Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic

Experiences of U.S. frontline physicians during the COVID-19 pandemic: a qualitative study

BACKGROUND

The COVID-19 pandemic caused profound and rapid changes in patient care and healthcare system organization. There is a compelling need for insight into the challenges that confronted physicians during the early phase of the pandemic to identify successful adaptations and strategies that minimize disruption to patient care and protect clinician wellbeing. The purpose of this study was to understand physicians' lived experiences of providing patient care during the early COVID-19 pandemic.

METHODS

This qualitative, descriptive study used a thematic analysis approach. The sample included 17 physicians from five specialties with direct care experience of COVID-19 patients (infectious disease, primary care, emergency medicine, critical care, and hospitalists). Participants were identified through snowball sampling. Data were collected through focus groups and interviews in May and June 2020 and analyzed with an inductive and deductive approach using thematic analysis.

RESULTS

Three overarching themes relating to patient care delivery during the ongoing COVID-19 pandemic were identified: facilitators, barriers, and acute stressors. Facilitator subthemes included: organizational logistical and operational support, organizational support for self-care and wellness, and peer and family support/debriefing. Barrier subthemes included: lack of clear and consistent governmental guidelines and organizational support, uncertainty resulting from poor communication or lack of information, and interpersonal barriers to physician self-care and wellbeing. Stressor subthemes included: concern about exposure, feeling unprepared, and anticipating the worst.

CONCLUSIONS

Physicians reported that both patient care and their own wellbeing were greatly impacted by organizational and systems level facilitators and barriers. Findings from this study can inform the creation of best practices, tools, and strategies that can assist with future emergency preparedness and pandemic response planning efforts.

Migrants' experiences as health ambassadors during the COVID-19 pandemic in Norway-a qualitative study

BACKGROUND

In response to the high incidence of COVID-19 infections among migrants, and lack of information, several interventions relying on migrants to deliver information to their peers were implemented. Although these strategies seem to be effective, the experiences of the migrants disseminating health information have not been studied. The Health Ambassador Project (HA-project) was one of such projects connecting key members from migrant communities (Health Ambassadors (HAs)) with health experts and the municipality, to disseminate health information to migrants. The HA-project was conducted in Bergen, Norway, in 2021-2022. This study aims to understand the experiences of the HAs during their involvement in the HA-project, how their role affected them in positive or negative ways and how they coped with eventual difficulties in the role.

METHODS

We conducted individual interviews in January 2023 with seven HAs. The interviews were transcribed and analyzed using systematic text condensation.

FINDINGS

Participating in the HA-project was predominantly a positive experience for all HAs, by acquiring a sense of meaning and of being considered a valuable resource during the COVID-19 pandemic. There were positive social and professional aspects related to being able to meet other HAs and learning from each other's experiences. However, psychological distress was reported related to the responsibility of conveying correct health information about the COVID-19 pandemic to fellow migrants and fighting misinformation. Several HAs used more of their free time than was expected of them, helping people in practical ways. HAs from Ukraine joined the project in 2022 and experienced their roles as more stressful given limitations in the availability of interpretation when collaborating with the experts.

CONCLUSION

Targeted health interventions relying on migrants to address their peers should consider the experiences of those distributing information and minimize their psychological stress.

COVID-19 Personal Experiences and Posttraumatic Stress in National Guard Service Members

INTRODUCTION

The National Guard (NG) was an important component of the U.S. emergency response for the coronavirus (COVID-19) pandemic. Understanding how the personal COVID-19 experiences of NG members may be associated with posttraumatic stress symptoms (PTSS) and disorder (PTSD) can inform approaches to identifying and sustaining service members' mental health.

MATERIALS AND METHODS

We surveyed 3,993 NG service members (75% Army; 79% enlisted; 33% 30-39 years old; 81% male) during the pandemic. Forty-six percent of participants were activated in response to COVID-19. Surveys were administered between August and December 2020. We defined personal COVID-19 experiences as having COVID-19, a family member(s) having COVID-19, and/or having a close relationship with someone who died from COVID-19. In addition, using a 4-item form of the PTSD Checklist for DSM-5 (PCL-5), current posttraumatic stress symptoms (PTSS) and probable PTSD were assessed. Linear and logistic regression analyses were conducted to examine the relationship of COVID-19 experiences to PTSS and probable PTSD, respectively.

RESULTS

Approximately 32% of participants reported at least one personal COVID-19 experience. Univariable linear regression analyses indicated that NG service members who had a personal COVID-19 experience reported more PTSS than those with no personal experience (B = 0.53, SE = 0.12, P < .001). After adjusting for demographics and service-related characteristics, having a personal COVID-19 experience continued to be associated with higher PTSS (B = 0.48, SE = 0.12, P < .001). When examining the relationships of distinct types of personal COVID-19 experiences to PTSS and PTSD together in multivariable models, those who had a close relationship with someone who died from COVID-19 had higher levels of PTSS (B = 1.31, SE = 0.22, P < .001) and were almost 3 times more likely to have PTSD (OR = 2.94[95%CI = 1.93-4.47], P < .001).

CONCLUSIONS

Personal COVID-19 experiences are associated with increased PTSS and PTSD risk in NG service members. Such knowledge may aid in selection of service members for activation and identifying those in need of care.

Association between working conditions during the COVID-19 pandemic and sleep and stress among Colombian healthcare workers

INTRODUCTION

Although COVID-19 is no longer a public health emergency, its mental health effects on healthcare workers persist.

AIM

This study investigated the relationship between working conditions, sleep, and stress among Colombian hospital healthcare personnel during the pandemic.

METHODS

In this cross-sectional study, 79 healthcare workers completed questionnaires on working conditions, stress, and sleep. Sleep duration was measured with Fitbit Armbands. Associations were analyzed using Generalized Linear Models with Gamma and ordinal distributions.

RESULTS

Approximately 79% of participants reported high to very high stress levels (61% "very high," 18% "high"). Sleep complications were minimal, averaging 6.2 hours. Nurses showed significantly higher stress and longer sleep duration than administrative workers. Overtime correlated with less sleep, while workers who had COVID-19 reported lower stress.

CONCLUSION

The study highlights connections between stress, sleep, and working conditions, suggesting targeted health promotion programs could enhance work-life balance.

The mental health consequences of COVID-19 on a sample of health professions students: a mixed methods study

Objective: To assess and examine how the COVID-19 pandemic may have impacted the mental health of a sample of health professions students (HPS) using an explanatory sequential mixed-methods design. Participants: Participants included 41 HPS enrolled in a co-curricular interprofessional education (IPE) program. Measurements: Measures included the CES-D scale, PSS scale, and the GAD scale. Qualitative description was used to explore the experiences of these HPS. Results: The HPS explained that fear of acquiring COVID-19, transmitting the virus to loved ones, and dying as a result of the disease negatively influenced their mental health. The HPS revealed that there were some beneficial outcomes resulting from the pandemic, including the strengthening of family bonds and the cultivation of resiliency. Conclusions: The pandemic has had a negative impact on the mental health of these HPS. It is essential that these students receive support for their mental health in order to provide optimal care to the population they serve.

Psychometric Properties and Gender Invariance of the Positive Mental Health Scale in Spanish Nurses During the COVID-19 Pandemic

AIM

Positive mental health (PMH) can be considered a key aspect of mental health in the face of potentially stressful healthcare situations such as the COVID-19 pandemic. The aim of this study was to analyse the psychometric properties of the Spanish version of the Positive Mental Health Scale (PMS) in Spanish nurses during the COVID-19 pandemic.

DESIGN

Descriptive analysis, confirmatory factor analysis, gender invariance analysis and convergent and divergent analyses were performed, and reliability indices were calculated.

METHODS

A total of 661 nurses (425 women and 236 men) participated in the study. They completed various questionnaires during August-October 2021.

RESULTS

Factor analysis demonstrated a unidimensional structure with very good indices of model fit, high positive convergent validity, especially with social support, self-efficacy and resilience to suicide attempts, and high divergent validity with anxiety and, to a lesser extent, with depression. There was also strong invariance between genders and high reliability indices. In conclusion, the data show that the PMS has adequate validity and reliability in nurses. Furthermore, this study allows us to confirm gender invariance, which has not been examined in other studies. The data show that PMS is a suitable measure for assessing the mental health of healthcare professionals exposed to high-stress situations.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contributions.

"I seemed calmer, clearer, and better able to react to challenging situations": phenomenological reflections on learning about mindfulness in health professions education

It is widely acknowledged that healthcare practitioner well-being is under threat, as many factors like excessive workloads, perceived lack of organizational support, the rapid introduction of new technologies, repercussions of the COVID-19 pandemic, and other factors have transformed the health care workplace. Distress, anxiety and burnout are on the rise, and are particularly concerning for health professions' students who must navigate challenging academic and clinical demands, in addition to personal responsibilities. While not a panacea for the systemic issues at play, 'mindfulness practices' have shown some promise in supporting students to navigate stressful environments. Yet despite calls for more phenomenological studies, little is known about health professions students' lived experiences of learning about and using mindfulness in higher education contexts. The objective of this hermeneutic phenomenological study was to inquire into the first-hand lived experiences of health professions students by examining their written reflections on learning about and using mindfulness in a higher education context. The study reports on themes identified in an analysis of students' phenomenological reflections written during and following a mindfulness elective course offered at a Canadian University. The analysis revealed four predominant themes: (a) reframing perceptions, (b)'being' while 'doing', (c) witnessing the struggle, and (d) compassion for self and others. In a time when health professionals are increasingly under strain, and systemic reform is needed but slow to take shape, the findings of this study reveal potential affordances of mindfulness for helping students to navigate the myriad of challenges they face. The findings are unique in their in-depth exploration of students' reflections on the experience of learning about and engaging in 'mindfulness practices' in a higher education context. The findings contribute first-hand perspectives to the evolving field of mindfulness education research and generate new conversations about mindfulness education in the health professions curriculum.

Effectiveness of Self-Help Plus in its digital version in reducing anxiety and post-traumatic symptomatology among nursing home workers during the COVID-19 pandemic: secondary analysis of randomised controlled trial data

BACKGROUND

Healthcare workers (HCWs) face substantial daily work-related pressures, leading to frequent reports of depression, anxiety and post-traumatic stress disorder (PTSD) symptoms.

OBJECTIVE

To compare the effects of Self-Help Plus in its digital version Doing What Matters in Times of Stress (DWM) to an equally structured activity in reducing anxiety and/or PTSD symptoms among HCWs.

METHODS

We compared the proportion of participants with moderate-to-severe anxiety (General Anxiety Disorder Scale; GAD-7 ≥10) and/or PTSD symptoms (Impact of Event Scale-Revised (IES-R)) ≥26) between DWM and the alternative activity. We used an intention to treat analysis and performed χ2 tests at 1 and 14 weeks. We assessed compliance (≥five logins) and conducted per-protocol analyses. We also analysed GAD-7 and IES-R scores as continuous outcomes. Possible differential effectiveness was also assessed through login frequency.

FINDINGS

At 14 weeks, 14.5% of DWM and 27.6% of control participants showed at least moderate anxiety and/or PTSD symptoms (χ2=3.712, p=0.054). Among those with ≥five logins, DWM participants had fewer moderate symptoms (10.6% vs 31.4%, p=0.012), with reductions in anxiety (6.3% vs 19.6%, p=0.049) and PTSD symptoms (6.4% vs 27.5%, p=0.006). At 1 week, 30.6% of DWM and 28.2% of control participants reported moderate symptoms (χ2=0.113, p=0.736). Interaction analysis suggested compliance influenced outcomes (OR 4.560, p=0.096 at 14 weeks; OR 0.266, p=0.067 at 1 week).

CONCLUSIONS

DWM is a promising strategy to reduce moderate-to-severe PTSD and/or anxiety symptoms in HCWs. Compliance is crucial to ensure efficacy.

CLINICAL IMPLICATIONS

DWM is a scalable digital tool that could be considered as an intermediate or complementary intervention for distressed HCWs.

Supports for Mental Well-Being Valued by Healthcare Workers: Qualitative Analysis of Data From a Canadian Cohort of Healthcare Workers During the COVID-19 Pandemic

A prospective cohort of 4964 HCWs from four Canadian provinces was established early in the COVID-19 pandemic. Participants were invited to comment about workplace mental health supports at three time points. We performed a thematic content analysis of responses from 1738 participants using the Social Support Behaviour Code framework to categorize barriers to support as informational, tangible, emotional, social, or expressing esteem. Themes were synthesized into suggestions for healthcare organizations to prepare for future crises. Formal and informal peer support, workplace mental health supports, and one-on-one counseling were most often mentioned as valued. Analysis suggested that workplace social networks as a source of support and mental health supports would have been appreciated. HCWs perceived that a lack of tangible workplace supports, such as staffing, compensation, and time off, were barriers to well-being. Medical workplaces could consider the availability of tangible supports in addition to developing formal mental health supports for healthcare workers.

Meaning in life during the COVID-19 pandemic in Brazil: Impact of quality of life and sociodemographic factors

Research on meaning in life typically emphasizes the psychological aspects of quality of life, neglecting broader dimensions. Additionally, its relevance to the COVID-19 context remains limited. This study investigated the relationship of meaning in life with quality of life and sociodemographic factors related to COVID-19 pandemic in Brazil. A total of 4133 Brazilian adults completed Meaning in Life Questionnaire (MLQ), WHOQOL-BREF, WHOQOL-SRPB BREF, and sociodemographic information. Our results indicated a positive correlation between the presence of meaning and quality of life dimensions, with psychological health exhibiting the strongest relationship. We found a lower presence of meaning among individuals experiencing heightened social isolation, while vaccinated individuals exhibited a greater presence of meaning. Additionally, non-working participants reported lower presence and higher search for meaning than employed individuals, with frontline workers showing the highest search for meaning. Theoretical and practical implications of these findings are discussed.

The role of intrinsic spirituality, emotion dysregulation, and resilience on post-traumatic stress disorder symptoms in university students who survived earthquake

PURPOSE

The study aimed to explore the relationship between intrinsic spirituality, emotion dysregulation, resilience, and PTSD in Turkish university students who were earthquake survivors. In addition, the validity and reliability of the Brief Emotion Dysregulation Scale (BEDS) were evaluated among Turkish university students who were earthquake survivors.

METHODS

A sample of 651 Turkish university students who were earthquake survivors participated in an online survey distributed via WhatsApp, completing the Intrinsic Spirituality Scale (ISS), the Brief Emotion Dysregulation Scale (BEDS), the Brief Resilience Scale (BRS), and the Post-Traumatic Stress Disorder Checklist for DSM-5. Structural equation modeling and mediation analysis were employed to explore the predictive relationships between these psychological variables and PTSD symptoms.

RESULTS

The findings confirmed that the BEDS is a valid and reliable scale for assessing emotion dysregulation levels in Turkish university students who were earthquake survivors. Intrinsic spirituality had a negative correlation between emotion dysregulation and PTSD, indicating that higher levels of PTSD are associated with lower intrinsic spirituality. A positive correlation was found between intrinsic spirituality and resilience, suggesting that increased intrinsic spirituality is linked to higher levels of resilience. Furthermore, emotion dysregulation and resilience were found to mediate the relationship between intrinsic spirituality and PTSD. Moreover, emotion dysregulation has a mediating effect in the relationship between resilience and PTSD.

CONCLUSIONS

The study highlights the determinant effects of intrinsic spirituality on emotional dysregulation, resilience and PTSD in Turkish university students who survived the earthquake. Interventions and support programs designed to reduce PTSD symptoms should benefit from the results of this research, and future research should include longitudinal studies to assess the long-term effects of intrinsic spirituality on PTSD. It is also crucial to examine the effects on various demographic groups, including differences in age, education level, and socio-economic status.

Analysis of mental health of healthcare workers and its influencing factors in three consecutive years

Background: Healthcare workers are an indispensable part of society, and a healthy mind and body are important to them, but today's exacerbation of psychological problems in healthcare, has attracted the attention of society. Objective: This study spans two particular phases: the COVID-19 pandemic phase and the full liberalization of epidemic control. To explore trends in the mental health status of healthcare workers, particularly anxiety, depression and sleep quality, and to analyze the influencing factors and inform the development of interventions through data collection over three consecutive years. Methods: A general information questionnaire, SAS, SDS, and PSQI were used to survey in-service healthcare workers in a regional tertiary care hospital for three consecutive years, and data were collected to cover multiple time points to observe trends in mental health and to synthesize and analyze potential influencing factors such as demographic characteristics. Results: The SAS, SDS, and PSQI scores of the healthcare workers were significantly higher than the national norm. With psychological interventions, the incidence of depression and sleep problems decreased year by year, and the incidence of anxiety problems fluctuated little. Anxiety, depression and sleep problems are affected by a variety of factors, and healthcare workers whose gender is female, whose occupation is nurseing whose age is younger, whose job title is lower, and whose position is on the front line of epidemic prevention are more likely to have mental health problems. Conclusions: This study identifies the severity and complexity of mental health problems among healthcare workers, analyzes their mental health needs and factors affecting mental health, and provides a scientific basis for providing psychological interventions.

Reducing anxiety and enhancing innovation in nurses: a psychological capital intervention study in China

AIM

This study aimed to test whether increasing psychological capital through psychological capital interventions affects anxiety and innovation among nursing staff through an experimental study.

METHOD

This study utilized a two-group (experimental and wait-list control) pre-test and post-test design. In August 2022, eighty clinical nurses from the same hospital were randomly assigned to either the experimental group (40) or the wait-list control group (40) to complete self-report questionnaires at pre-intervention (T1), post-intervention (T2), and one month post-intervention (T3). The experimental group received a 6-week training on the psychological capital intervention.

RESULT

The scores of anxiety, psychological capital, and innovative behaviour of experimental subjects in the two groups before and after the intervention showed no significant difference in between-group effects (P > 0.05). In contrast, the time effect and between-group × time effect were significant (P < 0.05), and the trends of anxiety, psychological capital and innovative behaviour over time differed between the two groups of nurses.

CONCLUSION

Online psychological capital interventions can weaken the constraints of time and space to maximize the effective development of nursing staff's psychological capital, reduce anxiety, and improve nurses' innovative behaviors.

Prevalence and Factors Associated with Common Mental Disorders and Posttraumatic Stress Disorder Among Healthcare Workers in a Reference Center for Infectious Diseases During the COVID-19 Pandemic: A Survey-Based Cross-Sectional Study

A cross-sectional survey conducted between July and September 2020 and August and September 2021 estimated the prevalence and predictors of common mental disorders (CMDs) and post-traumatic stress disorder (PTSD) among healthcare workers (HCWs) at an infectious disease referral center during the COVID-19 pandemic. CMDs were assessed using the General Health Questionnaire (GHQ-12), and PTSD using the Impact of Event Scale-Revised (IES-R). Multivariate logistic regressions identified predictors of CMD and PTSD. The study included 371 HCWs in 2020 and 167 in 2021. The CMD prevalence was 34.3% (95% confidence interval (CI): 29.5-39.4) in 2020 and 30.5% (95% CI: 23.7-38.1) in 2021. The PTSD prevalence was 25.4% (95% CI: 21.0-30.2) in 2020 and 32.7% (95% CI: 25.6-40.5) in 2021. Factors increasing CMD odds included lower education (adjusted odds ratio (AOR) = 3.71, 95% CI: 1.60-8.61), lack of physical activity (AOR = 2.23, 95% CI: 1.33-3.73), and experiencing COVID-19 symptoms (AOR = 1.64, 95% CI: 1.02-2.64) in 2020; chronic diseases (AOR = 3.14, 95% CI: 1.34-7.35) and SARS-CoV-2 testing (AOR = 3.39, 95% CI: 1.13-10.17) raised CMD odds in 2021. Frontline HCWs had lower CMD odds in 2020 (AOR = 0.60, 95% CI: 0.36-1.00) and 2021 (AOR = 0.33, 95% CI: 0.14-0.75). PTSD was associated with having COVID-19 symptoms (AOR = 2.06, 95% CI: 1.23-3.45), living with high-risk individuals (AOR = 1.75, 95% CI: 1.03-2.95), and losing loved ones (AOR = 1.86, 95% CI: 1.09-3.17) in 2020. Chronic diseases increased PTSD odds in 2020 (AOR = 2.20, 95% CI: 1.25-3.86) and 2021 (AOR = 2.30, 95% CI: 1.03-5.13), while age decreased them in 2020 (AOR = 0.95, 95% CI: 0.93-0.98) and 2021 (AOR = 0.95, 95% CI: 0.91-0.99). Younger HCWs with chronic conditions living with high-risk individuals were particularly affected. These findings highlight the urgent need for targeted emotional support and stress management programs for HCWs.

Committed care in the shadow of fear: The experiences of emergency medical services staff encountering with COVID-19 patients

BACKGROUND

By the beginning of the coronavirus disease 2019 (COVID-19) pandemic, emergency medical services (EMSs) played a key first-line role in patients affected by this disease care. In Iran, EMSs is a main part of health system that has a substantial role in managing emerging crisis and disasters. This study aimed to investigate the experience of the EMSs staff encountering with COVID-19 patients.

MATERIALS AND METHODS

This was a descriptive qualitative study conducted on 14 EMSs staff selected by purposive sampling from August 2021 to September 2022. This study was conducted in the southern part of Iran. Data were collected using a semi-structured interview, and Graneheim, U.H. and Lundman, B. (2004) conventional content analysis method applied for their analysis MAXQDATA 2020 was used to store the interview data and codes. Till reaching data saturation, sampling was continued.

RESULTS

Data analysis contributed to the extraction of 783 primary codes, 15 subclasses, 4 classes, and 2 main themes, including "committed care" (with two classes of "respect to the personal identity of the patient" and "facilitators to adhere to care") and "the bottleneck of care in the shadow of fear" (with two classes of "the fine line between fear and responsibility" and "the sacrifice in care").

CONCLUSIONS

Although there was a fear of encountering COVID-19 patients among the EMSs staff, they provided devotional and committed care to patients considering moral values and human principles. Health policymakers should minimize the challenges of EMSs staff encountering with emerging infectious diseases with effective planning.

Exploring the mental well-being of Ekurhuleni primary healthcare clinic managers during COVID-19

Background

The coronavirus disease 2019 (COVID-19) pandemic extensively disrupted the management dynamics and stretched the mental well-being of Ekurhuleni primary healthcare clinic managers. Their workload was increased, and they also had to deal with the grief of losing colleagues, family members and patients in large numbers as a result of the pandemic.

Aim

This study sought to explore and describe the mental well-being of Ekurhuleni primary healthcare clinic managers during the COVID-19 pandemic.

Setting

This study was conducted in the primary healthcare clinics of Ekurhuleni region in Gauteng province.

Methods

A qualitative, exploratory, descriptive and contextual research design was adopted in this study. The sample size comprised 14 clinic managers. Purposive sampling was used to select the participants, and in-depth semi-structured individual interviews were conducted to collect data. The descriptive thematic analysis method was used to analyse data.

Results

Four themes emerged from the study: (1) unbearable level of stress because of the new management dynamics, (2) fear and anxiety because of a sudden escalating death rate, (3) unresponsive employee wellness programmes and (4) lack of support from senior management.

Conclusion

The senior management of primary healthcare clinics should safeguard the mental well-being of clinic managers during the pandemic by giving support and ensuring that the existing employee wellness system is responsive.

Contribution

This study revealed that a strong support from senior management and responsive employee wellness programmes can strengthen the mental health of the primary healthcare clinic managers. Thus, this enables them to be future ready for possible pandemics like COVID-19.

Prevalence and correlates of severe anxiety among front-line nurses during and after the COVID-19 pandemic: a large-scale multi-center study

BACKGROUND

Nurses have been at the forefront of the battle against the COVID-19 pandemic, facing extended work hours and heightened stress, predisposing them to psychological distress. This study aims to investigate the prevalence and correlates of severe anxiety among frontline nurses in China during and after the COVID-19 pandemic.

METHODS

A large-scale multi-center survey was conducted from November to December 2022 and from April to July 2023. Data were collected using online surveys, covering demographic characteristics, job-related factors, anxiety, depression, and sleep disorders. Statistical analyses, including chi-square tests, t-tests, and logistic regression, were performed to assess the incidence and factors influencing severe anxiety.

RESULTS

The study included 816 nurses during the pandemic and 763 nurses after the pandemic. The prevalence of severe anxiety during the pandemic (52.3%) was significantly higher than after the pandemic (8.0%). Factors such as nursing title, night shift frequency, educational level, exercise frequency, COVID-19 infection status, economic pressure, and work pressure showed significant differences between the two periods. Binary logistic regression revealed associations between severe anxiety and factors such as night shift frequency, COVID-19 infection status, nursing title, depression, and sleep disorders. Receiver Operating Characteristic analysis demonstrated good predictive value for severe anxiety.

CONCLUSION

The study underscores the importance of understanding and addressing severe anxiety among frontline nurses during and after the COVID-19 pandemic. Future research should delve into long-term psychological effects and implement effective intervention measures to support nurses' mental health.

Job-related Factors Associated with Depression, Anxiety, and Stress among Healthcare Workers in a Tertiary Government Hospital in Metro Manila during the COVID-19 Pandemic

Background and Objectives

Ensuring the total well-being of healthcare workers (HCWs), including their mental health and psychological well-being, is an essential aspect in the delivery of patient care and the preservation of the health workforce. This study aimed to determine the level of mental well-being and emotional state of HCWs in terms of depression, anxiety, and stress using the DASS-21 scale in a tertiary government hospital during the COVID-19 pandemic in the Philippines and to identify the job-related factors that may be associated with these outcomes.

Methods

This is an analytical, cross-sectional study among HCWs involved in direct patient care in a tertiary government hospital in the Philippines during the COVID-19 pandemic. Data collection was conducted from February to March 2022 through an online self-administered questionnaire, which included the Demand-Control-Support Questionnaire (DCSQ), and the 21-item Depression Anxiety Stress Scale (DASS-21). This was sent to doctors, nurses, and allied medical workers actively working in the clinical areas. All responses were collected and analyzed.

Results

Three hundred sixty-four healthcare workers were included in the study. Majority were single (62.62%), living with immediate family (50.82%), and working in a COVID-designated area (62.09%). High prevalence of depression (49.18%), anxiety (61.54%), and stress (30.22%) was found among the HCWs. Work in high infection/COVID-designated areas was significantly associated with anxiety and stress, and high-job demand was significantly associated with all three mental health states compared to low job-demand.

Conclusion

Focus should be placed on modifying the condition of high job demand among healthcare workers working in hospitals. This includes ensuring optimum staffing levels and patient to HCW ratio which avoids HCWs from being subjected to high workloads and time pressures that subsequently increase risk for stress, anxiety, and depression.

Insights into general practitioners' self-care across 38 countries during the pandemic: a cross-sectional study

BACKGROUND

The adoption of healthy self-care practices has proven necessary for professional life, as they often serve as a shield against stressors in the workplace. The COVID-19 pandemic created a high strain on general practitioners (GPs), contributing to increased workload, burnout, and anxiety. The present study aimed to identify self-care practices adopted by GPs amid the COVID-19 pandemic; and to explore the relationships between self-care practices and risk of distress.

METHODS

The current study utilized an online questionnaire arriving from the PRICOV-19 study, which was distributed among GP practices across 38 countries. The main focus was on the open-text responses where participants disclosed self-care practices employed to maintain mental health during COVID-19. The Six Domains of Self-Care theoretical framework was applied to investigate GP self-care practices across 6 domains including Physical, Professional, Relational, Emotional, Psychological, and Spiritual. The Mayo Clinic Well-Being Index (eWBI) was applied to assess mental well-being and risk of distress among GPs. The analysis was carried out using SPSS Statistics software.

RESULTS

In total, 2,949 GPs provided open-text responses on maintaining their mental health. 65.5% of GPs had an eWBI score of ≥ 2 and were considered at risk of distress. The majority of the participants prioritised physical (61.7%), followed by relational (38.0%) and psychological (34.6%) self-care practices to maintain their mental health during the pandemic. GPs who applied relational, physical, and professional self-care were significantly less likely to experience depression, stress, and emotional exhaustion, in comparison with the ones who did not apply these practices. GPs who practiced professional self-care practices had the lowest distress risk (eWBI = 1.99). Overall, 5% of GPs disclosed not applying any practices to maintain their mental health during the pandemic and were the most prone to mental health distress.

CONCLUSIONS

GPs have navigated the pandemic uniquely, and despite applying self-care practices they faced some level of impact, hence self-care interventions for healthcare professionals should be regarded as essential rather than optional. A long-term investment in strategies focused on improving GPs' self-care is necessary to increase resilience among GPs and ensure their optimal well-being levels are achieved.

The mental health of first- and second-generation migrant vs. native healthcare workers during the COVID-19 pandemic: The VOICE survey of 7,187 employees in the German healthcare sector

The COVID-19 pandemic exacerbated the challenging working conditions of healthcare workers (HCWs) in many regions. A considerable proportion of HCWs in Germany are migrants facing additional migration-related stressors. The aim of this cross-sectional web-based survey was to examine depressive and generalized anxiety symptoms among migrant and native HCWs in Germany during the pandemic. We compared 780 migrant (first- and second-generation) HCWs from different backgrounds with 6,407 native HCWs. Multiple linear regression analyses were used to examine associations between occupational and COVID-19 related variables, controlling for sociodemographics. Migrant HCWs from low-/middle-income countries more frequently had clinically relevant depressive symptoms (PHQ-2 ≥ 3) than did those from high-income countries (29.9% vs. 16.7%, p = .002, ϕ = .156) (all other ϕs/Cramer's Vs ≤ .036). There were no clinically relevant differences in anxiety levels (GAD-2 ≥ 3) between native vs. migrant HCWs, native vs. the individual migrant HCW groups, or between the sexes (all ϕs/Cramer's Vs ≤ .036). After controlling for key sociodemographic characteristics, native HCWs did not differ from the individual migrant HCW groups on depression and anxiety severity (depression: all βs ≤ |.030|, anxiety: all βs ≤ |.014|). A high percentage of HCWs reported distress, with migrants from low-/middle-income countries reporting highest burden. The results indicate the need to establish prevention programmes for HCWs, with special consideration to vulnerable populations including certain migrant groups.

Nursing as an earthquake survivor: A qualitative study on nurses traumatized by the Kahramanmaraş earthquake in Turkey

BACKGROUND

Nurses' critical input and firsthand disaster management experience are vital to healthcare quality.

AIM

This study aims to comprehend nurses' experiences during and after the earthquakes, their coping mechanisms for posttraumatic stress disorder (PTSD), and the consequent effects on their profession, given the nurses' crucial role in disaster response.

METHODS

A descriptive qualitative study using semistructured interviews was conducted between April and May 2024. Fifteen nurses were selected using criterion and snowball sampling methods from those working as earthquake survivor nurses in the affected areas. The COREQ guidelines for reporting qualitative research were followed.

FINDINGS

Five main themes were: emotional reactions/physical difficulties, career and motivation, PTSD and well-being, suggestions, and work performance. The results highlighted the significant psychological and professional challenges that nurses encounter, including the effects of severe PTSD symptoms, coping strategies, and the influence on their capacity to deliver care.

CONCLUSIONS

Nurses dealing with earthquakes face unique challenges that test their resilience on all levels. Learning from their experiences and coping mechanisms can help healthcare systems support these frontline workers better. Investing in disaster preparedness and mental health resources for nurses is crucial for their well-being and the overall strength of the healthcare system during crises.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Effectively managing workloads and rest periods can reduce physical fatigue and prevent burnout. Shift rotations and adequate staffing levels are necessary. Access to psychological mental health support is vital for nurses to recover from the psychological effects of disasters. Regular disaster preparedness training is imperative for physical safety and psychological resilience. Robust support systems, including safe accommodation and peer support groups, are crucial for nurses in disaster response.

Coping strategies used by migrant healthcare workers to support their mental health during COVID-19 in the United Kingdom: a qualitative analysis

Background: The incidence of mental illness has risen since the coronavirus disease 2019 (COVID-19) pandemic. The number of healthcare workers (HCWs) needing mental health support has increased significantly.Objective: This secondary analysis of qualitative data explored the coping strategies of migrant HCWs living in the UK during the COVID-19 pandemic. Our aim was to identify the coping strategies used by migrant HCWs, and how they could be explored post-pandemic as support mechanisms of an increasingly diverse workforce.Method: As part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes among Healthcare workers (UK-REACH), we conducted in-depth semi-structured interviews and focus groups with clinical and non-clinical HCWs across the UK, on Microsoft Teams, from December 2020 to July 2021. We conducted a thematic analysis using Braun and Clarke's framework to explore the lived experiences of HCWs born overseas and living in the UK during the COVID-19 pandemic. The key themes that emerged were described using Lazarus and Folkman's transactional model of stress and coping.Results: The emerging themes include stressors (situation triggering stress), appraisal (situation acknowledged as a source of stress), emotion-focused coping (family and social support and religious beliefs), problem-focused coping (engaging in self-care, seeking and receiving professional support), and coping strategy outcomes. The participants described the short-term benefit of the coping strategies as a shift in focus from COVID-19, which reduced their anxiety and stress levels. However, the long-term impact is unknown.Conclusion: We found that some migrant HCWs struggled with their mental health and used various coping strategies during the pandemic. With an increasingly diverse healthcare workforce, it will be beneficial to explore how coping strategies (family and social support networks, religion, self-care, and professional support) could be used in the future and how occupational policies and infrastructure can be adapted to support these communities.

Real-world predictors of severe psychological distress during the COVID-19 pandemic in Japan: Insights from a large-scale internet-based cohort study

AIM

The COVID-19 pandemic has had negative physical and psychological impacts worldwide. However, there has been a lack of real-world evidence concerning the predictors of severe psychological distress (SPD) among the general population in Japan during the COVID-19 pandemic. The aim of this study was to examine predictors of SPD during the COVID-19 pandemic.

METHODS

We investigated the predictors of new-onset SPD in the general Japanese population using data from a large-scale internet-based cohort study.

RESULTS

We included 16 489 study participants (age range = 16-81, mean age = 52.7, percentage of male = 50%) in the analysis. Over the course of 1 year from baseline, the estimated proportion of participants who experienced SPD was 5.2% with inverse probability weighting. The predictors of SPD included younger age, being never married, being unemployed, having a higher education background, scoring higher on the Fear of Coronavirus-19 Scale, experiencing more adverse childhood experiences, reporting poorer subjective health status, and COVID-19 with oxygen therapy. Our internet-based survey of the Japanese population may have selection bias, limiting the generalizability to other countries and cultures.

CONCLUSION

This study revealed that being afflicted with COVID-19 requiring oxygen therapy is the most significant predictor of SPD. In addition, we found that vulnerability to social isolation, such as never being unmarried, anxiety toward COVID-19, and susceptibility to stress, are predictors of the emergence of SPD. Therefore, the implementation of online support systems and ensuring access to accurate information may protect against SPD during the COVID-19 pandemic in Japan.

Psychological distress among healthcare providers during the COVID-19 pandemic: patterns over time

BACKGROUND

COVID-19 added to healthcare provider (HCP) distress, but patterns of change remain unclear. This study sought to determine if and how emotional distress varied among HCP between March 28, 2021 and December 1, 2023.

METHODS

This longitudinal study was embedded within the 42-month prospective COVID-19 Cohort Study that recruited HCP from four Canadian provinces. Information was collected at enrollment, from annual exposure surveys, and vaccination and illness surveys. The 10-item Kessler Psychological Distress Scale (K10) was completed approximately every six months after March 28, 2021. Linear mixed effects models, specifically random intercept models, were generated to determine the impact of time on emotional distress while accounting for demographic and work-related factors.

RESULTS

Between 2021 and 2023, the mean K10 score fell by 3.1 points, indicating decreased distress, but scores increased during periods of high levels of mitigation strategies against transmission of SARS-CoV-2, during winter months, and if taking antidepression, anti-anxiety or anti-insomnia medications. K10 scores were significantly lower for HCP who were male, older, had more children in their household, experienced prior COVID-19 illness(es), and for non-physician but regulated HCP versus nurses. A sensitivity analysis that included only those who had submitted at least five K10 surveys consisted of the factors in the full model excluding previous COVID-19 illness, occupation, and season, after adjustment. Models were also created for K10 anxiety and depression subscales.

CONCLUSIONS

K10 scores decreased as the COVID-19 pandemic continued but increased during periods of high mitigation and the winter months. Personal and work-place factors also impacted HCP distress scores. Further research into best practices in distress identification and remediation is warranted to ensure future public health disasters are met with healthcare systems that are able to buffer HCP against short- and long-term mental health issues.

The aftermath of COVID-19: generalized anxiety disorder and burnout among radiology practitioners and interns in Saudi Arabia

Background

The coronavirus disease (COVID-19) pandemic has presented unprecedented stressors and difficulties for healthcare professionals. This study explored the prevalence of generalized anxiety disorders and burnout among radiology practitioners and interns in various hospitals in Saudi Arabia after the end of the COVID-19 global public health emergency.

Methods

A cross-sectional survey of 230 radiology practitioners and interns was conducted between October and November 2023. This study utilized the Generalized Anxiety Disorder 7-item (GAD-7) scale and Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP) 22-item questionnaire, employing a non-probability convenience sampling method. The average scores of the individual components constituting the GAD-7 scale and each burnout scale were calculated, and statistical analyses were conducted using the Mann-Whitney U and Kruskal-Wallis H nonparametric tests.

Results

Of 382 radiology practitioners and interns, 230 (60.2%) responded to the survey. Notably, 42.6% of the participants reported experiencing GAD. Regarding burnout, 82.3% were at moderate-to-high risk for emotional exhaustion, 93.5% for depersonalization, and 52.1% for personal achievement. The 31-40 years age group showed significantly higher burnout rates (p = 0.001) compared with the other age groups. Those with more than three years of experience had notably higher emotional exhaustion scores (p = 0.002) and a nearly significant increase in depersonalization scores (p = 0.051) than those with less experience.

Discussion

Our study revealed that 42.6% of radiology practitioners and interns experienced GAD, with the majority facing significant burnout. Furthermore, our research indicates a decline in GAD levels among radiology practitioners and interns compared with the peak COVID-19 pandemic period. It also showed a significant increase in both the incidence and severity of burnout, surpassing pre-pandemic levels in a comparable cohort. These findings emphasize the pressing challenges of GAD and burnout among healthcare workers, especially radiology professionals.

Depression, anxiety and coping mechanisms among mental healthcare practitioners during COVID-19

Background

The coronavirus disease 2019 (COVID-19) pandemic has placed the psychological functioning of mental healthcare practitioners under severe strain. Coping methods may affect mental health outcomes.

Aim

The study examined the relationship between depression, anxiety, stress, and coping styles utilised by mental healthcare practitioners during the COVID-19 pandemic.

Setting

Three private and one public mental healthcare facility in Bloemfontein, South Africa.

Methods

Respondents completed the Depression, Anxiety and Stress Scale (DASS-21) and Brief Coping Orientation to Problems Experienced (Brief-COPE) inventories. An ordinal regression model was used to assess the relationship between coping styles, anxiety and depression.

Results

A total of 212 practitioners were included in the analysis. According to DASS-21 measures, approximately 41% and 28% of respondents had moderate to severe depressive and anxiety symptoms, respectively, with the highest prevalence among younger female respondents and nurses. The association between stress severity, anxiety and depression was significant. Avoidant coping methods and two approach coping strategies (planning and acceptance) were associated with depression and anxiety. Anxiety was linked to an increased likelihood of transitioning to higher avoidant categories, while participants with depression were less likely to move to higher avoidant or approach categories.

Conclusion

Mental healthcare practitioners, especially nurses, experienced significant COVID-19-related psychological distress during the pandemic. Avoidant coping mechanisms may increase the risk of poor mental health outcomes.

Contribution

This study added data on the mental health effects of COVID-19 on mental healthcare practitioners, as well as psychological methods used to cope during the pandemic.

Factors Associated with Stress among Healthcare Personnel after COVID-19 in Northeast Thailand: A Cross-sectional Study

Background

The coronavirus disease (COVID-19) has affected people psychologically worldwide, particularly healthcare personnel. Even though the COVID-19 pandemic situation has eased, healthcare personnel must still perform their duties, which has resulted in psychological impacts, particularly stress.

Objectives

This study aimed to examine the risk factors associated with stress among healthcare personnel post-COVID-19 pandemic in northeast Thailand.

Methods

A cross-sectional analytic design was conducted from January to April 2023. One thousand and three hundred healthcare workers were selected from primary, secondary, and tertiary hospitals across 16 districts within Chaiyaphum province. The questionnaires were used to collect data, and the stress test 5 (ST-5) questionnaire was used to investigate stress among healthcare personnel.

Results

The overall stress rate for healthcare workers was 15.47%, including very severe (8.85%) and severe (6.62%). The factors associated with stress consisted of work position, environment of work, personal life such as education level and income, and responsibility for taking care of family members, in addition to experiencing quarantine from COVID-19 were more likely to have a high risk of stress problems among healthcare workers.

Conclusion

This result highlighted that the mental health of personnel should be in critical situations, and those found severely afflicted should undergo professional care. To prevent psychological issues, particularly stress, health organizations should be concerned with strong organizational management, which includes supporting bonuses and providing high-quality personal protective equipment (PPE) to healthcare staff.

Psychological mediators between risk perception and psychological wellbeing in emergency healthcare workers

Healthcare workers are subjected to numerous work-related stress factors, which have negative consequences on their physical and mental health, making them a vulnerable group. The recent pandemic caused by the new coronavirus created a high demand for attention from healthcare workers, which put their mental health at risk. This study aimed to test a mediation model in which resilience and the satisfaction of psychological needs play a mediating role in risk perception, the attitude toward the management carried out by the administration, emotional intelligence on psychological wellbeing, and depressive symptoms of frontline professionals. The sample consisted of 405 healthcare professionals aged between 22 and 65 years, belonging to critical care units in southern Spain. Linear correlation and mediation analyses were performed. The results showed that psychological wellbeing had positive correlations with resilience and negative correlations with the discrepancy in the satisfaction of psychological needs. Depressive symptoms had negative correlations with resilience and positive correlations with the satisfaction of psychological needs. To explore these results further, a mediation analysis was conducted, and a large set of significant indirect effects was found.

The Role of Ombuds in Graduate Medical Education: Fostering Wellness and Psychological Safety

The authors propose an educational innovation in graduate medical education, the creation of an Education Ombudsperson. Although this role has been implemented for faculty and students within the medical field, it has not been described in residency programs. The Ombudsperson for house staff is distinct from institutional or programmatic leadership. His or her primary role within a department is to foster psychological safety, wellness, advocacy, and professionalism in residency or fellowship programs. This manuscript describes the process for selection, visitor consultation, escalation pathways, and examples of concerns addressed proactively. The Ombudsperson can complement the role of the Program Director, Chair, and Designated Institutional Official in a collaborative model that addresses challenges in the learning environment.

Influence of nurse work environment and psychological distress on resignation from hospitals: a prospective study

With the global nurse shortage, identifying nurse work environments that allow nurses to continue working is a common concern worldwide. This study examined whether a better nurse work environment (1) is associated with reducing nurses' psychological distress; (2) reduces nurse resignations; (3) weakens the influence of psychological distress on their resignation through interaction effect; and (4) whether psychological distress increases nurse turnover. Multilevel logistic regression analyses were performed using data obtained in 2014 from 2,123 staff nurses from a prospective longitudinal survey project of Japanese hospitals. The nurse work environment was measured by the Practice Environment Scale of the Nursing Work Index (PES-NWI) consisting of five subscales and a composite, and psychological distress by K6. All the PES-NWI subscales and composite (ORs 0.679-0.834) were related to K6, significantly. Regarding nurse turnover, K6 had a consistent effect (ORs 1.834-1.937), and only subscale 2 of the PES-NWI had a direct effect (OR 0.754), but there was no effect due to the interaction term. That is, (1) and (4) were validated, (2) was partly validated, but (3) was not. As better work environment reduces K6 and a lower K6 decreases nurses' resignation, high-level hospital managers need to continue improving the nurse work environment.

A Comparison of Psychological Distress and Coping Styles among Physicians and Nurses in a COVID-19 Referral Hospital in Manila: A Cross-sectional Study

Objectives

This study aimed to compare the levels of depression, anxiety, and stress, and the coping styles among physicians and nurses in a COVID-19 referral hospital in Manila from June to July 2020.

Methods

A cross-sectional study among medical residents and nurses selected via convenience sampling was employed. Data were obtained through COVID Stressors and Stress Reduction Questionnaire, Depression, Anxiety, and Stress Scale-21, and Filipino Coping Strategies Scale. Descriptive and inferential analysis of data was done.

Results

Five hundred seventy-one (571) healthcare workers (total population: 1,650 nurses and physicians) participated in the study, representing 81.6% of the computed sample size of 700 respondents. Among the participants, 60.6 %, 69.0%, 48.9% reported symptoms of depression, anxiety, and stress, respectively. Nineteen percent (19%) of nurses reported severe to extremely severe depression, and 42.0% reported severe to extremely severe anxiety. In contrast, 30.8% of residents reported severe to extremely severe depression, and 28.4% conveyed severe to extremely severe anxiety. There was no association observed between perceived levels of stress between the two healthcare professions.There were more mildly to extremely severe anxious healthcare workers in the COVID areas (74.6%) compared to the non-COVID areas (61.2%). Differences in coping styles were observed among the participants' clinico-demographic characteristics. Top healthcare worker stressors include being negligent and endangering co-workers (88.6%), frequent modification of infection control procedures (87.0%), and discomfort from protective equipment (81.4%). Top stress-reducing factors include provision of food and vitamins (86.7%), sufficient rest (84.2%), and support from higher-ranking colleagues (73.7%).

Conclusion

This study has shown that more than half of the healthcare workers reported mild to extreme levels of depression and anxiety, while a little less than half reported mild to extreme levels of stress. The development and implementation of hospital interventions and programs based on the sources of distress and stress-reducing factors is recommended to mitigate the impact of sustained psychological distress on mental health and physical wellbeing of hospital healthcare workers.

Well-Being Outcomes of Health Care Workers After a 5-Hour Continuing Education Intervention: The WELL-B Randomized Clinical Trial

Importance

Compromised well-being in health care workers (HCWs) is detrimental to the workforce, organizations, and patients.

Objective

To test the effectiveness of Well-Being Essentials for Learning Life-Balance (WELL-B), a web-based continuing education program to deliver brief, evidence-based, reflective, psychological interventions to improve 4 dimensions of HCW well-being (ie, emotional exhaustion, emotional thriving, emotional recovery, and work-life integration).

Design, Setting, and Participants

A randomized clinical trial (RCT) of US inpatient and outpatient HCWs randomized 1:1 was conducted from January 3 through May 31, 2023, using a web-based intervention. Cohort 1 received 5 hours of WELL-B over 8 days; cohort 2 acted as the control group and received WELL-B after the end of the RCT. Eligibility criteria were US HCWs aged 18 years or older, including clinical (physician, nurse, and respiratory therapist) and nonclinical (administrative, information technology, and finance) roles.

Interventions

Continuing education sessions exposed participants to positive psychology interventions (gratitude letter, work-life integration, self-compassion and cultivating awe).

Main Outcomes and Measures

The primary outcome was emotional exhaustion on day 8; secondary outcomes included emotional thriving, emotional recovery, and work-life integration. All outcomes were measured using psychometrically valid scales previously reported in well-being RCTs and were assessed on days 1 and 8 (primary end point). Differences in outcome measures between the WELL-B intervention group and controls were assessed using t tests. Baseline-adjusted multiple linear regression models were evaluated to examine the association between the WELL-B intervention and the outcome measures after adjusting for additional covariates (sex, race and ethnicity, age, HCW role, and discipline). Intention-to-treat analysis was performed.

Results

The cohorts were similar at baseline, mostly female (528 [89%]) and nurses (177 [30%]). A total of 643 respondents participated in the study. In cohort 1, 331 participants initiated WELL-B, and 262 (71%) completed the day 8 follow-up; in cohort 2, 312 participants initiated WELL-B and 291 (77%) completed the day 8 follow-up. Compared with the control cohort, WELL-B significantly improved emotional exhaustion (estimate: -9.0; 95% CI, -13.1 to -4.9; P < .001), emotional thriving (estimate: 6.6; 95% CI, 3.2-10.0; P < .001), emotional recovery (estimate: 5.5; 95% CI, 2.0-9.0; P = .002), and work-life integration (estimate: -5.0; 95% CI, -8.2 to -1.9; P = .002). After adjusting for baseline outcome measures, sex, race and ethnicity, age, HCW role, and discipline, the linear regression model showed WELL-B improved day 8 emotional exhaustion (estimate: -9.6; 95% CI, -12.5 to -6.6; P < .001) compared with the control group. Favorable impressions of WELL-B were reported by more than 90% of the participants.

Conclusions and Relevance

In this RCT, brief well-being activities delivered during continuing education sessions improved short-term HCW emotional exhaustion, emotional thriving, emotional recovery, and work-life integration, with and without adjusting for covariates. Health care worker impressions of WELL-B were positive. These findings suggest that WELL-B is a beneficial intervention.

Trial Registration

ClinicalTrials.gov Identifier: NCT05636072.

Age and Hair Cortisol Levels as Predictors of SARS-CoV-2 Infection

Chronic psychosocial stress is known to adversely impact immune function. During the SARS-CoV-2 pandemic, occupational stress among workers in healthcare was at an unprecedented level due to risks of infection and work demands. We performed a nested case-control study to investigate the associations between chronic stress and the risks of contracting SARS-CoV-2. We collected 3 cm of hair from employees at an academic medical center who tested positive for SARS-CoV-2 (N = 49) and controls who tested negative (N = 49), matched for age, race, and sex. The diagnosis of SARS-CoV-2 was based on polymerase chain reaction or antibody tests. As a proxy for chronic stress, we segmented hair into 1 cm sections each representing one month and measured cortisol levels using a cortisol enzyme-linked immunosorbent assay. For cases, we used cortisol concentrations measured in hair segments from the month prior to a positive SARS-CoV-2 test, and for controls, we used time-matched hair segments. We fitted conditional logistic regression models adjusted for sex, age, race, body mass index, and healthcare worker status, and stratified models by older vs. younger age (cutoff = 41 years). African Americans had higher hair cortisol levels relative to participants of other races and ethnicities. In adjusted models, higher hair cortisol concentrations were associated with an increased odds of infection with SARS-CoV-2 (OR = 1.84; CI: 1.10-3.07) among older, but not younger, participants. The results suggest that psychosocial stress may be a risk factor for SARS-CoV-2 infection; stress management may be an important part of a comprehensive approach to protect against SARS-CoV-2 infection.

Perinatal meaning-making and meaning-focused coping in the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic caused unprecedented levels of stress amongst pregnant women and new mothers. The current qualitative study explored the ways in which perinatal women made meaning of their experiences during the COVID-19 pandemic.

METHODS

Data came from a parent study in which 54 perinatal (pregnant and postpartum) women in the United States completed semi-structured interviews from October 2021 to January 2022 describing their experiences during the COVID-19 pandemic. The data was interpreted using a hermeneutic, phenomenological approach to delve deeply into the concept of meaning-making.

RESULTS

Despite high levels of stress and challenging circumstances, participants reported engaging in meaning-making through finding connection, focusing on gratitude, and identifying openings for change. Unique forms of meaning-making amongst this population include a sense of connection to women throughout history, connection to their baby, and recognition of the need for systemic change for perinatal women.

CONCLUSIONS

Perinatal women coped with the stress of the COVID-19 pandemic by making meaning from their experiences. Future research should further explore the importance of these aspects of meaning-making to perinatal women and implement these findings to adapt prevention and treatment approaches to address perinatal stress, especially during times of crisis.

Interprofessional Comparisons in Patient Safety Culture at a Teaching Hospital Before and During the COVID-19 Pandemic

The COVID-19 pandemic has posed unprecedented challenges with its impact on patient safety culture and staff well-being. This study was to identify potential changes in safety culture among health care workers from before to during the COVID-19 pandemic, and to determine the differences across occupational groups. The Safety Attitudes Questionnaire (SAQ) was administered electronically in both English and Malay languages using the Google Forms platform in 2018 and was repeated in 2021, during the COVID-19 pandemic. Comparisons were made between 2018 and 2021 to determine changes in patient safety culture for the overall staff population and by occupational groups. A total of 3175 health care workers completed the questionnaire in 2021. Overall, a comparable percentage agreement was found for all SAQ domains in 2018 and 2021 with visible improvements for doctors and support staff. Safety Attitudes Questionnaire domain scores differed in teamwork, safety climate, perception of hospital management, and working condition domains across occupational groups. Self-isolation and COVID-19 were associated with poorer SAQ domain scores, while redeployment was associated with improvements in SAQ domain scores. Interventions targeting areas of weakness as well as utilizing positive experiences such as redeployment should be explored to enhance patient safety in hospitals settings postpandemic.

Burnout and psychological distress among Hispanic nurses across Illinois and New York hospitals: Implications for structural and person-centered solutions

BACKGROUND

Despite high levels of burnout and psychological distress among nurses, few studies have evaluated these outcomes among Hispanic nurses.

PURPOSE

To evaluate the differences in job-related and psychological well-being outcomes for Hispanic and non-Hispanic White nurses and the association of nurse work environments.

METHODS

Cross-sectional analysis of the 2021 RN4CAST-New York-Illinois nurse survey. Multilevel logistic regression models examined the association between nurse ethnicity and job-related outcomes and psychological well-being.

DISCUSSION

Our sample included 798 (10.7%) Hispanic and 6,642 (89.3%) non-Hispanic White nurses in 249 hospitals. In unadjusted models, Hispanic ethnicity was associated with higher odds of burnout (odds ratio (OR) 1.21, 95% confidence interval (CI): 1.03-1.42), which diminished when considering the work environment (OR 1.16, 95% CI: 1.01-1.35) and nurse characteristics (i.e., age) (OR 1.01, 95% CI: 0.83-1.21).

CONCLUSION

Equity-driven solutions to support the well-being of Hispanic nurses should consider a focus on the needs of young Hispanic nurses and include increased support in work environments.

Professional, educational and psychosocial impacts of the COVID-19 pandemic on pediatricians

OBJECTIVES

COVID-19 infection is not limited to medical aspects, but may have significant negative impacts on education, tourism, the economy as well as sociocultural, ethical, and legal aspects. We aimed to assess the multidimensional impact of the COVID-19 pandemic on pediatricians by examining their COVID-19 infection, domestic life and quarantine, as well as work patterns, educational activities, and psychosocial impact.

METHODS

An online survey consisted of seven sections and 68 questions was prepared through 'Google Forms.' The survey was sent via e-mail to physicians who are members of the National Pediatric Association of Turkey.

RESULTS

The pandemic has affected pediatricians working in our country in a multifaceted aspect. They experienced significant anxiety/depression/stress, 8% of them felt it at a pathological level and were receiving treatment, and women and young pediatricians were more vulnerable to the pandemic. The more adequately informed about the disease, the more prepared for COVID-19 and lower levels of psychological distress, which emphasizes the importance of education and institutional continuing support. Our study showed that academic education was seriously disrupted and the satisfaction rate with virtual education was low.

CONCLUSION

Although COVID-19 has less impact today, it has taught us that it is necessary to be ready for new pandemics in the future. The required measures should be taken urgently and effectively healthcare professionals should follow a rational and applicable disaster plan.

Impact of the COVID-19-pandemic and perception of self-efficacy on the mental health of out-of-hospital emergency healthcare professionals by modality of care

OBJECTIVE

To analyse the influence of the COVID-19 pandemic and the perception of self-efficacy on the health professionals of the Spanish out-of-hospital emergency services.

DESIGN

Observational, cross-sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February-30 April, 2021).

METHODS

The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self-efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self-efficacy on mental health.

RESULTS

The means of the sample for stress, anxiety, depression and self-efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self-efficacy. Self-efficacy had a direct effect on the mental health for working in patient care.

CONCLUSIONS

Healthcare workers showed moderate stress, severe anxiety, mild depression and good self-efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self-efficacy is a determining factor of mental health in the direct care modality.

IMPLICATIONS

The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out-of-hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self-efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk.

REPORTING METHOD

We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros - ASISA Foundation (Spain). PATIENT OR PUBLIC CONTRIBUTION: 'No patient or public involvement'.

Modifiable work stress factors and psychological health risk among nurses working within 13 countries

INTRODUCTION

Nurses are identified as having higher work stress and poor mental health risk among health care workforce globally. It remains unclear which modifiable stress factors pose the greatest risk for poor psychological health among nursing workforce and needed to inform targeted practice and policy change. To determine which occupation-related or personal stress factors precipitate higher risk for burnout, depression, anxiety, job satisfaction or intention to leave one's position among nurses globally.

DESIGN

A cross-sectional anonymous survey was administered via email using a snowball recruitment strategy.

METHODS

Academic researchers and clinical industry leaders across 3 global regions collaborated to generate an email listserv of professional nursing contacts for survey distribution. The survey included valid and reliable measures to scale stress factors (Work Stress Questionnaire), and screen for burnout (single item), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2), resilience (Brief Resilience Scale) and intention to leave one's job (single item). We used logistic regression, first unadjusted and then adjusted for personal and professional characteristics, to determine associations between stress factors and psychological health risk.

RESULTS

The final sample consisted of responses from 2864 nurses working across 13 countries. Most respondents reported working as a clinical nurse in the Philippines (n = 2275), United States (n = 424) and Saudi Arabia (n = 104). One third of nursing respondents endorsed high burnout and intention to leave their job. Those reporting work conflict had significantly higher odds of burnout (odds ratio 3.18; 95% CI 2.22-4.54) and three times more likely to screen positive for depression (odds ratio 3.02; 95% CI 1.36-6.72) and anxiety (odds ratio 2.92; 95% CI 1.57-5.43). Those endorsing difficulty sleeping were 15 times more likely to screen positive for depression (odds ratio 15.63; 95% CI 2.09-117.06). Lack of social support was significantly associated to higher risk for burnout, job dissatisfaction, depression, anxiety, and intention to leave one's position.

CONCLUSIONS

Nurses remain at risk for burnout and poor psychological health stemming from work stress. Factors such as clear workplace goals and assignments, increased engagement, good sleep health and social support may serve as protective factors against suboptimal psychological health, and in-turn poor workforce retention.

CLINICAL RELEVANCE

Nurses reporting conflict in the workplace are three times more likely to screen positive for burnout, depression, and anxiety. Nurses reporting difficulty sleeping are 15 times more likely to screen positive for depression. Several modifiable factors can be targeted to reduce poor psychological health and high workforce turnover among nurses across countries.

Caring through crisis: The professional quality of pediatric nurses during the COVID-19 pandemic

PURPOSE

This study described pediatric nurses' professional quality of life during COVID-19 and explored demographic/clinical practice factors independently associated with compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS).

DESIGN AND METHODS

The Relational Caring Complexity Theory was used. This study employed a cross-sectional, descriptive, correlational design to describe professional quality of life of pediatric nurses (demographic questionnaire and ProQOL 5 measure) working during the COVID-19 pandemic.

RESULTS

From 150 pediatric nurses, the mean scores were CS 40.8 (± 4.8), BO 22.6 (± 4.7), and STS 22.8 (± 5.8). Results of the multiple regression revealed that two variables, deployed to the same unit versus not deployed (β = 2.424, p = .02) and currently practicing in perioperative/ambulation settings versus intensive care (β = -0.272, p = .03), were independently associated with CS. Deployed to the same unit versus not deployed was found to be independently and significantly associated with BO (β = -0.28, p = .005). The number of patients cared for with COVID-19 (β = 0.196, p = .03) was significantly associated with STS.

CONCLUSIONS

While the overall response was positive, these nurses were more likely to experience BO when deployed to the same area (likely a COVID-19 adult unit) and STS as they cared for more patients with COVID-19.

PRACTICE IMPLICATIONS

Leaders should be aware of the impact of caring in times of crisis. Decentralized staffing may help meet emergent needs on a particular shift, but ensuring deployed nurses are well-supported is vital.

Exploring Risk Perception, Mental Health, Mental Fatigue, Stigma, and the Quality of Life among UAE Healthcare Workers during the COVID-19 Pandemic: A National Multicentric Cross-Sectional Study

Globally, the COVID-19 pandemic has presented serious mental health challenges for healthcare professionals. This study investigated the mental health, mental fatigue, quality of life, and stigma of social discrimination among healthcare workers in the United Arab Emirates (UAE) during the COVID-19 pandemic. A correlational, cross-sectional, multi-centric design was employed to collect data from 1383 healthcare workers across various healthcare settings. Participants were recruited using combined cluster and purposive sampling techniques. Standardized questionnaires, including the COVID-19 Pandemic Mental Health Questionnaire (CoPaQ), the Mental Fatigue Scale (MFS), the Social Discrimination Scale-Stigma Subscale (SDS), and the WHO Quality of Life Questionnaire-Brief (WHOQOL-BREF), were administered to assess the study variables. The results indicated significant mental health impacts, with high average scores for post-traumatic stress disorder (PTSD) (9.37 ± 6.74) and positive coping by inner strengths (17.63 ± 5.72). Mental fatigue was prevalent (8.15 ± 8.62), and stigma of social discrimination scored notably (23.83 ± 7.46). Quality of life was the highest in the social domain (65.38 ± 24.58). Significant correlations were observed between mental health subscales, mental fatigue, and quality of life domains. These findings highlight the critical need for targeted mental health support programs, improved social support networks, and personalized interventions to mitigate the mental health challenges faced by healthcare workers. Healthcare organizations can guarantee a resilient workforce that can handle future health crises by giving mental health resources and support systems top priority.

Fear of the unknown: Experience of frontline healthcare workers with coping strategies used to face the COVID 19 pandemic

The COVID 19 pandemic presented various challenges among health care workers, one of them being the impact it has on mental health. The psychological problems such as anxiety, depression, insomnia and stress, all consequences of the pandemic cause psychopathological outcomes reverberating negatively on the emotional well-being of health care workers. This study aimed to explore the experience of frontline healthcare workers (HCWs) during the COVID-19 pandemic in a middle-income country in Latin America and to identify the coping mechanisms they used to face stressful situations during this time. A qualitative study based on an interpretative paradigm was conducted allowing to examine complex, ambiguous and emotionally loaded topics to explore in detail the experience of frontline HCWs during the COVID-19 pandemic. Through convenience sampling eleven frontline HCWs were recruited to participate in semi-structured interviews. An inductive analysis was done with four pre-established categories: the experience of HCWs during the attention of COVID-19 patients, the experience during their own infection, the experience during the work reintegration and the coping mechanisms used. Our results show that fear and uncertainty predominated throughout the attention of COVID-19 patients. Participants used both coping strategies based on problem-solving efforts, such as routine changes, and emotional management efforts, like social support or psychological counselling. The choice of coping strategies was influenced by their personal beliefs, past emotional experiences, and prior medical formation. These findings provide public and private institutions insight for creating effective policies, based on the HCWs' preferences, to promote their psychological well-being.

Knowledge graph analysis of research on nurses' psychological resilience

In recent years, a surge in literature on psychological nurse resilience, largely driven by the COVID-19 pandemic, has prompted the need for a comprehensive understanding of the current state and emerging trends through reliable methodologies. The purpose of this study was to analyzes the research on nurses' psychological resilience through bibliometrics to understand the current situation, foundation, and hotspot of this research field. The Web of Science core collection database was used as the search source, and CiteSpace analysis software was employed to conduct bibliometric analysis on authors, countries, institutions, keywords, and references of nurse psychological resilience-related literature published from the establishment of the database to July 11, 2023. A total of 1060 articles were included in the final analysis. The study of nurses' psychological resilience had been highly popular and had formed a new and important research basis in recent years. China and the United States led in the number of publications and centrality respectively, with Monash Univ and Curtin Univ as top institutions in the number of publications and centrality respectively. The authors with the highest number of publications and the most frequently cited were Rees and Connor Km respectively. The most frequently cited article was Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019 published by Lai, JB, etc. Important key keywords included mental health, resilience, stress, health, outbreak, acute respiratory syndrome, etc. The research topics in this field mainly focused on 4 aspects, including nurses' mental health, post-traumatic stress disorder, job burnout and job satisfaction, and intervention research on psychological resilience. The results of bibliometric analysis provide direct support for future scholars to explore and determine the research direction, hot spots, and find authoritative authors and institutions. At the moment, nurses' psychological resilience research has established a new foundation, primarily focusing on COVID-19-related topics. Given the potential prolonged coexistence of COVID-19 and other diseases, the main research focus remains innovating and validating effective psychological resilience intervention strategies for nurses' overall well-being.

A visualized and bibliometric analysis of nursing research during the COVID-19 pandemic

BACKGROUND

The global spread of Coronavirus disease 2019 (COVID-19) has been increasing since December 2019. A total of 8460 publications were obtained from the Web of Science Core Collection from 2019 to 2023, providing insights into the progress of nursing research throughout the COVID-19 pandemic.

METHODS

Bibliometric analysis was conducted on these articles using CiteSpace. The analysis focused on examining the distribution of these publications in terms of space and time, distribution of authors, subject categories, distribution of topics, and cited references.

RESULTS

These results may be explained from 3 perspectives. Initially, the number of yearly publications on nursing research consistently increased during the COVID-19 pandemic. Furthermore, a co-occurrence analysis of the countries and the authors revealed that certain countries, including the United States, China, and England, have successfully implemented organized and standardized nursing models. These countries also have well-developed and established nursing research systems. Notably, academic communities in specific regions, such as the team led by MD Stefan Gravenstein, Mor Vincent, and White Elizabeth at Brown University in the United States, have emerged as leaders in this field. Furthermore, examining the papers' subject categories and topic distribution indicate that nursing during the COVID-19 pandemic has been predominantly interdisciplinary, encompassing various disciplines such as clinical medicine, essential medicine, psychology, public health management, and even telematics science.

CONCLUSION SUBSECTIONGS

Our study provided valuable insights into acquiring knowledge on nursing research during the COVID-19 pandemic, pinpointed possible partners for researchers interested in nursing, and uncovered prevalent research patterns and popular subjects.

Incidence of effort-reward imbalance among nurses: a systematic review and meta-analysis

Introduction

To systematically evaluate the incidence of effort-reward imbalance among nurses.

Method

PubMed, Web of Science, Embase, CNKI, WanFang Data, and VIP databases were searched to collect studies on the incidence of effort-reward imbalance among nurses. The search timeframe was from database construction to December 2023. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. The meta-analysis was performed using Stata 17.1 software.

Results

A total of 60 studies, including 79,644 participants, were included. The prevalence of effort-reward imbalance among nurses was 52.3% (95% CI: 44.9-59.7%). In terms of time, the incidence of effort-reward imbalance among nurses before 2010 (26.6, 95%CI: 6.8-46.4%) and in 2010-2015 (42.4, 95%CI: 32.1-52.8%), 2016-2020 (60.2, 95%CI: 49.6-70.7%), and 2021-2023 (65.0, 95%CI: 51.5-78.4%) continued to increase. Geographically, Asia (57.4, 95%CI: 51.8-63.1%) nurses had a relatively higher prevalence of effort-reward imbalance. In terms of department, the incidence of effort-reward imbalance among nurses was relatively higher in operating rooms (71.8, 95%CI: 64.5-79.0%), ICU (64.6, 95%CI: 27.7-100.0%), emergency (68.7, 95%CI: 62.9-74.5%), and pediatrics (65.8, 95%CI: 32.2-99.3%).

Discussion

The prevalence of nurse effort-reward imbalance is high, and there are differences in its prevalence across time, geography, department. Hospital administrators should actively take measures to effectively prevent and reduce the effort-reward imbalance for nurses, especially for nurses in Asia, operating rooms, emergency pediatrics and ICU departments.

Systematic review registration

PROSPERO (CRD42023452428).

Turkish Validity and Reliability of the Self-Applied Acute Stress Scale (EASE) for Healthcare Providers

Background

Acute stress induced by a sudden burden of emergency conditions and traumatic events, such as wars, earthquakes, situations requiring isolation, pandemics, and disasters, can have pathological consequences on healthcare providers (HCPs) if not diagnosed early. Therefore, the objective of this investigation is to culturally validate the self-administered Acute Stress Scale (EASE) in the Turkish context.

Method

The study consisted of 127 HCPs working with COVID-19 patients in services and clinics during the pandemic. The individual information form and EASE were used for data collection. Confirmatory factor analysis (CFA) was used to test the factor structure of the EASE.

Results

All the statistical procedures showed that the Turkish version of the EASE scale is a valid and reliable measurement tool for the Turkish culture. The content validity index (CVI = 0.84), intraclass correlation coefficient (ICC = 0.912), and model fit indices (χ 2/df = 1.826, RMSEA = 0.083, CFI = 0.947, NFI = 0.893, GFI = 0.905) explained two-factor structure.

Conclusion

Institutional approaches are necessary to support the psychological needs of HCPs. The Turkish version of the EASE scale demonstrated adequate reliability and validity properties. The scale could provide appropriate support during the early stages of acute stress among HCPs related to needs during isolation conditions or unexpected emergencies such as recent pandemics and epidemics in the future.

Our New Normal: Pediatric Nurse Residents' Experiences with Transition to Practice during the COVID-19 Pandemic

This phenomenological qualitative study examined the lived experience of pediatric nurse residents' transition to practice during the COVID-19 pandemic. The purposive sample included nine pediatric nurses, participating in a nurse residency program, who entered the nursing profession during the first year of the pandemic. The setting was a free-standing, Magnet-recognized, pediatric academic medical center in the Northeastern U.S. Individual interviews were audio recorded and transcribed. Narratives were analyzed using a hermeneutic phenomenological approach. Five themes emerged from the data: Our New Normal; The Rules Keep Changing; I'm Not Ready for This (transition to practice); The Toll of COVID; and Shattered Family-Centered Care. Sub-themes emerged in The Toll of COVID theme: COVID and the Nursing Care Environment, Emotional Toll of COVID, Burnout: A Universal Truth, and The Pandemic within the Pandemic. The nurse residents' narratives uncovered the essence of their uncertainty, sorrow, growth, and resilience. Through the eyes of pediatric nurse residents, this study illuminated the experiences of these novices as they entered the nursing profession amid a pandemic.