Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK

Hardship, coping, and joy: ACPs' experiences of working through the COVID-19 pandemic

PURPOSE

This paper reports Advanced Clinical Practitioners' (ACPs) experiences of working in the United Kingdom during the COVID-19 pandemic, specifically the factors that impacted their mental, emotional, and physical wellbeing.

METHODS

The study presents qualitative data collected via two surveys in 2020 and 2021. Several survey questions elicited free-text responses, including a specific request for narratives. Narrative responses were thematically analysed and cross-referenced with non-narrative qualitative responses.

RESULTS

Three factors contributed to poor wellbeing: a changing work environment and expectations; bearing witness to the impact of Covid on patients; and the risk of catching and spreading Covid. Three factors improved wellbeing, whether through mitigating these challenges or directly, in the absence of specific hardship. These factors were new working practices; support structures; and individual resilience and self-managed coping strategies.

CONCLUSION

This study expands research on professionals' experiences of working through Covid to the under-researched experience of ACPs and demonstrates the intersecting and overlapping nature of factors contributing to poor and positive wellbeing. There are significant implications for stakeholders who need to consider the impact of future pandemics and opportunities for supporting and promoting wellbeing post-pandemic. The analysis also highlights the rich narrative data that can be collected using surveys.

The Multiple Determinants of Infection Prevention and Control Practices in Nursing Homes: A Scoping Review

OBJECTIVES

To map the barriers and facilitators influencing infection prevention and control (IPC) practices in nursing homes (NHs) from a behavior change perspective and to identify research gaps.

DESIGN

Scoping review using the Joanna Briggs Institute methodology.

SETTING AND PARTICIPANTS

NHs for older adults and health care workers in NHs.

METHODS

We conducted database searches in March 2022 and updated them in November 2024, including additional sources from citation tracking and reference list checks. We analyzed barriers and facilitators using the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation-Behavior (COM-B) model.

RESULTS

Of 1591 identified records, 54 reports published between 2003 and 2024 met our inclusion criteria. The analysis identified 101 determinants (25 in Capability, 46 in Opportunity, and 30 in Motivation within the COM-B model) categorized into 36 categories and 16 themes as barriers and facilitators. The most frequently mentioned barriers were related to the "Environmental context and resources" domain of the TDF. Relatively few reports addressed the determinants of the TDF domain classified within the Motivation area of the COM-B model. Although many facilitators were identified in this area, including beliefs, intentions, and goals, they were coded based on limited descriptions.

CONCLUSIONS AND IMPLICATIONS

This review provides a detailed mapping of the barriers and facilitators to IPC in NHs based on existing literature. It demonstrates the complexity of sustaining IPC practices, influenced by multiple determinants. Although Motivation may impact IPC adherence, its determinants remain insufficiently studied, indicating a research gap. Further research is needed to explore these determinants and understand how Motivation interacts with other factors in IPC implementation.

The Psychosocial Effects of the COVID-19 Pandemic on Primary School Children of Health Professionals

During the COVID-19 pandemic, health professionals had to spend much of their time working in hospitals, which may have caused psychological distress to their children. This study was in the form of a case study pattern, one of the qualitative research methods aimed to identify the psychosocial effects of the COVID-19 pandemic on the primary school children of health professionals. Its sample consisted of health professionals (n = 60) and their children (n = 60), who were all at primary school. Data were collected from the parents using a questionnaire, and from the children by asking them to create drawings and explain them. Descriptive and content analysis were carried out. The findings were grouped under the headings of "Spatial and Social Effects on the Child's Daily Life," "Effects on the Child's Emotions," and "Effects on the Parent From the Child's Perspective." It is recommended that interventions to maintain the psychosocial well-being of children be planned.

When safety becomes the priority: defensive nursing practice and its associated factors among nurses in Egypt: a cross-sectional study

Background

Defensive nursing practices, which prioritize legal protection over patient care, are becoming increasingly common. This study aims to explore the prevalence and factors associated with defensive nursing practices among nurses in Egypt, considering the impact of workplace violence and legal threats.

Methods

A descriptive cross-sectional study was conducted from February to April 2024 using a self-report online questionnaire. The target population included clinical nurses working in various hospitals in Egypt. A sample size of 1,267 nurses was achieved through convenience sampling. The questionnaire assessed demographic data, experiences of workplace violence, legal consequences, and defensive nursing practices, categorized into positive and negative behaviors.

Results

The sample consisted of 1,267 nurses, predominantly female (75.9%), with a mean age of 28.57 years. Positive defensive practices, such as detailed documentation (79%) and thorough explanation of procedures (58.5%), were highly prevalent. Negative practices included avoiding high-risk procedures (15.9%) and patients more likely to file lawsuits (13.6%). Older nurses and those with higher educational qualifications were more likely to engage in positive defensive practices. Nurses who experienced workplace violence or legal threats were significantly more likely to avoid high-complication procedures.

Conclusion

The study identified a high engagement in both positive and negative defensive practices among nurses in Egypt. These practices are influenced by factors such as age, education level, and experiences of workplace violence and legal threats. The findings underscore the need for strategies to support nurses, reduce reliance on defensive practices, and ensure better patient outcomes.

Exploring the Experiences of LTCF Staff in Implementing Visitation Policies in England During the COVID-19 Pandemic

Background: Restrictions on family visitation to long-term care facilities (LTCFs) during the COVID-19 pandemic remain an area of contention for residents, family members and staff members. Current research has explored the experience of family members; however, fewer studies have explored the impact of visitation restrictions from the perspective of LTCF staff members. We examined the experiences of LTCF staff members in implementing visitation restrictions, including maintaining contact with families, in England over the course of the COVID-19 pandemic. Method: A sample of twenty-four LTCF staff members employed at eight LTCFs in one region of England was recruited. Qualitative, in-depth interviews were conducted with staff members to explore their experiences of implementing government policies during the COVID-19 pandemic. Thematic analysis was used to analyse data on maintaining contact and visitation with relatives. Results: Five broad themes were identified from the data. These were: (i) engaging with family members on visitation, (ii) facilitating visitation with family members, (iii) maintaining remote contact with family members, (iv) managing visitation restrictions with residents and (v) navigating equitable access for residents and family members. While some staff welcomed the introduction of national guidance on restrictions as a source to refer family members to for justification of the LTCFs' decisions to restrict access, others reflected on the negative effect of limited social contact on resident wellbeing and difficulties in implementing the guidance. At times, LTCFs felt conflicted in their responsibility for supporting family members in visiting at the same time as communicating, enforcing and policing visitation restrictions. Guidance on facilitating remote contact required substantial time and resources required to support it. Discussion: The extent to which restricting visitation was a proportionate response to reducing the spread of COVID-19, within the wider context of negative impacts on relatives and family members, is an ongoing debate. This study identified some of the challenges experiences by LTCF staff in implementing such guidance, and calls into question the practicality of restricting visitation. Further research is needed on how social contact can be maintained between relatives and their families during pandemics, which is both equitable and achievable.

"New Normal:" Opportunities and Challenges Faced by Syringe Service Programs Following the Effects of the COVID-19 Pandemic

Syringe services programs (SSPs) provide critical evidence-based public health services that decrease harms from drug use for people who use drugs (PWUD). Many SSPs have experienced significant and evolving COVID-19-related disruptions. We aimed to characterize the impacts of COVID-19 on SSP operations in the United States approximately two years into the pandemic.

Participating sites, selected from a national sample of SSPs, completed a semi-structured interview via teleconference and brief electronic survey evaluating the impacts of COVID-19 on program operations. Data collection explored program financing, service delivery approaches, and perspectives on staff morale two years into the pandemic. Interview data were analyzed qualitatively using Rapid Assessment Process. Survey data were analyzed using descriptive statistics and triangulated with qualitative findings.

Twenty-five SSPs completed the interview and survey between April - June 2022. Triangulation of qualitative and quantitative data characterized the dynamic ways that demand for SSP services has evolved throughout the pandemic, and how approaches to care delivery have increased in flexibility and participant-centeredness. However, SSPs expressed worry about longer-term barriers to program participant and staff engagement, and a mismatch between available programmatic resources and the "new normal" of service delivery needs.

The COVID-19 pandemic has had lasting impacts on multiple facets of syringe service delivery. While SSPs consistently meet barriers with ingenuity, greater programmatic and staff support is needed to ensure SSPs can continue to meet the changing public health needs for PWUD.

The influence of hierarchy as an Implicit curriculum on medical trainees during the COVID-19 pandemic

BACKGROUND

Understanding the hierarchy in medical education is considered one of the hidden curriculum agendas that help to guide the medical trainees throughout their careers in healthcare. However, many negative aspects to the hierarchy and a few positive aspects have been uncovered in recent years. The COVID-19 pandemic had a tremendous impact on the healthcare system, deploying healthcare workers, including trainees from their primary speciality training to help caring for COVID-19 patients. The effect of hierarchy on medical trainees in such situations has not been discussed before. This study aims to uncover whether the COVID-19 pandemic emergency had any impact on the hierarchical system among healthcare workers.

METHODS

Individual semi-structured virtual interviews were conducted with six residents from different residency programs who were redeployed from their primary subspeciality to work with COVID-19 patients in different healthcare facilities across the country. The interviews aimed to uncover the resident's experience with the hierarchical structure while working in a diverse COVID-19 team. Responses were analysed qualitatively using an interpretive approach.

RESULT

Interviews yielded data broadly covered the aspects of 1. The impact of hierarchy during the pandemic on the resident's training in the absence of academic and clinical teaching and the limited exposure to clinical cases where the primary focus was treating COVID-19 patients. 2. The functional and dysfunctional impact of hierarchy on team dynamic before the COVID-19 pandemic from the residents 'perspective when they worked with different teams before the pandemic. 3. The functional and dysfunctional impact of hierarchy on team dynamic during the COVID-19 pandemic where some aspects of hierarchy, like mentorship, were prominent among teams. 4. The resident personal experience with the COVID-19 team during the pandemic in terms of team diversity and the war zone experience. The trainees described in a narrative approach the hierarchy impact on their experience during the COVID-19 pandemic.

CONCLUSIONS

The COVID-19 pandemic impacted the hidden curriculum of medical hierarchy in both functional and dysfunctional ways. This period underscored positive hierarchical elements, such as role clarity and team leadership, which were often overlooked pre-pandemic, while also exposing limitations that hindered flexibility and inclusivity.

Understanding the contribution of primary and community services to health system resilience during the COVID19 Pandemic in Aotearoa, New Zealand: a qualitative interview study

BACKGROUND

The COVID-19 pandemic exposed critical gaps in health system preparedness. This study, guided by a critical ecological model, examines the experiences of primary health and community services in Aotearoa New Zealand during the pandemic, focusing on their response to older people and their unpaid caregivers. The study aims to identify effective strategies for health system resilience. It addresses the question, what can we learn from the experiences of organisations supporting older people and caregivers during COVID-19, to prepare for other similar (emergency health) situations?

METHODS

A multidisciplinary research team conducted cross-sectional qualitative research through semi-structured telephone interviews with service providers (SPs) delivering primary or community home-based services to older people and caregivers across Aotearoa New Zealand. SPs included national organisations, Māori, Pacific, or rural providers and dementia services. Data were collected between July and October 2020. Notes were taken during interviews using a Rapid Appraisal Procedure grid, which were later revised and validated by participants. Data were analysed using a hybrid deductive-inductive thematic analysis, following COREQ guidelines.

RESULTS

Twenty staff (Chief Executive Officers and representatives) from national organisations (N = 4), Māori (N = 3), Pacific (N = 5), rural (N = 4), and regional dementia (N = 4) SPs were interviewed. SPs demonstrated resilience through collaboration, adapting delivery models, and upskilling staff. Key challenges involved inconsistent identification of vulnerable clients, limited access to aged residential care, and barriers relating to digital access which disproportionately affected older adults and staff, and clients in rural areas. Workforce shortages, and unclear public policy concerning travel across regions further complicated service delivery, highlighting the interaction between policy, community, interpersonal, and individual factors.

CONCLUSIONS

Aotearoa New Zealand managed COVID-19 effectively, but the pandemic exposed areas for improvement in health system resilience. The government demonstrated absorptive resilience through swift actions, including lockdowns and clear communication, while SPs exhibited adaptive resilience by modifying service protocols. Knowledge gained from this study can contribute to transformative resilience. Long-term strategic changes are necessary to improve emergency planning, such as developing a unified framework to inform a 'Priority List', enhancing workforce capacity, and addressing digital exclusion. These steps can strengthen health system robustness and preparedness for future crises.

Human resource management in homecare in England: managing people for safe care during crisis

BACKGROUND

Human resource management (HRM) of healthcare organisations plays an important role in improving the continuity of care, managing staff, and ensuring patient safety. During COVID-19, there were several HR-related issues, creating a significant challenging situation for health and social care institutions. This study explored the HRM issues that are associated with the patient safety in homecare, and how homecare providers have responded to these HR-related challenges during the COVID-19 pandemic. The aim of this is to explore the role of HRM practices in helping care organisations operate efficiently and supporting their workforce to adapt to future disruptive changes and crises.

METHODS

Qualitative strategies include narrative inquiry involving gathering information in the form of storytelling by the research participants. Between February 2021 and December 2021, data were collected through semi-structured interviews of 31 participants, including homecare staff (homecare transition practitioners, homecare social workers, and carers), family members, and service users in England.

RESULTS

The research identified key HRM challenges during the pandemic, including staff shortages, high turnover, ineffective communication, occupational stress for front-line carers, and lack of training, all adversely affecting the safety of homecare patients. In response, homecare providers employed strategies like opportunistic recruitment, digital technology for training and communication, and flexible work arrangements to mitigate these issues.

CONCLUSIONS

Several implications are proposed, with the over-riding aim of ensuring effective management of HRM practices in responding to address key areas: staffing, performance management, and training. Homecare providers should utilise short-term adaptive recruitment strategies, while also focusing on long-term workforce development and resilience to effectively respond to current and future care needs. Prioritising staff well-being for retention and care quality are crucial. Homecare providers are encouraged to offer flexible work arrangements and digital communication methods, all while being mindful of preventing technostress and digital exhaustion among their staff. They also need to bridge training gaps and employ effective delivery methods to equip healthcare workers with essential skills, thereby enhancing resilience and adaptability in homecare.

Consequences of the Pandemic on Mental Health of Healthcare Workers in the NHS

In recent years, the public health system of the United Kingdom, the National Healthcare System (NHS), has encountered difficulties that have been acknowledged in research studies and public policy discussions, such as resignations and staff shortages. During the COVID-19 pandemic, NHS healthcare workers were confronted with demanding circumstances, exacerbating the constraints of an already struggling system. With this, the authors of this paper aim to better understand the relationships between frustration at work, fear of infection, working hours, and the turnover intention of healthcare workers during the pandemic. This study employed a mixed-methods research approach, as a questionnaire survey was conducted along with an online self-administered interview questionnaire. Using mediation and moderated mediation analyses, it was found that the indirect effect of frustration at work through fear of infection on turnover intention was positively significant. Working hours moderated the mediation effect of fear of infection on the relationship between frustration at work and turnover intention. Surprisingly, the conditional indirect effect of frustration at work on turnover intention through fear of infection was the strongest among those with short working hours. This evidence was supplemented with qualitative results that enhance the understanding of why healthcare workers want to leave the system and the actions that can be taken on the organisational and policy fronts to address this issue.

Examining moral distress and injury resulting from the COVID-19 pandemic: Insights from the Ghanaian radiography workforce

BACKGROUND

Moral distress has been an issue under consideration in healthcare practice. The COVID-19 pandemic became a critical factor that contributed to heightened moral distress and injury among healthcare professionals, including radiographers. Despite the substantial engagement of radiographers in the management of COVID-19 patients, the consequent moral distress and injury states experienced by this critical frontline workforce have not been widely explored. This study investigated the level of moral distress and the coping mechanisms employed by radiographers in Ghana during the pandemic to provide valuable information to support radiographers and prepare the workforce better against any future pandemics.

METHODS

Utilising a cross-sectional design, a survey approach was employed for data collection between June 2023 and August 2023 from clinically-active radiographers who worked before and during the pandemic in Ghana. Both descriptive and inferential statistics were generated using Microsoft Excel 2019 and the Statistical Package for the Social Sciences (v.26).

RESULTS

Hundred (100) radiographers participated in the study. The result demonstrated that the COVID-19 pandemic escalated the risk of moral distress among radiographers from 22 % (n = 22) to 43 % (n = 43), with 33 % (n = 33) exhibiting signs of moral injury. This escalation impacted the mental health of 12 % (n = 12) of respondents and was reported as a contributor to career-changing decisions among radiographers. Notably, many of those affected did not seek formal support but relied on personal coping strategies and family support. Inadequate resources (69 %, n = 69), particularly regarding consumables, emerged as the primary cause of moral distress. The study underscored that the most effective means of mitigating moral distress in radiographers was through the provision of resources and additional staff support (66 %, n = 66).

CONCLUSION

This study sheds light on the state of moral distress and injury among radiographers during the COVID-19 pandemic, impacting the mental health of a minority and contributing to career-changing decisions. The findings emphasise the importance for healthcare institutions to proactively implement systems, such as resource provision, improved staffing, and emotional support, now and during similar future pandemics. This is crucial to address moral distress and cater to the mental health needs of radiographers, ensuring a resilient clinical radiography workforce.

The challenges of frontline health managers during the COVID-19 pandemic in India: A framework analysis study

Background

Coronavirus was first officially reported in Wuhan city of China in December 2019. As this novel coronavirus spread rapidly throughout the world, health care workers faced many difficulties addressing the pandemic. In the present study, we explored the challenges faced by front-line health managers on human resource management, execution of the central policies, and training and in formulating innovative approaches during the coronavirus disease 2019 (COVID-19) pandemic in India.

Methods

A qualitative study was conducted using framework analysis among front-line health managers concerning COVID-19 management at the district level. We conducted 120 in-depth interviews among eight states with the use of an interview guide.

Results

The results are described under five sections: 'challenges of front-line managers in policymaking and its execution', 'human resource management', 'gaps in local execution of central policies', 'challenges in training workforce and data management', and 'innovative approaches adopted during COVID 19'.

Conclusions

We observed that a centre-down approach was not appreciated much. Many participants felt that there was a need to understand the local context and appropriate amendment. The private system is a part of the Indian health system and can never be ignored; thus, all guidelines should include the private system.

Resilience for working in Ontario home and community care: registered practical nurses need the support of themselves, family and clients, and employers

BACKGROUND

The context of practice is often not explicit in the discourse around the personal and professional resilience of nurses. The unique factors related to providing nursing care in home and community care may provide novel insight into the resilience of this health workforce. Therefore, this research addressed how nurses build and maintain resilience working in the home and community care sector.

METHOD

A qualitative study was conducted between November 2022 to August 2023 using 36 in-depth interviews (29 registered practical nurses [RPNs], five supervisors of RPNs, two family/care partners (FCPs) of clients receiving home and community care services). Analysis was consistent with a grounded theory approach including coding and comparative methods.

RESULTS

The factors of personal and professional resilience were not distinct but rather mixed together in the experience of nurses having resilience working in the home and community care sector. The process of building and maintaining resilience as home and community care nurses was informed by three categories: (1) The conditions of working in HCC; (2) The rapport RPNs held with FCPs; and (3) The nurses' ability for supporting the 'self'. Multiple components to inform these categories were identified and illustrated by the words of the nurse participants.

CONCLUSION

The process of building and maintaining resilience by RPNs working in the home and community care sector was guided by the day-to-day experiences of providing care for clients and the conditions of being a mobile health care provider. However, nurses may sense when they need to support their 'self' and must be empowered to request and receive support to do so.

Resilience in home and community care registered practical nurses: a scoping review

Critical nursing shortages and experiences of burnout present a significant challenge in the home and community care (HCC) health sector. Determining what factors influence resiliency could inform HCC organizations in developing recruitment and retention resources and strategies. This scoping review identified factors that influence professional resilience in nurses working in the HCC sector. From 1819 documents identified from database searches, using a librarian-informed strategy, eight articles were included. Two domains emerged for HCC nurses, that is, i) professional and work-related characteristics of being resilient; and ii) strategies to promote professional nurse resilience. One domain emerged addressing organizational infrastructure, policy and practices contributing to professional nurse resilience in the HCC sector. The findings revealed that resiliency in HCC nurses extends beyond individual characteristics as nurse professionals, and their personal "self-care" strategies as individual people. Further research is needed to disentangle personal and professional resilience in nurses working in the HCC sector.

Professional perspectives on facilitators and barriers for high quality provision of health, education and social care services to disabled children in England during the COVID-19 pandemic: a qualitative study

OBJECTIVES

To understand how health, education and social care services for disabled children changed during the COVID-19 pandemic, what did or did not work well and what the impacts of service changes were on both professionals and families.

DESIGN

Qualitative study using semistructured interviews.

SETTING

Telephone and video call interviews and focus groups with professionals working in one of five local authority areas in England.

PARTICIPANTS

78 health, education and social care professionals working with children in one of five local authority areas in England.

RESULTS

There was a significant disruption to services and reduced contact with families during the early stages of the pandemic; nevertheless, professionals were able to reflect on innovative ways they interacted with and sought to support and maintain health, education and social care provision to disabled children and their families. As waitlists have substantially increased, this and the longevity of the pandemic were perceived to have had negative consequences for staff health and well-being, the health and psychosocial outcomes of children and young people, and their parent carers.

CONCLUSIONS

Key learning from this study for service recovery and planning for future emergencies is the need to be able to identify disabled children, classify their level of need and risk, assess the impact of loss of services and maintain clear communication across services to meet the needs of disabled children. Finally, services need to work collaboratively with families to develop child-centred care to strengthen resilience during service disruption.

Design and validation of a preliminary instrument to contextualize interactions through information technologies of health professionals

The communication of e-Health has been transformed with the advancement of information technologies, therefore it is feasible to carry out studies in the context of health professionals' interactions. Objective: This study aimed to design and validate a preliminary questionnaire to investigate the context of the communications of health professionals through information technologies considering three significant dimensions. Method: The stages provided by Hernández Sampieri guided the building, validation through Cronbach's alpha and factorial analysis. The questionnaire was applied to 43 participants who simulated health professionals. Results: We obtained an instrument that includes a demographic data section and 20 items distributed into three factors. Internal consistency reliability with Cronbach's alpha values generally of 0.848 and higher than 0.811 was obtained in each dimension. Kaiser-Meyer-Olkin's measure of sampling adequacy was regular, with 0.781, and Bartlett's test of sphericity was significant (p < 0.001). Conclusion: It is necessary to apply in real-world environments to reaffirm the results obtained.

Organizational response to the COVID-19 pandemic and its association with moral distress in community mental health teams in the UK: A qualitative study

In March 2020, Coronavirus-19 (COVID-19) rapidly spread across the globe impacting the mental health of the population and putting an overwhelming pressure on health services. Much has been written about the impact of the pandemic on health-care workers working in hospital settings but less attention has been paid to its effect on community mental health teams (CMHTs). This study is based on 21 remote interviews with community mental health professionals during the first wave of the COVID-19 pandemic. Interviews were transcribed and analysed using a thematic analysis whereby codes of similar meaning were grouped into main themes. Analysis identified three major contributors to moral distress; changes in the nature of contact with service users, changes to the place of work, and difficulties of balancing risks to the families of CMHT staff and service users. This study demonstrates that necessary organizational changes instituted to minimize the spread of COVID-19, required different ways of working which were not perceived to be in the best interests of service users or the families of CMHT staff. In order to comply with Government directives, CMHT staff were forced to behave in a way which did not match their moral values causing them to experience moral distress.

Decision to self-isolate during the COVID-19 pandemic in the UK: a rapid scoping review

OBJECTIVE

Testing for COVID-19 was a key component of the UK's response to the COVID-19 pandemic. This strategy relied on positive individuals self-isolating to reduce transmission, making isolation the lynchpin in the public health approach. Therefore, we scoped evidence to systematically identify and categorise barriers and facilitators to compliance with self-isolation guidance during the COVID-19 pandemic in the UK, to inform public health strategies in future pandemics.

DESIGN

A rapid scoping review was conducted.

SEARCH STRATEGY

Key terms were used to search literature databases (PubMed, Scopus and the WHO COVID-19 Research Database, on 7 November 2022), Google Scholar and stakeholder-identified manuscripts, ultimately including evidence published in English from UK-based studies conducted between 2020 and 2022.

DATA EXTRACTION AND SYNTHESIS

Data were extracted and synthesised into themes, organised broadly into capability, opportunity and motivation, and reviewed with key stakeholders from the UK Health Security Agency (UKHSA).

RESULTS

We included 105 sources, with 63 identified from UKHSA and used to inform their decision-making during the pandemic. Influences on the decision to comply with isolation guidance were categorised into six themes: perceived ability to isolate; information and guidance; logistics; social influences, including trust; perceived value; and perceived consequences. Individuals continuously assessed these factors in deciding whether or not to comply with guidance and self-isolate.

CONCLUSIONS

Decisions to self-isolate after a positive test were influenced by multiple factors, including individuals' beliefs, concerns, priorities and personal circumstances. Future testing strategies must facilitate meaningful financial, practical and mental health support to allow individuals to overcome the perceived and actual negative consequences of isolating. Clear, consistent communication of the purpose and procedures of isolating will also be critical to support compliance with self-isolation guidance, and should leverage people's perceived value in protecting others. Building public trust is also essential, but requires investment before the next pandemic starts.

Health risks at work mean risks at home: Spatial aspects of COVID-19 among migrant workers in precarious jobs in England

During COVID-19 lockdowns in England, 'key workers' including factory workers, carers and cleaners had to continue to travel to workplaces. Those in key worker jobs were often from more marginalised communities, including migrant workers in precarious employment. Recognising space as materially and socially produced, this qualitative study explores migrant workers' experiences of navigating COVID-19 risks at work and its impacts on their home spaces. Migrant workers in precarious employment often described workplace COVID-19 protection measures as inadequate. They experienced work space COVID-19 risks as extending far beyond physical work boundaries. They developed their own protection measures to try to avoid infection and to keep the virus away from family members. Their protection measures included disinfecting uniforms, restricting leisure activities and physically separating themselves from their families. Inadequate workplace COVID-19 protection measures limited workers' ability to reduce risks. In future outbreaks, support for workers in precarious jobs should include free testing, paid sick leave and accommodation to allow for self-isolation to help reduce risks to workers' families. Work environments should not be viewed as discrete risk spaces when planning response measures; responses and risk reduction approaches must also take into account impacts on workers' lives beyond the workplace.

Frontline Nurses' Job Satisfaction and Missed Nursing Care in a COVID-19 Dedicated Hospital in China: A Cross-Sectional Study

This study examined the current situation and relationship between missed nursing care (MNC) and job satisfaction among frontline nurses in a hospital dedicated to treating COVID-19 patients in China. Many dedicated hospitals were constructed or refurbished to centrally manage patients with COVID-19. Most nurses and doctors in these hospitals were redeployed from other departments or hospitals. This may have compromised nursing quality and job satisfaction. The omission of nursing care is a critical factor in assessing nursing quality; therefore, focusing on both MNC and job satisfaction is essential. This cross-sectional study used convenience and snowball sampling techniques to recruit frontline nurses working in a hospital for treating COVID-19 patients from November to December 2022. The questionnaires used in this study included sociodemographic information, job satisfaction, and the MISSCARE survey. Differences in job satisfaction and MISSCARE scores among participants' demographic deviations were explored using the Mann-Whitney Z test (two groups) and the Kruskal-Wallis H test (three or more groups). The correlation between participants' job satisfaction and missed nursing actions was analysed using Spearman's correlation analysis. The analysis included 306 frontline nurses. Frontline nurses' job satisfaction was high, and their MNC was low. The highest MNC was "offer rehabilitation care and guidance to patients in need every day." The most reported reasons for the MNC were "urgent patient situations." In addition, the job satisfaction scale, MNC scores, and reasons for MNC scores showed statistically significant differences among participants' demographic variables. Moreover, this study identified a negative correlation between frontline nurses' job satisfaction and MNC. Frontline nurses' job satisfaction was high, and their MNC was low. Frontline nurses' demographics were shown to affect their job satisfaction, MNC, and reported reasons. Furthermore, participants' job satisfaction can influence the MNC. Tailored interventions aimed at maintaining low levels of MNC should consider frontline nurses' demographic characteristics and job satisfaction.

Who works on the 'frontline'? comparing constructions of 'frontline' work before and during the COVID-19 pandemic

This article provides a comparative analysis of how frontline workers were constructed by the UK media prior to and during the COVID-19 pandemic in the UK. Both the News on the Web Corpus and the Coronavirus Corpus, as monitor corpora of web-based new articles, were utilised to identify changes in both the frequency and use of the word front*line from 2010 to 2021. Findings show that, following the outbreak of COVID-19, constructions of frontline work were more frequently associated with medical professions and became more figurative in nature. Our findings provide a counterpoint to claims that the COVID-19 pandemic led to an increased awareness of the critical nature of many types of 'low-skilled' work not previously recognised as essential. The study also extends previous research which has traced changes in language and its deployment during the COVID-19 pandemic.

The perceived impact of the COVID-19 pandemic on interprofessional education and collaborative practice: preliminary results from phase I of a global survey

The COVID-19 pandemic has had a sizable effect on interprofessional education and collaborative practice (IPECP) globally, yet much of the available literature on the topic remains anecdotal and locally bounded. This body of literature reflects celebratory and aspirational reports, with many case studies of successful response and perseverance under conditions of extreme pressure. There is, however, a more worrisome narrative emerging that pointed to differences in pandemic response with concerns raised about the sustainability of IPECP during and after the pandemic. The COVID-19 task force of InterprofessionalResearch.Global (IPRGlobal) set out to capture the successes and challenges of the interprofessional community over the pandemic through a longitudinal survey, with a view to inform global attempts at recovery and resilience. In this article, we report preliminary findings from Phase 1 of the survey. Phase 1 of the survey was sent to institutions/organizations in IPRGlobal (representing over 50 countries from Europe, North and South America, Australia, and Africa). The country-level response rate was over 50%. Key opportunities and challenges include the abrupt digitalization of collaborative learning and practice; de-prioritization of interprofessional education (IPE); and rise in interprofessional collaborative spirit. Implications for IPECP pedagogy, research, and policy post-pandemic are considered.

Path of fear: Experiences of health professionals in the fight against COVID-19

This study aimed to understand the expressions of fear in the journeys of health professionals who worked in the confrontation of coronavirus disease 2019 (COVID-19), in the city of Manaus, in the Brazilian Western Amazon. This is an exploratory qualitative study that adopts interpretive description as a method to generate informed knowledge responsive to the needs of the practice. We included 56 participants, comprising 23 health managers and 33 health workers (middle and higher level) of different professional categories. The results revealed three circles of experience: (1) knowledge and professional experience in dealing with the disease (unknown-known-experienced); (2) the growing proximity to death and loss (predicted-witnessed-suffered); and (3) the involvement and proximity to whatever affects the individual, their emotions, and personal transformations in the face of the threat (the collective, the neighbor, and oneself). Our results suggest that health professionals who worked during the COVID-19 pandemic in Manaus experienced insecurity, dread, and fear, illustrating the complexity of developing their activities in the front line of care and management during the different phases of the pandemic. A contribution of the study is precisely that of capturing this complexity, which suggests the impossibility of analyzing fear only in its simple manifestation, or in each circle of experience.

A Massive Open Online Course Delivered Just-in-Time: A Cohort Study

BACKGROUND

Just-in-time education enables knowledge improvement during health crises. This study was conducted to determine whether nurses' knowledge improved after participating in an innovative online education intervention designed to upskill subacute nurses to prepare for a health crisis.

METHOD

The intervention was developed by university nursing academics and supported and promoted through a partnership with a government health department and clinical nurses. Quantitative data obtained with a pretest/post-test knowledge survey were analyzed with independent samples and paired t tests.

RESULTS

Statistically significant improvements were seen in nurses' knowledge according to qualification level. The mean difference for knowledge improvement for registered nurses was 1.90, SD = 2.54, and the mean difference for knowledge improvement for enrolled nurses was 2.93, SD = 2.43 (mean difference = 1.03; 95% CI [0.04, 2.03].

CONCLUSION

The intervention was highly effective during the emergent and ongoing phases of the coronavirus disease 2019 pandemic. This study showed that delivering just-in-time education can improve nurses' knowledge. [J Contin Educ Nurs. 2023;54(10):472-479.].

Structure of the perception of health professionals regarding the quality of health services in the context of COVID-19

BACKGROUND

The health emergency caused by COVID-19 revealed the shortcomings of health services (HS), but little is known about how this has impacted the mental health of health professionals (HP) when perceiving these difficulties.

METHODS

Data were collected through an online survey administered to HP in Lima (Peru) between May and July 2020. A questionnaire was applied to identify perceived quality of health services (PHQS). A network analysis was performed, and the centrality measures of the variables were calculated and plotted.

RESULTS

A total of 507 HP completed the survey. In the network analysis of PHQS, four clusters were identified: (A) "empathy" and "recognition of competencies," (B) "logistical support," "protection," "personal early diagnosis," and "early family diagnosis"; C) "professional competence with regard to their treatment and treatment for their family," "equipment for their treatment and treatment for their family," "professional competence with regard to their treatment and treatment for their family," and "institutional support for them and their family"; and D) "fear of being infected or infecting their family," "fear of dying or death of a family member," "knowledge stability," "job burnout," and "role change." The variables of PHQS with the greatest centrality were "equipment for their treatment," "equipment for the treatment of their family," and "early family diagnosis."

CONCLUSIONS

The structure of the PHQS of HP describes direct and indirect influences of different variables in the context of COVID-19.

Experiences of health professionals in EU institutions during the Covid crisis

We performed a quantitative and a qualitative study, addressing the experiences of health services of 16 European Union institutions during the Covid-19 pandemic. Among the 165 eligible subjects, 114 (69%) participated in the survey. The biggest problem reported was limitation of social contacts (53%). At work, the biggest problems were workload (50%) and shortage of staff (37%). The majority were positive about teamwork. Teleworking was seen positively by 81%. Most participants felt better prepared for future situations by their recent experience (94%). Participants underlined the importance of strengthening the collaboration with the local health systems (80%), as well as with medical services and internal services within their own institution (75%). The qualitative analysis also reported participants' fear of becoming infected, and of their family members getting sick. Similarly reported were the sense of isolation and anxiety, the excessive workload and work complexity, shortage of staff, and the benefits of teleworking. Study findings highlight: i) the need to strengthen mental health support to health personnel, not only during crisis situations; ii) the need for sufficient health workers, with swift recruitment strategies in times of crisis; iii) the importance of clear protocols to ensure no shortages of personal protective equipment (PPE); iv) the importance of teleworking, which represents an opportunity for major reorganisation of work within EU medical services; v) the need to strengthen collaboration with local health systems and the medical services of EU institutions.

Indonesian healthcare professionals' experiences in rural and urban settings during the first wave of COVID-19: A qualitative study

INTRODUCTION

During the COVID-19 pandemic, healthcare workers (HCWs) faced unprecedented challenges, increased workload, and often struggled to provide healthcare services. We explored the experiences faced by HCWs working at primary healthcare centers (PHCs) and hospitals across urban and rural settings in Indonesia.

METHODS

As part of a larger multi-country study, we conducted semi-structured in-depth interviews with a purposive sample of Indonesian HCWs. We used thematic analysis to identify the main challenges described by the participants.

RESULTS

We interviewed 40 HCWs between December 2020 and March 2021. We identified that challenges varied depending on their role. i) For those in clinical roles, challenges included maintaining trust with communities, and patient referral issues; ii) for those in non-clinical roles, sub-optimal laboratory capacity and logistics, and lack of training were the main challenges; iii) for managerial roles, challenges included access to budget and supplies, and staff shortages due to isolation and overwork. There were also several cross-cutting challenges across all the roles including limited or rapidly changing information (in urban settings), and culture and communication (in rural settings). All of these challenges contributed to mental health issues among all HCW cadres.

CONCLUSIONS

HCWs across roles and settings were confronted with unprecedented challenges. Understanding the various challenges across different healthcare cadres and within different settings is crucial for supporting HCWs during pandemic times. In rural areas, in particular, HCWs should be more sensitive to cultural and linguistic differences to enhance the effectiveness and awareness of public health messages.

The COVID-19 pandemic impact on the Polish medical personnel work: a survey and in-depth interviews study

Objective

The objective of the study was to examine the impact of the COVID-19 pandemic on the work of medical personnel in terms of: task scope, preparation to perform medical tasks related to the pandemic, team collaboration, involvement in tasks performed, concerns about performing tasks related to the pandemic, stress levels.

Methods

The mixed-method approach was applied to this cross-sectional study. The online questionnaire which included 40 questions was completed via Google among medical personnel in Poland. Eight semi-structured, in-depth interviews were conducted to deepen the data obtained with the questionnaires.

Participants

The questionnaire was completed by 215 healthcare professionals, with the largest group being nurses (56.3%) followed by physicians (22.3%), midwives (11.6%) and other healthcare professionals (e.g., physiotherapists, paramedics, nutritionists - 9.8%). Among the respondents were people who worked in the hospital in the so-called "covid wards" (31.2%) and other hospital wards (60%) as well as people who were employed outside the hospital (8.8%).

Results

The pandemic affected the nature and range of tasks performed by health professionals. Initially, respondents felt unprepared to work under pandemic conditions, but over time their ratings increased in all areas studied. More than half of respondents reported no change in interpersonal relationship within the team, but nearly 35% noted a worsening and only one in 10 claimed improvement. Study participants rated their own commitment to tasks slightly higher than that of their colleagues (mean 4.9 and 4.4 respectively) but the overall rating was high. The mean self-rating of work stress increased from 3.7 before the pandemic to 5.1 during the pandemic. Most of the respondents were afraid of transmission of the infection to their relatives. Other fears included the possibility of making a medical error, not being able to help the patient, not having enough personal protective equipment (PPE) and contracting SARS-CoV-2.

Conclusion

The conducted study revealed that the organization of medical care in the initial period of the pandemic, especially the hospital care of patients infected with SARS-CoV-2, was quite chaotic. The most affected were the people who were transferred to work in the covid wards. Not all medical professionals were prepared to work with the COVID-19 patients, as they lacked experience working in such facilities, especially in intensive care units (ICU). Working under time pressure and under new conditions led mainly to an increase in perceived stress and conflicts between staff.

Mental distress of physicians in the outpatient care throughout the COVID-19 pandemic: emotional and supportive human relations matter - Cross-sectional results of the VOICE-study

BACKGROUND

The aim of this cross-sectional study was to evaluate the course of self-reported mental distress and quality of life (QoL) of physicians, working in the outpatient care (POC). Outcomes were compared with a control group of physicians working in the inpatient care (PIC), throughout the Corona Virus Disease (COVID)-19 pandemic. The impact of risk and protective factors in terms of emotional and supportive human relations on mental distress and perceived QoL of POC were of primary interest.

METHODS

Within the largest prospective, multi-center survey on mental health of health care workers (HCW), conducted during the first (T1) and second (T2) wave of the COVID-19 pandemic in Europe, we investigated the course of current burden (CB), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2) and QoL, cross-sectionally, in n = 848 POC (T1: n = 536, T2: n = 312). The primary outcomes were compared with an age- and gender-matchted control group of n = 458 PIC (T1: n = 262, T2: n = 196). COVID-19-, work-related, social risk and protective factors were examined.

RESULTS

At T1, POC showed no significant differences with respect to CB, depression, anxiety, and QoL, after Bonferroni correction. Whereas at T2, POC exhibited higher scores of CB (Cohen´s d/ Cd = .934, p < .001), depression (Cd = 1.648, p < 001), anxiety (Cd = 1.745, p < .001), work-family conflict (Cd = 4.170, p < .001) and lower QoL (Cd = .891, p = .002) compared with PIC. Nearly all assessed parameters of burden increased from T1 to T2 within the cohort of POC (e.g. depression: CD = 1.580, p < .001). Risk factors for mental distress of POC throughout the pandemic were: increased work-family conflict (CB: ß = .254, p < .001, 95% CI: .23, .28; PHQ-2: ß = .139, p = .011, 95% CI: .09, .19; GAD-2: ß = .207, p < .001, 95% CI: .16, .26), worrying about the patients´ security (CB: ß = .144, p = .007, 95% CI: .07, .22; PHQ-2: ß = .150, p = .006, 95% CI: .00, .30), fear of triage situations (GAD-2: ß = .132, p = .010, 95% CI: -.04, .31) and burden through restricted social contact in spare time (CB: ß = .146, p = .003, 95% CI: .07, .22; PHQ-2: ß = .187, p < .001, 95% CI: .03, .34; GAD-2: ß = .156, p = .003, 95% CI: -.01, .32). Protective factors for mental distress and QoL were the perceived protection by local authorities (CB: ß = -.302, p < .001, 95% CI: -.39, -.22; PHQ-2: ß = -.190, p < . 001, 95% CI: -.36, -.02; GAD-2: ß = -.211, p < .001, 95% CI: -.40, -.03; QoL: ß = .273, p < .001, 95% CI: .18, .36), trust in colleagues (PHQ-2: ß = -.181, p < .001, 95% CI: -.34, -.02; GAD-2: ß = -.199, p < .001, 95% CI: -.37, -.02; QoL: ß = .124, p = .017, 95% CI: .04, .21) and social support (PHQ-2: ß = -.180, p < .001, 95% CI: -.22, -.14; GAD-2: ß = -.127, p = .014, 95% CI: -.17, -.08; QoL: ß = .211, p < .001, 95% CI: .19, .23).

CONCLUSIONS

During the pandemic, the protective role of emotional and supportive human relations on the mental distress and quality of life of POC should be taken into account more thoroughly, both in practice and future research.

A Qualitative Study on Frontline Nurses' Experiences and Challenges in Providing Care for COVID-19 Patients in the Volta Region of Ghana: Implications for Nursing Management and Nursing Workforce Retention

Since the outbreak of COVID-19, studies related to the COVID-19 pandemic have been published widely. However, there are limited qualitative studies in Ghana that explored and shed light on frontline nurses' experiences and challenges in caring for patients diagnosed with COVID-19. This study aimed to explore frontline nurses' experiences and challenges of providing care for COVID-19 patients in the Volta Region of Ghana. This study adopted a descriptive qualitative research design to collect data. We conducted the study among frontline nurses who provided nursing care for COVID-19 patients in the Treatment Centre for COVID-19 cases in the Volta Region of Ghana. A purposive sampling method was used to select fifteen (15) participants for this study. We collected data through individual in-depth interviews facilitated by a semi-structured interview guide. The content analysis approach was used to analyse the data. The results showed: frontline nurses received inadequate information and training during the initial stages of the pandemic; stress and burnout because of inadequate staffing; logistical challenges; stigmatisation by family members and friends; frontline nurses displeased with the decision to exclude other nurses as frontline workers; participants made some recommendations towards supporting frontline nurses for effective management of patients during pandemics. This study revealed an in-depth understanding of the experiences of frontline nurses who provided nursing care to COVID-19 patients during the pandemic. Our study concludes that the frontline nurses experienced both physical and psychological problems while caring for COVID-19 patients at the treatment centre. Some challenges frontline nurses encountered were inadequate information on COVID-19 prevention and management in the early stages of the pandemic, logistical inadequacies, and stigmatisation in providing care for COVID-19 patients during the pandemic, all of which affected the quality of nursing care, work productivity, and efficiency. Therefore, nurse managers need to provide support to frontline nurses providing care for patients with COVID-19.

Mental health experiences and coping strategies of BAME care workers who worked in nursing and residential care homes during the COVID-19 pandemic in Luton, England

BACKGROUND

The COVID-19 pandemic intensified the risk factors for poor mental health among care workers in the UK. However, there is inadequate evidence on the mental health impact of COVID-19 on Black, Asian, and minority ethnic (BAME) care workers in particular. This study seeks to explore mental health experiences and coping strategies of BAME care workers who worked in nursing and residential care homes during the COVID-19 pandemic.

METHOD

This is a qualitative study conducted between February and May, 2021 in Luton, England. A sample of n = 15 care workers from BAME background working in nursing and residential care homes were recruited purposively using the snowball sampling technique. In-depth interviews were conducted around topics such as views on COVID-19, the impact of the COVID-19 pandemic on mental health and coping during the COVID-19 pandemic. Data from the interviews was analysed using the Framework Analysis Approach.

RESULTS

The COVID-19 pandemic had a negative impact on the participants' mental health as they experienced stress, depression, anxiety, trauma and paranoia. The majority of the participants explained that they managed their mental health by belief in God and religious practices, by keeping themselves busy doing activities they were passionate about, following government guidelines on the prevention of COVID-19, seeing the service users happy and some participants managed through support that was offered by the government. However, some participants did not have any support for their mental health.

CONCLUSION

Issues such as increased workload associated with COVID-19 restrictions engendered mental health problems among BAME care workers, however, the workload only further increased during the pandemic, but the health and social care sector was already affected by heavy workload due to staff shortages and this needs to be addressed through increasing their wages to encourage more people to work in the health and social care sector. In addition, some BAME care workers never received any support for their mental health during the pandemic. Hence, integrating mental health services such as counselling, supportive psychotherapy and recreational therapies in care homes could help to support the mental health of care workers in the COVID-19 era.

Experiences of nurses providing care for patients with COVID-19 in acute care settings in the early stages of the pandemic: A thematic meta-synthesis study

AIM

The aim of this work is to synthesize and interpret qualitative research examining the experiences of nurses providing care for patients with COVID-19 in acute care settings in the early stages of the pandemic in different countries.

BACKGROUND

The prevalence of disasters, including the pandemic, is increasing globally. It is important to understand nurses' experiences in depth to effectively manage extraordinary events that may occur in the future.

DESIGN

This is a thematic meta-synthesis study.

METHODS

Electronic databases, including CINAHL, MEDLINE, PubMed, Web of Science, OVID, and Scopus, were searched for publications from December 2019 to October 2020. The search was updated for publications to 30 May 2022. The thematic synthesis method was used to analyse and interpret the data.

FINDINGS

The experiences of the nurses giving care to patients with COVID-19 were grouped under four themes: (1) Difficulties encountered in the care of patients with COVID-19; (2) mixed emotions experienced in the care of patients with COVID-19; (3) coping strategies that nurses used in the management of the pandemic; (4) the benefits of the COVID-19 to nurses.

CONCLUSION

Nurses faced many difficulties and experienced mixed emotions while providing care for patients with coronavirus disease. Perceived social support was seen as the most important strategy for coping with these difficult situations. It is important to be aware of the difficulties and emotions experienced by nurses and support them during the COVID-19 pandemic for the management of future pandemics.

COVID-19 infection in nursing staff: A cohort study

AIM

This study aims to identify the working conditions of Brazilian nursing professionals and the risk factors for these professionals to become infected by coronavirus disease.

BACKGROUND

Understanding the factors that affected nursing professionals during the pandemic can support better nursing management.

DESIGN

This is a quantitative, cross-sectional survey study.

METHODS

Data collection was carried out between February and March 2022 in Brazil. All nursing professionals registered in the national database received by e-mail the study instrument with the data collection variables: professionals' sociodemographic and comorbid, professional and institutional characteristics, and professionals' health conditions and disease-related aspects for COVID-19.

RESULTS

Four thousand eight hundred sixty-two nursing professionals reported a lack of personal protective equipment for patient care, and 4424 were infected by coronavirus disease. The risk factors to become infected were having cardiovascular disease, being under 60 years of age, living in the northern region, using public transportation, working in a hospital, an emergency department or reference institution for COVID-19, living with an infected person and lack of respirators or waterproof aprons.

CONCLUSION

Multiple risk factors for infection with SARS-CoV-2 were demonstrated for the nursing professionals during the pandemic, highlighting current and future pandemics factors that are modifiable in a worthwhile time frame to minimize nurses' infection risks, such as inadequate working conditions associated with lack of essential personal protective equipment.

Impact of the COVID pandemic on mental health and training opportunities of Public Health Residents from 4 European countries: A cross-sectional study

Objectives

There is little evidence on the impact of the COVID-19 pandemic on Public Health Residents' (PHR) mental health (MH). This study aims at assessing prevalence and risk factors for depression, anxiety and stress in European PHR during the COVID-19 pandemic.

Methods

Between March and April 2021, an online survey was administered to PHR from France, Italy, Portugal and Spain. The survey assessed COVID-19 related changes in working conditions, training opportunities and evaluated MH outcomes using the Depression Anxiety Stress Scales-21. Multivariable logistic regressions were applied to identify risk factors.

Results

Among the 443 respondents, many showed symptoms of depression (60.5%), anxiety (43.1%) and stress (61.2%). The main outcome predictors were: female gender for depression (adjOR = 1.59, 95%CI [1.05-2.42]), anxiety (adjOR = 2.03, 95%CI [1.33-3.08]), and stress (adjOR = 2.35, 95%CI [1.53-3.61]); loss of research opportunities for anxiety (adjOR = 1.94, 95%CI [1.28-2.93]) and stress (adjOR = 1.98, 95%CI [1.26-3.11]); and COVID-19 impact on training (adjOR = 1.78, 95%CI [1.12-2.80]) for depression.

Conclusions

The pandemic had a significant impact on PHR in terms of depression, anxiety and stress, especially for women and who lost work-related opportunities. Training programs should offer PHR appropriate MH support and training opportunities.

Towards a Feminist Geo-legal Ethic of Caring Within Medical Supply Chains: Lessons from Careless Supply During the COVID-19 Pandemic

The COVID-19 crisis illustrates the fragility of supply chains. Countries with excellent health systems struggled to ensure essential supplies of food, medicines, and personal protective equipment which were vital to a fast and effective response. Using geo-legality, which maps the constitutive relations between law and space, we argue that the failure of supply chains in many western countries during the crisis reveals a fundamental tension between their role as facilitators of care and caring, and the logistic logics by which they operate. While supply chains link the intimate, domestic concerns of providing medical care with the globalised geographical concerns of moving goods across different jurisdictions at the right time, their contemporary organisation and regulation does not reflect the caring relations and public goods they are meant to support. Drawing on analysis of examples from Canada, the United Kingdom, and the United States, this article argues that a reconfiguration of supply chains in accordance with feminist approaches that place care at the centre of supply chain operation and organisation will be important to amendments of both domestic and global health law.

The impact of COVID-19 on the mental health and substance use health (MHSUH) workforce in Canada: a mixed methods study

BACKGROUND

The increased need for mental health and substance use health (MHSUH) services during the COVID-19 pandemic underscores the need to better understand workforce capacity. This study aimed to examine the pandemic's impact on the capacity of MHSUH service providers and to understand reasons contributing to changes in availability or ability to provide services.

METHODS

We conducted a mixed method study including a pan-Canadian survey of 2177 providers of MHSUH services and semi-structured interviews with 13 key informants. Survey participants answered questions about how the pandemic had changed their capacity to provide services, reasons for changes in capacity, and how their practice had during the pandemic. Thematic analysis of key informant interviews was conducted to gain a deeper understanding of the impact of the pandemic on the MHSUH workforce.

RESULTS

Analyses of the survey data indicated that the pandemic has had diverse effects on the capacity of MHSUH workers to provide services: 43% indicated decreased, 24% indicated no change, and 33% indicated increased capacity. Logistic regression analyses showed that privately funded participants had 3.2 times greater odds of increased capacity (B = 1.17, p < 0.001), and participants receiving funding from a mix of public and private sources had 2.4 times greater odds of increased capacity (B = 0.88, p < 0.001) compared to publicly funded participants. Top reasons for decreases included lockdown measures and clients lacking access or comfort with virtual care. Top reasons for increases included using virtual care and more people having problems relevant to the participant's skills. Three themes were constructed from thematic analysis of key informant interviews: the differential impact of public health measures, long-term effects of pandemic work conditions, and critical gaps in MHSUH workforce data.

CONCLUSIONS

The COVID-19 pandemic has had a substantial impact on the capacity of the MHSUH workforce to provide services. Findings indicate the importance of increasing and harmonizing funding for MHSUH services across the public and private sectors, developing standardized datasets describing the MHSUH workforce, and prioritizing equity across the spectrum of MHSUH services.

From Heroes to Scoundrels: Exploring the effects of online campaigns celebrating frontline workers on COVID-19 outcomes

This paper examines the effects of online campaigns celebrating frontline workers on COVID-19 outcomes regarding new cases, deaths, and vaccinations, using the United Kingdom as a case study. We implement text and sentiment analysis on Twitter data and feed the result into random regression forests and cointegration analysis. Our combined machine learning and econometric approach shows very weak effects of both the volume and the sentiment of Twitter discussions on new cases, deaths, and vaccinations. On the other hand, established relationships (such as between stringency measures and cases/deaths and between vaccinations and deaths) are confirmed. On the contrary, we find adverse lagged effects from negative sentiment to vaccinations and from new cases to negative sentiment posts. As we assess the knowledge acquired from the COVID-19 crisis, our findings can be used by policy makers, particularly in public health, and prepare for the next pandemic.

Being a technician during COVID-19: a qualitative cross-sectional survey on the experiences of clinical neurophysiology technicians

BACKGROUND

During the Sars-CoV-2 virus pandemic, Italy faced an unrivaled health emergency. Its impact has been significant on the hospital system and personnel. Clinical neurophysiology technicians played a central role (but less visibly so compared to other healthcare workers) in managing the COVID-19 pandemic. This research aims to explore the experiences of clinical neurophysiology technicians during the pandemic and contribute to the debate on the well-being of healthcare workers on the front line.

METHODS

We implemented a cross-sectional survey across Italy. It contained questions that were open-ended for participants to develop their answers and acquire a fuller perspective. The responses were analyzed according to the framework method.

RESULTS

One hundred and thirty-one responses were valid, and the following themes were generated: technicians' experiences in their relationship with patients, technicians' relationship with their workgroup and directors, and technicians' relationship with the context outside of their work. The first theme included sub-themes: fear of infection, empathy, difficulty, a sense of obligation and responsibility, anger, and sadness. The second theme contained selfishness/solidarity in the workgroup, lack of protection/collaboration from superiors, stress, and distrust. The last theme included fear, stress/tiredness, serenity, sadness, and anger.

CONCLUSION

This study contributes to building a humanized perspective for personnel management, bringing attention to the technical work of healthcare professionals in an emergency and the emotional and relational dimensions. These are the starting points to define proper, contextually adequate support.

Building a Covid-19 secure intensive care unit: A human-centred design approach

Background

The Covid-19 pandemic has highlighted weaknesses in the National Health Service critical care provision including both capacity and infrastructure. Traditionally, healthcare workspaces have failed to fully incorporate Human-Centred Design principles resulting in environments that negatively affect the efficacy of task completion, patient safety and staff wellbeing. In the summer of 2020, we received funds for the urgent construction of a Covid-19 secure critical care facility. The aim of this project was to design a pandemic resilient facility centred around both staff and patient requirements and safety, within the available footprint.

Methods

We developed a simulation exercise, underpinned by Human-Centred Design principles, to evaluate intensive care designs through Build Mapping, Tasks Analysis and Qualitative data. Build Mapping involved taping out sections of the design and mocking up with equipment. Task Analysis and qualitative data were collected following task completion.

Results

56 participants completed the build simulation exercise generating 141 design suggestions (69 task related, 56 patient and relative related, 16 staff related). Suggestions translated to 18 multilevel design improvements; five significant structural changes (Macro level) including wall moves and lift size change. Minor improvements were made at a Meso and Micro design level. Critical care design drivers identified included functional drivers (visibility, Covid-19 secure environment, workflow, and task efficiency) and behavioural drivers (learning and development, light, humanising intensive care and design consistency).

Conclusion

Success of clinical tasks, infection control, patient safety and staff/patient wellbeing are highly dependent on clinical environments. Primarily, we have improved clinical design by focusing on user requirements. Secondly, we developed a replicable approach to exploring healthcare build plans revealing significant design changes, that may have only been identified once built.

Feeling Informed and Safe Are Important Factors in the Psychosomatic Health of Frontline Workers in the Health Sector during the COVID-19 Pandemic in Austria

The global spread of the coronavirus disease (COVID-19) has created new challenges for the entire healthcare system, and those who work directly with the patients or even on the front lines with COVID-19 patients have been particularly stressed. Only a few studies are currently available investigating psychosomatic symptoms among healthcare workers, particularly frontline workers, over the entire pandemic period (2020-2022). There is also a lack of knowledge about strategies to prevent stress during and after a health crisis.

METHODS

An online survey was conducted at three times (April 2020, winter 2020/2021, and winter 2021/2022) during the COVID-19 pandemic in Austria. The sample included 160 healthcare workers at screening time 1, 1.361 healthcare workers at screening time 2, and 1.134 healthcare workers at screening time 3. The survey included COVID-19 work-related fears, satisfaction with the frontline work, and standardized inventories to assess psychosomatic symptoms, such as the Patient Health Questionnaire (PHQ-D).

RESULTS

Psychosomatic symptoms were more common among women compared to men, and among frontline workers compared to non-frontline workers, especially during the course of the pandemic at t2 and t3. Self-reported scores of COVID-19 work-related fears were significantly associated with psychosomatic symptoms. Furthermore, in frontline workers, there was a significant association between the feeling of being safe and well-informed and psychosomatic symptoms.

CONCLUSION

COVID-19 work-related fears and psychosomatic symptoms have been prevalent among healthcare workers throughout the pandemic. Feeling safe and informed appears to be essential to prevent psychosomatic symptoms, leading to a recommendation for employers in the healthcare sector to focus on communication and information. As frontline workers are especially prone to psychosomatic symptoms, more stress prevention programs for them will be essential to maintain productivity and reduce sick days and fluctuations in the healthcare system.

Barriers and Facilitators to the Use of Personal Protective Equipment in Long-Term Care: A Scoping Review

OBJECTIVE

To review existing literature evaluating barriers and facilitators to the use of personal protective equipment (PPE) by health care workers in long-term care (LTC).

DESIGN

Scoping review.

SETTING AND PARTICIPANTS

Health care workers in LTC settings.

METHODS

Several online databases were searched and a gray literature search was conducted. Study inclusion criteria were (1) conducted in nursing homes or LTC settings, (2) focused on LTC health care workers as the study population, and (3) identified barriers and/or facilitators to PPE use. The Theoretical Domains Framework (TDF), which assesses barriers to implementation across 14 behavioral change domains, was used to extract and organize data about barriers and facilitators to appropriate use of PPE from the included studies.

RESULTS

A total of 5216 references were screened for eligibility and 10 studies were included in this review. Eight of the 10 studies were conducted during the COVID-19 pandemic. Several barriers and facilitators to PPE use were identified. The most common TDF domain identified was environmental context and resources, which was observed in 9 of the 10 studies. Common barriers to PPE use included supply issues (n = 7 studies), the cost of acquisition (n = 3 studies), unclear guidelines on appropriate use of PPE (n = 2 studies), difficulty providing care (n = 2 studies), and anxiety about frightening patients (n = 2 studies). Having PPE readily available facilitated the use of PPE (n = 2 studies).

CONCLUSIONS AND IMPLICATIONS

Further research is necessary to identify barriers and facilitators more extensively across behavior change domains to develop effective strategies to improve PPE use and prevent infection transmission within LTC.

Stressors Among Healthcare Workers: A Summative Content Analysis

Healthcare workers are experiencing high stress and burnout, at rates up to 70%, hindering patient care. Studies often focus on stressors in a particular setting or within the context of the pandemic which limits understanding of a more comprehensive view of stressors experienced by healthcare workers. The purpose of this study was to assess healthcare workers’ self-reported major stressors. Between June 2018 and April 2019, U.S. healthcare workers ( N = 2,310) wrote answers to an open-ended question: “What are your biggest stressors as you look back over the last few weeks?” A summative content analysis was used to analyze the data. Healthcare workers described three types of stressors: work stressors (49% of total stressors), personal life stressors (32% of total stressors), and stressors that intersect work and personal life (19% of total stressors). Future research and clinical practice should consider the multi-faceted sources of stress.

Challenges faced by frontline health managers during the implementation of COVID-19 related policies in India: A qualitative analysis

Background & objectives

The COVID-19 pandemic exposed the strengths and weaknesses of the healthcare systems across the world. Many directives, guidelines and policies for pandemic control were laid down centrally for its implementation; however, its translation at the periphery needs to be analyzed for future planning and implementation of public health activities. Hence, the objectives of this study were to identify the challenges faced by frontline health managers in selected States in India during the pandemic with regard to implementation of the COVID-19-related policies at the district level and also to assess the challenges faced by the them in adapting the centrally laid down COVID-19 guidelines as per the local needs of the district.

Methods

A qualitative study using the grounded theory approach was conducted among frontline district-level managers from eight different States belonging to the north, south, east and west zones of India. The districts across the country were selected based on their vulnerability index, and in-depth interviews were conducted among the frontline managers to assess the challenges faced by them in carrying out COVID-19 related activities. Recorded data were transcribed verbatim, manually coded and thematically analyzed.

Results

Challenges faced in implementing quarantine rules were numerous, and it was also compounded by stigma attached with the disease. The need for adapting the guidelines as per local considerations, inclusion of components of financial management at local level, management of tribal and vulnerable populations and migrants in COVID context were strongly suggested. The need to increase human resource in general and specifically data managers and operators was quoted as definite requirement.

Interpretation & conclusions

The COVID-19 guidelines provided by the Centre were found to be useful at district levels. However, there was a need to make some operational and administrative modifications in order to implement these guidelines locally and to ensure their acceptability.

Time Analysis of an Emergent Infection Spread Among Healthcare Workers: Lessons Learned from Early Wave of SARS-CoV-2

AIM

To find whether an emergent airborne infection is more likely to spread among healthcare workers (HCW) based on data of SARS-CoV-2 and whether the number of new cases of such airborne viral disease can be predicted using a method traditionally used in weather forecasting called Autoregressive Fractionally Integrated Moving Average (ARFIMA).

METHODS

We analyzed SARS-CoV-2 spread among HCWs based on outpatient nasopharyngeal swabs for real-time polymerase chain reaction (RT-PCR) tests and compared it to non-HCW in the first and the second wave of the pandemic. We also generated an ARFIMA model based on weekly case numbers from February 2020 to April 2021 and tested it on data from May to July 2021.

RESULTS

Our analysis of 8998 tests in the 15 months period showed a rapid rise in positive RT-PCR tests among HCWs during the first wave of pandemic. In the second wave, however, positive patients were more commonly non-HCWs. The ARFIMA model showed a long-memory pattern for SARS-CoV-2 (seven months) and predicted future new cases with an average error of ±1.9 cases per week.

CONCLUSION

Our data indicate that the virus rapidly spread among HCWs during the first wave of the pandemic. Review of published literature showed that this was the case in multiple other areas as well. We therefore suggest strict policies early in the emergence of a new infection to protect HCWs and prevent spreading to the general public. The ARFIMA model can be a valuable forecasting tool to predict the number of new cases in advance and assist in efficient planning.

Healthcare workers' experiences in caring for critically ill COVID-19 patients at a tertiary hospital in Malawi

Introduction

The coronavirus pandemic overwhelmed the healthcare landscape, placing a strain on healthcare workers worldwide. In addition to directly causing the deaths of people, the COVID-19 pandemic disrupted critical health services in developing countries. The study aimed to explore the experiences of healthcare workers who cared for critically ill COVID-19 patients at a tertiary hospital in Malawi.

Methods

A qualitative descriptive design was used. Data were gathered through in-depth interviews with doctors, clinical officers, nurses, and allied staff (n=25) who were involved in the care of critically ill COVID-19 patients at the hospital's COVID-19 treatment centres during the first and second waves of the pandemic in Malawi. The interviews were conducted in English, audiotaped, and later transcribed verbatim. Conventional content analysis was used to analyse the data following the steps proposed by Hsieh and Shannon1.

Results

The overall experience of the health workers was negative. However, delivering care to critically ill COVID-19 patients was associated with positive and negative experiences. The positive experience was a result of teamwork among staff and support from hospital authorities and the community. Negative experiences, on the other hand, were attributed to a lack of knowledge and skills in managing critically ill COVID-19 patients, a lack of resources, and abuse by some patients and members of the community. Furthermore, there was fear of contracting the virus from patients and fellow health workers while providing care.

Conclusion

The findings point to the need for adequate preparedness within the health sector to support and protect the healthcare workers and individuals they look after. There is a need for disease awareness strategies for health workers and the general public for future pandemics.

Making global health 'work': Frontline workers' labour in research and interventions

This Special Issue of Global Public Health draws on the concept of 'body work' among those employed to support operationalising, researching, and implementing global health while in direct contact with the bodies of others. This collection brings into sharp focus the specific forms of labour of those occupying positions as frontline workers - those who make global health work. Making Global Health Work includes authors from diverse backgrounds, disciplines, and geographies. Through compelling ethnographies, qualitative interviews, and focus group discussions, they explore 'body work' globally, including: Afghanistan, Bangladesh, Ethiopia, India, Indonesia, Kenya, Malawi, Myanmar, Nigeria, Nepal, Pakistan, Sierra Leone, South Sudan, Tanzania, Thailand, The Democratic Republic of the Congo (DRC), The Gambia, Vietnam, and Zimbabwe. These papers demonstrate that proximity to, and work on, the bodies of others engenders specific forms of (physical, emotional, mental, social, ethical, and political) labour, which occur not only in emergencies and pandemics, but also throughout the quotidian practice of global health. Making Global Health Work provides insights into the provision of maternal healthcare, treatment of multidrug resistant tuberculosis, rapid HIV testing programmes, sleeping sickness and polio eradication campaigns, mass drug administration clinical trials, epidemic preparedness and response, and the management and care of dead bodies. These papers argue for greater attention by global health actors on frontline workers in management of the complexities involved in making global health work.

Covid-19 Coping Survey: an In-depth Qualitative Analysis of Free-Text Responses from People With and Without Existing Health Conditions in the UK

BACKGROUND

There is currently a lack of qualitative research exploring how cognitive and emotional reactions to the threat of SARS-CoV-2 affected the health behaviours of people living with and without pre-existing mental and physical health conditions. We aimed to investigate how the threat of SARS-CoV-2 influenced the thoughts, feelings and health behaviours of people with and without pre-existing health conditions in the UK.

METHODS

A cross-sectional online survey of UK adults (aged 18 and over). Free-text responses were analysed using a qualitative framework approach guided by the Common-Sense Model of Self-Regulation.

RESULTS

Of the 9110 respondents, 2763 participants provided at least one free-text response. Three main themes were derived from the data. Theme one, locus of control, reports on the extent to which people felt in control during the first wave of the pandemic. Theme two, emotional impact, conveys how individuals felt and how people's personal circumstances made them more vulnerable to experiencing negative emotions during the pandemic. Theme three, coping strategies, describes common health-protective and health-threatening behaviours performed by individuals, as well as the importance of social connectedness, the social context and the need for collective action during the first national lockdown.

CONCLUSION

Complex psychological interventions including behaviour change are required to mitigate the psychological burden of the SARS-CoV-2 pandemic and increase autonomy in people with and without pre-existing conditions during this highly uncertain time. Behavioural scientists can support governments and public health agencies to develop evidence-based communication and behaviour change strategies that support people to address unhelpful beliefs and emotions and strengthen coping abilities as the UK moves through and beyond the SARS-CoV-2 pandemic.

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.

"I don't mean to be rude, but could you put a mask on while I'm here?" A qualitative study of risks experienced by domiciliary care workers in Wales during the COVID-19 pandemic

Domiciliary care workers (DCWs) continued to provide care to adults in their own homes throughout the COVID-19 pandemic. The evidence of the impact of COVID-19 on health outcomes of DCWs is currently mixed. The OSCAR study will quantify the impact of COVID-19 upon health outcomes of DCWs in Wales, explore causes of variation and extrapolate to the rest of the UK DCW population. An embedded qualitative study aimed to explore DCW experiences during the pandemic, including factors that may have varied risk of exposure to COVID-19 and adverse health and wellbeing outcomes. Registered DCWs working throughout Wales were invited to participate in a semi-structured telephone interview. 24 DCWs were interviewed between February and July 2021. Themes were identified through inductive analysis using thematic coding. Several themes emerged relating to risk of exposure to COVID-19. First, general changes to the role of the DCW during the pandemic were identified. Second, practical challenges for DCWs in the workplace were reported, including staff shortages, clients and families not following safety procedures, initial shortages of personal protective equipment (PPE), DCW criticism of standard use PPE, client difficulty with PPE and management of rapid antigen testing. Third, lack of government/employer preparation for a pandemic was described, including the reorganisation of staff clients and services, inadequate or confusing information for many DCWs, COVID-19 training and the need for improved practical instruction and limited official standard risk assessments for DCWs. Pressure to attend work and perceptions of COVID-19 risk and vaccination was also reported. In summary, this paper describes the risk factors associated with working during the pandemic. We have mapped recommendations for each problem using these qualitative findings including tailored training and better support for isolated team members and identified the required changes at several socio-ecological levels.

The implications of COVID-19 on health and social care personnel in long-term care facilities for older people: An international scoping review

This scoping review mapped out the existing literature pertaining to health and social care personnel experiences during the coronavirus disease-2019 (COVID-19) pandemic and their work in a long-term care setting for older people. This review identified the gaps in the implications of health and social care personnel's own health and well-being during the pandemic as well as the ethical dilemmas inherent in providing care during the COVID-19 pandemic. The authors utilised the PRISMA checklist for undertaking scoping reviews. The Databases Medline, PsychINFO, CINAHL, SCOPUS, Web of Science and Google Scholar were searched for relevant articles in English that were published between March 28, 2020 and June 1, 2022. This time period was selected to focus specifically on the COVID-19 pandemic. In the context of this review, long-term care facilities were defined to include institutions such as nursing homes, skilled nursing facilities, retirement homes and residential care homes. The gaps identified were a paucity of research on the experiences of health and social care personnel in long-term care facilities, the impact on their mental health, and the wider challenges experienced during the COVID-19 pandemic is discussed. The findings of this scoping review indicate a need for adequate preparedness during a pandemic within the health and social care sector to protect health and social care personnel and the individuals they care for.