The Impact of COVID-19: Nurses Occupational Stress and Strategies to Manage It

"I couldn't say goodbye": Thematic analysis of interviews with bereaved relatives who lost their loved ones during the COVID-19 pandemic

BACKGROUND

Delivering serious news is usually challenging for healthcare professionals and the pandemic of COVID-19 and related restrictions brought additional challenges in this process.

AIMS

To explore the experience of bereaved relatives with receiving serious news from healthcare professionals during the pandemic COVID-19.

DESIGN

A qualitative study using thematic analysis and a codebook approach of data collected in semi-structured interviews with bereaved relatives.

SETTING/PARTICIPANTS

Data were collected from July to August 2022 in person/via phone with bereaved relatives who lost their relatives during the pandemic (from March 2020 to March 2022). Participants were recruited using a convenience sample and snowball method through social media and through one university hospital palliative care unit that invited bereaved relatives of deceased patients treated at the unit to participate in this study.

RESULTS

A total of 22 participants, consisting of 4 men and 18 women, were interviewed for this study. Most of the participants were sons or daughters of individuals who had died (5 grandchildren, 14 sons/daughters, 2 spouses, 1 great-niece). Six themes were identified: Burden caused by visit ban, Fear of COVID-19, Inappropriate behaviour and communication of healthcare professionals, High need for emotional support, Need for detailed and honest communication, Tendency to make excuses for mistakes and lapses by healthcare professionals.

CONCLUSIONS

Delivering serious news during a pandemic was negatively influenced by a lack of contact with patients and a lack of support and empathetic communication with staff. Overcoming these circumstances can be achieved by frequent communication using various communication tools (such as videoconferences or phone calls), and maintaining empathy and honesty in the communication process.

How Does Mindfulness Affect Registered Nurses Practicing in Acute Care Settings? A Study of the Lived Experiences of Nurses After Participating in a Mindfulness Program

BACKGROUND

Psychological well-being of nurses is necessary to protect the overall care of themselves, as well as their patients. This is especially concerning given the effects of the COVID-19 pandemic. There are several research studies on mindfulness for RNs and its impact on psychological health and well-being. There is limited research on how nurses may use mindfulness during patient care.

AIM

The purpose of this study was to explore the effects of mindfulness education and practice on helping RNs to develop self-care skills and to apply mindfulness in the clinical setting.

METHOD

This was an exploratory mixed method design including quantitative (pilot study) and qualitative methods. Upon completion of a 4-week course on mindfulness practices, focus groups were held with the seven participants who completed the program. Open-ended, semi-structured interviews were held 1 week and then 3 months post-intervention. A constant comparative method and thematic analysis were utilized to analyze the data.

RESULTS

Four themes were identified; (1) using mindfulness to calm down one's emotional response in the clinical setting; (2) awareness; (3) loving yourself; and (4) self-care. Nurses reported increased awareness and were able to use the technique of mindfulness practice during patient care.

CONCLUSION

The findings of this study validate the benefits of mindfulness for self-care. Nurses were able to utilize mindfulness while caring for patients in different settings and during difficult patient situations, including in Behavioral Health. Further research is needed longitudinally, to explore how mindfulness can be practiced and utilized to improve outcomes in patient care.

The Evolution of Employee Assistance Programs to Best Support Healthcare Organizations

GOAL

Employee assistance programs (EAPs) have been evolving since they first became prevalent in the 1970s. The important counseling component of EAPs is sometimes lost in discussions about what they do, with many EAPs marketing a broad portfolio of services such as childcare, elder care, legal referral, and other concierge services rather than counseling. The objective of this study was to examine outcomes for the EAP of one organization (Mayo Clinic), compare them to outcomes reported in the literature, and gain insights to help all healthcare organizations best support their employees.

METHODS

Consistent with customary EAP practice, data for this study was collected through an anonymous survey link distributed by e-mail to users of individual counseling as well as users of organizational consulting services such as advising leaders and supervisors and leading educational sessions.

PRINCIPAL FINDINGS

All (n = 82) individual counseling respondents indicated they would recommend the EAP, none reported worse symptoms, 90% decreased their stress levels, 92% reduced their feelings of anxiety, 88% enjoyed an overall improvement in mood, and 95% developed new skills. If their concern was work-related, 96% agreed the counselor understood the work culture and was able to provide helpful guidance; of the clients who were feeling burned out, 86% agreed they gained strategies to reduce its symptoms. Thematic analysis of individual counseling services indicated that participants highly valued their counselors. Regarding organizational consulting services, respondents (n = 50) indicated EAP services increased their confidence as leaders, supported their work, and provided tangible guidance. They appreciated having an internal EAP counselor. Thematic analysis of organizational consulting services indicated that EAP supported leaders by listening, coaching, and empowering them to normalize issues.

PRACTICAL APPLICATIONS

EAPs have evolved into distinct internal, external, and hybrid internal-external models. Internal model counselors are company employees with inside knowledge of company culture, external EAP model counselors are contracted outside of the company, and hybrid models combine a small cadre of internal counselors with the support of outside contractors. Regardless of the model, EAP counselors must collaborate with internal stakeholders, notably the human resources department, to efficiently identify and troubleshoot employee relational issues and allow for customized initiatives to improve mental health. Based upon these findings and the authors' direct experiences with EAP providers, components of an ideal EAP are outlined to show how EAPs can best support employees. Healthcare leaders seeking to add EAP services are advised to focus on offerings that are custom fit to the organization.

Work-related psychosocial challenges and coping strategies among nursing workforce during the COVID-19 pandemic: a scoping review

BACKGROUND

Nurses and midwives have been stretched by the COVID-19 pandemic amidst the heroic roles they have played during the peak of the COVID-19 pandemic. Nurses stood tall among their peers in the healthcare industry saving lives. The pandemic has had a toll on nurses physically, psychologically, and socio-economically. The numerous deaths have traumatized nurses coupled with the fear of possible infection. Nurses have seen their colleagues and loved ones lose their lives to the pandemic, nevertheless, they still render care to patients no matter the circumstances. Due to that, it is imperative to ascertain the extent to which nurses who are much needed in healthcare delivery have been affected by this pandemic. This scoping review used Arksey and O'Malley's review methodology to investigate the nature of work-related psychosocial challenges nurses encountered during the peak of the pandemic, noting the major contributors to the challenges and the coping strategies used to address them.

METHODS

We performed a scoping review and searched for articles from five databases including PUBMED, CINAHL, SCOPUS, Google Scholar, and Grey literature from December 2019 to December 2021. A total of 7,334 articles were retrieved for the study but 45 met the inclusion criteria.

RESULTS

Work-related psychosocial challenges identified included stress, burnout (emotional exhaustion and depersonalization), Post-Traumatic Stress Disorder, depression, sleeplessness, and anxiety. Factors that accounted for the challenges were inadequate personal protective equipment (PPEs), discomfort using the PPEs, extreme workload, and fatigue. Nurses experienced job insecurity, business closure, and separation from family and loved ones, and these contributed to their challenges. Strategies used to deal with the challenges centred on emotion-focused and problem-focused coping.

CONCLUSIONS

The study recommends regular counselling and support for all nurses working at the frontline to help them better cope with the devastating effects of the pandemic so that they could build resilience towards future pandemics.

Emotional intelligence and coping strategies among intensive care unit nurses

BACKGROUND

Stress is an integral part of daily work for nurses, especially those who work in intensive care units (ICUs). However, chronic stress can affect nurses' mental and physical well-being, increasing their risk of burnout and decreasing the quality of care. A higher emotional intelligence (EI) level may be correlated with greater use of effective coping strategies, leading to a reduction of the adverse effects of stress.

AIM

This study aimed to examine the relationship between EI and coping strategies among adult ICU nurses in Poland.

STUDY DESIGN

A cross-sectional survey design was used. Current adult ICU nurses in nine Polish hospitals were invited to participate. The survey instruments used were: the Polish version of the Schutte Self-Report Emotional Intelligence Test, the Inventory to Measure Coping Strategies with Stress (Brief-COPE), and a self-constructed questionnaire.

RESULTS

114/543 (21%) nurses completed the survey. ICU nurses showed an average level of EI (70.2%). The main stress coping strategies were active coping and planning, the rarest being substance use, behavioural disengagement, and denial. For nurses with a higher EI level, the most frequently used strategies included positive reframing (R = 0.43; p < .001), active coping (R = 0.38; p < .001), planning (R = 0.37; p < .001) and religion (R = 0.25; p = .006). Nurses were less likely to utilize strategies of behavioural disengagement (R = -0.32; p = .001) and self-blame (R = -0.40; p < .001).

CONCLUSIONS

EI may have an impact on coping strategies, as a higher EI level was correlated with the greater use of effective coping strategies in ICU nurses.

RELEVANCE TO CLINICAL PRACTICE

Training in coping with stress and increasing EI may have a positive impact on reducing the risk of burnout in nurses and thus improving the quality of care delivered.

Psychoeducational interventional programme during the COVID-19 pandemic for nurses with severe occupational stress: A randomized controlled trial

BACKGROUND

Occupational stress is generally acknowledged as a major issue in the health sector that may have a detrimental impact on nurses' psychological and physical health, particularly during the COVID-19 epidemic.

AIM

This study evaluated the effectiveness of a psychoeducational interventional programme in decreasing occupational stress and improving coping methods among nurses during the COVID-19 pandemic.

METHODS

This study used a cluster-randomized approach. Data were collected from 80 nurses working in two public health-care centres from May to August 2020 in Jordan. Two centres were assigned randomly to the intervention and control groups. The psychoeducational programme was delivered to the intervention group in six sessions over 6 days for 2 weeks. The collected data were analysed using SPSS through descriptive and inferential statistics. Occupational stress and coping strategies were measured.

RESULTS

Repeated-measures analysis of variance (ANOVA) indicated that the degrees of occupational stress and coping strategies significantly differed between study groups over the three points of data collection.

CONCLUSION

This psychoeducational interventional programme is a valuable noninvasive method that can improve individual coping strategies to manage stress in practice during the COVID-19 pandemic.