Dying and caring on the edge: Taiwan's surviving nurses' reflections on taking care of patients with severe acute respiratory syndrome

Nurses' coping strategies caring for patients during severe viral pandemics: A mixed-methods systematic review

BACKGROUND

Nurses play an essential role in responding to severe viral disease which bring considerable challenges to their personal and professional well-being. This subsequently can affect the delivery of care and healthcare systems' organisational capacity to respond. Understanding nurses' experiences of these challenges will help inform healthcare policies.

AIM

To explore the experiences and coping strategies of nurses caring for patients during severe viral disease pandemics.

DESIGN

A mixed-methods systematic review informed by the Joanna Briggs Institute (JBI) methodology.

METHODS

A mixed-methods systematic review. Five electronic databases Medline, CINAHL, PsychInfo, ASSIA and Scopus were searched on 4th April 2021. Results were reported in accordance with PRISMA. The findings were analysed and reported in the context of the Self-Regulatory Common-Sense Model.

RESULTS

In total, 71 peer-review primary research articles describing nurses' experiences of caring for patients during SARS, MERS, Swine flu H1N1, Avian influenza or SARS-CoV-2 / COVID-19 published in English from 2003 to 2021 were included. We found links between nurses' perception of the health threats, their emotional reactions, and coping strategies. Perceived health threats were influenced by organisational factors including frequent changes in clinical guidelines and workplace protocols, onerous workloads and working hours, unavailability of PPE, and lack of knowledge and training in pandemic management. These impacted nurses' physical, psychological and social well-being. Nurses also reported helpful and unhelpful coping strategies to manage the health threats.

CONCLUSIONS

It is vital for stakeholders, policymakers, government and healthcare institutions to recognise and monitor the wider impact on healthcare workers from health emergencies. In addition, support to develop and implement effective systems and individual mechanisms to offset the anticipated impact pre and post pandemics/epidemics is needed. Our findings can inform those strategies for similar future health emergencies.

RELEVANCE TO CLINICAL PRACTICE

Nurses are often the first point of contact in providing direct care to patients, hence they are at high risk of being infected. The findings from this review can help managers and policymakers in developing programmes to enhance resilience in the nursing workforce.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a literature review study.

Effectiveness of Internet-delivered self-help acceptance and commitment therapy (iACT) on nurses' obsessive-compulsive symptoms and sleep quality: A randomized controlled trial with 3-month follow-up

BACKGROUND

Frontline nurses suffered unprecedented mental distress during the COVID-19 pandemic. It's essential to explore new and more accessible alternatives to improve the availability of psychological treatments. This study aimed to investigate the influence of online self-help iACT linear intervention and iACT loop intervention on sleep quality (SQ), obsessive-compulsive symptoms (OCS), and psychological flexibility (PF) in nurses.

METHODS

A randomized controlled trial was conducted at a hospital in China. 602 participants were randomly assigned to the iACT linear intervention, iACT loop intervention, or wait list control group, and required to complete the questionnaires of OCS, PF and SQ. The linear mixed effects analysis (LMM) was used to analyze the impact of the intervention on outcome variables.

RESULTS

LMM analyses demonstrated that both two intervention had significant improvement on OCS (t = -38.235, p < 0.001), PF (t = 28.156, p < 0.001), as well as SQ (t = -16.336, p < 0.001). There were significant differences between the linear group and loop group on the PF in T2 (t = -8.271, p < 0.001), T3 (t = -8.366, p < 0.001), T4 (t = -8.302, p < 0.001), with the iACT loop model (Cohen's d = 1.652) showing a slight advantage over the iACT linear model (Cohen's d = 1.134).

CONCLUSIONS

The findings indicate that two interventions positively impact OCS, PF, and SQ. Compared to the iACT linear psychotherapy model, the iACT loop model shows greater effectiveness in enhancing PF, making it helpful to promote significant improvements in psychotherapy planning.

Burnout in healthcare workers in COVID-19-dedicated hospitals

BACKGROUND

Considering the prolongation of the COVID-19 pandemic, the lack of studies on burnout, particularly in healthcare workers, needs to be addressed. This report aimed to identify the risk factors of burnout by comparing the level of burnout between nurses in general wards and those in COVID-19-dedicated wards in a national university hospital.

METHODS

A survey based on the Korean version of Burnout Assessment Tool (BAT-K) was conducted on nurses between 10 January and 31 January 2022. The BAT-K consists of exhaustion, mental distance, cognitive impairment, emotional impairment and secondary symptoms.

RESULTS

A total of 165 nurses, including 81 nurses from the COVID-19-dedicated ward, completed the questionnaire. The percentage of general-ward nurses with an emotional impairment score above the clinical cutoff was higher than that of COVID-19 ward nurses. General ward compared to the COVID-19 ward increased the risk of presenting with total-core symptoms. Two factors increased the risk regarding mental distance: short career length and underlying disease.

CONCLUSIONS

In contrast to previous studies, the risk of burnout in the COVID-19-ward nurses was lower than that of the general ward nurses. The risk regarding mental distance was correlated with short career length and presence of an underlying disease.

Mental health complaints among healthcare workers engaged in the care of COVID-19 patients: A prospective cohort study from Japan

Background

Healthcare workers (HCWs) caring for patients with coronavirus disease-2019 (COVID-19) can experience physical and mental health burdens. It is imperative that hospitals reduce such burdens on frontline HCWs, protect them, and support their healthcare. This study aimed to investigate the association between occupation and the manifestation of physical or psychological symptoms among HCWs during the current COVID-19 pandemic.

Methods

A twice-weekly survey using questionnaires targeting HCWs who care for COVID-19 patients was performed at Osaka Metropolitan University Hospital (tertiary hospital). The demographic characteristics of the participants, exposure level, and physical and psychological complaints were evaluated.

Results

Seventy-one HCWs participated in this study, of whom 27 (38.0%) were doctors, 25 (35.2%) were nurses, and 19 (26.8%) were technicians. Among the HCWs, the proportions of those who experienced any physical or psychological symptoms were 28.2% and 31.0%, respectively. The frequency of depression and anxiety was obviously higher among the nurses than that among the doctors (both p < 0.01). Multivariate analysis revealed that being a nurse (odds ratio 4.90; p = 0.04) and having physical complaints (odds ratio 4.66; p = 0.02) might be independent predictors of the manifestation of psychological symptoms.

Conclusion

Our results indicate that the follow-up of HCWs experiencing physical symptoms, especially nurses engaged in the care of COVID-19 patients, may require more careful management to improve the psychological outcomes. We believe that this study is the first step toward establishing a psychological health management strategy for HCWs caring for COVID-19 patients.

Using Technology to Facilitate Evidence-Based Practice During the COVID-19 Pandemic

The COVID-19 pandemic brought many challenges to the health care workforce. A novel infectious disease, COVID-19 uncovered information gaps that were essential for frontline staff, including nurses, to care for patients and themselves. The authors developed a Web-based solution consisting of saved searches from PubMed on clinically relevant topics specific to nurses' information needs. This article discusses the objectives, development, content, and usage of this Internet resource and also provides tips for hospitals of all sizes to implement similar tools to evidence-based practice during infectious disease outbreaks.

Nurses' strategies for overcoming barriers to fundamental nursing care in patients with COVID-19 caused by infection with the SARS-COV-2 virus: Results from the 'COVID-NURSE' survey

AIMS

To identify strategies used by registered nurses and non-registered nursing care staff in overcoming barriers when providing fundamental nursing care for non-invasively ventilated inpatients with COVID-19.

DESIGN

Online survey with open-ended questions to collect qualitative data.

METHODS

In August 2020, we asked UK-based nursing staff to describe any strategies they employed to overcome barriers to delivering care in 15 fundamental nursing care categories when providing care to non-invasively ventilated patients with COVID-19. We analysed data using Framework Analysis.

RESULTS

A total of 1062 nurses consented to participate in our survey. We derived four themes. 1) Communication behaviours included adapting verbal and non-verbal communication with patients, using information technology to enable patients' significant others to communicate with staff and patients, and establishing clear information-sharing methods with other staff. 2) Organizing care required clustering interventions, carefully managing supplies, encouraging patient self-care and using 'runners' and interdisciplinary input. 3) Addressing patients' well-being and values required spending time with patients, acting in loco familiae, providing access to psychological and spiritual support, obtaining information about patients' wishes early on and providing privacy and comforting/meaningful items. 4) Management and leadership behaviours included training, timely provision of pandemic information, psychological support, team huddles and facilitating regular breaks.

CONCLUSIONS

Our respondents identified multiple strategies in four main areas of clinical practice. Management and leadership are crucial to both fundamental care delivery and the well-being of nurses during pandemics. Grouping strategies into these areas of action may assist nurses and leaders to prepare for pandemic nursing.

IMPACT

As these strategies are unlikely to be exclusive to the COVID-19 pandemic, their global dissemination may improve patient experience and help nurses deliver fundamental care when planning pandemic nursing. However, their effectiveness is unknown. Therefore, we are currently evaluating these strategies in a cluster randomized controlled trial.

[COVID-19 Pandemic: Psychosocial impact among healthcare professionals in Tunisia]

OBJECTIVE

To determine the psycho-affective impact of the Covid-19 pandemic on the mental health of health professionals in Tunisia and to estimate the associated factors.

METHODS

This is a multicenter, cross-sectional, descriptive and analytical study of health professionals carried out from May 2, 2020 to June 30, 2020 in Tunisia. Healthcare professionals included doctors, nurses, dentists and pharmacists. The participants answered a pre-established questionnaire using an electronic "Google Form". This questionnaire gathered demographic data and medical history. It included two psychometric scales, the GAD-7 (General Anxiety Disorder-7) and the PHQ-9 (Patient Health Questionnaire-9) to assess the prevalence and intensity of anxiety symptoms and depressive symptoms respectively.

RESULTS

The study included 203 healthcare professionals. The professionals had a mean age of 30.74±6.33years, 69.5 % were women, and the majority were doctors (77.8 %). Among professionals, 9.4 % were nurses, 7.4 % were dentists, and 5.4 % were pharmacists. A third of the participants 34.3 % worked in departments with Covid-19 patienfor having moderate to severe anxiety symptoms.

CONCLUSION

In order to ensure better patient care, early detection of psychiatric disorders and the implementation of specific strategies to ensure better mental health among healthcare professionals are priorities not only during the current pandemic but also in the event of a future similar pandemic.

Stress among health care providers in NICU department, tertiary pediatric care hospital during COVID-19 pandemic in Egypt

Background

Many of the pediatric health care workers (HCWs) suffered from sleep disturbance, anxiety, and potential stress disorder during the COVID-19 pandemic. Work-related stress is a potential cause of concern in HCWs and is associated with decreased job satisfaction, anxiety, depression, medical errors, and near misses. This study aims to investigate the various psychological consequences on medical personnel working in the neonatal intensive care unit (NICU) in the context of the COVID-19 pandemic.

Design and methods

A cross-sectional analytical study was conducted on a convenient sample of doctors and nurses working in NICU in pediatric hospitals at Cairo University teaching hospitals, Egypt. Two anonymous self-administered validated questionnaires were used to assess the level of stress, and the COVID-19 Rapid Quantitative Assessment Tool to assess the knowledge, attitude, and perception about COVID-19.

Results

Among 96 participants, 66.7% were nurses, and 33.3% were physicians, 79.2% of the participants showed a reasonably safe level of stress. The mean work stress score was 43.89 ± 5.77. The mean score for commonly experienced stress symptoms was 7.53 ± 4.54, median 7, IQR (4, 10). Females and physicians were found to be with a statistically significantly higher median score of commonly experienced stress symptoms than males (p-value < 0.001 and 0.028 simultaneously).

Conclusion

While such descriptive research provides valuable information on the scope of the problem, a strong theoretical framework is required to interpret these findings appropriately and develop preventive and therapeutic strategies. Particular attention should be warranted to the mental health well-being of women treating patients with COVID-19.

Prevalence of psychological symptoms and associated risk factors among nurses in 30 provinces during the COVID-19 pandemic in China

BACKGROUND

With the outbreak of the coronavirus disease 2019 (COVID-19), nurses have won well-deserved recognition for their indispensable roles in providing humane and professional healthcare for patients. However, by the nature of their role working at the forefront of patient care, nurses are prone to experiencing mental health consequences. Therefore, we pay attention to measuring the magnitude of psychological symptoms and identifying associated factors among nurses in China.

METHODS

We launched a nationwide, cross-sectional survey of nurses who worked in secondary or tertiary hospitals and public or private hospitals from 30 provinces in China. The prevalence and severity of symptoms of burnout, depression, and anxiety were investigated, respectively. Multivariable logistic regression analyses were performed to identify factors associated with each psychological symptom.

FINDINGS

A total of 138 279 respondents who worked in 243 hospitals completed this survey. A substantial proportion of nurses reported symptoms of burnout (34%), depression (55·5%), and anxiety (41·8%). In line with the disproportionality of economic development, we noted that the middle or western region was an independent risk factor for depression and anxiety. Compared with those working in the secondary hospital, nurses who worked in tertiary hospitals were associated with a higher likelihood of burnout and depression.

INTERPRETATION

Nurses are experiencing emotional, physical, and mental exhaustion during the COVID-19 epidemic. Governments and health policymakers need to draw attention to reinforcing prevention and ameliorating countermeasures to safeguard nurses' health.

FUNDING

The strategic consulting project of the Chinese Academy of Engineering [2021-32-5]. Advanced Institute of Infomation Technology, Peking University, Zhejiang Province [2020-Z-17].

Prevalence of Psychological Disorders among Health Workers During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Background

Repeated contact with patients with COVID-19 and working in quarantine conditions has made health workers vulnerable to psychological distress during the COVID-19 pandemic. The goal of the present systematic review and meta-analysis was to examine the prevalence of the various psychological distresses among health workers during the COVID-19 pandemic.

Methods

PubMed, Scopus, Web of Science, EMBASE, and Cochrane databases were searched for access to papers examining psychological distress among healthcare workers during the COVID-19 pandemic. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Heterogeneity among the studies was examined using the Cochran's Q test; because heterogeneity was significant, the random effects model was used to examine the prevalence of psychological distress.

Results

Overall, 12 studies with a total sample size of 5265 were eligible and included in the analysis. Prevalence rates of depression, anxiety, and PTSD were 20% (95% CI: 14-27), 23% (95% CI: 18-27), and 8% (95% CI: 6-9), respectively. The highest prevalence rates of depression and anxiety were related to the SDS and the GAD-7, respectively, and the lowest prevalence rates of the two aforementioned variables were related to the DASS-21.

Conclusions

The high prevalence of psychological distress among healthcare workers during the COVID-19 epidemic can have negative effects on their health and the quality of services provided. Therefore, training coping strategies for psychological distress in this pandemic seems necessary.

Relationship of Societal Adaptation with Vaccine Worries among Healthcare Workers during the COVID-19 Pandemic: The Mediating Effects of Posttraumatic Stress Disorder

Vaccine hesitancy has become a major public health problem among healthcare workers (HCWs) in this coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to examine the relationship between societal adaptation and vaccine worries and the mediating effects of posttraumatic stress disorder (PTSD) indicators in HCWs. A total of 435 HCWs (327 women and 108 men) were recruited. Their levels of societal adaptation were evaluated using the Societal Influences Survey Questionnaire (SISQ). Their severity and frequency of PTSD symptoms were examined using the Disaster-Related Psychological Screening Test (DRPST). The severity of vaccine worries was assessed using the Vaccination Attitudes Examination (VAX) Scale. The relationships among societal adaptation, PTSD, and vaccine worries were examined using structural equation modeling. The severity of societal adaptation was positively associated with both the severity of PTSD and the severity of vaccine worries. In addition, the severity of PTSD indicators was positively associated with the severity of vaccine worries. These results demonstrated that the severity of societal adaptation was related to the severity of vaccine worries, either directly or indirectly. The indirect relationship was mediated by the severity of PTSD. Societal adaptation and PTSD should be taken into consideration by the community of professionals working on vaccine hesitancy. Early detection and intervention of PTSD should be the objectives for programs aiming to lower vaccine hesitancy among HCWs.

State and trait anxiety among medical staff during the first month of COVID-19 pandemic: A sample from Turkey

OBJECTIVES

During the COVID-19 pandemic, excessive workload, a rapidly changing workplace environment, the danger of carrying the virus and transmitting the disease to their families, relatives and those they live with creates stress for the medical workers. In our study, we aimed to evaluate the state and trait anxiety levels of healthcare professionals who encounter patients with suspected COVID-19 infection and related factors.

METHOD

Data were collected from healthcare professionals working with patients diagnosed or suspected with COVID-19 via online self-report questionnaire between 9-19 April 2020. The state (STAI-S) and trait anxiety (STAI-T) scale was used to measure anxiety.

RESULTS

A total of 291 healthcare professionals, 216 women and 75 men, participated in the study. Women's state and trait anxiety were significantly higher than men's. 11 participants without any lifetime psychiatric illness experienced psychiatric symptoms and consulted to a psychiatrist. The state anxiety of those who have children, nurses and those working in branches directly related to the pandemic (Infectious Diseases, Respiratory Diseases, Emergency Medicine, Internal Medicine, Radiology, Anesthesiology and Reanimation) was higher than others. The state anxiety of those who thought they were not protected with personal protective equipment and those who did not stay in their own home was higher than others.

CONCLUSIONS

At the forefront of the fight against COVID-19, there are medical personnel who pay a serious psychological cost. Especially in terms of anxiety, we should pay attention to women, workers with children, nurses and people working in branches that are directly related to pandemics.

Resilience among health care workers while working during a pandemic: A systematic review and meta synthesis of qualitative studies

Background

Aim

Method

Results

Conclusion

Explaining the challenges and adaptation strategies of nurses in caring for patients with COVID-19: a qualitative study in Iran

Background

Nurses, as the primary human resource in the fight against COVID-19, encounter several obstacles and concerns. As a result, the current study used a qualitative method to describe the problems and adaptation techniques of nurses caring for COVID-19 patients.

Methods

The current study used a qualitative conventional content analysis technique with 30 nurses working in COVID-19 wards in Tehran hospitals. Purposive sampling, snowball sampling, and semi-structured interviews were used to get access to participants and gather data. The data was examined using conventional qualitative content analysis and the MAXQDA-18 program. To assess the quality of study findings, Guba and Lincoln’s trustworthiness criteria were fulfilled.

Results

The data analysis revealed two main categories and sixteen subcategories: (1) experiences and challenges (lack of protective equipment, high work pressure, marginalized physical health, problems related to the use of protective equipment, being excluded, a lack of a supportive work environment, problems related to patients, psychological problems, fear, marginalized personal and family life, and the challenge of communicating with patients’ families); and (2) adaptation strategies for work conditions (performing religious-spiritual activities, creating an empathetic atmosphere in the workplace, spiritualizing their work, trying to convince the family and gaining their support, and strengthening their sense of self-worth and responsibility).

Conclusion

Nurses’ working conditions can be improved by providing adequate protective equipment, a suitable work environment, and more social and financial support; paying more attention to nurses’ physical and mental health; and considering appropriate communication mechanisms for nurses to communicate with their families and patients’ families.

The Mental Health of Malaysia’s Northwest Healthcare Workers during the Relaxation of COVID-19 Restrictions and Its Associated Factors

The COVID-19 pandemic has affected people in many ways, including mental health status. Depression, anxiety, and stress (DAS) are terms often used to describe mental health status worldwide. The present study describes the prevalence of DAS and its associated factors among healthcare workers (HCWs) in the northwest region of Malaysia, during the early phase of recovery of movement control order (RMCO), where some restrictions were lifted, and cases are reducing in number. This cross-sectional study used HCW’s mental health surveillance data using the DASS-21 questionnaire. A total of 981 data collected between 1 July and 31 August 2020 were randomly sampled. Socio-demographic factors, occupational characteristics, and health backgrounds were extracted and analyzed using multiple logistic regression. The prevalences of DAS are 8.4% (6.7, 10.3), 17.1% (14.8, 19.6), and 6.4% (5.0, 8.1), respectively. Age is significantly associated with depression (Adjusted Odd Ratio (Adj.OR) 0.96 (0.93, 0.99)) and stress (Adj.OR 0.96 (0.93, 0.997)). Working at the hospital is associated with depression (Adj.OR 1.88 (1.19, 2.97)) as well as anxiety (Adj.OR 1.91 (1.36, 2.68). HCWs with a degree or postgraduate education level are more stressed compared to those with lower educational levels (Adj.OR 8.43 (1.95, 36.37)). Mental health surveillance helps to identify those at risk. Those younger in age, working in hospitals, and with more responsibility in management are the most affected. With the easing of COVID-19 pandemic restrictions, which lead to the release of certain movement control, the mental health status of HCWs was less affected. Those working directly with COVID-19 patients and with more responsibility in management are the most affected.

Quality of life (QoL) among COVID-19 recovered healthcare workers in Bangladesh

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has taken the lives of more than 100,000 healthcare workers (HCWs) so far. Those who survived continuously work under immense physical and psychological pressure, and their quality of life (QoL) is impacted. The study aimed to assess the QoL among HCWs in Bangladesh who recovered from COVID-19.

METHODS

This cross-sectional, telephonic interview-based study was conducted among 322 randomly selected HCWs from Bangladesh who were positive for COVID-19 and recovered from the infection before the interview. Data were collected from June to November 2020. We examined the impact of COVID on the QoL of the participants using the validated Bangladesh version of the World Health Organization (WHO) Quality of life questionnaire brief (WHOQOL-BREF). All analyses were done by STATA (Version 16.1).

RESULTS

More than half of the health care professionals were male (56.0%), aged between 26-35 years (51%), and completed graduation (49%). The majority of the study participants in the four domains were married (n = 263, 81%) and living in Dhaka. The average score of the participants was 70.91 ± 13.07, 62.68 ± 14.99, 66.93 ± 15.14, and 63.56 ± 12.11 in physical, psychological, social relationship and environmental domains, respectively. HCWs in urban areas enjoyed 2.4 times better socially stable lives (OR: 2.42, 95% CI: 1.18-4.96) but 72% less psychologically satisfactory lives.

CONCLUSION

HCWs' post-COVID quality of life depended on variable interaction of demographic socioeconomic, including old age, female sex, graduation, and higher monthly income. The findings indicate the issues which should be addressed to improve the quality of life of frontline workers who fight against the pandemic.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Nurses' Experiences of their Ethical Responsibilities during Coronavirus Outbreaks: A Scoping Review

Globally, nurses have experienced changes to the moral conditions of their work during coronavirus outbreaks. To identify the challenges and sources of support in nurses’ efforts to meet their ethical responsibilities during SARS, MERS, and COVID-19 outbreaks a scoping review design was chosen. A search was conducted for eligible studies in Ovid MEDLINE, Ovid Embase and Embase Classic, EBSCO CINAHL Plus, OVID APA PsycInfo, ProQuest ASSIA, and ProQuest Sociological Abstracts on August 19, 2020 and November 9, 2020. The PRISMA-ScR checklist was used to ensure rigor. A total of 5204 records were identified of which 41 studies were included. Three themes were identified related challenges in meeting ethical responsibilities: 1) substandard care, 2) impeded relationships, 3) organizational and system responses and six themes relating to sources of support: 1) team and supervisor relationships, 2) organizational change leading to improved patient care, 3) speaking out, 4) finding meaning, 5) responses by patients and the public, 6) self-care strategies.Our review revealed how substandard care and public health measures resulted in nurses not being fully able to meet their ethical responsibilities of care. These included the visitation policies that impeded the support of patients by nurses and families, particularly with respect to face-to-face relationships. Organizational and system responses to the evolving outbreaks, such as inadequate staffing, also contributed to these challenges. Supportive relationships with colleagues and supervisors, however, were very beneficial, along with positive responses from patients and the public

Evaluation of the caregiving roles and attitudes of nurses during the COVID-19 pandemic

Background

Nurses play a critical role in providing care to patients, in particular, they work in the frontlines in caring for patients with complicated COVID‐19 requiring hospitalization. Evaluation of the caregiving roles and attitudes of nurses is critical in the current crisis. Therefore, this study aimed to determine the caregiving roles and attitudes of nurses during the COVID‐19 pandemic.

Methods

A quantitative descriptive study was performed with 130 nurses in Turkey. The attitude scale for the caregiving roles of nurses (ASCRNs) was used to collect data. We conducted an online survey between May and November 2020.

Results

The mean total score of the participants on the ASCRN was 62.20 ± 18.42. All nurses stated that they were affected by the COVID‐19 pandemic. The ASCRN scores of nurses who received training about the COVID‐19 pandemic and who thought that the personal protective equipment they used was sufficient had statistically higher scores on the ASCRN (p < .05).

Conclusion

The results of this study suggested that the COVID‐19 pandemic had a negative effect on the caregiving roles and attitudes of the nurses.

Factors associated with mental health outcomes among health care workers in the Fangcang shelter hospital in China

BACKGROUND

Faced with surging infections and considering that 80% of cases were mild and moderate, the city government transformed stadiums and exhibition centers into the Fangcang shelter hospitals (temporary treatment centers) in Wuhan.

AIM

The aims of this study were to evaluate psychological impact on health care workers in the Fangcang shelter hospitals and analyze potential risk factors associated with these symptoms, including PTSS, symptoms of anxiety, depression, insomnia, and perceived stress.

METHODS

This cross-sectional study used an online survey to assess mental health problems of 522 health care workers in a Jianghan Fangcang shelter from February 21 to February 28, 2020.

RESULTS

Overall, 25.3%, 25.3%, 51.0%, 58.0%, 14.8%, and 39.1% of all participants reported symptoms of posttraumatic stress, anxiety, depression, insomnia, and perceived stress, respectively. Multivariable logistic regression analysis showed that, occupation and technical title were associated with all investigated outcomes. Nurses were more likely to endorse posttraumatic stress symptoms (OR, 4.63; 95% CI, 2.43-8.82; p < .001), anxiety symptom (OR, 4.58; 95% CI, 2.76-7.62; p < .001), depression symptom (OR, 3.45; 95% CI, 2.17-5.64; p < .001). Participants with senior technical title were associated with higher perceived stress and insomnia than other technical title.

CONCLUSION

In this survey, participants reported high rates of symptoms of posttraumatic stress, anxiety, depression, insomnia, and perceived stress. Combining with the special environment of the shelter hospitals and the psychological needs, the health care workers should be given more effective interventions to relieve their stress and improve mental symptoms.

Nurses’ contribution during pandemic conditions: A synthesis of qualitative literature

OBJECTIVE

To synthesise the evidence relating to the contribution nurses make during respiratory infectious disease pandemics.

BACKGROUND

Pandemics are known for their abrupt and contagious nature, as well as their impact on individuals and society. Nurses are more likely to work closely with patients experiencing illness and disease during pandemics, and studies on the role of the profession have mainly focused on the challenges, barriers and shortfalls in nursing care provision. The nursing role in service delivery and their contribution in improving patient well-being has received far less attention.

METHODS

In May 2020, three review registers, grey literature and the following databases were searched: Medline via Ovid, Web of Science, CINAHL via EBSCO and Cochrane Library. The specific focus was on qualitative literature that considered the experiences and perceptions of nurses providing care during several respiratory pandemics. Selected papers were appraised using CASP checklist. ENTREQ checklist was used to inform stages associated with the synthesis of selected papers.

RESULTS

From 5553 retrieved citations, the analysis of 24 eligible papers resulted in three key themes: the implications of working during pandemics on nurses' personal and family life, nursing contribution in challenging conditions, and working above and beyond. Considering nurses' role in healthcare system, research on their contribution found to have received little appreciation in peer-reviewed journals.

CONCLUSIONS

This review pertains to nurses' work in global context and highlights the huge contribution made by the profession in the context of respiratory pandemics. It confirms that nurses' experiences outweighed economic, social and psychological implications of providing care during the pandemic crisis. Acknowledging nurses' resilience and professional motivations, we also argue that the nurse contribution during pandemics can be enhanced when resources, support and training are provided. Further research on contexts and conditions which mitigate nurses the potential for sustained contribution is needed.

Factors associated with peritraumatic stress symptoms among the frontline healthcare workers during the outbreak of COVID-19 in China

OBJECTIVES

This study aimed to examine the prevalence of peritraumatic stress symptoms (PTSSs), perceived threat, social support and factors contributing to clinically significant PTSS among frontline COVID-19 healthcare workers (HCWs) in China.

DESIGN AND SETTING

An online survey through self-administered questionnaires was conducted from 18 February to 4 March 2020, during the outbreak of COVID-19.

OUTCOMES MEASURES

PTSS was assessed using the post-traumatic stress disorder (PTSD) self-rating scale. Demographic and socioeconomic characteristics, self-reported health, physical/psychological symptoms, perceived threat from frontline work and perceived social support were investigated. Multivariable line regression analysis distinguished factors associated with HCWs' PTSS scores.

RESULTS

A total of 676 (58.1%) HCWs have shown clinically significant high levels of PTSS. Only 441 (37.9%) self-reported good health. Most had physical symptom(s) (915 (78.7%)), psychological symptom(s) (906 (77.9%)), inability to vent emotions (284 (24.4%)), emotional exhaustion (666 (57.3%)) and 1037 (89.2%) needed professional respect. Moreover, social support received was less than expected, and the receipt of psychological services/help scored the lowest (3.11±1.73). Combined psychological and physical symptoms, difficulty in releasing tension and venting emotions timely, fear of infection, emotional exhaustion and depersonalisation are significantly associated with PTSS scores among frontline HCWs. Working ≥8 hours, having the senior professional title, self-reported health, enjoying perfect protection and control measures, economic subsidy and control policy on reducing discriminatory practices are negatively correlated with PTSS scores.

CONCLUSIONS

During the outbreak of COVID-19, frontline HCWs experienced clinically significant high levels of PTSS and heavy workload, and the emergency resulted in their inadequate psychosocial support. If this is left unchecked, HCWs have a higher risk of developing PTSD. Early detection, identification and person-directed, targeted multidisciplinary interventions should be undertaken to address various influencing factors. Comprehensive measures, including setting up emotional release channels, as well as providing psychological and social support intervention for HCWs globally, are highly recommended.

Impact of COVID-19 and other infectious conditions requiring isolation on the provision of and adaptations to fundamental nursing care in hospital in terms of overall patient experience, care quality, functional ability, and treatment outcomes: systematic review

AIM

This systematic review identifies, appraises and synthesizes the evidence on the provision of fundamental nursing care to hospitalized patients with a highly infectious virus and the effectiveness of adaptations to overcome barriers to care.

DESIGN

Systematic review.

DATA SOURCES

In July 2020, we searched Medline, PsycINFO (OvidSP), CINAHL (EBSCOhost), BNI (ProQuest), WHO COVID-19 Database (https://search.bvsalud.org/) MedRxiv (https://www.medrxiv.org/), bioRxiv (https://www.biorxiv.org/) and also Google Scholar, TRIP database and NICE Evidence, forwards citation searching and reference checking of included papers, from 2016 onwards.

REVIEW METHODS

We included quantitative and qualitative research reporting (i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID-19, MERS, SARS, H1N1 or EVD or (ii) the views, perceptions and experiences of professional nurses and non-professionally registered care workers who have provided that care. We included review articles, commentaries, protocols and guidance documents. One reviewer performed data extraction and quality appraisal and was checked by another person.

RESULTS

Of 3086 references, we included 64 articles; 19 empirical research and 45 review articles, commentaries, protocols and guidance documents spanning five pandemics. Four main themes (and 11 sub-themes) were identified. Barriers to delivering fundamental care were wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges of care. These barriers were addressed by multiple adaptations to communication, organization of care, staff support and leadership.

CONCLUSION

To prepare for continuation of the COVID-19 pandemic and future pandemics, evaluative studies of adaptations to fundamental healthcare delivery must be prioritized to enable evidence-based care to be provided in future.

IMPACT

Our review identifies the barriers nurses experience in providing fundamental care during a pandemic, highlights potential adaptations that address barriers and ensure positive healthcare experiences and draws attention to the need for evaluative research on fundamental care practices during pandemics.

Lived experiences of healthcare workers on the front line during the COVID-19 pandemic: a qualitative interview study

OBJECTIVES

This study aimed to investigate the presence of perceived stressors, psychological safety and teamwork in healthcare professionals. As the timeframe for this study spanned the first wave of the COVID-19 pandemic, data were captured demonstrating the impact of the pandemic on these factors.

DESIGN

Qualitative interview study.

SETTING

All staff working within the emergency and critical care departments of one National Health Service Trust in London, UK.

PARTICIPANTS

Forty-nine participants were recruited using a purposive sampling technique and interviewed when the first wave of the COVID-19 pandemic had subsided.

MAIN OUTCOME MEASURES

Evaluation of changes in perceived stressors, psychological safety and teamwork in individuals working during the COVID-19 pandemic.

RESULTS

The thematic analysis relating to a participant's lived experiences while working during COVID-19 led to the construction of five key themes, including 'psychological effects' and 'changes in team dynamics'. Several psychological effects were described, including the presence of psychological distress and insights into the aetiology of moral injury. There was marked heterogeneity in participants' response to COVID-19, particularly with respect to changes in team dynamics and the perception of a psychologically safe environment. Descriptions of improved team cohesiveness and camaraderie contrasted with stories of new barriers, notably due to the high workload and the impact of personal protective equipment. Building on these themes, a map of key changes arising due to the pandemic was developed, highlighting potential opportunities to provide targeted support.

CONCLUSIONS

Working on the front line of a pandemic can have significant implications for healthcare workers, putting them at risk of psychological distress and moral injury, as well as affecting team dynamics. There is striking heterogeneity in the manifestation of these challenges. Team leaders can use the themes and qualitative data from this study to help identify areas for management focus and individual and team support.

The relationship between coronavirus 19 fear and occupational fatigue, burnout and recovery levels in healthcare professionals in Turkey

Studies conducted after the SARS outbreak (2003) reported that healthcare professionals experienced high levels of psychological distress. These psychological problems need to be addressed during and after the epidemic. This study was planned to be carried out in healthcare professionals to determine the relationship between the fear of COVID-19 and burnout. Data were collected online from 538 healthcare professionals working in different cities and units using the Personal Information Form consisting of questions about demographic characteristics, the COVID-19 Phobia Scale and the Occupational Fatigue Exhaustion Recovery Scale. It was determined that the fear of COVID-19 high and burnout levels of the participants were above the scale. There was a significant difference between the burnout level of individuals, the level of fear of COVID-19, the individual's profession and the unit they work in. It is important to implement psychosocial interventions in order to take the necessary precautions to ensure that healthcare workers are less affected by the negative effects of fear and burnout during the epidemic process. The role of professional teams, including psychiatric nurses, is of great importance in determining and resolving the negative effects of the pandemic on healthcare professionals.

Emotional Distress of the COVID-19 Cluster Infection on Health Care Workers Working at a National Hospital in Korea

BACKGROUND

Frontline healthcare workers responding to coronavirus disease 2019 (COVID-19) inevitably face tremendous psychological burden. Thus, the present study aimed to identify the psychological impact and the factors contributing to the likely increase in emotional distress of healthcare workers.

METHODS

The participants include a total of 99 healthcare workers at Bugok National Hospital. Psychometric scales were used to assess emotional distress (12-item General Health Questionnaire; GHQ-12), depression symptoms (Patient Health Questionnaire-9; PHQ-9), and post-traumatic stress disorder-related symptoms (Impact of Events Scale-Revised; IES-R). A supplementary questionnaire was administered to investigate the experience of healthcare workers exposed to COVID-19-infected patients. Based on the results of GHQ-12 survey, participants were categorized into two groups: distress and non-distress. All the assessed scores were compared between the two groups. A logistic regression model was constructed to identify factors associated with emotional distress.

RESULTS

Emotional distress was reported by 45.3% (n = 45) of all participants. The emotionally distressed group was more likely to be female, manage close contacts, have higher scores on PHQ-9 and IES-R, feel increased professional risk, and report that proper infection control training was not provided. Female gender, managing close contacts, higher scores on PHQ-9, and a feeling that proper infection control training was not provided were associated with emotional distress in logistic regression.

CONCLUSION

Frontline healthcare workers face tremendous psychological burden during the COVID-19 pandemic. Therefore, appropriate psychological interventions should be provided to the HCWs engaged in the management of COVID-19-infected patients.

The lived experience of healthcare professionals working frontline during the 2003 SARS epidemic, 2009 H1N1 pandemic, 2012 MERS outbreak, and 2014 EVD epidemic: A qualitative systematic review

Objective

To synthesize qualitative literature exploring the lived experience of healthcare workers (HCWs) who cared for patients during the following infectious disease outbreaks (IDOs): the 2003 SARS epidemic, 2009 H1N1 pandemic, 2012 MERS outbreak, and 2014 EVD epidemic. We aim to reveal the collective experience of HCWs during these four IDOs and to create a reference for comparison of current and future IDOs.

Methods

Three electronic databases were searched, yielding 823 results after duplicates were removed. Forty qualitative and mixed-methods studies met the criteria for full file review. Fourteen studies met the inclusion and exclusion criteria. The data from the Results or Findings sections were manually coded and themes were conceptualized using thematic analysis.

Results

Of the 14 studies, 28.6% focused on SARS, 21.4% on H1N1, 21.4% on MERS, and 28.6% on EVD. Studies occurred in six different countries and included physicians, nurses, paramedics, and emergency medical technicians as participants. Five themes were conceptualized: Uncertainty, Adapting to Change, Commitment, Sacrifice, and Resilience.

Conclusion

This review identified the collective experience of HCWs caring for patients during four 21st century IDOs. This qualitative systematic review offers a reference to compare similarities and differences of other IDOs, including the COVID-19 pandemic.

Psychosocial experiences of frontline nurses working in hospital-based settings during the COVID-19 pandemic - A qualitative systematic review

BACKGROUND

Frontline nurses have been directly exposed to the SARS-CoV-2 virus and come in close contact with patients during the COVID-19 pandemic. Nurses execute tasks related to disease control and face multiple psychosocial challenges in their frontline work, potentially affecting their mental well-being and ability to satisfyingly perform their tasks.

OBJECTIVES

To explore the psychosocial experiences of frontline nurses working in hospital-based settings during the COVID-19 pandemic.

DESIGN

The qualitative systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Registered in PROSPERO (CRD42021259111).

DATA SOURCES

Literature searches were performed through PubMed, CINAHL, and the WHO COVID-19 database. Inclusion criteria were: All types of nurses having direct contact with or taking care of patients; Primary, secondary, and tertiary health-care services admitting and treating COVID-19 patients; Experiences, perceptions, feelings, views in psychosocial aspects from the identified population group; Qualitative studies; Mixed methods studies; Language in English; Published date 2019-2021. Exclusion criteria were: Commentaries; Reviews; Discussion papers; Quantitative studies; Language other than English; Published in 2018 or earlier; Studies without an ethical approval and ethical statement.

REVIEW METHODS

The studies were screened and selected based on the inclusion and exclusion criteria. Quality appraisal was conducted according to the Critical Appraisal Skills Program qualitative study checklist. Data was extracted from included studies and a thematic synthesis was made.

RESULTS

A total of 28 studies were included in the review. The experiences of 1141 nurses from 12 countries were synthesised. Three themes were constructed: 'Nurses' emotional, mental and physical reactions to COVID-19', 'Internally and externally supported coping strategies', and 'A call for future help and support'.

CONCLUSION

Nurses working frontline during the COVID-19 pandemic have experienced psychological, social, and emotional distress in coping with work demands, social relationships, and their personal life. The results pointed to a need for increased psychological and social support for frontline nurses to cope with stress and maintain mental well-being, which may subsequently affect nursing care outcomes.

An Assessment of Mental Health Outcomes During the COVID-19 Pandemic

In late 2019, the first case of COVID-19 was reported in Wuhan, China. Soon after, cases began to spread globally. This study aimed to examine the psychological impact of the COVID-19 pandemic on the adult population in the United States. We conducted an exploratory cross-sectional study using an anonymous online survey methodology distributed to participants across 13 states. The data collected included demographical information and outcomes from validated mental health screeners (GAD-7, PHQ-9, and IES-R) to assess levels of anxiety, depression, and stress. A total of 1356 participants completed the survey. GAD-7, PHQ-9, and IES-R levels differed significantly (p < 0.05) according to age, gender, and educational level. There was also significant difference between GAD-7 level as well as IES-R level between healthcare and non-healthcare workers (p = 0.02 and p = 0.028). Overall, this study has helped to garner a better understanding of COVID-19's impact on mental health outcomes.

Anxiety and COVID-19 Related Stressors Among Healthcare Workers Who Performed Shift Work at Four COVID-19 Dedicated Hospitals in Korea

OBJECTIVE

To assess the relationship between anxiety and shift work of healthcare workers (HCWs) during COVID-19 pandemic.

METHODS

From four COVID-19-dedicated hospitals in Korea, 381 HCWs were analyzed to estimate anxiety in relation to four COVID-19 job stressors and the impact of shift work on this relationship. Anxiety was measured with a generalized anxiety disorder 7-item scale. Multiple logistic regression models were utilized after stratification by sex, occupation, and shift work, after adjusting for a number of variables.

RESULTS

Anxiety prevalence was 32%. Among female nurses or nursing assistants who performed shift work, anxiety risk was significantly associated with three COVID-19 related job stressors: contact with confirmed cases or patients, dealing with unpleasant patients, and discomfort from wearing protective equipment.

CONCLUSIONS

Special attention is required for mental health of HCWs working shifts during the COVID-19 pandemic.

Impacts of COVID-19 on the Life and Work of Healthcare Workers During the Nationwide Partial Lockdown in Vietnam

Background: Healthcare workers are frontline responders facing a disproportionate increase in occupational responsibilities during the COVID-19 pandemic. Added work-related stress among healthcare personnel may lead to personal and work-related repercussions, such as burnout or decreased quality of care for patients; however, little is known about how the COVID-19 pandemic affects the daily work and life of these workers. This study aimed to evaluate the personal and occupational impacts of the COVID-19 induced partial lockdown in Vietnam among hospital staff.

Methods: A cross-sectional web-based study was carried out to collect demographic data and the personal and job impacts of respondents during the second week of national lockdown in April 2020. Snowball sampling technique was applied to recruit 742 hospital staff. The exploratory factor analysis (EFA) was used to examine the validity of the instrument.

Results: Of the 742 respondents, 21.2% agreed that “working attitude well-maintained,” followed by 16.1% of respondents who reported that there were “enough employees at work.” Only 3.2% of respondents agreed that “their work was appreciated by society.” Furthermore, healthcare workers in the central region were less likely to have experienced “Avoidance of disclosure and discrimination related to COVID-19” than other areas (Coef. = – 0.25, CI: −0.42 to −0.07). Being women also had a negative association with scores in “Avoidance of disclosure and discrimination related to COVID 19” domain (Coef. = −0.27, CI: −0.43 to −0.12) while having a positive association with “negative attitude towards working conditions” domain (Coef. = 0.19, CI: 0.09 to 0.3). In addition, working in administrative offices (Coef. = 0.20; 95% CI = 0.05 to 0.36) and infectious departments (Coef. = 0.36; 95% CI = 0.09 to 0.63) had a positive association with “Increased work pressure due to COVID 19” domain.

Conclusion: These findings revealed marginal impacts of the COVID-19 pandemic on the work and life of hospital staff in Vietnam. Furthermore, this study highlighted the importance of implementing preventive strategies during the nationwide partial lockdown to manage hospital admissions and the burden on healthcare workers. Finally, this study characterizes targeted demographics that may benefit from appreciation by employers and society during a national pandemic.

Burnout and anxiety level of healthcare professionals during the COVID-19 pandemic in Turkey

BACKGROUND

COVID-19 has affected many countries in the world and has been known as one of the fast-spreading viruses in recent history.

OBJECTIVE

Our aim is to reveal the level of anxiety and burnout, attitudes, thoughts, and behaviors of healthcare professionals about COVID-19 in Turkey.

METHODS

The individuals included in the study answered seven questions containing demographic information, 27 questions determining their views and perspectives on COVID-19. Anxiety level was measured by Beck Anxiety Scale (BAI), and State Anxiety Inventory (SAI); burnout was measured by Maslach Burnout Inventory (MBI).

RESULTS

We included 66 health staff (50 female, 16 male) whose mean age was 31.71±5.18 years (22-46 ranged). Twenty-two (33.3%) of the participants worked on the COVID-19 frontline while 44 (66.6%) of them worked on usual wards.We found that participants' anxiety was at a moderate level in BAI (mean: 14.00±12.66). The mean of the SAI was 49.93±13.06. MBI subscales were low. We found that there was a significant difference in BAI between COVID-19 frontline healthcare professionals and those who worked on the usual wards (p = 0.01).

CONCLUSIONS

It is important to consider the level of anxiety and burnout in all healthcare professionals and to help them to protect their mental health.

Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: a systematic review and qualitative meta-synthesis

BACKGROUND

Healthcare workers across the world have risen to the demands of treating COVID-19 patients, potentially at significant cost to their own health and wellbeing. There has been increasing recognition of the potential mental health impact of COVID-19 on frontline workers and calls to provide psychosocial support for them. However, little attention has so far been paid to understanding the impact of working on a pandemic from healthcare workers' own perspectives or what their views are about support.

METHODS

We searched key healthcare databases (Medline, PsychINFO and PubMed) from inception to September 28, 2020. We also reviewed relevant grey literature, screened pre-print servers and hand searched reference lists of key texts for all published accounts of healthcare workers' experiences of working on the frontline and views about support during COVID-19 and previous pandemics/epidemics. We conducted a meta-synthesis of all qualitative results to synthesise findings and develop an overarching set of themes and sub-themes which captured the experiences and views of frontline healthcare workers across the studies.

RESULTS

This review identified 46 qualitative studies which explored healthcare workers' experiences and views from pandemics or epidemics including and prior to COVID-19. Meta-synthesis derived eight key themes which largely transcended temporal and geographical boundaries. Participants across all the studies were deeply concerned about their own and/or others' physical safety. This was greatest in the early phases of pandemics and exacerbated by inadequate Personal Protective Equipment (PPE), insufficient resources, and inconsistent information. Workers struggled with high workloads and long shifts and desired adequate rest and recovery. Many experienced stigma. Healthcare workers' relationships with families, colleagues, organisations, media and the wider public were complicated and could be experienced concomitantly as sources of support but also sources of stress.

CONCLUSIONS

The experiences of healthcare workers during the COVID-19 pandemic are not unprecedented; the themes that arose from previous pandemics and epidemics were remarkably resonant with what we are hearing about the impact of COVID-19 globally today. We have an opportunity to learn from the lessons of previous crises, mitigate the negative mental health impact of COVID-19 and support the longer-term wellbeing of the healthcare workforce worldwide.

Stress level assessment among health care workers involved in the management of critically ill COVID-19 patients

Background

Intensive care health care workers (HCWs) are frontlines of this crisis as they deal with critically ill COVID-19 patients which can potentially affect their mental well-being and causes different levels of stress.

Aim

To determine the prevalence of stress among HCWs involved in the management of critically ill COVID-19 patient, identify the factors associated with stress, and highlight the availability of psychological support provided to HCWs.

Methods

A cross-sectional multicenter, international study using a web-based questionnaire of 27 questions including the Perceived Stress Scale-10 (PSS-10) for assessment of stress level. Questions to identify factors associated with stress, the psychological support provided, and the sociodemographic characteristics were included.

Results

We received a total 1649 responses from 59 countries: 550 (34%) were from Europe, 525 (32.36%) from Asia, 283 (17.44%) from Africa, 177 (11%) from America, and 88 (5.42%) from Australia. The average stress level was 22 points on the PSS denoting moderate stress in 1327 (81.8%) respondents, while 239 (14.73%) respondents had a severe level of stress. Female gender, working in high capacity units and remote areas in addition to lack of psychological support, was significantly associated with stress in our study.

Conclusion

Stress level was moderate to severe among intensive care HCWs during this pandemic, and many factors were associated with stress emphasizing the importance of psychological support during that unprecedented pandemic.

Supplementary information

The online version contains supplementary material available at 10.1007/s11845-021-02721-0.

Which of us were more affected by the pandemic? The psychiatric impacts of the COVID-19 pandemic on healthcare professionals in the province where the first quarantine units were established in Turkey

INTRODUCTION

Psychiatric problems, such as stress and anxiety disorders, are encountered amongst healthcare professionals fighting epidemics. Considering that COVID-19 suddenly became a pandemic and healthcare professionals have not had access to sufficient information, it is a fact that healthcare professionals have been affected on a large scale. Heavy workloads, insufficient equipment and anxiety over families increase this impact. We aimed to investigate the extent to which healthcare professionals have been psychologically affected by COVID-19 and related factors.

METHODOLOGY

Data obtained through questionnaires completed by 348 healthcare professionals working during the COVID-19 pandemic and 350 participants who are in the control group were investigated. The Impact of Event Scale-revised (IES-R) for post-traumatic stress disorder (PTSD) and the Severity Index (ISI) for insomnia were used. Differences regarding gender, occupation, age group, marital status and sub-groups were statistically analysed.

RESULTS

Of the 348 healthcare professionals, 176 (50.6%) were women and 172 (49.4%) men, while 190 (54.6%) were doctors and 158 (45.4%) nurses. The incidence of PTSD was statistically significantly higher in the healthcare professionals group than in the control group (P < .001). The incidence of PTSD was statistically significantly higher amongst nurses (P = .001), women (P = .002) and those who were married (P = .007). Both PTSD and insomnia were found to be statistically significantly higher amongst those working in the "area of final diagnosis" (P = .016 and P = .002, respectively).

CONCLUSIONS

The determination of the groups most affected amongst professionals working in epidemics is important for the planning of in-service training and psychological support studies. If the fight against pandemics includes health teams with strong psychological grounding, it leads to qualified medical care for patients.

Stress and anxiety among physicians during the COVID-19 outbreak in the Iraqi Kurdistan Region: An online survey

Background

During infectious disease outbreaks, healthcare workers are at high risk of infection, infecting others, and psychological distress. This study aimed to determine the prevalence of stress and anxiety in physicians during the COVID-19 outbreak in the Iraqi Kurdistan Region and assess their associated factors.

Methods

This cross-sectional study was carried out in Erbil, Iraqi Kurdistan Region, from March 28 to April 15, 2020. An online self-administered survey questionnaire was used to collect data from physicians working in specialized COVID-19 centers and other healthcare facilities. The level of stress was measured based on the 10-items Perceived Stress Scale. The level of anxiety was measured based on the 7-item Generalized Anxiety Disorder scale.

Results

A total of 370 participants responded to the perceived stress component of the survey, of whom 57 (15.4%) had low perceived stress, 249 (67.3%) had moderate stress, and 64 (17.3%) had high stress. Being female was significantly associated with having moderate/high stress (adjusted odds ratio (AOR) = 2.40 (95% CI 1.31–4.39)). A total of 201 participants responded to the generalized anxiety disorder component of the survey, of whom 19 (9.5%) had no anxiety, 57 (28.4%) had mild anxiety, 79 (39.3%) had moderate anxiety, and 46 (22.9%) had severe anxiety. Working in COVID-19 centers (AOR = 2.23 (95% CI 1.02–4.86)) and being general practitioners (AOR = 4.16 (95% CI 1.14–15.14)) were significantly associated with having moderate/severe anxiety.

Conclusion

A considerable proportion of physicians experience stress and anxiety during the COVID-19 outbreak in Iraqi Kurdistan region. Generalists and those in special COVID-19 units report the greatest anxiety. There a need to establish mechanisms to reduce the risks of stress and anxiety among physicians. Mental health coping interventions through counseling should be based on COVID-19 protocol guidelines. Interventions should also emphasize physicians’ ability to work safely and efficiently in providing care to the patients.

Experiences of nurses amidst giving care to COVID-19 patients in clinical settings in Iraqi Kurdistan: A qualitative descriptive study

Aim and objective

We explored the experiences of nurses who cared for coronavirus disease 2019 patients in Iraqi Kurdistan.

Background

Nurses play a major role in response to pandemics and epidemics in delivering patient care. The experiences of nurses who provided care have significant short and long‐term consequences for individuals, communities, and the nursing profession.

Methods

Descriptive qualitative research approach was adopted in this study. We interviewed 12 nurses (22–50 years) who cared for the coronavirus disease 2019 patients in one of the clinical units of two coronavirus disease 2019 hospitals in Iraqi Kurdistan in 2020. Interviews were conducted via phone calls and were analysed using the thematic analysis method. The Consolidated criteria for reporting qualitative research checklist was applied when constructing this paper.

Results

The nurses had to care for a number of situations during the outbreak of coronavirus disease 2019 in Kurdistan. As people in the public did not believe that there was such a virus, nurses often had to deal with this lack of knowledge and aggression from some patients and their family members. Most nurses changed their preventive behaviours since the coronavirus disease 2019 outbreak at hospital or in public. This was mainly to protect not only themselves but their patients, colleagues, family members and friends. They were cautious about the use of a mask at the hospital and in public. Most nurses experienced fear, stress, anxiety and isolation during this period.

Conclusions

The patients had some concerns about their health and staying at hospitals, and some of them had aggressive behaviours towards nurses at corona hospitals. The public, close friends and relatives of the nurses had a fear of getting the infection by the virus through the nurses. However, the nurses attempted to protect themselves, colleagues and family members, and provide the best care to coronavirus disease 2019 patients. The nurses had a high obligation towards care giving at hospitals.

Relevance to clinical practice

The negative experiences of the nurses regarding the care of coronavirus disease 2019 patients must be considered in clinical settings. Sensitive policy programs must be established to protect nurses from the ostracization and stigmatization of the coronavirus disease 2019 pandemic and to allow them to be able to achieve their professional practices safely.

The COVID-19 Pandemic and nursing challenges: A review of the early literature

BACKGROUND

The COVID-19 pandemic has put health systems under unprecedented pressure, challenging their workforce, especially nurses.

OBJECTIVE

The current paper presented a review of the early literature concerning emerging nursing challenges during the early stages of the COVID-19 pandemic.

METHODS

A systematic search of the published literature between January and May 2020 was carried out in Medline, Science Direct, and Google Scholar to identify relevant quantitative and qualitative studies.

RESULTS

Twenty-two original articles were retrieved, the majority of which were survey studies from China. Synthesis of the evidence resulted in four overarching themes including "being physically and mentally drained in the face of fear and uncertainty," "shortage of personal protective equipment and usability issues," "psychosomatic disturbances among nurses," and "moderators to mitigate nurses' challenges."

CONCLUSIONS

Providing care for demanding COVID-19 patients, nurses experienced a gruelling situation, during which a significant amount of psychological and physical distress was inflicted to them. However, receiving proper support from their organization and society could improve the condition substantially. Further research is required to explore the impact of the COVID-19 pandemic on nurses, especially from Western countries.

Perception Toward Exposure Risk of COVID-19 Among Health Workers in Vietnam: Status and Correlated Factors

Background: Hospital staff are at the frontline for the prevention and control of COVID-19. Understanding their perception of exposure risk is, therefore, important during the early phase of this pandemic. In this study, we evaluated the perception regarding risk of exposure to COVID-19 among Vietnamese hospital staff in Vietnam.

Method: A cross-sectional online study was carried out to collect demographic data and risk exposure perception during the second week of the national lockdown in April 2020 in Vietnam. Seven hundred and forty two hospital staff were recruited using the snowball sampling to answer 5-point Likert scale questions regarding their risk exposure perception. Exploratory factor analysis (EFA) was used to examine the construct validity of the questionnaire. Pearson coefficient analysis and multivariable regression models were applied to identify factors associated with the perceived COVID-19 exposure risk.

Results: Participants perceived a high risk of being infected with SARS-CoV-2 (score = 3.4, SD = 0.8). They also perceived the workplace response to COVID-19 as inadequate (score = 2.0, SD = 0.5). In particular, participants who worked in the emergency or intensive care departments were more likely to perceive an exposure risk, compared to those in infectious disease control departments (Coef. = −0.38, 95%CI: −0.74; −0.02). Participants from central regions perceived a lower risk of exposure to COVID-19 than those from northern regions (OR = 0.52, 95%CI: 0.28–0.96). Nurses were less likely than doctors to report being at risk of exposure to COVID-19 (OR = 0.56, 95%CI: 0.33–0.95).

Conclusions: We identified a high level of perceived risk regarding COVID-19 exposure among hospital staff during the unprecedented lockdown period in Vietnam. A comprehensive approach, incorporating improved risk communications, safety training and psychological support programs, for all hospital staff, including nurses and those residing in high population density areas, might further strengthen the national effort to control the pandemic.

Factors Related to Nurses' Burnout during the First Wave of Coronavirus Disease-19 in a University Hospital in Italy

Safety of healthcare workers in hospitals is a major concern during the COVID-19 pandemic. Being exposed for several working hours per day to infected patients, nurses dealing with COVID-19 face several issues that lead to physical/psychological breakdown. This study focused on burnout and its associated factors in nurses working in an Italian University Hospital during the first wave of COVID-19 pandemic. We designed a web-based cross-sectional study addressed to nurses working at the University Hospital in Foggia, Italy. The online questionnaire was organized in sections aimed at collecting demographic and occupational variables, including the Maslach Burnout Inventory (MBI) and the Oldenburg Burnout Inventory (OBI). Two hundred and ninety-three nurses agreed to participate. According to MBI, we reported moderate/high emotional exhaustion in 76.5%, depersonalization in 50.2%, and personal gratification in 54.6% of participants. COVID-19-related burnout measured by OBI resulted medium/high in 89.1% of participants. Among demographic and occupational factors, a multivariate regression analysis identified emotional support, consideration of leaving job, and workload as predictive of burnout in nurses. In conclusion, this study suggests that the improvement of employer and family support to nurses, as well as reduction of workload and job-related stress, would contribute to reducing burnout in nurses during COVID-19 pandemics.

Geographical distribution and prevalence of mental disorders among healthcare workers in China: A cross-sectional country-wide survey: A cross-sectional study to assess mental disorders of healthcare workers in China

BACKGROUND

Reliable and detailed nationwide data on the prevalence and distribution of mental disorders among healthcare workers in China during the coronavirus disease 2019 (COVID-19) outbreak are scarce.

METHODS

We did a cross-sectional online survey from March 2 to 2 April 2020 and a total of 19,379 healthcare workers from 25 provinces participated. Depression, anxiety and post-traumatic stress disorder (PTSD) were assessed by the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and PTSD Checklist for DSM-5 (PCL-5), respectively.

RESULTS

The age-standardized prevalence of depression, anxiety and PTSD was 15.5%, 12.7% and 5.2%, respectively. Frontline workers had higher prevalence estimates than non-frontline workers (depression: 18.2% vs. 13.9%; anxiety: 14.7% vs. 11.6%; PTSD: 6.1% vs. 4.6%). Subgroups who were nurses, were married or had dependent children reported higher prevalence of depression, anxiety and PTSD. Despite of the large variations, the prevalence of mental disorders was lowest in East China, followed by Middle China, and highest in West China.

CONCLUSION

Healthcare workers faced enormous stress not only from the direct risk presented by the COVID-19 outbreak, but also from the profound changes in their professional practice. Prevalence of adverse psychological outcomes has a significant association with geographically distribution of health resources and regional economic level. Sufficient medical resource may be a protective factor to mental health condition of healthcare personnel when such a public health emergency happened.

A grounded theory of clinical nurses' process of coping during COVID-19

AIMS AND OBJECTIVES

To explore clinical nurses' process of coping during COVID-19 and develop a grounded theory that can be used by leaders to support clinical nurses during a disaster.

BACKGROUND

The COVID-19 pandemic has provoked widespread disruption to clinical nurses' work. It is important to understand clinical nurses' processes of coping during disasters to support the nursing workforce during events such as global pandemics.

DESIGN

We employed the Corbin and Strauss variant of grounded theory methodology, informed by symbolic interactionism, and applied the EQUATOR guidelines for qualitative research publication (COREQ).

METHODS

Data collection entailed semi-structured interviews with experienced clinical nurses (n =20) across diverse settings. We analysed data by identifying key points in the nurses' coping processes inductively building concepts around these points.

RESULTS

The predictor of nurses' outcomes in this grounded theory was their confidence in their ability to cope during the pandemic. When nurses lacked confidence, they experienced working in the context of acute COVID-a state of chaos and anxiety, with negative consequences for nurses. However, when nurses were confident in their abilities to cope with the pandemic, they experienced working in the context of chronic COVID, a calmer state of acceptance. There were many workplace factors that influenced nurses' confidence, including adequacy of personal protective equipment, clear information and guidance, supportive leadership, teamwork and adequate staffing.

CONCLUSIONS

Understanding clinical nurses' experience of coping during COVID-19 is essential to maintain the nursing workforce during similar disasters.

RELEVANCE TO CLINICAL PRACTICE

Nurse leaders can target areas that support nurses' confidence, such as adequate PPE and staffing. In turn, increased confidence enables clinical nurses to cope during disasters such as a global pandemic.

The Lived Experiences of Nurses Working During the COVID-19 Pandemic

Background

Previous research on nurses during pandemics has focused on nurses working in one facility or type of unit; this study focuses on nurses caring for COVID-19 patients in a variety of units in different sites across the United States.

Objective

The aim of this study was to understand the experiences of registered nurses working with hospitalized COVID-19 patients.

Methods

This study used a hermeneutic phenomenology design. Semistructured interviews via telephone were conducted and then transcribed verbatim. Colaizzi's method of analysis was used. Data saturation was achieved with 14 participants.

Results

Three major themes were evident. They were “the human connection,” “the nursing burden,” and “coping.” Subthemes were identified under each major theme.

Discussion

This study depicted nurses who are caring, empathetic, and resilient. They had many recommendations for fellow nurses, the public, and health care organizations.

Mental health symptoms among the nurses of Bangladesh during the COVID-19 pandemic

Background

The coronavirus disease-19 (COVID-19) pandemic has wreaked havoc on healthcare staff and caused serious psychological distress. We aimed to determine the effects of the COVID-19 pandemic on the mental health of Bangladeshi nurses, as well as the relationship between occupational factors and mental health symptoms. We conducted a cross-sectional study among registered nurses in Bangladesh. We used the Depression, Anxiety and Stress Scale-21 (DASS-21) and the Impact of Event Scale-Revised (IES-R) to assess mental health symptoms.

Results

Among the 547 nurses included in the study, the prevalence of mild to extremely severe depression, anxiety, and stress was 50.5%, 51.8%, and 41.7% respectively, and 61.9% of the respondents reported mild to severe psychological impact for COVID-19. Psychological symptoms were more prevalent among female nurses than male nurses (p <0.05). Linear regression revealed that having complete personal protective equipment (PPE) during working was significantly associated with lower levels of depression, anxiety, and stress (p <0.05). Facing any emotional abuse working in the COVID-19 pandemic situation was significantly associated with higher levels of depression, anxiety, and stress and greater psychological impact of the outbreak (p <0.05).

Conclusions

A high prevalence of mental health symptoms was observed in nurses. We recommend the implementation of mental well-being interventions and ensuring a proper work environment for nurses during the pandemic.

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era

OBJECTIVE

We aimed to investigate the effect of nursing professionals' resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic.

METHODS

We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores.

RESULTS

Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31-1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03-1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85-0.97) were expecting variables for the depression of healthcare workers.

CONCLUSION

Nursing professionals' level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.

Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19

BACKGROUND

Health care professionals exposed to coronavirus disease 2019 (COVID-19) are facing high levels of stress.

AIM

The aim was to evaluate the quality of sleep (QoS) and health-related quality of life (HRQoL), among health care professionals treating patients with COVID-19, as well as quantifying the magnitude of symptoms of depression and levels of anxiety.

METHODS

We included 201 health care professionals in a cross-sectional, web-based study by applying 7-item Generalized Anxiety Disorder (GAD-7) Scale, Zung Self-rating Depression Scale, 36-item Health Survey of the Medical Outcomes Study Short Form (SF36), Pittsburgh Sleep Quality Index (PSQI) and additional survey constructed for the purpose of the study.

RESULTS

Health care workers who treated COVID-19 patients were more afraid of becoming infected or of transmitting the infection to a family member with a significantly low self-assessment of their mental status. Poor QoS and HRQoL correlated with high health anxiety and severe depressive symptoms and several demographic characteristics. Multiple linear regression analysis showed that higher scores on GAD-7 (beta = .71, p < .01) and lower scores on mental health (MH) subscale on SF36 questionnaire (beta = -.69; p < .01) were independent predictors of the higher PSQI score (adjusted R² = .61, p < .01 for overall model). Higher scores on GAD-7 (beta = .68, p < .01) and worse self-perceived mental status (beta = .25; p < .05) were independent predictors of the lower SF36 scores (adjusted R² = .73, p < .01 for overall model).

CONCLUSION

The major MH burden of health care professionals treating infected patients during the COVID-19 pandemic indicates that they need psychological support.

Knowledge and attitude evaluation of physicians and nurses on COVID-19

OBJECTIVE:

This study aims to evaluate the knowledge, perceptions, and attitudes of physician faculty members, nurses, and medical students who work in a hospital in Istanbul regarding COVID-19.

METHODS:

This cross-sectional study was conducted in a tertiary hospital from March 2 to March 10, 2020. The research data were collected through a survey consisting of 22 questions about their demographics and their level of knowledge, sources of information, actions, attitudes, and thoughts about COVID-19. The collected data were analyzed using SPSS 22.0.

RESULTS:

Out of 1.460 people, 614 (42%) participated in this study. More than 60% of the participants correctly answered the information questions about COVID-19. 72.6% of the participants stated that the situation that would stress them out the most in case of a COVID-19 outbreak in Turkey would be the diagnosis of one of their family members with COVID-19. Social media (66.4%) was the primary source of information in this process.

CONCLUSION:

The findings obtained in this study showed that right before the outbreak, healthcare professionals were concerned and stressed about the inadequacy of protective measures and the possibility of transmission, although they were ready for the outbreak in the professional sense.

A Large Scale of Nurses Participated in Beating down COVID-19 in China: The Physical and Psychological Distress

The outbreak of coronavirus disease 2019 (COVID-19) posed an unprecedented threat to health care providers (HCPs) in Wuhan, China, especially for nurses who were frequently exposed to infected or suspected patients. Limited information was available about the working experience of nurses in fighting against the pandemic. To learn the physical and psychological responses of nurses during the pandemic and explore the potential determinants, we conducted a large-scale survey in Wuhan. This multicenter cross-sectional study enrolled 5521 nurses who worked in designated hospitals, mobile cabins, or shelters during the pandemic. A structured online questionnaire was distributed to assess the physical discomforts, emotional distress and cognitive reactions of nurses at work, and the log-binomial regression analysis was performed to explore potential determinants. A considerable proportion of nurses had symptoms of physical discomforts [3677 (66.6%)] and emotional distress [4721 (85.5%)]. Nurses who were directly involved in the care of patients (i.e., care for severe patients: RR, 2.35; 95% CI, 1.95-2.84), with irregular work schedules (RR, 2.36; 95% CI, 1.95-2.87), and working overtime (RR, 1.34; 95% CI, 1.08-1.65) were at a higher risk for physical discomforts. Nurses who were directly involved in the care of patients (i.e., care for severe patients: RR, 1.78; 95% CI, 1.40-2.29), with irregular work schedules (RR, 3.39; 95% CI, 2.43-4.73), and working overtime (RR, 1.51; 95% CI, 1.12-2.04) were at a higher risk for emotional distress. Therefore, formulating reasonable work schedules and improving workforce systems are necessary to alleviate the physical and emotional distress of nurses during the pandemic.