Posttraumatic growth levels of healthcare workers in two periods with different intensities of COVID-19 pandemic

Longitudinal cross-lagged association between posttraumatic stress disorder, post-traumatic growth, and deliberate rumination among healthcare staff 2 years after the COVID-19 pandemic in Hubei Province, China

BACKGROUND

Post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG) are inspiratory areas of psychological research in which deliberate rumination has important implications. However, these relationships have not yet been assessed in the COVID-19 pandemic using longitudinal designs.

METHODS

In this study, measures of PTSD, PTG, and deliberate rumination were collected from 2,292 healthcare staff members at two-time points six months apart in 2022-2023 from two general hospitals in Hubei Province, China. A cross-lagged analysis was used to simultaneously determine the directional relationships between these three variables.

RESULTS

The results suggest that the relationship between PTG and deliberate behavior is bidirectional and mutually reinforcing (β = 0.133, P < 0.001; β = 0.129, P < 0.001). Significant prospective relations were observed between PTG and PTSD (β = 0.054, P < 0.01), and PTSD prospectively predicted changes in deliberate rumination (β = 0.204, P < 0.001). In addition, significant sex differences were observed in the cross-lagged models.

CONCLUSION

These findings highlighted the noteworthy cross-lagged relationship between PTSD, PTG, and deliberate rumination two years after the COVID-19 pandemic in Hubei Province, China. Therefore, interventions to reduce PTSD, promote PTG, and improve well-being among healthcare staff are important.

Addressing Mental Health Symptoms Among COVID-19 Healthcare Workers: A Heart Rate Variability Biofeedback Pilot Study

Psychological stress among frontline healthcare workers (HCWs) increased during the COVID-19 pandemic, elevating mental health risks. Heart rate variability biofeedback (HRV-BF) is an evidence-based intervention with potential to reduce psychological burden on frontline HCWs; however, no studies have examined its use among this population since the pandemic began. We designed a trial to assess the effects of a brief HRV-BF intervention delivered via telemedicine on measures of anxiety, depression and stress, and heart rate variability, compared to an in-person intervention. We hypothesised that the telemedicine intervention would be non-inferior to the in-person intervention. Using a randomized comparison trial design, we tested a 10-day brief heart rate variability biofeedback intervention among frontline HCWs during the COVID-19 pandemic. They received remote, 30-min guided sessions every other day and were taught methods of heart rate variability biofeedback. Depression, anxiety and stress were assessed at baseline, 10 days, and 40 days with additional measures of anxiety measured before and after each session. HRV scores were collected at baseline, as well as during the course of the 10 days. Multilevel modelling was used to examine the change in depression, anxiety, stress and HRV scores across multiple time points and session types (telemedicine vs. in-person). There was no significant differences between telemedicine (n = 32) and in-person (n = 15) interventions on the main outcomes. Both session types showed a significant decrease in depression, anxiety and stress scores across the entire intervention, and HRV scores significantly increased across both groups. Anxiety levels also significantly decreased after each session. The non-inferiority of the telemedicine intervention to a comparable in-person intervention affirms its promise for decreasing anxiety, depression and stress among frontline HCWs and may offer a cost-effective and feasible tool to use in crises situations.

A theoretical framework for Acute Care Nurse Stress Appraisal: Application of the transactional model of stress and coping

AIM

To develop a framework for understanding the stress appraisal process among acute care nurses during the COVID-19 pandemic.

DESIGN

A secondary analysis of open-ended responses from a cross-sectional survey of 3030 frontline, acute care nurses in New Jersey and the effect of burnout during the COVID-19 pandemic.

METHODS

Lazarus and Folkman's transactional model of stress and coping guided the study. Thematic analysis was used to analyse 1607 open-ended responses.

RESULTS

Nine themes emerged during the secondary appraisal of stress. Five themes contributed to distress and burnout including (1) high patient acuity with scarce resources, (2) constantly changing policies with inconsistent messaging, (3) insufficient PPE, (4) unprepared pandemic planning and (5) feeling undervalued. Four themes led to eustress and contributed to post-traumatic growth including (1) team nursing to ensure sufficient resource allocation, (2) open channels of communication, (3) sense- of-duty and (4) personal strength from new possibilities.

CONCLUSION

The COVID-19 pandemic was a traumatic event for patients and the nursing workforce. Internal and external demands placed on acute care nurses increased burnout, however, a subset of nurses with adequate support experienced personal growth.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Beyond mental health interventions for acute care nurses, organizational interventions such as reevaluation of emergency action plans to optimize resource allocation, and work environment strategies such as improved communication and decision-making transparency are necessary.

IMPACT

To better understand how frontline acute care nurses experienced stress during COVID-19, a data-informed framework was developed that included a primary and secondary appraisal of stress. Themes contributing to distress and burnout were identified, and themes leading to eustress and post-traumatic growth were also identified. These findings can assist nurse leaders in optimizing strategies to reduce burnout and promote post-traumatic growth in the post-COVID years.

REPORTING METHOD

No patient or public contribution.

Psychological Assessment of Health Care Workers in the Aftermath of the February 2023 Earthquakes in Turkey

OBJECTIVE

The goal of this study was to examine the psychological and physical effects experienced by health care workers (HCWs) participating in the response to the February 2023 earthquakes in Turkey and to identify any associated factors.

METHODS

An online survey was used to collect data from HCWs on duty in earthquake-stricken areas. The following assessment tools were utilized: Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Maslach Burnout Inventory, Posttraumatic Growth Inventory, and Short Form-12.

RESULTS

A total of 175 HCWs with a mean age of 37.27 years participated in the study. Of these, 39.4% suffered from PTSD, 30.3% experienced depression, and 31.4% experienced anxiety. Female gender, loss of significant others, and previous psychiatric treatment were found to be associated with worse mental health. Nurses tended to have higher levels of PTSD than the medical doctors; the medical doctors had significantly lower scores on the Posttraumatic Growth Inventory compared with the nurses and the other HCWs and lower mental component summary scores on the Short Form-12 compared with the other HCWs. Meeting basic needs and subjective evaluation of teamwork were also linked to mental health. The study also found that marital status, age, and length of time spent in earthquake-stricken areas were associated with scores on the Maslach Burnout Inventory.

CONCLUSIONS

After the earthquake in Turkey, HCWs experienced a significant amount of various adverse mental health outcomes related to certain demographic variables such as gender, profession, previous psychiatric treatment, loss of relatives, and evaluation of living conditions and teamwork. Since HCWs play an essential role in reducing the harmful effects of disasters, recognizing groups at risk and planning tailored interventions may help prevent mental health issues.

Posttraumatic growth of medical staff during COVID-19 pandemic: A scoping review

BACKGROUND

The COVID-19 pandemic has imposed unprecedented stress and challenges upon medical staff, potentially resulting in posttraumatic growth (PTG). This scoping review aims to synthesize the existing knowledge on PTG among medical staff during the pandemic by identifying its current status and potential influencing factors. The findings may provide a foundation for future research and interventions to enhance the medical staff's psychological resilience and well-being.

METHODS

Literature was systematically searched on PTG among medical staff during the COVID-19 pandemic from 01 January 2020 to 31 December 2022. The following databases were searched: PubMed, Web of Science, Embase, CINAHL, PsycINFO, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), and Wanfang Data. Eligibility criteria included: (1) medical staff as research subjects; (2) a focus on "posttraumatic growth" or "alternative posttraumatic growth" related to the COVID-19 outbreak and pandemic; (3) discussion of the situation and influencing factors of PTG; and (4) study types, such as qualitative, quantitative, and mixed methods. Two researchers independently selected and extracted study characteristics (study design, study population, region, measurement instruments, and primary outcomes) from the included literature. The data were synthesized qualitatively and descriptively.

RESULTS

Thirty-six papers from 12 countries met the inclusion criteria. Moderate PTG levels were observed among healthcare workers during the COVID-19 pandemic, with emphasis on "interpersonal relationships," "changes in life philosophy," and "growth in personal competence." Influencing factors included trauma exposure, sociodemographics, psychological characteristics (resilience and positive qualities), coping, and social support.

CONCLUSIONS

This review discovered moderate PTG levels among medical staff during the COVID-19 pandemic, with critical areas in interpersonal relationships, life philosophy, and personal competence. The identified influencing factors can inform future research and interventions to enhance healthcare workers' psychological resilience and well-being.

Coping profiles and their association with vicarious post-traumatic growth among nurses during the three waves of the COVID-19 pandemic

AIMS

This study aimed to examine (a) changes in coping strategies and vicarious post-traumatic growth (VPTG) across three timepoints of the COVID-19 pandemic among nurses; (b) discrete groups of nurses with unique coping profiles and (c) the association of these coping profiles with VPTG across the timepoints.

BACKGROUND

Although literature abounds with the negative mental health consequences of the pandemic among healthcare professionals, much less is known about the positive consequences on nurses, the coping strategies that they use, and how these change over time.

DESIGN

This was a cross-sectional web-based survey at three timepoints during the pandemic.

METHODS

A sample of 429 nurses completed online the Post-Traumatic Growth Inventory (PTGI) and the Brief Coping Orientation to Problems Experienced Inventory (COPE) to measure vicarious post-traumatic growth (VPTG) and coping strategies, respectively. The STROBE checklist was used to report the present study.

RESULTS

Significantly higher VPTG scores were observed during the third timepoint. Different coping strategies were employed across the three timepoints. Nurses responded to the pandemic either with an active, an avoidant or a passive coping profile. Significantly higher VPTG levels were reported by the nurses of the active profile compared to those of the passive profile, whereas the difference between active and avoidant profiles was not significant.

CONCLUSIONS

Notwithstanding the preponderance of the nurses with the active coping profile in achieving high VPTG, the avoidant copers had more gains (VPTG) than the passive copers, suggesting that doing something to cope with the stressor-let it be trying to avoid it-was better than doing nothing.

RELEVANCE TO CLINICAL PRACTICE

The identification of distinct coping profiles among nurses and their association with VPTG is of particular use to policymakers and practitioners in developing tailored prevention and intervention efforts to help the nurses effectively manage the demands of the pandemic.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution since the study was exclusively conducted by the authors.

Nursing and Maternity in the Pandemic: A Qualitative Study from Turkey

OBJECTIVES

This study was conducted to examine the experiences and perceived challenges of nurses who are also mothers having a child during the coronavirus disease (COVID-19) pandemic.

METHODS

A descriptive phenomenological design. The study was conducted with 18 nurse mothers working at COVID-19 clinics in Turkey.

RESULTS

Nurse mothers missed their children and are worried about infecting their children. Based on content analysis, the themes of the study were determined as follows: (1) Nursing Care Process, (2) Disruption of Family Processes, (3) Nurse Mother's Perspective: Being a Child in a Pandemic, and (4) Coping with Challenges-"Searching for a solution."

CONCLUSIONS

Necessary conditions should be provided for nurses with children or family members in need of care and protocols should be made with relevant institutions.

Posttraumatic growth levels of healthcare workers in two periods with different intensities of COVID-19 pandemic

The COVID-19 pandemic threatens health-care workers' (HCW) mental health and well-being. Although traumatic life events may result in psychiatric disorders, occasionally they give rise to positive changes, such as post-traumatic growth. Accordingly, the present study evaluated the traumatic stress, anxiety, and depression levels of HCWs and their post-traumatic growth levels during the pandemic. In addition, the study aimed to assess the changes in psychological outcomes during the pandemic. For this aim, the data were collected in two different periods. The first data-collection period was between May and July 2020, and the second period started in November 2020 and ended in January 2021. The sociodemographic data form, Impact of Events Scale-Revised (IES-R), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Post-traumatic Growth Inventory (PTGI) were used to collect data. Sixty-six HCWs participated in the study. No significant differences appeared between the baseline scores and 6-month follow-up in the depression, anxiety, and traumatic stress levels of HCWs. Furthermore, the PTGI scores decreased significantly over time. Although the change in the psychological distress scores was not statistically significant, the depression and post-traumatic stress scores increased over time. Previous research specified an inverse-parabolic relationship between traumatic stress and PTGI. Our results support previous research; as the exposure to the stressors continues, individual traumatic stress levels increase, psychiatric disorders become frequent, and affirmative changes (like post-traumatic growth) decline.