Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review

Psychological first aid in the intensive care unit

The intensive care unit (ICU) is a stressful environment for patients and their families as well as healthcare workers (HCWs). Distress, which is a negative emotional or physical response to a stressor is common in the ICU. Psychological first aid (PFA) is a form of mental health assistance provided in the immediate aftermath of disasters or other critical incidents to address acute distress and re-establish effective coping and functioning. The aim of this narrative review is to inform the development and utilization of PFA by HCWs in the ICU to reduce the burden of distress among patients, caregivers, and HCWs. This is the first such review to apply PFA to the ICU setting.

Development and psychometric validation of the frontline health workers' occupational risk and characteristics in emergencies index (FORCE-index) - The covid Hospital cohort study

Objectives

A lack of tools for the systematic identification of frontline health workers' changing occupational risks, characteristics, and needs, poses a major barrier to supporting vital personnel to stay in practice through health emergencies and beyond. The current study reports on the development and psychometric evaluation of the Frontline health workers' Occupational Risk and Characteristics in Emergencies index (FORCE-index).

Study design

The Covid hospital study is a large, multisite, four-wave, open cohort study of frontline health workers responding to the first four waves of the COVID-19 pandemic (2020-2022).

Methods

2496 frontline health workers responded to questionnaires assessing various aspects of their work environment. Using exploratory factor analysis, we estimated the latent structure of the FORCE-index at the first and second waves. This structure was evaluated using confirmatory factor analysis at the third and fourth waves. The internal consistency of the instrument's subscales (e.g., factors) was evaluated using omega reliability, Cronbach's alpha coefficient, and mean inter-item correlation.

Results

A nine-factor solution provided best fit to the data. These factors mapped onto the following aspects of the work environment; competency, stress management, familiarity, workload manageability, work performance, infection safety, personal protective equipment, social safety, and social support. Internal consistency for the full FORCE-index and the nine factors was satisfactory.

Conclusions

The initial psychometric validation indicates that the FORCE-index is a valid measure which can be used by health authorities, services, and institutions to adequately and systematically assess central aspects of frontline health workers' work environment that are commonly challenged in health emergencies.

Prediction models for sleep quality among frontline medical personnel during the COVID-19 pandemic: cross-sectional study based on internet new media

Background

The factors associated with sleep quality among medical personnel providing support on the frontline during the height of the COVID-19 pandemic remain unclear, and appropriate predictive and screening tools are lacking. This study was designed and conducted to investigate whether factors such as weight change, job title, and tea consumption influence the sleep quality of these workers. Additionally, the study aims to develop predictive models to analyze the sleep problems experienced by healthcare workers during periods of epidemic instability, and to provide relevant data and tools to support effective intervention and prevention strategies.

Methods

A cross-sectional study was conducted from June 25 to July 14, 2022, using a self-administered general information questionnaire and the Pittsburgh Sleep Quality Index (PSQI) to investigate the sleep quality of medical personnel providing aid in Shanghai. The relevant influencing factors were obtained via univariate analysis and multivariate stepwise logistic regression analysis, and 80% of the data were used in the training-test set (n = 1,060) and 20% were used in the independent validation set (n = 266). We used snowball sampling to establish the six models of logistics (LG), deep learning (DL), naïve Bayes (NB), artificial neural networks (ANN), random forest (RF), and gradient-boosted trees (GBT) and perform model testing.

Results

Among the participants, 75.8% were female. Those under 35 years of age comprised 53.7% of the medical staff, while those over 35 years accounted for 46.3%. The educational background of the participants included 402 individuals with an associate degree (30.3%), 713 with a bachelor's degree (53.8%), and 211 with a master's degree or higher (15.9%).Weight, job title, and tea consumption during the aid period were the main factors influencing the sleep quality of medical personnel during the aid period. The areas under the curve (AUC) of LG, DL, NB, ANN, RF, and GBT were 0.645, 0.656, 0.626, 0.640, 0.551, and 0.582, respectively. The DL model has the best prediction performance (specificity = 86.1%, sensitivity = 45.5%) of all the models.

Conclusion

During the height of the COVID-19 pandemic, the sleep quality of frontline medical personnel providing aid in Shanghai was influenced by multiple factors, and the DL model was found to have the strongest overall predictive efficacy for sleep quality.

The negative and positive: perceptions regarding COVID-19 pandemic among an online sample of adults; qualitative study

BACKGROUND

The novel coronavirus disease, which is a global public health issue, changed the regular lifestyle of public globally causing multitude of stressors. This study aimed to describe the perception regarding the COVID-19 pandemic among an online sample of adults in Sri Lanka.

METHODS

A descriptive exploratory study was conducted with a purposive selected sample of general public in Sri Lanka. Twelve in-depth interviews were conducted using a semi-structured interview guide until data saturation. The data were analyzed using thematic analysis.

RESULTS

All participants were below 50 years and educated upto advanced level. Seven themes were identified based on in-depth interviews; (1) traditional views regarding disease; (2) fear; (3) disrupted future plans; (4) impaired sense of responsibilities; (5) intense work stress (6) time to cherish, and (7) anticipated adjustments for future pandemics.

CONCLUSIONS

People have experienced fear, uncertainty, distracted future plans, and work stress due to the pandemic. However, they have also enjoyed spending time with their family members during this period.

Anxiety or reflection? exploring profiles of death awareness among chinese nurses: a latent profile analysis

BACKGROUND

Nurses frequently encounter death due to their professional roles, impacting their perceptions of mortality. Previous research has largely focused on the negative aspect of death awareness, known as death anxiety, while the other aspect, death reflection, has been less explored. This study aims to investigate the profiles of death awareness among Chinese nurses and identify factors influencing these profiles, such as socio-demographic characteristics, work-related characteristics, death education, and resilience.

METHOD

A cross-sectional study was conducted using a convenience sample of 2882 nurses across China. Data were collected through an online survey from September to November 2023. Latent Profile Analysis was utilized to identify distinct profiles of death anxiety and death reflection among nurses. Multinomial logistic regression was used to analyze the predictive factors for different death awareness profiles.

RESULTS

Three distinct profiles were identified: Calm Reflectors (low death anxiety, high death reflection), The Anxious (high death anxiety, low death reflection), and Anxious Reflectors (high levels of both death anxiety and death reflection). Factors such as resilience, years of service, parental status, education level, and read death education-related information significantly predicted the classification into these profiles. Specifically, higher resilience and engagement in death education were associated with the Calm Reflectors profile.

CONCLUSIONS

Our study suggests that nurses' death awareness can be categorized into three distinct profiles: Calm Reflectors, The Anxious, and Anxious Reflectors. Key predictors of these profiles include resilience, educational level, years of service, parental status, and read death education-related information. The findings suggest that enhancing resilience and targeted educational interventions are crucial for supporting nurses in managing death-related emotional and cognitive responses effectively.

Unveiling the impact: understanding long-term care workers' experiences and their perceptions of resident challenges amidst the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, long-term care (LTC) facilities in Canada were confronted with many rapidly changing public health safety guidelines. Based on the guidelines, LTC facilities had to implement a series of virus containment and mitigation measures, presenting significant challenges for both workers and residents. This research aims to provide insights that could be used to guide improvements in the experiences of LTC workers, and of residents, in future pandemic crises.

METHODS

A qualitative multi-case study was used to explore the pandemic experiences of a demographically diverse group of LTC workers in Canada, focusing on how public health safety guidelines impacted them, and their perceptions of challenges faced by residents. Fourteen workers were engaged from facilities in Nova Scotia and British Columbia, which are regions distinct geographically and with differences in safety guidelines and implementation. Semi-structured interviews were conducted between April to October 2021. Using thematic analysis, we identified patterns within and across the interview transcripts.

RESULTS

The thematic analysis provided an understanding of the experiences and perspectives of LTC workers. There were four key themes: (1) Tangling with Uncertainty, that describes the effects of ambiguous messaging and shifting COVID-19 safety guidance on workers; (2) Finding Voice, that highlights how workers coped with feelings of helplessness during the healthcare crisis; (3) Ripple Effects, of pandemic pressures on workers beyond resident care, that included strengthening of inter-colleague support as well as financial challenges, and; (4) Loss of Home, where workers perceived that protection of residents led to a loss of the residents' home environment, personal freedom, and autonomy.

CONCLUSIONS

The findings suggest that LTC workers' experiences during future pandemics may be improved by their inclusion in the development of public health safety guidelines, facilitating inter-colleague support systems, and ensuring worker financial stability. A balance should be found between preventing infection in LTC facilities and retaining the principles of holistic and resident-centered care for workers' and residents' mental health benefits.

Evolution of burnout syndrome in Spanish healthcare professionals during and after the COVID-19 pandemic: psychosocial variables involved

Introduction

Evidence shows that throughout the COVID-19 pandemic, healthcare workers have experienced high levels of burnout. The preceding literature also points to the need to consider the three elements of burnout independently, as they appear to have different evolutionary trends and possibly different buffering and amplifying variables, although these aspects have hardly been explored.

Methods

The aim of the present investigation is precisely to shed light on these latter issues. It is a prospective study, carried out in 256 healthcare workers in Spain during three time points in relation to the COVID-19 pandemic: (1) (T1) between 5 May and 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March), (2) (T2) 6 months after the end of the state of alarm (January-April 2021), and (3) (T3) 1 year after this second evaluation (April-July 2022). The different components of burnout syndrome (emotional exhaustion, depersonalization and self-fulfillment) were assessed at the second and third time points. Together with sociodemographic and occupational data (age, gender, professional category, years of experience, hours of work), anxiety, depression, stress, family support, friends' support, and self-efficacy were assessed at the first time point. At the second time point, cognitive fusion and resilience were assessed. At the third time point, optimism and hopelessness were assessed.

Results

The results show significant decreases in burnout syndrome (p < 0.001). However, when observing the evolution of each of the dimensions, it can be seen that emotional exhaustion has significantly decreased (p < 0.001), while an increase in depersonalization (p < 0.001) and a decrease in self-fulfillment (all p < 0.001) are observed. The results of the repeated measures General Linear Models, after controlling for the effect of the covariates show that the evolution of emotional exhaustion is associated with the levels of depression at T1 (p = 0.031), of cognitive fusion at T2 (p < 0.001) and of resilience at T2 (p = 0.039). The evolution of depersonalization is associated with levels of hopelessness at T2 (p = 0.042). Finally, the evolution of self- fulfillment is associated with levels of optimism at T3 (p = 0.043) and hopelessness at T3 (p = 0.019).

Discussion

The results highlight the need to attend to the three components of burnout in a differentiated manner. Our results indicate that, during the COVID-19 pandemic, although overall burnout levels tend to decrease, it is actually emotional exhaustion that decreases, but levels of depersonalization increase and self- fulfillment decreases. In addition, the data point to the different personality factors involved in each of the dimensions. While the evolution of emotional exhaustion seems to be more affected by the levels of symptomatology (i.e., depression) at the onset of the pandemic, and of the inability to handle intrusive thoughts (i.e., cognitive fusion), the evolution of depersonalization and self- fulfillment are more related to long-term cognitive-emotional personality variables such as optimism and hopelessness.

Practical implications

The results found have important practical implications for the prevention of each of the implicated components of the syndrome. Although further research is needed, emotional exhaustion is shown to be one of the dimensions affected in the short term and intervention programs aimed at reducing anxiety and depression at times of acute stress (onset of the COVID-19 pandemic), including thought management, seem fundamental. Depersonalization and decreased self-fulfillment do not seem to respond to the same pattern. They are shown as results of a chronification of a poor management of emotional exhaustion, and in the case of their appearance, given the variables associated with their evolution (i.e., optimism and hopelessness), therapies more focused on the meaning of existence, such as Acceptance and Commitment Therapy, could be useful.

[Workload and mental health of nursing staff in Germany during the COVID-19 pandemic-a scoping review]

BACKGROUND

In March 2023, there was no comprehensive overview of job demands, resources, and mental health consequences for nurses in Germany during the COVID-19 pandemic. Because of country-specific differences with regard to the course/management of the pandemic and the organization of the healthcare system, data from Germany were analyzed specifically.

METHODS

A systematic search in databases (PubMed/Medline, PsycINFO) yielded 50 relevant studies that were included in the scoping review.

RESULTS

The studies were based on cross-sectional designs, mostly from the hospital setting and the first year of the pandemic. Frequently investigated job demands were work intensification, lack of protective equipment, rapidly changing regulations, contact with COVID-19 patients, and pandemic-related worries/anxieties. Pandemic phase and setting-specific demand cascades became clear. Frequently examined mental health problems (including stress experience, anxiety, depression, burnout, and intention to change career/job) were higher in groups with higher levels of reported job demands. Nurses generally reported less favorable values than medical professionals. Social support, reward/appreciation, humor, resilience, and sense of coherence proved to be resources.

CONCLUSION

In preparation for further pandemics and crises, pre-pandemic job demands should be reduced through targeted measures and relevant resources should be strengthened. Pandemic-specific job demands should be systematically reflected and cross-organizational solutions developed. Longitudinal studies using validated instruments and intervention studies should be the focus of future research funding.

An Exploratory Model of How Ethical Indicators Predict Health Professional Burnout

The objectives of this study were to characterize burnout in five different health professions (i.e., pharmacists, nurses, occupational therapists, psychologists, and mental health counselors) as well as to determine if moral distress, ethical stress, and/or ethical climate were predictive of burnout and job satisfaction. Cross-sectional survey data were collected in the USA using validated measures from a sample of 291 in early 2022 (COVID-19 Omicron wave). The average age of participants was 51 years (s.d. = 12.59) and most identified as female (78%), White/Caucasian (82%), married/in a domestic partnership (72%), without dependents (57%), and had > 20 years of experience (53%). Results demonstrated that two of the three dimensions of burnout (i.e., emotional exhaustion and depersonalization) reached clinically significant levels among nurses, occupational therapists, and pharmacists, but not among psychologists or mental health counselors. In testing an exploratory structural equation model, moral distress, ethics stress, and ethical climate contributed significantly to the burnout and job satisfaction of all professionals (CFI = 0.905; SRMR = 0.056; Gamma hat scaled = 0.931). These findings support a theoretical framework for explaining associations between ethical indicators and burnout and job satisfaction. Future research should explore if professions with less burnout experience differences in the organizational environment, autonomy, and independence of clinical work, and/or professional identity. Exploration into professional socialization, such as strategies learned as part of training and development, may be warranted to identify factors that buffer or mitigate burnout risk.

Digital-based emergency prevention and control system: enhancing infection control in psychiatric hospitals

BACKGROUND

The practical application of infectious disease emergency plans in mental health institutions during the ongoing pandemic has revealed significant shortcomings. These manifest as chaotic management of mental health care, a lack of hospital infection prevention and control (IPC) knowledge among medical staff, and unskilled practical operation. These factors result in suboptimal decision-making and emergency response execution. Consequently, we have developed a digital-based emergency prevention and control system to reinforce IPC management in psychiatric hospitals and enhance the hospital IPC capabilities of medical staff.

METHODS

The system incorporates modern technologies such as cloud computing, big data, streaming media, and knowledge graphs. A cloud service platform was established at the PaaS layer using Docker container technology to manage infectious disease emergency-related services. The system provides application services to various users through a Browser/Server Architecture. The system was implemented in a class A tertiary mental health center from March 1st, 2022, to February 28th, 2023. Twelve months of emergency IPC training and education were conducted based on the system. The system's functions and the users' IPC capabilities were evaluated.

RESULTS

A total of 116 employees participated in using the system. The system performance evaluation indicated that functionality (3.78 ± 0.68), practicality (4.02 ± 0.74), reliability (3.45 ± 0.50), efficiency (4.14 ± 0.69), accuracy (3.36 ± 0.58), and assessability (3.05 ± 0.47) met basic levels (> 3), with efficiency improvement and practicality achieving a good level (> 4). After 12 months of training and study based on the system, the participants demonstrated improved emergency knowledge (χ2 = 37.69, p < 0.001) and skills (p < 0.001).

CONCLUSION

The findings of this study indicate that the digital-based emergency IPC system has the potential to enhance the emergency IPC knowledge base and operational skills of medical personnel in psychiatric hospitals. Furthermore, the medical personnel appear to be better adapted to the system. Consequently, the system has the capacity to facilitate the emergency IPC response of psychiatric institutions to infectious diseases, while simultaneously optimising the training and educational methodologies employed in emergency prevention and control. The promotion and application of this system in psychiatric institutions has the potential to accelerate the digitalisation and intelligence construction of psychiatric hospitals.

The well-being of polish general practitioners during the COVID-19 pandemic-cross-sectional questionnaire-based study

BACKGROUND

The COVID-19 pandemic has caused psychological distress to the population and healthcare workers. Physicians' well-being is essential and contributes significantly to overall health. This study aimed to assess the strain on Polish general practitioners from the effects of the COVID-19 pandemic and to ascertain the potential predictors of their distress.

METHODS

Data was collected using a self-reported online questionnaire from 162 GPs in Poland between December 2020 and August 2021 as part of the international PRICOV-19 study. General practitioners' well-being was evaluated using the validated Mayo Clinic's expanded 9-item well-being index (eWBI). Spearman's correlation was used to measure the strength and direction of association between general practitioners' distress level and continuous variables, and for ordinal variables, Gamma correlation was recommended for many tide ranks. We also checked the association of the level of distress with continuous variables by categorizing them and applying the Kruskal-Wallis test likewise for a comparison of the distress in different practice locations.

RESULTS

A vast majority (80%) of respondents were considered at risk of distress during the COVID-19 outbreak, with an eWBI score of 2 or more. Higher distress scores were exhibited among general practitioners who reported increased responsibilities during the COVID-19 pandemic and perceived need for additional training. The experience of collaboration with neighbouring practices and the provision of adequate governmental support emerged as significant protective factors against distress. No correlation was observed between Polish general practitioners' distress level and years of professional experience, number of patients in the practice, number of doctors working there, the practice's location, or working with more vulnerable patient populations.

CONCLUSIONS

Our findings proved that COVID-19 placed an extraordinary emotional burden on Polish general practitioners and highlighted the importance of targeted support services and resource allocation to primary healthcare in Poland in case of any potential future crisis similar to the COVID-19 pandemic.

Community-based health programme for nurses and midwives: A mixed methods evaluation

AIM

To evaluate a community-based psychological health and well-being programme for nurses and midwives.

DESIGN

Mixed methods programme evaluation.

METHODS

Four studies were included: observational descriptive study (cross-sectional survey) of the health, well-being and experiences of previous programme participants (Study 1); observational exploratory prospective cohort study (longitudinal survey) of health, well-being and experiences of participants who engaged in the programme from 2020 to 2023 (Study 2); qualitative descriptive study (interviews) of experiences and perceptions of nurses and midwives who have engaged with the programme as participants or clinicians (Study 3); observational descriptive study (cross-sectional survey) of experiences and perceptions of programme stakeholders (Study 4). Surveys included validated measures. Data were collected online. Descriptive, repeated measures and thematic analyses were conducted.

RESULTS

One-hundred and fifteen participants completed Study 1: 20% (n = 23) reported stress in the severe-to-extremely severe category; 22% (n = 25) reported psychological distress in the moderate-to-severe category. Thirty-one programme participants were followed in Study 2: the effect of the programme on participant well-being over time was not significant. Sixteen programme participants and eight programme clinicians were interviewed (Study 3). Experiences of nurses and midwives engaging with the programme were highly positive and strong attributes of the programme included (1) shared professional experience of clinicians and participants which supported a common language and facilitated understanding, and (2) effective programme leadership, and autonomy and flexibility in the clinicians' role which enabled and supported a positive working experience. Thirty-nine broader stakeholders participated in a cross-sectional survey (Study 4). All stakeholders reported high satisfaction with the programme. Participants considered the programme being 'by nurses and midwives, for nurses and midwives' critical to the programme's success and value.

CONCLUSIONS

The community-based psychological health and well-being programme developed, led and delivered by nurses and midwives, for nurses and midwives, was a highly valued resource.

IMPACT

Levels of stress and burnout in the health workforce are high. A community-based psychological health and well-being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives. A programme delivered by nurses and midwives, for nurses and midwives, was considered critical to programme success. Programme leadership, and autonomy and flexibility in the programme clinicians' roles, facilitated and supported a positive working experience for programme clinicians.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Quality and safety in patient care is directly impacted by the well-being of nurse and midwives. A community-based psychological health and well-being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives.

REPORTING METHOD

Survey findings were reported according to STROBE (von Elm et al. in Lancet, 370:1453-1457, 2007) and qualitative findings according to COREQ (Tong et al. in International Journal for Quality in Health Care, 19(6):349-357, 2007).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Sleep disorders among frontline nurses after the COVID-19 outbreak: a large-scale cross-sectional study

This large-scale cross-sectional multicenter study aims to investigate the prevalence of sleep disorders among frontline nurses in China after the COVID-19 pandemic and to identify potential influencing factors contributing to these sleep disturbances. A total of 2065 frontline nurses from 27 provinces in China participated in an online survey conducted through the Wenjuan Xing platform. Data on demographic characteristics, work-related factors, and mental health assessments, including the Pittsburgh Sleep Quality Index (PSQI), Zung Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS), were collected. Statistical analyses, including chi-square tests, t-tests, binary logistic regression, and ROC analysis, were conducted to explore the relationships between various factors and sleep disorders. Over half (52.7%) of the surveyed nurses exhibited sleep disorders, reflecting a considerable post-pandemic impact on sleep quality. Factors such as nursing titles, personality traits, COVID-19 infection status, and exercise frequency showed statistically significant associations with sleep disorders. Extraverted nurses and those who had recovered from COVID-19 displayed a lower risk of sleep disorders, while anxiety was identified as an independent risk factor. The study also identified a nuanced relationship between exercise frequency and sleep quality. The study highlights a high prevalence of sleep disorders among frontline nurses post-COVID-19, emphasizing the need for targeted interventions. Factors such as nursing titles, personality traits, COVID-19 infection status, exercise habits, and anxiety levels were found to influence sleep quality. Comprehensive support strategies addressing these factors are essential for improving the overall well-being of frontline nurses and, subsequently, sustaining a resilient healthcare workforce. Further research is recommended to explore additional influencing factors and consider diverse nurse populations.

Misaligned Supports: Differences in Reported Health Care Worker Well-being Supports Provided and Needed During the COVID-19 Pandemic

PURPOSE

To describe the well-being supports provided to health care workers (HCWs) during the COVID-19 pandemic in health centers and hospitals.

DESIGN

Cross-sectional qualitative interviews before and after implementation of a peer-based support intervention.

SETTING

Purposively sampled hospitals and health centers across the US.

PARTICIPANTS

28 site leaders and 56 HCWs sampled from 16 hospitals and 12 health centers.

METHOD

Site leaders and HCWs were asked to describe supports available to HCWs during the COVID-19 pandemic. Thematic and content coding and analysis of interview responses were conducted using Dedoose.

RESULTS

Both site leaders and HCWs identified a range of support resources available. Communication resources were the most frequently cited in both groups. Health care workers reported bi-directional communication, while one-way communication was emphasized by site leaders. Hospitals highlighted counseling support, particularly Employee Assistance Programs (EAP), while health centers prioritized community support. Wellness activities were more prevalent in hospital settings, while health centers offered specific workplace-provided training for HCWs. Health care workers encountered barriers when accessing support, including limited time, fear of stigma, and disruptions to their existing support networks attributable to the pandemic.

CONCLUSION

While there are resources for HCWs, the available supports may not align with their needs and barriers to access may limit the effectiveness of these supports. Continued engagement between leaders and HCWs could help better align resources with needs.

Nurses' Sleep Quality and Its Influencing Factors During the First Explosive COVID-19 Outbreak in Zhejiang, China, After the Relaxation of Epidemic Prevention and Control Measures: A Multicentre Cross-Sectional Study

AIM

To investigate the sleep quality and its influencing factors among nurses in hospitals in Zhejiang, China, during the first explosive COVID-19 outbreak following the relaxation of prevention and control measures.

DESIGN

A multicentre cross-sectional study.

METHODS

Between 10 January and 20 January 2023-approximately 1 month after the policy was loosened-a total of 573 nurses from tertiary and community hospitals in Zhejiang participated in an online, self-administered survey. The participants were recruited using convenience sampling, and the survey was distributed via the WeChat platform. The survey included a general information form; the Self-Rating Scale of Sleep (SRSS); the Depression, Anxiety, and Stress Scale-21 (DASS-21); the Perceived Social Support Scale (PSSS); and the Brief Resilience Scale (BRS). Data analysis was conducted using SPSS version 26.0. Statistical methods employed included t-tests, one-way analysis of variance (ANOVA), chi-square tests and Mann-Whitney U-tests for comparisons between groups. Pearson correlation coefficients were calculated to analyse the relationship between the SRSS score and the DASS-21, PSSS and BRS scores. A multiple linear stepwise regression analysis was conducted to determine the independent influencing factors of sleep quality.

RESULTS

More than 90% of the nurses were infected with COVID-19, and 60.6% had sleep disorders. The regression analysis revealed that anxiety, the BRS score, comorbidities, hospital grade, clinical front-line, age and COVID-19 infection independently predicted sleep quality. The scores for several SRSS items were higher than the Chinese norm, especially for the nurses in tertiary hospitals.

PATIENT AND PUBLIC CONTRIBUTION

No patient or public contribution.

Enhancing the psychological well-being and sleep quality of healthcare providers with a multimodal psychological support program: a randomized controlled trial

Background

The COVID-19 pandemic significantly challenged the global healthcare system, especially frontline healthcare professionals, such as those working in intensive care units (ICUs). In late 2022, a sudden increase in COVID-19 cases in China led to a large number of ICU admissions, requiring new ICU staff (non-ICU professionals to work in ICUs), exacerbating their stress. This study aimed to develop an effective stress management strategy for new ICU professionals, focusing on reducing the detrimental effects of stress on their psychological state. We hypothesized that the online multimodal psychological support (MPS) program might improve the psychological well-being and sleep quality of the participants.

Methods

This single-center, single-blind randomized controlled trial included new ICU staff during the COVID-19 pandemic. Participants were randomly assigned to either an intervention (online psychological support, MPS) or a control (routine wellness care, RWC) group for 28 days, and assessments were conducted before intervention (baseline), after intervention, and at the 1-month follow-up. The intervention included music therapy, sleep hygiene education, psychoeducation, and relaxation training, tailored to address common psychiatric issues experienced by healthcare professionals during the pandemic. The primary outcome was a DASS-21 score 28 days after the end of the intervention.

Results

One hundred and one professionals eventually participated in the study, 47 in the MPS group and 54 in the RWC group. No significant differences were observed in the overall psychological well-being immediately after the end of the intervention. However, the MPS group showed improved sleep and sustained lower stress levels, anxiety, and depression scores at the 1-month follow-up, significantly improving the severity of insomnia (marginal mean difference -2.028; SE 1.00; p = 0.044).

Conclusion

The online multimodal psychological support program effectively enhanced the psychological well-being and sleep quality of new ICU staff demonstrating the potential of off line training in managing stress and improving health outcomes during crises. The findings of this study emphasize the importance of accessible, flexible psychological support, especially in high-stress environments such as ICUs during pandemics.

Impact of COVID-19 on nurse outcomes in the private sector of South Africa: a cross-sectional study

BACKGROUND

This study explored and described the impact of the COVID-19 pandemic on nurse outcomes in the private sector of South Africa. National research shows that nurses had poor nurse outcomes prior to the pandemic, amidst these issues the COVID-19 pandemic occurred, with nurses having to play a key role in the public health response. International studies have shown that although nurses were willing to serve in this manner, they experienced moderate to high burnout, anxiety, depression, fear and exhaustion. However, this topic has received comparatively little attention in African countries.

METHODS

A cross-sectional survey design was conducted. Multistage sampling was applied in selection of provinces, hospital groups, hospitals, units, and nursing personnel. Valid and reliable tools were used to measure nurse outcomes. Data was collected from April 2021 until January 2022.

RESULTS

Nurses described having high levels of compassion satisfaction, moderate levels of compassion fatigue, and high levels of burnout. Nurses appeared satisfied with their job and career. Almost a quarter of nurses reported the intention to leave their job, and of those about a fifth indicated that they intended to leave the profession. The nurses who routinely cared for COVID-19 patients had a small statistically significant increase in compassion fatigue, compassion satisfaction, emotional exhaustion and, job turnover intention, and a small statistically significant decrease in job satisfaction. Increased exposure to death and dying showed small correlations with emotional exhaustion and career turnover intentions.

CONCLUSION

The results of this study show that nurses were impacted by COVID-19 and death and dying during the pandemic, and that follow-up studies are needed post-pandemic.

IMPLICATIONS OF STUDY

It is important that burnout and compassion fatigue be addressed on an organizational level, as nurse outcomes were already negative prior to the pandemic, and all global evidence points to the worsening of these outcomes post-pandemic. There were many psychological support interventions with proven effectiveness that should be explored and applied for the South African context.

Anxiety and depression in healthcare workers are associated with work stress and poor work ability

Background

Symptoms of anxiety and depression are very common among healthcare workers (HCWs) and could impact the quality of care.

Objective

This study aimed to evaluate the prevalence of these disorders in a public health company and their association with work ability and work-related stress.

Methods

A cross-sectional study involved 80 HCWs being treated for mental disorders (MD), 55 HCWs who said they suffered from MD but were not being treated, and 824 healthy colleagues. All workers completed the Work Ability Index (WAI), the Siegrist's Effort/Reward Imbalance questionnaire (ERI), the Goldberg's scales of anxiety and depression (GADS), and the Warr's scale of job satisfaction.

Results

Three-quarters of workers with MD suffered from anxiety and/or depression. Workers who declared at the periodic medical examination in the workplace that they were being treated for MD had significantly lower levels of work ability than those of their colleagues who declared good mental health. They also reported greater work stress (high effort, low rewards, high overcommitment) and lower job satisfaction than their healthy colleagues. Symptomatic but untreated workers reported significantly lower work ability, lower satisfaction, and greater occupational stress than their healthy colleagues. In the entire sample, there were many workers with symptoms of anxiety or depression who did not declare these disorders during the examination. Overall, there were 328 suspected cases of anxiety (34.2%) and 334 cases of depression (34.8%). Anxious workers [OR = 8.11, 95% confidence interval (CI) = 3.74-17.58] and depressed workers (OR = 4.49, 95% CI = 2.22-9.10) had an increased risk of being classified as having "poor work ability".

Conclusion

The negative association between psychological symptoms and work ability even in undiagnosed/untreated workers demonstrates the usefulness of screening for these symptoms in work environments.

Satisfaction and Workload as Predictors of Psychological Distress in Professionals of Psychosocial Care Centers During the COVID-19 Pandemic

BACKGROUND AND AIMS

The COVID-19 pandemic significantly impacted the mental health of healthcare professionals, especially those working in Psychosocial Care Centers (CAPS), which are crucial services in the Brazilian mental health system. This study aimed to investigate the association between job satisfaction, workload, and psychological distress among CAPS professionals during the pandemic.

METHODS

A cross-sectional study was conducted with 53 professionals from seven CAPS. The Workload Impact Scale (IMPACTO-BR) and Job Satisfaction Scale (SATIS-BR), the General Health Questionnaire (GHQ-12), and a sociodemographic questionnaire were used. Descriptive and analytical statistical analyses were performed. Multiple linear regression analysis was conducted to examine the relationship between job satisfaction, workload, and psychological distress.

RESULTS

Professionals reported moderate satisfaction (3.67 ± 0.45) and mild workload (1.82 ± 0.63). One-third of the sample showed scores indicative of psychological distress. Multiple linear regression analysis revealed that workload (p = 0.0025) and low job satisfaction (p = 0.0495) were significantly associated with psychological distress.

CONCLUSIONS

Low job satisfaction and high professional workload were predictive variables of psychological distress. These findings highlight the need for investments in promoting the quality of life at work for mental health professionals, especially during crises. The implications for human resource management and public policy development emphasize the importance of an integrated approach that considers the well-being of professionals for the effectiveness and sustainability of the psychosocial care model.

Psychosocial well-being and mental health of low- and middle-income countries' internally displaced persons and refugees during COVID-19: a systematic literature review

Background

The COVID-19 pandemic brought to light the need to address the psychosocial and mental health needs of refugees and internally displaced persons in low- and middle-income countries. COVID-19 prevention measures slowed essential services and healthcare, creating unique challenges for refugees and IDPs, including economic insecurity and societal instability. All of these factors may contribute to the reported declines in their psychosocial well-being.

Methods

To effectively define the problems of low-and middle-income countries (LMICs) in addressing the needs of these populations, we conducted a systematic literature review of literature on the mental health and psychosocial well-being of refugees and displaced persons who have migrated between LMICs in the context of COVID-19.

Findings

Our findings indicate that mental health interventions, such as digital healthcare and community-focused solutions, have the potential to address the problems faced by refugees and IDPs. Nevertheless, these community-based support networks are overextended, continuously developing to meet the needs of these vulnerable populations while considering the limited digital literacy of the subject population, internet accessibility, and overall limits in reach. We found that the efficacy of interventions varied according to the distinctive needs and challenges of various refugee and IDP populations.

Implications

The findings indicate a need for an intersectional policy approach to address the complex network of factors influencing mental health outcomes, including gender, housing, employment status, and social inequalities. Global agencies, policymakers, and local governments must prioritize the development of comprehensive mental health support systems, assuring refugees and IDPs have sustainable and equitable access.

Advanced Clinical Practitioners' Resilience and Emotional and Spiritual Well-Being During COVID-19

Aim: This study investigated the impact of the COVID-19 pandemic on the emotional and spiritual well-being and the resilience of advanced clinical practitioners in the United Kingdom. Background: Advanced clinical practitioners are experienced healthcare professionals educated to a master's level who demonstrate expertise, professional judgment, and autonomy across four pillars of advanced practice. Normally, in nursing and the allied health professions, advanced clinical practitioners provide clinical leadership and improve clinical continuity by providing high-quality care to patients through complex decision-making and managing risk. The role contributes to workforce transformation enabling organizations to meet changing population, patient, and service delivery needs. Advanced clinical practitioners' well-being and resilience were particularly at risk during the pandemic due to the increased workload, moral distress, redeployment into other clinical areas, and isolation. Phase 1 of this study identified that advanced clinical practitioners had worryingly low levels of well-being and resilience during the first 6 months of the pandemic. This paper reports Phase 2' findings 1 year into the pandemic. Method: Three hundred and seventy-one respondents completed an online survey comprising three validated scales assessing resilience and emotional and spiritual well-being. Results: One year into the pandemic, advanced clinical practitioners reported a continued decline in their well-being, with average scores on this measure being 12 percent lower compared to prepandemic levels Differences also emerged in the scores of advanced clinical practitioners practicing in primary and secondary care services. Conclusion: Our findings showed the ongoing deleterious impact of the pandemic on the well-being and resilience of advanced clinical practitioners. As the attention of healthcare leaders shifts to the delivery of services post-COVID-19, the longer-term impact of the pandemic on the mental health and well-being of the workforce, alongside the ongoing workforce crisis in the UK and globally, means the well-being and resilience of advanced clinical practitioners need urgent addressing if these role holders are to continue to lead patient care, workforce transformation, and service innovation. Tailored interventions to support advanced clinical practitioners appear necessary to prevent significant workforce impact including absenteeism, long-term stress, sickness absence, and loss to the healthcare workforce.

Digital Coaching to Address Health, Wellness, and Burnout Among Healthcare Workers: Pilot Study Results

BACKGROUND

Healthcare worker (HCW) well-being is essential for safe, high-quality patient care, but clinicians and front-line staff continue to experience alarming rates of burnout. This pilot study evaluated a novel 6-week program of remote wellness coaching supported by daily digital messaging to reduce burnout and increase well-being among HCWs.

METHODS

In spring 2023, staff from a large community health center in California were invited to participate in this single-group pretest-posttest study in an academic-practice partnership. Thirty-four participants who were mostly female (91%), Latina (77%), 36 years old on average (range = 20-61), and represented all major job categories provided informed consent and completed the baseline survey. Of these, 17 completed 6 weekly 20-minute coaching sessions; received daily messages about stress management, self-care, workplace well-being, social connections, and lifestyle and health behaviors, and completed follow-up data collection. The Wilcoxon matched pair signed-rank tests assessed changes from baseline to 2-months follow-up.

RESULTS

Self-reported burnout decreased from 59% at baseline to 35% at follow-up. Work exhaustion (p < .05), stress (p < .05) and sleep problems (p < .01) reduced significantly, and wellness practices (p < .05), moderate physical activity (p < .01), and healthy daily eating (p < .05) improved.

CONCLUSIONS/APPLICATIONS TO PRACTICE

Our pilot study suggests that a brief digital wellness program may address burnout and increase health and well-being among front-line staff and clinicians. Healthcare settings should consider this type of program for their workers, especially given the added burden of COVID-19 on the healthcare system.

Effect of pandemic-induced PTSD in pregnant women on infant physical growth: a prospective cohort study

BACKGROUND

The COVID-19 pandemic has had a profound impact on global mental health, particularly affecting vulnerable groups such as pregnant women. Post-traumatic stress disorder (PTSD) in this population may potentially hinder infant physical development, underscoring the necessity for specific interventions. This study seeks to explore the prevalence of PTSD among pregnant women during the pandemic and its implications for infant physical development, thereby providing evidence to mitigate the adverse effects of the pandemic on maternal and child health.

METHODS

A prospective cohort study was carried out involving 450 pregnant women from December 2022 to February 2023. Data included demographic details, PTSD evaluation using the PTSD Checklist-Civilian version (PCL-C) scale, coping mechanisms, and infant growth indicators at three months postpartum. Statistical methods included descriptive statistics, univariate analysis, and multivariate analysis of covariance (ANCOVA) to control for confounding factors.

RESULTS

The study enrolled a total of 450 pregnant women. Following exclusions and follow-up attrition, 422 pregnant women were analyzed. There were 72 pregnant women with PTSD and 350 without PTSD. There was no statistically significant difference in birth weight between the two groups of participants. Three months after birth, infants of PTSD-positive mothers exhibited significantly lower weight percentiles at three months (P < 0.001), adjusted for birth weight, feeding method, and coping strategies. Multivariate analysis affirmed a 9.44-point reduction in weight percentile among infants in the PTSD-positive group (95% CI: 4.01-14.87, P = 0.001).

CONCLUSION

Pregnant women suffering from PTSD during the pandemic are at risk of giving birth to infants with impaired physical growth. These findings highlight the critical need for mental health support for pregnant women to foster optimal infant development and to guide public health policies and clinical practices.

Implementation facilitators and barriers of stress first aid to protect mental health of frontline health care workers during the COVID-19 pandemic: a qualitative study

BACKGROUND

The COVID-19 pandemic has taken a toll on frontline health care workers (HCWs), leading to poor mental and physical well-being. We conducted a large, cluster randomized controlled trial to implement an adapted Stress First Aid (SFA) intervention to support HCW well-being using a train-the-trainer (TTT) approach for rapid deployment in the United States and collected qualitative data through interviews to understand implementation. The goal of this study is to understand barriers and facilitators to deploying SFA using a TTT model, with particular emphasis on the acceptability, uptake, and barriers from the implementation.

METHODS

We conducted seven individual and seven group semi-structured qualitative interviews with 28 trainers (i.e., site champions) who delivered SFA training to their local HCWs from Spring 2021 to Winter 2022 in hospitals and health care centers within the United States. We utilized both inductive and deductive approaches to coding transcripts. All transcripts were coded in Dedoose. We used the Consolidated Framework for Implementation Research (CFIR) to rigorously assess implementation experiences.

RESULTS

Site champions highlighted leadership buy-in, protected time and incentives, and teams as implementation facilitators, while implementation barriers included unhelpful training materials and content, time constraints and scheduling difficulties, and pandemic-related factors, such as COVID-19 surges. SFA implementation processes varied: some champions had virtual SFA presentations, while others held informal discussions about SFA material in person. Champions also differed on their perceptions of SFA sustainability: some indicated it would be difficult to sustain SFA in their organization due to limited structure and time, while others stated they would continue to utilize it.

CONCLUSION

Limited research has examined the implementation of HCW well-being interventions using a TTT approach in a changing environment. Site champions were able to implement SFA during a period of rapid and frequent change and shared several implementation facilitators and barriers related to the SFA intervention. In the future, addressing the implementation barriers proactively and prioritizing the implementation facilitators may prove to be useful for large-scale interventions implemented during disease outbreaks and pandemics.

Resilience and the Dynamics of Job Demands: A Diary Study on Interactions in Healthcare Professionals During the COVID-19 Pandemic

AIM(S)

To explore the day-level interactions between challenge and hindrance job demands and their effects on work engagement and emotional exhaustion among healthcare professionals, focusing on the moderating role of resilience.

DESIGN

A longitudinal, diary-based design was employed.

METHODS

This study utilised a multilevel modelling approach to analyse 351 diary entries from 85 healthcare professionals, collected during the COVID-19 pandemic (in March-April 2021). Participants recorded their daily experiences, including job demands, work engagement, emotional exhaustion and resilience.

RESULTS

Challenge demands, such as increased workload, are associated with both higher work engagement and greater emotional exhaustion, highlighting a dual impact. Resilience moderated these effects, reducing the negative impacts of both challenge and hindrance demands on emotional exhaustion. Surprisingly, higher resilience also diminished the positive relationship between effort and engagement.

CONCLUSION

The study highlights the critical role of resilience in moderating the effects of job demands on healthcare workers' well-being, particularly under the stressful conditions of a global pandemic.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Insights from this study can assist healthcare organisations in developing strategies to enhance employee resilience and effectively manage job demands. Improved management of these factors can lead to better employee well-being and sustained engagement, ultimately benefiting patient care during high-stress periods.

IMPACT

The study addressed the impact of daily job demands on the well-being and performance of healthcare workers during the COVID-19 pandemic. The main findings highlighted the dual effects of challenge demands and the protective role of resilience in mitigating the adverse effects of job demands. This research will impact healthcare organisations and policymakers, informing strategies to bolster workforce resilience and well-being, thereby potentially enhancing patient care during crises.

REPORTING METHOD

We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Neither patients nor the public were involved in the design, conduct, reporting or dissemination plans of our research. Healthcare professionals participated only as research subjects and did not engage in any aspect of the research process.

Barriers and facilitators to high-volume evidence-based innovation and implementation in a large, community-based learning health system

BACKGROUND

Broad-scale, rapid health care change is critically needed to improve value-based, effective health care. Health care providers and systems need to address common barriers and facilitators across the evidence to implementation pathway, across diverse specialties. However, most evidence translation / implementation research evaluates single topic areas, and may be of limited value for informing comprehensive efforts. This project's objective was to identify, characterize, and illustrate common trans-topic facilitators and barriers of translating new health care evidence results to clinical implementation across multiple medical specialties.

METHODS

This study was an evaluation of all evidence-based innovation projects completed during 2019-2021. Each project was created with medical group clinical leaders and was intended to inform clinical care. The evaluation took place in a large community-based integrated health care system, and an embedded delivery science and applied research program. Clinical investigators, scientific investigators, and clinical operational leaders received structured questionnaires regarding barriers and facilitators for the operational implementation of new research findings for each project. Responses were mapped to the Consolidated Framework for Implementation Research to identify perceived implementation barriers and facilitators.

RESULTS

All 48 projects completed between 2019 and 2021 were evaluated; responses were received for 45 (94%) and 34 had comments mappable to framework domains. Potential barriers and facilitators to clinical implementation of new research results were identified across all five framework domains and, within these, the 38 constructs or sub-constructs. Among 245 total comments, the most commonly cited facilitators were how the new research evidence generated, compelled change (n = 29), specialty communication networks for disseminating results and initiating change (n = 20), leadership engagement in the project (n = 19), and the innovation's relative advantage over existing practices (n = 11). The most commonly cited barriers were inadequate resource commitment for next-step implementation (n = 15), insufficient learning/implementation culture (n = 5), and insufficient individual-level willingness/ability for change (n = 5).

CONCLUSIONS

A novel large-scale evaluation of barriers and facilitators across the evidence to implementation pathway identified common factors across multiple topic areas and specialties. These common potentially replicable facilitators and modifiable barriers can focus health systems and leaders pursuing large-volume evidence-to-implementation initiatives on those areas with the likely greatest benefit-for-effort, for accelerating health care change.

Patterns and Predictors of Resilience in Frontline Nurses Before and After Public Health Emergencies: A Latent Transition Analysis

OBJECTIVE

To explore the stability of resilience among frontline nurses and to analyse the predictive role of internal and external factors on the patterns of resilience transformation in China during public health emergencies.

METHODS

The study used a longitudinal design and surveyed 258 frontline nurses at three different time points: February-March 2020 (T1), May-June 2020 (T2) and May-June 2022 (T3). The survey included the 10-item Connor-Davidson resilience scale, the Emotion Regulation Questionnaire and the Simple Coping Style Questionnaire. Latent profile analysis and latent transition analysis were used to examine the potential classes and changes. Multivariate logistic regression analysis was applied to evaluate the predictors of resilience transitions.

RESULTS

The resilience of frontline nurses was divided into three categories: fragile group, general group and high resilience group. From T1 to T2, the general group exhibited the least stability, with a probability of maintaining its original latent state at 72.9%. Marriage and positive coping styles significantly impacted the transition between resilience categories. From T2 to T3, the fragile group showed the lowest stability, with a 74.9% likelihood of retaining its initial latent state. In this context, supportive hospital management (including psychological counselling, restful environments, and both spiritual and material incentives) and individuals' emotional regulation and sleep quality significantly affected the transition between resilience categories.

CONCLUSIONS

These findings emphasise the necessity for early intervention. For frontline nurses, conducting initial assessments of resilience coupled with sustained hospital support is crucial for maintaining mental health and improving the quality of nursing care in public health emergencies.

IMPACT

This study offers a fresh perspective for understanding the resilience of frontline nurses during public health emergencies. At the same time, it reveals the factors that promote or hinder the change in resilience among frontline nurses at both individual and organisational levels. This provides a theoretical basis for future resilience interventions and helps us formulate effective crisis management strategies to respond to future public health emergencies. For frontline nurses with diverse resilience characteristics and relevant transformation factors, a personalised multi-mode resilience improvement plan can be developed to mitigate public health emergencies' potential adverse psychological impact on frontline nurses, especially those in the fragile group.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Compassionate engagement of communities in support of palliative and end-of-life care: challenges in post-pandemic era

Over the years, humanity has faced various global crises of different kinds that have caused great suffering in the community, such as wars, slavery, torture or the Holocaust, but also climate change, economic crises, or sanitary disasters. The recent pandemic posed a barrier to palliative and End-of-Life (EoL) care, as the need for physical distance made it difficult to retain essential human interactions while minimizing the risk of viral transmission. During the COVID-19 pandemic, the robustness of supportive networks (i.e., family, friends, neighbors, and community members) determined whether someone experienced a calm death at home or an unnecessary hospital admission, labeled as an 'emergency'. In this vein, active establishment and strengthening of such networks are the foundation of compassionate community efforts. Firstly, providing both physical and emotional support to the entire network of caregivers enhances their ability to care for others and improves the overall experience of death, including the process of dying and the ensuing bereavement period. Furthermore, individuals can enhance their own physical and mental health by practicing compassion. The ability of networks to withstand and recover from physical and emotional challenges, while maintaining strong and supportive relationships among its members, depends on the health and overall well-being of those members. Therefore, we argue that active community participation and death education can strengthen a community's capacity to assist people facing death, dying, and bereavement.

Self-care strategies used by disaster responders after the 2023 earthquake in Turkey and Syria: a mixed methods study

BACKGROUND

Disaster responders are exposed to several physical and mental health risks. This study aimed to describe self-care strategies used by disaster responders after the earthquake in Syria and eastern Turkey in February 2023.

METHODS

A study specific web-based questionnaire survey was used to collect quantitative and qualitative data according to a convergent mixed methods approach. Data from 252 disaster responders responding to the earthquakes in Turkey and Syria were analyzed using both descriptive and analytical statistics and summative content analysis of free-text answers. Data were collected in March to July, 2023.

RESULTS

The most used self-care strategies included resting, social support from colleagues in the field, extra intake of food or drink, and intake of medicines. The recovery strategies varied due to previous disaster response experience, indicating that supportive self-care strategies can be developed or learned.

CONCLUSION

Given the extreme conditions and limited possibilities of external support, sufficient self-care is an essential competence among disaster responders. Self-care strategies can be both external processed such as intake of medicines, social support from others, and internal processes such as personal reflection. Providing oneself with self-care activities seems to be a skill developed with increasing experience supported by pre-deployment training. Therefore, to enhance resilience, self-care strategies should be encompassed in pre-disaster response training.

Remote consultations in community mental health: A qualitative study of clinical teams

WHAT IS KNOWN ON THE SUBJECT?: Mental health care can be delivered remotely through video and telephone consultations. Remote consultations may be cheaper and more efficient than in person consultations.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Accessing community mental health care through remote consultations is perceived as not possible or beneficial for all service users. Delivering remote consultations may not be practical or appropriate for all clinicians or community mental health teams. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Remote consultation cannot be a 'one-size-fits-all' model of community mental health care. A flexible approach is needed to offering remote consultation that considers its suitability for the service-user, service and clinician.

ABSTRACT

INTRODUCTION: Responding to COVID-19, community mental health teams in the UK NHS abruptly adopted remote consultations. Whilst they have demonstrable effectiveness, efficiency, and economic benefits, questions remain around the acceptability, feasibility and medicolegal implications of delivering community mental health care remotely.

AIM

To explore perceived advantages, challenges, and practice adaptations of delivering community mental health care remotely.

METHODS

Ten community mental health teams in an NHS trust participated in a service evaluation about remote consultation. Fifty team discussions about remote consultation were recorded April-December 2020. Data analysis used a framework approach with themes being coded within a matrix.

RESULTS

Three major horizontal themes of operations and team functioning, clinical pathways, and impact on staff were generated, with vertical themes of advantages, challenges, equity and adaptations.

DISCUSSION

Remote consultation is an attractive model of community mental healthcare. Clinical staff note benefits at individual (staff and service-user), team, and service levels. However, it is not perceived as a universally beneficial or practical approach, and there are concerns relating to access equality.

IMPLICATIONS FOR PRACTICE

The suitability of remote consultation needs to be considered for each service-user, clinical population and clinical role. This requires a flexible and hybrid approach, attuned to safeguarding equality.

Experiences of residents of the San Ignacio University Hospital in Bogotá DC, Colombia during the COVID-19 pandemic: a qualitative study

The COVID-19 pandemic has caused a major health crisis around the world. Health professionals have contributed with all their abilities to provide adequate medical care in a scenario of great uncertainty and with many difficulties. The objective of this article is to investigate the experiences narrated by the residents of the San Ignacio University Hospital, in Bogotá DC, Colombia, during the pandemic. A qualitative study was carried out in which 15 in-depth interviews were conducted with residents of different medical specialties, which allowed us to explore the difficulties, challenges, opportunities, and capacities they have faced during the pandemic. Through a thematic analysis, the following categories were identified: "Working with COVID-19", "Building relationships", "Learning during a pandemic", and "How did residents feel?". We found an increase in workload, limitations in the learning tools, overwhelming feelings and augmented tensions in work and social interactions, all this due to the health system in crisis, the prioritization systems implemented, as well as the increase in the number of deaths despite the effort to preserve life. As a recommendation, we propose a reform to the Colombian residency program, with main emphasis on the academics and a greater recognition of the work they do, as well as providing them with tools that helps them manage their emotions for the maintenance of their well-being and mental health.

Moral distress and protective work environment for healthcare workers during public health emergencies

BACKGROUND

Public health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors.

OBJECTIVES

The current study aimed to examine: [1] risk factors associated with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic.

METHODS

We employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic.

RESULTS

About half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30-2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0-10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress.

CONCLUSIONS

Our findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs' work environment.

Support for Nursing Home Caregivers During the COVID-19 Pandemic: A Review

PURPOSE

To review support systems for nursing home caregivers (NHCGs) that were implemented during the first year of the coronavirus disease 2019 (COVID-19) pandemic.

METHOD

Database searches in PubMed, ScienceDirect, and CINAHL resulted in five publications.

RESULTS

Studies differed in design, interventions, and outcomes. An urgent eye movement desensitization and reprocessing protocol was feasible and effective among nurses in services highly mobilized during the acute phase of the pandemic. The "self-help plus" psychological intervention was not associated with significant reductions in anxiety or posttraumatic symptoms but prompted exploration of non-specific factors influencing its effectiveness. The Extension for Community Healthcare Outcomes in Long-Term Care of the Elderly virtual program increased confidence among NHCGs. Self-compassion training was associated with positive changes for certified nursing assistants. Weekly debriefing sessions implemented at one hospital highlighted pathogenic and salutogenic factors.

CONCLUSION

The COVID-19 pandemic had a marked psychosocial impact on NHCGs and necessitated targeted interventions. Despite their limitations, these promising studies provided insights into potential support avenues. Policy considerations should stress the pivotal role of advanced practice nurses in shaping supportive work environments. Future research should focus on robust assessments of the efficacy of psychosocial interventions for NHCGs facing ongoing challenges posed by the pandemic, and even recurrent viral epidemics. [Journal of Gerontological Nursing, 50(10), 24-33.].

Resource loss a significant issue for healthcare professionals: A case study of an Australian regional hospital

Healthcare professionals report poor overall well-being, with many citing mental health concerns and stress as contributing factors. Given that healthcare professionals are crucial to the sustainability of the health sector, examining the factors affecting their well-being at work is essential. This paper reports the findings of research conducted in an Australian regional public hospital, utilising the conservation of resources theory to examine the factors (similarities and differences) that influence the resource loss of healthcare professionals (nurses, medical professionals, and allied health professionals). Qualitative semi-structured interviews were conducted with 43 healthcare professionals of varying roles, and participant perspectives revealed two themes contributing to a resource-poor work environment: 'occupational demands and obstacles' and 'barriers to effective teams'. These challenges caused individual resource loss, and as stress arises from resource depletion, each turn of the stress spiral left the individuals and organization with fewer resources to counteract the loss, causing loss spirals to intensify in momentum and scale. The findings of this research emphasise the importance of executing a proactive approach to well-being initiative implementation to support resource investment and assist in creating a more nurturing healthcare work environment that fosters resource creation and sustenance for healthcare professionals.

What Mattered Most: Personal, Work-Related, and Psychopathological Characteristics Associated with Healthcare Workers' Impairment of Functioning during COVID-19

Background: The COVID-19 pandemic greatly impacted healthcare workers (HWs) around the world. Italy was the first Western country hit by the pandemic, and several studies have been published targeting the mental health burden held by Italian HWs. Notwithstanding, only a few studies focused on the impact of COVID-19 on HWs' levels of functioning. Methods: An online survey was distributed to HWs in Italy through physicians' and nurses' associations, social networks, and researchers' direct contacts, between 4 April and 13 May 2020. Participants provided sociodemographic, work-related, and pandemic-related data and filled out a set of psychometric questionnaires (Patient Health Questionnaire-9-PHQ-9, General Anxiety Disorder-7-GAD-7, Impact of Event Scale-Revised-IES-R, and Work and Social Adjustment Scale-WSAS). Results: The final sample included 1041 HWs (mean age 45.01 ± 11.62, 63.9% females). In total, 58.1% of the subjects screened positive on the GAD-7, 27.5% on the PHQ-9, and 25.9% on the IES-R. Furthermore, 67.4% showed a significant level of impairment in functioning according to the WSAS, while 35.8% reached scores of moderate or worse impairment. In the multiple linear regressions, screening positive on any of the psychometric scales and being exposed to unusual suffering significantly predicted worse scores in all WSAS domains (p < 0.05). Having a history of mental disorders significantly predicted worse scores in the WSAS domain of work ability (p = 0.002), while being the parent of children younger than 18 years significantly predicted worse WSAS family functioning scores (p < 0.001). Conclusions: Our results corroborate extant data about the impact of the COVID-19 pandemic on HWs' mental health and shed light on its detrimental effect on functioning. Tailored interventions should be designed in order to support HWs during times of crisis.

Risk perception and quality of working life of nurses in infectious disease department in China: The chain-mediating effects of psychological resilience and social support

AIM

To determine whether social support and psychological resiliency are significant mediators of the associations between risk perception and quality of working life in Chinese nurses working with infectious diseases.

DESIGN

A cross-sectional study.

METHODS

A cross-sectional survey of 879 nurses in infectious diseases department of specialty or general hospitals in China completed online questionnaires on the nurses' risk perception questionnaire, quality of working life, psychological resilience and the social support rating scale.

RESULTS

Our study observed that risk perception directly negatively influences the quality of working life of infectious disease nurses, while psychological resilience and social support positively chain mediate this relationship.

CONCLUSION

Critical elements impacting the quality of working life of infectious disease nurses are risk perception, psychological resilience and social support. Managers may think about decreasing the level of risk perception and enhancing the quality of working life of infectious disease nurses by enhancing their psychological resilience and providing support.

PUBLIC CONTRIBUTION

The quality of working life of infectious disease nurses should be a priority for nursing management; it is critical to maintain their health and well-being, raise the quality of care and lower turnover. Managers should create resilience-building programmes and support tools to assist nurses properly perceive risks and adopt protective strategies to deal with them to improve the quality of working life for nurses.

Health professional retention in underserved areas: findings from the National Health Service Corps Loan Repayment Program participants in the United States, 2019-2021

Health care provider retention is important for mitigating workforce shortages in underserved areas. The National Health Service Corps (NHSC) provides loan repayment for a two or three-year service commitment from clinicians to work in underserved areas. Prior studies have mixed findings as to what influences clinician retention and have focused mainly on individual-level background characteristics. We used measures of NHSC clinicians' work environment during their service experience, in addition to background characteristics, to identify patterns of experiences, and assess whether these patterns were associated with post-service intentions. We observed that technical assistance and job resources were more influential on clinicians' intentions, compared to individual- or community-level characteristics. Organizations with efficient and supportive work environments may help retain clinicians in underserved areas.

Research hotspots and trends in healthcare workers' resilience: A bibliometric and visualized analysis

Background

The resilience of healthcare workers has gained increasing attention, yet comprehensive studies focusing on recent trends and developments are scarce. We conducted an extensive bibliometric analysis from inception to 2023 to address this gap.

Methods

Publications on healthcare workers' resilience were extracted from the Web of Science Core Collection database. Bibliometric analysis was conducted with CiteSpace, VOSviewer, and Scimago Graphica, focusing on annual publications, country/region, institution, journal, author, keyword analysis, and reference co-citation analysis related to resilience in healthcare workers.

Results

The analysis included 750 documents, revealing a general upward trend in publications across 67 countries/regions, 1,251 institutions, and 3,166 authors. The USA and China emerged as the top contributors, with 192 and 168 publications, respectively. Based on keyword analysis and reference co-citation analysis, the focus areas include the Resilience Scale, the impact of the COVID-19 pandemic on HCWs and their resilience, and nurse resilience.

Conclusion

This study highlights the growing interest in healthcare workers' resilience by using bibliometric and visualization techniques for effective analysis. This paper will enhance scholars' understanding of the dynamic evolution of healthcare workers' resilience and identify emerging research topics.

Barriers and Facilitators to Coping with Second Victim Experiences: Insights from Nurses and Nurse Managers

Background

Second victim experiences have long-term impacts on the personal and professional well-being of nurses. Individual-centered support is necessary to help nurses cope with the various stages of the second victim experience.

Objectives

To explore personal and workplace factors that facilitate or hinder coping styles for second victim experiences from the perspectives of both frontline nurses and nurse managers.

Design

This was a descriptive qualitative study that incorporated semistructured interviews.

Methods

Purposive sampling was employed to enlist a total of eight nurses and seven nurse managers selected from five tertiary hospitals located in Hunan Province, China. The study participants included nurses who had suffered second victim experiences and nurse managers who had grappled with their nurses' second victim experiences. The data were transcribed verbatim and analysed using thematic analysis.

Results

The analysis revealed four main themes that influenced nurses' ability to cope with second victim experiences: source of emotional trauma, personal factors, job stress, and support system. In contrast, emotional trauma from patients and relatives, negative personal traits, shadows from the second victim experience, and unsupportive workplace environments were obstacles to coping with second victim experiences.

Conclusion

The study highlights facilitators and barriers that nurses cope with second victim experiences, providing insight to develop targeted interventions that support nurses and mitigate the negative impacts of second victim experiences. A comprehensive approach is more effective in supporting nurses in coping with second victim experiences, improving patient safety, and enhancing the quality of care.

Health Workers' Mindfulness-Based Stress Reduction and Resilience During COVID-19 Pandemic

Background

Research indicates that a significant number of healthcare workers accounted for all confirmed Coronavirus disease 2019 (COVID-19) cases, and many of the infected healthcare workers were asymptomatic. During the COVID-19 outbreak, a considerable number of people in Taiwan contracted the disease. Therefore, health workers in Taiwan often experienced lack of medical resources, and this problem is worse for outer island areas. In terms of stress and mental health, this study investigated the effect of poor healthcare capacity and high workload on health workers during the COVID-19 pandemic. This study also explored mindfulness-based stress reduction and resilience in health workers.

Methods

This study conducted an in-depth interview to investigate stress perceived by health workers in a hospital located on an outer island of Taiwan as well as their mental health and stress relieving strategies.

Results

It was found that during the COVID-19 outbreak, some common sources of stress for health workers included exposure to infectious diseases, heavy workloads, facing ethical dilemma in clinical decision-making, and unfamiliar problems from the pandemic. These types of stress cause worries, anxiety, and depression in health workers, which affects their mental and physical health as well as their patient-care performance.

Conclusion

This study proposed that mindfulness-based stress reduction and protecting mental health are important for health workers.

Strategic Enhancement of Healthcare Services During the Hajj Season in Makkah: A Comprehensive Geographic Information System (GIS) Analysis

Annually, over two million international pilgrims embark on the Hajj pilgrimage to Makkah, presenting a significant challenge for healthcare services. This study analyzes the spatial distribution of healthcare facilities in the Al Mashaer area using Geographic Information System (GIS) technology to enhance healthcare during this religious gathering. It evaluates the accessibility and efficacy of healthcare facilities, including primary care centers, clinics, and hospitals, each addressing distinct medical needs to ensure a holistic approach for pilgrims. The study maps the distribution, service radius, and services offered by each facility, along with an analysis of travel distances and times, to evaluate the viability of healthcare services. Identifying coverage gaps and accessibility issues is critical for making strategic recommendations to enhance resource allocation and distribution. The research addresses challenges such as data precision, population density, infrastructural constraints, and resource limitations. The study offers recommendations to optimize resource distribution, improve transportation strategies, expand healthcare capacity, and enhance cultural competency, resulting in improved healthcare accessibility, reduced congestion, quicker medical responses, and a safer pilgrimage experience, promoting a world-class pilgrimage management system.

How did COVID-19 pandemic impact on healthy behaviours among Polish professionally active physiotherapists aged 20-50?

BACKGROUND

Due to the introduction of a number of changes to the health care system and the work nature of medical staff, theCOVID-19 pandemic still pose a public health challenge. The objective of the study was to characterize the health behaviours of Polish professionally active physiotherapists during the COVID-19 pandemic.

METHODS

The study included 104 Polish licensed and professionally active physiotherapists in whom health behaviours were assessed using an original questionnaire contained, among others, questions from the Global Physical Activity Questionnaire (GPAQ), the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS), available via social media platforms.

RESULTS

Among the physiotherapists, 34% worked directly with COVID-19 patients and 49% with those who had survived COVID-19. There were no statistically significant differences in most of the rates of physical activity undertaken by the physiotherapists surveyed (P > 0.05). Men were more likely to report taking up movement-related physical activity than women (P > 0.05). However, they spent more time sitting or lying down on a typical day (P > 0.05). The average time spent on the above-mentioned physical activities was also higher among the male participants than in the group of women (P > 0.05). There was an increase in the proportion of physiotherapists working over 40 h per week, from 29% before the pandemic to 38% during the pandemic. Statistically significant differences were observed for the products constituting the basison which of the diet of the examined physiotherapists was based (P < 0.05). The majority of the respondents reported no problems with falling asleep (p > 0.05). Stress related to the risk of contracting COVID-19, as well as concerns about the health of loved ones were more common and severe in the group of female subjects (P < 0.05).

CONCLUSIONS

During the COVID-19 pandemic, the health behaviours in some physiotherapists changed. Further studies are required to assess whether physiotherapists' health behaviours returned to baseline levels or slightly improved compared to the initial results. Also, it is necessary to introduce health-promoting initiatives that would focus on physiotherapists, support their positive health behaviours and provide special recommendations helping them to maintain health during a pandemic.

Resilience resources for mental health among people living with HIV: a mixed-method systematic review

People living with HIV (PLWH) experience a disproportionate burden of mental health problems compared to people living without HIV. This systematic review aims to depict the spectrum of resilience resources that may promote the mental health of PLWH at the individual, interpersonal, organisational, community and policy levels. A systematic literature search was conducted in PsycINFO, Scopus, Medline and advanced Google Scholar. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Of the 591 studies identified, fourteen were included representing a total of 5,142 PLWH from China, Ghana, Nepal, Spain, Tanzania and the USA. Resilience resources were identified at the individual level (self-efficacy, self-esteem, acceptance, hope, optimism, religiosity/spirituality, belief in fate, mindfulness, strength and self-responsibility); interpersonal level (social support and parental monitoring); and community level (attending HIV clinic support groups and access to healthcare). All quantitative studies were cross-sectional, limiting inferences about causation or directionality. Future research should focus on resilience resources at the organisational and policy levels and incorporate longitudinal designs.

Psychological resilience and related factors among primary care workers in Wuhan, China: A cross-sectional study

Purpose

Primary medical workers constitute a high-risk group for mental health problems, and psychological resilience might protect them from the negative psychological impacts of their work. Therefore, this study aimed to investigate the current situation of psychological resilience among primary care workers in Wuhan, China, as well as related factors.

Methods

In this cross-sectional study, a total of 417 primary care workers (30.0 % men; 38.5 ± 8.5 years old) were randomly selected to complete a questionnaire. The brief version of the National Mental Health Literacy Questionnaire and the Psychological Resilience Scale were used to assess participants' mental health literacy and psychological resilience, respectively. Multiple linear regression was performed to identify factors associated with the psychological resilience of primary care workers.

Results

More than four-fifths of the primary care workers included in this study exhibited appropriate levels of mental health knowledge. In terms of mental health skills, participants' attainment rates, ranging from high to low, were 60.9 % for distracting attention, 45.3 % for interpersonal support and 43.9 % for cognitive reappraisal. The average psychological resilience score obtained by primary care workers was 27.81 ± 5.71, and the factors associated with increased psychological resilience included being male, being older, and possessing higher mental health skills, including skills pertaining to interpersonal support and distracting attention.

Conclusion

The psychological resilience of primary care workers in Wuhan is at a moderate level and thus requires further improvement. Although these medical staff exhibit appropriate levels of mental health knowledge, their mental health skills are relatively poor, despite the fact that interpersonal support and distracting attention are significantly associated with psychological resilience. Hence, interventions targeting mental health skills are recommended to promote psychological resilience among primary care workers.

Correlation analysis of mental toughness, family social support, and anxiety of nursing staff

OBJECTIVE

This study aims to explore the impact of family social support affects anxiety levels and mental toughness among nursing staff, and to identify the pathways of how mental toughness develops.

METHODS

We selected 256 nursing staff from the Third People's Hospital of Chengdu using a convenience sampling method. Participants completed a questionnaire assessing family social support, anxiety level and mental toughness of the nursing staff. The questionnaires included the general information questionnaire, Perceived Social Support Scale (PSSS), Self-Rating Anxiety Scale (SAS), and the Connor-Davidson resilience scale (CD-RISC). Then, we analyzed the correlation between nursing staff' family social support, anxiety symptoms and mental toughness by using Pearson correlation. Finally, we analyzed the effect of family social support on mental toughness and anxiety levels by using linear regression, and analyzed the path of family social support and psychological toughness on anxiety symptoms by using structural equation modeling.

RESULTS

We finally collected 246 valid questionnaires with a valid recovery rate of 96.09%. 116 (47.15%) nursing staff reported a moderate level of family social support, with a mean PSSS score of (58.98 ± 7.64). Anxiety risk was identified in 43.39% of participants, with a mean SAS score of 50.47 ± 10.96. In terms of mental toughness, 104 (42.28%) nursing staff exhibited a low level of mental toughness, and 116 (47.15%) demonstrated moderate level of mental toughness with CD-RISC score of (58.23 ± 10.12). Correlation analyses revealed a strong negative correlation between the family social support, mental toughness and their anxiety (r = -0.586, -0.516, respectively), and a strong positive correlation between family social support and mental toughness (r = 0.571). Regression analysis showed that family social support was a significant negative predictor for anxiety (β = -0.841, t = -9.488), but a significant positive predictor for mental toughness (β = 0.756, t = 11.669). Mediation analysis indicated that mental toughness mediated 26.28% of the relationship between family social support and anxiety levels.

CONCLUSION

Family social support can significantly reduce anxiety levels in nursing staff directly, as well as indirectly by increasing mental toughness.

Case management interventions seeking to counter radicalisation to violence and related forms of violence: A systematic review

Background

Increasingly, counter-radicalisation interventions are using case management approaches to structure the delivery of tailored services to those at risk of engaging in, or engaged in, violent extremism. This review sets out the evidence on case management tools and approaches and is made up of two parts with the following objectives.

Objectives

Part I: (1) Synthesise evidence on the effectiveness of case management tools and approaches in interventions seeking to counter radicalisation to violence. (2) Qualitatively synthesise research examining whether case management tools and approaches are implemented as intended, and the factors that explain how they are implemented. Part II: (3) Synthesise systematic reviews to understand whether case management tools and approaches are effective at countering non-terrorism related interpersonal or collective forms of violence. (4) Qualitatively synthesise research analysing whether case management tools and approaches are implemented as intended, and what influences how they are implemented. (5) Assess the transferability of tools and approaches used in wider violence prevention work to counter-radicalisation interventions.

Search Methods

Search terms tailored for Part I and Part II were used to search research repositories, grey literature sources and academic journals for studies published between 2000 and 2022. Searches were conducted in August and September 2022. Forward and backward citation searches and consultations with experts took place between September 2022 and February 2023. Studies in English, French, German, Russian, Swedish, Norwegian and Danish were eligible.

Selection Criteria

Part I: Studies had to report on a case management intervention, tool or approach, or on specific stages of the case management process. Only experimental and stronger quasi-experimental studies were eligible for inclusion in the analysis of effectiveness. The inclusion criteria for the analysis of implementation allowed for other quantitative designs and qualitative research. Part II: Systematic reviews examining a case management intervention, tool or approach, or stage(s) of the case management process focused on countering violence were eligible for inclusion.

Data Collection and Analysis

Part I: 47 studies were eligible for Part I. No studies met the inclusion criteria for Objective 1; all eligible studies related to Objective 2. Data from these studies was synthesised using a framework synthesis approach and presented narratively. Risk of bias was assessed using the CASP (for qualitative research) and EPHPP (for quantitative research) checklists. Part I: Eight reviews were eligible for Part II. Five reviews met the inclusion criteria for Objective 3, and seven for Objective 4. Data from the studies was synthesised using a framework synthesis approach and presented narratively. Risk of bias was assessed using the AMSTAR II tool.

Findings

Part I: No eligible studies examined effectiveness of tools and approaches. Seven studies examined the implementation of different approaches, or the assumptions underpinning interventions. Clearly defined theories of change were absent, however these interventions were assessed as being implemented in line with their own underlying logic. Forty-three studies analysed the implementation of tools during individual stages of the case management process, and forty-one examined the implementation of this process as-a-whole. Factors which influenced how individual stages and the case management process as a whole were implemented included strong multi-agency working arrangements; the inclusion of relevant knowledge and expertise, and associated training; and the availability of resources. The absence of these facilitators inhibited implementation. Additional implementation barriers included overly risk-oriented logics; public and political pressure; and broader legislation. Twenty-eight studies identified moderators that shaped how interventions were delivered, including delivery context; local context; standalone interventions; and client challenges. Part II: The effectiveness of two interventions - mentoring and multi-systemic therapy - in reducing violent outcomes were each assessed by one systematic review, whilst three reviews analysed the impact that the use of risk assessment tools (n = 2) and polygraphs (n = 1) had on outcomes. All these reviews reported mixed results. Comparable factors to those identified in Part I, such as staff training and expertise and delivery context, were found to shape implementation. On the basis of this modest sample, the research on interventions to counter non-terrorism related violence was assessed to be transferable to counter-radicalisation interventions.

Authors' Conclusions

The effectiveness of existing case management tools and approaches is poorly understood, and research examining the factors that influence how different approaches are implemented is limited. However, there is a growing body of research on the factors which facilitate or generate barriers to the implementation of case management interventions. Many of the factors and moderators relevant to countering radicalisation to violence also impact how case management tools and approaches used to counter other forms of violence are implemented. Research in this wider field seems to have transferable insights for efforts to counter radicalisation to violence. This review provides a platform for further research to test the impact of different tools, and the mechanisms by which they inform outcomes. This work will benefit from using the case management framework as a way of rationalising and analysing the range of tools, approaches and processes that make up case managed interventions to counter radicalisation to violence.

A Pilot Feasibility Evaluation of a Heart Rate Variability Biofeedback App to Improve Self-Care in COVID-19 Healthcare Workers

COVID-19 exacerbated burnout and mental health concerns among the healthcare workforce. Due to high work stress, demanding schedules made attuned eating behaviors a particularly challenging aspect of self-care for healthcare workers. This study aimed to examine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) mobile app for improving well-being among healthcare workers reporting elevated disordered eating during COVID-19. We conducted a mixed methods pre-mid-post single-arm pilot feasibility trial (ClinicalTrials.gov NCT04921228). Deductive content analysis of participants' commentary generated qualitative themes. Linear mixed models were used to examine changes in pre- mid- to post-assessment scores on well-being outcomes. We consented 28 healthcare workers (25/89% female; 23/82% Non-Hispanic White; 22/79% nurses) to use and evaluate an HRVB mobile app. Of these, 25/89% fully enrolled by attending the app and device training; 23/82% were engaged in all elements of the protocol. Thirteen (52%) completed at least 10 min of HRVB on two-thirds or more study days. Most participants (18/75%) reported being likely or extremely likely to continue HRVB. Common barriers to engagement were busy schedules, fatigue, and technology difficulties. However, participants felt that HRVB helped them relax and connect better to their body's signals and experiences. Results suggested preliminary evidence of efficacy for improving interoceptive sensibility, mindful self-care, body appreciation, intuitive eating, stress, resilience, and disordered eating. HRVB has potential as a low-cost adjunct tool for enhancing well-being in healthcare workers through positively connecting to the body, especially during times of increased stress when attuned eating behavior becomes difficult to uphold.

Availability, use, and impact of workplace mental health supports during the COVID-19 pandemic in a Canadian cohort of healthcare workers

We investigated the availability and use of workplace mental health (MH) supports during the COVID-19 pandemic in a Canadian cohort of healthcare workers (HCW) and measured anxiety and depression by the Hospital Anxiety and Depression Scale (HADS) completed at four contacts 2020-2022. Reports were available for 4400 HCW working with patients. Half the HCWs had a clinically significant HADS score at one or more contacts Access to MH supports increased during the pandemic, with 94% reporting access to some workplace support by 2022: 47% had made use of at least one support. 25% of those with high HADS scores used no support. Older women and men with depressive conditions were less likely to report use. Reported use of an Employee Assistance Program was associated with a reduction in HADS scores in the following months.

Mapping the needs of healthcare workers caring for COVID-19 patients using the socio-ecological framework: a rapid scoping review

Undoubtedly, the mental health of healthcare workers (HCWs) was negatively affected because of caring for patients during the COVID-19 pandemic. However, literature is limited on mapping the challenges and needs of HCWs during COVID-19 pandemic. A widely used framework in public health for mapping evidence includes the socio-ecological models, suggesting behavior can be influenced by individual, interpersonal, organizational, and community factors. The aim of this rapid scoping review was to use the socio-ecological model to map and compile lessons learnt from the literature regarding primarily the challenges and needs and secondly available psychological interventions for HCWs caring for COVID-19 patients. PubMed, CINAHL and Scopus databases were searched, with 21 studies finally included examining challenges and needs of HCWs and 18 studies presenting psychological interventions. Organizational-level challenges and needs such as inadequate staff preparation and supplies of protective equipment, flexible work policies and paid rest periods were the most reported. Individual-level challenges and needs included COVID-19-related fears and reduced mental health, whereas interpersonal-related needs included support provision. Community-level challenges included societal stigma. Certain psychological interventions were found to be promising for HCWs, but these were utilized to address only individual-level challenges and needs. Given that well-being entails an interaction of factors, multi-level interventions addressing multiple socio-ecological levels (interpersonal, organizational, community) and that place HCWs in their social context should be administrated to increase and maintain intervention' effects long-term and possibly aid in better coping with future pandemics.