How can we build and maintain the resilience of our health care professionals during COVID-19? Recommendations based on a scoping review

Organizational resilience and its implications for healthcare workers in the COVID-19 pandemic: A literature review

Background

Organizational resilience is crucial in supporting the well-being of healthcare workers and ensuring the quality of healthcare services during crises like the COVID-19 pandemic. This study aims to comprehensively review organizational resilience of healthcare facilities in terms of its conception, measurement, and impacts on healthcare workers during the COVID-19 pandemic.

Methods

A search was conducted in four databases (PubMed, ScienceDirect, PsycINFO, and Web of Science) for empirical articles considering organizational resilience among healthcare facilities during the COVID-19 pandemic from 2019 to 2024. Several keywords from three categories ("COVID-19", "organizational resilience," and "healthcare facilities") were used, and RAYYAN was used to manage references.

Results

Four empirical articles from 172 studies were included, which encompassed a total sample of 6,606 healthcare workers from Switzerland, Saudi Arabia, Iran, and Türkiye. Organizational resilience could influence the individual resilience of healthcare practitioners, enhance crisis management and ensure safety performance. The strategies of enhancing organizational resilience at healthcare worker level included staff training, crisis management protocols, collaboration promotion, and stress management approaches. The ones at health facility level included government intervention, funds for hospital preparedness, competency-based crisis management, and mental health programs for healthcare workers. Our review also suggests a lack of empirical studies, no commonly used measurement instruments, and the heterogeneity of study contexts in the research of organizational resilience in public health.

Conclusions

This review highlights effective strategies to enhance the organizational resilience of healthcare workers and examines their impact during the COVID-19 pandemic. Immediate government action, funding to support hospital preparedness, and the formation of flexible healthcare teams are essential to strengthen organizational resilience among healthcare workers for future crises.

Understanding the impact of expertise on compassion fatigue in counseling via core self-evaluation and resilience

Compassion fatigue is a prevalent challenge experienced by helping professionals, influencing both their personal well-being and the quality of services they deliver. While the beneficial impact of expertise in counseling on alleviating compassion fatigue has been established, limited research has investigated this association specifically among mental health counselors within the cultural context of China. Additionally, the underlying mechanisms remain unclear. This study examined whether expertise in counseling can reduce compassion fatigue and whether this relationship is mediated by core self-evaluation and resilience. A cross-sectional survey of 109 mental health counselors revealed that expertise negatively predicted compassion fatigue both directly and indirectly through enhanced core self-evaluation. However, resilience only exhibited a negative correlation with compassion fatigue and a positive correlation with core self-evaluation, its mediating effect between expertise and compassion fatigue was not supported. This study highlights the crucial role of expertise and core self-evaluation as mediating factors in alleviating compassion fatigue.

Long-term impact of COVID-19 pandemic: Moral tensions, distress, and injuries of healthcare workers

Given the longevity of the COVID-19 pandemic, it is important to address the perceptions and experiences associated with the progression of the pandemic. This narrative can inform future strategies aimed at mitigating moral distress, injury, and chronic stress that restores resilience and well-being of HCWs. In this context, a longitudinal survey design was undertaken to explore how health care workers are experiencing the COVID-19 pandemic over time. A qualitative design was employed to analyze the open ended survey responses using a thematic analysis approach. All physicians and staff at an academic health science centre in Toronto, Ontario, Canada were invited to participate in the survey. The majority of survey respondents were nurses and physicians, followed by researchers/scientists, administrative assistants, laboratory technicians, managers, social workers, occupational therapists, administrators, clerks and medical imaging technologists. The inductive analysis revealed three themes that contributed to moral tensions and injury: 1) experiencing stress and distress with staffing shortages, increased patient care needs, and visitor restrictions; 2) feeling devalued and invisible due to lack of support and inequities; and 3) polarizing anti- and pro-public health measures and incivility. Study findings highlight the spectrum, magnitude, and severity of the emotional, psychological, and physical stress leading to moral injury experienced by the healthcare workforce. Our findings also point to continued, renewed, and new efforts in enhancing both individual and collective moral resilience to mitigate current and prevent future moral tensions and injury.

Factors influencing the formation of balanced care teams: the organisation, performance, and perception of nursing care teams and the link with patient outcomes: a systematic scoping review

BACKGROUND

The composition of care teams is crucial for delivering patient-centered healthcare, yet assembling a well-balanced team remains a challenge. This difficulty stems from the intricate dynamics of team capacity, culture, context, and the demands of the job. The current literature offers limited guidance for decision-makers on how to effectively navigate these dynamics to compose a balanced care team.

METHODS

We conducted a systematic scoping review of literature spanning from 2009 to 2022. The aim was to identify factors that significantly influence the work environment, team performance, nursing outcomes, and patient outcomes within healthcare settings. Our review focused on extracting and synthesizing evidence to uncover these influencing factors.

RESULTS

Our analysis identified 35 factors that play a significant role in shaping the work environment and influencing team performance, nursing outcomes, and patient outcomes. These factors were categorized into nine key domains: workload, leadership, team composition, stress and demands, professional relationships, safety, logistics and ergonomics, autonomy and responsibility, and transparency and task clearness.

CONCLUSIONS

To improve patient care and nursing job satisfaction, policymakers and decision-makers can consider these influencing factors in the design and management of care teams. The findings advocate for strategic adjustments in these domains to enhance a team's balance. Furthermore, our review underscores the need for further research to fill the identified gaps in knowledge, offering a directive for future studies into optimal care team composition. This systematic approach to team composition can significantly impact patient outcomes and nurse satisfaction, providing a roadmap for creating more effective and harmonious teams.

Association of personal and professional factors, resilience and quality of life of registered nurses in a university medical city in the Kingdom of Saudi Arabia

This study assessed the resilience of nurses in Saudi Arabia during the corona virus 2019 (COVID-19) pandemic and examined its influence on their quality of life (QOL). A sample of 356 nurses was surveyed in this quantitative, cross-sectional study using the Resilience Scale for Nurses and the World Health Organization Quality of Life (WHOQOL-BREF) from October 2020 to March 2021. The nurses reported the highest resilience score on "situational pattern", while the lowest score was on "relational pattern." The nurses had good perceptions on their overall QOL and health and rated their "social relationship" as having the highest quality, while their "environmental" domain as having the least quality. Gender, marital status, provision of direct nursing care to COVID-19 patients, "philosophical pattern", "situational pattern" and "dispositional pattern" had multivariate impacts on the QOL dimensions. The study concluded that being resilient can positively impact the nurses' QOL during stressful situations, such as the COVID-19 pandemic.

Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review

BACKGROUND

Primary Health Care (PHC) systems are pivotal in delivering essential health services during crises, as demonstrated during the COVID-19 pandemic. With varied global strategies to reinforce PHC systems, this scoping review consolidates these efforts, identifying and categorizing key resilience-building strategies.

METHODS

Adopting Arksey and O'Malley's scoping review framework, this study synthesized literature across five databases and Google Scholar, encompassing studies up to December 31st, 2022. We focused on English and Persian studies that addressed interventions to strengthen PHC amidst COVID-19. Data were analyzed through thematic framework analysis employing MAXQDA 10 software.

RESULTS

Our review encapsulated 167 studies from 48 countries, revealing 194 interventions to strengthen PHC resilience, categorized into governance and leadership, financing, workforce, infrastructures, information systems, and service delivery. Notable strategies included telemedicine, workforce training, psychological support, and enhanced health information systems. The diversity of the interventions reflects a robust global response, emphasizing the adaptability of strategies across different health systems.

CONCLUSIONS

The study underscored the need for well-resourced, managed, and adaptable PHC systems, capable of maintaining continuity in health services during emergencies. The identified interventions suggested a roadmap for integrating resilience into PHC, essential for global health security. This collective knowledge offered a strategic framework to enhance PHC systems' readiness for future health challenges, contributing to the overall sustainability and effectiveness of global health systems.

"They really trust us!": Medical Interpreter's Roles and Experiences in an Integrated Primary Care Clinic

This study describes medical interpreters' experiences with behavioral health (BH) services in a primary care clinic. Focus group data with medical interpreters representing multiple languages was analyzed using hybrid inductive-deductive thematic analysis. Themes related to interpreter roles were: (1) case management, (2) patient-interpreter relationship, and (3) patient-provider liaison. Themes related to barriers and facilitators to interpreter-mediated BH care were: (1) cultural factors, (2) patient-provider interactions, (3) BH-specific considerations, and (4) clinic factors. Results illustrate ways that interpreters directly (e.g., interpreter-mediated services) and indirectly (e.g., relationship building) support care. The interpreter-patient relationship reportedly helped improve patient attitudes and buy-in for BH.

Bracing for the next wave: A critical incident study of frontline decision-making, adaptation and learning in ambulance care during COVID-19

AIM

To explore frontline decision-making, adaptation, and learning in ambulance care during the evolving COVID-19 pandemic.

DESIGN

Descriptive and interpretative qualitative study.

METHODS

Twenty-eight registered nurses from the Swedish ambulance services described 56 critical incidents during the COVID-19 pandemic through free-text questionnaires. The material was analysed using the Critical Incident Technique and Interpretive Description through the lens of potential for resilient performance.

RESULTS

The findings were synthesized into four themes: 'Navigating uncharted waters under never-ending pressure', 'Balancing on the brink of an abyss', 'Sacrificing the few to save the many' and 'Bracing for the next wave'. Frontline decision-making during a pandemic contribute to ethical dilemmas while necessitating difficult prioritizations to adapt and respond to limited resources. Learning was manifested through effective information sharing and the identification of successful adaptations as compared to maladaptations.

CONCLUSIONS

During pandemics or under other extreme conditions, decisions must be made promptly, even amidst emerging chaos, potentially necessitating the use of untested methods and ad-hoc solutions due to initial lack of knowledge and guidelines. Within ambulance care, dynamic leadership becomes imperative, combining autonomous frontline decision-making with support from management. Strengthening ethical competence and fostering ethical discourse may enhance confidence in decision-making, particularly under ethically challenging circumstances.

IMPACT

Performance under extreme conditions can elevate the risk of suboptimal decision-making and adverse outcomes, with older adults being especially vulnerable. Thus, requiring targeted decision support and interventions. Enhancing patient safety in ambulance care during such conditions demands active participation and governance from management, along with decision support and guidelines. Vertical communication and collaboration between management and frontline professionals are essential to ensure that critical information, guidelines, and resources are effectively disseminated and implemented. Further research is needed into management and leadership in ambulance care, alongside the ethical challenges in frontline decision-making under extreme conditions.

REPORTING METHOD

Findings are reported per consolidated criteria for reporting qualitative research (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Peer support as a potential tool to promote pharmacists' wellbeing

Discussion regarding burnout in health professionals, including community pharmacists, has grown substantially since the arrival of the COVID-19 pandemic. Rapid legislative and societal behavioural changes led to significant global disruption of physical and emotional wellbeing during the pandemic as pharmacists continued to provide care while under unprecedented levels of stress. Community pharmacists have had an essential role in maintaining face-to-face care as the number of COVID-19 diagnoses and deaths rose. Communications emerged from the World Health Organization which implored long-term changes to healthcare workplaces, including increased access to psychosocial support for employees. Peer support is a unique initiative, and it is low-cost and accessible across many platforms. Its main purpose is to bring people together with shared experiences and can often include people in the same career field or workplace. The feasibility and efficacy of peer support programs have been studied in other professional groups such as nurses and physicians, and also in undergraduate medical students. The conclusions drawn from these studies suggest that involvement in peer support reduced the risk of burnout and increased workplace engagement. In contrast to many other healthcare professionals, community pharmacists often work in relative isolation. Research has shown that younger pharmacists, and those in the earlier stages of their careers, reported feeling stressed, undervalued, and supported. They also mentioned a desire for access to a mentoring or coaching program. Following the success of peer support in other cohorts, research is needed to verify if this intervention will similarly benefit early career community pharmacists.

What makes health systems resilient? An analytical framework drawing on European learnings from the COVID-19 pandemic based on a multitiered approach

Introduction

The COVID-19 pandemic posed an unprecedented challenge, which caught many health systems widely unprepared. The aim of this research was to develop a comprehensive analytical framework on health system resilience in the context of pandemics. In addition to serving as a tool to analyse the preparedness and resilience of health systems, the framework is intended to provide guidance to decision-makers in health policy.

Methods

The analytical framework was developed based on a multitiered approach. A comprehensive review of the existing literature was conducted to identify relevant frameworks on health system resilience (published between 1 January 2000 and 30 November 2021) and determinants of resilience that emerged during the COVID-19 pandemic. Input was then gathered in several rounds of consultations with designated field experts and stakeholders, drawing on their experiences from the pandemic. Finally, the framework was empirically validated in several case studies.

Results

The framework distinguishes between prerequisites of resilience, pertaining to precautions to be taken in 'normal' times, and response strategies in the face of shocks. Both sections are further divided into six building blocks that were adapted from the WHO health system framework: governance and leadership, information and research, financing, physical resources, human resources, and service delivery. An overarching component on contextual factors-subdivided into situational, structural, cultural and international factors-represents an important addition to the existing spectrum of resilience frameworks.

Conclusions

Foundations for a resilient health system must be laid in 'normal' times and in all areas of the health system. In the face of a shock, adequate response strategies need to be developed. An essential learning from the COVID-19 pandemic has been that contextual factors of societies and subgroups play a major role in the ability of health systems to overcome a shock, as they impact the implementation and effectiveness of crisis management policies.

The Relationship Between Pharmacist Resilience, Burnout, and Job Performance

Background: Resilience aids healthcare professionals in navigating through and bouncing back from stressful situations in the workplace. Resilience can increase job satisfaction, work motivation, and professional commitment while decreasing burnout, and ultimately job turnover. More resilient employees experience lower instances of burnout and greater life satisfaction. Objective: The primary study objective is to determine the relationship that pharmacist resilience has on burnout and job performance. Methods: Licensed pharmacists in Florida were sent a Qualtrics survey (Qualtrics, Provo, UT) via email, which included demographics data, and valid and reliable assessment tools for resilience, burnout, and job performance. Linear regressions were used to test if resilience significantly predicted each of the output variables: burnout and job performance. Results: Survey responses were received from 942 pharmacists. The regressions showed that resilience significantly predicted both burnout (β1 = -.701, P < .001) and job performance (β1 = .35, P < .001). As resilience increased, the levels of burnout decreased, and job performance increased. Resilience explained 29% of the variance in burnout, and 11% of the variance in job performance. Conclusion: The results of this study suggest that resilience significantly predicts both pharmacist work-related burnout and job performance. The more resilient the pharmacist, the lower the chances of work-related burnout and the higher the likelihood of better job performance. Organizations should pursue opportunities to educate healthcare workers on methods to increase resilience and to bring attention to the importance of this topic.

'Not a panacea' - Expert perspectives on the concept of resilience and its potential for palliative care

Background

Resilience is an increasingly used term in medicine and subject to various definitions, often not easy to grasp. There are established core concepts for patients receiving palliative care, for example, meaning in life, that have already been researched a lot. Resilience, relative to these concepts, is a new object of research in palliative care, where it has so far been used predominantly with regard to the well-being of teams.

Aim

To explore how experts in palliative care define the concept of resilience and its suitability for patients, significant others, and professionals.

Design

Qualitative study using summarizing content analysis according to Mayring.

Setting/participants

Twenty-one health and social care professionals with expertise caring for persons with life-threatening/limiting illnesses and their relatives were interviewed in three individual interviews and four focus groups. All conversations were recorded, transcribed, coded via MAXQDA, and validated by another researcher.

Results

Resilience has been described as something procedural, dynamic, individual, and flexible. In connection with well-known concepts such as posttraumatic growth or terms from the field of mindfulness, social environment or personal factors have also been linked to resilience. Resources such as spirituality can contribute to resilience, and resilience itself can function as a resource, for example, by contributing to quality of life. An active use of the term in practical work with patients or relatives is rare, but it is used in education or team measures. Limited lifespan can pose a challenge to an active use of the concept of resilience.

Conclusion

Resilience as a very individual approach provides added value to other core concepts of palliative care. Within the palliative context, the normative dimension of resilience must be well reflected. A broader definition of resilience is recommended, leaving room for everyone to find their own form of resilience. The concept of resilience in palliative care includes opportunities as well as risks and should, therefore, be implemented carefully, requiring specific training.

A Focus on Leadership Communication and Feeling Valued to Prevent Burnout and Turnover Among Healthcare Professionals

OBJECTIVE

The purpose of this study was to examine the relative importance of leadership communication in predicting burnout and intention to stay among faculty and staff while controlling for other factors such as satisfaction with compensation and work-home flexibility.

METHODS

This study involved a secondary analysis of data derived from an organizational engagement survey that included 2336 faculty members (75% response rate) and 17,664 staff members (72% response rate).

RESULTS

Effective leadership communication was a stronger predictor of burnout and intent to stay than satisfaction with compensation and work-home flexibility. Feeling valued by the organization mediated the relationship between leadership communication and the outcome variables.

CONCLUSIONS

Leadership communication provides a low-cost solution to burnout and staff shortages and is primarily effective because it conveys to both faculty and staff that they are valued by the organization.

Framing doctor-managers' resilience during Covid-19 pandemic: A descriptive analysis from the Italian NHS

With the aim of providing evidence about doctor-managers' resilience during the Covid-19 pandemic, this study analyzes the characteristics of 114 doctor-managers operating within the Italian National Health Service (NHS). During the emergency, doctor-managers had to show adaptive capacities to deal with unexpected situations and develop new paradigms, procedures, and quick responses to patients' needs. This is in line with resilience, and in this perspective, it is crucial to investigate resilience determinants. The paper, therefore, provides an identikit of the resilient doctor-manager. The research was conducted between November and December 2020. Primary data were collected through an online questionnaire consisting of six sections. Participation was voluntary and anonymous. Data were analyzed using quantitative techniques and employing Stata 16. Confirmatory Factor Analysis was employed to test construct validity and scale reliability. Results show that increasing levels of individual resilience are related to increasing levels of managerial identity. Moreover, physicians' individual resilience has a positive association with commitment, knowledge diffusion, and Evidence-Based Medicine adoption. Finally, physicians' individual resilience has a negative association with their role in the university, their specialty, and their gender. The study suggests some practical implications for healtcare organizations. In general, career paths are decided primarily on competency assessment, while an important role should be devoted to behavioral characteristics. Furthermore, organizations should take care of the levels of individual commitment and encourage professional networking because both help doctor-managers cope with uncertainty. The originality of the study relies on a fresh look at all previous work. There are currently few contributions in the literature to explore and investigate resilience elements in doctor-managers during the pandemic era.

Cancer Care Team Functioning during COVID-19: A Narrative Literature Review and Synthesis

Amid pandemics, health care teams face unprecedented challenges, requiring significant efforts to sustain optimal functioning and navigate rapid practice changes. It is therefore crucial to identify factors affecting team functioning in these contexts. The present narrative review more specifically summarizes the literature on key elements of cancer teams' functioning during COVID-19. The search strategy involved four main databases (i.e., Medline OVID, EMBASE, PsycINFO, and CINAHL), as well as Google Scholar, from January 2000 to September 2022. Twenty-three publications were found to be relevant. Each was read thoroughly, and its content summarized. Across publications, three key themes emerged: (1) swiftly adopting virtual technology for communication and interprofessional collaboration, (2) promoting team resilience, and (3) encouraging self-care and optimizing team support. Our findings underscore key team functioning elements to address in future pandemics. More research is needed to document the perspectives of broader-based team members (such as patients and lay carers) to inform more comprehensive evidence-based team functioning guidelines.

Measures to Prevent and Reduce Healthcare Worker Burnout During the COVID-19 Pandemic: A Scoping Review

Introduction

In the COVID-19 era, burnout is a major occupational hazard among healthcare workers. This scoping review intended to investigate the pertinent literature concerning COVID-19 burnout among healthcare workers (HCWs) and the measures to prevent and reduce HCW burnout during the COVID-19 pandemic.

Methods

The databases CINAHL, PubMed, ScienceDirect, and Scopus were systematically searched and screened for relevant papers. Additionally, manual searching was employed to supplement the electronic database results. The researchers examined 21 publications to answer the research question, "What have been the measures to prevent and reduce healthcare worker burnout during the COVID-19 pandemic?" The PRISMA 2020 checklist was used to guide the reporting of this scoping review.

Results

It was found that to diminish healthcare workers' burnout, it is vital to use multilevel, evidence-based approaches. These interventions may include increasing awareness of the risks and preparing for potential occupational stress and burnout; promoting mindfulness and self-care practices to enhance mental well-being; enhancing organizational policies and procedures to address burnout among healthcare workers; and ensuring the availability of optimal mental health services, including the use of digital technologies to address workplace stress and facilitate mental health interventions.

Conclusion

The interventions to prevent and reduce HCW burnout during the COVID-19 pandemic include supporting HCWs individually, improving work environments, and addressing health system factors contributing to burnout complemented by interventions aimed at enhancing work culture.

COVID-19 in Workplace Settings: Lessons Learned for Occupational Medicine in the UK

This paper addresses lessons learned from the COVID-19 pandemic from a UK Occupational Medicine perspective to permit comparison with other national accounts. In spite of good prior research and statute, the necessary resources to protect workers' health were seriously lacking when the pandemic struck. Weak public health guidance, which did not recognise dominant airborne transmission, was applied to workplaces, leaving workers and others unprotected, especially in respect to Respiratory Protective Equipment (RPE). The Health and Safety Executive (HSE) as regulator was lacking, for example, in not producing guidance to protect HealthCare Workers (HCW) who were amongst the most at risk. The UK COVID-19 Public Inquiry should address shortcomings such as these, but recommendations must be accompanied by robust means to ensure appropriate implementation. These should range from substantial measures to improve indoor air quality, to a permanent pandemic management organization with adequate resources. The enforcing authority has to be obliged to publish more specific workplace guidance than the public health authorities. Occupational medicine as a discipline needs to be better prepared, and hence to assert its responsibility towards high standards of workers' health protection. Future research has to include investigating the best means of mitigation against airborne infection and the management of post-acute covid sequelae.

Violence against healthcare workers during the COVID-19 pandemic: a cross-sectional survey at Cairo University Hospital

Introduction

Healthcare workers have a significant chance of experiencing violence, with physical violence impacting anywhere from 8 to 38% of healthcare professionals throughout their careers. Besides physical abuse, many healthcare workers are subject to verbal aggression or threats, with patients and visitors being the most frequent sources of such incidents.

Methods

This research examines the work atmosphere of healthcare professionals at Kasr Al-Aini University Hospital in Cairo, Egypt, during the pandemic. The study aims to evaluate the frequency of violence toward healthcare workers and health professionals training through a cross-sectional survey conducted among them. The research was conducted on Egyptian healthcare workers over 6 months, from November 2020 until the end of January 2021, using convenience sampling in a cross-sectional study. Over half of the respondents reported experiencing violence.

Results

Among those who experienced violence, 93% reported verbal aggression, 43% reported physical and verbal abuse, and 59% claimed that violence increased during the pandemic. Additionally, 97% of those who experienced violence reported it occurring within the 4 months following the survey. About 42.5% of the respondents were female, and nearly 65% were over 30. 82% of the respondents did not receive training on handling violence while performing their job.

Conclusion

This study highlights the high prevalence of verbal assaults in healthcare settings, primarily by patients' families or acquaintances. Despite reporting such incidents, most respondents did not see any significant government action. Furthermore, the COVID-19 pandemic did not significantly change the frequency of violent incidents, indicating that the root causes of violence are systemic and extend beyond the pandemic. These findings underscore the need for systemic changes in healthcare organizations to address and prevent violence against healthcare workers.

Cancer Center Staff Satisfaction: Descriptive Results of a Canadian Study

Caring for cancer patients is generally considered very rewarding work, but it can also be stressful and demanding. Therefore, it is important for oncology healthcare professionals to feel satisfied with their work environment in order to provide the best care possible. An ethics-approved 61-item staff satisfaction survey was developed in-house to gain insights regarding workplace satisfaction among all staff at The Ottawa Hospital Cancer Center. Descriptive statistics were used to analyze the responses. A total of 478 individuals completed the online survey, with 75.1% women, 23.2% men, and 1.7% preferring not to say. This represented the vast majority (>75%) of cancer center staff. The approximate breakdown according to healthcare professional type was as follows: 21% nurses, 20% radiation therapists, 18% physicians, 13% clerical staff, and 28% other types of staff. Almost all (97.4%) generally enjoyed their work, with 60% stating "very much" and 37.4% stating "a little bit", and 93.3% found working with cancer patients rewarding. The overall satisfaction level at work was high, with 30.1% reporting "very satisfied" and 54.2% "somewhat satisfied". However, in terms of their work being stressful, 18.6% stated it was "very much" and 62.1% "a little bit". Also, in terms of their workload, 61.3% stated it was "very busy" and 10% stated it was "excessively busy". The most enjoyable aspects of work were listed as interactions with colleagues, interactions with patients, and learning new things. The least enjoyable aspects of work were excessive workload, a perceived unsupportive work environment, and technology problems. Levels of satisfaction and stress at work varied according to role at the cancer center. Most cancer center staff seem to enjoy their work and find it rewarding. However, the work environment can be challenging and stressful. Areas for improvement include managing workloads, ensuring staff feel supported, and improving the user-friendliness of technology.

Physicians' Resilience as a Positive Effect of COVID-19

People devoid of COVID-19 may exhibit mental health problems, such as anxiety disorders, depression, panic attack, insomnia, emotional disorder, and suicidal actions. Healthcare workers (HCWs) may also exhibit these problems. Physicians should be careful an "at-risk" population. Physicians revealed higher levels of resilience than the popular workers. Humans with stronger resilience have lower feeling of anxiety and depression. We investigated the risk to physicians from an infected environment to infected patients during the pandemic. The social and psychological support of all HCWs, particularly physicians, is significant in the fight against this pandemic. Physicians working with patients with COVID-19 should set enough time to relax, sleep, and spend time with family. Resilience in physicians facing COVID-19 can induce post-traumatic growth in the future.

Delivering Primary Health Care (PHC) Services for Controlling NCDs During the COVID-19 Pandemic: A Scoping Review

Non-communicable diseases (NCDs) are the leading cause of death worldwide. NCDs also increase mortality from COVID-19 and primary health care (PHC) services are an important component in the prevention and control of long-term NCDs. The main goal of the present study was to review primary healthcare services for the NCDs patients via primary healthcare network during COVID-19 pandemic. In this scoping review, Search engines including PubMed, Scopus, and Science-direct up to 1st February 2022 were searched to identify studies regarding primary care services for NCDs patients via primary health care during COVID-19 pandemic. A total of 42 studies met the inclusion criteria and were included in our analysis. 24 studies were about the status and changes of primary health services for NCDs patients in PHC settings, while 18 studies focused on adaptive strategies used during COVID-19 in different countries including United States, Canada, United Kingdom, Portugal, Georgia, South Africa, Thailand, Mexico, India, Kenya, Guatemala and Saudi Arabia. These strategies included remote monitoring, follow up, consultation, empowerment and educational services as well as home visiting Disruption of NCDs services in PHC during the COVID-19 pandemic was observed in different countries, which highlights the urgency of attention of researchers and policy-makers to development of appropriate and adaptive policies to improve PHC service coverage and its quality during the pandemics.

Healthcare Professionals' Resilience During the COVID-19 and Organizational Factors That Improve Individual Resilience: A Mixed-Method Study

Healthcare workers are a susceptible population to be psychologically affected during health crises, such as the recent COVID-19 pandemic. Resilience has been pointed out in the literature as a possible protective factor against psychological distress in crisis situations. This can be influenced by internal and external factors, such as individual characteristics and organizational factors. Thus, this study aims to characterize the overall resilience levels among healthcare professionals in Portugal and to understand the perspectives of this healthcare workers regarding organizational factors that improve individual resilience. This is a mixed-method study: a first quantitative study using a cross-sectional design to administer the Resilience Scale for Adults (RSA) to 271 healthcare professionals (Mage 33.90, SD = 9.59 years, 90.80% female), followed by a qualitative study through 10 in-depth interviews. The mean score for the total RSA was 178.17 (SD = 22.44) out of a total of 231. Qualitative analysis showed 4 major themes on factors that enhance resilience: "Professional's Training," "Support and Wellbeing Measures," "Reorganization of Services" and "Professional Acknowledgment." The findings may contribute to the development of targeted interventions and support systems to enhance resilience and well-being among healthcare workers.

Resilient communities? A qualitative interview study on sustaining a community project for health promotion among socially disadvantaged women during the first two years of the COVID-19 pandemic

OBJECTIVES

With the emergence of SARS-CoV-2 a global pandemic impacted on health promotion, overlapping and hindering efforts to overcome the worldwide pandemic of lacking physical activity (PA). Nationwide lockdowns, the closure of public facilities and sports venues, made it significantly more difficult to sustain community-run PA projects. In our case study, we explore (a) under which circumstances a community-basedhealth promotion project can be maintained during crisis and (b) what resilience capacities are important for community project coordinators to deal with those aggravating circumstances.

METHODS

Our case study looks at a community-based project called BIG, an exercise promotion project for women in difficult life circumstances. The case study was conducted between July 2021 and January 2022 with six municipalities implementing the project. Following a triangulation approach, we used minutes from short exchanges (n=17) with community project coordinators, information brochures about current exercise classes (n=6) and semi-structured qualitative interviews with project coordinators (n=6). All data were analyzed using the framework approach.

RESULTS

All sites showed a high level of willingness to adapt to the pandemic situation and to maintain the project as best as possible. Findings highlight that coordinators whose work routine was characterized by intense relationship management with participants and trainers demonstrated higher levels of adaptive and absorptive capacities on an individual level than coordinators of those communities with less social cohesion. At a community level, important resources for strengthening adaptive and absorptive resilience capacities were job security of the coordinators, sufficient financial resources to adapt classes to changing circumstances, and a supportive organizational climate in the coordinators' working environment to allow them to react flexibly according to current pandemic regulations.

CONCLUSION

Despite high resilience capacities especially on an individual level, the low-threshold nature of the project could not be maintained at a pre-pandemic level. For many women, participation in the project was no longer possible at times. Awareness should be raised in communities that PA promotion programs are crucial to strengthening physical and mental health, even in times of crisis. It seems necessary to find permanent funding options for such programs, to integrate them permanently into municipal structures.

The impact of emotional support on healthcare workers and students coping with COVID-19, and other SARS-CoV pandemics - a mixed-methods systematic review

BACKGROUND

Pandemics such as COVID-19 pose threats to the physical safety of healthcare workers and students. They can have traumatic experiences affecting their personal and professional life. Increasing rates of burnout, substance abuse, depression, and suicide among healthcare workers have already been identified, thus making mental health and psychological wellbeing of the healthcare workers a major issue. The aim of this systematic review is to synthesize the characteristics of emotional support programs and interventions targeted to healthcare workers and students since the onset of COVID-19 and other SARS-CoV pandemics and to describe the effectiveness and experiences of these programs.

METHOD

This was a mixed method systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the review was registered on PROSPERO [CRD42021262837]. Searches were conducted using Medline, CINAHL, PsycINFO, Cochrane Library, and Scopus databases. The COVIDENCE systematic review management system was used for data selection and extraction by two independent reviewers. The JBI (Joanna Briggs Institute) critical appraisal tools were used to assess the quality of selected studies by two additional reviewers. Finally, data extraction and narrative analysis were conducted.

RESULTS

The search retrieved 3161 results including 1061 duplicates. After screening, a total of 19 articles were included in this review. Participants in studies were nurses, physicians, other hospital staff, and undergraduate medical students mostly working on the front-line with COVID-19 patients. Publications included RCTs (n = 4), quasi-experimental studies (n = 2), cross-sectional studies (n = 6), qualitative interview studies (n = 3), and systematic reviews (n = 4). Most (63.4%) of the interventions used online or digital solutions. Interventions mostly showed good effectiveness (support-seeking, positive emotions, reduction of distress symptoms etc.) and acceptance and were experienced as helpful, but there were some conflicting results.

CONCLUSION

Healthcare organizations have developed support strategies focusing on providing emotional support for these healthcare workers and students, but it is difficult to conclude whether one program offers distinct benefit compared to the others. More research is needed to evaluate the comparative effectiveness of emotional support interventions for health workers.

Post-pandemic self-reported mental health of mental healthcare professionals in the Netherlands compared to during the pandemic - an online longitudinal follow-up study

The mental health of professionals was under pressure during- and post-pandemic. Initially, the focus was mainly on the health workers in the hospitals, but over time the pressure shifted to other sectors, including mental health care. An increase in workload and decrease in mental health of healthcare professionals in mental health care can lead to a decrease in the available care capacity. In an earlier online survey of mental health professionals, 1,300 professionals from a large number of mental healthcare institutions were involved. In this study, conducted in September 2021, about half of the respondents reported increased levels of stress. Feelings of anxiety, anger, and sadness were also increasingly experienced due to the COVID-19 pandemic. Furthermore, 4.2% replied that they were considering resigning their jobs. One of the recommendations of this previous study was to monitor these professionals repeatedly to be able to make an estimate of the stress and vision of work during the course of the pandemic and afterwards. Following this recommendation, the online survey was repeated. The aim of the current online longitudinal follow-up study was to re-evaluated mental status of healthcare workers. 510 healthcare workers participated in this follow-up survey. The reported mental health complaints were significantly higher during compared to post-pandemic. Respondents were less able to maintain work/life balance during the pandemic and even reported a shift to work. However, the majority of respondents indicated that they had restored this balance post-pandemic. Moreover, more sick leave was reported post-pandemic than during the pandemic and more frequent absences post-pandemic. This highlights the importance of focusing on resilience over training and career.

Global prevalence of low resilience among the general population and health professionals during the COVID-19 pandemic: A meta-analysis

Objective

To estimate the global prevalence of low resilience among the general population and health professionals during the COVID-19 pandemic.

Methods

Embase, Ovid-MEDLINE, PubMed, Scopus, Web of Science, CINAHL, WHO COVID-19 databases, and grey literature were searched for studies from January 1, 2020, to August 22, 2022. Hoy's assessment tool was used to assess for risk of bias. Meta-analysis and moderator analysis was performed using the Generalized Linear Mixed Model with a corresponding 95 % confidence interval (95 % CI) adopting the random-effect model in R software. Between-study heterogeneity was measured using I² and τ² statistics.

Results

Overall, 44 studies involving 51,119 participants were identified. The pooled prevalence of low resilience was 27.0 % (95 % CI: 21.0 %–33.0 %) with prevalence among the general population being 35.0 % (95 % CI: 28.0 %–42.0 %) followed by 23.0 % (95 % CI: 16.0 %–30.9 %) for health professionals. The 3-month trend analysis of the prevalence of low resilience beginning January 2020 to June 2021 revealed upward then downward patterns among overall populations. The prevalence of low resilience was higher in females, studied during the delta variant dominant period, frontline health professionals, and undergraduate degree education.

Limitations

Study outcomes showed high heterogeneity; however, sub-group and meta-regression analyses were conducted to identify potential moderating factors.

Conclusions

Globally, 1 out of 4 people among the general population and health professionals experienced low resilience due to COVID-19 adversity. The prevalence of low resilience was twice as much among the general population compared to health professionals. These findings provide information for policymakers and clinicians in the development and implementation of resilience-enhancing programs.

Associations between COVID-19 mental impact and distress, resilience, burnout and well-being in Hong Kong community adults: A structural equation model

The COVID-19 pandemic poses substantial risks to individuals' physical and mental health and prolonged psychological responses to the pandemic could lead to emotional exhaustion. The present study aimed to examine the mediating role of COVID-19 related mental impact and distress in the relationship among resilience, burnout, and well-being. The present study recruited 500 community adults (mean age = 38.8 years, SD = 13.9; 76% females) in Hong Kong via an online survey in autumn 2021. The participants completed the Mental Impact and Distress Scale: COVID-19 (MIDc) and validated measures on resilience, burnout, and well-being. Confirmatory factor analysis was conducted to evaluate the psychometric properties of the MIDc. Direct and indirect effects of resilience on burnout and well-being via MIDc were examined via structural equation modeling. Confirmatory factor analysis supported factorial validity for the three factors of MIDc (situational impact, anticipation, and modulation). Resilience showed negative effects on the MIDc (β = -0.69, SE = 0.04, p < 0.01) and burnout (β = 0.23, SE = 0.06, p < 0.01). Burnout was positively associated with MIDc (β = 0.63, SE = 0.06, p < 0.01) and negatively associated with well-being (β = -0.47, SE = 0.07, p < 0.01). Resilience showed a significant and positive indirect effect (αβγ = 0.203, 95% CI = 0.131 to 0.285) on well-being via MIDc and burnout. The results support a potential mediating role for MIDc as psychological responses in the relationship among resilience and burnout and well-being.

Relationship between three aspects of resilience-adaptive characteristics, withstanding stress, and bouncing back-in hospital workers exposed to prolonged occupational stress during the COVID-19 pandemic: a longitudinal study

BACKGROUND

The term resilience is used to refer to multiple related phenomena, including: (i) characteristics that promote adaptation to stressful circumstances, (ii) withstanding stress, and (iii) bouncing back quickly. There is little evidence to understand how these components of resilience are related to one another. Skills-based adaptive characteristics that can respond to training (as opposed to personality traits) have been proposed to include living authentically, finding work that aligns with purpose and values, maintaining perspective in the face of adversity, managing stress, interacting cooperatively, staying healthy, and building supportive networks. While these characteristics can be measured at a single time-point, observing responses to stress (withstanding and bouncing back) require multiple, longitudinal observations. This study's aim is to determine the relationship between these three aspects of resilience in hospital workers during the prolonged, severe stress of the COVID-19 pandemic.

METHODS

We conducted a longitudinal survey of a cohort of 538 hospital workers at seven time-points between the fall of 2020 and the spring of 2022. The survey included a baseline measurement of skills-based adaptive characteristics and repeated measures of adverse outcomes (burnout, psychological distress, and posttraumatic symptoms). Mixed effects linear regression assessed the relationship between baseline adaptive characteristics and the subsequent course of adverse outcomes.

RESULTS

The results showed significant main effects of adaptive characteristics and of time on each adverse outcome (all p < .001). The size of the effect of adaptive characteristics on outcomes was clinically significant. There was no significant relationship between adaptive characteristics and the rate of change of adverse outcomes over time (i.e., no contribution of these characteristics to bouncing back).

CONCLUSIONS

We conclude that training aimed at improving adaptive skills may help individuals to withstand prolonged, extreme occupational stress. However, the speed of recovery from the effects of stress depends on other factors, which may be organizational or environmental.

Burnout, coping and resilience of the cancer care workforce during the SARS-CoV-2: A multinational cross-sectional study

PURPOSE

Over the past year, the SARS-CoV-2 pandemic has significantly increased the demand placed on health care professionals around the world. The already complex cancer care has been complicated further by the restructuring of services (e.g., working processes, treatment allocation). This study was designed to explore the level of burnout, coping and resilience of the cancer care workforce during SARS-CoV-2.

METHODS

Cross-sectional, multinational study undertaken between March-May 2021. In total 271 healthcare professionals were recruited in the study. These were specialized and/or working in the oncology sector from around the globe. Data were collected with an online survey with the Connor-Davidson Resilience Scale, Brief-COPE (Coping Orientation to Problems Experienced) Scale and The Maslach 's Burnout Inventory.

RESULTS

The majority of the participants were cancer nurses followed by oncologists. The mean overall Burnout score was 64.86 (SD 17.15), the overall COPE score was 31.72 (SD 12.39) and the overall Resilience score was 69.48 (SD 12.4). Positive correlations were found between the COPE dimensions and the burnout overall score (0.316, 0.388, 0.398). The burnout overall score was negatively correlated with the resilience score (p -0.126).

CONCLUSION

The findings showed significand levels of burnout, diminished coping abilities and reduced resilience among cancer care professionals. This study emphasizes the need for a timely and appropriate preparation of the healthcare systems to better support cancer care professionals in the event of a new SARS-CoV-2 healthcare emergency.

Association between proximity to COVID-19 and the quality of life of healthcare workers

Background

The coronavirus disease 2019 (COVID-19) affects almost all countries in the world and it impacts every aspect of people’s life-physically, mentally, and socio-economically. There are several research studies examining the impact of this pandemic on health, however, very few studies examining the impact of this pandemic on quality of life. This study aimed to investigate the association between proximity to the COVID-19 and quality of life of healthcare workers and identify factors influencing quality of life.

Methods

A cross-sectional study was conducted among hospital staff in a tertiary hospital in Singapore. Data on demographic, medical history, lifestyle factors, psychosocial factors, and quality of life were collected using online self-administered questionnaire. Quality of life (QoL) was measured by the WHOQOL-BREF questionnaire. Robust linear regression was used to determine factors associated with quality of life.

Results

A total of 1911 participants were included in the analysis. The average age of participants was 38.25 (SD = 11.28) years old. 26.90% of participants had been quarantined, hospitalised, being suspected or diagnosed of having COVID-19 infection and they were found to have the lowest levels of QoL across all four domains (physical, psychological, social, and environmental domains). Participants who were singles or nurses, worked in shifts or worked longer hours, had chronic diseases were likely to have lower QoL scores compared to participants in other categories. Healthy lifestyle, social connectivity, resilience, social and workplace support were associated with higher QoL scores.

Conclusions

In planning of measures which aim to improve QoL of healthcare workers, priority should be given to individuals who have been quarantined, hospitalised, being suspected, or diagnosed of having COVID-19 infection. In addition to the proximity of the COVID, lifestyle and psychosocial factors contribute to QoL of healthcare workers. Hence, multifaceted interventions are needed to improve QoL of healthcare workers.

Mediating effects of fatigue on the relationship between sleep quality and the quality of life of shift-working nurses

The mediating role of fatigue in the relationship between the quality of sleep and quality of life of shift-working nurses has been predicted in previous studies. Interventions that focus on improving the quality of life of a nurse, who works 24 h shifts in close proximity to patients, should take the mediating role of fatigue into account. This study investigates the mediation of fatigue in the relationship between sleep quality and quality of life for shift-working nurses. This cross sectional study collected self-reported questionnaire responses on variables including sleep quality, quality of life, and fatigue of shift-working nurses. We performed a three-step mediating effect verification procedure with 600 study participants. We found a negative and significant correlation between sleep quality and quality of life, a significant positive correlation between sleep quality and fatigue, and a negative correlation between quality of life and fatigue. We found: (1) that the quality of sleep affects the quality of life of shift-working nurses, (2) that the quality of sleep is correlated with the degree of fatigue, and (3) that the degree of fatigue is high, which means that quality of life decreases. Thus, it is necessary to develop and apply a strategy to reduce shift-working nurses' fatigue to improve their sleep quality and quality of life.

A Multicenter Survey of Pediatric-Neonatal Transport Teams in the United States to Assess the Impact of the Coronavirus Disease 2019 Pandemic on Staffing

Objective

The coronavirus disease 2019 pandemic has resulted in unprecedented burnout in frontline health care providers. However, the impact of the pandemic on interfacility pediatric and neonatal transport team members has not been studied. The current study uses a survey design to document the impact of the pandemic on pediatric and neonatal transport team members with a focus on staffing and resilience promotion strategies.

Methods

Data for this study came from a short cross-sectional survey distributed to members of the American Academy of Pediatrics Section on Transport Medicine.

Results

Sixty-six teams responded (around 45%). Forty-one respondents (62%) reported vacancies on their transport teams, with 35 (53.8%) reporting more vacancies during the pandemic. Forty percent of highly trained registered nurses and respiratory therapists from specialty teams left their positions for those with better compensation during the pandemic. Forty-two percent of respondents were not trained to recognize burnout, stress, or compassion fatigue.

Conclusion

Our study shows that half of the respondents had more vacancies during the pandemic than in previous years and reported difficulty in filling those positions. We were unable to link the vacancies to the pandemic and burnout because hospitalizations and transports in the pediatric facilities decreased during the pandemic; however, we do report that coronavirus disease 2019 exposure before the vaccine was a source of stress for team members. There are opportunities to improve the identification of burnout and to foster resilience and boost retention of this highly skilled niche workforce.

Which Aspects of Work Safety Satisfaction Are Important to Mental Health of Healthcare Workers during COVID-19 Pandemic in Poland?

The outbreak of the COVID-19 pandemic increased the occupational burden experienced by healthcare workers. The aim of this study was to investigate a change in work satisfaction during the pandemic and specific factors contributing to mental health among healthcare providers. We obtained data from 367 healthcare professionals. Respondents were asked about their satisfaction with selected aspects of work (clarity of procedures, access to personal protective equipment, the flow of information, financial stability and general security) during the epidemic and retrospectively how satisfied they were before the outbreak. They also completed measures assessing mental health: the World Health Organization-Five Well-Being Index, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale and the Insomnia Severity Index. The results showed that satisfaction with all safety-related work aspects decreased during the pandemic. The flow of information and financial stability were significant predictors of WHO-5, PHQ-9 and ISI scores. GAD-7 scores were predicted by satisfaction with the clarity of procedures, the flow of information and financial stability. The COVID-19 pandemic significantly changed the lives of everyone. However, due to conditions of employment in Polish healthcare, the COVID-19 pandemic put a great financial strain in addition to pandemic stressors specific to medical staff.

Lived Experiences of Hemodialysis Health Care Workers during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network

Key Points

Hemodialysis workers' well-being and work were affected by the COVID-19 pandemics. Effective communication strategies and taking into account psychological distress are ways to mitigate the challenges faced by health care workers.

Background

The COVID-19 pandemic has disrupted health systems and created numerous challenges in hospitals worldwide for patients and health care workers (HCWs). Hemodialysis centers are at risk of COVID-19 outbreaks given the difficulty of maintaining social distancing and the fact that hemodialysis patients are at higher risk of being infected with COVID-19. During the COVID-19 pandemic, HCWs have had to face many challenges and stressors. Our study was designed to gain HCWs' perspectives on their experiences of the impacts of the COVID-19 pandemic in hemodialysis units.

Methods

Semistructured interviews were conducted with 22 HCWs (nurses, nephrologists, pharmacists, social workers, patient attendants, and security agents) working in five hemodialysis centers in Montreal, between November 2020 and May 2021. The content of the interviews was analyzed using thematic analysis.

Results

Four themes were identified during the interviews. The first was the impact of COVID-19 on work organization, regarding which participants reported an increased workload, a need for a consistent information strategy, and positive innovations such as telemedicine. The second theme was challenges associated with communicating and caring for dialysis patients during the pandemic. The third theme was psychological distress experienced by hemodialysis staff and the psychosocial impact of COVID-19 on their personal lives. The fourth theme was recommendations made by participants for future public health emergencies, such as maintaining public health measures, ensuring an adequate supply of protective equipment, and developing a consistent communication strategy.

Conclusions

During the first and second waves of the COVID-19 pandemic, HCWs working in hemodialysis units faced multiple challenges that affected their well-being and their work. To minimize challenges for HCWs in hemodialysis during a future pandemic, the health care system should provide an adequate supply of protective equipment, develop effective communication strategies, and take into account the psychological distress related to HCWs' professional and personal lives.

The organization of healthcare work in the light of ergology: experiences in the COVID-19 pandemic

OBJECTIVE

To understand the work organization of health professionals when coping with the COVID-19 pandemic in Manaus.

METHOD

This is a qualitative case study which adopted ergology as theoretical framework. Data production used document analysis and semi-structured interviews with 33 health workers from the Health Care Network. The resources of the software Atlas.ti 8.0 were used for data analysis.

RESULTS

The precepts of Thematic Networks analysis revealed the following categories: "Reordering services and functions"; "Incorporation and management of instruments application"; "Professional experiences and tactics: changing roles, attitudes and relationships".

CONCLUSION

It was found that they express a dynamic view of the organizational process, in which the worker, when discussing past standards and comparing his/her knowledge, experiences and values, modifies the environment, flows and conducts as needed, facing the lack of safety, conditions and solidity of the technical bases of work.

Are we ready for the next pandemic? Lessons learned from healthcare professionals' perspectives during the COVID-19 pandemic

Background

The mental health and wellbeing of people watching the Corona Virus Disease 2019 (COVID-19) pandemic unfold has been discussed widely, with many experiencing feelings of anxiety and depression. The state of mental health of medical staff on the frontlines providing care should be examined; medical staff are overworked to meet the demands of providing care to the rise in cases and deterioration in capacity to meet demands, and this has put them under great psychological pressure. This may lead to an increase in medical errors, affect quality of care, and reduce staff retention rates. Understanding the impact the pandemic has had on healthcare professionals is needed to provide recommendations to prepare for future crises.

Objectives

To be able to meet the needs of the medical workforce on the frontlines and inform psychological support interventions and strategies for future pandemics, we aim to identify and explore the psychological impact of COVID-19 in Kuwait on healthcare professionals in close contact with patients.

Methods

Using semi-structured interviews, we conducted interviews between February and July 2021 with 20 healthcare professionals across Ministry of Health hospitals who were part of COVID teams. Interviews were transcribed verbatim, and analysis was conducted using principles of thematic framework analysis.

Results

Three themes emerged to help prepare future healthcare frontline workers on an individual, organizational, and national level: enhance self-resilience, a better-equipped workforce and healthcare environment, and mitigate stigma and increase public awareness.

Conclusion

The results have assisted in highlighting areas of improvement to support the healthcare workforce in the current environment, as well as better prepare them for future pandemics. The findings have also provided insight to recommend targeted interventions. These should improve the psychological wellbeing and help in supporting healthcare professionals to reduce burnout, continue effective care of patients, and enhance resilience.

General well-being of intensive care nurses: A prototype analysis

BACKGROUND

Prototype analyses of well-being have identified central characteristics and prototypicality for New Zealand teachers, lawyers, adolescents, and work well-being of nurses. What has not yet been explored is the broad construct of well-being in intensive care nurses.

AIMS

To identify intensive care nurses' conceptions of general well-being and investigate whether their general well-being is prototypically organized.

DESIGN

Prototype analysis.

METHODS

Three linked studies conceptualize well-being in this prototype analysis. In study 1, nurses reported features of well-being. Study 2 investigated the organization of these features. Study 3 sought confirmation of prototypical organization.

RESULTS

Sixty-five New Zealand nurses participated. For study 1 (n = 23), the most frequently reported elements of well-being included physical health (n = 26), work-life balance (n = 20), and personal relationships (n = 18). For study 2 (n = 25), the highest rated elements included mental and emotional health, [general] health, work-life balance, and love. Work-life balance, physical health, and personal relationships were in the top five most frequently reported and were rated in the top 12 most central. Overall, ratings of centrality and the number of times reported were positively correlated (r = 0.33, P < .005). For study 3 (n = 17), confirmatory analyses did not reach statistical significance (P = .15).

CONCLUSIONS

Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. Mental, emotional, and general health and work-life balance were considered most important for well-being.

RELEVANCE TO CLINICAL PRACTICE

Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. These characteristics of the broad construct of well-being are helpful in both defining and identifying conceptual models of well-being that may be used to inform the development and measurement of well-being programmes.

Comparison of Resilience Among Healthcare Workers During the COVID-19 Pandemics: A Multinational Cross-Sectional Survey in Southeast Asian Jurisdictions

Objectives: To examine the level of resilience among the frontline healthcare workers (HCWs) in four different Southeast Asian jurisdictions and identify the potential factors that may enhance healthcare workers resilience. Methods: An online cross-sectional survey was carried out among 3,048 eligible healthcare workers in Hong Kong, Nepal, Vietnam, and Taiwan from May 2021 to July 2022, and information on individual resilience, socio-demographic characteristics, organizational supports, and personal exposures were collected. A binary logistic regression model was used to identify the factors that were associated with a high resilience level. Results: The resilience score was the highest among healthcare workers of Vietnam, followed by Taiwan and Hong Kong, with Nepal scoring the lowest. Participants with old age, part-time work, higher education level, more satisfaction with workplace policy, better organizational supports, and fewer COVID-specific worries were associated with higher resilience. Healthcare workers who were satisfied with the overall organizational policy support had an OR of 1.48 (95% CI: 1.25-1.76) for a high resilience level. Conclusion: Implementing satisfying organizational policies and establishing supportive work environments for frontline healthcare workers can increase individual resilience and organizational stability.

Ways that nursing home nursing staff build resilience: a phenomenographic approach

Background

Resilience has been studied as an effective concept in nursing that acts as a protective factor which aids in overcoming difficult situations and related mental problems. With the recent increase in demand for nursing homes, nursing home nursing staff are facing a variety of stresses and psychological burdens. Improving resilience has been suggested as one way to deal with the difficulties, such as stress, exhaustion, and burnout, that nursing home nursing staff are experiencing. In order to provide successful education aimed at improving such resilience, it is very important to understand how to perceive experience from the learner’s point of view.

Aim

The study’s aim is to identify the ways that nursing home nursing staff build resilience.

Method

This study used phenomenography, a methodology for exploring the relationship between subject and phenomenon. From January 15, 2022 to February 20, 2022, data collection was undertaken at three nursing homes located in the Republic of Korea. The data was collected through semi-structured interviews with 20 nursing staff members in NHs and a data analysis that strictly followed the 7-step analysis process of phenomenography.

Results

Eight categories were derived. The eight categories were then divided into two groups of four representing perception and strategy. Perception included four categories: ‘grasping the situation’, ‘thinking about one’s responsibility for the resident and personal values’, ‘considering one’s strength’ and ‘thinking of an improved self’. Strategy included four categories: ‘evaluation of oneself and one’s environment’, ‘taking care of oneself’, ‘finding concrete ways to manage the problem’ and ‘self-development for growth’. Perception had three levels of awareness, valuing and assuring, while strategy had three levels of identifying, introspecting and concretizing.

Conclusion

This study provides insight into how individual nursing staff build resilience, a complex and subjective concept. It provides a foundation for future resilience education of nursing home nursing staff and suggests future educational intervention development directions.

Resilience resources and coping strategies of COVID-19 female long haulers: A qualitative study

Background

Female long haulers deal with persistent post-acute COVID-19 symptoms that have serious health implications. This study aimed to identify resilience resources at multiple socio-ecological levels for female long haulers and describe how resilience resources affect their responses to long COVID.

Methods

Purposive sampling was adopted to recruit participants through social media from April to June 2021 followed by 15 semi-structured interviews. An inductive analytical approach was adopted to categorize themes by open and axial coding that were verified by peer review.

Results

Female long haulers relied on resources at various socio-ecological levels to foster their resilience in response to long COVID. At the individual level, they utilized cognitive and emotional resources to increase knowledge, learn new skills, set goals, and manage emotions; behavioral resources (e.g., internal motivation and executive functioning) to perform physical, creative, and recreational activities, and adopt healthier eating habits; and spiritual resources to perform spiritual rituals and connect with God. At the social level, the support from existing relationships and/or online social support groups enhanced their social identity and provided material and informational resources. At the health systems level, the guidance from counselors and physicians and availability of clinics, medicines, and health equipment assisted them in symptom management and medication adherence.

Conclusion

The resilience of female long haulers can be enhanced through (1) offering financial and health-related resources, (2) developing online social-support groups, (3) counseling and care service training for healthcare professionals, and (4) implementing more psychosocial interventions by labor organizations.

Career resilience of the tourism and hospitality workforce in the COVID-19: The protection motivation theory perspective

By applying the protection motivation theory, the study aims to investigate factors influencing tourism and hospitality (T&H) workers' career resilience when faced with health-related risks at work during a pandemic. Data were collected from 495 part-time and full-time employees in the Vietnamese tourism and hospitality sector. The study found that workers' perceived vulnerability and perceived severity of the pandemic were positively associated with career resilience. Perceived severity was positively related to self-efficacy and response efficacy, while perceived vulnerability was positively associated with self-efficacy only. Both self-efficacy and response efficacy positively influenced career resilience through the mediating role of health risk preventative behavior. Theoretically, the study advances the stream of research in resilience in general and career resilience in particular among T&H workers when faced with a health-related crisis. Practical implications are provided with recommendations on how to facilitate career resilience among T&H employees working in the current high-risk environment.

A global overview of healthcare workers' turnover intention amid COVID-19 pandemic: a systematic review with future directions

BACKGROUND

Globally, the health workforce has long suffered from labour shortages. This has been exacerbated by the workload increase caused by the COVID-19 pandemic. Major collapses in healthcare systems across the world during the peak of the pandemic led to calls for strategies to alleviate the increasing job attrition problem within the healthcare sector. This turnover may worsen given the overwhelming pressures experienced by the health workforce during the pandemic, and proactive measures should be taken to retain healthcare workers. This review aims to examine the factors affecting turnover intention among healthcare workers during the COVID-19 pandemic.

METHODS

A mixed studies systematic review was conducted. The PubMed, Embase, Scopus, CINAHL, Web of Science and PsycINFO databases were searched from January 2020 to March 2022. The Joanna Briggs Institute's Critical Appraisal Tools and the Mixed Methods Appraisal Tool version 2018 were applied by two independent researchers to critically appraise the methodological quality. Findings were synthesised using a convergent integrated approach and categorised thematically.

RESULTS

Forty-three studies, including 39 quantitative, two qualitative and two mixed methods studies were included in this review. Eighteen were conducted in the Middle East, ten in the Americas, nine in the Asia-Pacific region and six in Europe. Nurses (n = 35) were included in the majority of the studies, while physicians (n = 13), allied health workers (n = 11) and healthcare administrative or management staff (n = 7) were included in a smaller proportion. Five themes emerged from the data synthesis: (1) fear of COVID-19 exposure, (2) psychological responses to stress, (3) socio-demographic characteristics, (4) adverse working conditions, and (5) organisational support.

CONCLUSIONS

A wide range of factors influence healthcare workers' turnover intention in times of pandemic. Future research should be more focused on specific factors, such as working conditions or burnout, and specific vulnerable groups, including migrant healthcare workers and healthcare profession minorities, to aid policymakers in adopting strategies to support and incentivise them to retain them in their healthcare jobs.

Effect of an online resourcefulness training in improving psychological well-being of front-line medical staff: a quasi-experimental study

Background

The global COVID-19 pandemic is still not under effective control, and strong workplace supports with comprehensive mental health interventions are urgently needed to help medical staff effectively respond to the pandemic. This study aimed to verify the effect of an online resourcefulness training program on the resourcefulness, and psychological variables of front-line medical staff working in the COVID-19 isolation ward.

Design

A pre-test and post-test quasi-experimental design with control group was employed.

Participants

A total of 60 participants working in two isolation wards were recruited via convenience sampling. The two isolation wards were randomly assigned to the control group (isolation ward 1, n = 30) and the intervention group (isolation ward 2, n = 30).

Intervention

The participants were trained online by video conferences and WeChat. The control group received conventional training (e.g., psychological training, psychological counseling), while the intervention group received a 4-h online resourcefulness training. Both groups learned updated guidelines of COVID-19 simultaneously via video conference. The primary outcomes (resourcefulness, anxiety, depression and coping styles) and the secondary outcome (psychological resilience) were measured before intervention and three time points after intervention.

Results

After the intervention and one week after the intervention, the resourcefulness, resilience, and positive response scores of the participants in the intervention group were significantly higher than those of the control group. The anxiety and negative response scores in the intervention group were significantly lower than those of the control group (all p < 0.05).

One month after the intervention, the scores of resourcefulness, tenacity, and positive response of the intervention group were higher than those of the control group (all p < 0.05). Repeated measures analysis of variance showed that the two groups of participants had statistically significant changes in the time-based effect and group-based effect in resourcefulness, resilience, anxiety scores and coping styles (p < 0.01).

Conclusion

The results showed that our online resourcefulness training can significantly improve the resourcefulness, resilience, and positive response scores and effectively reduce anxiety and depression scores of front-line medical staff. This demonstrates that online resourcefulness training would be an effective tool for the psychological adjustment of front-line medical staff in fighting against COVID-19.

Building resilience in German primary care practices: a qualitative study

Background

In recent years, healthcare has faced many different crises around the world such as HIV-, Ebola- or H1N1-outbrakes, opioid addiction, natural disasters and terrorism attacks). In particular, the current pandemic of Covid-19 has challenged the resilience of health systems. In many healthcare systems, primary care practices play a crucial role in the management of crises as they are often the first point of contact and main health care provider for patients. Therefore, this study explored which situations are perceived as crises by primary care practice teams and potential strategies for crisis management.

Methods

A qualitative observational study was conducted. Data were collected in interviews and focus groups with experts from primary care practices and stakeholders focusing on primary care practices in Germany such as physicians, medical assistants, practice managers, quality managers, hygiene managers and institutions on health system level (politics, research and health insurance). All interviews and focus groups were audio-recorded and transcribed verbatim. A qualitative content analysis was performed using a rapid qualitative analysis approach first, followed by a thematic analysis.

Results

Two focus groups and 26 interviews including 40 participating experts were conducted. Many different situations were perceived as crises, varying from issues in the practice organization to problems on health system level and international disasters. Distinct aspects associated with the perception of a crisis situation by interviewees were the presence of emotional reactions, a need for organizational changes and a lack of necessary resources. A broad spectrum of possible strategies was discussed that could help to cope with or even prevent the emergence of an actual crisis. In particular, strengthening communication within practice teams and resilience among employees was perceived to be fundamental for improving responses to crises or preventing them.

Conclusions

The study provides perspectives of primary health care workers on crises in health, that could inform health policy regarding prevention and management of future crises in primary care facilities.

It's What We Do: Experiences of UK Nurses Working during the COVID-19 Pandemic: Impact on Practice, Identity and Resilience

The COVID-19 pandemic increased pressure on a nursing workforce already facing high levels of stress, burnout, and fatigue in the United Kingdom (UK) and internationally. The contribution of nurses to keeping the public safe was widely recognised as they met the challenges of delivering complex patient care during the healthcare crisis. However, the psychological impact of this on nurses' health and wellbeing has been substantial, and the number of nurses leaving the profession in the UK is rising. The aim of this study was to explore the experiences of nurses working during the COVID-19 pandemic and the impact of this on their psychological health, wellbeing and resilience. The study is part of a wider project to develop and pilot an online resilience intervention for nurses during COVID-19. Five focus groups with 22 nurses were carried out online. Data was analysed thematically using the Framework Method. Four key themes relating to positive and negative impacts of working during the pandemic were identified: Rapid changes and contexts in flux; loss and disruption; finding opportunities and positive transformation; and reinforcing and strengthening identity. Implications for coping and resilience in nursing, nursing identities and workforce development are discussed.

Resilience and its impact on the mental health of physiotherapists during the COVID-19 pandemic in São Paulo, Brazil

OBJECTIVE

To analyze whether resilience modulates the levels of depression, anxiety, stress and the impact of events in physiotherapists who work with COVID-19 patients with those who do not.

METHODS

A cross-sectional study was conducted from August 2020 up to October 2020. A total of 519 physiotherapists were enrolled and divided according to resilience and whether they worked with COVID-19 patients. Volunteers answered sociodemographic questionnaires, rating their depression, anxiety, and stress on a scale (DASS-21). The impact of event scale revised (IES-R) and 14-item resilience scale (14-RS) were also used.

RESULTS

Physiotherapists with low resilience present scores significantly high of depression, anxiety, stress and impact of event compared to the high resilience group (P < .001). Additionally, working with COVID-19 patients also resulted in increased levels of depression, anxiety, stress, and impact of event compared with the NO COVID-19 group (P < .001). These responses were modulated by age, sex, number of absences from work, whether or not personal protective equipment was received, host leadership, and the practice and maintenance of regular physical activity.

LIMITATIONS

The responses to the questionnaires were anonymous and self-administered. We cannot assess whether these people had a previous diagnosis of depression, anxiety and stress.

CONCLUSIONS

Low resilience and work with COVID-19 patients were associated with high levels of depression, anxiety, and stress and worse psychological impacts of events. Several aspects modulate these responses and can contribute to improving the resilience and mental health of physiotherapists who are responsible for the care of COVID-19 patients.

Psychological Responses of Health Care Workers Are Strongly Associated With Pandemic Management

Background

Globally, governments adopted protective measures to stabilize the worsening COVID-19 pandemic situation. These measures had a large impact on health care workers (HCWs) and could make the work environment more stressful for them. Therefore, we explored the associations of the psychological responses of HCWs and pandemic management among Slovak health care workers during the second wave of the pandemic.

Materials and Methods

We obtained data about psychological responses, COVID-19 experiences, information overload, non-adherence of the public, work stress and barriers and facilitators of health care provision from HCWs at the COVID-19-related departments of one hospital that mainly covered eastern Slovakia (215 health care professionals, 77.7% females, M/SD = 44.4). Data were analyzed using logistic regression models adjusted for gender.

Results

Pandemic management was most strongly associated with psychological responses, such as irritability, sadness, anxiety, dizziness, and back pain, in health care workers. The non-adherence of the public had the strongest associated psychological impact on HCWs, mostly affecting anxiety and irritability (odds ratios, ORs varying from 3.9 to 7.0). From the barriers and facilitators of health care provision, the use of personal protective equipment had the most impact psychologically, whereas efficient department management was most protective, with ORs around 0.3.

Conclusion

Pandemic management has a large impact on health care workers, and promoting resilience may seriously decrease job-related stress and associated psychological responses of HCWs.

A meta-review of psychological resilience during COVID-19

Psychological resilience has emerged as a key factor in mental health during the global COVID-19 pandemic. However, no work to date has synthesised findings across review work or assessed the reliability of findings based on review work quality, so as to inform public health policy. We thus conducted a meta-review on all types of review work from the start of the pandemic (January 2020) until the last search date (June 2021). Of an initial 281 papers, 30 were included for review characteristic reporting and 15 were of sufficient review quality for further inclusion in strategy analyses. High-level strategies were identified at the individual, community, organisational, and governmental levels. Several specific training and/or intervention programmes were also identified. However, the quality of findings was insufficient for drawing conclusions. A major gap between measuring the psychological resilience of populations and evaluating the effectiveness of strategies for those populations was revealed. More empirical work, especially randomised controlled trials with diverse populations and rigorous analyses, is strongly recommended for future research.

Resilience among health care workers while working during a pandemic: A systematic review and meta synthesis of qualitative studies

Background

Aim

Method

Results

Conclusion