Factors associated with emotional exhaustion in healthcare professionals involved in the COVID-19 pandemic: an application of the job demands-resources model

Psychosocial factors contributing to value creation in value-based healthcare: a scoping review

Background

Healthcare systems constantly evolve to improve care quality and resource utilization. One way is implementing Value-Based Healthcare (VBHC) an economic approach. This scoping review aims to identify and describe the literature on VBHC, particularly its psychosocial aspects, to uncover research gaps.

Method

The review followed the PRISMA guidelines for Scoping Reviews. We took the following 14 steps: (a) defining the research question; (b) identifying relevant studies; (c) selecting studies; (d) 15 mapping data; (e) collecting, synthesizing and reporting results. A detailed Boolean search was conducted from January 2021 to August 31, 2021, across APA PsycINFO and PubMed databases using keywords such as "Value-Based Healthcare" and "psychosocial perspective." Initially, three reviewers screened 70 e-records independently, assessing titles, abstracts, and full-text against the inclusion criteria. Discrepancies regarding the evaluation of the articles were resolved through consensus sessions between the reviewers.

Results

The final review included 14 relevant e-records in English from peer-reviewed sources, focusing on quantitative and qualitative research. From the analysis, four areas emerged: (1) Value chains in Healthcare; (2) Styles, activities, and practices of value co-creation in Healthcare; (3) Value co-creation in the encounter process; (4) Value co-creation in preventive health services.

Conclusion

The scoping review findings suggest several potential key aspects, including the interdependence between patients and healthcare organizations, organizational culture in healthcare, and the role of patient-centered approaches that focus on relationships, communication, and social support in healthcare. This can be achieved through patient engagement, patient-centered care and communication, health literacy, psychosocial support services, comprehensive psychosocial assessments, care coordination, and continuity of care. Integrating psychosocial elements in VHBC enhances quality and optimizes resource use. Findings highlight the need to develop practical guidance on how to implement a culture of value in care that takes into account the psychosocial aspects that have emerged, but not fully addressed. The pandemic teaches that the workforce poorly receives sudden and unsystematic changes. This review could provide an initial basis for the redesign of value in healthcare and a paradigm shift that has already begun with patient-centered medicine and patient engagement.

The impact of psychological capital on nurses' job performance: a chain mediation analysis of problem-focused coping and job engagement

BACKGROUND

Previous studies have explored the relationships of psychological capital with employees' job performance in the health sector. However, the possible indirect pathways, including a serial mediation of problem-focus coping and job engagement, have not been extensively examined. This article explores how psychological capital influences nurses' coping strategies focused on problem-solving, their level of engagement with their jobs, and how this, in turn, affects their job performance.

METHODS

The study involved 575 nurses from Cameroon's public health sector. It investigated how psychological capital, an intrinsic resource, triggers nurses' problem-focus coping liaison with job engagement to impact job performance. Analysis was conducted to assess the relationships among psychological capital, problem-focus coping, job engagement, and job performance with the use of SmartPLS 4.0 and PROCESS 4.2.

RESULTS

Findings revealed a significant effect of psychological capital on problem-focus coping, job engagement and job performance. Moreover, notable relationships were identified between psychological capital, problem-focus coping, job engagement, and performance, highlighting a chain mediation effect.

CONCLUSION

The research advocates for hospital managers to employ strategies fostering employees' psychological capital to better cope with organizational stressors to promote job engagement and enhance job performance. The study contributes fresh insights into healthcare organizational dynamics and human resource management, providing a foundation for future advancements in this field.

Unmasking the Unrecognized: Exploring Registered Pharmacy Technicians' Stressors During COVID-19 Through a Demands-Resources Inquiry and Looking Ahead

Canadian registered pharmacy technicians (RPTs) were vital in supporting pharmacy operations during the pandemic. However, they have received little attention during or pre-pandemic. This study aimed to identify and understand the stressors experienced by Canadian RPTs during the pandemic and gain insights on lessons learned to help improve the profession. Through a descriptive qualitative design, virtual semi-structured focus groups were conducted with RPTs who were recruited through various sampling methods across Canada. Data were inductively analyzed and then deductively; themes were categorized using the Job Demands-Resources (JD-R) model. We reached data saturation after 4 focus group sessions with a total of 16 participants. As per the JD-R model, job demands included: (1) increased work volume and hours to meet patient demand; (2) drug shortages and managing prescriptions increased due to influx of orders coinciding with restricted access to medications; (3) fear of the unknown nature of COVID-19 met with frequent change in practices due to protocol changes and ineffective communication; and, (4) the pandemic introduced several factors leading to increased staff shortages. Themes pertaining to resources included: (1) poor incentives and limited access to well-being resources; (2) limited personal protective equipment delaying work operations; (3) and a general lack of knowledge or appreciation of the profession impacting work morale. Lessons learned from the pandemic were also provided. Overall, our findings revealed an imbalance where RPTs experienced high job demands with limited resources. Improved leadership within pharmacies, including improved communication between team members, is required. Furthermore, efforts to highlight and recognize the work of RPTs to the public is important to help improve enrollment, especially with their recent scope of practice expansion.

Examining Medical Staff Well-Being through the Application and Extension of the Job Demands-Resources Model: A Cross-Sectional Study

For medical staff, job satisfaction is essential for advancement on an individual and organizational level. This study looked into the relationships between challenging job demands, job resources, personal resources, and well-being. Additionally, it examined the potential mediating effects of emotional exhaustion and work motivation within the framework of the job demands-resources (JD-R) model. Results from a cross-sectional study of 267 medical employees at a second-grade comprehensive hospital in Jiangsu, China's mainland, indicated that challenging job demands and job satisfaction were positively correlated and mediated via (decreasing) emotional exhaustion. The relationship between job resources and job satisfaction was found to be mediated via (decreasing) emotional exhaustion and (increasing) work motivation. The investigation also demonstrated that the two regulatory focuses serve different purposes. It was discovered that promotion focus had a favorable effect on work motivation but a negative effect on emotional exhaustion. Conversely, preventive focus only positively predicted emotional exhaustion. Thus, the JD-R model offers a valuable structure for clarifying the job satisfaction of health personnel. The implications for enhancing individual and job outcomes are discussed.

Medical staff's emotional exhaustion and its relationship with patient safety dimensions

PURPOSE

Medical staff's emotional exhaustion increases cynical attitudes and behaviors about work and patients and leads medical staff to become detached from work. This may decrease patients' trust and satisfaction and even endanger patients' lives. There is a need to examine the critical factors affecting the medical staff's emotional exhaustion by investigating its relationship with the patient-safety dimensions based on the safety attitudes questionnaire (SAQ).

DESIGN/METHODOLOGY/APPROACH

A case study is conducted from the viewpoints of physicians and nurses to examine the relationship between emotional exhaustion and six dimensions of the SAQ from 2016 to 2020 from a regional teaching hospital in Taiwan. Linear regression with forward selection is employed. Six dimensions of the SAQ are the independent variables, whereas emotional exhaustion is the dependent variable for each year.

FINDINGS

Stress recognition is the most important variable to influence emotional exhaustion negatively, while job satisfaction is the second important variable to affect emotional exhaustion positively from 2016 to 2020. On the contrary, working conditions do not influence emotional exhaustion in this hospital from medical staff's viewpoints.

ORIGINALITY/VALUE

This study uses longitudinal data to find that both stress recognition and job satisfaction consistently influence emotional exhaustion negatively and positively, respectively, in this five-year period. The third dimension to impact emotional exhaustion varies from time to time. Thus, the findings from a cross-sectional study might be limited. The authors' findings show that reducing stress recognition and enhancing job satisfaction can lead to the improvement of emotional exhaustion from medical staff's viewpoints, which should be monitored by hospital management.

Job demand and job resource factors explaining stress and job satisfaction among home care nurses - a mixed-methods sequential explanatory study

BACKGROUND

Increasing home care has been seen as a way to respond to the growing care needs of the aging population. To secure a sufficient number of nurses to provide home care, it is essential to identify and take into account the factors related to their well-being and job satisfaction. This study examined associations of both objective and subjective job demands and resources with stress and job satisfaction among nurses working in home care.

METHODS

This study used a mixed-methods sequential explanatory design. First, quantitative data was collected with a survey, followed by a qualitative survey with open-ended questions. Linear regression analyses and qualitative content analysis with an inductive approach were used to analyze the quantitative and qualitative data, respectively. Joint display in a form of a table was used to integrate the results.

RESULTS

Of the objectively measured job demands and resources, higher proportion of direct care time and higher number of interruptions were associated with higher stress in the fully adjusted models. Of the subjective measures, higher time pressure, role conflicts and disruptions were associated with higher stress. Higher time pressure, role conflicts, and disruptions in the workday were associated with lower job satisfaction, whereas higher care continuity and having more autonomy were associated with higher job satisfaction. The results of the qualitative study, in which the nurses described their experiences of their working week, partly explained and confirmed the results of the quantitative study but were also contradictory in some respects.

CONCLUSIONS

Many demands, both subjectively experienced and objectively measured in terms of work organization, may undermine home care nurses' well-being and enjoyment at work. A severe nursing shortage combined with a growing number of clients is the reality of home care, significantly increasing the risk of burnout and turnover among employees. Strategies must be developed urgently to ensure sufficient personnel in home care. For example, investments should be made in opportunities for autonomous planning of work, and promotion of good cooperation and functionality of work teams.

Impact of work schedule characteristics on teacher mental health and burnout symptoms while remote working

BACKGROUND

During the COVID-19 pandemic, teachers quickly shifted to remote teaching with many teachers experiencing increased work demands with limited resources, affecting both mental health and work.

METHODS

Within a cross-sectional study, we evaluated the relationship between one type of work demand, non-standard work schedule characteristics, and depressive and burnout symptoms in kindergarten through 8th grade U.S. teachers working remotely in May 2020. We further assessed the impact of COVID-19 and work resources. Work schedule characteristics were self-assessed across six domains on a 5-point frequency scale from always (1) to never (5). We used multilevel Poisson models to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs).

RESULTS

In fully adjusted models, frequently working unexpectedly was associated with a higher prevalence of depressive symptoms (PR = 1.18, 95% CI = 1.07-1.31, p < 0.01), high emotional exhaustion (PR = 1.17, 95% CI = 1.05-1.30, p < 0.01), and high depersonalization (PR = 1.40, 95% CI = 1.02-1.92, p = 0.03). Remote work resources were significantly associated with a lower prevalence of depressive symptoms (PR = 0.88, 95% CI = 0.79-0.98, p = 0.02). There was a linear association between low coworker support and a low sense of personal accomplishment (PR = 0.68, 95% CI = 0.53-0.87, p < 0.01).

CONCLUSIONS

Frequently having to work unexpectedly while remote teaching was associated with symptoms of depression and burnout during the COVID-19 pandemic. Workplaces should support predictable working times to lessen the disruption caused by unexpected work to promote worker well-being.

Radiographers' organisational commitment and occupational stress: First Covid-19 wave

INTRODUCTION

Radiographers, like many health professionals, are in a high-risk group for succumbing to workplace demands beyond their ability to cope, particularly in the context of the COVID-19 pandemic resulting in occupational stress. Occupational stress has been linked to poor organisational commitment. Therefore, the purpose of this research was to evaluate radiographers' organisational commitment and occupational stress after the first wave of the COVID-19 pandemic.

METHODS

A mixed method approach entailed data collected from purposively sampled Australian radiographers working during the first COVID-19 wave. The quantitative phase used an online commitment questionnaire, and 21 semi-structured individual virtual interviews were conducted in the qualitative phase. Data interpretation and analysis used statistical and thematic approaches.

RESULTS

The quantitative data revealed a higher level of continuance than affective and normative commitment. Whereas the qualitative findings showed participants high levels of affective commitment to their occupation and, together with leadership support, working collectively towards a positive outcome.

CONCLUSION

Despite the variety of occupational stressors that arose during the COVID-19 crisis, Australian radiographers enjoy a high level of occupational and organisational commitment.

IMPLICATIONS FOR PRACTICE

Radiographers' organisational commitment represents their emotional and psychological attachment to their workplace, and radiographers experiencing occupational stress represent high levels of psychosomatic distress and burnout. Therefore, considering radiographers' organisational commitment and occupational stress is essential in the delivery of services, quality of patient care and radiographers well-being.

Impact of the COVID-19 pandemic crisis on turnover intention among nurses in emergency departments in Thailand: a cross sectional study

BACKGROUND

During the COVID-19 pandemic in Thailand, a large volume of COVID-19 patients were referred to hospital emergency departments (EDs). This increased job demand and job strain among ED nurses, resulting in a high risk of intention to leave their organization.

AIMS

To investigate turnover intention during the COVID-19 pandemic among ED nurses and examine the effect of organizational resources, maladaptive regulation, and job burnout on nurses' turnover intention.

METHOD

This cross-sectional study investigated 322 ED nurses. We divided participants into two groups: dark-red zone areas (pandemic crisis areas) and non-red zone areas (non-pandemic crisis areas). Descriptive statistics, Pearson's correlation analysis, and multiple linear regression (forward stepwise method) were used to analyze factors that predicted turnover intention.

RESULTS

Most participants were female and the mean age was 34.54 years. During COVID-19 pandemic crisis, 72.8% of ED nurses in dark-red zone areas desired to leave their organization. The factors of motivation, exhaustion, and cognitive impairment positively influenced turnover intention among ED nurses in dark-red zone areas. Low availability of organizational resources was associated with an increase in the turnover intention rate. Maladaptive regulation, exhaustion, and cognitive impairment positively influenced turnover intention among ED nurses in non-red zone areas.

CONCLUSION

Exhaustion and cognitive impairment stand as significant facets of burnout linked to the intention of turnover among ED nurses. To address this, we recommend fostering secure workplace settings and implementing interventions that alleviate job demands and strains for ED nurses, potentially reducing turnover intentions.

The influence of nurse managers' authentic leadership style and work environment characteristics on job burnout among emergency nurses

BACKGROUND

Emergency nurses experience excessive workloads and high job burnout. Limited evidence exists exploring the role of authentic leadership and nurse work environment on job burnout among emergency nurses.

OBJECTIVE

To assess the influence of nurse managers' authentic leadership and nurse work environment on job burnout among emergency nurses.

METHODS

A cross-sectional study was conducted among 160 emergency nurses working in six hospitals in the Sultanate of Oman. The Maslach Burnout Inventory, Authentic Leadership Questionnaire, and the Practice Environment Scale of the Nursing Work Index were used to assess study variables.

RESULTS

Of the 233 distributed surveys, 160 emergency nurses responded resulting in a response rate of 69%. More than two thirds of emergency nurses (72.1%) reported high levels of burnout. Authentic leadership and a favorable work environment were significantly associated with lower job burnout. Nurse managers' transparency (β = - 0.481, p = 0.031), ethical/moral conduct (β = - .408, p = 0.043), managerial ability and support (β = - 0.497, p = 0.018), and adequate staffing and resources (β = -.068, p = 0.028) were all associated with lower job burnout.

CONCLUSIONS

Results suggest the importance of providing effective leadership, adequate support to staff, maintaining optimum staffing and resources, and developing nurse managers' authentic leadership to reduce nurses' job burnout.

Value of Care: An Exploratory Qualitative Study with Doctors and Patients

The concept of value in healthcare is mainly based on economic and financial aspects. However, the literature has emphasised the need to investigate value from other perspectives. The present study aimed to explore the views of physicians and patients on the value of healthcare, and to examine in depth the psychosocial and organisational elements that have emerged but that need to be investigated more. Therefore, two qualitative studies were performed, in which 69 physicians and 111 patients participated. The data were analysed using content analysis and text mining using t-lab software. The results revealed common elements between the two healthcare actors that constitute value in healthcare, including competence, professionalism, and soft skills like communication and empathy. Furthermore, the importance of functioning health services and effective organisational culture in local healthcare and investment emerged. These findings can guide healthcare organisations to consider the potential psychosocial factors related to value in healthcare, which affect organisation in terms of costs and healthcare relationships. In addition, these findings are a first step in filling the gap found in the literature regarding the consideration of value from a non-economic perspective and the difficulty of defining and measuring it.

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring?

The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016-2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.

Workplace Bullying among Healthcare Professionals: A Quanti-Qualitative Survey in a Sample of Women Working in an Italian Healthcare Setting

The main objective of this study was to analyze, in a sample of female healthcare workers in Italy, the training needs to improve positive relationships in the healthcare organization. To better understand these needs, perceived workplace bullying and its consequences in terms of professional commitment and well-being were analyzed from a descriptive and quantitative perspective (or mixed-methods analysis). A questionnaire was completed online in a healthcare facility in northwestern Italy. The participants were 231 female employees. The quantitative data showed that, on average, the sampled population perceived a low burden of WPB. The majority of the sample expressed moderate engagement at work and moderate perception of psychological well-being. It is interesting to note that one element seemed to be overarching in the responses to the open-ended questions: communication, which emerged as a problematic element that affects the entire organization. The research data provide useful evidence for intervention in favor of an environment that helps to recognize the phenomenon and intervene in time, offering the possibility of accepting the discomfort and fatigue of healthcare workers and offering useful interventions to the individual and the team.

Beyond heroism: a qualitative study on the lived experiences of nurses caring for patients with COVID-19 in Pakistan

BACKGROUND

Healthcare professionals around the globe suffered severely during the COVID-19 pandemic. The present study aims to explore the lived experiences of nurses caring for COVID-19 patients in Pakistan.

METHODS

The study is a qualitative exploration of the lived experiences caring for patients with COVID-19 in Pakistan. This research was conducted in two government hospitals there. Face-to-face in-depth interviews were conducted amongst 30 nurses who had been selected using purposive sampling technique. Thematic analysis was applied to extract the themes from respondents' answers.

RESULTS

By using thematic analysis, social response, impacts on physical and mental health, and experience of handling COVID-19 patients were extracted as major themes.

CONCLUSIONS

The findings of this research are of immense importance in showing the impact of COVID-19 on mental and physical health, along with the social and personal consequences for nurses providing care to COVID-19 patients.

Correlates of burnout among healthcare workers during the COVID-19 pandemic in South Korea

Burnout is a form of negative emotional and physical response to job stress. This study aimed to investigate the prevalence of burnout among healthcare workers responding to the coronavirus disease 2019 (COVID-19) outbreak in Korea and to explore correlates of burnout among healthcare workers. A nationwide questionnaire-based survey was conducted from December 1, 2020, to January 29, 2021 on 1425 healthcare workers who worked in one of the 16 healthcare facilities designated for COVID-19 care, in public health centers, or as paramedics in Korea. Burnout was assessed using 16 Korean-adapted items based on the Oldenburg Burnout Inventory (OLBI). Data were collected using a structured questionnaire and analyzed using the R version 4.1.1 software program. OLBI results indicate clinically exhaustion in 84.5% (1204/1425) and clinically disengagement in 91.1% (1298/1425), and 77.3% (1102/1425) met the score criteria for both the exhaustion and disengagement subscales for burnout. Burnout rate was significantly increased in the group with chronic fatigue symptoms (Fatigue Severity Scale ≥ 3.22) after the outbreak of COVID-19 (OR, 3.94; 95% CI 2.80-5.56), in the female group (OR, 2.05; 95% CI 1.46-2.86), in the group with physical symptoms (Patient Health Questionnaire-15 ≥ 10) after the outbreak of COVID-19 (OR, 2.03; 95% CI 1.14-3.60), in the group with a higher Global Assessment of Recent Stress scale (OR, 1.71; 95% CI 1.46-2.01), in the group with post-traumatic stress symptoms (Primary Care Post-Traumatic Stress Disorder-5 ≥ 2) (OR, 1.47; 95% CI 1.08-2.01), and in the younger age group(OR, 1.45; 95% CI 1.22-1.72). The chronic fatigue symptoms were correlated with cumulative days of care (OR, 1.18; 95% CI 1.02-1.37). The physical symptoms were correlated with average contact hours with COVID-19 patients per day (OR, 1.34; 95% CI 1.17-1.54), and cumulative days of care (OR, 1.21; 95% CI 1.06-1.38). Most Korean healthcare workers suffered from burnout related to excessive workload during the COVID-19 pandemic. During a widespread health crisis like COVID-19, it is necessary to regularly check the burnout status in healthcare workers and reduce their excessive workload by supplementing the workforce and providing appropriate working hours sufficient rest hours.

An Explanatory Model of Work-family Conflict and Resilience as Predictors of Job Satisfaction in Nurses: The Mediating Role of Work Engagement and Communication Skills

BACKGROUND

The Job Demands and Resources (JD-R) model is used to examine predictors of well-being, work engagement, and individual or organizational outcomes. According to the model, work engagement and communication skills play a mediating role between work-family conflict and resilience to job satisfaction in nurses.

METHODS

A cross-sectional study was conducted considering 431 Peruvian nurses of mean age (M = 40.31 years; SD = 10.94) ranging from 22 to 68 years working in public hospitals in the Lima region. Data were collected using a self-reported form of the Job Satisfaction Scale, communication skills, work engagement, work-family conflict, and resilience. The theoretical model was evaluated using structural equation modeling (SEM).

RESULTS

A theoretical model with adequate fit was obtained [χ²(2) = 6.0, P < .001, CFI = 0.995, RMSEA = 0.068, SRMR = 0.015]. Results indicated an inverse relationship between work-family conflict with communication skills (β = -.24, P < .001) and work engagement (β = -.10, P = .003). Likewise, resilience had an influence on communication skills (β = .55, P < .001) and work engagement (β = .33, P < .001). In addition, the model explains 71% of job satisfaction. Also, the results indicate the influence of work-family conflict and resilience through the mediating role of work engagement and work-family conflict on job satisfaction.

CONCLUSIONS

The model confirmed that work engagement and communication skills are valid moderators to mitigate work-family conflict and strengthen resilience that favors job satisfaction in nurses.

Emotional Exhaustion Variables in Trainee Teachers during the COVID-19 Pandemic

INTRODUCTION

emotional exhaustion among trainee teachers is a relevant topic since it could have repercussions regarding the lives of their future pupils. Our objective was to determine the degree of trainee teachers' emotional exhaustion and associated variables during the COVID-19 pandemic.

METHODS

the design was cross-sectional and descriptive. Questionnaires with sociodemographic variables, perceptions of mental health, and the Emotional Exhaustion Scale (ECE) (α = 0.890; ω = 0.893) validated for the Chilean context were answered by 204 trainee teachers. The results were analyzed using SPSS software version 25 and the Emotional Exhaustion Interpretation Table (EES-Int).

RESULTS

the results show that 92.2% of the trainee teachers presented a worsening in their mental health, stress (66.2%), irritability (38.2%), anxiety (37.7%), and depressive symptoms (32.8%). Online classes (73.04%) and the pandemic (67.6%) were the main influencing factors. Education students who perceived their mental health had worsened became 6.63 times more likely to develop emotional exhaustion [AOR = 6.63; 95% CI: 1.78, 24.69]. In addition, education students with a high perception of academic stress were 7.45 more likely to develop emotional exhaustion [AOR = 7.45; 95% CI: 1.98, 28.09].

CONCLUSION

we can conclude that trainee teachers have high levels of emotional exhaustion and their perception of their mental health and the academic stress they are being subjected to during the COVID-19 pandemic may lead them to present symptoms of frequent or permanent problems with concentration, attention, recall of information, dissatisfaction with their performance, and frequent learning difficulties. From the affective dimension, they present frequent or permanent anxiety, restlessness, irritability, indifference, low mood, and psychomatization. From the socio-interactional dimension, they present frequent or permanent social withdrawal, interpersonal problems, problems at work or school, and family and relationship problems. Increasing the sample to delve into emotional exhaustion by subject area is necessary. For future studies, research should be conducted on the causes of emotional exhaustion by subject area and the coping strategies of trainee teachers to understand differences and provide input on emotional support in practice.

Predicting Challenge and Threat Appraisal of Job Demands among Nurses: The Role of Matching Job Resources

(1) Background: Empirical studies have started to examine employees' subjective appraisals of job demands and their relations to employees' health. However, knowledge of working conditions, which might contribute to how employees appraise specific job demands, is scarce. The present study aimed to examine predictors of nurses' appraisals of job demands (i.e., time pressure, emotional demands, physical demands, and role ambiguity) as challenges and/or threats among corresponding job resources (i.e., autonomy, social support, physical resources, participation in decision-making). It also examined moderating effects of these predictors. (2) Methods: Cross-sectional data were collected via an online survey in a sample of 425 nurses working in Luxembourg. (3) Results: Multiple regression analyses indicated that matching job resources predicted nurses' appraisal of job demands as challenging. Threat appraisal was predicted by three out of four kinds of job resources (i.e., autonomy, physical resources, participation in decision-making). However, the current study did not find any moderating effects between job demands and job resources on challenge/threat appraisals. (4) Conclusions: The present study identified domain-specific job resources that contribute to how employees perceive selected job demands. Accordingly, we encourage scholars and practitioners to align job demands with matching job resources to prevent nurses' threat appraisal of job demands, and to promote their challenge appraisals.

The state of general surgery residents in Italy after COVID-19 outbreak: a nationwide cross-sectional study

INTRODUCTION

A significant reorganization of working activities including those of teaching hospitals occurred after COVID-19 outbreak, leading to the need to re-assess the current status of training after the pandemic. This study aimed to investigate the state of general surgery (GS) residency in Italy. The impact of COVID-19 on GS residents was also assessed.

METHODS

Between October and November 2020, an anonymous online survey was distributed to GS residents across Italy. Email addresses were provided by the Regional Committees of the Italian Polyspecialistic Society of Young Surgeons. The residents completed a set of questions regarding their training schedule and three standardized questionnaires to measure burnout and psychological distress.

RESULTS

Overall, 1709 residents were contacted and 648 completed the survey. Almost two-thirds of the residents (68.4%, n = 443) reported to not reach the minimum annual operative case volume. According to ordinal logistic regression analysis, two of the most perceived effects of COVID-19 by trainees on training were reduction of surgical activities (OR = 2.21, p < 0.001) and increased concerns about future employment (OR = 1.14, p = 0.025). Loss of training opportunities was also associated with a significant increase of distress (OR = 1.26, p = 0.003) but not with burnout.

CONCLUSIONS

This study provided a snapshot of the situation of GS residents in Italy after COVID-19 outbreak. Reduction of activities due to pandemic highlighted the need to improve the level of surgical education in our country by implementing all the new available tools for training and ensuring at the same time the well-being of the residents.

UK healthcare support workers and the COVID-19 pandemic: an explorative analysis of lived experiences during the COVID-19 pandemic

Support workers are an underrepresented profession that receives less attention with a high degree of responsibilities. The aim of this study was to explore the lived experiences of healthcare support workers within the care sector during the COVID-19 pandemic. This is a qualitative semi-structured interview study using an interpretative phenomenology (IP) framework. Fifteen (15) support workers were interviewed while all COVID-19 restrictions from the government were still in place. We identified five main themes: (1) challenging experiences; (2) coping mechanisms; (3) emotions and behaviors arising from the COVID-19 pandemic; (4) external interest on support worker's health; (5) take-home message from the COVID-19 pandemic. The organization selected for the research is a good representative of how care organizations operate within the UK both in terms of policies and staff selection.

The language of healthcare worker emotional exhaustion: A linguistic analysis of longitudinal survey

Importance

Emotional exhaustion (EE) rates in healthcare workers (HCWs) have reached alarming levels and been linked to worse quality of care. Prior research has shown linguistic characteristics of writing samples can predict mental health disorders. Understanding whether linguistic characteristics are associated with EE could help identify and predict EE.

Objectives

To examine whether linguistic characteristics of HCW writing associate with prior, current, and future EE.

Design setting and participants

A large hospital system in the Mid-West had 11,336 HCWs complete annual quality improvement surveys in 2019, and 10,564 HCWs in 2020. Surveys included a measure of EE, an open-ended comment box, and an anonymous identifier enabling HCW responses to be linked across years. Linguistic Inquiry and Word Count (LIWC) software assessed the frequency of one exploratory and eight a priori hypothesized linguistic categories in written comments. Analysis of covariance (ANCOVA) assessed associations between these categories and past, present, and future HCW EE adjusting for the word count of comments. Comments with <20 words were excluded.

Main outcomes and measures

The frequency of the linguistic categories (word count, first person singular, first person plural, present focus, past focus, positive emotion, negative emotion, social, power) in HCW comments were examined across EE quartiles.

Results

For the 2019 and 2020 surveys, respondents wrote 3,529 and 3,246 comments, respectively, of which 2,101 and 1,418 comments (103,474 and 85,335 words) contained ≥20 words. Comments using more negative emotion (p < 0.001), power (i.e., references relevant to status, dominance, and social hierarchies, e.g., own, order, and allow) words (p < 0.0001), and words overall (p < 0.001) were associated with higher current and future EE. Using positive emotion words (p < 0.001) was associated with lower EE in 2019 (but not 2020). Contrary to hypotheses, using more first person singular (p < 0.001) predicted lower current and future EE. Past and present focus, first person plural, and social words did not predict EE. Current EE did not predict future language use.

Conclusion

Five linguistic categories predicted current and subsequent HCW EE. Notably, EE did not predict future language. These linguistic markers suggest a language of EE, offering insights into EE's etiology, consequences, measurement, and intervention. Future use of these findings could include the ability to identify and support individuals and units at high risk of EE based on their linguistic characteristics.

The Mediation Chain Effect of Cognitive Crafting and Personal Resources on the Relationship between Role Ambiguity and Dentists' Emotional Exhaustion

Based on Job Demands-Resources (JD-R), Conservation of Resources (COR) and self-regulation theories integration, this study investigated the association between role ambiguity and emotional exhaustion among 191 Romanian dentists, as well as the chain mediating role of cognitive crafting and three personal resources (resilience, optimism, and self-efficacy). Three conceptual models which included, separately, the three personal resources were proposed. PROCESS macros were used to verify the hypotheses related to the testing of the path mediation models. The results indicated that role ambiguity was directly and positively associated with dentists' burnout. More importantly, the sequential indirect effect of role ambiguity on burnout via mediators in chains (cognitive crafting and resilience for the first model; cognitive crafting and optimism for the second model; cognitive crafting and self-efficacy for the third model) was significant. The findings provide a direction for dentists' health intervention because it reveals how the negative impact of role ambiguity on emotional exhaustion increasing can be buffered by the cumulative effect of cognitive crafting and different personal resources, as a result of their chain reinforcement.

Risk factors for workplace bullying, severe psychological distress and suicidal ideation during the COVID-19 pandemic among the general working population in Japan: a large-scale cross-sectional study

OBJECTIVES

To investigate the risk factors for workplace bullying and mental health outcomes among workers during the COVID-19 pandemic.

DESIGN

A cross-sectional study.

SETTING

A nationwide online survey was conducted from August to September 2020 in Japan.

PARTICIPANTS

16 384 workers (men: n=9565; women: n=6789).

MAIN OUTCOME VARIABLES

Workplace bullying was measured by one item from the Brief Job Stress Questionnaire; severe psychological distress according to the Kessler Psychological Distress Scale (≥13) and suicidal ideation by one item. Prevalence ratios were calculated by modified Poisson regression analyses adjusting for potential confounders such as gender, age, occupational characteristics and a prior history of depression.

RESULTS

Overall, 15% of workers experienced workplace bullying, 9% had severe psychological distress and 12% had suicidal ideation during the second and third wave of the COVID-19 pandemic in Japan. The results of this study showed men, executives, managers and permanent employees had a higher risk of bullying than women or part-time workers. Increased physical and psychological demands were common risk factors for bullying, severe psychological distress and suicidal ideation. Starting to work from home was a significant predictor for adverse mental health outcomes but a preventive factor against workplace bullying.

CONCLUSIONS

The results of this study showed different high-risk groups for bullying or mental health during the pandemic. Any intervention to decrease workplace bullying or mental health problems should focus not only on previously reported vulnerable workers but also workers who have experienced a change in work style or job demands.

When workaholism is negatively associated with burnout: A moderated mediation

Aim

Previous theory and research postulate that workaholism is one of the important factors that contribute to burnout. The present study aimed to analyze the role of psychological capital as a mediator between the two. Moreover, the study examined the moderating role in the stated mediated relationship.

Methods

The researchers approached a sample of university teachers (N = 1,008) including both male (n = 531) and female (n = 477) university teachers by using a multi-stage random sampling technique. For this purpose, DUWAS-10 Oldenburg Burnout Inventory, Challenging Job Demands Scale, and Anila PsyCap Scale were applied to measure workaholism, burnout, challenging job demands, and PsyCap, respectively. The data obtained from the sample was subjected to analysis by using Model 14 of Process Macro by Hayes.

Results

The results confirmed the mediating role of PsyCap and moderating role of time pressure and cognitive demands in the relationship of the two variables. The results concluded that workaholism is not directly related to burnout rather the negative relationship existed through psychological capital, and the mediated relationship was stronger for the university employees who were to face a higher level of challenging job demands including cognitive demands and time pressure.

Conclusion

Burnout is an occupational health problem that causes devastating effects on both the employees as well as to the organizational economy. Improving personal resources might help the negative relationship between workaholism and burnout in higher education institutions in the country.

Lack of Interventional Studies on Suicide Prevention among Healthcare Workers: Research Gap Revealed in a Systematic Review

Addressing the mental health needs of healthcare workers (HCWs), who are at high risk of suicide, is an important public health issue. Therefore, this systematic review investigated the effect of psychosocial intervention targeting suicidal behavior (i.e., suicidal ideation, attempt, or fulfillment) of HCWs. Five electronic databases were searched for interventional studies reporting HCWs' suicidal behavior outcomes. Only two interventional studies were included in this review, and no consistent conclusion was drawn from the existing literature regarding the psychosocial prevention strategies focusing on the suicide risk of HCWs. The results indicate that compared with numerous observational studies reporting poor mental health and/or severity of suicidal risk among HCWs, intervention studies using psychosocial strategies to reduce the risk of suicide are relatively scarce. Although the insufficient number and heterogeneity of the included studies leave the results inconclusive, our findings emphasize the need to fill the research gap in this field. The causes of the gap are further explored, and suggestions for future research are provided.

Causes of Stress among Healthcare Professionals and Successful Hospital Management Approaches to Mitigate It during the COVID-19 Pandemic: A Cross-Sectional Study

The outbreak of the COVID-19 pandemic posed an immediate challenge to the management of hospitals in Germany and elsewhere. The risk of stress for front-line healthcare professionals forced occupational health and safety units to adopt a variety of protective measures, not all of which have been thoroughly validated. The main objective of the present analysis is to assess what the most important sources of stress were and which of the protective measures applied to counteract stress among healthcare staff had the greatest impact. A better understanding of these factors will improve hospital management and worker safety in a future health crisis situation and may also prove to be beneficial in non-crisis situations. For this purpose, in 2020, an exploratory, cross-sectional and quantitative study using a questionnaire created for this purpose was carried out on a total of 198 professionals-133 nurses and 65 physicians-at the Klinikum Mittelbaden Balg hospital in Baden-Baden, Germany, during the first wave of the pandemic. Statistical analyses showed that nurses suffer more stress than physicians and that stress is higher among professionals in critical care and emergency units than in units that are less exposed to infected patients. It was also found that measures such as salary incentives, encouragement of work in well-integrated teams, and perceived support from hospital management mitigate stress. These findings highlight the importance of support measures from management and superiors. Knowing the actual effectiveness of the measures applied by management and the factors mentioned above could help to protect healthcare professionals in the event of another pandemic or similar situations and may still be of value in dealing with the continuing COVID-19 pandemic.

Patient Engagement in Oncology Practice: A Qualitative Study on Patients' and Nurses' Perspectives

Patient engagement has gained increasing attention in cancer care as it is widely acknowledged as an essential element of high-quality care. There are limited data on how oncology nurses might apply techniques that encourage patient engagement. Therefore, this study aims to understand which nursing strategies can favour patient engagement in oncological care from patients' and nurses' perspectives. We conducted a qualitative study involving oncology patients and oncology nurses. Patients were interviewed, while nurses were involved in focus groups (FGs). Both interviews and FGs were analysed by the means of thematic analysis. We interviewed six patients and conducted two FGs, involving 17 nurses. Five themes were identified from patients' interviews: effective information, having the opportunity to choose, being considered a person, trusted relationship with nurses, and receiving support and advice. Additionally, five themes were identified from the FGs: the nurse-patient relationship, personalisation of care, information style, engagement strategies, and the team. The participants highlighted the importance of comprehensive information in order for patients to feel more involved. Great importance was given to the nurse-patient relationship, which must be based on trust and mutual respect. Both nurses and patients emphasised the importance of person-centred care. A more systematic implementation of suggestions from the participants in this study is desirable for the future.

Psychological Distress in South African Healthcare Workers Early in the COVID-19 Pandemic: An Analysis of Associations and Mitigating Factors

While the global COVID-19 pandemic has been widely acknowledged to affect the mental health of health care workers (HCWs), attention to measures that protect those on the front lines of health outbreak response has been limited. In this cross-sectional study, we examine workplace contextual factors associated with how psychological distress was experienced in a South African setting where a severe first wave was being experienced with the objective of identifying factors that can protect against HCWs experiencing negative impacts. Consistent with mounting literature on mental health effects, we found a high degree of psychological distress (57.4% above the General Health Questionnaire cut-off value) and a strong association between perceived risks associated with the presence of COVID-19 in the healthcare workplace and psychological distress (adjusted OR = 2.35, p < 0.01). Our research indicates that both training (adjusted OR 0.41, 95% CI 0.21−0.81) and the reported presence of supportive workplace relationships (adjusted OR 0.52, 95% CI 0.27−0.97) were associated with positive outcomes. This evidence that workplace resilience can be reinforced to better prepare for the onset of similar outbreaks in the future suggests that pursuit of further research into specific interventions to improve resilience is well merited.

Buffering the Effects of Burnout on Healthcare Professionals' Health-The Mediating Role of Compassionate Relationships at Work in the COVID Era

Managing the COVID-19 pandemic posed several challenges for healthcare professionals, which likely heightened their risk of burnout (Amanullah and Ramesh Shankar, 2020) and, consequently, their general physical and mental health. Although it may not be possible to address and eliminate the causes of burnout, current research informs healthcare organizations about protective strategies to reduce its detrimental consequences. The promotion of compassionate interactions among healthcare professionals may play such a role. Compassion within healthcare organizations positively affects individual performance and well-being. Building on these considerations and within the framework of the Conservation of Resources theory, this study explores the relationships among burnout dimensions, received compassion at work, and general health in 711 Italian healthcare professionals (68.5% female), aged between 21 and 73 years (Mage = 36.4, SD = 11.2). Analyses were conducted to investigate the association between burnout and general well-being (H1) and between burnout symptoms and perceived compassion at work (H2); and the mediational role of compassion in the relationship between burnout symptoms and general well-being. H1 and H2 were confirmed (r < 0.01 for both), and a SEM model showed the mediating role of compassion at work in the association between burnout symptoms and general well-being (RMSEA < 0.08, SRMR < 0.08, CFI and TLI > 0.90). Theoretical and practical implications of the findings are discussed in the paper.

Individual Workplace Well-Being Captured into a Literature- and Stakeholders-Based Causal Loop Diagram

This study demonstrates an innovative approach to capture the complexity of individual workplace well-being, improving our understanding of multicausal relationships and feedback loops involved. The literature shows that a high number of interacting factors are related to individual workplace well-being. However, many studies focus on subsets of factors, and causal loops are seldomly studied. The aim of the current study was, therefore, to capture individual workplace well-being in a comprehensive conceptual causal loop diagram (CLD). We followed an iterative, qualitative, and transdisciplinary systems-thinking approach including literature search, group model building sessions, retrospective in-depth interviews with employees, and group sessions with human resource professionals, managers, job coaches, and management consultants. The results were discussed with HR and well-being officers of twelve organizations for their critical reflection on the recognizability and potential of the developed CLD. The final result, a conceptual individual workplace well-being CLD, provides a comprehensive overview of multiple, measurable key factors relating to individual workplace well-being and of the way these factors may causally interact over time, either improving or deteriorating workplace well-being. In future studies, the CLD can be translated to a quantitative system dynamics model for simulating workplace well-being scenarios. Ultimately, these simulations could be used to design effective workplace well-being interventions.

The emotional impact of COVID-19 on Spanish nurses and potential strategies to reduce it

BACKGROUND

Although the emotional and psychological impact of nurses' work had been identified before the COVID-19 pandemic, the pandemic aggravated risk indicators for their mental health.

AIM

The objective of this study was to analyse the levels of anxiety, depression, post-traumatic stress and burnout of nurses in the Balearic Islands (Spain) during the pandemic to identify possible sociodemographic and related occupational factors.

DESIGN

A cross-sectional study of 892 nurses was conducted during four weeks from February to March 2021.

METHODS

Sociodemographic data related to the pandemic were collected and anxiety, depression, burnout and post-traumatic stress were measured with validated scales. A multivariate and predictive analysis was carried out with risk estimates.

FINDINGS

About 75.6% of the nurses had experience in COVID-19 units, and 49.1% had worked for more than 10 months in a COVID-19 unit. Nurses in COVID-19 units (hospital ward or ICU) were more likely to report emotional fatigue (OR 1.9, p < 0.001) and anxiety (OR 1.5, p = 0.021). In general, moderate post-traumatic stress was evident in general nurses (p = 0.027), and severe post-traumatic stress was evident in ICU nurses (p = 0.027). A 1.24-month reduction in COVID-19 patient care predicted reduced levels of emotional fatigue (5.45 points), depersonalisation (1.87 points) and post-traumatic stress (4.65 points) in nurses.

CONCLUSION

Given the occurrence of new waves of COVID-19, the need to establish preventive strategies that focus on the personal and occupational characteristics related to these indicators and to implement urgent psychological support strategies is demonstrated.

IMPACT

Given these findings, it is imperative solutions are urgently applied in order to prevent compounding risk to the health system.

Tiny Habits® for Gratitude-Implications for Healthcare Education Stakeholders

The COVID-19 pandemic has led to diminished sleep and increased stress, anxiety, and burnout for many health professionals and health professions students. One simple approach that may be effective for bolstering personal well-being is consciously cultivating gratitude. Gratitude is positively associated with physical health, psychological health, hope, sleep, and health behavior engagement; and randomized studies indicate that gratitude interventions can improve psychological well-being and sleep. The primary aim of this study was to assess the impact of practicing Tiny Habits^® on self-reported gratitude, as measured by the 6-Item Gratitude Questionnaire (GQ-6). In January 2021, 154 adult participants with GQ-6 <35/42 were randomized to one of 3 groups: Tiny Habits for Gratitude (n = 50), Tiny Habits Control (n = 52), and Inactive Control (n = 52). Both Tiny Habits groups chose 3 Tiny Habits Recipes to practice daily and participated in the free, email-based 5-Day Program with automated daily check-in emails and personalized feedback from a Certified Tiny Habits Coach. The Recipes for the Tiny Habits for Gratitude group focused on cultivating gratitude, while those for the Tiny Habits Control group did not. Post-intervention, the mean change in GQ-6 scores in the Tiny Habits for Gratitude (Δ = ↑6.9 ± 5.6; n = 37/50, 74%; p< 0.001, Cohen's d = 0.85) and Tiny Habits Control (Δ = ↑5.6 ± 4.1; n = 31/52, 60%; p = 0.009, Cohen's d = 0.71) groups were greater than that of the Inactive Control group (Δ = ↑2.5 ± 4.4; N = 42/52, 81%). At 1 month, the mean change in GQ-6 scores in the Tiny Habits for Gratitude group (Δ = ↑7.0 ± 5.3; N = 28/50, 56%) was greater than that of the Inactive Control group (Δ = ↑2.9 ± 5.4; N = 39/52, 72%; p = 0.002, Cohen's d = 0.78). These findings suggest that practicing Tiny Habits Recipes and participating in the 5-Day Program can significantly increase gratitude in the short term and focusing specifically on gratitude during this process can sustain the increase in gratitude for up to 1 month. Implementation is quick, simple, and free. This has significant implications for healthcare education stakeholders.

Job Satisfaction and Burnout in Croatian Physiotherapists

BACKGROUND

Physiotherapists are important healthcare professionals in modern and multidisciplinary health forces. However, they are exposed to a high risk of occupational burnout, which is associated with reduced job satisfaction. Job satisfaction is essential for medical professionals because it directly influences patient safety and the quality of medical care. Therefore, this study aimed to determine the association between sociodemographic variables of Croatian physiotherapists, job satisfaction, and occupational burnout.

METHODS

A cross-sectional study was performed among 404 physiotherapists using a sociodemographic questionnaire, the Job Descriptive Index (JDI), and Oldenburg Burnout Inventory (OLBI).

RESULTS

The study group of Croatian physiotherapists was marked by a high level of job satisfaction and occupational burnout. However, a higher level of occupational burnout is associated with lower job satisfaction. The main determinants of job satisfaction were younger age, female gender, less work experience, and married or partnership. At the same time, a higher level of occupational burnout was associated with working in government institutions and being single.

CONCLUSIONS

As a reaction to psychological stress at work with the main components of exhaustion and disengagement, occupational burnout is negatively associated with job satisfaction. Therefore, assessing the factors influencing job satisfaction and burnout in the workplace can help develop physiotherapists' mental health prevention strategies.

Validation of the Connor-Davidson Resilience Scale-10 in South Africa: Item Response Theory and Classical Test Theory

Purpose

During times of crisis, and in particular during the current COVID-19 pandemic, resistance resources, such as resilience, are key to managing the negative impacts of the crisis. The Connor-Davidson Resilience Scale-10 has been extensively used to assess resilience. In the current study, we examined the reliability, validity and dimensionality of this instrument using Rasch analysis, Mokken analysis and classical test theory. Using both item response theory and classical test theory provides a more comprehensive overview of the psychometric properties of the Connor-Davidson Resilience Scale-10.

Participants and Methods

School teachers from South Africa (N = 355) constituted the sample for the study and they completed the following scales: Connor-Davidson Resilience Scale-10, the Center for Epidemiological Studies Depression Scale, State-Trait Anxiety Inventory-Trait Scale, the Beck Hopelessness Scale, and the Sense of Coherence Scale.

Results

Both item response theory and classical test theory provided strong evidence for the reliability and validity of the Connor-Davidson Resilience Scale-10. In addition, the analyses provided support for considering the scale as essentially unidimensional.

Conclusion

The obtained results provide additional support for the reliability and validity, of the Connor-Davidson Resilience Scale-10 for samples from diverse contexts.

Acute stress disorder and job burnout in primary and secondary school teachers during the COVID-19 pandemic: The moderating effect of sense of control

The study aim was to examine the relationship between acute stress disorder and job burnout among primary and secondary school teachers, and to explore the moderating effect of sense of control on this relationship. A total of 751 teachers completed self-report questionnaires during the COVID-19 pandemic. The results showed that acute stress disorder, emotional exhaustion, and depersonalization were significantly lower in female teachers than in male teachers. Age was positively associated with acute stress disorder and negatively associated with inefficacy. Acute stress disorder was significantly and positively associated with emotional exhaustion and depersonalization dimensions of job burnout. The relation between acute stress disorder and inefficacy was moderated by sense of control: acute stress disorder was positively associated with inefficacy when the sense of control was strong and was negatively associated with inefficacy when the sense of control was weak. These findings demonstrate that acute stress disorder is a risk factor for job burnout, and that sense of control is a protective factor for some aspects of job burnout. However, in individuals with a strong sense of control, acute stress disorder is associated with greater inefficacy, suggesting that sense of control can both positively and negatively affect burnout.

Workplace Protections and Burnout Among Brazilian Frontline Health Care Professionals During the COVID-19 Pandemic

Health care workers from low- and middle-income countries have been playing a critical role in overcoming the challenges related to the COVID-19 pandemic; yet little is known about the relationship between workplace protections and wellbeing of Brazilian health care workers during the pandemic. This study aimed to evaluate whether Brazilian health care workers were satisfied with their workplace measures to protect their physical and mental health during the pandemic, and to assess the associations of such levels of satisfaction with indicators of burnout. Licensed Brazilian health care professionals were recruited via popular media between 5/19/2020 and 8/23/2020 to complete an online survey including questions about their demographic/professional characteristics, satisfaction with their workplace protective measures during the pandemic, and validated questionnaires assessing neuroticism, resilient coping, and symptoms of burnout. Most participants reported being dissatisfied with their workplace measures to protect their physical (516, 56.3%) and mental health (756, 82.5%). In multivariable analysis adjusted for personal and environmental factors, dissatisfaction with workplace physical health protections was significantly associated with higher levels of emotional exhaustion (B = 1.08, 95% CI = 0.47–1.69) and depersonalization (B = 0.61, 95% CI = 0.10–1.12), and dissatisfaction with workplace mental health protections significantly associated with higher levels emotional exhaustion (B = 1.17, 95% CI = 0.40–1.95). Efforts to improve both physical and mental health protective measures are critical to guarantee that health care workers continue to provide care at their maximum capacity.

The impact of the COVID-19 pandemic on pediatric developmental services: a cross-sectional study on overall burden and mental health status

BACKGROUND

The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers, even those who have not been directly involved in the care of acutely ill patients. The aims of this study were to identify the overall burden and mental health status of healthcare workers in pediatric developmental services under the influence of the COVID-19 pandemic, and to identify the risk and protective factors associated with mental health.

METHODS

This cross-sectional web-based study was part of a large multicenter VOICE study conducted among employees ((neuro-)pediatricians, psychologists, speech therapists, occupational therapists, etc.) from various pediatric developmental services between June and July 2020. A total of 1291 questionnaires regarding overall burden, mental health status (depression, generalized anxiety disorder and emotional exhaustion) and risk and protective factors for mental health (working conditions, potential problems during the COVID-19 pandemic and psychological resources) were analyzed. Descriptive statistics and multiple linear regression were used for data analysis.

RESULTS

A total of 44.5% (574/1291) participants felt a high or very high overall burden during the COVID-19 pandemic. Of all the participants, 14.6% (171/1173) reported clinically significant levels of depressive symptoms, 17.0% (199/1173) reported generalized anxiety disorder symptoms and 44.6% (532/1192) reported emotional exhaustion. Multiple linear regression analyses identified several common risk and protective factors for mental health status variables. The burden of an increase in the quantity of work, fear of work and fear of becoming infected showed the strongest negative associations, whereas psychological resources and sufficient relaxation in leisure time exhibited the strongest positive associations.

CONCLUSION

Employees who were not directly involved in the care of acutely ill patients were also exposed to considerable stress, some of which was not different from that experienced by professionals who were directly affected. These employees should not be lost sight of and must be offered appropriate support.

Mental Well-Being and Job Satisfaction of Hospital Physicians during COVID-19: Relationships with Efficacy Beliefs, Organizational Support, and Organizational Non-Technical Skills

The COVID-19 outbreak has led worldwide governments to take preventive measures to contain the spread of the virus and its extraordinary demands upon healthcare workers. Consequently, healthcare workers have been under high pressures, putting them at risk of developing adverse outcomes. The present study aims to investigate the psychological and organizational factors that contributed to physicians’ well-being during the pandemic. A total of 78 Italian physicians participated in the study. They completed a self-report questionnaire measuring efficacy beliefs, orientation towards patient engagement, job satisfaction, non-technical skills, organizational support, sense of belonging to the hospital, job satisfaction, and mental well-being. Physicians’ sense of belonging to their hospital, efficacy beliefs about their organizations and communication with patients, as well as non-technical skills related to communication and risk awareness were positively associated with job satisfaction. In addition, the latter and sense of belonging to own hospital were positively associated with mental well-being. These findings may guide policymakers and healthcare organizations managers to consider the potential psychosocial factors related to physicians’ well-being and the required preventive measures that can help in enhancing their human and organizational resources to cope with stressful situations such as the COVID-19 pandemic.

Patients' Engagement in Early Detection of COVID-19 Symptoms: An Observational Study in the Very Early Peak of the Pandemic in Italy in 2020

COVID-19 exerted a strong impact on the Italian healthcare systems, which in turn resulted in a reduction in the citizens’ trust towards healthcare authorities. Moreover, the focused attention on the typical COVID-19 symptoms (fever, cough) has also impacted the social representation of health priorities, potentially reducing the perceived importance and severity of other symptoms. This study aimed to determine the association of general-practitioner (GP) contact with various symptoms during the COVID-19 pandemic in Cremona, an Italian city at the very epicentre of the pandemic. Between April and June 2020, an anonymous survey was completed by 2161 respondents. Logistic-regression analyses were used to examine the associations of GP contact with sociodemographic characteristics and the presence of symptoms. Of the 2161 respondents (43.5% female, 75.0% aged less than 55 years), 959 (44.4%) reported experiencing various symptoms and 33.3% contacted a GP. GP contact was significantly associated with poor appetite (OR, 2.42; 95% CI 1.63 to 3.62; p < 0.001), taste dysfunctions (OR 1.67; 95% CI 1.20 to 2.34; p < 0.001) and sleepiness during the day (OR 4.15; 95% CI 2.13 to 8.09; p = 0.002). None of the gastrointestinal symptoms resulted in significantly increasing the likelihood of contacting a GP. This study offers a unique observation of citizens’ attitudes and behaviours in early symptom communication/detection during the initial peak of the Italian COVID-19 pandemic.

Return to Work during the COVID-19 Outbreak: A Study on the Role of Job Demands, Job Resources, and Personal Resources upon the Administrative Staff of Italian Public Universities

Background: Compared to healthcare workers and teleworkers, occupational wellbeing of employees who continued or suddenly returned to work during the COVID-19 pandemic have received less attention thus far. Using the Job Demand–Resource model as a framework, the present study aimed at evaluating the role of job demands and job and personal resources in affecting emotional exhaustion among university administrative staff. Methods: This cross-sectional study analyzed data collected through an online questionnaire completed by 364 administrative employees that continued working in presence (WP) and 1578 that continued working blended (WB), namely, partly remotely and partly in presence. Results: Among job demands, quantitative job demand overloads and perceived risk of being infected were positively associated with higher levels of emotional exhaustion. Among job resources, colleague support was significantly associated with lower emotional exhaustion for both WB and WP, whereas supervisor support and fatigue management were salient only for WB. Among personal resources, personal contribution in managing COVID-19-related risk at work emerged as a protective factor for emotional exhaustion. Conclusion: Insights for the development of targeted preventive measure for a more psychologically safe and productive return to work can be derived from these results.

The Impact of Job Stress and State Anger on Turnover Intention Among Nurses During COVID-19: The Mediating Role of Emotional Exhaustion

Based on the social exchange theory, the aim of this study is to identify the association between job stress state anger, emotional exhaustion and job turnover intention. This study postulates that job related stress and state anger among nurses during COVID-19 subsequently leads to their job turnover intentions. In addition, the study also aims to see the mediating role of emotional exhaustion between COVID-19-related job stress, state anger, and turnover intentions. The sample of this study is gathered from 335 registered nurses working in Pakistani hospitals dealing with COVID-19-related patients. The interrelationships between variables are checked by using structural equation modeling through AMOS. Key findings confirm that COVID-19-related job stress and state anger had a significant effect on nurses' turnover intentions. Furthermore, emotional exhaustion mediated the relationship between COVID-19-related job stress, state anger, and turnover intentions. There is a lack of research which has assessed the impact of Novel COVID-19-related job stress and state anger on nurses' turnover intentions in hospitals, providing empirical evidence from a developing country-Pakistan. This study offers managerial implications for hospital management and health policymakers. Moreover, nursing managers need to pay attention to nurses' turnover intentions who are facing the issue at the front line as patients receive their initial treatment from nurses in the COVID-19 outbreak.

Cyberchondria, but not preventive behavior, mediates the relationship between fear of COVID-19 and somatic burden: Evidence from Russia

BACKGROUND

There is extensive available research on the relationship between fear of COVID-19 pandemic and physical symptoms. This study was the first to examine the cyberchondria and COVID-19 preventive behavior as mediators of this relationship.

METHODS

A cross-sectional study was conducted from October to December 2021, during the fourth wave of the COVID-19 pandemic in Russia. The participants were 2,011 Russian-speaking volunteers aged 18 years and older. They completed questionnaires on somatic burden, cyberchondria, COVID-19 preventive behavior, and fear of COVID-19 pandemic. Mediation analysis was used to explore the mediating roles of cyberchondria and preventive behavior in the relationship between fear of COVID-19 and somatic burden.

RESULTS

Fear of COVID-19 positively predicted somatic burden, cyberchondria, and COVID-19 preventive behavior. Mediation analysis showed that the relationship between fear of COVID-19 pandemic and somatic burden was mediated by cyberchondria (effect = 0.08, bootstrapping SE = 0.01, bootstrapping 95% CI [0.08, 0.12]), but not COVID-19 preventive behavior (effect = 0.02, bootstrapping SE = 0.01, bootstrapping 95% CI [0.00, 0.05]).

CONCLUSION

The findings suggest that cyberchondria had negative effects on somatic burden during the COVID-19 pandemic. The knowledge of the mediating role of cyberchondria may be used by health care workers when consulting persons with physical health complaints and psychosomatic disorders.

Kidney Care during COVID-19 in the UK: Perspectives of Healthcare Professionals on Impacts on Care Quality and Staff Well-Being

In light of the rapid changes in healthcare delivery due to COVID-19, this study explored kidney healthcare professionals' (HCPs) perspectives on the impact of these changes on care quality and staff well-being. Fifty-nine HCPs from eight NHS Trusts across England completed an online survey and eight took part in complementary semi-structured interviews between August 2020 and January 2021. Free-text survey responses and interviews were analysed using inductive thematic analysis. Themes described the rapid adaptations, concerns about care quality, benefits from innovations, high work pressure, anxiety and mental exhaustion in staff and the team as a well-being resource. Long-term retention and integration of changes and innovations can improve healthcare access and efficiency, but specification of conditions for its use is warranted. The impact of prolonged stress on renal HCPs also needs to be accounted for in quality planning. Results are further interpreted into a theoretical socio-technical framework.

Burnout syndrome and its determinants among healthcare workers during the first wave of the Covid-19 outbreak in Italy: a cross-sectional study to identify sex-related differences

Introduction:

Several studies described burnout levels of healthcare workers (HCWs) during the COVID-19 pandemic; however, sex-related differences remain poorly investigated. Objective: To describe sex-related differences in burnout and its determinants among HCWs during the first pandemic wave of the COVID-19 in Italy.

Methods:

A cross-sectional study was performed between April and May 2020. The framework given by the Job Demands Resources (JD-R) model was used to assess burnout determinants (risk and protective factors).

Results:

Male HCWs (n=133) had higher levels of depersonalization than female HCWs (P=0,017) and female HCWs (n=399) reported greater emotional exhaustion rates (P=0,005). Female nurses were the most exposed to burnout (OR=2,47; 95%CI=1,33-4,60; P=0,004), emotional exhaustion (OR=1,89; 95% CI=1,03-3,48; P=0,041), and depersonalization (OR=1,91; 95% CI=1,03-3,53; P=0,039). Determinants of burnout differed between sexes, and some paradoxical associations were detected: the score of job demands was a protective factor in females for burnout, emotional exhaustion, and depersonalization, resilience was a risk factor for males.

Conclusions:

This study reveals that the stressors in male and female HCWs tended to be associated with burnout differently. Both sexes showed alarming burnout levels, even if the weights of emotional exhaustion and depersonalization acted in different ways between the sexes. The revealed paradoxical effects in this study could reflect the study’s cross-sectional nature, highlighting that more resilient and empathic individuals were more consciously overwhelmed by the challenges related to the COVID-19 pandemic, thus reporting higher scores of emotional exhaustion and burnout. Future in-depth and longitudinal analyses are recommended to further explore sex-related differences in burnout among HCWs.

The association between core job components, physical activity, and mental health in African academics in a post-COVID-19 context

This study examined the association between core job components (i.e. teaching, research, and student assessment), physical activity (PA), and mental health in a post-COVID-19 context. An online questionnaire administered via Google Forms was used to gather data from 1064 African academics in four countries. A sensitivity analysis was applied to adjust for covariates. Data were analyzed with the hierarchical linear regression analysis. The average age of participants was 44 years. The study found that PA was positively associated with research but negatively associated with student assessment. Mental health was positively associated with onsite teaching but negatively associated with online teaching and research. PA did not predict mental health and mediate the relationship between the job components and mental health. It is concluded that PA may not increase mental health in African academics in a post-COVID-19 situation that required the resumption of work while observing social distancing protocols.