The impact of the COVID-19 pandemic on the mental health of healthcare professionals

Network analysis on psychopathological symptoms, psychological measures, quality of life and COVID-19 related factors in Chinese psychiatric patients in Hong Kong

BACKGROUND

Psychiatric patients are susceptible to adverse mental health impacts during COVID-19, but complex interplays between psychopathology and pandemic-related variables remain elusive. This study aimed to investigate concomitant associations between psychopathological symptoms, psychological measures and COVID-19 related variables in Chinese psychiatric patients during the peak of fifth pandemic wave in Hong Kong.

METHODS

We employed network analysis to investigate inter-relationships among psychopathological symptoms (including depression, anxiety, post-traumatic stress disorder-like [PTSD-like] symptoms, insomnia, psychotic symptoms), cognitive complaints, health-related quality of life, loneliness, resilience and selected pandemic-related factors in 415 psychiatric outpatients between 28 March and 8 April, 2022. Network comparisons between genders, diagnosis (common mental disorders [CMD] vs. severe mental disorders [SMD]), and history of contracting COVID-19 at fifth wave were performed as exploratory analyses.

RESULTS

Our results showed that anxiety represented the most central node in the network, as indicated by its highest node strength and expected influence, followed by depression and quality of life. Three comparatively strong connections between COVID-19 and psychopathological variables were observed including: fear of contagion and PTSD-like symptoms, COVID-19 stressor burden and PTSD-like symptoms, and COVID-19 stressor burden and insomnia. Network comparison tests revealed significant network structural difference between participants with history of contracting COVID-19 and those without, but showed no significant difference between genders as well as between CMD and SMD patients.

CONCLUSIONS

Our findings suggest the pivotal role of anxiety in psychopathology network of psychiatric patients amidst COVID-19. Pandemic-related variables are critically associated with trauma/stress and insomnia symptoms. Future research is required to elucidate potential network structural changes between pandemic and post-COVID periods.

Structural Factors Contributing to Compassion Fatigue, Burnout, and Secondary Traumatic Stress Among Hospital-Based Healthcare Professionals During the COVID-19 Pandemic

High levels of burnout among healthcare providers (HCPs) have been a widely documented phenomenon, which have been exacerbated during the COVID-19 pandemic. In the United States, qualitative studies that are inclusive of HCPs in diverse professional roles have been limited. Therefore, we utilized a qualitative-quantitative design to examine professional quality of life in terms of compassion fatigue, burnout, and secondary traumatic stress among hospital-based HCPs, including social workers, hospitalists, residents, and palliative care team members during COVID-19. HCPs (n = 26) participated in virtual semi-structured focus groups or individual interviews and online surveys (n = 30) including the Professional Quality of Life (ProQOL) Scale. While ProQOL scores indicated low levels of compassion fatigue, burnout, and secondary traumatic stress, thematic analysis of our qualitative data included rich descriptions of compassion fatigue, burnout, and secondary traumatic stress. Safety concerns and value misalignment characterized structural stressors perceived to contribute to HCP compassion fatigue, burnout, and secondary traumatic stress. The discrepancy between our qualitative and quantitative findings may be indication that modifications to current screenings are warranted. These findings also suggest a need to identify and implement structural and policy changes that increase HCPs' physical and emotional safety and promote better alignment of institutional interests with HCP values.

Anxiety prevalence and associated factors among frontline nurses following the COVID-19 pandemic: a large-scale cross-sectional study

Introduction

Nurses are more likely to experience anxiety following the coronavirus 2019 epidemic. Anxiety could compromise nurses' work efficiency and diminish their professional commitment. This study aims to investigate nurses' anxiety prevalence and related factors following the pandemic in multiple hospitals across China.

Methods

An online survey was conducted from April 16 to July 3, 2023, targeting frontline nurses who had actively participated in China. Anxiety and depression symptoms were assessed using the Self-rating Anxiety Scale and the Self-rating Depression Scale (SDS), respectively. Multivariable logistic regression analysis was employed to identify factors linked with anxiety.

Results

A total of 2,210 frontline nurses participated in the study. Overall, 65.07% of participants displayed clinically significant anxiety symptoms. Multivariable logistic regression revealed that nurses living with their families [2.52(95% CI: 1.68-3.77)] and those with higher SDS scores [1.26(95% CI: 1.24-1.29)] faced an elevated risk of anxiety. Conversely, female nurses [0.02(95% CI: 0.00-0.90)] and those who had recovered from infection [0.05(95%CI: 0.07-0.18)] demonstrated lower rates of anxiety.

Discussion

This study highlights the association between SDS score, gender, virus infection, living arrangements and anxiety. Frontline nurses need to be provided with emotional support to prevent anxiety. These insights can guide interventions to protect the mental well-being of frontline nurses in the post-pandemic period.

What are effective strategies to respond to the psychological impacts of working on the frontlines of a public health emergency?

Background

The COVID-19 pandemic has disrupted the healthcare and public health sectors. The impact of working on the frontlines as a healthcare or public health professional has been well documented. Healthcare organizations must support the psychological and mental health of those responding to future public health emergencies.

Objective

This systematic review aims to identify effective interventions to support healthcare workers' mental health and wellbeing during and following a public health emergency.

Methods

Eight scientific databases were searched from inception to 1 November 2022. Studies that described strategies to address the psychological impacts experienced by those responding to a public health emergency (i.e., a pandemic, epidemic, natural disaster, or mass casualty event) were eligible for inclusion. No limitations were placed based on study design, language, publication status, or publication date. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute critical appraisal tools. Discrepancies were resolved through discussion and a third reviewer when needed. Results were synthesized narratively due to the heterogeneity of populations and interventions. Outcomes were displayed graphically using harvest plots.

Results

A total of 20,018 records were screened, with 36 unique studies included in the review, 15 randomized controlled trials, and 21 quasi-experimental studies. Results indicate that psychotherapy, psychoeducation, and mind-body interventions may reduce symptoms of anxiety, burnout, depression, and Post Traumatic Stress Disorder, with the lowest risk of bias found among psychotherapy interventions. Psychoeducation appears most promising to increase resilience, with mind-body interventions having the most substantial evidence for increases in quality of life. Few organizational interventions were identified, with highly heterogeneous components.

Conclusion

Promoting healthcare workers' mental health is essential at an individual and health system level. This review identifies several promising practices that could be used to support healthcare workers at risk of adverse mental health outcomes as they respond to future public health emergencies.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=203810, identifier #CRD42020203810 (PROSPERO).

Role of resilience and self-coping strategy in determining positive emotions during pandemic among healthcare professionals in Iran

BACKGROUND

The unprecedented COVID-19 pandemic placed immense stress on healthcare professionals worldwide. This strain often resulted in imbalances in their physical and mental well-being, necessitating effective coping mechanisms. In light of this context, this study investigates the correlations between the fear of COVID-19, self-coping strategies, and positive emotions, with particular reference to the Iranian health care industry.

METHODS

Data were collected from 1050 healthcare professionals in Iran and the data were analysed sing structural equation modelling.

RESULTS

The study revealed that pandemic fear negatively impacts self-coping strategies and positive emotions during crisis scenarios. Conversely, self-coping strategies have a positive correlation with positive emotions. The research also underscored the role of resilience in reinforcing the favorable link between self-coping strategies and positive emotions.

CONCLUSIONS

This study is one of the first to explore the significance of resilience and self-coping strategies among Iranian healthcare professionals during the pandemic. Its findings offer valuable insights for researchers and practitioners, paving the way for further contributions in this field. Future research endeavors may consider investigating the effects of various psychological interventions, including breathing techniques, self-talk, physical exercises, yoga, optimizing sleep, and dietary measures on the resilience and self-coping practices of healthcare professionals.

Quality of working life of employees in public healthcare organization in Finland: A cross-sectional study

AIM

Work dissatisfaction, burnout and workforce shortage are major problems in healthcare globally, all of which are associated with QWL. Previous studies have found that the QWL of healthcare professionals is moderate or low. The aim was to describe the quality of working life (QWL) of employees working in public healthcare and describe the association between QWL and background variables.

DESIGN

This study had a quantitative cross-sectional survey design.

METHODS

Data was collected from the employees of a Finnish healthcare organization in autumn 2021 using an online questionnaire (n = 837). Convenience sampling was used in the selection of the healthcare organization. The study was reported according to STROBE guidelines.

RESULTS

The QWL was moderate, and the mean QWL index calculated from the questionnaire responses was 0.524. The QWL index was lowest in healthcare professionals and highest in upper management, with some dissatisfaction towards leadership noted.

Untangling the Professional Web: Understanding the Impact of Work-Related Factors on the Mental Health of Healthcare Professionals During the Late Stages of Covid-19 Pandemic

Purpose

The COVID-19 pandemic has determined an extraordinary challenge to healthcare systems worldwide. The extraordinary circumstances, characterized by elevated stress levels, prolonged working hours, new medical procedures, media attention, and high population expectations, have created an extremely stressful situation for healthcare professionals. This period has offered a unique opportunity to examine the medical system and the responses of healthcare practitioners to stress. This research aimed to identify the work-related factors that significantly impact the mental health of healthcare professionals.

Patients and Methods

Three mental health variables were assessed: anxiety, depression and stress. The work-related factors considered were professional degree, type of medical unit (COVID or non-COVID), the number of hours spent at work in a single shift, type of shifts, monthly on-call frequency, and number of COVID-19 treated patients per month. In the spring of 2022, three inventories and a demographic survey were distributed and completed online by 300 healthcare professionals from Timisoara's public hospitals in Romania.

Results

Among the respondents, 47.7% reported mild symptoms of anxiety, 65.3% reported moderate levels of stress, and 33% of the participants reported mild symptoms of depression. The intensity of anxious, depressive, and stress symptoms varied significantly depending on the professional degree, number of on-calls per month, the type of medical unit where the participants worked, and the number of SARS CoV-2 patients treated in the previous month.

Conclusion

Current data underlines the urgency of implementing effective strategies to reduce the stress and anxiety of medical practitioners who work with COVID-19 patients. Possible interventions encompass a variety of approaches, such as improving working conditions, reducing working hours where possible, increasing access to mental health services, and promoting team-building activities to enhance social support among colleagues. Digital mental health interventions, including online counseling and stress management programs, have also shown promise in these challenging times. Sustaining the mental health of medical practitioners is vital to support the continued provision of first-rate care to patients and to build a resilient healthcare workforce capable of navigating future health crises.

From purists to pragmatists: a qualitative evaluation of how implementation processes and contexts shaped the uptake and methodological adaptations of a maternal and neonatal quality improvement programme in South Africa prior to, and during COVID-19

BACKGROUND

Despite progress, maternal and neonatal mortality and still births remain high in South Africa. The South African National Department of Health implemented a quality improvement (QI) programme, called Mphatlalatsane, to reduce maternal and neonatal mortality and still births. It was implemented in 21 public health facilities, seven per participating province, between 2018 and 2022.

METHODS

We conducted a qualitative process evaluation of the contextual and implementation process factors' influence on implementation uptake amongst the QI teams in 15 purposively selected facilities. Data collection included three interview rounds with the leaders and members of the QI teams in each facility; intermittent interviews with the QI advisors; programme documentation review; observation of programme management meetings; and keeping a fieldwork journal. All data were thematically analysed in Atlas.ti. Implementation uptake varied across the three provinces and between facilities within provinces.

RESULTS

Between March and August 2020, the COVID-19 pandemic disrupted uptake in all provinces but affected QI teams in one province more severely than others, because they received limited pre-pandemic training. Better uptake among other sites was attributed to receiving more QI training pre-COVID-19, having an experienced QI advisor, and good teamwork. Uptake was more challenging amongst hospital teams which had more staff and more complicated MNH services, versus the primary healthcare facilities. We also attributed better uptake to greater district management support. A key factor shaping uptake was leaders' intrinsic motivation to apply QI methodology. We found that, across sites, organic adaptations to the QI methodology were made by teams, started during COVID-19. Teams did away with rapid testing of change ideas and keeping a paper trail of the steps followed. Though still using data to identify service problems, they used self-developed audit tools to record intervention effectiveness, and not the prescribed tools.

CONCLUSIONS

Our study underscores the critical role of intrinsic motivation of team leaders, support from experienced technical QI advisors, and context-sensitive adaptations to maximise QI uptake when traditionally recognised QI steps cannot be followed.

A new form of checking obsessive-compulsive disorder in physicians: Another consequence of the COVID-19 pandemic. A case series

The current article provides information that facilitates early identification of a new form of checking obsessive-compulsive disorder (OCD) detected in physicians during the COVID-19 pandemic. This article describes three cases of professional checking OCD in physicians. Physicians with checking OCD are obsessively concerned about making a mistake that will result in fatal consequences. The most frequent strategies of neutralization include avoiding direct contact with patients by taking sick or vacation leaves; compulsively studying for many hours daily (neglecting other aspects of life); checking the status of their patients by arranging additional follow-up consultations or making phone calls even out of working hours; repeatedly checking the medical history of their patients, and persistently recalling the last appointment. Physicians with check OCD often seek reassurance from their colleagues and consult the scientific literature for information about issues they used to be competent in. These patients may also experience anticipatory anxiety and mental blocks. However, egodystony is milder than in other forms of OCD. The COVID pandemic may have exacerbated these neutralization behaviors, since it has forced physicians to adapt to a new work environment. The recommended treatments (Exposure with Response Prevention Therapy or/and SSRI) provide beneficial effects in a short time.

Home care nurses' and managers' work environment during the Covid-19 pandemic: Increased workload, competing demands, and unsustainable trade-offs

Little research exists on how home care nursing personnel have experienced the Covid-19 pandemic. This qualitative study explores the work environment related challenges nurses and managers in home care faced during the pandemic. We discuss these challenges in relation to the Demand-Control-Support Model and reflect on how the organizational dynamics associated with them can be understood using the competing pressures model. During the pandemic, home care nurses and managers experienced both an increased workload and psychosocial strain. For managers, the increased complexity of work was a major problem. We identify three key takeaways related to sustainable crisis management: 1) to support managers' ability to provide social support to their personnel, 2) to increase crisis communication preparedness, and 3) to apply a holistic perspective on protective gear use. We also conclude that the competing pressures model is useful when exploring the dynamics of the work environment in complex organizational contexts.

[Psychological Impact of COVID-19 on Health Workers During the Second Year of the Pandemic in Latin America: Cross-Sectional Survey Study]

Introduction

The coronavirus pandemic continues to affect the mental health of healthcare personnel in Latin America (LA).

Objective

To estimate the prevalence of psychological disturbances and associated risk factors for mental health in healthcare personnel in LA during the second year of the COVID-19 pandemic.

Method

This multicenter cross-sectional study included a total sample of 5437 healthcare professionals from Argentina, Bolivia, Chile, Colombia, Ecuador, and Peru. The PHQ-9, GAD-7, and a brief demographic questionnaire were used. The prevalence of anxiety and depression was estimated based on the cut-off points of the instruments. Two multivariate logistic regressions were performed.

Results

A population burden of anxiety (40.1%) and depression (62.2%) was found in healthcare personnel in LA. Among professionals in Argentina (OR = 1.374; P<.001), those working in state hospitals (OR = 1.536; P<.003), frontline healthcare workers for COVID patients (OR = 1.848; P<.001), general practitioners (OR = 1.335; P<.001), and specialists (OR = 1.298; P<.001), a higher risk of experiencing mental disorders was observed. Among women, younger personnel, and administrative staff, a higher probability of experiencing anxiety and depression was identified.

Conclusions

The burden of mental disorders on healthcare personnel in Latin America is alarming. Psychological support services are necessary, aimed at providing measures for professionals to develop healthy coping mechanisms that mitigate the impact of the pandemic on their well-being and facilitate post-crisis adjustment.

Indian Healthcare Workers' Issues, Challenges, and Coping Strategies during the COVID-19 Pandemic: A Cross-Sectional Study

India faced the maximum number of mortalities and morbidities during the second wave of COVID-19. Healthcare workers (HCWs) worked in high-pressure and stressful environments. Therefore, this study aimed to assess the common issues, challenges, and coping strategies of HCWs, as well as the statistical association between demographical characteristics and coping strategies. A cross-sectional study was conducted with 759 HCWs, involving simple, random sampling in Rajasthan, India, between August 2022 and October 2022. Participants responded to a self-administered questionnaire that included a Brief-COPE inventory. The statistical association between commonly adopted coping strategies and demographic characteristics was tested using the chi-square test and Fisher's exact test. A total of 669 (88%) respondents agreed that they faced issues during the COVID-19 pandemic: 721 (95%) participants experienced challenges at the personal level, 716 (94%) at the organizational level, and 557 (74%) at the societal level. Problem-focused coping strategies were frequently adopted by the participants. Gender, marital status, education, hours of work per day, and residential area were significantly associated with a problem-focused coping strategy (p < 0.05). The findings of this study reported a limited use of coping strategies by the participants during the public health crisis, despite facing issues and challenges at work. These findings highlight the need to assist HCWs in developing coping mechanisms to maintain good mental health at work.

Presenteeism in front-line physicians involved in COVID-19-related clinical practice: a national survey of employed physician members of the Japan Medical Association

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic may have increased the rate of presenteeism among front-line physicians. Presenteeism is the term used to describe attendance at work despite ill health that would normally prompt rest or absence from work. This study aimed to examine the associations between COVID-19 clinical practice and presenteeism among physicians.

METHODS

A cross-sectional study was conducted from December 2021 to January 2022. The questionnaires were distributed to 21,737 employed physicians who were members of the Japan Medical Association. Presenteeism was measured by the Work Functioning Impairment Scale. Multiple logistic regression analysis was used to evaluate the association between COVID-19 clinical practice and presenteeism.

RESULTS

Overall, 3,968 participants were included in the analysis, and presenteeism was observed in 13.9% of them. The rate of presenteeism significantly increased with both the number of COVID-19 patients treated and the percentage of work time spent treating these patients (both P values for trend < 0.001). In comparison to those not currently engaged in the treatment of COVID-19 patients, presenteeism was significantly higher among front-line (adjusted odds ratio [aOR] = 1.71, 95% confidence interval [CI]: 1.16-2.53) and second-line physicians supporting those in the front-line (aOR = 1.45, 95% CI: 1.17-1.78). There was no association between involvement in COVID-19 vaccination services and presenteeism.

CONCLUSIONS

The burden on front-line and second-line physicians in COVID-19 clinical practice must be minimized. Employed physicians also need to recognize the importance of communicating with their workplaces about presenteeism.

Nursing Students' Perception about Gender Inequalities Presented on Social Networks: A Qualitative Study

During the COVID-19 pandemic, gender inequalities in nurses have been exacerbated through the images shown on social networks. This study aimed to explore and describe nursing students' experiences and perceptions about gender inequalities in nurses during the COVID-19 pandemic. A descriptive qualitative study was carried out in two universities in 264 undergraduate nursing students. The photovoice method was used to guide the study. Results: Two main categories and four subcategories were described from the data: "gender-related stereotypes", with "male leadership in a female profession" and "sexualization of female nurses" and "women's vulnerability in the pandemic" with "the gender gap in the face of increased risk of contagion " and "women's emotional fragility". Over the years, care has been considered a female task, and nursing continues to be thought of in this way. The nurse has been discriminated against, poorly considered as a professional, and, as a woman, subjected to gender roles.

Perception of COVID-19-related stigma and associated psychological challenges among healthcare workers at Cairo University hospitals

OBJECTIVES

The current study explores the level of perceived social stigma and associated psychological challenges among healthcare workers during the second wave of the COVID-19 pandemic in Egypt.

METHODS

This was a cross-sectional study of 150 healthcare workers at Cairo University hospitals that were confirmed positive for COVID-19 infection. Participants were interviewed for assessment of perceived COVID-19-related stigma and associated psychological symptoms using the Patient Health Questionnaire for depression, the Generalized Anxiety Disorder Assessment for anxiety, and the Post-Traumatic Stress Disorder Checklist for post-traumatic stress symptoms.

RESULTS

Two-thirds of participants perceived moderate-to-severe COVID-19-related stigma. Depression, anxiety, and post-traumatic stress symptoms were observed at varying levels in 58.0%, 38.0%, and 11.3% of participants, respectively. Female sex and occupation as a nurse were significantly associated with the total perceived COVID-19-related stigma score. COVID-19-related stigma perception significantly correlated with depression, anxiety, and post-traumatic stress.

CONCLUSION

Perceived social stigma prevails among healthcare workers and is associated with numerous psychological disturbances.

UK healthcare support workers and the COVID-19 pandemic: an explorative analysis of lived experiences during the COVID-19 pandemic

Support workers are an underrepresented profession that receives less attention with a high degree of responsibilities. The aim of this study was to explore the lived experiences of healthcare support workers within the care sector during the COVID-19 pandemic. This is a qualitative semi-structured interview study using an interpretative phenomenology (IP) framework. Fifteen (15) support workers were interviewed while all COVID-19 restrictions from the government were still in place. We identified five main themes: (1) challenging experiences; (2) coping mechanisms; (3) emotions and behaviors arising from the COVID-19 pandemic; (4) external interest on support worker's health; (5) take-home message from the COVID-19 pandemic. The organization selected for the research is a good representative of how care organizations operate within the UK both in terms of policies and staff selection.

To introduce or not? Strategic analysis of hospital operations with telemedicine

Despite its efficiency in reducing the impact of pandemics (e.g., the COVID-19), whether to introduce telemedicine as an additional way to serve chronically ill patients remains controversial for hospitals in many countries. This paper builds a stylized model to investigate a hospital's telemedicine strategy and the corresponding impacts on its operations regarding outpatient management of chronic diseases. We implement our analysis from three key concerns of the hospital in the presence of a pandemic: the differences in medical consumption and reimbursement between in-person and telemedicine modalities and the effort cost of infection reduction resulting from the pandemic. We find that in the absence of the pandemic, the hospital prefers to introduce telemedicine when the differences in medical consumption and reimbursement are both small. In the presence of the pandemic, we find that the introduction of telemedicine does not always benefit the hospital and that it is better not to introduce telemedicine in some cases since it may exacerbate the negative influence of the pandemic on the hospital's total costs. Furthermore, we surprisingly find that the hospital may set greater in-person capacity but less telemedicine capacity in response to the outbreak of the pandemic under certain conditions, which contradicts public beliefs. Finally, we show that social welfare can be improved by introducing telemedicine when the effort cost of infection reduction and the difference in reimbursement are both of moderate size. The condition under which social welfare is improved tightens with a greater difference in medical consumption.

Reflections, resilience and recovery: a qualitative study of Covid-19's impact on an international adult population's mental health and priorities for support

The impact of the coronavirus 2019 (Covid-19) pandemic on different countries and populations is well documented in quantitative studies, with some studies showing stable mental health symptoms and others showing fluctuating symptoms. However, the reasons behind why some symptoms are stable and others change are under-explored, which in turn makes identifying the types of support needed by participants themselves challenging. To address these gaps, this study thematically analysed 925 qualitative responses from five open-ended responses collected in the UCL-Penn Global COVID Study between 17 April and 31 July 2021 (Wave 3). Three key themes that comprised 13 codes were reported by participants across countries and ages regarding the impact of Covid-19 on their health, both mental and physical, and livelihoods. These include: (1) Outlook on self/life, (2) Self-improvement, and (3) Loved ones (friends and family). In terms of support, while 2.91% did not require additional support, 91% wanted support beyond financial support. Other unexpected new themes were also discussed regarding vulnerable populations suffering disproportionately. The pandemic has brought into sharp focus various changes in people's mental health, physical health and relationships. Greater policy considerations should be given to supporting citizens' continued access to mental health when considering pandemic recovery.

Psychological Impact of the COVID-19 Pandemic on Dentists in Latin America's Epicenter: São Paulo, Brazil

The present study aimed to assess the prevalence and associated factors of stress and anxiety symptoms among dentists during the COVID-19 pandemic in the state of São Paulo, Brazil. A structured questionnaire was sent electronically to 93,280 dentists with active registration in the Dental Council of São Paulo, Brazil, enquiring about information regarding the first-wave peak period in Brazil. Descriptive analyses of background characteristics, perceptions of preparedness, and psychological impact were calculated. Multiple logistic regression analysis was performed, and independent variables that showed p < 0.20 were used in the adjusted logistic regression model to compare the psychological impact on dental professionals. Among the 2113 respondents, female participants had 63% lower chance of reporting anxiety than males. Older dentists had a lower likelihood of reporting anxiety compared to 21-30-year-old dentists (p ≤ 0.05). Dentists working in the public health service were 1.78 times more likely to report anxiety than those who worked in private practice. Finally, dentists in the COVID-19 high-risk group and those with a family or team member with a positive COVID-19 diagnosis were more likely to have anxiety. This study can help dental and other healthcare professionals to better understand the consequences of COVID-19 in terms of mental health.

How Are You Feeling? Interpretation of Emotions through Facial Expressions of People Wearing Different Personal Protective Equipment: An Observational Study

(1) Background: The perception of others’ emotions based on non-verbal cues, such as facial expressions, is fundamental for interpersonal communication and mutual support. Using personal protection equipment (PPE) in a work environment during the SAR-CoV-2 pandemic challenged health professionals’ ability to recognise emotions and expressions while wearing PPE. The working hypothesis of this study was that the increased limitation of facial visibility, due to the use of a personal protective device, would interfere with the perception of basic emotions in the participants. (2) Methods: Through a cross-sectional descriptive study, the present research aimed to analyse the identification of four basic emotions (happiness; sadness; fear/surprise; and disgust/anger) through three types of PPE (FFP2 respirator, protective overall and powered air-purifying respirator (PAPR)), by using 32 photographs. The study was conducted using volunteer participants who met the inclusion criteria (individuals older than 13 without cognitive limitations). Participants had to recognise the emotions of actors in photographs that were randomly displayed in an online form. (3) Results: In general, the 690 participants better recognised happiness and fear, independently of the PPE utilised. Women could better identify different emotions, along with university graduates and young and middle-aged adults. Emotional identification was at its worst when the participants wore protective overalls (5.42 ± 1.22), followed by the PAPR (5.83 ± 1.38); the best scores were obtained using the FFP2 masks (6.57 ± 1.20). Sadness was the least recognised emotion, regardless of age. (4) Conclusions: The personal protective devices interfere in the recognition of emotions, with the protective overalls having the greatest impact, and the FFP2 mask the least. The emotions that were best recognised were happiness and fear/surprise, while the least recognised emotion was sadness. Women were better at identifying emotions, as well as participants with higher education, and young and middle-aged adults.

Workplace violence against Bangladeshi registered nurses: A survey following a year of the COVID-19 pandemic

AIMS

To investigate the prevalence of workplace violence and its associated factors among Bangladeshi registered nurses.

BACKGROUND

Workplace violence is prevalent among nurses, particularly in developing countries. However, the issue has never been examined in Bangladeshi nurses.

METHODS

Between February 26 and July 10, 2021, this cross-sectional survey involving 1264 registered nurses was conducted. Workplace violence was determined by the Workplace Violence Scale (WVS). A multivariable logistic regression model was fitted to find the factors associated with workplace violence. This study complies with the EQUATOR (STROBE) checklist.

RESULTS

Of the 1264 nurses, 885 (70%) nurses reported being exposed to workplace violence in the previous year. Three hundred twenty-four (324; 25.6%) nurses reported physical violence, whereas 902 (71.4%) nurses reported nonphysical violence. According to the multivariable logistic regression model, male nurses, nurses in the Sylhet division, emergency department nurses, nurses working extended hours, and non trained nurses to tackle workplace violence were prone to physical violence. Furthermore, public hospital nurses and non trained nurses to tackle workplace violence were more likely to be exposed to nonphysical violence. Nurses who had not been exposed to workplace violence were satisfied with their current job, but those who had been exposed to workplace violence were dissatisfied and intended to leave their current job.

CONCLUSIONS AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

High prevalence of workplace violence underscores nurses' current working conditions, which are particularly poor in public hospitals and emergency departments. Moreover, the COVID-19 pandemic put unprecedented pressure on the whole healthcare system and caused various difficulties for healthcare workers. To develop a zero-violence practice environment, health authorities should implement policy-level interventions. Healthcare staff should be guided to deal more successfully with patients and coworkers to create a positive working environment.

Network analysis of comorbid depression and anxiety and their associations with quality of life among clinicians in public hospitals during the late stage of the COVID-19 pandemic in China

BACKGROUND

Mental health problems are common among clinicians working in public hospitals even in the late stage of the COVID-19 pandemic. Network analysis is a novel approach to explore interactions between mental health problems at the symptom level. This study examined the network structure of comorbid depression and anxiety and their associations with quality of life (QOL) among hospital clinicians in China during the late stage of the COVID-19 pandemic.

METHODS

A total of 4931 participants were recruited from October 13 to 22, 2020. The nine-item Patient Health Questionnaire (PHQ-9), seven-item Generalized Anxiety Disorder Scale (GAD-7), and the World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF) were used to measure depressive and anxiety symptoms, and QOL, respectively. Central and bridge symptoms were identified with centrality and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure.

RESULTS

The prevalence of depression (defined as PHQ-9 total score ≥ 5) was 35.1 % [95 % confidence interval (CI) = 33.73-36.41 %)], the prevalence of anxiety (GAD-7 total score ≥ 5) was 32.5 % (95 % CI = 31.20-33.84 %), while the prevalence of comorbid depression and anxiety was 26.9 % (95 % CI = 25.7-28.2 %). "Impaired motor skills", "Trouble relaxing" and "Uncontrollable worry" were the central symptoms in the whole depression-anxiety network. "Irritability", "Feeling afraid" and "Sad mood" were the most key bridge symptoms linking depression and anxiety. Three symptoms ("Fatigue", "Trouble relaxing" and "Nervousness") were the most strongly and negatively associated with QOL. Neither gender nor the experiences of caring for COVID-19 patients was associated with network global strength, distribution of edge weights or individual edge weights.

LIMITATIONS

The causality between variables could not be established. Depressive and anxiety symptoms were assessed by self-report measures, which may result in recall bias and limitations in capturing clinical phenomena.

CONCLUSIONS

Both the central (i.e., "Impaired motor skills", "Trouble relaxing" and "Uncontrollable worry") and bridge symptoms (i.e., "Irritability", "Feeling afraid" and "Sad mood") identified in this network analysis should be targeted in specific treatment and preventive measures for comorbid depressive and anxiety symptoms among clinicians in the late stage of the pandemic. Furthermore, "Fatigue", "Trouble relaxing" and "Nervousness" are key symptoms to address to improve clinicians' QOL.

Nurses' Experiences of Caring for Patients with COVID-19: A Qualitative Study

The purpose of this study was to explore nurses' experiences, abilities, and willingness to care for patients with Coronavirus Disease 2019 (COVID-19). A descriptive qualitative study was conducted among 12 nurses working with patients with COVID-19. Purposive sampling was used to recruit participants from two national hospitals in Jordan. Semi-structured interviews (45-90 minutes each) with open-ended questions were held via Zoom to collect data. Four major themes emerged from the data analysis. The first theme, uncertainty, consisted of two subthemes: new experience and lack of training. The second theme was related to social stigma by society and other staff members. The third theme of front-line fighters consisted of two subthemes: empowering the main health caregiver and community acknowledgment. The fourth theme was related to challenges and consisted of two subthemes: physical and psychological challenges. At the beginning of the outbreak of COVID-19, the nurses had experienced a lack of certainty, physical and psychological challenges, and social stigmatization, which had negatively affected their willingness and ability to fight the outbreak. However, the nurses reported growing professionally and psychologically with time and becoming more knowledgeable, skillful, powerful, and confident care providers during the pandemic. Being able to fulfill their responsibilities and being acknowledged by others gave the nurses a sense of achievement. Early education and training about COVID-19, clear infection control protocols and guidelines, psychological counseling, and adequate social support are essential steps for enhancing nurses' mental well-being and willingness and ability to fight COVID-19.

Autonomy and isolation experienced by patients and primary caregivers during COVID-19 hospitalization in Barcelona (Spain)

This study aims to describe patients' and family caregivers' hospitalization experiences during the COVID-19 pandemic. Using qualitative exploratory descriptive methods, 13 patients admitted to the largest hospital in Barcelona (Spain) due to COVID-19 were interviewed by telephone once discharged, as were eight primary caregivers. Data were analyzed using the content analysis method proposed by Krippendorff. Two main themes were identified: (i) Acceptance of mandatory isolation for patients and family caregivers, which refers to the verbalization of a feeling that justifies the imposed isolation and the need for the use of personal protective equipment by the health team for everyone's safety; and (ii) Limited autonomy during hospitalization for patients and family caregivers, which describes participants' perceptions of autonomy during hospitalization. Patients and caregivers experienced feelings of loneliness, which negatively affected their emotional health. In addition, they experienced reduced autonomy due to new habits and routines intended to control the pandemic for the benefit of public and global health.

The Evolving Personal, Professional and Physical Impact on Healthcare Professionals During Three Covid-19 Waves: A Cross-Sectional Study

Background

The COVID-19 pandemic has led to huge pressure on not only healthcare systems, but also on healthcare professionals.

Objective

As the pandemic continues, the aim of this study is to evaluate how 10 reactions of healthcare professionals evolved during the first 18 months of COVID-19.

Methods

A repeated cross-sectional study was performed with eight measurement points between April 2020 and September 2021 in Belgium. Participants were asked how frequently (on a scale of 0–10) they experienced positive and negative reactions during normal circumstances and during past week, referred to as before and during COVID-19, respectively. These reactions were stress, fatigue, difficulty sleeping, muscle strain, hypervigilance, leaving profession, headache, doubting knowledge and skills, flashbacks and fear.

Results

In total, 13 308 respondents were included in our study. During both the first (March 2020) and second COVID-19 peak (November 2020), the measured personal, professional and physical reactions were significantly higher compared to before COVID-19. The third wave in April 2021 was shorter and less severe with regard to hospital admissions and deaths, yet an important impact on healthcare professionals could still be observed. ‘Fatigue,’ ‘stress,’ ‘difficulty sleeping’ and ‘muscle strain’ are the most worrying reactions in September 2021, which are increasing compared to the previous measurements.

Conclusion

Our results showed that acute stress reactions decreased over time but that chronic stress reactions and professional reactions, such as ‘intent to leave,’ increased. Healthcare organizations and policy makers should realize that 18 months after the start of COVID-19 almost all of the measured reactions continue to be more prevalent than before COVID-19. Moreover, the continuous increase over the last three measurement periods of the number of healthcare professionals who want to leave their profession is alarming. Continuous follow-up of the personal, professional and physical reactions is more than necessary.

Interventional Studies on Nurses’ Mental Health in the COVID-19 Pandemic: A Systematic Review

This systematic review’s primary aim is to examine the interventional studies on the mental health of nurses during the COVID-19 pandemic, and the secondary aim is to determine the interventions that can be planned for future pandemics. For this, databases were searched, and a total of 12 studies meeting the inclusion criteria were included. It was determined that most of the studies were conducted online due to pandemic restrictions. The effects of the interventions (diaphragmatic breathing relaxation, emotional freedom techniques, sending motivational messages, a mobile wellness program, acceptance and commitment therapy, a neuro-meditation program, laughter yoga, gong meditation, distant Reiki, e-aid cognitive behavioral therapy, mindfulness-based breathing, and music therapy) on the parameters affecting the mental health of the nurses working actively in the COVID-19 pandemic were examined. In these studies, the interventions applied to nurses were seen to have positive results on mental health and well-being. The COVID-19 pandemic, which is a traumatic experience for healthcare professionals, shows that more interventional studies are needed to protect and improve the mental health of nurses who take care of critically ill patients during difficult times.

Applicability and Psychometric Comparison of the General-Population Viral Anxiety Rating Scales among Healthcare Workers in the COVID-19 Pandemic

We aimed to explore the reliability and validity of viral anxiety rating scales (developed for the general population) among healthcare workers. In addition, we compared the psychometric properties of rating scales in accordance with the Generalized Anxiety Scale-7 items (GAD-7) during this COVID-19 pandemic. The viral anxiety of 330 healthcare workers was measured with Stress and Anxiety to Viral Epidemics-9 items (SAVE-9), SAVE-6, Coronavirus Anxiety Scale (CAS), Fear of COVID-19 Scale (FCV-19S), and COVID-19 Anxiety Scale (CAS-7). Factor analyses, item response theory, and Rasch model analyses were conducted to confirm the construct validities of the scales and compare the psychometric properties of rating scales. The receiver operating curve (ROC) analysis examined the cutoff scores of rating scales in accordance with a mild degree of generalized anxiety. The SAVE-9, SAVE-6, CAS, FCV-19S, and CAS-7 scales showed good reliability of internal consistency among healthcare workers. Their construct validity and convergent validity of each scale were similarly good. Furthermore, in comparing the psychometric properties of rating scales, we observed that the CAS scale was the most discriminating and difficult among the scales. The CAS and FCV-19S provided more information and were more efficient than the SAVE-9, SAVE-6, and CAS-7 scales when they were used to measure healthcare workers' viral anxiety. Viral anxiety rating scales can be applied to healthcare workers with good reliability and validity.

Moral Distress among Frontline Physicians and Nurses in the Early Phase of COVID-19 Pandemic in Italy

During the COVID-19 health emergency, healthcare professionals faced several ethical demanding job stressors, becoming at particular risk of moral distress. To date, only a few scales have been developed to evaluate moral distress among frontline professionals working in contact with COVID-19 patients. Moreover, although many healthcare professionals from various disciplines were converted to COVID-19 patient care, no study has yet analyzed whether the resulting change in duties might represent a risk factor for moral distress. Thus, this study aimed to investigate how and when the change in duties during the emergency would be related to healthcare professionals' psycho-physical malaise. To this aim, a first Italian adaptation of the Stress of Conscience Questionnaire (SCQ) was provided. In total, 272 Italian healthcare professionals participated in this cross-sectional study. Healthcare professionals who had to perform tasks outside their usual clinical duties were more likely to experience moral distress and then psycho-physical malaise. This was particularly likely for those who were extremely concerned about becoming infected with the virus. The results also indicated that the Italian adaptation of the SCQ had a one-factor solution composed of six items. This study provides the first Italian adaptation of SCQ and practical suggestions on how supporting professionals' well-being during emergencies.

Relationship between COVID-19-specific occupational stressors and mental distress in frontline and non-frontline staff

This study investigated the difference in the severity of mental distress and factors contributing to mental distress in frontline and non-frontline healthcare professionals during the coronavirus disease (COVID-19) pandemic. A cross-sectional web-based survey of medical staff collected by snow-ball sampling was performed in Japan in October 2020 using the Kessler Psychological Distress Scale (K6) as an outcome measure for mental distress. Originally developed items asking about the degree of change in psychological and physical burdens, COVID-19-related fear, and experience of discrimination were obtained. The median score of the K6 was 7 in the frontline staff group (n = 86) and 6 in the non-frontline staff group (n = 504), without a statistically significant difference. Multiple regression analyses showed that among the participants, an increase in psychological burden and COVID-19-related fear was significantly associated with mental distress in both groups. Experience of discrimination was significantly associated with mental distress only in the frontline staff group. However, an increase in physical burden was significantly associated with mental distress only in the non-frontline staff group. The results indicate that the factors contributing to mental distress between frontline and non-frontline staff can be different, although the severity of mental distress is comparable between them.

The Cause of Mental Health Problem Among Urban Residents During the COVID-19 Outbreak: Implication for information Communication

This study examined the causes of mental health problems among urban residents in Bahir Dar City Administration. To achieve the objectives, data were gathered from residents, psychologists, psychiatrists, and medical doctors through deep interviews. The qualitative analysis of the data gathered through interviews revealed that mental health problem is prevalent and linked with social, psychological, and economic factors and female and the adult population was disposed to the mental health problem than the remaining populations. Based on the findings conclusions and possible recommendations were also forwarded.

Psychological impact of COVID-19 on nursing personnel: A regional online survey

Aims

This study investigated mental health reactions to dealing with COVID‐19 in a population of nurses working in a variety of settings. The study attempted to expand our current understanding of the psychological reactions unique to nurses working during the highly stressful period of the COVID‐19 pandemic.

Design

The study used an online questionnaire design.

Methods

Nurses were recruited using social media via an electronic link between July and September 2020. Of them, 112 nursing professionals completed the 66‐item questionnaire.

Results

Significant findings included the presence of moderate or greater levels of anxiety (62%), depression (31%), and posttraumatic stress disorder (15%) and with significantly greater intrusive thoughts and memories for nurses who provided direct patient care than those who did not. Nurses with a prior history of anxiety or depression were found to be at greater risk for psychological distress. Results further highlighted concerns and fears related to coronavirus in both their daily personal and professional lives.

Conclusion

The use of standard, commonly used, measures of psychological disorders allow for a more precise comparison among studies both for this population at the time of the survey and over a period of time.

Impact

Suggestions for helping nursing professionals identify nurses at risk and improved ways to cope and deal with adverse psychological effects are discussed.

Prevalence of Workplace Violence Against Healthcare Workers During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Background

A large number of anxious and concerned people refer to health centers during the COVID-19 pandemic, increasing the workload of healthcare workers (HCWs) and violence against these professionals. The present study aimed to estimate the prevalence of workplace violence (WPV) against HCWs during the COVID-19 pandemic.

Methods

This systematic review and meta-analysis was conducted via searching in databases such as Scopus, PubMed, and Web of Science, and observational articles reporting the prevalence of WPV against HCWs were selected. Heterogeneity between the studies was assessed using Cochran's Q test. A random-effects model was used to estimate the prevalence of WPV. Data analysis was performed in the Stata software version 16.

Results

In the initial search, 680 articles were identified and screened based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) steps. In total, 17 studies with a sample size of 17,207 HCWs were analyzed. The total prevalence of violence was estimated at 47% (95% CI: 34–61%). In addition, the prevalence of physical and psychological violence was 17% (95% CI: 6–28%) and 44% (95% CI: 31–57%), respectively. The prevalence of WPV was higher among physicians (68%; 95% CI: 31–95%) compared to other HCWs. The WPV in the America and Asia was 58 and 44%, respectively.

Conclusion

According to the results, WPV against nurses is prevalent during the COVID-19 pandemic, and intervention measures are required to protect the nursing staff against such violence.

Mental health and psychosocial support concerns among frontline workers within the Eastern and Southern Africa COVID-19 response

We carried out a mental health assessment survey of frontline workers in Eastern and Southern Africa regarding COVID-19 pandemic in the region. A total of 723 people responded to the anonymous survey which was available in English, French and Portuguese. Two thirds of respondents felt overwhelmed and the remaining one third expressed fear of the pandemic. Concern about self and one´s wellbeing was associated with the feeling of being supported by one´s supervisor. Frontline workers that acknowledged supervisor support also expressed a significantly better wellbeing than others that did not receive supportive supervision. It is important to strengthen supervisors´ capacity for psychological support to their subordinates. It is also necessary to emphasise the importance of giving attention to staff mental health concerns. Supervisors should provide information on referral opportunities and encourage their staff to take advantage of them when in need of specialised services. While frontline workers have been celebrated worldwide for their efforts during the COVID-19 pandemic, reports also indicate that some of them are exposed to stigma, discrimination and even violence within their communities, at workplace and surroundings. Further studies will improve current understanding of the mental health and psychological concerns other categories of professional caregivers experienced while responding to the pandemic.

Trauma exposure and depression among frontline health professionals during COVID-19 outbreak in China: the role of intrusive rumination and organizational silence

BACKGROUND

Healthcare professionals bared particularly high risk and stress during the COVID-19 outbreak. Previous studies have demonstrated that healthcare professionals exposed to COVID-19 incurred various affective disorders including depressive symptoms, anxiety, insomnia, and distress. However, the mechanism underlying the relationship between trauma exposure and depressive symptom among frontline hospital staff has yet to be investigated. This study aims to assess the prevalence of depressive symptoms among frontline healthcare professionals in Shenzhen, China, and elucidate the complex relationship among trauma exposure, intrusive rumination, and organizational silence.

METHODS

The data of this study were collected through a time-lagged panel questionnaire survey with three rounds of measurements from February 2020 to May 2020 at an infectious disease hospital in Shenzhen, in which all the confirmed cases of COVID-19 patients were accommodated. Based on cluster sampling design, a total of 134 frontline healthcare professionals directly involved in providing diagnosis, treatment, and nursing services for COVID-19 patients completed three times of web survey. The depressive symptom and trauma exposure were measured via the 12-items General Health Questionnaire and the Explosion Exposure Questionnaire respectively. A moderated mediation model examined the complex interplay among the major study variables. Gender and working year were included as control variables.

RESULTS

Trauma exposure was significantly associated with depression in frontline healthcare professionals. Intrusive rumination mediated the effect of trauma exposure on the depressive symptom, which was moderated by organizational silence. Intrusive rumination presented a more substantial impact on depression while organization silence was lower.

CONCLUSIONS

This research demonstrates that intrusive rumination and organizational silence are imperative for predicting the depressive symptoms among the frontline healthcare professionals during the COVID-19 pandemic.

Psychological Health and Diabetes Self-Management among Patients with Type 2 Diabetes during COVID-19 in the Southwest of Saudi Arabia

Background and objectives: The prevalence of type 2 diabetes in Saudi Arabia is high and rising steeply. However, the management of type 2 diabetic patients has largely employed a medical approach and ignored the self-care management approach. This observation has even been obscured further by the COVID-19 pandemic, which has affected the psychological health of these patients. This study aimed to understand the effects of psychological health and DSM on type 2 diabetic patients in the Jazan region during COVID-19. Materials and methods: An analytical cross-sectional study was employed in this study. Participants were type 2 diabetic patients from the diabetic center at Jazan, Saudi Arabia. The Arabic-translated version of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to collect data. Data were analyzed using SPSS software. Results: Depression and anxiety were higher in females compared to males and were more reported by participants from urban compared to rural settings. Smoking and Khat chewing were inappropriate diabetic self-care management practices while exercising was appropriate. A negative correlation was observed between depression vs. health care utilization, and depression vs. diabetic self-care management. Anxiety results also showed similar findings to that of depression. Additionally, depression and anxiety were easily predicted by urban residence, and diabetic self-care management was predicted by exercise. Conclusions: Adequate self-care behavior in patients with type 2 diabetes is needed. Medical professionals should ensure improved efforts to accurately ascertain how an individual can implement the recommended lifestyle changes and facilitate self-care education.

Calidad de vida del personal de salud durante la pandemia de COVID-19: revisión exploratoria

Objetivo.

Describir la calidad de vida del personal de salud, el ambiente laboral y la interacción entre el empleado y ambiente laboral durante la pandemia.

Métodos.

Se realizó una revisión exploratoria. Se utilizaron las bases de datos electrónicas PubMed, Cumulative Index of Nursing and Allied Literature Complete, Google Scholar y los repositorios de la Organización Mundial de la Salud y los Centro para el Control y Prevención de Enfermedades. Se incluyeron estudios primarios, secundarios y literatura gris publicados entre diciembre de 2019 y marzo de 2021 en idioma español, inglés y portugués. La calidad metodológica fue evaluada por la lista de verificación de Autoridad, exactitud, cobertura, objetividad, fecha e importancia (AACODS, por su sigla en inglés) A measurement tool to assess systematic reviews (AMSTAR) y Critical Appraisal Checklist for Text and Opinion Papers. Se efectuó un análisis temático basado en el modelo de calidad de vida y bienestar.

Resultados.

De un total de 208 artículos, se incluyeron 11. La calidad de vida del personal de salud durante pandemia por COVID-19 estuvo influenciada por las características del personal de salud, el ambiente laboral y la interacción entre el empleado y el ambiente laboral; se observaron falencias relacionadas con factores psicosociales y ocupacionales.

Discusión.

La calidad de vida del personal de salud estuvo caracterizada por estigmatización, estrés, ansiedad y fatiga. La gestión organizacional y la aplicación de intervenciones psicológicas evidencian un efecto en la interacción entre el empleado y el ambiente laboral, e influyen en su calidad de vida.

Collective Occupational Trauma, Health Care Quality, and Trauma-Informed Leadership: Intersections and Implications

Managing stress, burnout, and vicarious trauma is a long-standing issue for the health and behavioral health workforce, including those in case management. Yet, the recent novel coronavirus pandemic has amplified routine burnout to record levels. Practitioners and patients are amid a new dynamic of collective occupational trauma (COT). In this realm, health and behavioral health workers (HBWs) experience the same reality as their patients, families, and support systems; professional boundaries become blurred, leading to heightened levels of emotional vulnerability that can prompt the development of more pervasive psychopathology. This reality has put the Quadruple Aim in peril, with increased workforce turnover, staff shortages, costs, and quality challenges. This article: Applicable to all health and behavioral health settings where case management is practiced. Organizational cultures must shift from a "process and roll" mindset to one that is trauma-informed. Implementation of TIC has yielded successful outcomes for the workforce via enhanced patient engagement, treatment adherence, and successful outcomes. In tandem, TIC leadership and supervision models have had promising results and should be more readily utilized; they acknowledge and address workforce trauma while prioritizing staff health, mental health, and wellness. Failure to shift the culture will result in an ongoing exodus of practitioners, leaving insufficient numbers to render safe, cost-effective, efficient, and patient-centered care. The case management workforce comprises professional disciplines across health and behavioral health, employed in every setting. The expanding workforce presence has put them at risk of COT. Leadership strategies must shift to acknowledge workforce exposure to occupational trauma, address mental health and wellness, and address professional self-care. This shift is key to mitigating retention, sustainability, and quality challenges.

Impacts of COVID-19 Pandemic on Geopolitics, Health, Economics, Education and Sociocultural Events

The number of active cases of COVID-19 and deaths is markedly escalating. The pandemic had affected almost every aspect of our lives including geopolitics, health, economics, education, and sociocultural events. However, besides the negative impacts of the pandemic, there are some positive impacts as well, such as improving our awareness of the daily hygienic practices, emphasizing digital inequality, and increasing global collaboration in combating the crisis by intensifying scientific research to establish a promising vaccine. Other positive impacts are the activation and use of online education, also raising awareness about close family relationships and much more. This review addresses the impacts of the COVID-19 pandemic on various important aspects of life.

Nutritional benefits in pediatric patients with percutaneous endoscopic gastrostomy placement

Gastrostomy is an enteral nutrition option. Indications for its placement are diverse, among them, the alteration in the mechanics of swallowing, frequently present in patients with neurological diseases. Nutritional recovery is the objective in these patients evaluating the nutritional status after the placement of a PEG in the pediatric population. This is a retrospective cohort conducted to evaluate nutritional recovery in pediatric patients with PEG placement. It was performed using anthropometric and biochemical parameters before and after placement. Forty-seven subjects were included, from which weight, height, and upper arm circumference were obtained, to evaluate nutritional recovery using BMI or W/L according to age. Significant nutritional improvement was demonstrated in a population of 39 patients, who had a mean follow-up of 7 months. In our population, PEG is an enteral nutrition strategy that has a significant positive impact on nutritional status in a mean of 7 months after its placement. Therefore, considering the evolution time of these patients will guide the clinician in making decisions regarding surveillance and monitoring parameters of the nutritional status.

Wellbeing and Stress Coping among Healthcare and Pharmacy Workers: Experiences during the First COVID-19 Lockdown in Lithuania

(1) Background. During the COVID-19 pandemic, healthcare professionals faced psychological and social challenges in addition to a sharp increase in workload. The aim of this work was to reveal how healthcare and pharmacy workers assessed their wellbeing and the methods of coping they employed to overcome stress during quarantine. (2) Methods. The mixed-method study was conducted between August and October 2020, integrating quantitative (n = 967) and qualitative (n = 27) strategies. Doctors, nurses, healthcare administrative staff, pharmacy specialists, and other employees of the healthcare system were interviewed retrospectively about their experiences during and following lockdown (March–June 2020). (3) Results. Overall, 38.7% of the respondents reported a decrease in psychological wellbeing, while 23.4% of the respondents reported a decrease in physical wellbeing during quarantine. The healthcare professionals’ narratives identified a shift from nonspecific fears at the beginning of the pandemic to the more concrete fear of contracting COVID-19, of infecting others, and about their loved ones, as well as undifferentiated fear. Multivariate analysis revealed that a subjective decrease in wellbeing was typical in professionals who had had direct contact with patients infected with COVID-19, as well as those with stronger fears, and those who were more likely to employ compulsive distancing and substance use as ways to cope with stress. (3) Conclusions. The results suggest that lockdown had a negative impact on healthcare workers’ wellbeing during the first pandemic wave in 2020.

Pandemic experiences of family physicians infected with the COVID-19: a qualitative study

OBJECTIVES

Family physicians are usually patients' first point of contact with primary healthcare. This study aims to understand the experiences of family physicians who were infected with the COVID-19 and started working again.

STUDY DESIGN AND SETTING

This qualitative study was conducted on 18 different family health centres in Adana. Data collection was performed through 18 interviews, each lasting an average of 46.6 min. The data were analysed using the qualitative content analysis method.

PARTICIPANTS

The study included 18 family physicians (9 women and 9 men), and there were no significant differences between them by gender or seniority.

RESULTS

The results of the study have shown that family physicians who were infected with the COVID-19 and started working again have experienced high levels of anxiety at work. In addition, due to the fear of being reinfected, family physicians' social relations with their colleagues have decreased. The results are discussed under two themes: anxieties and social relationships.

CONCLUSION

In primary healthcare services, family physicians play a vital role during the pandemic. Many family physicians either lost their lives or got infected with the virus, recovered and worked in difficult conditions for a long time. Understanding the experiences of family physicians during the pandemic when they underwent COVID-19 and after they recovered could help to protect their psychological health and improve their work conditions.

Gestão de recursos humanos do SUS na pandemia: fragilidades nas iniciativas do Ministério da Saúde

RESUMO A Covid-19 produziu graves impactos no sistema público de saúde do Brasil, tornando premente a necessidade de conhecer e considerar os desafios para a gestão de recursos humanos no Sistema Único de Saúde (SUS). O presente estudo, por meio de pesquisa exploratória, buscou identificar iniciativas do Ministério da Saúde voltadas à gestão de recursos humanos em saúde do SUS durante a pandemia, utilizando como percurso metodológico a análise documental. Foram consultadas informações veiculadas pelo Ministério da Saúde em seu portal eletrônico, bem como por demanda direta dos pesquisadores a áreas de reconhecido papel estratégico. Ainda, foi considerado o relatório da Força Nacional do SUS disponibilizado aos pesquisadores para complementação das investigações inicialmente realizadas. As pesquisas permitiram identificar diversas iniciativas implementadas, porém de forma isolada, fragmentada e descontinuada, o que inviabilizou a qualificação dos resultados de modo mais profundo, objetivo que o presente estudo pretendia alcançar. Destaque-se que não foi propósito da presente pesquisa esgotar todas as iniciativas do Ministério da Saúde, mas sim de tentar identificar, na fonte oficial do ente federal do SUS, uma apresentação estruturada de suas iniciativas e respectivos impactos na gestão de recursos humanos no SUS durante a pandemia.

A multi-country survey on the impact of COVID-19 on dental practice and dentists' feelings in Latin America

BACKGROUND

The COVID-19 pandemic has significantly influenced the routine of healthcare workers. This study investigated the impact of the pandemic on dental practice and dentists' feelings in Latin America.

METHODS

A survey was conducted with dentists from 11 Spanish-speaking Latin American countries in September-December 2020. Professionals were invited by email and via an open campaign promoted on social media. The questions investigated dental care routines, practice changes, and feelings about the pandemic. Descriptive statistics were used to identify frequencies and distributions of variables. Proportions were compared using chi-square tests.

RESULTS

A total of 2127 responses were collected from a sample with diverse demographic, sex, work, and education characteristics. The impact of COVID-19 was considered high/very high by 60% of respondents. The volume of patients assisted weekly was lower compared with the pre-pandemic period (mean reduction = 14 ± 15 patients). A high rate of fear to contracting the COVID-19 at work was observed (85%); 4.9% of participants had a positive COVID-19 test. The main professional challenges faced by respondents were reduction in the number of patients or financial gain (35%), fear of contracting COVID-19 (34%), and burden with or difficulty in purchasing new personal protective equipment (22%). The fear to contracting COVID-19 was influenced by the number of weekly appointments. A positive test by the dentists was associated with their reports of having assisted COVID-19 patients. The most cited feelings about the pandemic were uncertainty, fear, worry, anxiety, and stress. Negative feelings were more prevalent for professionals who did not receive training for COVID-19 preventive measures and those reporting higher levels of fear to contract the disease.

CONCLUSION

This multi-country survey indicated a high impact of the pandemic on dental care routines in Latin America. A massive prevalence of bad feelings was associated with the pandemic.

Meta-Regression on the Heterogenous Factors Contributing to the Prevalence of Mental Health Symptoms During the COVID-19 Crisis Among Healthcare Workers

Objective

This paper used meta-regression to analyze the heterogenous factors contributing to the prevalence rate of mental health symptoms of the general and frontline healthcare workers (HCWs) in China under the COVID-19 crisis.

Method

We systematically searched PubMed, Embase, Web of Science, and Medrxiv and pooled data using random-effects meta-analyses to estimate the prevalence rates, and ran meta-regression to tease out the key sources of the heterogeneity.

Results

The meta-regression results uncovered several predictors of the heterogeneity in prevalence rates among published studies, including severity (e.g., above severe vs. above moderate, p < 0.01; above moderate vs. above mild, p < 0.01), type of mental symptoms (PTSD vs. anxiety, p = 0.04), population (frontline vs. general HCWs, p < 0.01), sampling location (Wuhan vs. Non-Wuhan, p = 0.04), and study quality (p = 0.04).

Conclusion

The meta-regression findings provide evidence on the factors contributing to the prevalence rate of mental health symptoms of the general and frontline healthcare workers (HCWs) to guide future research and evidence-based medicine in several specific directions.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220592, identifier: CRD42020220592.

Modelling the COVID-19 Pandemic Effects on Employees' Health and Performance: A PLS-SEM Mediation Approach

The COVID-19 pandemic has resulted in the imposition of certain changes in the management of organizations and in the behavior and actions of employees. The purpose of this paper is to investigate the impact of COVID-19 pandemic effects on employees’ health and mental well-being, as well as on their working performance. Moreover, the paper aims to highlight whether health- and work-related stress factors mediate the above relations. For the purpose of data collection, a structured questionnaire was used. The first results of the study showed that the pandemic effects felt by employees did not directly affect their mental and physical well-being. On the other hand, the COVID-19 pandemic effects felt by employees affected their general work performance. The findings of the study may provide a useful perspective for organizations and their employees in order to adopt the most effective measures to minimize the effects generated by the pandemic.

Global prevalence of resilience in healthcare professionals: A systematic review, meta-analysis, and meta-regression

AIMS

This review aims to examine the prevalence estimate of low resilience among healthcare professionals and identify the factors affecting the prevalence.

BACKGROUND

Healthcare professionals experience high levels of stress. Understanding the healthcare professionals' resilience may provide an insight into how they perform in a highly stressed environment. Evaluation A comprehensive search of 11 databases was conducted. Studies that provided prevalence rates for low resilience among healthcare professionals working in a healthcare setting were included. Meta-analyses, sensitivity, subgroup analyses and meta-regression were conducted.

KEY ISSUES

Among 27,720 studies, 41 studies (N = 17,073) across 16 countries were included. The prevalence of low resilience was 26% (95% CI: 20-32). Subgroup analyses indicated that types of resilience measures affect resilience prevalence significantly. A higher prevalence of low resilience was observed among allied health professions during the COVID-19 pandemic in the Middle East.

CONCLUSIONS

This review indicated the prevalence of low resilience and type of resilience measurement instruments that affected the prevalence.

IMPLICATIONS FOR NURSING MANAGEMENT

This review provides a roadmap to design tailored, discipline-specific, and sustainable resilience training for nurses. Nursing managers should monitor the working hours and workload of nursing staffing in order to provide a protective working environment.

The wounded helper: moral injury contributes to depression and anxiety among Israeli health and social care workers during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic can affect the mental health of health and social care workers (HSCWs) who are frontline workers in this crisis. The pandemic poses unique challenges to HSCWs as they face morally daunting decisions while working with limited knowledge and resources. This study examined the relationships between exposure to potentially morally injurious events (PMIEs) and depression and anxiety among HSCWs.

METHOD

A sample of 243 Israeli HSCWs completed validated self-report questionnaires that include measures of depression, anxiety, exposure to PMIEs, perceived stress, and moral injury symptoms.

RESULTS

About one-third (33.6%) of the sample met the criteria for major depressive disorder, 21.5% met the criteria for generalized anxiety disorder, and 19.1% reported comorbidity of depression and anxiety. Beyond demographic, COVID-19, and work-related characteristics, PMIEs contributed to depression and anxiety among HSCWs. The integrative model indicated the mediating role of perceived stress and moral injury symptoms in the associations of PMIEs with depression and anxiety.

CONCLUSIONS

The study's findings highlight HSCWs' mental burden during the COVID-19 pandemic and the important contribution of exposure to PMIEs to this burden. Clinicians treating HSCWs coping with depression and anxiety following the COVID-19 should also attend to moral injury symptoms.

Hospital workforce mental reaction to the pandemic in a low COVID-19 burden setting: a cross-sectional clinical study

Τhe COVID-19 pandemic has mental health implications for both healthcare workforces and general population, particularly in regions heavily hit by the crisis. Τhe study aimed (i) to investigate anxiety- and depression severity differences between staff of a COVID-19 treatment unit (N = 84) and a hospital without such a unit (N = 55) in comparison to participants of a convenience general population online survey (N = 240) and (ii) to explore relations between such symptoms and hospital staff reaction to COVID-19 in a low COVID-19 burden setting. Anxiety was studied with the Generalized Anxiety Disorder 7-Item in hospital workforces and with the Hospital Anxiety Depression Scale (HADS) in online survey participants. Depression symptoms were assessed with the Patient Health Questionnaire-9 in hospital employees and the HADS in the online survey sample. Symptoms were classified as absent/minimal, borderline abnormal or indicating clinical caseness. Staff reaction to COVID-19 was tapped with a 9-item-questionnaire and the 22-item Impact of Event Scale-revised (IES-R). Proper tests for differences and stepwise ordered logistic regression models were employed. Anxiety- and depression severity was higher in hospital workforces than in online survey participants (P < 0.05). Anxiety was more severe in frontline- compared to backstage employees (P < 0.001) was inversely correlated with age (P = 0.011) and positively with avoidance (P = 0.028). Both anxiety and depression symptoms related to intrusion symptoms (P < 0.001). Regarding the relatively long data collection period, an inverse association between crisis duration and depression symptoms was detected (P = 0.025). These observations point to the urgent need for distress-mitigating interventions for hospital workforces even in low COVID-19 burden settings.

Healthcare Professionals, Post-traumatic Stress Disorder, and COVID-19: A Review of the Literature

The recent COVID-19 pandemic impacted healthcare professionals psychologically. They were unprepared to handle such a powerful and unknown virus. Consequently, they had to face situations of extreme distress, developing vicarious traumatization and post-traumatic stress disorder (PTSD). The first one is associated with the "cost of caring" for others and affected persons who constantly are exposed to other sufferings. PTSD is a psychiatric disorder that could affect people who have experienced or witnessed a traumatic event. Post-traumatic stress disorder (PTSD) and correlated symptoms might impact the lives of healthcare professionals at the personal, professional, and relational levels. Furthermore, the pandemic could decrease the empathy of healthcare professionals, influencing their relationship with patients. This review aimed to describe the incidence of PTSD among HPs during the COVID-19 pandemic. We focused on the following aspects: (a) PTSD symptoms and correlated psychological issues, (b) repercussions at working and personal levels, (c) change in empathetic involvement of healthcare professionals.

The impact of COVID-19 non-pharmaceutical interventions on the lived experiences of people living in Thailand, Malaysia, Italy and the United Kingdom: A cross-country qualitative study

This qualitative study explores the impact of non-pharmaceutical interventions (NPIs), including social distancing, travel restrictions and quarantine, on lived experiences during the first wave of the COVID-19 pandemic in Thailand (TH), Malaysia (MY), Italy (IT) and the United Kingdom (UK). A total of 86 interviews (TH: n = 28; MY: n = 18; IT: n = 20; UK: n = 20) were conducted with members of the public, including healthcare workers (n = 13). Participants across countries held strong views on government imposed NPIs, with many feeling measures lacked clarity. Most participants reported primarily negative impacts of NPIs on their lives, including through separation, isolation and grief over missed milestones; work-related challenges and income loss; and poor mental health and wellbeing. Nonetheless, many also experienced inadvertent positive consequences, including more time at home to focus on what they most valued in life; a greater sense of connectedness; and benefits to working life. Commonly employed coping strategies focused on financial coping (e.g. reducing spending); psycho-emotional coping (e.g. engaging in spiritual practices); social coping and connectedness (e.g., maintaining relationships remotely); reducing and mitigating risks (e.g., changing food shopping routines); and limiting exposure to the news (e.g., checking news only occasionally). Importantly, the extent to which participants' lived experiences were positive or negative, and their ability to cope was underpinned by individual, social and economic factors, with the analysis indicating some salient differences across countries and participants. In order to mitigate negative and unequal impacts of NPIs, COVID-19 policies will benefit from paying closer attention to the social, cultural and psychological-not just biological-vulnerabilities to, and consequences of public health measures.