess resident perceptions, coping strategies, and self-reported levels of depression, anxiety, and stress. We used the COPE inventory to assess coping strategies and the Depression, Anxiety, and Stress Scale-21 questionnaire.

Results

A total of 59 (41.3%) of 143 eligible residents completed the survey, 52 (88.1%) of whom believed that they were likely or very likely to become infected with COVID-19. If infected, 17 (28.8%) believed that their illness would be serious or very serious. The top three strategies to cope with COVID-19 included acceptance, self-distraction, and use of emotional support. With respect to depression, anxiety, and stress, all of the mean scores were in the normal range.

Conclusions

During COVID-19, residents in a southern community-based program with an academic affiliation reported effective coping strategies, predominantly acceptance, self-distraction, and use of emotional support. They reported concerns about becoming infected and, if they did, that their illness would likely be serious. Finally, they have not experienced depression, anxiety, or reported stress. The findings may be restricted in generalizability to a southern community-based program with an academic affiliation.

Individual and organizational resilience-Insights from healthcare providers in Germany during the COVID-19 pandemic

We explored the effects of resilience in the healthcare setting during the COVID-19 pandemic in Germany. Our study sheds light on the cross-level effects of resilience in hospitals and thus responds to calls to research this empirically. In a cross-sectional study design, the perceptions of resilience of employees in hospitals and of transformations at the individual, team, and organizational level were analyzed. An online survey was conducted in summer 2020 in Germany in which 1,710 healthcare workers completed a self-report questionnaire. Results indicate that resilience is both a highly interrelated construct on the individual and organizational level and also positively linked to perceptions of transformation as an indicator for demonstration of resilience. We also found a partial mediation effect of organizational resilience and team efficacy, respectively, on the relationship between individual resilience and perceived transformation on the individual and organizational level as well as a full mediation on the team level. The study highlights the interdependence of individual and organizational resilience (which is mediated by team efficacy) and its impact on perceived transformation in German hospitals during the COVID-19 pandemic. Whereas team efficacy is crucial for performance in regular work operations, during a pandemic the organizational level becomes more relevant. Theoretical and practical implications are discussed.

Examining the discourse regarding the delivery of occupational infection prevention and control training to healthcare workers: a scoping review of pandemic plans of 23 countries

BACKGROUND

Over the years, countries reformed their pandemic plans but still healthcare systems were unprepared to handle the COVID-19 pandemic. Throughout the COVID-19 pandemic, healthcare workers (HCWs) raised issues around shortage of personal protective equipment (PPE), inadequate occupational infection prevention and control (IPC) training, lack of guidance regarding reuse/extended use of PPE and absence of HCWs.

OBJECTIVE

The objective of this scoping review was to compare national and transnational pandemic plans and COVID-19 guidelines for the inclusion of recommendations regarding pandemic-specific occupational IPC training for HCWs, as well as strategies for managing the surge in PPE needs and staffing.

INCLUSION CRITERIA

From each of the six WHO defined world regions, four countries with the highest burden of COVID-19 cases (as of mid-2020) were selected and attempted to locate the relevant pandemic plans and COVID-19 guidelines.

METHODS

Searches were undertaken of 1: National Guidelines Clearinghouse, 2: websites of international public healthcare agencies such as WHO, the European Centre for Disease Prevention and Control (ECDC) and, 3: in-country health departments/Ministry of Health/Department of Public Health, between June 2020 and July 2021. The data were summarised under six themes drawn from publicly available pandemic plans and COVID-19 (IPC) guidelines of WHO, ECDC and 23 countries.

RESULTS

The WHO, ECDC and 14 countries reported pandemic-specific IPC training; however, only four discussed training HCWs on correct PPE use; six countries listed strategies to manage the surge in demand of HCWs, while only five discussed managing the shortage of PPE. None of the COVID-19 guidelines recommended training HCWs for correct reuse or extended use of PPE and only one country's guideline outlined mandatory HCWs attendance and delivery of training in a regional language.

CONCLUSION

Pandemic plans should be revised to include guiding principles regarding the delivery of pandemic specific IPC training. There is also a need to provide guidance on when countries should consider reuse and extended use of PPE. This discourse should also be reflected in disease-specific pandemic guidelines, like COVID-19 (IPC) guidelines. The aim of this review is to assist international health agencies in generating evidence-based guideline updates.

Depression, anxiety, and stress among Iranian nurses in COVID-19 care wards

BACKGROUND

Nurses are at the frontline of care provision to patients with coronavirus disease 2019 (COVID-19). The high communicability of COVID-19, high levels of stress associated with the disease, and challenges of care provision to afflicted patients faced nurses in Iran with problems such as depression, anxiety, and stress. The aim of the study was to assess depression, anxiety, and stress among Iranian nurses who provided care to patients with COVID-19.

METHODS

This cross-sectional descriptive-analytical study was conducted in 2020-2021. Participants were 468 nurses purposively selected from university hospitals in Iran. They completed two online instruments, namely a demographic questionnaire and the 21-item Depression Anxiety Stress Scale. Data were analyzed using the SPSS software (v. 23.0).

RESULTS

Most participants were female (75.9%) and married (73.4%) and held bachelor's degree (88%). The means of participants' age and work experience were 33.59 ± 6.40 years and 10.26 ± 6.61 years, respectively. The mean scores and the prevalence rates of depression, anxiety, and stress were 13.56 ± 5.37 and 74.1%, 13.21 ± 4.90 and 89.7%, and 15.13 ± 4.76 and 54.9%, respectively. The prevalence rates of moderate to severe depression, anxiety, and stress were 43.7%, 73%, and 24%, respectively. The mean scores of participants' depression, anxiety, and stress had significant relationship with their employment status (p < 0.05). Besides, the mean scores of their anxiety had significant relationship with their educational level, employment status, and work shift (p < 0.05).

CONCLUSION

Most nurses who provide care to patients with COVID-19 suffer from depression, anxiety, and stress. Psychological support services may be needed for nurses in order to protect and promote their mental health.

Psychosocial response to the COVID-19 pandemic in Panama

Background

The impact of the COVID-19 pandemic and the associated restrictions on mental health is being studied.

Objective

To analyze the psychosocial response to the COVID-19 pandemic in adults residing in Panama.

Methods

A community sample of 480 adult residents of Panama completed a survey that included sociodemographic questions, COVID-19 related questions (e.g., health concerns regarding the virus, knowledge and behaviors in biosafety) and scales of stress, anxiety, depression, prosocial behavior, resilience, perceived social support, and insomnia.

Results

Most of the participants (>60%) reported being negatively affected by the pandemic. Women experienced greater depression, anxiety, and stress symptoms than men, and age was negatively associated with depression, anxiety, and stress symptoms. Self-perceived health status and self-perceived social support were negatively associated with depression, anxiety, and stress symptoms. Self-perceived social isolation was positively associated with depression, anxiety, and stress symptoms. Psychiatric illness and insomnia were positively associated with depression, anxiety, and stress symptoms, whereas psychological resilience was negatively associated with depression, anxiety, and stress symptoms.

Discussion

These results corroborate other studies regarding COVID-19 and mental health. This study highlights the need for specific prevention and intervention mechanisms related to the COVID-19 pandemic in different population groups. This is the first report of the psychological impact of COVID-19 in the general Panamanian population and one of the only studies in the Latin American region and, therefore, contributes to research in the Latino population and lower-middle income countries.

Global research trends in MERS-CoV: A comprehensive bibliometric analysis from 2012 to 2021

Background

The Middle East respiratory syndrome coronavirus (MERS-CoV) was first reported in Saudi Arabia in 2012. So far, the cases of MERS-CoV have been reported in 27 countries. The virus causes severe health complications, resulting high mortality.

Aim

The current study aimed to evaluate the global research trends and key bibliometric indices in MERS-CoV research from 2012 to 2021.

Methods

A retrospective bibliometric and visualized study was conducted. The Science Citation Index Expanded Edition of Web of Science Core Collection database was utilized to retrieve published scientific literature on MERS-CoV. The retrieved publications were assessed for a number of bibliometric attributes. The data were imported into HistCite^TM and VOSviewer software to calculate the citations count and perform the visualization mapping, respectively. In addition, countries or regions collaboration, keywords analysis, and trend topics in MERS-CoV were assessed using the Bibliometrix: An R-tool.

Results

A total of 1,587 publications, published in 499 journals, authored by 6,506 authors from 88 countries or regions were included in the final analysis. Majority of these publications were published as research article (n = 1,143). Globally, these publications received 70,143 citations. The most frequent year of publication was 2016 (n = 253), while the most cited year was 2014 (11,517 citations). The most prolific author was Memish ZA (n = 94), while the most published journal was Emerging Infectious Diseases (n = 80). The United States of America (USA) (n = 520) and Saudi Arabia (n = 432) were the most influential and largest contributors to the MERS-CoV publications. The extensively studied research area was infectious diseases. The most frequently used author keywords other than search keywords were Saudi Arabia, SARS-CoV-2, COVID-19, epidemiology, transmission, spike protein, vaccine, outbreak, camel, and pneumonia.

Conclusion

This study provides an insight into MERS-CoV-related research for scientific community (researchers, academicians) to understand and expand the basic knowledge structure, potential collaborations, and research trend topics. This study can also be useful for policy makers. After the emergence of MERS-CoV, a significant increase in scientific production was observed in the next 4 years (2013–2016). In 2021, the trend topics in MERS-CoV-related research were COVID-19, clinical characteristics, and cytokine storm. Saudi Arabia had the strongest collaboration with the USA, while the USA had the highest collaboration with China.

Gazing the dusty mirror: Joint effect of narcissism and sadism on workplace incivility via indirect effect of paranoia, antagonism, and emotional intelligence

Workplace productivity is badly affected by many negative factors such as narcissism, and sadism. In addition, paranoia and antagonism play an important role in increasing workplace incivility. Through emotional intelligence, such negative behaviors could be addressed by managers and their junior colleagues. The current study aims to investigate the parallel mediating role of paranoia, antagonism, and emotional intelligence on the relationship between narcissism, sadism, and workplace incivility. A survey approach was used. Primary data was collected in PLS-SEM. The population of the study was all faculty members in higher education institutions in the Khyber Pakhtunkhwa (Pakistan) region. A measurement model and structural model were developed. The measurement model demonstrated that convergent and discriminant validities were established. The structural model's findings revealed that narcissism, antagonism, and emotional intelligence were not mediated between narcissism and workplace incivility. Similarly, emotional intelligence did not play any mediating role between sadism and workplace incivility. This implied that emotional intelligence has no role in decreasing or reducing workplace uncivil behavior.

Exploring the Experience of Nurses in Providing Care to Patients With COVID-19: A Qualitative Study

BACKGROUND

The COVID-19 pandemic has caused conflicts in the world health system. The role of nurses is prominent because of their close contact with patients.

PURPOSE

The aim of this study was to explore the experiences of nurses in providing care to patients with COVID-19.

METHODS

This phenomenological study was conducted in 2020. Purposive sampling was used and continued until data saturation. Semistructured interviews were conducted with 14 nurses at Tohid Hospital, Sanandaj, Iran, all of whom had experience providing care to patients with COVID-19. Interviews were transcribed verbatim and analyzed using Colaizzi's phenomenological method.

RESULTS

The participants included four men and 10 women. Data analysis revealed four main themes (14 subthemes) related to the experience of the participants in providing care to patients with COVID-19. These themes included (a) fear (fear of being infected, fear of being a carrier, fear of the disease, and high mortality of patients), (b) compulsion (compulsion to care, being under pressure), (c) distinct experience (need for self-care, working with personal protective equipment, and ambiguity in care/treatment), and (d) sacrifice (altruism, compassion, self-sacrifice, and being proud of yourself).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The experience of participants in caring for patients with COVID-19, in addition to the unique experience of care, was associated with fear, compulsion, and sacrifice. Because of the ongoing COVID-19 pandemic and the unique experience of nurses serving in COVID-19 units, it is necessary to educate and support nurses to deal effectively with this situation.

Investigating the Psychological Impact of COVID-19 on Healthcare Professionals: Implications and Recommendations

Public health crises that increase the demand for healthcare professionals (HCPs) often result in increased mental distress in HCPs. The current study investigated the specific mental health ramifications of the COVID-19 pandemic on HCPs and perceived support from their places of work. Data was collected from US-based HCPs (N = 325) working as physicians (21.8%), nurses (26.8%), mental health professionals (MHPs; 30.5%), and allied healthcare professionals (AHPs; 20.9%) from April 2020 to April 2021 amidst the COVID-19 pandemic, using an online self-report survey. Descriptive and correlational statistical analyses assessed worry, stressors, psychological functioning, and perceived support. A majority of participants expressed worry about the pandemic broadly (93%), and approximately half (50.5%) indicated that their degree of worry was moderate to extreme. Respondents worried most about the risk of infection for family and relatives. HCPs reported not having been able to enjoy daily activities (66.9%), losing sleep (43.1%), and feeling constantly under strain (66.9%), compared to usual. Most HCPs indicated a strong desire for clear communication regarding the pandemic and psychological support from their workplaces. This paper provides recommendations to support HCP mental health by both ameliorating distress caused by the COVID-19 pandemic as well as protecting the health and wellness of HCPs more generally. HCPs and institutions that employ them should seek out or provide access to mental health resources and services, engage with or provide opportunities and activities to actively address mental health, and improve communication regarding COVID-19 or other topics HCPs demonstrate interest in.

Predictors of problem-solving skills among emergency medical services staff in Iran: A cross-sectional correlational study

Background and aims

Pre-hospital emergency technicians face many problems in the workplace daily, so the ability to solve or overcome them in the workplace is essential. This article aimed to assess the predictors of problem-solving skills among emergency medical services staff in Iran.

Methods

This study was cross-sectional correlational research. Using convenience sampling methods, 140 emergency medical services (EMS) staff were enrolled in the study. Response time was assessed using ASAYAR software, problem-solving skills (PSS) were measured using the Hepner Petersen Problem Solving Questionnaire (PSI), and cognitive emotion regulation strategies were assessed using the Garnfsky Cognitive Emotion Regulation Questionnaire. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's r correlation coefficient, and multiple linear regression analysis were applied using SPSS 14.0.

Results

The results of our study showed that the total mean score for problem-solving skills was 136.84 (14.65) (range, 175–107 points). Multiple linear regression indicated that refocusing on planning, positive evaluation, stress management courses, delays and their causes, positive refocusing, catastrophizing, and acceptance were effective predictors of problem-solving skills in emergency personnel, accounting for 54% of the total variances.

Conclusion

This study is one of the first studies in this field. Based on our findings, individuals who consider their emotions and feelings when solving problems are better able to use the process of thinking and problem-solving skills. Therefore, by training people in the field of emotional regulation skills, the skills to solve problems technicians can be increased.

Academic, clinical and personal experiences of undergraduate healthcare students during the COVID-19 pandemic: A prospective cohort study

Background

Coronavirus disease 2019 has impacted upon the role and safety of healthcare workers, with the potential to have a lasting effect on their wellbeing. Limited research has been conducted during previous pandemics exploring how student healthcare workers are impacted as they study and train for their professional careers.

Objective

The aim of the current study was to examine the specific impact of COVID-19 on the academic, clinical and personal experiences of healthcare students.

Method

Undergraduate students across three year groups within the School of Health Sciences at Ulster University completed online Qualtrics surveys at three timepoints during one academic year (2020/2021). Quantitative survey data was downloaded from Qualtrics into SPSS Version 25 for descriptive analysis of each cross-sectional sample. Qualitative survey data was downloaded into text format, which was thematically analysed using content analysis.

Results

412 students completed the survey at Time 1 (October 2020), n = 309 at Time 2 (December 2020) and n = 259 at Time 3 (April 2021). Academically, the pandemic had mostly a negative impact on the learning environment, the development of practical skills, the assessment process and opportunities for peer learning and support. Students reported increased stress and challenges managing their workload and maintaining a sense of motivation and routine. Clinically, they felt unprepared by the university for placement where the pandemic had an increasingly negative impact over time on learning and skill development. In terms of personal experiences, despite the majority of students taking steps to keep physically and mentally well, negative impacts on friendships, mental wellbeing and concerns for family were reported. The pandemic had not impacted upon career choice for most students.

Conclusion

Consideration must be given to the development of practical skills so students feel prepared for their professional careers given the practical nature of their roles. Programme coordinators should adopt a holistic approach to student wellbeing.

Factors and optimizations of healthcare workers' perception in alternative care facilities

Background

Diverse measures have been carried out worldwide to establish Alternative Care Facilities (ACFs) for different ends, such as receiving, curing or isolating patients, aiming to cope with tremendous shock in the urban medical system during the early passage of the COVID-19 epidemic. Healthcare workers always felt anxious and stressed during multiple major public health emergencies in medical facilities. Some active measures to improve healthcare workers' perceptions, such as temporary training, workflow improvement, and supplementary facilities, were proved insufficient in several past public health emergencies. Therefore, this study aims to analyze the contributing factors of the healthcare workers' perceptions of the ACFs in this pandemic, which can help find an innovative path to ensure their health, well-being and work efficiency.

Method

This paper conducted semi-structured in-depth interviews with the world's first batch of healthcare workers who have worked in ACFs through a qualitative study based on Grounded Theory. The healthcare workers interviewed from Heilongjiang, Shandong, Fujian, and Hubei provinces, have worked in one of the four different ACFs built in Wuhan. The results are obtained through the three-level codes and analyses of the interview recordings.

Results

The factors affecting the perception of healthcare workers in ACFs during the epidemic situation can be summarized into five major categories: individual characteristics, organization management, facilities and equipment, space design, and internal environment. The five major categories affecting the composition of perception can be further divided into endogenous and exogenous factors, which jointly affect the perception of healthcare workers in ACFs. Among them, individual characteristics belong to endogenous factors, which are the primary conditions, while other categories belong to exogenous factors, which are the decisive conditions.

Conclusion

This paper clarifies factors affecting the perception of healthcare workers in ACFs and analyzes the mechanism of each factor. It is posited that the passive strategies are a promising solution to protect healthcare workers' health, improve their work efficiency, and help reduce the operation stress of ACFs. We should train multidisciplinary professionals for future healthcare and enhance collaborations between healthcare workers and engineers. To sum up, this paper broadens new horizons for future research on the optimization of ACFs and finds new paths for alleviating healthcare workers' adverse perceptions of ACFs.

The longitudinal association between Perceived Stress, PTSD Symptoms, and Post-Traumatic Growth during the COVID-19 Pandemic: the role of coping strategies and psychological inflexibility

The present study investigates the mediating roles of psychological inflexibility and differential coping strategies on perceived stress and post-traumatic symptoms and growth in the context of COVID-19. Study one recruited 662 participants (54.8% women; Mage = 40.64 years, SD = 13.04) who completed a cross-sectional questionnaire. It was proposed that orientation to the problem, avoidance strategies, psychological inflexibility, and positive attitude were mediators for the positive association between perceived stress and PTSD symptoms. The fit indices for the path model were excellent: CFI = 0.977, TLI = 0.950, RMSEA = 0.057 [90%CI = 0.043-0.081], and SRMS = 0.042. Gender and stressful events encountered had indirect effects on the endogenous variables. In study two, 128 participants (57.8% women; Mage = 42.30, SD = 12.08) were assessed for post-traumatic growth one year later. Psychological inflexibility and orientation acted as mediators between perceived stress and PTSD symptoms. Furthermore, a novel path model was constructed in which psychological inflexibility and orientation to the problem as mediators for perceived stress and PTSD symptoms. The indices for the path model were excellent: CFI = 0.99, TLI = 0.97, RMSEA = 0.055 [90%CI = 0.001-0.144], and SRMS = 0.49. Furthermore, PTSD symptoms, psychological inflexibility, and orientation to the problem predicted post-traumatic growth. Specifically, both orientation to the problem (β = .06 [90%CI: .01;.13]) and psychological inflexibility (β = .14 [90%CI: .08;.26]) had an indirect effect on post-traumatic growth. Overall, these results significantly contribute to the literature as orientation to the problem positively predicted PTSD symptoms and post-traumatic growth one year later while psychological inflexibility predicted PTSD symptoms and less post-traumatic growth one year later. These results underline the importance of assessing both symptomology and psychological growth to determine adaptive coping strategies in specific contexts.

"We were building the plane as we were flying it, and we somehow made it to the other end": syringe service program staff experiences and well-being during the COVID-19 pandemic

BACKGROUND

Syringe service programs (SSPs) provide essential harm reduction and prevention services for people who inject drugs in the USA, where SSP coverage is expanding. During the COVID-19 pandemic, US SSPs underwent unprecedented shifts in operational procedures (e.g., closures of physical sites, staff redeployment into pandemic response efforts). Given the critical role of US SSP workers in the pandemic, we sought to explore the occupational experiences and well-being of SSP staff to inform future emergency response efforts.

METHODS

From July-October 2020, we conducted semi-structured interviews with staff members of four SSPs in diverse regions of Massachusetts. Trained interviewers administered qualitative interviews virtually. Interviews were coded in NVivo v12 and thematic analysis identified common occupational experiences and related impacts on staff well-being in the context of the COVID-19 pandemic.

RESULTS

Among 18 participants, 12 (67%) had client-facing roles such as harm reduction specialists and six (33%) worked in program management or leadership. We found that staff were frequently anxious about SARS-CoV-2 transmission, which contributed to staff turnover. SSPs rapidly adapted and expanded their services to meet increasing client needs during the pandemic (e.g., food distribution, COVID-19 testing), leading to staff overexertion. Simultaneously, public health measures such as physical distancing led to staff concerns about reduced social connections with clients and coworkers. Through these challenges, SSPs worked to protect staff well-being by implementing flexible and tangible COVID-19-related policies (e.g., paid sick leave), mental health resources, and frequent communication regarding pandemic-related operational changes.

CONCLUSION

SSPs in the USA adapted to the COVID-19 pandemic out of necessity, resulting in operational changes that threatened staff well-being. Despite the protective factors revealed in some narratives, our findings suggest that during prolonged, complex public health emergencies, SSPs may benefit from enhanced occupational supports to prevent burnout and promote wellness for this essential public health workforce.

Posttraumatic Stress Disorder among Registered Nurses and Nursing Students in Italy during the COVID-19 Pandemic: A Cross-Sectional Study

(1) Background: Posttraumatic stress disorder (PTSD) is a mental health disorder characterized by a range of syndromal responses to extreme stressors. The present study aimed to explore any differences in PTSD between registered nurses and nursing students, according to sex and nursing experience, during the COVID-19 pandemic. (2): Methods: An observational descriptive study was conducted among Italian nurses and nursing students during the first wave of the COVID-19 pandemic. An online questionnaire was distributed in an anonymous form through the Google function of Google Modules to some social pages and nursing groups. (3) Results: In total, 576 participants were enrolled in this study. Of these, 291 (50.50%) were registered nurses and 285 (49.50%) were nursing students. By considering the Impact of Event Scale—Revised values in nurses and in nursing students according to sex, a significant difference was reported in the avoidance sub-dimension (p = 0.024), as female nurses recorded higher levels than nursing students. No further significant differences were suggested by considering both sex and nursing experience, respectively. (4) Conclusion: PTSD could be a serious consequence for both nurses and nursing students during the COVID-19 pandemic.

Coping strategies at the frontline of care: Comparisons between Covid-19 and non-Covid-19 units' nurses and the role of moderator variables

INTRODUCTION

Relatively few studies focused on the coping strategies adopted by the healthcare workers during the second phase of the pandemic. The present study compared the coping strategies between Italian nurses working in Covid-19 and in other units and it explored whether socio-demographic and work-related variables moderate the relation between the type of unit and coping strategies.

METHODS

A web-based questionnaire that included sociodemographic and work-related questions and the Coping Orientation to Problem Experienced-New Italian Version-25 item was administered. Moderation effects between variables and coping strategies were analyzed using generalized linear models.

RESULTS

253 nurses participated. Nurses who worked in a Covid-19 unit had significantly lower scores on Avoidance Strategies subscale and higher scores on Positive Attitude and Social Support subscales than nurses working in other units.

DISCUSSION

Gender differences emerged only on the social support coping dimension, with women being more likely to adopt social support than men. No association between the type of unit and the other coping strategies was found.

CONCLUSION

Nurses working in Covid-19 units showed better coping strategies than their colleagues: this suggests that support interventions aimed to promote coping strategies should be offered also to Covid-19-free units' nurses.

COVID-19-A Qualitative Orthopaedic Nurse Perspective

In response to a March 2020, New York State mandate, our elective surgery center began a physical and operational transformation to provide inpatient care to COVID-19 patients. Research study aims included (1) a description of the orthopaedic nurses' experience during the pandemic, and (2) tactics used to cope with related stress. Researchers used a descriptive, qualitative design to achieve study aims. During April to December 2020, nine nurses responded to seven open-ended, study prompts asking them to journal their thoughts about the pandemic. The majority (66%) of participants were experienced nurses and all provided direct patient care. Nurses provided 51 journal entries that generated 12 themes, which encapsulated their experience living through the pandemic: (1) Whirlwind, (2) War, (3) Control, (4) Death and Dying, (5) Staying Safe, (6) Loss, (7) Looking for Meaning, (8) Whatever It Takes, (9) Adaptability and Resilience, (10) What I Have Learned, (11) The New Normal, and (12) When Will This Be Over? Orthopaedic nurses in this study pivoted to the needs of patients requiring them to draw on all their training and resources. Nurses described the enormity and taxing nature of the viral threat and their ability to manage their well-being while caring for patients and loved ones, amidst social distancing and need for aggressive infection control. Support from peers and leadership were paramount factors in nurse coping. Positive thinking and personal resilience were considered essential. Most participants described personal growth; however, decreased participation in journal responses overtime, suggested emotional strain. Future studies should examine nurses' observations about the impact of changes to their practice brought on by the pandemic, and reliance on technology.

Factors affecting the professional functioning of health care workers during the COVID-19 pandemic: A cross-sectional study

AIM

To examine personal and organisational factors related to professional functioning of nurses and physicians during the COVID-19 pandemic.

BACKGROUND

Exposure to COVID-19-related stressors has been associated with lower self-reported professional functioning among health care workers.

METHODS

A cross-sectional study among 115 hospital workers during the COVID-19 pandemic in Israel was designed to explore (a) personal professional functioning, (b) clarity of guidelines, (c) work organisation by the management, and (d) health care workers' feeling of contribution to a global effort.

RESULTS

A feeling of contribution to a global effort while treating patients with COVID-19 mediated the relationships between work organisation by the management and professional functioning (β = .05, p < .05). The clarity of guidelines for routine procedures (β = .21, p < .05) and a feeling of β contribution to a global effort (β = .34, p < .01) positively predicted professional functioning of nurses and physicians during COVID-19 pandemic (R2  = .19, p < .01).

CONCLUSIONS

In order to achieve optimal functioning of health care workers in an emergency, managers should provide clear guidelines and promote workers' feelings of contribution to a global effort.

IMPLICATIONS FOR NURSING MANAGEMENT

The provision of clear guidelines and protocols is essential for efficient emergency management. Expressing appreciation for health care workers and providing positive feedback may improve professional functioning.

Behavioral Intentions and Factors Influencing Nurses' Care of COVID-19 Patients: A Cross-Sectional Study

Objective

Behavioral intentions to care for patients with infectious diseases are crucial for improving quality of care. However, there have been few studies of the behavioral intentions and factors influencing patient care by clinical nurses during the COVID-19 pandemic. This study aims to explore cognition, attitudes, subjective norms, self-efficacy, and behavioral intentions of clinical nurses while caring for COVID-19 patients and to explore any influencing factors.

Method

A cross-sectional survey was conducted of nurses through convenience sampling in southeast China from February 2020 to March 2020. The questionnaire was developed based on the theory of planned behavior and self-efficacy.

Results

A total of 774 nurses completed the survey. Of these, 69.12% (535/774) reported positive behavioral intentions, 75.58% (585/774) reported a positive attitude, and 63.82% (494/774) reported having the confidence to care for patients. However, the lack of support from family and friends and special allowance affected their self-confidence. Attitude, self-efficacy, subjective norms, and ethical cognition were significantly positively correlated with behavioral intentions (r = 0.719, 0.690, 0.603, and 0.546, respectively, all P < 0.001). Structural equation model showed that self-efficacy, attitude, ethical cognition, and subjective norms had positive effects on behavioral intentions (β = 0.402, 0.382, 0.091, and 0.066, respectively, P < 0.01). The total effect of behavioral intentions was influenced by attitude, ethical cognition, self-efficacy, and subjective norms (β = 0.656, 0.630, 0.402, and 0.157, respectively, P < 0.01). In addition, ethical cognition had a positive mediating effect on behavioral intentions (β = 0.539, P < 0.001).

Conclusion

The study results indicated that attitude, ethical cognition, and self-efficacy were the main factors influencing nurses' behavioral intention. Efforts should be made to improve nurses' attitude and self-efficacy through ethical education and training to increase behavioral intentions to care for patients with infectious diseases, which will improve the quality of nursing care.

Sociodemographic and Psychological Predictors of Resilience Among Frontline Nurses Fighting the COVID-19 Pandemic

OBJECTIVE

According to a WHO report, the number of patients with coronavirus disease 2019 (COVID-19) has reached 456,797,217 worldwide as of 15 March, 2022. In Wuhan, China, large teams of health-care personnel were dispatched to respond to the COVID-19 emergency. This study aimed to determine the sociodemographic and psychological predictors of resilience among frontline nurses fighting the current pandemic.

METHODS

A total of 143 nurses were recruited from February 15 to February 20, 2020, to participate in this study. The 10-item Connor-Davidson Resilience Scale and the 21-item Depression Anxiety Stress Scale were used to estimate the participants' resilience and mental wellbeing.

RESULTS

Results showed that the nurses displayed a moderate resilience level. Their median depression, anxiety, and stress scores were 1, 2, and 3, respectively, which were negatively correlated with resilience. Female gender, being dispatched to Wuhan, and depression levels were the significant predictors of resilience.

CONCLUSIONS

The results suggest that particular attention should be given to nurses who were dispatched to Wuhan and who exhibited depression symptoms, and appropriate measures should be taken to boost their resilience.

COVID-19, Long COVID Syndrome, and Mental Health Sequelae in a Mexican Population

The COVID-19 pandemic is currently a worldwide threat and concern, not only because of COVID-19 itself but its sequelae. The aim of this study was to evaluate whether a relation between COVID-19, Long COVID, and the prevalence of mental health disorders exist. A total of 203 people from Tabasco were included in this study, answering a survey integrated by three dominions: General and epidemiological data, the DASS-21 test (to determine the presence of signs or symptoms suggestive of depression, anxiety, and/or stress) and an exploratory questionnaire about Long COVID syndrome. A descriptive and inferential statistical analysis was made via Microsoft Excel and Graphpad Prism software, evaluating differences through the Mann−Whitney U test and considering p < 0.05 as statistically significant. Of the 203 people surveyed, 96 (47.29%) had had COVID-19 and 107 (52.71%) had not; from the ones that had COVID-19, 29 (30.21%) presented mental health disorders and 88 (91.66%) presented at least one symptom or sign of Long COVID syndrome; meanwhile, 31 (32.29%) presented 10 or more symptoms or signs. From the comparison between the population with previous mental health disorders and COVID-19 and those without background disorders or COVID-19, the results were the following: 27.58% vs. 16.82% presented severe depression, 48.27% vs. 17.75% presented severe anxiety, and 27.58% vs. 20.56% presented severe stress. A high prevalence of mental health effects was observed in patients without COVID-19 and increased in the population with Long COVID syndrome and previous mental health disorders.

The COVID-19 experience: A survey of RNs

PURPOSE

To explore the psychological factors that impacted RNs during the COVID-19 pandemic.

METHODS

Survey response data were collected from 151 respondents across 25 states and various healthcare system settings.

RESULTS

RNs in clinical settings had slightly more emotional stress than those in academia. Concerns ranged from personal health and family considerations to large-scale sociopolitical issues.

CONCLUSIONS

RNs in all settings experienced at least some emotional stress during the early stages of the pandemic. However, in a majority of respondents, none of the stressors individually or in combination were so great as to encourage departure from the profession.

The Work Environment during Coronavirus Epidemics and Pandemics: A Systematic Review of Studies Using Quantitative, Qualitative, and Mixed-Methods Designs

We aimed to provide an overview of how work environment and occupational health are affected, and describe interventions designed to improve the work environment during epidemics and pandemics. The guidelines on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were followed. The databases Cinahl, Medline, PsycInfo, and Web of Science were searched for population: working population; exposure: coronavirus epidemic or pandemic; and outcome: work environment, in articles published until October 2020. Quality assessment was based on a modified version of the Mixed Methods Appraisal Tool (MMAT). After deduplication 3711 articles remained, of which 530 were selected for full-text screening and 119 for quality assessment. After the exclusion of studies that were low quality, 95 remained, of which 85 focused on healthcare personnel and 10 on employees in other industries; 73 used quantitative methods and 22 used qualitative or mixed methods; the majority were based on cross-sectional data. Healthcare staff experienced increased job demands, poor leadership, and lack of resources (personal protective equipment, personnel, and competence). High demands and work with infected patients were associated with negative mental health outcomes. There was a lack of studies assessing interventions, studies from industries other than healthcare, and studies of high quality.

"Getting caught unprepared": A phenomenological study of Indonesian nurses dealing with difficulties when caring for patients with coronavirus disease (COVID-19)

The emergence of coronavirus disease 2019 (COVID-19) has brought pressure and challenges to nurses worldwide. This study aims to understand the lived experiences of nurses in overcoming challenges when delivering care for patients with COVID-19 in Indonesia. The study employed a phenomenological research design. The researchers purposely selected nine nurses who provided care for patients with COVID-19 at an urban public hospital in Yogyakarta, Indonesia, between September and December 2020. The researchers conducted face-to-face interviews with participants. The interview data transcriptions were analyzed using Colaizzi's phenomenological analysis. The experiences of nurses in providing care for patients with COVID-19 can be summarized into three themes: (1) getting caught unprepared, (2) understanding and adapting to a new working situation, and (3) finding new meaning in the nursing profession. This study suggested that nurses overcame difficulties in caring for patients with COVID-19 by using multidimensional and culturally informed coping strategies. Hospital managers and policymakers need to consider culturally relevant coping strategies (i.e., religious-based coping strategies) when supporting healthcare providers during public health emergencies.

Lessons from the COVID-19 epidemic in Hubei, China: Perspectives on frontline nursing

Background

The emergence of COVID-19 has been an ordeal for nurses worldwide. It is crucial to understand their experiences at the frontline, attempt to allay their concerns, and help inform future pandemic response capabilities.

Aims

To explore nurses’ lived experiences at the frontline in order to identify and address their concerns and help enhance future responses to infectious disease outbreaks.

Methods

A qualitative study was carried out. Semi-structured interviews were conducted with 60 registered nurses who came to Hubei from different parts of China to care for patients with COVID-19. Interviews were audio-recorded and transcribed verbatim for thematic analysis.

Results

Six major themes emerged: emotional turmoil due to personal and professional concerns, quality issues with personal protective equipment and associated physical discomfort, witnessing and managing patient distress, readiness of emergency response mechanisms in the health system, collective community awareness and preparedness, and heightened professional pride and confidence in future epidemic control.

Discussion

Nurses were placed in challenging and unfamiliar situations to deal with unexpected and unpredictable events which caused considerable psychological and physical distress. Support in the form of government edicts, hospital management policies, community generosity and collegiality was highly welcomed by the nurses. Policy makers and managers should ensure that nurses are provided with the support and resources necessary for dealing with large-scale infectious disease outbreaks. Priority should be given to risk assessment, infection prevention and control, and patient and staff health and safety.

The perceptions of nursing students regarding coronavirus and occupation according to gender: A qualitative study

Outbreaks are experienced differently based on gender. In the context of the Covid-19 epidemic, students' perceptions of the nursing profession, their feelings related to themselves, their social circle, nursing, and the appropriateness of nursing practices are important. This study aimed to determine the perceptions of nursing students of the Coronavirus and their occupation according to gender. Twenty nursing students were interviewed using the semi-structured interview method. Content analysis and MAXQDA were performed. Five categories were identified: Visual perceptions regarding the nursing occupation and Covid-19, future nurses' occupational perceptions according to gender of pandemics such as the Coronavirus, the effect of the pandemic on occupational perception, perceptions of the people around them of their profession in relation to the pandemic, and the approach toward any pandemic in the future in terms of their profession as a nurse. Pandemics such as Covid-19 can affect the occupational perceptions of nursing students.

The psychological distress and COVID-19 pandemic during lockdown: A cross-sectional study from United Arab Emirates (UAE)

Background

The pandemic resulted in the societal changes as conflicts and instability were the common concerns experienced by families because of the lockdown. However, the psychological impact of the COVID-19 on the United Arab Emirates (UAE) population is not studied extensively.

Objective

The study evaluates the psychological impact of lockdown during the pandemic on the people in the UAE.

Material and methods

This study was cross-sectional in nature and was conducted using a questionnaire consisting of 35-items. The questions were related to social, psychological, and personal aspects. Multivariate Linear regression was used to find the outcomes between independent variables.

Results

The mean value of social phobia was 2.56 ± .620, followed by the mean score of anxiety (2.47 ± .666), stress (2.44 ± .631), and depression (2.42 ± .682). The higher the respondents experienced the scores, the more depression, anxiety, and stress. Demographics such as marital status, age, and occupation and education level have a statistically significant association with social phobia, anxiety, depression, and stress.

Conclusion

The study concludes that the lockdown more psychologically impacted males, older people, and unemployed individuals during the pandemic.

The Effect of Mindfulness-Based Breathing and Music Therapy Practice on Nurses' Stress, Work-Related Strain, and Psychological Well-being During the COVID-19 Pandemic: A Randomized Controlled Trial

Infectious diseases cause psychological problems for health care workers and especially nurses. Nurses who provided coronavirus disease-2019 (COVID-19) patients with care experience negative feelings such as stress, work-related strain, discomfort, and helplessness related to their high-intensity work. The aims of this study are to investigate the effect of the mindfulness-based breathing and music therapy practice on stress, work-related strain, and psychological well-being levels of nurses who provided COVID-19 patients with care. This randomized controlled trial was conducted in a COVID-19 department at a university hospital in Turkey. Nurses who care for patients infected with COVID-19 were randomly divided into an intervention group (n = 52) and a no-treatment control group (n = 52). The intervention group received mindfulness-based breathing and music therapy. In data collection, the Personal Information Form, State Anxiety Inventory, Work-Related Strain Scale, and Psychological Well-Being Scale were used. The data from the study showed that mindfulness-based breathing and music therapy decreased stress and work-related strain (P < .05) and increased psychological well-being (P < .05). The control group showed no statistically significant changes on these measures (P > .05). The mindfulness-based breathing and music therapy practice reduced nurses' stress and work-related strain and increased psychological well-being during the COVID-19 pandemic.

The Experiences of Nurses in Care Provision to COVID-19 Patients: A Qualitative Study

Introduction

Nurses are key fighters in the forefront of care provision to COVID-19 patients. Due to the diversity of nurses' experiences in different countries because of variable nursing resources, health care systems, and cultural contexts, the present study aimed to divulge a deep understanding of the essence of health system problems based on nurses' experiences of care provision to COVID-19 patients in Iran.

Methods

The present study was conducted based on the conventional content analysis method and Graneheim &amp; Lundman approach. The participants included the nurses working in the COVID-19 wards and were recruited by purposeful sampling and based on inclusion criteria. The data were collected by conducting semi-structured, one-to-one interviews, and taking field notes, until reaching data saturation.

Results

In-depth interviews with 12 nurses. represented four main categories and six subcategories. Sudden exposure to an unknown threat (nurses' feelings and concerns and nurses' reactions), being involved in an unequal war (a vicious virus and weary nurses), stressful working conditions, and efforts to confine the threat (seeking for new and adequate information and gathering all forces) were among the emerged data.

Conclusion

The nurses' experiences showed that despite passing a while since the coronavirus pandemic, there are still individual and professional concerns that all root in organizational and governmental factors.

Changes in Anxiety Level and Personal Protective Equipment Use Among Healthcare Workers Exposed to COVID-19

BACKGROUND

The relationship between changes in anxiety levels and personal protective equipment (PPE) use is yet to be evaluated. The present study assessed this relationship among healthcare workers (HCWs) involved in the care of patients with coronavirus disease 2019 (COVID-19).

METHODS

An online survey was conducted in a municipal hospital with 195 nationally designated negative pressure isolation units in Korea. Anxiety level was measured using the self-rating anxiety scale (SAS), and changes in anxiety levels were assessed based on the time when COVID-19 vaccine was introduced in March 2021 in Korea. Monthly PPE usage between June 2020 and May 2021 was investigated.

RESULTS

The mean SAS score (33.25 ± 5.97) was within normal range and was lower than those reported in previous studies conducted before COVID-19 vaccination became available. Among the 93 HCWs who participated, 64 (68.8%) answered that their fear of contracting COVID-19 decreased after vaccination. The number of coveralls used per patient decreased from 33.6 to 0. However, a demand for more PPE than necessary was observed in situations where HCWs were exposed to body fluids and secretions (n = 38, 40.9%). Excessive demand for PPE was not related to age, working experience, or SAS score.

CONCLUSION

Anxiety in HCWs exposed to COVID-19 was lower than it was during the early period of the pandemic, and the period before vaccination was introduced. The number of coveralls used per patient also decreased although an excessive demand for PPE was observed.

Alleviating psychological symptoms in nurses during disease outbreaks: An integrative review

AIM

To explore interventions and coping strategies used to treat the psychological symptoms associated with compassion fatigue among nurses.

BACKGROUND

The rapid transmission of infectious diseases (e.g., COVID-19) has put nurses, around the world, at high risk of developing profound psychological health issues due to compassion fatigue. If unrelieved, compassion fatigue can lead to catastrophic psychological symptoms such as depression, stress, anxiety, and insomnia, negatively impacting patient care. This necessitates interventions to prevent or mitigate the psychological symptoms of compassion fatigue.

METHOD

Following Whittemore and Knafl's integrative review method, the literature search comprised three databases: CINAHL, MEDLINE-OVID, and Scopus.

RESULTS

The 11 included studies were categorized into four themes: (1) using relaxation strategies, (2) neutralizing emotional trauma, (3) enhancing nurses' preparedness for confronting disasters, and (4) educating nurses about coping strategies to manage their psychological issues.

CONCLUSION

Researchers studied several coping strategies and interventions. There is a need for policymakers' support and hospital-level interventions. Early interventions may prevent or relieve psychological issues.

IMPLICATIONS

The findings have implications for hospital leaders around the world to initiate interventions that teach nurses strategies to cope with stressful events. Future researchers might consider long-term supports and multiple interventions that target several leading causes of psychological symptoms among nurses before, during, and after high-stress situations. Policymakers around the world could use the findings to initiate policies to facilitate nurses' access to needed resources, hence protecting their mental health and increasing the quality of patient care.