The impact of COVID-19 on nurse alcohol consumption: A qualitative exploration

Student Registered Nurse Anesthetists' Perceptions of Substance Use [Formula: see text]

BACKGROUND

Nurses enrolled in certified registered nurse anesthetists programs are taught to be experts in complex pharmaceutical agents, often under high stakes conditions. Such conditions may create maladaptive coping mechanisms, such as substance use. However, exploration of student registered nurse anesthetists' (SRNAs) perceptions of substance use and drug diversion have only been minimally described in the literature.

AIMS

The study aims were to (a) investigate SRNAs' ratings of the American Association of Nurse Anesthesiology's (AANA) recommended strategies to reduce drug diversion and (b) analyze qualitative responses to open-ended items related to the use of substances.

METHODS

Approximately 400 students responded to an online survey in March 2021. The survey was randomly sent to 3,000 SNRAs who were members of the AANA (return rate of 13%). Descriptive statistics and paired t-tests were calculated to determine differences between strategies viewed as effective and strategies that have been implemented. A descriptive content analysis was conducted to derive themes from four open-ended questions.

RESULTS

For all 11 AANA strategies, the means for effectiveness were significantly higher than means for strategies that were implemented, indicating that strategies were seen as effective, but were not being implemented. The highest scored perceived effectiveness strategy was "Creating a safe environment for prompt reporting." Themes captured a high-pressured, high-stakes educational environment, characterized by rigidity and incivility.

CONCLUSIONS

Policies to support a safe environment to encourage students to self-report substance use, an awareness of alternative-to-discipline programs, and reintegration into educational programs should be formulated and implemented by educational institutions.

Are "Alternative to Discipline" Programs for Nurses With Alcohol and Other Drug Challenges Relevant to Global Contexts? A Scoping Review

Alternative to discipline programs, defined as programs for nurses 'impaired' by issues such as alcohol and/or drug use, provide treatment and support to return to the profession. This paper aims to explore alternative to discipline programs for nurses to determine whether these programs are relevant to other geographical contexts. A scoping review was conducted in accordance with the JBI methodology. The PRIMSA-ScR checklist was used in this scoping review. The databases searched included MEDLINE (PubMed), Embase (Elsevier), Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), and ProQuest Dissertations and Theses Global (ProQuest) from 1984 to 2024. Title and abstract screening was conducted on 1622 papers, resulting in 90 papers for full-text screening. After full-text screening, 19 papers met the inclusion criteria for this scoping review. Issues related to the cost of programs, strict requirements for abstinence, and a lack of 'bespoke' options that address participant needs were identified in this review and need to be addressed prior to global implementation of these programs. Impairment of nurses due to alcohol and/or drug use threatens workforce sustainability, and without 'alternatives to discipline', can mean experience nurses are lost to the profession, often without treatment. Exploration of alterative to discipline programs is essential to ensure that nurses with alcohol and other drug challenges are retained in the profession and receive the treatment required to remain safe practitioners. Likewise, the perception that programs were punitive in nature should be addressed to ensure acceptability of these programs as an alternative to the loss of employment.

Perceived Trauma Among Nurses During the COVID-19 Pandemic: A Qualitative Descriptive Study

The COVID-19 pandemic has caused disruption to healthcare services worldwide, and although the pandemic was declared over, nurses continue to experience burnout and mental health implications because of events experienced since 2020. The aim of this study was to explore the experiences of trauma among nurses during the COVID-19 pandemic, using a qualitative descriptive study design. This paper used secondary analysis of qualitative, semi-structured interviews conducted with 55 Australian nurses exploring their alcohol consumption, due to the frequent narratives of trauma and traumatic events arising during this process. Data were analysed using structural coding and reported in accordance with the Consolidated Checklist for Reporting Qualitative Data (CORE-Q guidelines). Four themes emerged during data analysis: managing the traumatic stress of the clinical environment in COVID ('it doesn't feel like it's gone away'), post-pandemic trauma ('it was like war, wasn't it?'), bonding over shared trauma ('I was not expecting the camaraderie that developed') and managing trauma after the event ('If something bad happens whilst you're on shift, you just have to pretend like it hasn't happened'). Participants in this study described lasting mental health effects from working clinically during the COVID-19 pandemic that they described as trauma. These effects have lasted since governments worldwide have announced an end to the pandemic, and although participants described bonding over these shared experiences, they continue to have a detrimental impact on workforce well-being and sustainability.

Determining the Acceptability of Targeted Apps for High-Risk Alcohol Consumption in Nurses: A Qualitative Study

AIM

To determine the acceptability of targeted apps and provide recommendations for the implementation of and app addressing high risk alcohol use to nurses.

DESIGN

A qualitative descriptive study design, using the Behavioural Change Wheel implementation framework.

METHODS

Semi-structured interviews with 42 Australian nurses were subject to structural coding using the Capability, Opportunity, and Motivation (COM-B) model linked to the Behaviour Change Wheel. Qualitative data has been reported using the COREQ framework.

RESULTS

Most participants agreed that targeted apps would appeal to nurses, provided specific design considerations were included. These considerations related to privacy and confidentiality, strategies to target the app to nurses across wide age and experience ranges and identified the need for a considered campaign to both launch the app and position it with existing interventions for high-risk alcohol use.

CONCLUSIONS

Our findings indicate that a targeted app to reduce high-risk alcohol consumption could be acceptable to nurses, however the needs to include specific components suitable for nurses. We recommend further research into specific components of a targeted app, leading to a co-design process where nurses can determine app components and function.Summary of relevanceHigh-risk alcohol consumption has been shown to be an issue amongst nurses.Targeted apps have been shown to have an effect in addressing high-risk alcohol consumption among specific groups.However, consideration for privacy of data provided to the app must be considered, especially given the link between disciplinary action, loss of role identity, and nurse suicide.This paper indicates that nurses would accept a targeted app, subject to specific design considerations, particularly related to confidentiality.

Problem drinking and comorbidity with mental ill health: a cross-sectional study among healthcare workers in Sweden

AIMS

Problem drinking in healthcare workers (HCWs) is highly relevant to study as it could result in personal suffering, as well as inefficiencies in health service delivery. This study aims to investigate the prevalence of nondrinking, drinking, and problem drinking and to investigate the comorbidity between drinking alcohol and mental illness (burnout and depression) among HCWs in Sweden.

METHODS

This cross-sectional study draws on the 2022 Longitudinal Occupational Health survey in Healthcare Sweden of physicians, nurses, and nurse assistants in Sweden (N = 5966). Measures include levels of alcohol use assessed by the Cut, Annoyed, Guilty, and Eye Opener questionnaire, the 12-item Burnout Assessment Tool, and the Symptom CheckList-Core Depression. Multinomial Logistic regressions were used to investigate the likelihood of reporting nondrinking and problem drinking compared to drinking.

RESULTS

The prevalence of problem drinking among Swedish HCWs was 3.7%. Only sex differences were observed for those with a problem drinking, with male nurses and nurse assistants being more likely to report problem drinking. Comorbidity was found between problem drinking and depression but not between problem drinking and burnout.

CONCLUSIONS

This study demonstrated that ~3.7% of Swedish HCWs had problem drinking and that those also had a higher likelihood of reporting depression but not burnout. Results contribute to new knowledge about the use of alcohol and comorbidities with depression and burnout among HCWs in Sweden. Findings could benefit employers in implementing preventive and tailored strategies to preserve the psychosocial well-being of HCWs.

Revisiting Alcohol Consumption Among Nurses After the COVID-19 Pandemic: A Qualitative Descriptive Study

The COVID-19 pandemic continues to cause nurses stress and trauma, with alcohol potentially being used to manage this stress. Prior studies of nurses' alcohol consumption during the COVID-19 pandemic have shown increases in alcohol consumption to manage stress associated with the pandemic. The aim of this paper is to explore perceptions of alcohol consumption and stress among nurses, particularly since the declared end of the COVID-19 pandemic. We used semi-structured interviews with Australian nurses (n = 55), using a qualitative-descriptive study design, conducted between October 2023 and January 2024. Data were analysed using structural coding and reported in accordance with CORE-Q guidelines. Four key themes emerged from the data: (1) Alcohol consumption in response to ongoing role stress, (2) Alcohol consumption in response to incidents, (3) The lasting impact of the COVID-19 pandemic and (4) Do nurses feel comfortable seeking help for alcohol use? High-risk alcohol consumption has persisted beyond the end of the COVID-19 pandemic to manage the stress associated with clinical environments. Alcohol was also used in response to incidents, and the ongoing trauma and impact of the pandemic was described as a significant source of stress and anxiety. Not all nurses in our study felt comfortable seeking help for alcohol use, with participants describing concern for their nursing registration if they self-reported their alcohol consumption. Participants reported stronger links between stressful working environments and increased alcohol consumption. Nurses in our study do not feel safe seeking help or self-reporting alcohol consumption for fear of the regulatory body instituting sanctions that lead to loss or suspension of their registration. These factors require urgent attention to ensure workforce wellbeing and sustainability.

Anxiety and burnout in infectious disease nurses: the role of perceived stress and resilience

BACKGROUND

Nurses serving in infectious disease ward represent a distinct occupational group that has attracted considerable attention following epidemic outbreaks. However, prior to this study, no research had delved into the underlying mechanism linking anxiety to burnout symptoms among infectious disease nurses. This study aimed to explore investigate the association between anxiety and burnout among nurses working in such environments and scrutinized the mediating role of perceived stress and the moderating influence of resilience on the principal relationship.

METHODS

Employing a cross-sectional study using a web-based design, data were collected from 1,579 clinical nurses working in infectious disease ward across 50 hospitals in China. Participants responded to questionnaires assessing anxiety, perceived stress, resilience and burnout. Statistical analyses encompassed descriptive statistics, one-way analyses of variance, independent-samples t-tests, Pearson correlations, and bootstrapping techniques to evaluate the indirect and moderating effects.

RESULTS

The study revealed that 62.13% of the respondents reported high levels of burnout, and 55.92% experienced moderate to high degrees of emotional exhaustion among infectious disease nurses. Significant correlations were observed between anxiety, perceived stress, resilience, and each component of burnout (P < 0.05). Notably, the mediating effect of perceived stress was accounting for 30.61% of the relationship between anxiety and burnout. Simple slope analysis demonstrated that perceived stress significantly predicted emotional exhaustion at both low (B = 0.854, t = 16.586, and P < 0.001) and high (B = 0.498, t = 9.503, and P < 0.001) levels of resilience. The perceived stress and emotional exhaustion were more serious when resilience levels were lower.

CONCLUSION

Anxiety was identified as a critical risk factor for burnout among nurses in infectious disease units. The relationship between anxiety and burnout was markedly affected by the levels of perceived stress and resilience. Specifically, the deleterious impact of perceived stress on burnout was amplified in nurses with diminished resilience relative to those with heightened resilience. Based on these findings, it is imperative to allocate resources for stress management programs and resilience training. Such initiatives would bolster support for nurses in infectious disease wards, ultimately enhancing their job satisfaction and well-being.

Mindfulness Smartphone Application Implementation to Impact Stress and Burnout in Adult Healthcare Professionals

Many healthcare professionals are experiencing increased stress and burnout, worsened by the COVID-19 pandemic, leading to negative individual and organizational outcomes such as mental illness, maladaptive coping, job dissatisfaction, poor patient care, and higher turnover costs. Mindfulness practice is a promising evidence-based approach to impact stress and burnout. This quality improvement pilot project evaluated the impact of a free mindfulness smartphone application on stress and burnout levels in certified or licensed adult healthcare professionals over 6 weeks. Using a quasi-experimental pre- and post-intervention design, the project assessed the Mindfulness Coach application's (app) impact on stress and burnout using the Perceived Stress Scale and the Mini Z 2.0 survey. The results indicated that using the app significantly reduced perceived stress but did not impact burnout symptoms.

Coping profiles and their association with vicarious post-traumatic growth among nurses during the three waves of the COVID-19 pandemic

AIMS

This study aimed to examine (a) changes in coping strategies and vicarious post-traumatic growth (VPTG) across three timepoints of the COVID-19 pandemic among nurses; (b) discrete groups of nurses with unique coping profiles and (c) the association of these coping profiles with VPTG across the timepoints.

BACKGROUND

Although literature abounds with the negative mental health consequences of the pandemic among healthcare professionals, much less is known about the positive consequences on nurses, the coping strategies that they use, and how these change over time.

DESIGN

This was a cross-sectional web-based survey at three timepoints during the pandemic.

METHODS

A sample of 429 nurses completed online the Post-Traumatic Growth Inventory (PTGI) and the Brief Coping Orientation to Problems Experienced Inventory (COPE) to measure vicarious post-traumatic growth (VPTG) and coping strategies, respectively. The STROBE checklist was used to report the present study.

RESULTS

Significantly higher VPTG scores were observed during the third timepoint. Different coping strategies were employed across the three timepoints. Nurses responded to the pandemic either with an active, an avoidant or a passive coping profile. Significantly higher VPTG levels were reported by the nurses of the active profile compared to those of the passive profile, whereas the difference between active and avoidant profiles was not significant.

CONCLUSIONS

Notwithstanding the preponderance of the nurses with the active coping profile in achieving high VPTG, the avoidant copers had more gains (VPTG) than the passive copers, suggesting that doing something to cope with the stressor-let it be trying to avoid it-was better than doing nothing.

RELEVANCE TO CLINICAL PRACTICE

The identification of distinct coping profiles among nurses and their association with VPTG is of particular use to policymakers and practitioners in developing tailored prevention and intervention efforts to help the nurses effectively manage the demands of the pandemic.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution since the study was exclusively conducted by the authors.

Anger and Aggression in Relation to Psychological Resilience and Alcohol Abuse among Health Professionals during the First Pandemic Wave

Mental health problems, behavior changes, and addictive issues have been consistently documented among healthcare workers during the pandemic. The objective of this study was to investigate the levels of anger and aggression in relation to psychological resilience and alcohol abuse among healthcare workers during the first wave of the COVID-19 pandemic. A total of 120 physicians and 123 nurses completed an online survey of the Dimensions of Anger Reactions-5 (DAR-5), the Brief Aggression Questionnaire (BAQ), the Brief Resilience Scale (BRS), and the Alcohol Screening questionnaire CAGE which is an acronym for the focus of the questions (Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers). Demographic and professional data were also recorded. A total of 53 men and 190 women participated in the study. Almost one-third of the participants had a positive score on the DAR-5 scale and one out of ten respondents presented with current problematic alcohol use. Male participants demonstrated lower scores on the DAR-5 scale compared to females. Individuals with current problematic alcohol use displayed higher scores on the BAQ compared to those without alcohol use disorders. Regression analysis revealed that 16.4% of the variance in the BAQ scores can be attributed to scores on the DAR-5, 5.9% to the BRS scores, 2.1% to the CAGE scores, 1.7% to gender, and 1.2% to years of work experience. Mediation analysis highlighted the role of psychological resilience as a negative mediator in the DAR-5 and BAQ relationship. Professional experience and alcohol abuse emerged as positive and negative risk factors contributing to aggression and psychological resilience. The findings hold practical implications for implementing interventions to strengthen resilience in order to compensate for aggressive tendencies and discourage addictive issues.

Psychosocial ergonomics of the workplace of medical staff during the COVID-19 pandemic in three risk's dimensions: working hours, violence and the use of psychoactive drugs-a prospective pilot study

Introduction

Workplace ergonomics should also be considered in the context of psychosocial factors affecting the worker, which have a real impact on occupational risk. The present study examined psychosocial risk factors in medical personnel in three domains: working hours, violence and substance abuse.

Methods

The purpose of the present study is to assess the current state of psychosocial ergonomics of medical personnels by measuring occupational risks in the domains of: working hours, violence and psychoactive substance abuse. The survey is consisted of two parts: socio-demographic information of participants and participants' assements of psychosocial risk factors.

Results

In more than half of the respondents (52%), increased risk was identified in the domain of working hours. Nearly half of the respondents (49.6%) have an identified high risk in the domain of violence, and more than half of the respondents (52%) are at high risk in the domain of psychoactive substance abuse.

Discussion

Our findings show that the present psychosocial ergonomics of the Polish health system must be improved. The COVID-19 pandemic has been a compelling test to assess the current state. Our findings highlighted the fact that HCWs often worked overtime and that many cases of workplace violence and substance abuse were reported.

Mental health and wellbeing of health and aged care workers in Australia, May 2021 - June 2022: a longitudinal cohort study

OBJECTIVES

To assess the mental health and wellbeing of health and aged care workers in Australia during the second and third years of the coronavirus disease 2019 (COVID-19) pandemic, overall and by occupation group.

DESIGN, SETTING, PARTICIPANTS

Longitudinal cohort study of health and aged care workers (ambulance, hospitals, primary care, residential aged care) in Victoria: May-July 2021 (survey 1), October-December 2021 (survey 2), and May-June 2022 (survey 3).

MAIN OUTCOME MEASURES

Proportions of respondents (adjusted for age, gender, socio-economic status) reporting moderate to severe symptoms of depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder scale, GAD-7), or post-traumatic stress (Impact of Event Scale-6, IES-6), burnout (abbreviated Maslach Burnout Inventory, aMBI), or high optimism (10-point visual analogue scale); mean scores (adjusted for age, gender, socio-economic status) for wellbeing (Personal Wellbeing Index-Adult, PWI-A) and resilience (Connor Davidson Resilience Scale 2, CD-RISC-2).

RESULTS

A total of 1667 people responded to at least one survey (survey 1, 989; survey 2, 1153; survey 3, 993; response rate, 3.3%). Overall, 1211 survey responses were from women (72.6%); most respondents were hospital workers (1289, 77.3%) or ambulance staff (315, 18.9%). The adjusted proportions of respondents who reported moderate to severe symptoms of depression (survey 1, 16.4%; survey 2, 22.6%; survey 3, 19.2%), anxiety (survey 1, 8.8%; survey 2, 16.0%; survey 3, 11.0%), or post-traumatic stress (survey 1, 14.6%; survey 2, 35.1%; survey 3, 14.9%) were each largest for survey 2. The adjusted proportions of participants who reported moderate to severe symptoms of burnout were higher in surveys 2 and 3 than in survey 1, and the proportions who reported high optimism were smaller in surveys 2 and 3 than in survey 1. Adjusted mean scores for wellbeing and resilience were similar at surveys 2 and 3 and lower than at survey 1. The magnitude but not the patterns of change differed by occupation group.

CONCLUSION

Burnout was more frequently reported and mean wellbeing and resilience scores were lower in mid-2022 than in mid-2021 for Victorian health and aged care workers who participated in our study. Evidence-based mental health and wellbeing programs for workers in health care organisations are needed.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12621000533897 (observational study; retrospective).

Compassion Fatigue and Perceived Social Support among Polish Nurses

BACKGROUND

Social support has a vital role in preventing traumatic stress in nurses. Nurses are regularly exposed to contact with violence, suffering, and death. The situation worsened during the pandemic because they were also faced with the possibility of infection SARS-CoV-2 and death from COVID-19. Many nurses are faced with increased pressure, stress, and other adverse effects on their mental health. The study aimed to measure the relationship between compassion fatigue and perceived social support in polish nurses.

METHODS

The study was conducted on 862 professionally active nurses in Poland using the CAWI method (Computer-Assisted Web Interview). The professional Quality of Life scale (ProQOL) and the Multidimensional Scale of Perceived Social Support (MSPSS) were used for collecting the data. StatSoft, Inc. (2014) was used for data analysis. For comparisons between the groups: Mann-Whitney U test, ANOVA Kruskal-Wallis test, and multiple comparisons (post-hoc). The relationships between variables were tested using Spearman's rho, Tau Kendall, and the chi-square test.

RESULTS

The research showed the presence of compassion satisfaction, compassion fatigue, and burnout in the group of Polish hospital nurses. A higher level of perceived social support was associated with lower compassion fatigue (r = -0.35; p < 0.001). A higher level of social support was associated with higher job satisfaction (r = 0.40; p < 0.001). The study also found that a higher level of social support was associated with a lower risk of burnout (r = -0.41; p < 0.001).

CONCLUSIONS

Preventing compassion fatigue and burnout should be a priority for healthcare managers. Notably, an essential predictor of compassion fatigue is that Polish nurses often work overtime. It is necessary to pay more attention to the crucial role of social support in preventing compassion fatigue and burnout.