Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: A systematic review and meta-analysis

Unveiling nurses' perspectives on decent work: A qualitative exploration

AIM

This study explores nurses' perspectives on the concept of "decent work" and the factors influencing their viewpoints.

DESIGN

This qualitative study employed a conventional content analysis approach using face-to-face interviews.

METHODS

In-depth interviews were conducted with 20 registered nurses at two tertiary hospitals in Hangzhou, China, from October to November 2023.

FINDINGS

Decent work for nurses refers to their engagement in a profession within a secure, fair, and friendly practice environment where they could receive respect, support, reasonable compensation, social security, and opportunities for career development, all of which could enable nurses to recognize their intrinsic values and achieve a state of professional and personal fulfillment. Key factors that influence decent work for nurses include the work environment, societal perceptions, and individual characteristics.

CONCLUSIONS

The concept of decent work holds paramount importance for nurses, necessitating collaborative efforts at the individual, family, institutional, and societal levels to promote the professional dignity of nurses and enhance the quality of nursing care.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Policymakers should establish regional minimum wage standards for nurses, promote flexible scheduling, and support professional development through subsidized training programs. Additionally, national media campaigns and comprehensive mental health support can enhance the public image and resilience of nurses, respectively, improving their decent work perception.

Prevalence of sleep disturbances among intensive care nurses: A systematic review and meta-analysis

BACKGROUND

Demanding intensive care unit (ICU) work environments may lead to sleep disturbances in nurses, impacting their health and potentially patient safety. Yet, the prevalence remains unclear around the world.

AIM

To quantify the prevalence of sleep disturbances in intensive care nurses.

STUDY DESIGN

Systematic review and meta-analysis. A database search was conducted in Embase, PubMed, Web of Science, Scopus and CINAHL from their inception to April 2024 for relevant studies. Data from observational studies (cross-sectional or cohort) that reported the prevalence of sleep disturbances, assessed using the Pittsburgh Sleep Quality Index (PSQI > 5), pooled in random-effects meta-analyses. Subgroup analyses were used to investigate variations in the prevalence estimates in terms of available variables. A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant protocol was registered in PROSPERO (CRD42023476428).

RESULTS

In total, 24 articles were included in this study published from 1996 to 2023. Included studies were from 15 unique countries. Almost all of the studies were descriptive cross-sectional studies (n = 22; 91.7%). The included studies encompassed a range of intensive care nurses, from 42 to 605, involving a total of 3499 intensive care nurses. The reported proportion of intensive care nurses with sleep disturbances ranged from 20.0% to 100.0%, with a median of 76.7% (interquartile range: 62.9-85.7). The pooled prevalence of sleep disturbances in intensive care nurses was 75.1% (95% confidence interval: 37.2-53.1; 95% prediction interval: 30.5-95.4).

CONCLUSIONS

Sleep disturbance is a common issue in intensive care nurses. The study results highlight the importance of implementing effective interventions as early as possible to improve ICU sleep quality.

RELEVANCE TO CLINICAL PRACTICE

High prevalence of sleep disturbances among intensive care nurses necessitates global interventions. Gender-neutral approaches that acknowledge comparable risks and stable prevalence over time require long-term strategies. Raising awareness through programmes is vital for implementing evidence-based interventions to promote sleep health in intensive care nurses.

Risk factors of anxiety, depression, stress, job burnout, and characteristics of sleep disorders in critical care nurses: An observational study

AIM/OBJECTIVE

The aim of this study was to determine risk factors and associations between anxiety, depression, stress, and job burnout and describe sleep disorders in critical care nurses.

SETTING

Data were collected in six intensive care units.

METHODS

A descriptive cross-sectional design was used. Multivariate and univariate regressions were used to determine significant risk factors. Significance levels were established at p <0.05. We use Depression Anxiety Stress Scales to determine anxiety, depression, and stress. Work burnout was detected using the Maslach Burnout Inventory scale, and sleep quality was determined by the Pittsburgh Sleep Quality Index.

RESULTS

A total of 140 critical care nurses were included. The female gender was associated with high levels of anxiety (odds ratio [OR] = 3.03; 95% confidence interval [CI] = [1.12-8.23]; p = 0.029), depression (OR = 10.55; 95% CI = [2.17-51.19]; p = 0.003), and stress (OR = 2.87; 95% CI = [1.02-8.07]; p = 0.045). Multivariate regression showed that critical care nurses with intention of leaving were exposed to high levels of anxiety (OR = 3.65; 95% CI = [1.40-9.53]; p = 0.008), depression (OR = 6.79; 95% CI = [2.01-22.95]; p = 0.002), stress [OR = 4.13; 95% CI = [1.49-11.45]; p = 0.006), and burnout (OR = 4.15; 95% CI = [1.63-10.56]; p = 0.003). Sleep quality is influenced by high latency, low duration, the use of medications, and daytime dysfunction.

CONCLUSION

Females were exposed to a higher risk of developing mental health problems such as anxiety, depression, and stress than men. The intention to leave was an independent predictor of anxiety, depression, and stress. Characteristics such as high sleep latency, low duration, use of medications, and daytime dysfunction have a negative impact on sleep quality. Early detection of mental health would allow nursing managers to implement nonpharmacological preventive interventions to improve well-being at work.

An umbrella review and meta-analysis of 87 meta-analyses examining healthcare workers' mental health during the COVID-19 pandemic

During the COVID-19 pandemic, healthcare workers (HCWs) experienced several changes in their work (e.g., longer hours, new policies) that affected their mental health. In this study, an umbrella review and meta-analysis of meta-analyses was conducted to examine the prevalence of various mental health problems experienced by HCWs during the COVID-19 pandemic. We conducted a systematic review searching PubMed, EMBASE, PsycINFO, Cochrane Library, and Scopus databases (PROSPERO: CRD42022304823). We performed a meta-analysis to summarize prevalence of different mental health problems and examined whether these differed as a function of job category, sex/gender, sociodemographic index (SDI), and across time. Eighty-seven meta-analyses were included in the umbrella review and meta-analysis, including 1846 non-overlapping articles and 9,400,962 participants. The overall prevalence ratio for the different mental health outcomes ranged from 0.20 for PTSD (95 % CI: 0.16-0.25) to 0.44 for burnout (95 % CI: 0.32-0.56), with ratios for depressive symptoms, anxiety symptoms, psychological distress, perceived stress, sleep problems, and insomnia symptoms falling between these ranges. Follow-up analyses revealed little variation in outcomes across job category, and sex. Prevalence of mental health problems in HCWs was high during the pandemic. Administrators and policymakers worldwide need to address these growing problems through institutional policies and wellness programming.

Comparative efficacy and acceptability of resilience-focused interventions for nurses: a systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

The mental health of nurses is deteriorating. Maintaining nurses' resilience has become a focal point for future nursing development.

OBJECTIVE

We aim to rank the effectiveness and acceptability of resilience-focused interventions for nurses.

METHODS

A systematic review and network meta-analysis were conducted, with comprehensive searches across PubMed, Embase, Cochrane Library, Web of Science, and other databases. Frequentist random-effects network meta-analyses were employed, and RoB-2 was used to assess the quality of evidence.

RESULTS

Resilience-focused interventions were found to significantly enhance nurses' resilience (95%CI 0.61, 1.41). Offline field interventions (95%CI 0.64, 1.59) outperformed online interventions (95%CI -0.02, 0.45). Both group (95%CI 0.32, 0.87) and individual (95%CI 0.63, 1.59) interventions showed effectiveness. Anger Management Psychoeducation (95%CI 3.65,7.93, SUCRA = 98.2), Emotional Intelligence training (95%CI 3.32,6.51, SUCRA = 95), and Mindfulness-Based Stress Reduction (95%CI 2.60,5.88, SUCRA = 92.4) were the most effective interventions.

CONCLUSION

Anger Management Psychoeducation, Mindfulness-Based Stress Reduction, and Emotional Intelligence training are the most effective interventions for enhancing nurses' resilience.

INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS

CRD42021289477. REGISTRATION OF CLINICAL TRIAL AND REGISTRATION IDENTIFICATION NUMBER: Not applicable.

Unmasking Distress: An Analysis of COVID-19's Mental Health Impact on Nurses in South Africa

BACKGROUND

The acute mental health challenges faced by nurses during the COVID-19 pandemic have the potential to result in long-lasting psychological impacts. Promoting the mental health of nurses is crucial not only to safeguard their wellbeing but also to ensure the delivery of optimal patient care.

OBJECTIVE

This study sought to ascertain the extended mental health impact of the COVID-19 pandemic among nurses in South Africa.

METHODS

Participants involved nurses working at four hospitals in the Western Cape province: Helderberg, TC Newman, Stellenbosch, and Tygerberg. A convenience sample of nurses (N = 264) from the four hospitals participated in the study. Data collection involved an online survey, which included a comprehensive battery of psychological measures, such as fear of COVID-19, perceived vulnerability to disease, anxiety, depression, post-traumatic stress disorder (PTSD), alcohol use, and worry about COVID-19 infection.

RESULTS

The mean age of participants was 34.4 (SD = 7.9), with a majority being female (82%). Age was positively correlated with hopelessness and life satisfaction but negatively associated with fear of COVID-19 and symptoms of anxiety, PTSD, alcohol use, and depression. Nurses in the private sector reported higher levels of alcohol use and PTSD than nurses in public, while married and partnered nurses reported reduced levels of anxiety compared to their unmarried counterparts. Higher education levels were associated with reduced adverse mental health outcomes.

CONCLUSION

Psychological distress among nurses was exacerbated even after the peak of the COVID-19 pandemic. Potential areas of concern are highlighted, indicating the need for targeted interventions.

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.

Temporal Changes in Nurse Mental and Behavioral Health Modified by Job Demands and Resources

BACKGROUND

The COVID-19 pandemic exacerbated barriers in the nurse work environment, influencing nurse well-being. This paper examines if workplace factors moderate temporal changes in the mental and behavioral health of nurses.

METHODS

Cross-sectional data from the HealthyNurse survey collected between May 2017 and July 2023 were analyzed (n = 34,273). Job resources was estimated by average agreement (0 = strongly disagree to 4 = strongly agree) with being treated with respect, recognized for efforts, and the employer values their well-being. Average agreement with working overtime, being assigned a high workload, and working through breaks estimated job demands. Multivariable regression models estimated the effect modification of job demands and job resources on changes over time in hours of sleep and odds of feeling sad, down, or depressed, past 30-day binge drinking, and current tobacco use.

RESULTS

By each year, nurses increased sleep hours (b = 0.011; 95% CI [0.004, 0.018]), but had greater odds of poor mental health (OR = 1.102; 95% CI [1.086, 1.117]), binge drinking (OR = 1.022, 95% CI [1.007, 1.036]), and tobacco use (OR = 1.070; 95% CI [1.043, 1.098]). With higher job resources, sleep increased at a greater rate over time (b = 0.016; 95% CI [0.007, 0.024]) and the odds of binge drinking increased at a lower rate over time (OR = 0.981; 95% CI [0.965-0.998]). Conversely, the prevalence of poor mental health increased at a greater rate over time when job demands were high (OR = 1.018; 95% CI [1.004, 1.033]).

LINKING EVIDENCE TO ACTION

Job demands and job resources may lead to differential mental and behavioral health among nurses. Understanding how these workplace factors can influence nurse health is an important and upstream approach to support well-being in times of crisis.

The silent strain: a systematic review and meta-analysis on the prevalence of occupational stress among Pakistani nurses

BACKGROUND

Occupational stress in the nursing profession is higher than in many other occupations, significantly impacting nurses' physical and mental health, job satisfaction, and the quality of patient care. It often leads to burnout and the decision to leave the profession. Various studies conducted in Pakistan have reported different findings. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of occupational stress among nurses in Pakistan.

METHODS

Databases such as Scopus, Medline, Web of Science, EMBASE, and CINAHL were searched, including studies published from 2000 to September 2024. The screening process, article selection, data extraction, and quality assessment were all conducted independently by two authors. Any disagreements were resolved through consultation. Heterogeneity among studies was assessed using the I² statistic and Cochran's Q test. Subgroup analysis based on the study location (city) was performed. The relationship between occupational stress prevalence and publication year and sample size was evaluated using meta-regression. Publication bias was assessed using funnel plots and the Egger test. All analyses were conducted using a random-effects model with Stata software version 17.

RESULTS

Eleven studies with a sample size of 1636 participants were included. The prevalence of mild, moderate, and severe occupational stress was 16% (95% CI: 10-21), 48% (95% CI: 36-61), and 30% (95% CI: 20-41) respectively. The prevalence of mild occupational stress was highest in other cities, moderate stress was most common in Lahore, and severe stress was more prevalent in Karachi. No significant relationship was found between occupational stress prevalence and publication year or sample size. Publication bias for mild and severe occupational stress was significant, but the trim-and-fill analysis showed no impact on the results. Sensitivity analysis confirmed the stability of the findings.

CONCLUSION

This meta-analysis estimates the high prevalence of occupational stress among nurses in Pakistan, with moderate stress being most common. Differences in stress levels between cities may be influenced by local factors. Despite publication bias, the results remain stable and reliable, emphasizing the need for addressing occupational stress to enhance nurse well-being and patient care quality.

Second victim syndrome among nursing professionals as a result of COVID-19: qualitative research

INTRODUCTION

The infection caused by the COVID-19 virus, with its high capacity for spread and transmission, reached the level of an international pandemic, affecting many people and resulting in a large number of deaths.

AIM

To analyse the experiences of nursing professionals caring for patients with COVID-19 during the early stages of the pandemic and the skills or coping strategies that they employed.

METHODS

A qualitative study was carried out with an interpretative phenological design. Semistructured interviews were conducted with 20 nursing professionals working in emergency and critical care units, which were adapted to care for patients with symptoms of the disease, in public hospitals in Madrid, Spain. The data were analysed following, the Interpretive Phenomenological Analysis (IPA) of Smith et al. FINDINGS: Five themes were identified: "emotional brain training (EBT) to cope with great emotional stress", "material and sequential difficulties"; "an experience similar to a war that can cause burnout"; "Second Victim Syndrome (SVS), the emotional impact of witnessing trauma"; and "Surviving COVID-19 with overloads of energy and positivity".

CONCLUSION

Nursing professionals who cared for patients with Covid-19 during the first wave of the pandemic lived an experience in which they experienced a brain training of feelings, including sadness, impotence, fear, anger, pain and much worry. They also experienced a great feeling of suffering and guilt as in Second Victim Syndrome, in a situation similar to a war, due to the number of deaths caused by the virus, with all this resulting in a great overload of work. It is essential that these situations do not affect the mental health of these professionals in the dimensions that they did, and it is necessary to regain enthusiasm and motivation to provide comprehensive care for patients with COVID-19. Nursing professionals are not alone and need to be taken care of to respond to the chaos that can cause a pandemic, without ignoring the risks that it entails. They require specific training, which is necessary to provide them with proper security, and it is necessary to develop health and welfare policies, which will not be possible without first understanding their experiences.

Behind the scrubs: Psychological distress and resilience among nurses

Background

Nurses are exposed to high levels of stress in the workplace. During the coronavirus disease 2019 (COVID-19) pandemic, levels of stress were exacerbated, impacting on nurses' mental health.

Aim

The aim of the study was to investigate psychological distress and resilience, and how nurses with different levels of education responded to stress.

Setting

The study was conducted in three hospitals (a psychiatric hospital, a general district hospital and a dedicated COVID-19 hospital) in the Western Cape province, South Africa.

Methods

A survey was conducted with frontline nurses (N = 167 [71.8%]) in three hospitals in the Western Cape using six validated self-administered scales.

Results

Respondents reported high levels of moral distress related to time (3.42/6, ± 1.6) and protection during COVID-19 (1.3/3, ± 0.7). Mild-to-moderate levels of fear of COVID-19 (19.4/35, ± 8.2) and a moderate perception of vulnerability to disease (60.7/105, ± 19.9) contributed to nurses' stress. High levels of psychological distress, especially during COVID-19 compared to current levels (27.2 vs 18.8; W = 8.9, p = < 0.001), with high levels of resilience (73.2/88, ± 17.9) were reported. Enrolled nurses reported significantly higher levels of stress during the pandemic.

Conclusion

Post COVID-19, there was reduction in the respondents who reported severe levels of psychological distress, highlighting the impact of the pandemic on nurses' mental health and the need to build resilience.

Contribution

This study enhances understanding of the factors that result in psychological distress in nurses and how nurses with different levels of education respond to stress.

Burnout among South African nurses during the peak of COVID-19 pandemic: a holistic investigation

BACKGROUND

The wellbeing of health care workers (HCWs) has been an ongoing challenge, especially within low and middle-income countries (LMICs) such as South Africa. Evidence suggesting that HCWs are increasingly stressed and burned out is cause for concern. Nurses in particular have been impacted physically, mentally and psychosocially during the recent COVID-19 pandemic. This may leave a disproportionate consequence, affecting various aspects of their wellbeing, thereby justifying a need for a more holistic investigation of the wellbeing of South African nurses and their coping mechanisms during the peak of the pandemic.

METHODS

This was a cross-sectional study design. Online self-reported questionnaires were administered in six hospitals, sampled purposively and conveniently from three South African provinces. Using STATA 18.0, the Wilcoxon Ranksum test at 5% alpha compared the wellbeing and coping mechanisms of nursing staff and nursing management during COVID-19's peak. Univariable and multivariable linear regression analyses were performed to determine factors associated with burnout in nurses, at a 95% confidence interval (CI). Validated scales measuring burnout, coping, resilience, as well as mental and physical health were utilised.

RESULTS

Of 139 participants, 112(97.4%) were females, with 91(82%) and 20(18%) being nursing staff and management respectively. The median age of the participants was 43.3 years (n = 112), with a practising duration of 12 years (n = 111). There was a significant difference in the burnout score between nursing staff and nursing management (p = 0.028). In the univariable linear regression model, burnout was significantly (p < 0.05) associated with the Brief COPE Inventory (BCI), Conor-Davidson Resilience Scale (CDRS), Global Mental and Health Scale (GMHS), Global Physical and Health Scale (GPHS) and Hospital Anxiety and Depression Scale (HADS), as well as occupation. In the multivariable linear regression model, burnout was significantly associated with the CDRS [Coeff.=0.7, 95%CI 0.4; 0.9], GMHS [Coeff.=-2.4, 95%CI -3.2; -1.6], GPHS [Coeff.2.1, 95%CI 1.3; 2.9], and HADS [Coeff.=0.7, 95%CI 0.2; 1.2].

CONCLUSION

Investigating multiple aspects of wellbeing in this study, it's shown that coping and resilience may not be key factors in promoting the wellbeing of South African nurses. However, effective mental health interventions are crucial and should be prioritised to mitigate burnout during future health emergencies. Future studies examining the associations between general health, coping and resilience may help generate further evidence towards holistic interventions aimed at promoting nurses' wellbeing.

CLINICAL TRIAL NUMBER

Not applicable.

Resilience and Social Support Protect Nurses from Anxiety and Depressive Symptoms: Evidence from a Cross-Sectional Study in the Post-COVID-19 Era

Background: Nurses experience high levels of anxiety and depression since they work in a highly stressful environment. Thus, the identification of preventive factors against nurses' anxiety and depression is essential to improve their quality of life. In this context, our aim was to examine the impact of resilience and social support on nurses' anxiety and depressive symptoms. Methods: A cross-sectional online study was implemented in Greece in September 2024. We used the Brief Resilience Scale, Multidimensional Scale of Perceived Social Support, and Patient Health Questionnaire-4 to measure resilience, social support, anxiety, and depressive symptoms, respectively. Results: Our sample included 677 nurses with a mean age of 37.73 years (standard deviation: 9.38). Our multivariable linear regression models identified a negative relationship between resilience and anxiety (adjusted standardized beta coefficient =-0.38; p < 0.001) and depressive symptoms (adjusted standardized beta coefficient = -0.36; p < 0.001). Similarly, we found that significant others' support was associated with reduced anxiety (adjusted standardized beta coefficient = -0.27; p < 0.001) and depressive symptoms (adjusted standardized beta coefficient = -0.23; p < 0.001). The standardized beta coefficient indicated that resilience has a greater impact on anxiety and depressive symptoms than significant others' support. Conclusions: Our findings suggest resilience and social support have a protective function against nurses' anxiety and depressive symptoms. Managers and policymakers should adopt appropriate interventions to improve nurses' resilience and social support and, thus, to improve their mental health and quality of life.

Depression and anxiety among nurses during the COVID-19 pandemic: Longitudinal results over 2 years from the multicentre VOICE-EgePan study

AIMS

To examine symptoms of depression and generalised anxiety among nurses over 2 years during the pandemic and compare them to the general population.

BACKGROUND

The COVID-19 pandemic has led to a significant increase in mental stress among the population worldwide. Nursing staff have been identified as being under remarkable strain.

DESIGN

A multicentre prospective longitudinal study.

METHODS

Symptoms of depression and generalised anxiety in 507 nurses were examined at four different time points (T1: April-July 2020, T2: November 2020-January 2021, T3: May-July 2021, T4: February-May 2022). Results were compared with values of the German general population, presence of gender-specific differences was analysed and frequencies of clinically relevant levels of depression and anxiety were determined.

RESULTS

Throughout the study (T1-T4), a significant increase in depressive and anxiety symptoms was observed. At all four measurement time points, nurses showed significantly higher prevalence for depression and anxiety compared to the German general population. No significant gender differences were found. Frequencies for probable depression and generalised anxiety disorder among nurses were: 21.6% and 18.5% (T1), 31.4% and 29.2% (T2), 29.5% and 26.2% (T3), 33.7% and 26.4% (T4).

CONCLUSION

During the pandemic, symptoms of depression and generalised anxiety among nurses increased significantly and remained elevated. Their symptom levels were permanently higher than in the general population. These findings strongly suggest that the circumstances of the pandemic severely affected nurses´ mental health.

RELEVANCE TO CLINICAL PRACTICE

The COVID-19 pandemic caused a great mental strain on caregivers. This study was able to demonstrate the significant increase in depression and anxiety among nurses during the pandemic. It highlights the urgent need for prevention, screening and support systems in hospitals.

IMPLICATIONS FOR THE PROFESSION

Supportive programmes and preventive services should be developed, not least to prevent the growing shortage of nurses in the health care systems.

REPORTING METHOD

The study adhered to relevant EQUATOR guidelines. The STROBE checklist for cohort study was used as the reporting method.

PATIENT CONTRIBUTION

Five hundred and seven nurses completed the questionnaire and provided data for analysis.

TRIAL AND PROTOCOL REGISTRATION

The study was registered with the German Clinical Trials Register (https://drks.de/search/en) under the following ID: DRKS00021268.

Physical activity patterns, sleep quality, and stress levels among rotating-shift nurses during the COVID-19 pandemic

AIM

To examine the associations between physical activity patterns, sleep quality, and stress levels among rotating-shift nurses during the COVID-19 pandemic.

BACKGROUND

Stress adversely impacts hospital nurses, particularly those on rotating shifts. The effects of physical activity patterns and sleep quality on the stress levels of these nurses during the COVID-19 pandemic warrant investigation.

METHODS

A multicenter cross-sectional study was conducted with 550 eligible registered hospital nurses, randomly selected from four hospitals during the COVID-19 pandemic in Taiwan. The work schedule type of these nurses was categorized into rotating shifts (working at least two shifts in a month, involving day, evening, and night shifts) or fixed-day shifts (working only the day shift). Data were collected on sociodemographic characteristics, physical activity patterns (sedentary or active), sleep quality (poor or adequate), and stress levels for analysis.

RESULTS

Rotating-shift nurses with active physical activity patterns exhibited lower stress levels compared with those with sedentary patterns. Nurses who experienced adequate sleep quality had lower stress levels compared with those with poor sleep quality among rotating and fixed-day shift nurses.

CONCLUSIONS

Active physical activity patterns and adequate sleep quality were associated with lower stress levels among rotating-shift nurses during the pandemic. Promoting active physical activity and enhancing sleep quality are essential strategies for reducing stress in these nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Strategies aimed at promoting physical activity and improving sleep quality should be integral components of health promotion programs and policymaking efforts directed at nursing leaders, to foster a healthy and supportive work environment and enhance the welfare of rotating-shift hospital nurses.

REPORTING METHOD

The study is reported using the statement of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Concept Analysis: The Occupational Experiences of Long-Term Care Nurses-Navigating Fragmented Transitions

AIM

Transitions are broadly defined as movements from one place, stage, or subject to another. However, transitions which are broken and incomplete are referred to fragmented transitions. The aims of this concept analysis were to analyze the navigation of fragmented occupational transitions among long-term care nurses and to develop a working conceptual definition of fragmented occupational transitions to inform diverse stakeholders.

DESIGN

Concept analysis.

DATA SOURCES

Google Scholar, PubMed, and the Cumulative Index of Nursing and Allied Health Literature databases were accessed. Identified sources were interprofessional scholarly literature published between January 1, 2018, and January 1, 2024, and seminal references.

METHOD

Walker and Avant's eight-stage concept analysis method.

RESULTS

Occupational transitions in long-term care are fragmented leading to grievous challenges across multiple aspects of nurses' lives. An analysis of the literature using a Transitions Theory lens reveals that their thoughts, feelings and ethical decisions are influenced over time by these transitions. Cardinal attributes include: (1) Fragmentation, (2) Ill-timing, (3) Disruption, (4) Liminality, (5) Ambiguity, (6) Ambivalence and (7) Facilitators/Inhibitors. Antecedents stem from external sources and facility-led initiatives. Consequences encompass product and process outcomes. Product outcomes include physical and psychological conditions, and process outcomes encompass resilience, flexibility, connection, coping, creativity, and communication.

CONCLUSION

This concept analysis advances the science for understanding nurses' occupational transitional experiences in long-term care. It will assist in risk assessment and instrument development ultimately improving the quality of long-term care.

IMPLICATIONS

Fragmented occupational transitions in long-term care are multifaceted and complex phenomena that require distinct responses from government, healthcare leaders, and scholars to improve the plight of long-term care nurses and stakeholders.

PATIENT OR PUBLIC CONTRIBUTION

Dr. A. I. Meleis contributed to this article by sharing her vast insight into transitions.

Mindfulness Bundle Toolkit's Impact on Nurse Burnout

BACKGROUND

Nurse burnout is a widespread problem affecting nurses' physical and mental health and patients' satisfaction. Nurses in intensive care units designated for patients with COVID-19 during the pandemic reported experiencing higher levels of emotional exhaustion, depersonalization, and stress and exhaustion and lower levels of personal accomplishment. The current literature does not have a solution to combat burnout.

OBJECTIVE

To test the effectiveness of a mindfulness bundle toolkit on burnout for nurses caring for patients with COVID-19.

METHODS

A quantitative quasi-experimental design was used. Participants were 52 frontline registered nurses caring for patients with COVID-19. A mindfulness bundle toolkit was provided with the goal of decreasing burnout in a 6-week period. Data were collected before intervention, immediately after intervention, and 6 weeks after intervention using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel, the Nursing Work Index-Revised, and the Stress/Arousal Adjective Checklist. Results The analysis indicated a statistically significant effect from the mindfulness bundle toolkit in 3 areas pertaining to burnout: emotional exhaustion (Wilks Λ = .66; F1,41 = 19.02; P = .001; η2 = .31), depersonalization (Wilks Λ = .70; F1,41 = 7.93; P = .007; η2 = .16), and stress (Wilks Λ = .81; F1,41 = 8.81; P = .005; η2 = .17).

CONCLUSIONS

The results suggest that the use of a 6-week mindfulness bundle toolkit is an effective intervention to mitigate emotional exhaustion, depersonalization, and stress associated with burnout in critical care nurses caring for patients with COVID-19.

The Relevance of Insomnia Among Healthcare Workers: A Post-Pandemic COVID-19 Analysis

Background: Insomnia significantly impairs healthcare worker (HCW) well-being, particularly amid COVID-19 sequelae and shift work demands. We aimed to assess the prevalence of insomnia among HCWs, identify those needing clinical intervention, analyze shift work as a potential risk factor, and explore associations with COVID-19 sequelae and psychiatric comorbidities. Methods: A cross-sectional online survey was administered at the University of Salamanca University Care Complex (CAUSA) from March 2023 to January 2024. Validated scales (Insomnia Severity Index, Patient Health Questionnaire-4, Generalized Anxiety Disorder Scale-2) were used to measure insomnia, depression, and anxiety. Participants scoring ISI ≥ 7 were invited for Occupational Medicine follow-up. Descriptive and inferential analyses were performed. Results: Overall, 1121 HCWs participated (mean age 44.59 ± 11.78, 78.3% women). The mean ISI score was 10.5 ± 5.8 (subclinical insomnia), with 22.7% reporting moderate and 3% reporting severe insomnia. Depression and anxiety affected 28.4% and 33% of respondents, respectively. Shift workers had poorer sleep (mean ISI 11.3 ± 0.9 vs. 8.8 ± 0.3, p < 0.001). Individuals reporting COVID-19 sequelae were 3.1 times more likely to have insomnia than those who did not (mean ISI 13.89 ± 5.9 vs. 10.33 ± 5.7, p < 0.001). Over one-quarter reported at least the monthly use of sleep or psychiatric medications. Conclusions: Insomnia remains prevalent among HCWs, influenced by shift work, COVID-19 sequelae, and mental health factors. Targeted, multidisciplinary interventions, e.g., workplace policy changes, mental health programs, and shift schedule adjustments) are urgently needed to safeguard well-being, reduce burnout, and maintain quality patient care. Ensuring adequate sleep is central to minimizing errors and preserving professional performance. Future studies should investigate the impact of coordinated workplace strategies to effectively address insomnia.

The underlying mechanisms of family function on anxiety among nurses during the public health emergency

The occurrence of public health emergency in China often makes nurses more susceptible to anxiety. The present study aimed to investigate the prevalence of anxiety among Chinese nurses during the public health emergency and explore the association between family function and anxiety and its underlying mechanisms. Family care index questionnaire, Connor-Davidson Resilience scale, physical activity rating scale and 7-item Generalized Anxiety Disorder Scale were employed to measure family function, resilience, physical activity and anxiety among 779 Chinese nurses during public health emergency. The prevalence of anxiety among nurses during public health emergency was 29.9%. Resilience partially mediated the association of anxiety with family function. Physical activity moderated the direct and indirect effects of family function on anxiety. The direct effect became insignificant when the standard scores of physical activity were 0.629 and over. In contrast, the indirect effect of family function on anxiety through resilience was stronger when the levels of physical activity increased. The present study suggested for nurses with low levels of physical activity, intervention enhancing family function should be designed to prevent anxiety. For those with higher levels of physical activity, programs aimed at strengthening family function and supporting resilience should be developed to manage anxiety.

Psychometric properties and measurement invariance of the medical staff occupational stress scale among Chinese clinical nurses

BACKGROUND

The Medical Staff Occupational Stress Scale (MSOSS) is a timely tool for the measurement of occupational stress among medical staff. It included a childhood stress dimension and seven other work-related stress dimensions. This study aimed to evaluate the psychometric properties and measurement invariance of the MSOSS using a large cohort of clinical nurses from Southeast China.

METHOD

A province-level survey was conducted from January 1st 2022 to May 31st 2022. Full-time clinical nurses from multiple hospitals in Hainan province were recruited. A total of 2989 nurses (1639 from secondary hospitals and 1350 from tertiary hospitals) completed the survey. The reliability of the MSOSS was assessed by its internal consistency. The validity of the MSOSS was assessed by its structural validity, convergent validity and concurrent validity. A series of multi-group confirmatory factor analyses were conducted to test and establish measurement invariance across variables such as age, work duration, hospital level, and job title.

RESULTS

The MSOSS exhibited excellent internal consistency in the different cohorts (Cronbach's α = 0.954-0.965, omega coefficient = 0.956-0.967 and Spearman-Brown coefficient = 0.883-0.905). The MSOSS exhibited stable structural validity and the confirmative factor analysis showed that the comparative fit index (CFI), incremental fit index (IFI) and Tucker-Lewis Index (TLI) were all around 0.9 in the different cohorts, indicating a good model fit. The measurement invariance of the MSOSS across hospital level, age, work duration and job title was supported by its metric invariance, scalar invariance and residual invariance. Cut-offs for the MSOSS as a depression and anxiety screening tool were also calculated. Scores above 102 and 207 were found to be indicative of depression and anxiety, respectively.

CONCLUSIONS

The MSOSS proved to be a suitable tool for assessing occupational stress among clinical nurses.

Evolution of Spanish population well-being during the COVID-19 pandemic: Results from the COSMO-Spain study

Introduction

The COVID-19 pandemic affected mental health worldwide. The COSMO-Spain study analyses risk perceptions, behaviours, knowledge and other pandemic related variables, such as well-being. This work aimed to assess the evolution of self-reported well-being in Spain from May 2021 to September 2022 and its association with demographic and COVID-19 related factors.

Methods

An online, nationwide cross-sectional panel survey was applied in seven rounds with 1000+ participants each, with a total sample of 7266 participants, representative of the Spanish adult general population. The main variable was well-being, measured with the World Health Organization Well-Being Index (WHO-5) total score, an index with a total score from 0 to 100 (0 = worst well-being, 100 = best well-being). Other variables included in the survey were: sociodemographic data, concern about COVID-19, feelings of depression and fear, COVID-19-related worries, risk perception, self-efficacy, preventive behaviours, pandemic fatigue, health literacy, information search behaviours, and trust in several institutions. A multiple linear regression was run to analyse the associated factors with the WHO-5 total score.

Results

The WHO-5 total score showed a significant increase from rounds 6 (May-June 2021) to 8 (September-October 2021). Women (standardized b coefficient (b) = -0.10), youth or people with lower socioeconomic status (worsened financial situation (b = -0.10) or unemployed/furloughs (b = -0.04)) reported lower well-being levels, whereas having a university-level education showed the opposite (b = 0.11). Feeling less depressed was associated with higher well-being (b = 0.31).

Conclusions

This study shows rising levels of well-being until a plateau was reached in October 2021. Vulnerable groups may be at higher risk of worsened mental health and should be addressed by policymakers. Further longitudinal studies should evaluate causality and evolution patterns of well-being throughout the COVID-19 pandemic.

Stress, Anxiety and Depressive Symptoms, Burnout and Insomnia Among Greek Nurses One Year After the End of the Pandemic: A Moderated Chain Mediation Model

Background/Objectives: Several studies have reported alarming rates of mental health issues and sleep problems among nurses even in the post-pandemic era. The objective was to investigate the prevalence of stress, anxiety and depressive symptoms, burnout and insomnia among nurses in Greece one year after the end of the pandemic and to construct a mediation model evaluating the impact of stress on insomnia, the chain mediating roles of depressive symptoms and burnout, as well as the moderating role of anxiety symptoms in the model. Methods: This cross-sectional study was conducted online in July 2024 and included 380 hospital nurses who completed the Depression Anxiety Stress Scale (DASS-21), the Copenhagen Burnout Inventory (CBI) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of stress, anxiety and depressive symptoms, burnout and insomnia were 33.9% with 95% confidence interval (CI): [0.292, 0.390], 33.3% (95% CI: [0.284, 0.381]), 35% (95% CI: [0.302, 0.400]), 46.8% (95% CI: [0.399, 0.502]) and 56.1% (95% CI: [0.509, 0.611]), respectively. Multiple regression analysis indicated that the Depression subscale of the DASS-21 explained 40.6% of the variance in the AIS, while an additional 7.6% was explained by the CBI and another 1.3% rate by the Stress subscale of the DASS-21. Mediation analysis revealed that stress affected insomnia both directly and indirectly through the chain mediating roles of depressive symptoms and burnout. Anxiety symptoms moderated the chain mediation path by enhancing the negative impact of stress on depressive symptoms. Conclusions: The proposed moderated chain mediation model introduces certain factors influencing insomnia and explains how changes in any one of these factors effectuate changes in the other factors, offering insights for individualized interventions.

Experiences of working as a clinical nurse while pregnant during the coronavirus disease-2019 pandemic: a qualitative study

BACKGROUND

Working as a pregnant clinical nurse might experience a range of challenges, such as significant anatomical and physiological changes as well as emotional and cognitive changes. That might be particularly obvious under the historical background of coronavirus disease-2019 (COVID-19) pandemic. However, a dearth of studies has explored the experiences of working as a pregnant nurse during this special period. This study aimed to explore the experiences of working as a clinical nurse while pregnant during the COVID-19 pandemic.

METHODS

A descriptive qualitative design was selected. Purposive sampling, combined with maximum variation strategy and snowball sampling, were utilized to identify and select participants from tertiary-teaching hospitals, specialized hospitals, and community hospitals in Zhejiang Province, southeastern China. Online semi-structured individual interviews were used to collect data, and conventional content analysis was used to analyze the data.

RESULTS

Eleven Chinese nurses with a mean age of 31.8 years, ranging from 26 to 40 years, participated in this study. Four themes and twelve subthemes emerged: (1) still adhering to work as a clinical nurse despite being pregnant during the pandemic; (2) working during pregnancy under pandemic is still an ordinary nurse; (3) still staying in the special life phase as a pregnant mother; and (4) growth and gains as pregnant mother.

CONCLUSION

The pregnant clinical nurses suffered from various changes and difficulties during the pandemic. Managers, occupational health and other health system leaders, and policymakers should be aware of the importance of establishing a work environment that guarantees safe continued pregnancy. Future studies should focus on the establishment of specific guidelines and manuals regarding how pregnant nurses worked, as well as the development of self-protection interventions during pregnancy. Moreover, research on moral stigma and bullying in nursing during pregnancy deserves further exploration.

CLINICAL TRIAL NUMBER

Not applicable.

Influence of sleep duration and quality on depression symptoms among nurses during the Omicron outbreak: a cross-sectional survey

BACKGROUND

Nurses who work during the global pandemic are known to experience physical and psychological exhaustion, as well as severe anxiety and depression symptoms. This study aimed to explore the relationships between sleep duration, sleep quality, and depression symptoms among nurses during the outbreak of the Omicron variant.

METHODS

A cross-sectional study was conducted between August 2022 and September 2022. Participants (N = 2140) were evaluated for depression symptoms via the Hospital Anxiety and Depression Scale (HADS), and sleep was evaluated via the Pittsburgh Sleep Quality Index (PSQI), and "short sleep duration" was defined as ≤ 5 h per day. Demographic information was also collected. Binary and multivariate logistic regression was performed to assess the relationships between sleep duration, sleep quality, and depression symptoms.

RESULTS

In total, 2140 nurses were included in this study; 1481 (69.2%) had poor sleep quality, while 866 (40.4%) had depression symptom scores > 7 according to the HADS criteria. Both duration and quality of sleep were significantly correlated with depression symptoms among nurses (P < 0.001). In multivariable analyses adjusted for potential confounders, short sleep duration (≤ 5 h) was associated with an odds ratio (OR) of 2.26 (95% confidence interval [CI] 1.25-4.07), whereas poorer sleep quality was associated with an OR of 1.97 (95% CI 1.32-2.94) for experiencing depression symptoms.

CONCLUSIONS

Following the COVID-19 pandemic, there was a strong association between the sleep quality, sleep duration and depression symptoms among nurses. We recommend the development of targeted interventions to increase sleep duration, enhance sleep quality and alleviate depression symptoms.

Prevalence of Anxiety and Depression among Nurses during the early phase of COVID-19: A meta-analysis

Background & Objective

The COVID-19 pandemic exposed significant mental health challenges among healthcare workers, particularly nurses, who are key frontline responders and are the largest segment of the global health workforce. Given the ongoing threat of Mpox and potential new COVID-19 variants, understanding these challenges is vital. This review estimates the prevalence of anxiety and depression among nurses during the early phase of the pandemic to inform future pandemic responses.

Methods

A systematic review was conducted to identify studies published from January 1st to November 9, 2020. The quality of the included studies was assessed using the JBI Critical Appraisal Checklist. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis was performed using a random-effects model to estimate the pooled prevalence of anxiety and depression.

Findings

Twenty-seven studies, involving 39,386 nurses from ten countries, were included in the meta-analysis. The pooled prevalence of anxiety across 24 studies was 38.54% (95% CI: 33.99, 43.10) (I2 = 97.89%). The pooled prevalence of depression in 22 studies was found to be 35.52% (95% CI: 26.61, 44.43) (I2 = 99.72%).

Interpretation

The pooled prevalence of anxiety and depression in nurses caring for patients with COVID-19 during the early phase of the pandemic was higher than that in other healthcare workers. With the ongoing Mpox outbreak and the potential for future pandemics, these findings necessitate timely screening and robust mental health strategies to support nurses and enhance healthcare resilience.

Nurses' health and work experiences during the COVID-19 pandemic in Swedish prehospital and hospital care: a deductive content analysis through the lens of the swAge model

Working as a nurse offers job security but also poses risks for mental health issues. This study aims to explore factors and processes that affected health and work experiences among nurses in Sweden during the COVID-19 pandemic. Semi-structured interviews were conducted with 14 nurses from high COVID-19 patient load areas (ambulance, emergency departments, ICU, infection wards, and specialized COVID-19 wards). A deductive content analysis using the SwAge model's nine determinant areas, was performed. The COREQ-checklist was adhered to. Nurses were prepared to sacrifice their health for the well-being of their patients, with many still facing the repercussions. They voiced their disappointment with healthcare organizations for providing insufficient support. The pandemic disrupted the social contract between healthcare organizations and the public, particularly in elder care. To perform effectively, nurses need adequate staffing, a safe work environment, fair compensation, manageable workloads, and recognition. Instances of deception and broken promises have undermined trust and professional well-being. During the pandemic, nurses leaned on their colleagues for support to manage stress and compensate for shortcomings. Nonetheless, nurses also reported experiencing resilience, adaptability, and flourishing. Nurses in Sweden face challenges such as undersized organizations and the need for primary care expansion to reduce hospital burdens. A better balance of resources is essential for effective performance. Improved working conditions and organizational support are crucial for retaining nurses. Identifying factors for a sustainable working life involves understanding key areas and their interactions. Healthcare organizations and managers should consider these areas to promote sustainability.

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

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

Association of COVID-19-related violence and harassment with visiting nurses' mental health and intention to resign: A cross-sectional study in Japan

BACKGROUND

Prejudice related to the coronavirus disease 2019 (COVID-19) reportedly led to violence against healthcare workers by clients and their families. However, the impact of such violence and harassment on the mental health of visiting nurses during the pandemic remains unclear.

AIM

We aimed to examine the association of violence and harassment against visiting nurses with their mental health and intention to resign during the COVID-19 pandemic.

METHOD

We conducted an anonymous self-administered cross-sectional questionnaire survey to gain insight into the victimization, mental health, and personal resources (i.e., coping profiles and work engagements) among visiting nurses in Osaka. A multiple regression analysis and logistic regression analysis were used to identify associations between COVID-19-related violence and harassment and mental health or the intention to resign. Open-ended question data were assessed using content analysis to describe the details of the violence.

RESULTS

Visiting nurses were victimized by various people, such as clients and their families, residents in communities they visited, their colleagues, and their own neighbors. COVID-19-related violence and harassment was not significantly associated with subjective psychological well-being but was significantly associated with the intention to resign.

CONCLUSION

Visiting nurses experienced a comprehensive range of COVID-19-related violence and harassment during the pandemic, which may have affected their intention to resign. Coping strategies may be a possible way to mitigate the impact of such violence and harassment. During a novel infectious disease outbreak, adopting a new perspective is crucial, and managing mood swings may be helpful as an emotional coping mechanism.

Prevalence of burnout and its determinants among Indonesian nurses: a multicentre study

Frontline health workers face a significant issue concerning mental health, particularly stress and burnout. Nurses, being among them, grapple with this problem. The study aims to investigate the prevalence and determinants of burnout among nurses. A multicenter cross-sectional study was conducted across twenty two hospitals. A total of nine hundred nurses participated through convenience sampling. Burnout was measured using a single-measurement approach. Both individual and unit-related factors were examined. Over half of the nurses experienced stress, while 7.3% had symptoms of exhaustion. One in every hundred nurses faced a high likelihood of experiencing complete burnout. Job satisfaction, basic salary, motivation, age, incentives, competence, extra responsibilities, and knowledge of quality emerged as significant predictors of burnout. Addressing burnout among nurses requires hospitals to improve job satisfaction, revisit salaries, and foster supportive environments with incentives. Tailored training and ongoing support are crucial for resilience. Prioritizing these strategies is vital for nurses' well-being and sustainable healthcare delivery.

The Effects of Confiding on Shift Work Nurses' Emotion Regulation and Self-Perceived Well-Being: An Online Randomized Controlled Trial

Shift work nurses suffered great stress and emotion dysregulation during the COVID-19 pandemic. Interpersonal emotion regulation has emerged as a promising therapeutic approach, often facilitated through confiding. It has been suggested that medical staff benefit from confiding, with the act of reflecting on the social support gained from confiding being associated with higher well-being. Consequently, we hypothesized that thinking about the social support derived from confiding about work-related hassles could enhance emotion regulation and well-being in shift work nurses. This study aimed to evaluate the effects of the intervention "thinking about the social support obtained from confiding about work-related hassles" on shift work nurses' emotion regulation and self-perceived well-being. An online randomized controlled trial was conducted with 66 shift work nurses, including 34 in the experimental group and 32 in the control group, to assess the impact of an 8-week confiding intervention focused on thinking about the social support obtained from confiding. The results indicated that the intervention significantly improved the interpersonal emotion regulation of shift work nurses in the experimental group compared to the control group. In terms of intrapersonal emotion regulation, the intervention appeared to reduce the cognitive reappraisal in the intervention group; however, there was no significant difference in cognitive reappraisal or expressive inhibition between the intervention group and control group. Furthermore, self-rated general health and sleep quality showed significant improvement in the intervention group compared to pre-test levels, but no significant differences were observed between the experimental and control groups. In conclusion, the online confiding intervention effectively enhanced interpersonal emotion regulation among shift work nurses. However, its effects on intrapersonal emotion regulation were not significant. Similarly, while participants in the intervention group reported improved self-rated general health and sleep quality, these improvements did not significantly differ from those in the control group.

An umbrella review of the prevalence of depression during the COVID-19 pandemic: Call to action for post-COVID-19 at the global level

BACKGROUND

Pandemics can lead to mental health problems such as depression. This meta-analysis of meta-analyses aimed to estimate the precise prevalence of depression during the COVID-19 pandemic.

METHODS

Web of Science, PubMed, Scopus, and Embase were searched for published meta-analyses using relevant keywords, such as depression, prevalence, COVID-19, and meta-analysis up to March 18, 2024 according to the PRISMA guidelines. Relevant journals as well as the search engine Google Scholar were manually searched to discover more articles. The AMSTAR tool was used for quality assessment. A random-effects model was used for the analysis. All analyses were conducted using the STATA 17 software.

RESULTS

Of 535 records, 82 meta-analyses were included. The results showed that the overall prevalence of depression was 30% [95% CI: 29-32] with a high heterogeneity (I2: 90.98%). The highest prevalence of depression according to population group was found in medical students (40% [30-49]), specific groups (40% [3-78]), and patients (36% [27-45]). The results of meta-regression based on the different times between the start of COVID-19 and the last date of search in the articles (week) and the prevalence of depression, showed that each past week of Covid-19 increases the prevalence of depression by almost 0.00021% [95% CI: -0.00025, 0.00068], P-value: 0.36, but "time" is not a significant predictor of an increase in depression.

CONCLUSIONS

The results showed that the prevalence of depression was high during the COVID-19 pandemic, particularly among medical students. Policy makers should pay more attention to these groups and those who are at greater risk. Primary mental health interventions and policies are necessary to support the mental health of these individuals during the pandemic.

Characteristics of sleep disturbance across two waves of the COVID-19 pandemic among nursing staffs

Objectives

COVID-19 has impacted human lifestyles, including sleep quality. For nursing staff, sleep disorders not only impact their health and daily lives but also have implications for patient safety. The objective of this study is to explore the impact of the COVID-19 pandemic on the psychological and social aspects of nursing staff and the factors influencing their sleep quality through a two-wave survey.

Methods

Nursing staff from a psychiatric hospital in southern Taiwan were recruited in two waves during the COVID-19 epidemic. The level of sleep disturbance and related variables, such as Lo's Healthy and Happy Lifestyle Scale (LHHLS) and Societal Influences Survey Questionnaire (SISQ), were collected through self-report questionnaires. Factors related to the level of sleep disturbance were examined using univariate linear regression and multilevel linear regression.

Results

508 nursing staff members were included in the study, with 254 members in each wave. A significant difference was found between the two waves in the positive thinking of LHHLS and all subscales of SISQ. During the second wave, sleep disturbances were mainly related to self-efficacy, positive thinking, social anxiety, and social desirability. At the fourth wave, sleep disturbances were mainly related to self-efficacy, positive thinking, and social anxiety. However, these effects change when the trend of the epidemic shifts, and other factors are taken into account.

Conclusions

This study analyzed the factors related to the sleep quality of nursing staff during the COVID-19 pandemic. We preliminarily explored the impact of the COVID-19 pandemic on the sleep quality of nursing staff. However, determining whether the end of the epidemic has reduced the impact on nursing staff requires further research.

Trends and associated factors of mental health diagnoses in Catalan Primary Care (2010-2019)

BACKGROUND

The prevalence of mental health disorders has significantly increased in recent years, posing substantial challenges to healthcare systems worldwide, particularly primary care (PC) settings. This study examines trends in mental health diagnoses in PC settings in Catalonia from 2010 to 2019 and identifies associated sociodemographic, clinical characteristics, psychopharmacological treatments, and resource utilization patterns.

METHODS

Data from 947,698 individuals without prior severe mental illness, derived from the Data Analytics Program for Health Research and Innovation (PADRIS), were analyzed for this study. Sociodemographic data, diagnoses, and resource utilization were extracted from electronic health records. Descriptive statistics, chi-square tests, Mann-Whitney tests, and a multivariate binary logistic regression were employed to analyze the data.

RESULTS

Over the study period, 172,112 individuals (18.2%) received at least one mental health diagnosis in PC, with unspecified anxiety disorder (40.5%), insomnia (15.7%) and unspecified depressive disorder (10.2%) being the most prevalent. The prevalence of these diagnoses increased steadily until 2015 and stabilized thereafter. Significant associations were found between mental health diagnoses, female sex, lower socioeconomic status, higher BMI, and smoking status in a multivariate binary logistic regression.

CONCLUSIONS

This study highlights a growing burden of stress-related mental health diagnoses in PC in Catalonia, driven by demographic and socioeconomic factors. These findings may be indicative of broader trends across Europe and globally. Addressing this rising prevalence requires innovative approaches and collaborative strategies that extend beyond traditional healthcare resources. Engaging stakeholders is essential for implementing effective, sustainable solutions that promote mental health in Catalonia and potentially inform similar initiatives worldwide.

A major-risk environment can impact nurses' expectations moderated by medical institutional trust and communication

BACKGROUND

Nurses' positive expectations of patients in medical interactions constitute an important component of nurse-patient trust and can foster good nurse-patient relationships; therefore, it is critical to investigate factors that influence nurses' expectations. This study aims to examine the relationship between nurses' institutional trust, nurse-patient communication, and nurses' expectations of patients before and after the outbreak of the COVID-19 pandemic.

METHODS

Self-reported questionnaires were administered to 1752 nurses (Mage = 32.14 years, SD = 7.62) before the COVID-19 outbreak and 768 nurses (Mage = 29.48 years, SD = 5.51) after the COVID-19 outbreak to assess their medical institutional trust, communication skills, and expectations of patients. Mediational models were constructed to examine the relationship between these variables.

RESULTS

Before the outbreak of the COVID-19 pandemic, there was a significant positive correlation between nurses' medical institutional trust and their expectations of patients, with nurse-patient communication serving as a mediator. During the COVID-19 pandemic, the association between nurses' medical institutional trust and expectations of patients was nonsignificant; however, a significant mediating effect of nurse-patient communication remained between nurses' medical institutional trust and expectations of patients.

CONCLUSIONS

Improving nurses' trust in medical institutions may enhance their positive expectations of patients. Healthcare managers should make efforts to foster nurses' trust in healthcare institutions. Furthermore, nurse-patient communication plays a critical mediating role between nurses' medical institutional trust and their expectations of patients, highlighting the importance of interventions and training programs that improve nurses' communication skills, especially when encountering high-risk circumstances.

Factors influencing sleep quality among nurses in tertiary hospitals in Kelantan, Malaysia: a cross-sectional study

BACKGROUND

Poor sleep quality among nurses can negatively impact their performance, leading to increased risks of errors in nursing practice, which directly affect patient safety. However, there is limited research on the factors influencing sleep quality and its subsequent consequences on patient safety, particularly in tertiary hospitals in Kelantan, Malaysia. This study aimed to determine the factors influencing sleep quality and the prevalence of poor sleep quality among nurses at tertiary hospitals in Kelantan.

METHODOLOGY

A cross-sectional study was conducted in two tertiary care hospitals in Kelantan between December 2023 and February 2024. A proportionate stratified random sampling method was employed to recruit a sample of 470 registered nurses. Data were collected using a validated self-administered questionnaire comprising 19 items across seven component scores.

RESULTS

The prevalence of poor sleep quality among nurses was found to be 69.8%. The study identified several significant factors associated with poor sleep quality, including sleep duration (aOR 0.291; 95% CI: 0.215-0.393; p < 0.001), years of work experience (aOR 0.953; 95% CI: 0.924-0.984; p = 0.003), history of involvement in medication errors (aOR 2.669; 95% CI: 1.413-5.041; p = 0.002), and experiences of commuting injury (aOR 1.869; 95% CI: 1.119-3.121; p = 0.017).

CONCLUSION

The high prevalence of poor sleep quality among nurses highlights the need for targeted interventions to address this issue. In addition to ongoing education, implementing sleep hygiene programs, offering stress management workshops, and introducing flexible work schedules could significantly improve sleep quality. Creating a supportive work environment that prioritizes nurse well-being is crucial for enhancing patient safety and overall healthcare outcomes.

"The leadership shown by nurses gave me such a boost": health resources used by nurses who experienced COVID-19 pandemic stressors

PURPOSE

To thoroughly describe 1) the stressors experienced by nurses during the first waves of the COVID-19 pandemic, 2) the extent to which experiencing these stressors affected nurses' psychological and physical health and 3) the health resources nurses used to protect and maintain their psychological and physical health during this period.

METHOD

We used a theory-driven descriptive qualitative design and conducted seven focus groups of 2-5 nurses (total = 23 nurses) distinguished by their degree of contact with COVID-19 patients hospitalized in Switzerland.

RESULTS

A thematic analysis identified three main themes and their respective sub-themes: 1) Lived experiences and stressors (Living in a strange world; Hard work alone behind closed doors; Contaminating or being contaminated; Living at home behind closed doors; A war of attrition after the first wave); 2) Health (Everything is fine; Multiple traumas; Stress; Long-term exhaustion); 3) Resources (Societal and institutional resources; Direct relational resources; Resources specific to individuals).

CONCLUSIONS

All the nurses interviewed had been ceaselessly and intensely exposed to stressors in their professional and private lives. However, the repercussions of these stressors on their mental or physical health differed. Indeed, some nurses reported having used resources to protect and maintain their health.

Prevalence of imposter syndrome and its association with depression, stress, and anxiety among nursing students: a multi-center cross-sectional study

OBJECTIVE

To examine the prevalence of imposter syndrome among nursing students and its association with depression, stress, and anxiety.

METHODS

A multi-center cross-sectional survey was conducted with 1572 nursing students randomly selected from three universities across Egypt. The study was conducted over 3 months, from the beginning of January to the end of March, during the academic year 2023/2024. Clance Imposter Phenomenon Scale and Depression Anxiety Stress Scale-21 were used for data collection.

RESULTS

A significant proportion of nursing students experience moderate to highly severe levels of depression, anxiety, and stress. Around a quarter of students had moderate depression, 22.6% had moderate anxiety, and 14.9% had severe anxiety. Additionally, 13.3% of participants experienced severe stress, with only 3.8% experiencing highly severe stress. The study also found that 46.3% of students experienced moderate imposter syndrome, with 33% having frequent imposter levels and 6.2% scoring intense imposter on the scale. Furthermore, imposter syndrome was positively correlated with depression, anxiety, and stress, and the total score of the Depression Anxiety Stress Scale (r = 0.639, p < 0.001). The stepwise linear regression analysis explained that 45.0% of the variance in students' depression, anxiety, and stress was due to imposter syndrome and other sociodemographic covariates.

CONCLUSION

This study highlighted the relationship between imposter syndrome, depression, anxiety, and stress among nursing students. Specifically, female students in higher academic years, with lower grade point averages, living in urban areas, with lower family incomes, and not participating in hobbies are more prone to depression, anxiety, and stress.

NURSING IMPLICATIONS

These findings underscore the need for a holistic approach to managing the complex nature of mental health among nursing students. Incorporating education and resources on self-care and stress management techniques into nursing training programs is imperative for addressing the implications of imposter syndrome in nursing practice. Equipping nursing students with these essential skills can enhance their resilience, foster a healthier work environment, and ultimately improve patient care outcomes.

Organizational resilience and primary care nurses' work conditions and well-being: a multilevel empirical study in China

Resilience is crucial for a health system to better prevent and respond to public health threats and provide high-quality services. Despite the growing interest in the concept of resilience in health care, however, there is little empirical evidence of the impact of organizational resilience, especially in primary care settings. As the largest professional group in primary care, primary care nurses are taking more and more responsibilities during their daily practice, which influences both their work conditions and well-being. This study aims to examine the association between organizational resilience and primary care nurses' working conditions and well-being. Using a convenience sampling approach, we recruited 175 primary care nurses from 38 community health centres (CHCs) in four cities in China. Organizational resilience was operationalized as comprising two domains: adaptive capacity and planning capacity, and measured using a 16-item scale. The primary care nurses' working condition indicators comprised variables of psychological safety, organizational commitment, professional commitment, and self-directed learning; well-being indicators included depression and burn-out. Hierarchical linear regression models were built for analysis. We found that the sampled CHCs have a relatively high level of organizational resilience. The organizational resilience was positively associated with the four indicators of working conditions: psychological safety (β = 0.04, P < 0.01), organizational commitment (β = 0.38, P < 0.01), professional commitment (β = 0.39, P < 0.01), and self-directed learning (β = 0.28, P < 0.01). However, organizational resilience was not significantly associated with the two well-being indicators. Furthermore, we found that the adaptive capacity has stronger association compared with planning capacity. Therefore, primary care manager should build resilient organizations, especially the adaptive capacity, in order to enhance primary care nurses' psychological safety, commitment and learning behaviours. Further studies should also be conducted to understand the link between organizational resilience and primary care nurses' well-being.

Exploring the challenges of taiwanese nurses in the COVID-19 post-pandemic era

In the wake of the COVID-19 pandemic, the fluctuating nurse resignation rates highlighted an understudied area in healthcare: post-pandemic challenges in clinical settings. This study, conducted from May to November 2023, employed a qualitative inquiry using focus groups to delve into these challenges. Six focus group sessions, involving 33 nurse participants recruited through snowball sampling from various hospital settings were conducted to explore their clinical experiences during and after the pandemic. Thematic analysis revealed two primary themes: the 'Invisibility of Nurses' within the healthcare system and the 'Moral Duty of Nursing Practice'. These findings illuminate a tension between the overlooked role of nurses and their ethical obligations, underscoring a critical need for policy reassessment. The study advocates for systemic changes, particularly in the undervaluation of the nursing profession and the National Health Insurance system, to address the poor working environment and mitigate long-term nursing shortages. This research deepens understanding of post-pandemic nursing workforce challenges in Taiwan, highlighting the need for policy evolution to enhance recognition and support for the nursing industry. It is suggested to provide tangible compensation to acknowledge nurses' daily care and health education for patients. A healthier working environment can be enhanced by collaborative efforts between healthcare institutions and nurses.

Depressive and anxiety symptoms amid COVID-19 pandemic among healthcare workers in a low-resource setting: a systematic review and meta-analysis from Ethiopia

Background

Coronavirus disease 2019 (COVID-19) outbreak is one of the public health problems that pose a serious mental health concern due to its high morbidity and mortality rate. The healthcare workers are at risk of developing mental health symptoms like depression and anxiety because they are the first point of contact in the diagnosis, treatment, and care of patients with COVID-19. This study aimed to systematically review the prevalence and the associated factors of depression and anxiety disorders among healthcare workers amid COVID-19 pandemic in Ethiopia.

Method

A systematic review and meta-analysis study was conducted. Different primary studies that assessed the depressive and anxiety disorders during amid COVID-19 pandemic in the Ethiopian healthcare workers were extracted by Microsoft Excel and exported to STATA version 11 for further analysis. Random-effects model meta-analysis was used to the estimate pooled effect size and the effect of each study with their 95% confidence interval. Funnel plot analysis and Egger regression tests were conducted to detect the presence of publication bias. Subgroup analysis and sensitivity analysis were conducted.

Results

Thirteen studies with 5,174 participants were included in this systematic review and meta-analysis study. The pooled prevalence of depression and anxiety disorders was 40.39% (95% CI: 28.54, 52.24) and 44.93% (95% CI: 31.39, 58.46), respectively. Being a woman, being married, working in the frontline, and having high perceived susceptibility were significantly associated with depression among the Ethiopian healthcare workers. Similarly, being a woman, being older in age, working in the frontline, and having high perceived susceptibility were the factors associated with anxiety disorder among the Ethiopian healthcare workers during the COVID-19 pandemic.

Conclusion

The prevalence of depression and anxiety disorders in the Ethiopian healthcare workers was high. The timely detection and appropriate management of mental health problems is essential for the quality of healthcare services, and proactive support methods for the female, married, and older-age healthcare professionals could result in these outcomes.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022299074.

Estimation of the prevalence of anxiety during the COVID-19 pandemic: A meta-analysis of meta-analyses

BACKGROUND

Pandemics such as COVID-19, can lead to psychiatric symptoms like anxiety. It seems that meta-analysis of meta-analysis studies can provide more comprehensive information regarding the needs for post-COVID-19 services. Therefore, this umbrella review and meta-analysis of meta-analyses aimed to estimate the precise prevalence of anxiety during the COVID-19 pandemic.

METHODS

PubMed, Scopus, and Web of Science were searched for published meta-analyses using relevant keywords, such as Anxiety, Prevalence, COVID-19, and Meta-analysis up to November 1, 2023. Google Scholar, reference check, citation check, and grey literature were manually searched. A random-effect model was used for the analysis. All analyses were conducted using STATA: 17.

RESULTS

Out of the 4263 records, Finally, 75 meta-analyses were included. The overall prevalence of anxiety was 30.4% [95% CI: 29-31.8] with a high heterogeneity (I2: 86.76%). The highest prevalence of anxiety according to population type was 41.3% in patients and then in students (30.8), pregnant women (30.6%), and health care workers (30.5%). The Result of meta-regression showed that "Time" (based on the time between the start of COVID-19 and the last search date in articles) was not a significant predictor of the prevalence of anxiety (R Coefficient = 0.000149, P = 0.61).

CONCLUSIONS

Considering the prevalence of anxiety among patients, students, pregnant women, and healthcare workers, special attention should be paid to these groups in case of the re-occurrence of COVID-19 or occurrence of other pandemics. As quarantine due to pandemics causes reduced social interactions, reduced income, and increased worry about severe illness and death, there is a need for large-scale mobilization of political measures.

Emotional eating and mental health of nurses working in Lebanese hospitals during the double crisis

The 2019 coronavirus (COVID-19) pandemic and strict quarantine increased the likelihood of mental symptoms and abnormal eating behaviours. This study aimed to assess the magnitude of emotional eating (EE) among nurses working in Lebanese hospitals and its association with mental health. A cross-sectional study was conducted among nurses aged between 18 and 50 years working in Lebanese hospitals during the COVID-19 outbreak and the economic crisis. A total of 303 nurses consented to participate. The mean EE score was 28.56 (±8.11). The results of this study revealed that 53.8% of the nurses reported depression, 58.1% suffered from anxiety and 95.1% experienced either moderate or severe stress. The study concluded that females (β = 8.112, P = 0.004), non-smokers (β = -4.732, P = 0.01) and depressed nurses (β = 0.596, P = 0.046) had a higher tendency towards EE. Additionally, it was found that EE was associated with weight gain (β = 6.048, P = 0.03) and increased consumption of fried foods (β = 5.223, P = 0.001). Females experienced more stress (β = 2.244, P = 0.003) and anxiety (β = 1.526, P = 0.021) than their male counterparts. With regard to mental health, depression was associated with weight gain (β = 2.402, P = 0.003) and with lower consumption of healthy foods such as nuts (β = -1.706, P = 0.009) and dishes prepared with sofrito sauce (β = -1.378, P = 0.012). These results can help the health authorities to design preparedness plans to ensure proper mental and physical well-being of nurses during any unforeseen emergencies.

Global prevalence of depression, anxiety, and stress in the elderly population: a systematic review and meta-analysis

BACKGROUND

Several preliminary studies have been conducted in the field of the prevalence of depression, anxiety, and stress in the elderly population. These studies have examined the prevalence in limited geographic areas with small sample sizes. Also, there are many limitations in the meta-analysis studies. The objective of the present study was to synthesize the global prevalence statistics of depression, anxiety, and stress in the elderly population through a systematic review and meta-analysis.

METHODS

The present systematic review included retrieval of primary studies from the oldest relevant study up to 2023. To find the relevant studies, international databases such as Scopus, Embase, PubMed, and Web of Science (WoS) were systematically searched. Also, a manual search was performed through the Google Scholar search engine and a review of the sources of related articles. The qualitative assessment of the studies was conducted using the Joanna Briggs Institute (JBI) checklist. Due to a high heterogeneity among the study results, a Random Effects model was chosen.

RESULTS

A total of 42 articles on depression, 47 articles on anxiety and 13 articles on stress were included in the meta-analysis. The overall estimates for prevalence based on a random-effects model were as follows: depression, 19.2% (95% CI: 13.0 - 27.5%); anxiety, 16.5% (95% CI: 11.1 - 22.8%); and stress, 13.9% (95% CI: 5.5 - 30.9%). The highest prevalence of depression and anxiety was recorded in Africa. The prevalence of depression was higher in nursing homes, and stress was more prevalent in individuals with COVID-19 compared to other populations.

CONCLUSION

The findings revealed a high prevalence of depression, anxiety, and stress in the elderly population. Therefore, it is recommended that healthcare professionals and policymakers pay more attention to the prevention and management of these disorders in the elderly population.

Association between sleep problems and impulsivity mediated through regional homogeneity abnormalities in male methamphetamine abstainers

Sleep problems and impulsivity frequently occur in methamphetamine (MA) abstainers and are linked to aberrant brain function. However, the interplay between these factors remains poorly understood. This study aimed to investigate the relationship between sleep, impulsivity, and regional homogeneity (ReHo) through mediation analysis in MA abstainers. 46 MA abstainers and 44 healthy controls were included. Impulsivity and sleep problems were evaluated using the Barratt Impulsivity Scale and the Pittsburgh Sleep Quality Scale, respectively. ReHo, indicative of local brain spontaneous neural activity, was assessed using resting-state functional magnetic resonance imaging. Results unveiled correlations between different dimensions of impulsivity and ReHo values in specific brain regions. Motor impulsivity correlated with ReHo values in the left postcentral gyrus and left precentral gyrus, while non-planning impulsivity was only associated with ReHo values in the left precentral gyrus. Additionally, the need for sleep medications correlated with ReHo values in the left precentral gyrus and bilateral postcentral gyrus. Also, the need for sleep medications was positively correlated with cognitive impulsivity and motor impulsivity. Mediation analysis indicated that reduced ReHo values in the left precentral gyrus mediated the association between impulsivity and the need for sleep medications. These findings imply that addressing sleep problems, especially the need for sleep medications, might augment spontaneous neural activity in specific brain regions linked to impulsivity among MA abstainers. This underscores the importance of integrating sleep interventions into comprehensive treatment strategies for MA abstainers.

Exploring views of South African research ethics committees on pandemic preparedness and response during COVID-19

South African research ethics committees (RECs) faced significant challenges during the COVID-19 pandemic. Research ethics committees needed to find a balance between careful consideration of scientific validity and ethical merit of protocols, and review with the urgency normally associated with public health emergency research. We aimed to explore the views of South African RECs on their pandemic preparedness and response during COVID-19. We conducted in-depth interviews with 21 participants from RECs that were actively involved in the review of COVID-19 related research, at seven academic institutions across South Africa. Interviews were conducted remotely using an in-depth interview guide that included questions regarding REC preparedness and response to COVID-19. Interviews were conducted until data saturation, and audio-recordings were transcribed verbatim and coded. An inductive approach to thematic analysis was used to organise data into themes and sub-themes. This study focused on three main themes: coping during COVID-19, building REC capacity during pandemic times and a consistently cautious approach to mutual recognition of REC reviews. Despite an initial sense of unpreparedness, RECs were able to adapt and maintain careful ethical oversight of both COVID and non-COVID research, and the rigour of REC reviews. Several important lessons for preparedness and response to future pandemics were identified, including heightened awareness of publication, funding and political pressures, the importance of regular training for RECs and researchers, and strategies to enhance moral resilience of REC members. Incremental steps are needed to build trust and authentic partnerships among RECs in inter-pandemic times, to facilitate collaboration during future public health emergencies.

Exploring work-related stressors experienced by mental health nurses: A qualitative descriptive study

INTRODUCTION

The challenging work environments mental health nurses (MHNs) encounter can negatively impact their mental health, psychological well-being and physical health. While these impacts have been investigated in quantitative research, little is known about work-related stress from the perspective of MHNs.

AIM

To explore the stresses faced by nurses working in mental health settings and to gain an understanding of the underlying workplace context.

METHOD

A descriptive qualitative study with data collected via semi-structured individual telephone interviews conducted with n = 21 Western Australian MHNs. Data were analysed using reflexive thematic analysis.

RESULTS

A total of 85 codes were generated that led to the identification of 13 subthemes and 4 main themes: (1) mental health nursing context, (2) work environment stressors, (3) factors that alleviate stress and (4) the impact of workplace stress.

DISCUSSION

Many of the stressors MHNs were exposed to are modifiable, such as understaffing and poor skill mix. Modifiable stressors increased risk for MHNs, impeded patient care and exacerbated inherent stressors such as patient acuity and complexity.

IMPLICATIONS FOR PRACTICE

This study collected data that provide rich descriptions of the experiences of MHNs and identify modifiable work-related stressors that could be alleviated through effective leadership and management.

Comparison of stress, anxiety and depression levels of health, education and security sector employees: The effect of psychological resilience

This study compared the stress, anxiety and depression levels in employees working in the health, education and security sectors. The study also investigated the effect of psychological resilience on stress, anxiety, and depression levels and whether the stress, anxiety, depression and psychological resilience levels of employees differ according to occupational and demographic variables. In this cross-sectional study, 1222 employees participated, comprising 50.8% from the health sector, 37.7% from education, and 11.5% from security. Data were collected using the Stress, Anxiety, and Depression Scale-21 and the Brief Resilience Scale. The study revealed varying rates of severe stress (49.1%), anxiety (74.0%), and depression (53.2%) among participants. Health employees experienced higher stress (52.1%), anxiety (77.0%), and depression (58%) rates compared to those in education (46.4%, 72.4%, and 48.4%) and security sectors (44.3%, 66.4%, and 48.5%). Health employees exhibited higher stress, anxiety, and depression levels, signifying a significant difference. Furthermore, the research identified psychological resilience as a crucial predictor of stress, anxiety, and depression. Additionally, these mental health issues were more prevalent among younger individuals with less work experience, females, private sector employees, singles, and those without children. The findings of the study showed that the level of stress, anxiety and depression was high in employees working in all three sectors (health, education and security), but mental problems were more common in health employees. The fact that psychological resilience is a significant predictor of stress, anxiety and depression levels indicates that this factor should be taken into account.

Sense of coherence on the relationship between COVID-19-related stress and sleep quality among nurses

AIM

We aimed to examine the mediating effects of the Sense of Coherence (SOC) on the relationship between stress and sleep in nurses during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A cross-sectional survey targeting nurses in Chiba and Tokyo during the summer of 2021 was conducted using Google Forms. Responses were obtained using the Pittsburgh Sleep Quality Index (PSQI), the 13-item version of the SOC scale (SOC-13), and questions regarding COVID-19-related stress. Structural equation modeling (SEM) was performed to investigate relevant relationships.

RESULTS

A total of 181 valid responses were obtained from 400 surveyed nurses. SEM analysis showed that COVID-19 stress was indirectly related to PSQI via its effect on SOC-13, with higher SOC-13 negatively correlated with PSQI.

CONCLUSIONS

Our findings suggest the need for interventions designed to promote SOC for nurses working under stressful conditions.

Development and validation of the Moral Injury Symptom Scale - Clinician Version - Short Form (MISS-CV-SF)

BACKGROUND

Moral injury occurs when one witnesses or perpetrates an act that transgresses strongly held moral beliefs and expectations. First documented among active military and veterans, moral injury is increasingly studied in healthcare personnel impacted by the coronavirus pandemic. Measurement of moral injury among this population, particularly nurses, is still in its infancy.

OBJECTIVE

To develop the Moral Injury Symptom Scale - Clinician-Short Form and validate it among United States based acute care nurses. .

METHODS

The Moral Injury Symptom Scale - Military Version was modified for a healthcare audience. 174 acute care nurses responded to a survey package including the scale and related instruments. Reliability and validity, including convergent and discriminant validities, were assessed, and a cutoff score was calculated using the area under the receiver operating characteristic curve.

RESULTS

Reliability (Cronbach α = .75) and validity were established and a cutoff score of 41, based on functional impairment caused by moral injury, demonstrated 86.4% sensitivity and 69.6% specificity. Nurses who screened positive for moral injury experienced higher depression, anxiety, work exhaustion, interpersonal disengagement, emotional exhaustion, and depersonalization. .

CONCLUSIONS

The Moral Injury Symptom Scale - Clinician Version - Short Form is a valid and reliable instrument with strong psychometric properties that can assess moral injury in acute care nurses, a population at risk due to the challenges of providing care during the pandemic. Appropriate measurement and establishing prevalence should prompt support and intervention from healthcare organizations. .

Quality of sleep after COVID-19 infection: a cross-sectional study in the Southern Italy

Introduction

This study investigated the quality of sleep in a sample of individuals from Southern Italy after the major waves of the COVID-19 pandemic, with the aim of evaluating how sleep patterns changed.

Methods

A cross-sectional study was conducted between March 2022 and January 2023 and involved adults who had a COVID-19 infection, who were invited to complete a self-administered online questionnaire.

Results

A total of 408 individuals participated in the survey. Overall, 66.4% had a reduction in social relations; 72.1% had an increase in the use of social media; and 86%, 77.2%, and 71.1% reported an extremely severe level of anxiety, stress, and depression, respectively. Almost all of the respondents had a Pittsburgh Sleep Quality Index score (PSQI) ≥5, indicating poor sleep quality. Subjects with a severe or extremely severe depression score, a severe or extremely severe stress score, who had a job, and who had someone close who died because of a COVID-19 infection were more likely to have a high PSQI global score. The use of sleep medication in the past months was significantly higher in those who were older, who had a job, who had a COVID-19 infection in the first and second waves, who had someone close who died from COVID-19, and who did not have changes in social relationships during the pandemic. Moreover, participants with severe or extremely severe depression scores, with severe or extremely severe stress scores, who were women, and who were older had troubles staying awake while engaging in social activities during the past month.

Conclusion

The results bring to light the high prevalence of poor sleep quality among individuals who were infected with SARS-CoV-2. Future research is needed to understand whether these disturbances are still present in the endemic period and whether it is necessary to investigate further determinants that have affected and/or are affecting sleep quality.