Work-related critical incidents in hospital-based health care providers and the risk of post-traumatic stress symptoms, anxiety, and depression: a meta-analysis

Patient safety incidents in paediatric radiology: how to care for the professional?

Patient safety incidents in paediatric radiology have profound impacts not only on the patient and their family, but also on the well-being and professional practice of healthcare professionals. These incidents, which range from procedural and diagnostic incidents to serious adverse events leading to harm or even death of the patient, may evoke feelings of distress, guilt, and anxiety among paediatric radiologists (in-training), ultimately affecting their confidence and ability to deliver high-quality care. Recognizing the importance of addressing these challenges, healthcare organizations should implement strategies to support professionals in coping with and learning from these incidents. By fostering a culture of open communication, providing access to peer support, and offering structured debriefing and educational opportunities, healthcare institutions can help mitigate the psychological toll of patient safety incidents and promote resilience among their staff. This article examines the multifaceted impacts of patient safety incidents on paediatric radiologists (in-training) and their staff and outlines effective approaches for handling these incidents to support professional well-being and enhance patient safety.

The effects of different types of organisational workplace mental health interventions on mental health and wellbeing in healthcare workers: a systematic review

OBJECTIVE

To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing.

METHODS

Following PRISMA guidelines, we searched six scientific databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible.

RESULTS

We identified 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type "Job and task modifications" and a moderate level of evidence for the types "Flexible work and scheduling" and "Changes in the physical work environment". For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed.

CONCLUSION

Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.

A Two-Phased Telehealth Model to Treat Post-Traumatic Stress Disorder in a Health Care Worker due to the COVID-19 Pandemic: A Case Report

Background: We report a case describing the use of a two-step telehealth intervention to treat symptoms of post-traumatic stress disorder (PTSD) that developed in a frontline health care worker (HCW) during the COVID-19 pandemic. HCWs are at increased risk of adverse psychological outcomes, including PTSD, due to the nature of their work, which has been exacerbated by the global pandemic. Methods: This case represents the first successfully completed participant in a larger ongoing trial to address psychological distress, PTSD, and comorbidities in HCWs consequent to the COVID-19 pandemic. Following a two-step intervention of self-directed narrative writing delivered entirely online followed by prolonged exposure therapy using videoconferencing, the HCW displayed significant improvement in symptoms of PTSD, depression, anxiety, and substance use. Results: The treatment model described here offers preliminary support for a two-step remote delivery approach to meet the need for scalable self-directed distance technology-based mental health interventions for HCWs. This study is registered on clinicaltrials.gov (NCT04626050).

Longitudinal depression screening of frontline critical care nurses during the COVID-19 pandemic: A mixed-methods study

PURPOSE

To evaluate the severity and longitudinal trends of depression in critical care nurses caring for patients with COVID-19 in the US during a global pandemic.

METHODS

The study employed longitudinal mixed methods. Using the Patient Health Questionnaire (PHQ-9), nurses were sent electronic surveys at baseline, 1 month, and between 3 and 6 months to measure the severity and trends of depression during the prevaccination stage of the COVID-19 pandemic. One-on-one interviews were conducted with critical care nurses to evaluate their depressive symptoms.

RESULTS

Forty-eight nurses completed the questionnaire at baseline, 40 completed 1-month surveys, and 20 completed the 3 to 6 month surveys. The mean PHQ-9 score was 5.85, 6.20, and 8.30 at baseline, at 1 month, and at 3 to 6 months, respectively. PHQ-9 scores increased significantly over time (estimate = 1.120, P = .037). The probability of participants being moderately to severely depressed was 0.980 (P = .049) at baseline, 0.990 (P = .013) at 1 month, and 1.0 (P = .002) at 3 to 6 months. Fourteen nurses were included in a single, one-on-one interview. Eight major themes were found in qualitative analyses. For example, nurses expressed fear of spreading COVID-19 to their loved one and community. Common themes identified within the interviews included uncertainty, limited human interaction, fluctuations in mood, life is in my hands, a threat to others, positive and negative coping, nurses as scapegoats, and emerging vulnerability to COVID-19 exposure. All 14 nurses who were interviewed denied accessing any mental health services.

CONCLUSIONS

More research is needed to evaluate critical care nurses who care for patients with COVID-19 and their levels of depression to improve practice at the bedside further and develop policies to promote their well-being.

To Err is human, but what happens when surgeons Err?

BACKGROUND

Physicians involved in adverse events may suffer from second victim syndrome and can experience emotional and physical distress long after the complication occurred. We sought determine the prevalence of second victim syndrome among surgeons at our children's hospital and evaluate any differences in how surgeons respond to adverse events based on their age, position, and gender.

METHODS

An anonymous 19-question questionnaire distributed via institutional emails linking to an anonymous Research Electronic Data Capture (REDCap) survey. Eligible participants included all surgeons and rotating surgical trainees at our hospital.

RESULTS

Of 64 faculty surgeons eligible to participate, 63 surveys were returned for a 98% completion rate. Ten additional surveys from surgical trainees were completed for a total of 73 participants. Eighty-four percent reported having had difficulty dealing with a poor outcome or unhappy patient/family. Speaking with a colleague was the most common coping strategy, reported by 82%. Fifty-six percent indicated they believed reporting a poor outcome would have negative ramifications for them. Younger surgeons were more likely to suppress their feelings following an adverse event, and trainees were less likely to advise their peers to speak to a superior about the event (p < 0.05).

CONCLUSION

There is a high prevalence of second victim syndrome among surgeons at our children's hospital. There exist differences in ways that surgeons respond to adverse events based on age and position. Healthcare institutions should establish formal mechanisms of support to shift the culture towards one where help is actively sought and offered.

LEVEL OF EVIDENCE

IV.

Emotional intelligence on job performance: A study on Malaysian employees

BACKGROUND

The COVID-19 pandemic has affected the emotional intelligence of employees through the negative effects on their mental health, and led to poor workplace performance.

OBJECTIVE

The purpose of this research is to examine the level of EI of Malaysian employees in various sectors affecting their job performance through the mediating influence of psychological capital by using the Schutte Self-Report Emotional Test (SSEIT), 24-item Psychological Capital Questionnaire (PCQ-24) and Role-Based Performance Scale (RBPS) theories.

METHOD

A quantitative study was conducted. 350 sets of questionnaires were given out to Malaysian employees, of which 311 were returned. Data were analysed through regression analysis.

RESULTS

The results showed that all emotional intelligence subscales, except for utilising emotions, have a significant relationship with job performance through the effect of psychological capital.

CONCLUSION

This study offers valuable and insightful implications by combining the SSEIT, PCQ-24, and RBPS models to investigate the effect of emotional intelligence on job performance in Malaysia, which is an unusual combination model to analyse employees' job performance. It helps Malaysian companies, managers, employers, and other related parties to recognise the processes and elements that influence employees' work performance. This research also successfully developed an extended SSEIT model together with PCQ-24 and RBPS and verified their applicability on workplace performance.

Prevalence and associated factors of mental health outcomes among healthcare workers in Northern Colombia: A cross-sectional and multi-centre study

Background

Mental health outcomes in Healthcare Workers (HCWs) has been few evaluated during COVID-19 pandemic in low-and middle-income countries. Our aim was carry-out a study to identify the prevalence of stress, anxiety, depressive symptoms in HCWs and associated factors to severe illness in a northern region in Colombia.

Method

A cross-sectional, hospital-based survey was conducted to assess mental health outcomes in 1,149 HCWs in Colombia. The study used Perceived Stress Scale (PSS-10), 7-item Generalized Anxiety Disorder (GAD-7), and 9-item Patient Health Questionnaire (PHQ-9) to evaluate stress, anxiety, and depression symptoms, respectively.

Results

682 HCWs completed the questionnaire. The 58,21% (397/682) were nurses, 31,23% were physicians (213/682), and 10,56% (72/682) were other health professionals. The proportion of HCWs with stress, anxiety, and depressive symptoms were 59,97%, 44,87%, and 23,02%, respectively. HCWs in emergency room and Intensive Care Units (ICU) have 2-3-fold increase risk to have severe symptoms of stress. Staff in ICU have 64% more likely to have severe anxiety symptoms, and 97% more likely to have severe depression symptoms.

Limitations

Including HCWs only in the northern region in Colombia; a non-probabilistic sample, and a cross-sectional design to identify causality.

Conclusion

A higher proportion on mental health outcomes has been reported in HCWs in Colombia. There are work areas related with severe mental symptoms such as ICU and emergency room. Hospitals and patient-care institutions in Latin-America needs consider the mental and physical health of HCWs during outbreaks and identify health staff at-risk to implementing support strategies to mitigate adverse mental outcomes.

Investigating the effectiveness of tele-counseling for the mental health of staff in hospitals and COVID-19 clinics: a clinical control trial

OBJECTIVE

To investigate the effectiveness of tele-counseling for the mental health of staff working in hospitals and reference clinics during the COVID-19 outbreak.

METHODS

In the first stage of the study, using a convenience sampling strategy, 313 staff members working at Iran's hospitals and COVID-19 clinics answered a Hospital Anxiety and Depression Scale and the Short Health Anxiety Inventory online. In a second stage, 95 staff members who were willing to participate in the intervention were randomly assigned to the intervention (n = 51) or control (n = 44) groups. The intervention consisted of seven intensive tele-counseling sessions.

RESULTS

In the first stage, the percentages of anxiety and depression related to coronavirus were 79.2% and 82.1% and the mean health anxiety score was 17.42. In the intervention phase, anxiety related to coronavirus and to perceived risk of illness (likelihood of illness) were significantly lower in the intervention group in comparison with the control group (p = 0.001). Depression related to coronavirus and anxiety related to the negative consequences of infection were non-significantly reduced in the intervention group compared to the control group (p = 0.08 and 0.12; respectively).

CONCLUSION

Continuous monitoring of the negative psychological impacts on medical staff of outbreaks as well as implementation of appropriate interventions to respond to them should be emphasized in order to improve staff mental health.

Psychological care needs for frontline nurses during the COVID-19 pandemic: A qualitative study

Background

In the course of the COVID-19 pandemic, nurses have played vital roles in clinical treatment. Their success in providing adequate care services depends on their psychological state, which determines their physical health, work status, therapeutic outcomes, and response to public health emergencies. However, a limited number of studies have evaluated psychological care needs from the perspective of nurses. This study aimed to describe the psychological care needs for frontline nurses in the course of the COVID-19 pandemic.

Methods

This was a qualitative descriptive study. Data were collected through semi-structured in-depth interviews with 15 frontline nurses who had been involved in the care of COVID-19 positive patients during the COVID-19 pandemic, and received psychological care. The conventional content analysis was used to identify themes from the interview transcripts.

Results

Four major themes about the psychological care needs of frontline nurses were identified: (1) psychological service providers (categories: professional service team, trustworthy person or group, ability to empathize with nurses); (2) problems with psychological care (categories: lack of universal screening and focused attention, online group counseling lacks targeting, psychological interventions lack individualization); (3) psychological care content (categories: mental health-related education, recognition of nurses' contributions, problem-solving therapy, psychological counseling and venting); (4) organization and management of psychological services (categories: focus on the psychological care needs of frontline nurses, build a standardized psychological service process system).

Conclusion

It is important to understand individual psychological care needs of frontline nurses and to provide them with tailor-made psychological care that meet their needs. This will improve their mental health, promote clinical care and quality responses to public health emergencies.

Post-traumatic stress disorder, anxiety, and depression symptoms in healthcare workers during COVID-19 pandemic in Colombia

Background

Mental health outcomes in healthcare workers (HCWs) in low- and middle-income countries (LMICs) have been poorly explored during COVID-19 pandemic. Our aim was to carry out a cross-sectional study of the prevalence of mental health symptoms in HCWs in Colombia.

Methods

A cross-sectional web-survey study was performed during the COVID-19 pandemic mid-2021 including HCWs in two hospitals in Colombia. The PCL-5, GAD-7, and PHQ-9 scales were used to assess the prevalence of symptoms and severity of PTSD, anxiety, and depression in Colombia.

Results

From 257 surveyed respondents, 44.36% were nurses, 36.58% physicians and 19.07% other health professionals. The prevalence of PTSD, anxiety, and depressive symptoms were 18.68%, 43.19%, and 26.85%, amongst HCWs. The regression model evidence a strong risk of PTSD, anxiety, and depressive symptoms in HCWs in Colombia during the second wave of COVID-19 in the middle of 2021.

Conclusions

The prevalence for several mental health symptoms in HCWs in Colombia were higher compared with the general population. HCWs are at-risk population to develop chronic symptoms and mental disorders during and after outbreaks. These results will be helpful to tailor strategies to support the physical and mental health of the HCWs in LMICs.

Prevalence and Associated Factors of Depression and Anxiety Among Healthcare Workers During the COVID-19 Pandemic

Cases and death counts rise as the world continues to scuffle with the COVID-19 pandemic and its catastrophic effects. Healthcare workers (HCWs) are at a heightened risk of developing psychological distress during the pandemic as a result of extreme work demands and poor experiences of recovery. This study aimed to evaluate the mental health outcomes of HCWs in hospitals during the pandemic and explore the associated psychosocial, individual, and work-related factors of depression and anxiety among them. The present study employed a cross-sectional survey study design. Participants from the Department of Medicine, Department of Surgery, and Department of Emergency were recruited via an online based questionnaire. A validated screening tool, the Depression, Anxiety and Stress Scale (DASS-21) questionnaire was utilized to assess the status of anxiety and depression among the HCWs. The prevalence of anxiety and depression among the HCWs were 12.2% and 1.4%, respectively. Multiple logistic regression analysis further demonstrated that being male (OR = 1.581) and having work-related stigma was significantly associated with anxiety (OR = 2.635).

COVID-19 Posttraumatic Stress Disorder in Clinical Nurse Specialists

The purpose of this study was to examine if a relationship exists between the coronavirus 2019 pandemic and posttraumatic stress disorder in clinical nurse specialists.

Thoughts of suicide or self-harm among healthcare workers during the COVID-19 pandemic: qualitative analysis of open-ended survey responses

BACKGROUND

Healthcare workers are at higher risk of suicide than other occupations, and suicidal thoughts appear to have increased during the COVID-19 pandemic.

AIMS

To understand the experiences of healthcare workers with frequent thoughts of suicide or self-harm during the pandemic, including factors that contributed to their distress, and the supports that they found helpful.

METHOD

We used content analysis to analyse free-text responses to the Australian COVID-19 Frontline Healthcare Workers Study, from healthcare workers who reported frequent thoughts that they would be better off dead or of hurting themselves, on the Patient Health Questionnaire-9.

RESULTS

A total of 262 out of 7795 healthcare workers (3.4%) reported frequent thoughts of suicide or self-harm in the preceding 2 weeks. They described how the pandemic exacerbated pre-existing challenges in their lives, such as living with a mental illness, working in an unsupportive environment and facing personal stressors like relationship violence or unwell family members. Further deterioration in their mental health was triggered by heavier obligations at home and work, amid painful feelings of loneliness. They reported that workplace demands rose without additional resources, social and emotional isolation increased and many healthful activities became inaccessible. Tokenistic offers of support fell flat in the face of multiple barriers to taking leave or accessing professional help. Validation of distress, improved access to healthcare and a stronger sense of belonging were identified as helpful supports.

CONCLUSIONS

These findings highlight the need for better recognition of predisposing, precipitating, perpetuating and protective factors for thoughts of suicide and self-harm among healthcare workers.

Moving on after critical incidents in health care: A qualitative study of the perspectives and experiences of second victims

Aims

To gain a deeper understanding of nurses and midwives' experiences following involvement in a critical incident in a non‐critical care area and to explore how they have 'moved‐on' from the event.

Design

An interpretive descriptive design guided inductive inquiry to interpret the meaning of moving‐on.

Methods

Purposive sampling recruited 10 nurses and midwives. Data collection comprised semi‐structured interviews, memos and field notes. Data were concurrently collected and analysed during 2016–2017 with NVivo 11. The thematic analysis enabled a coherent analytical framework evolving emerging themes and transformation of the data into credible interpretive description findings, adhering to the COREQ reporting guidelines.

Results

The findings revealed five main themes: Initial emotional and physical response, the aftermath, long‐lasting repercussions, workplace support and moving‐on.

Conclusion

This study shed light on the perceptions of nurses and midwives who lived through the impact of critical incidents. Through their lens, the strategies engaged in to move‐on were identified and their call for organizational and collegial support received a voice.

The impact of post-traumatic stress on the mental state of university hospital physicians - a cross sectional study

BACKGROUND

Hospital physicians have an increased risk for post-traumatic stress caused by work-related trauma. This study examines the frequency of reported traumatic events (TE), post-traumatic stress (PTS) and its possible consequences for the mental state and work ability of physicians at a university hospital.

METHODS

As part of the mandatory psychological risk assessment, n = 145 physicians (n = 56 female; 38.6%) were examined at a university hospital in Germany in a cross sectional study. TE, PTS and symptoms of depression and anxiety were assessed using the self-report questionnaires "Freiburger Screening Fragebogen to identify patients at risk for the development of a post-traumatic stress disorder in the group of severely injured patients" (PTBS-13), the "Patient Health Questionnaire" (PHQ-2) and the "Generalized Anxiety Disorder scale" (GAD-2). Work ability was assessed using a modified version of the questionnaire for workplace analysis (KFZA). The response rate was 52%.

RESULTS

Traumatic events were experienced by n = 125 physicians (86.2%) throughout their whole career. Of these, 19 physicians (15.2%) reported PTS. PTS is reported by 12 of 56 female physicians (63.2%), compared to 7 of 89 reports of PTS by male physicians (36.8%). Physicians with PTS symptoms had higher depression scores (p = 0.007) compared to physicians without TE or with TE, but without PTS. Physicians with PTS reported significantly reduced work ability caused by constantly interrupted work (p = 0.03). Female gender was the greatest risk factor for the development of PTS. (p = 0.001).

CONCLUSIONS

Physicians - especially females - with PTS may have an increased risk of developing depressive symptoms. Therefore, interventions aimed at reducing trauma-related stress symptoms may be helpful in improving mental health of hospital physicians. Further studies with more physicians from different hospitals are necessary to support the results.

Psychosocial support for providers working high-risk exposure settings during a pandemic: A critical discussion

Psychological first aid is a form of support designed to lessen disaster-related distress. In a pandemic, providers may need such support but with the high risk of exposure, such a program is offered only virtually. The research is scant for traditional post-disaster support and non-existent for virtual; therefore, by using related research this discussion considers the likelihood of providers accessing and benefiting from this program. The virtual platform is heralded as the responsible way to provide support in a pandemic but this standard may be ineffective and is inherently inequitable. As a global event, pandemics require containment strategies applicable on an international level; therefore, psychosocial support should also be developed with an international audience in mind. Online psychosocial support falls short of being such a strategy as it incorrectly assumes global internet access. Many low-income areas such as Sub-Saharan Africa will need support strategies which compliment local frontline staff and fit with community-driven initiatives, whereas wealthier countries may use a combination of onsite and online support. Provider psychosocial support needs in a pandemic, if articulated, are globally similar but how this support is offered requires contextually sensitive considerations not yet found in the literature.

Prevalence of pain, analgesic self-medication and mental health in German pre-hospital emergency medical service personnel: a nationwide survey pilot-study

PURPOSE

The aim of this study was to estimate the prevalence of pain, the extent of analgesics intake and the mental health status of German pre-hospital emergency medical service (EMS) personnel.

METHODS

We conducted a nationwide online survey, which consisted of sociodemographic and job-related items, questions on pain and analgesics intake and the short-version of the validated Depression-Anxiety-Stress Scale (DASS-21).

RESULTS

A total of 774 EMS personnel with a mean age of 33.03 (standard error [SE] 0.37) years were included into the final analysis of which 23.77% were female. Pain was reported by 58.64% (454 of 774) of the study participants with 10.72% (95% confidence interval [CI] 8.54%; 13.29%) suffering from chronic, 1.68% (95% CI 0.89%; 2.87%) from acute and 46.25% (95% CI 41.49%; 51.30%) from recurrent pain, respectively. Most frequent location of pain was lumbar spine. Analgesics were used by 52.76% (239 of 454) of pre-hospital EMS personnel with pain (acute 76.92% / chronic 69.88% / recurrent 47.90%). Moreover, participants with chronic and recurrent pain indicated significantly higher depression (p ≤ 0.001), anxiety (p ≤ 0.001), and stress (p ≤ 0.001) levels compared to those without pain, respectively.

CONCLUSION

This study indicates a high prevalence of pain and analgesics usage in participating German pre-hospital EMS personnel and a poorer mental health in those with chronic and recurrent pain. Therefore, disease prevention and health promotion measures are needed to preserve health of pre-hospital EMS personnel.

Unpacking the Mental Health of Nurses during COVID-19: Evidence from Pakistan

The prime objective of the present study is to test the effect of COVID-19 fear on the mental condition of nurses in the public health sector of Pakistan. This study seeks to measure the psychological distress, anxiety, and psychological well-being of nurses due to fear of COVID-19 and exposure to COVID-19. This research further reveals the moderating role of “social support” in the link between COVID-19 fear, exposure and mental health. Through a convenient sampling technique, 250 sample contributors were chosen from 12 public hospitals. The results were obtained by applying multiple regression and moderation analysis by SPSS and the Hayes process. The outcomes indicated that fear of exposure to COVID-19 affects the mental health of nurses. The findings also discovered that social support is not very constructive in the pandemic. However, we suggested that social support is the best weapon to encourage nurses to relieve their fear and minimize negative emotions.

Mental health impact among hospital staff in the aftermath of the Nice 2016 terror attack: the ECHOS de Nice study

BACKGROUND

The Nice terror attack of July 14, 2016 resulted in 84 deaths and 434 injured, with many hospital staff exposed to the attack, either as bystanders on site at the time of the attack ('bystander exposure') who may or may not have provided care to attack victims subsequently, or as care providers to victims only ('professional exposure only'). The objective of this study is to describe the impact on mental health among hospital staff by category of exposure with a particular focus on those with 'professional exposure only', and to assess their use of psychological support resources.

METHOD

An observational, cross-sectional, multicenter study conducted from 06/20/2017 to 10/31/2017 among all staff of two healthcare institutions in Nice, using a web questionnaire. Collected data included social, demographic and professional characteristics; trauma exposure category ('bystanders to the attack'; 'professional exposure only'; 'unexposed'); indicators of psychological impact (Hospital Anxiety and Depression Scale); PTSD (PCL-5) level; support sought. Responders could enter open comments in each section of the questionnaire, which were processed by inductive analysis.

RESULTS

804 staff members' questionnaires were analysed. Among responding staff, 488 were exposed (61%): 203 were 'bystanders to the attack', 285 had 'professional exposure only'. The staff with 'professional exposure only' reported anxiety (13.2%), depression (4.6%), suicidal thoughts (5.5%); rates of full PTSD was 9.4% and of partial PTSD, 17.7%. Multivariate analysis in the 'professional exposure only' category showed that the following characteristics were associated with full or partial PTSD: female gender (OR = 2.79; 95% CI = 1.19-6.56, p = 0.019); social isolation (OR = 3.80; 95% CI = 1.30-11.16, p = 0.015); having been confronted with an unfamiliar task (OR = 3.04; 95% CI = 1.18-7.85; p = 0.022). Lastly, 70.6% of the staff with 'professional exposure only' with full PTSD did not seek psychological support.

CONCLUSION

Despite a significant impact on mental health, few staff with 'professional exposure only' sought psychological support. Robust prevention and follow-up programs must be developed for hospital staff, in order to manage the health hazards they face when exposed to exceptional health-related events such as mass terror attacks.

STUDY REGISTRATION

Ethical approval for the trial was obtained from the National Ethics Committee for Human Research (RCBID N° 2017-A00812-51).

Providing Effective Mental Health Support for Oncology Health-Care Workers in the COVID-19 Era: Responding Quickly but Carefully

Oncology health-care workers (HCWs) are facing substantial stressors during the current coronavirus disease 2019 pandemic, resulting in a wide range of acute stress responses. To appropriately meet the growing mental health needs of HCWs, it is imperative to differentiate expectable stress responses from posttraumatic stress disorder and mental illness, because traditional mental health interventions may pathologize healthy stress reactions and risk retraumatizing HCWs under acute duress. Further, HCWs are experiencing protracted forms of acute stress as the pandemic continues, including moral injury, and require mental health interventions that are flexible and can adapt as the acuity of stressors changes. Previously developed frameworks to support people experiencing acute stress, such as Psychological First Aid, are particularly relevant for HCWs in the ongoing pandemic. Acute stress interventions like Psychological First Aid are guided by the Stress Continuum Model, which conceptualizes stress reactions on a continuum, from a zone of normal readiness and expectable consequences to a zone of more persistent and extreme reactions such as posttraumatic stress disorder and major depression. Key principles of the Stress Continuum Model include the expectation that emotional reactivity does not lead to psychiatric problems, that interventions need to be appropriately targeted to symptoms along the stress continuum, and that people will return to normal recovery. Various core actions to reduce acute stress include delivering practical assistance, reducing arousal, mobilizing support, and providing targeted collaborative services. This nonpathologizing approach offers a valuable framework for delivering both individual and organizational-level interventions during the coronavirus disease 2019 pandemic.

Pandemics: Implications for research and practice in industrial and organizational psychology

Pandemics have historically shaped the world of work in various ways. With COVID-19 presenting as a global pandemic, there is much speculation about the implications of this crisis for the future of work and for people working in organizations. In this article, we discuss 10 of the most relevant research and practice topics in the field of industrial and organizational psychology that will likely be strongly influenced by COVID-19. For each of these topics, the pandemic crisis is creating new work-related challenges, but it is also presenting various opportunities. The topics discussed herein include occupational health and safety, work–family issues, telecommuting, virtual teamwork, job insecurity, precarious work, leadership, human resources policy, the aging workforce, and careers. This article sets the stage for further discussion of various ways in which I-O psychology research and practice can address the issues that COVID-19 creates for work and organizational processes that are affecting workers now and will shape the future of work and organizations in both the short and long term. This article concludes by inviting I-O psychology researchers and practitioners to address the challenges and opportunities of COVID-19 head-on by proactively adapting the work that we do in support of workers, organizations, and society as a whole.

Burnout Status of Italian Healthcare Workers during the First COVID-19 Pandemic Peak Period

The pandemic of 2019 coronavirus disease (COVID-19) has burdened extraordinary psychological stress on the healthcare workforce. The present survey aimed to examine the personal resources and psychological symptoms associated with burnout in 933 healthcare workers in Italy during the COVID-19 outbreak period. Sociodemographic and occupational data, depression, anxiety, burnout, and post-traumatic symptoms, as well as psychological well-being, were cross-sectional assessed through an online questionnaire. A considerable part of the sample scored over the clinical levels of depression (57.9%), anxiety (65.2%), post-traumatic symptoms (55%), and burnout (25.61%). Working in the front-line (p < 0.05), being part of the medical staff (p < 0.05), experiencing lower levels of psychological well-being (p < 0.001), and higher levels of post-traumatic symptoms (p < 0.001) independently explained 38% of burnout variance. The healthcare industry, services, and professionals should be aware of the harmful effects of COVID-19 on healthcare workers and take adequate preventive measures.

The prevalence of PTSS under the influence of public health emergencies in last two decades: A systematic review and meta-analysis

BACKGROUND

Since the beginning of 21st century, several major public health emergencies (PHEs) have threatened the health of people globally. Posttraumatic stress symptoms (PTSS) was one of the most concerned mental health problems. The objective of this study is to systematically estimate the prevalence of PTSS under the influence of PHEs.

METHOD

We searched both English and Chinese databases. This meta-analysis used a random-effects model to estimate the prevalence of PTSS. Subgroup analyses were conducted to analyze the source of heterogeneity. Meta-regression model was used to calculate the proportion of the variance explained by subgroup moderators.

RESULTS

Forty eligible studies (n = 15,538) were identified. The results revealed a pooled prevalence of PTSS of 17.0% (95%CI: 13.5%-21.2%), higher than that of previous epidemiological survey, with high between-studies heterogeneity (Q = 1199, I2 = 96.75%, p < .001). There was variance of prevalence in different countries (4.0%-36.5%) and epidemics (12.1%-36.5%). The prevalence of PTSS showed the feature of fluctuation in the change of time (Q = 6.173, p = .290). Patients had higher prevalence (26.2%) compared to healthcare workers (HCWs) (18.5%) and community samples (12.4%) and frontline HCWs had marginally significantly higher estimated rate than general HCWs (22.2%, 95%CI:16.0%-30.1% vs. 10.4%, 95%CI: 6.4%-16.6%). The variance of prevalence screened by interview and self-reported was significant (Q = 3.393, p = .05) and studies with higher quality possessed lower prevalence (high:12.4%; moderate: 17.3%; low: 18.0%). The total variance explained by subgroup moderators was estimated 64% by meta regression model.

LIMITATIONS

Limitations include high level of heterogeneity between studies and within subgroups as well as the lack of studies with high quality and using probability sampling.

CONCLUSIONS

This study suggested that the PTSS was common under the influence of PHEs. It was crucial to further explore the psychological mechanism and effective strategies for prevention and intervention in future research with more high-quality studies.

The impact of critical incidents on nurses and midwives: A systematic review

AIMS

To synthesise the existing literature, which focuses on the impact of critical incidents on nurses and midwives, and to explore their experiences related to the support they received in the current healthcare environment to move on from the event.

DESIGN

Systematic review and qualitative synthesis.

DATA SOURCES

The electronic databases CINAHL, MEDLINE, PsycINFO, PubMed, Embase and Nursing and Allied Health (ProQuest) were systematically searched from 2013-2018, and core authors and journals identified in the literature were manually investigated.

REVIEW METHODS

Qualitative studies of all research design types written in English were included according to the PRISMA reporting guidelines. The methodological quality of included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research.

RESULTS

A total of 7,520 potential publications were identified. After removal of duplicate citations, study selection and appraisal process, 11 qualitative primary research papers progressed to the meta-synthesis by meta-aggregation. The 179 findings and sub-findings from the included studies were extracted, combined and synthesised into three statements addressing three different aspects within the context of critical incidents: the experiences of the impact, the perceptions of support and the ability to move on.

CONCLUSION

This review illuminated that moving-on after critical incidents is a complex and wearisome journey for nurses and midwives. More attention should to be drawn to second victims within general nursing and midwifery practice to strengthen their ability to navigate the aftermath of critical incidents and reclaim the professional confidence indispensable to remain in the workforce.

Brief Report: Characteristics and Needs of Persons Admitted to an Inpatient Psychiatric Hospital With Workers' Compensation Coverage

The rise of mental health issues in the workplace is widely known. Though mental health issues were not covered by the Workplace Safety Insurance Board (WSIB) in Ontario (Canada) until 2018, it was listed as responsible for payment of inpatient psychiatric hospital stays between 2006 and 2016. This population-level observational analytic study compares the clinical and service needs of 1,091 individuals admitted to inpatient psychiatry with WSIB coverage to all other admissions (n = 449,128). Secondary analysis was based on the interRAI Mental Health assessment. The WSIB group differed from all other admissions on almost all characteristics considered. Most notably, depression (65.08 vs. 57.02%), traumatic life events (25.48 vs. 15.58%), substance use (58.02 vs. 46.92%), daily pain (38.31 vs. 12.15%) and sleep disturbance (48.95 vs. 37.12%) were much higher in the WSIB group. Females with WSIB coverage had more depression (74.36 vs. 59.91%) and traumatic life events (30.00 vs. 22.97%), whereas males had more substance issues (63.62 vs. 47.95%). In addition, persons under the age of 55 had more substance issues (<25 = 75.47%; 25-54 = 61.64%: 55 ± 40.54%) and traumatic life events (<25 = 26.41%; 25-54 = 28.18%; 55 ± 15.31%), while those 25-54 years had more daily pain (41.67% vs. <25 = 3.77% and 55 ± 34.23%) and sleep disturbance (50.74% vs. <25 = 33.96% and 55 ± 45.94%). All variables differed significantly by sex and age within the comparison group, though not always following the patterns observed in the WSIB group. Future research examining mental health needs and outcomes among injured workers receiving inpatient psychiatric services is needed, and should take into account sex and age.

Factors affecting mental health of health care workers during coronavirus disease outbreaks (SARS, MERS & COVID-19): A rapid systematic review

INTRODUCTION

The novel Coronavirus Disease (COVID-19) outbreak currently puts health care workers at high risk of both physical and mental health problems. This study aimed to identify the risk and protective factors for mental health outcomes in health care workers during coronavirus epidemics.

METHODS

A rapid systematic review was performed in three databases (March 24, 2020) and a current COVID-19 resource (May 28, 2020). Following study selection, study characteristics and effect measures were tabulated, and data were synthesized by using vote counting. Meta-analysis was not possible because of high variation in risk factors, outcomes and effect measures. Risk of bias of each study was assessed and the certainty of evidence was appraised according to the GRADE methodology.

RESULTS

Out of 2605 references, 33 observational studies were selected and the identified risk and protective factors were categorized in ten thematic categories. Most of these studies (n = 23) were performed during the SARS outbreak, seven during the current COVID-19 pandemic and three during the MERS outbreak. The level of disease exposure and health fear were significantly associated with worse mental health outcomes. There was evidence that clear communication and support from the organization, social support and personal sense of control are protective factors. The evidence was of very low certainty, because of risk of bias and imprecision.

CONCLUSION

Safeguarding mental health of health care workers during infectious disease outbreaks should not be treated as a separate mental health intervention strategy, but could benefit from a protective approach. This study suggests that embedding mental health support in a safe and efficient working environment which promotes collegial social support and personal sense of control could help to maximize resilience of health care workers. Low quality cross-sectional studies currently provide the best possible evidence, and further research is warranted to confirm causality.

Fragile heroes. The psychological impact of the COVID-19 pandemic on health-care workers in Italy

This survey-based study aimed to explore the mental health status and psychological care needs of 933 health-care workers in Italy during the COVID-19 outbreak. Sociodemographic data, exposure to COVID-19, perception of psychological care needs, depression, anxiety, somatization, and post-traumatic symptoms were concurrently assessed. The majority of the sample (71%) suffered from somatization and 55% of distress. Female care workers experienced higher levels of anxiety (d = 0.50) and somatization symptoms (d = 0.82) and stated they needed psychological care more than men (p < .001). Younger participants (aged <40 years-old) reported higher levels of somatization, depression, anxiety, and post-traumatic symptoms (effects size range from d = 0.22 to d = 0.31). Working in a high infected area (red-zones) and directly with COVID-19 patients (front-line) affected the psychological health of participants to a smaller degree. Health-care workers who lost one of their patients reported higher levels of depression (d = 0.22), anxiety (d = 0.19), post-traumatic symptoms (d = 0.30), and psychological care needs than those who did not have the same experience (p < .01). Health-care workers who perceived the need for psychological support scored above the clinical alarming level (cut-off scores) in all the psychological scales, ranging from 76% to 88%. Psychological distress (p < .01), anxiety (p < .05), depression (p < .05), and being women (p < .01) contribute to explain the need for psychological care and accounted for 32% of the variance in this sample. These findings point out the importance to consider the psychological impact of COVID-19 on Italian health-care workers and strongly suggest establishing psychological support services for providing adequate professional care.

Effect of a brief cognitive behavioral program on depressive symptoms among newly licensed registered nurses: An observational study

Depressive symptoms are a serious problem in workplaces. Hospital staff members, such as newly licensed registered nurses (NLRNs), are at particularly increased risk of these symptoms owing to their limited experience. Previous studies have shown that a brief program-based cognitive behavioral therapy program (CBP) can offer effective treatment. Here, we conducted a longitudinal observational study of 683 NLRNs (CBP group, n = 522; no-CBP group, n = 181) over a period of 1 year (six times surveys were done during this period). Outcomes were assessed on the basis of surveys that covered the Beck Depression Inventory-I (BDI). The independent variables were CBP attendance (CBP was conducted 3 months after starting work), personality traits, personal stressful life events, workplace adversity, and pre-CBP change in BDI in the 3 months before CBP (ΔBDI_pre-CBP). All factors were included in Cox proportional hazards models with time-dependent covariates for depressive symptoms (BDI ≥10), and we reported hazard ratios (HRs). Based on this analysis, we detected that CBP was significantly associated with benefit for depressive symptoms in all NLRNs (P_uncorrected = 0.0137, HR = 0.902). To identify who benefitted most from CBP, we conducted a subgroup analysis based on the change in BDI before CBP (ΔBDI_pre-CBP). The strongest association was when BDI scores were low after starting work and increased before CBP (P_uncorrected = 0.00627, HR = 0.616). These results are consistent with previous findings, and indicate that CBP may benefit the mental health of NLRNs. Furthermore, selective prevention based on the pattern of BDI change over time may be important in identifying who should be offered CBP first. Although CBP is generally effective for all nurses, such a selective approach may be most appropriate where cost-effectiveness is a prominent concern.

Experiences of compassion fatigue in direct care nurses: a qualitative systematic review

OBJECTIVE

The objective of this review was to describe the experiences of direct care nurses with work-related compassion fatigue.

INTRODUCTION

The cumulative demands of experiencing and helping others through suffering have been considered to contribute to the potential of compassion fatigue. However, there is a lack of clarity on what specifically contributes to and constitutes compassion fatigue. Nurses suffering from compassion fatigue experience physical and emotional symptoms that leave them disconnected from patients and focused on the technical rather than the compassionate components of their role. This disconnect can also affect personal relationships outside of work.

INCLUSION CRITERIA

This review included any qualitative studies describing the experiences of direct care nurses from any specialty or any nursing work setting.

METHODS

This review followed the Joanna Briggs Institute (JBI) approach for qualitative systematic reviews. Studies included in this review include those published in full text, English and between 1992, when the concept of compassion fatigue was first described, and May 2017, when the search was completed. The main databases searched for published and unpublished studies included: PubMed, CINAHL, Academic Search Premiere, Science Direct, Scopus, PsycINFO, Web of Science and the Virginia Henderson Library.

RESULTS

Twenty-three papers, representing studies conducted in seven countries and 821 total nurse participants, met the criteria for inclusion. From these, a total of 261 findings were extracted and combined to form 18 categories based on similarity in meaning, and four syntheses were derived: i) Central to the work of nursing and the professional environment in which nurses work are significant psychosocial stressors that contribute to compassion stress and, if left unchecked, can lead to compassion fatigue; ii) Protection against the stress of the work and professional environment necessitates that the individual and team learn how to respond to "the heat of the moment"; iii) Nurses and other administrative and colleague staff should be alert to the symptoms of compassion fatigue that present as profound, progressive, physical and emotional fatigue: a feeling that the nurse just can't go on and a sense of being disconnected and drained, like a gas tank on empty; and iv) Keeping compassion fatigue at bay requires awareness of the threat of compassion fatigue, symptoms of compassion fatigue, and the need for work-life balance and active self-care strategies.

CONCLUSIONS

The major conclusions of this review are that compassion fatigue prevention and management must be acknowledged, and both personal and organizational coping strategies and adaptive responses are needed to keep nurses balanced, renewed and able to continue compassionate connection and caring.

Survey of prevalence of anxiety and depressive symptoms among 1124 healthcare workers during the coronavirus disease 2019 pandemic across India

Background

A prospective study was conducted during the second phase of the coronavirus disease 2019 (COVID-19) pandemic in India to assess the prevalence of anxiety and depressive symptoms among healthcare workers (HCWs) and factors that influence the outcome.

Methods

A self-administered questionnaire was completed by 1124 HCWs during the COVID-19 pandemic (March 30, 2020, to April 2, 2020). Demographic data, questions on COVID-19 and scores of the Hospital Anxiety and Depression Scale were analysed using the chi-square test (Bonferroni correction) and binary logistic regression.

Results

The study consists of 1124 HCWs, including 749 doctors, 207 nurses, 135 paramedics, 23 administrators and ten supporting staff members. The prevalence of anxiety and depressive symptoms were reported as 37.2% and 31.4%, respectively. The risk factors for anxiety were female gender (30.6% vs 45.5%), age group (20–35 years) (50.4% vs 61.2%), unmarried (21.2% vs 30.6%) and job profile (nurse) (14.7% vs 26.4%). The protective factor was having service of more than 20 years (23.4% vs 14.8%). The risk factors for depression were age group (20-35 years) (51.3% vs 61.3%) and employed at a primary care hospital (16.2% vs 23.4%). The protective factors were job profile (doctor) (69.9% vs 59.6%) and having service of more than 20 years (22.3% vs 15.5%).

Conclusion

Approximately one-third of the HCWs reported anxiety and depressive symptoms. The risk factors for anxiety symptoms were female gender, younger age and job profile (nurse) and for depressive symptoms were younger age and working at a primary care hospital. Future research studies should identify strategies for providing a safer and supportive work environment for HCWs to face epidemics/pandemics.

How I approach peer support in pediatric hematology/oncology

Peer support has begun to gain traction as a mechanism for improving well-being in medicine. In this paper, we share our experience building, training, and piloting a peer support team based on a "critical incident stress management" model. The HOPES team (Helping Our Peers Endure Stress) is dedicated to, and composed entirely of, members of our division of pediatric hematology/oncology. Peer support will not solve all the well-being problems afflicting medicine. It is, however, a very good place to start.

A Bibliometric Analysis of Corona Pandemic in Social Sciences: A Review of Influential Aspects and Conceptual Structure

Corona pandemic has affected the whole world, and it is a highly researched area in biological sciences. As the current pandemic has affected countries socially and economically, the purpose of this bibliometric analysis is to provide a holistic review of the corona pandemic in the field of social sciences. This study aims to highlight significant, influential aspects, research streams, and themes. We have reviewed 395 journal articles related to coronavirus in the field of social sciences from 2003 to 2020. We have deployed 'biblioshiny' a web-interface of the 'bibliometrix 3.0' package of R-studio to conduct bibliometric analysis and visualization. In the field of social sciences, we have reported influential aspects of coronavirus literature. We have found that the 'Morbidity and Mortality Weekly Report' is the top journal. The core article of coronavirus literature is 'Guidelines for preventing health-care-associated pneumonia'. The most commonly used word, in titles, abstracts, author's keywords, and keywords plus, is 'SARS'. Top affiliation is 'The University of Hong Kong'. Hong Kong is a leading country based on citations, and the USA is on top based on total publications. We have used a conceptual framework to identify potential research streams and themes in coronavirus literature. Four research streams are found by deploying a co-occurrence network. These research streams are 'Social and economic effects of epidemic disease', 'Infectious disease calamities and control', 'Outbreak of COVID 19,' and 'Infectious diseases and the role of international organizations'. Finally, a thematic map is used to provide a holistic understanding by dividing significant themes into basic or transversal, emerging or declining, motor, highly developed, but isolated themes. These themes and subthemes have proposed future directions and critical areas of research.

Factors influencing termination of resuscitation in children: a qualitative analysis

BACKGROUND

Pediatric Advanced Life Support provides guidelines for resuscitating children in cardiopulmonary arrest. However, the role physicians' attitudes and beliefs play in decision-making when terminating resuscitation has not been fully investigated. This study aims to identify and explore the vital "non-medical" considerations surrounding the decision to terminate efforts by U.S.-based Pediatric Emergency Medicine (PEM) physicians.

METHODS

A phenomenological qualitative study was conducted using PEM physician experiences in terminating resuscitation within a large freestanding children's hospital. Semi-structured interviews were conducted with 17 physicians, sampled purposively for their relevant content experience, and continued until the point of content saturation. Resulting data were coded using conventional content analysis by 2 coders; intercoder reliability was calculated as κ of 0.91. Coding disagreements were resolved through consultation with other authors.

RESULTS

Coding yielded 5 broad categories of "non-medical" factors that influenced physicians' decision to terminate resuscitation: legal and financial, parent-related, patient-related, physician-related, and resuscitation. When relevant, each factor was assigned a directionality tag indicating whether the factor influenced physicians to terminate a resuscitation, prolong a resuscitation, or not consider resuscitation. Seventy-eight unique factors were identified, 49 of which were defined by the research team as notable due to the frequency of their mention or novelty of concept.

CONCLUSION

Physicians consider numerous "non-medical" factors when terminating pediatric resuscitative efforts. Factors are tied largely to individual beliefs, attitudes, and values, and likely contribute to variability in practice. An increased understanding of the uncertainty that exists around termination of resuscitation may help physicians in objective clinical decision-making in similar situations.

Web-Based Peer Support Education Program for Health Care Professionals

BACKGROUND

Health care professionals can routinely face potential critical incidents in the workplace, which can cause high levels of occupational distress and mental health problems. Peer support, in which a trained colleague provides psychosocial support after a work-related critical incident, is an early intervention strategy to support health care professionals. This study describes the development and evaluation of an innovative new online program to educate peer supporters.

METHODS

An interactive Web-based peer support education program (e-learning Peer Support) was developed to teach health care professionals the theory of peer support in preparation for face-to-face training (hybrid learning). User acceptance was determined with a 21-item online survey and technical user data.

RESULTS

Forty-four health care professionals completed the e-learning Peer Support and the online evaluation survey. Participants were nurses (68.2%), physicians (18.2%), residents (6.8%), and staff (6.8%). The e-learning was well received and positively evaluated with regard to all studied indicators of acceptance, including perceived usefulness, ease of use, actual use, and effectivity. All participants would recommend the e-learning to future trainees.

CONCLUSION

The e-learning is a valuable addition to the theoretical peer support training curriculum. Future steps include implementing the e-learning as a yearly continuing education meeting, as a clinical lecture, or as part of the standard curriculum for health care professionals in medical training. Developments like this e-learning may contribute to a standardized training method and, eventually, the implementation of peer support programs.

Help in hand after traumatic events: a randomized controlled trial in health care professionals on the efficacy, usability, and user satisfaction of a self-help app to reduce trauma-related symptoms

Background: Despite the fact that many people are affected by trauma and suffer from posttraumatic stress symptoms (PTSS) there is a lack of easy-accessible interventions to self-manage these symptoms. Mobile apps may deliver low-intensity self-help to reduce trauma-related symptoms and empower individuals following trauma, such as high-risk professionals who are regularly exposed to potentially traumatic events. In this randomized controlled trial, we examined the efficacy, and evaluated the usability and user satisfaction of the app 'SUPPORT Coach' as a self-help tool to reduce trauma-related symptoms. Methods: Health care professionals (e.g. nurses, physicians, paramedics and ambulance drivers) completed an online screening on PTSS (T0). They were randomized when at least one PTSS was reported, either to the intervention (1 month unlimited access to SUPPORT Coach) or control condition (no access to SUPPORT Coach). Self-reported PTSS, negative trauma-related cognitions, psychological resilience, and social support were assessed online at baseline (T1), post-condition (T2), and 1 month follow-up (T3). Results: Of the 1175 participants screened, 287 (24.4%) indicated at least one posttraumatic stress symptom and were randomized. The majority of intervention condition participants (83%, n = 103) used SUPPORT Coach; they were slightly to moderately satisfied with the app. There was no significant group difference in change in PTSS and social support after one-month app usage. However, the intervention condition showed a greater decline in negative trauma-related cognitions at T2 and T3, and a larger increase in psychological resilience at T3 than the control condition. Conclusions: SUPPORT Coach without guidance could potentially provide easy-accessible self-help to diminish negative trauma-related cognitions, and strengthen resilience in coping with adversities. However, since the attrition rate was substantially higher in the intervention than in control condition, our findings should be interpreted with caution and warrant replication.

The prevalence of post-traumatic stress disorder among emergency nurses: a cross sectional study in northern Iran

Background and objective: Posttraumatic stress disorder (PTSD) is one of the anxiety disorders which occurs in response to facing events and accidents accompanied by fear, frustration, and terror. Nurses who worked in the emergency departments witness unpleasant accidents and are exposed to stress and violence more than others. The aim of this study was to investigate the prevalence of PTSD among Iranian nurses working in the emergency department.

Materials and Methods: In this cross-sectional study, all nurses working in the emergency department of educational hospitals affiliated with Mazandaran University of Medical Sciences were included through census method (n = 131). Each of the participants in this study responded to the questionnaires individually. The first part of the questionnaire captured demographics, while the second part was the Civilian Mississippi Scale for PTSD, which was used to investigate the extent of PTSD in this study. Data were analyzed using SPSS version 22.

Results: In this study, 131 respondents were included. In the classification of age, nurses with 20-30-year- old had the maximum frequency (41.2 %,). Most nurses in the study (93.1%, n = 122) had a bachelor’s degree in nursing and 84 were married. The prevalence of PTSD in emergency nurses was 82.96%, which was higher in nurses with shorter working background and nurses with lower levels of education. Further, the average score of PTSD was higher in married nurses.

Conclusion: The results of this study revealed the high prevalence of PTSD among nurses who worked in emergency department. Therefore, it seems that designing and providing supportive and educational services to emergency nurses can be effective for preventing and managing this disorder, which probably can improve their performance.

Health outcomes of the July 14, 2016 Nice terror attack among hospital-based professionals and students: the « ECHOS de Nice » health survey protocol

BACKGROUND

The terror attack of July 14, 2016, in Nice, France, resulted in 86 deaths, including children, and several hundred wounded, with a major psychological impact on the population. Hospital staff had to cope with exceptional circumstances which made them vulnerable to detrimental effects on their own health. This paper describes the method that was selected for the survey entitled "ECHOS de Nice 14 Juillet" which aimed to assess the impact of the attack on the psychological, psycho-traumatic and somatic health condition of the Nice University and Lenval hospital staff who were directly or indirectly exposed to the attack, and also to describe the support and care facilities they were offered.

METHOD

ECHOS de Nice 14 juillet is an observational, cross-sectional, multicentre study focusing on all the hospital staff and students of both institutions, i.e. 10,100 persons in June 2017. A web-based questionnaire based on the model developed by Santé Publique France (IMPACTS and ESPA 13 novembre 2015) was adapted to the contexts of the healthcare professionals and students employed in these healthcare institutions in Nice and published on line from June 21 to October 30, 2017. The paper describes the tools that were used to meet the aims of the study, i.e. identification of exposure categories ('civilian' exposure for those present during the attack and/or 'professional' exposure); indicators of psychological impact (anxiety, depression, burnout, compassion fatigue, suicidal states, tobacco and alcohol use, self-medications), psycho-traumatic and somatic impact; professional and social impact. Lastly, awareness of availability and use of psychological support and care-follow-up facilities by professionals were investigated. Respondents could include extensive qualitative comments on the various themes explored in the questionnaire, with text analysis complementing that of quantitative data.

DISCUSSION

The benefits and limitations of the selected methodology are discussed, in view of contributing useful information to help anticipate and manage health issues among hospital staff who have been victims of traumatic events.

Secondary traumatic stress among emergency nurses: Prevalence, predictors, and consequences

BACKGROUND

Nurses working in emergency units are in direct contact with traumatic events. Trauma effects do not solely affect patients and their caregivers and, rather, extend to secondarily influence nurses themselves. Secondary exposure to trauma may result in symptoms similar to symptoms experienced by the patient themselves. No previous study investigated the secondary traumatic stress among emergency nurses in Jordan.

PURPOSE

To identify prevalence, predictors, and consequences of secondary traumatic stress among nurses working in emergency departments.

METHOD

A descriptive correlation design was utilized to collect data using self-report questionnaires from 202 nurses working at eight emergency departments in Jordan.

FINDINGS

The study revealed that almost half of the sample reported high to severe levels of secondary traumatic stress. The analyses showed that nurses who demonstrated lower empathy (P = .016) and greater coping capacity (P < .001) tended to develop more secondary traumatic stress. Organizational factors were not significant predictors of secondary traumatic stress.

CONCLUSION

A significant proportion of emergency nurses suffer secondary traumatic stress that is found also to be associated with psychical factors. Emergency nurses need to consider the consequences of secondary traumatic stress on their health and quality of care provided.

Effects of two types of smartphone-based stress management programmes on depressive and anxiety symptoms among hospital nurses in Vietnam: a protocol for three-arm randomised controlled trial

INTRODUCTION

Due to an increasing demand for healthcare in low-income and middle-income countries in Asia, it is important to develop a strategy to manage work-related stress in healthcare settings, particularly among nurses in these countries. The purpose of this three-arm randomised controlled trial (RCT) is to examine the effects of a newly developed smartphone-based multimodule stress management programme on reducing severity of depressive and anxiety symptoms as primary outcomes at 3-month and 7-month follow-ups among hospital nurses in Vietnam.

METHODS AND ANALYSIS

The target study population will be registered nurses working in a large general hospital (which employs approximately about 2000 nurses) in Vietnam. They will be invited to participate in this study. Participants who fulfil the eligibility criteria will be randomly allocated to the free-choice, multimodule stress management (intervention group A, n=360), the internet cognitive behavioural therapy (iCBT), that is, fixed-order stress management (intervention group B, n=360), or a treatment as usual control group (n=360). Two types (free-choice and fixed sequential order) of smartphone-based six-module stress management programmes will be developed. Participants in the intervention groups will be required to complete one of the programmes within 10 weeks after the baseline survey. The primary outcomes are depressive and anxiety symptoms, measured by using the Depression Anxiety and Stress Scales (DASS) at 3-month and 7 month follow-ups.

ETHICS AND DISSEMINATION

The study procedures have been approved by the Research Ethics Review Board of Graduate School of Medicine/Faculty of Medicine, the University of Tokyo (no 11991) and the Ethical Review Board for Biomedical Research of Hanoi University of Public Health (no 346/2018/YTCC-HD3). If a significant effect of the intervention programmes will be found in the RCT, the programmes will be made available to all nurses in the hospital including the control group. If the positive effects are found in this RCT, the e-stress management programmes will be disseminated to all nurses in Vietnam.

TRIAL REGISTRATION NUMBER

UMIN000033139; Pre-results.

The Association of the Exposure to Work-Related Traumatic Events and Work Limitations among Firefighters: A Cross-Sectional Study

Many firefighters suffering from traumatic events while on duty participate in the work force. However, the impact of work-related traumatic events on work performance is unclear. To address this issue, we administered a work-related traumatic event experience survey, the health-related work limitations questionnaire, the Korea Depression Scale, and the World Health Organization quality of life assessment to firefighters from four cities in Korea. The health-related work limitations questionnaire measured limitations in their ability to perform three specific work demands-physical, psychosocial, and environmental. Of 685 firefighters enrolled in the study, 618 (90.2%) were included in the final analyses. Their mean age ± standard deviation (SD) was 41.1 ± 8.0 years and mean employment period ± SD was 163.0 ± 101.2 months. A large percentage of participants reported they had experienced work-related traumatic events. Among the firefighters, the total work limitation prevalence was 21.5%, 16.8% of them were limited in their abilities to perform physical work demands, 15.5% were limited in performing psychosocial work demands, and 13.8% were limited in their abilities to function without difficulty within the ambient work environment. Based on multivariable logistic regression, with having work-related traumatic event experience of a threat or injury to self, the odds ratio (OR) of having work limitations in physical (OR = 3.32, 95% CI = 1.17⁻9.41), psychosocial (OR = 3.05, 95% CI = 1.08⁻8.61), environmental (OR = 4.89, 95% CI = 1.66⁻14.40) work demands, and total work limitation (OR = 3.73, 95% CI = 1.44⁻9.68) increased significantly. With experiences of treating fatalities or injured patients, the OR of total work limitation increased significantly (OR = 2.07, 95% CI = 1.09⁻3.91). We demonstrated a relationship between the firefighters' exposure to work-related traumatic events and their work limitations. A professional care management system for firefighters to prevent and manage work-related traumatic events should be developed in order to protect and improve their performance ability.

Personality, Work-Life Balance, Hardiness, and Vocation: A Typology of Nurses and Nursing Values in a Special Sample of English Hospital Nurses

This initial report of a longitudinal study of 192 English hospital nurses measured Nursing Values (the 6Cs of nursing); Personality, Self-Esteem and Depression; Burnout Potential; Work-Life Balance Stress; “Hardy Personality”; and Intention to Leave Nursing. Correlational, component, and cluster analysis identified four groups: “The Soldiers” (N = 79), with medium scores on most measures, who bravely “soldier on” in their nursing roles, in the face of numerous financial cuts to the National Health Service, and worsening nurse–patient ratios; “Cheerful Professionals” (N = 54), coping successfully with nursing roles, and a variety of challenges, in upwardly mobile careers; “High Achievers” (N = 39), senior nurses with strong profiles of a “hardy personality”, and commitment to fundamental nursing values; and “Highly Stressed, Potential Leavers” (N = 20), with indicators of significant psychological distress, and difficulty in coping with nursing role challenges. We have initiated a program of co-counselling and social support for this distressed group, by nurses who are coping more successfully with multiple challenges. We discuss the role of nurse educators in fostering nursing values, developing and supporting a “hardy personality” and emotional resilience in recruits to nursing. This study is framed within the disciplinary approach of Critical Realism, which identifies the value basis for research and dialogue in developing strategies for social change. The importance of this research is that: (a) it is part of the new thrust in nursing research, applying Critical Realist theory and methodology to research on nursing stress; (b) it has established, through network sampling, a group of nurses who can be supportive of each other in their stressful careers; (c) it establishes the reliability and potential validity of a measure of core nursing values; (d) it is among the first studies in research on nursing stress, to use the humanizing methodology of moving from data analysis (description of “things”), to describing a typology of nursing stress and career progress (description of individuals).