Stress Reduction Techniques for Health Care Providers Dealing With Severe Coronavirus Infections (SARS, MERS, and COVID-19): A Rapid Review

Level of patient contact and Impact of Event scores among Canadian healthcare providers during the COVID-19 pandemic

BACKGROUND

Healthcare providers (HCP) continue to provide patient care during the COVID-19 pandemic despite the known risks for transmission. Studies conducted early in the pandemic showed that factors associated with higher levels of distress among HCP included being of younger age, female, in close contact with people with COVID-19, and lower levels of education. The goal of this study was to determine if level of patient contact was associated with concern for post-traumatic stress disorder (PTSD) as measured by the Impact of Event Scale-Revised (IES-R).

METHODS

This cross-sectional study, embedded within a prospective cohort study, recruited HCP working in hospitals in four Canadian provinces from June 2020 to June 2023. Data were collected at enrolment and annually from baseline surveys with the IES-R scale completed at withdrawal/study completion. Modified Poisson regression was used to determine the association between level of patient contact and concern for PTSD (i.e., IES-R scores ≥24).

RESULTS

The adjusted rate ratio (RR) associated with concern for PTSD among HCP with physical contact/direct patient care was 1.19 (95% confidence interval (CI) 1.03, 1.38) times higher than for HCP with no direct contact. In fully adjusted linear regression models, physical care/contact was associated with higher avoidance and hyperarousal scores, but not intrusion scores.

CONCLUSIONS

Administrators and planners need to consider the impact of heightened and ongoing stress among HCP by providing early screening for adverse emotional outcomes and delivery of tailored preventive strategies to ensure immediate and long-term HCP health.

Stigmatization experiences of healthcare workers in the context of the COVID-19 pandemic: a scoping review

BACKGROUND

During the COVID-19 pandemic, healthcare workers face the stigmatization of those caring for COVID-19 patients, creating a significant social problem. Therefore, this study investigated the stigmatization of healthcare workers in the context of the COVID-19 pandemic.

METHODS

In this scoping review study, searches were conducted from December 2019 to August 2023 in Persian and English using various databases and search engines including PubMed (Medline), Embase, Scopus, ISI Web of Science, ProQuest, Science Direct, Springer, Cochrane Library, Google Scholar, and national databases. The study used English keywords such as Social Stigma, Health Personnel, Healthcare Worker, Medical Staff, Medical Personal, Physicians, doctors, Nurses, nursing staff, COVID-19, and coronavirus disease 2019, and their Persian equivalents, and their Persian equivalents to explore healthcare workers' experiences of COVID-19-related stigma.

RESULTS

From a total of 12,200 search results, 77 eligible studies were included in this study. stigmatization of healthcare workers caring for COVID-19 patients was evident from the literature because of fear, misinformation, and negative self-image. Manifestations were violence and deprivation of social rights, resulting in adverse biopsychosocial, occupational, and economic consequences. This condition can affect negatively health staff themselves, their families, and society as well. Anti-stigmatization measures include informing society about the realities faced by healthcare workers, presenting an accurate and empathetic image of health workers, providing psychosocial support to health workers, and encouraging them to turn to spirituality as a coping mechanism. There are notable research gaps in comprehending the phenomenon, exploring its variations across diverse healthcare roles and cultural contexts, examining its long-term effects, and monitoring shifts in stigma perceptions over time.

CONCLUSION

The COVID-19 pandemic has resulted in the stigmatization of healthcare workers, causing mistreatment and rights violations. This stigma persists even post-pandemic, posing a psychological dilemma for caregivers. Addressing this requires comprehensive strategies, including tailored stigma prevention programs and research to understand its psychological impact.

Potential strategies for supporting mental health and mitigating the risk of burnout among healthcare professionals: insights from the COVID-19 pandemic

Healthcare professionals (HCPs) experienced prolonged stressful conditions during the coronavirus disease 2019 pandemic, and the global situation (particularly in the United Kingdom) meant that they continue to sustain mental stress related to the subsequent cost-of-living and healthcare budgeting crises. The psychological toll on HCPs may lead to increased staff attrition, adversely impacting the quality of patient care and work security. To help mitigate this psychological impact, the current evidence is strongly supportive of healthcare providers consistently adopting programmes fostering improvement in coping and resilience, facilitating healthy lifestyle, and allocating some resources for therapeutic strategies (e.g. cognitive behavioural therapy-based strategies and other strategies specified to trauma-related issues) which can be delivered by trained professionals. We stress that some approaches are not a one-size-fits-all strategy, and we also highlight the need to encourage treatment-seeking among those who need it. These strategies are highly relevant to healthcare employers and policymakers to support all HCPs in settings marked by prolonged periods of stress. The investment in these strategies are expected not only to reduce staff attrition in the long-term, but are likely to add to the cost-effectiveness of overall healthcare budgetary allocation.

Feasibility of a 3-Minute Mindful Breathing Intervention for Enhancing Psychiatric Mental Health Nurses' Resilience During COVID: Findings From a 4-Week Pilot Study

COVID created a perfect storm of conditions leading to excessive and prolonged stress on already vulnerable nurses. This study examines the feasibility of enhancing psychiatric mental health nurses' (PMHNs') resilience by practicing a 3-minute mindfulness-based intervention. In this pilot study, we explored if PMHNs could be recruited and retained for intervention implementation, intervention acceptability, and measurement of any notable changes over the prescribed period. Study feasibility is reflected in high participant retention and increased postintervention resilience scores. Given the positive outcomes, a larger-scale study is warranted. Additional areas of opportunity include strategies for increasing participant uptake, and, due to limited acceptability feedback, the introduction of a usefulness scale.

Opinions of emergency nurses in Turkey on their work environment during the COVID-19 pandemic and its relationship with their health: A qualitative study

Introduction

COVID-19 patients being admitted to emergency service pose a high risk of exposure and infection to emergency nurses. Therefore, one of the primary responsibilities of hospital management is to provide an appropriate work environment for nurses.

Aim

To analyze the opinions of emergency nurses about their work environment, and to understand how the working environment is related to their health during the COVID-19 pandemic.

Methods

The study employed a qualitative descriptive research design and purposive sampling method. It was conducted in the emergency service of a state hospital in the central Anatolia region of Turkey, which was providing COVID-19 care at the time. The data were collected through semi-structured individual interviews held between January and February 2021. Each interview was conducted only once via WhatsApp video calls. Data collection was continued to reach data saturation (n:14). The data were analyzed using Colaizzi's seven-step content analysis. The Consolidated Criteria for Reporting Qualitative (COREQ) Studies checklist was followed in the study.

Results

Three themes emerged in the analysis of the data obtained from a total of 14 emergency nurses: (a) "Insufficient Physical Environment"; (b) "Inadequacies in Managerial Roles and Skills"; and (c) "The Effect of the Work Environment on Nurses' Health". It was determined that the work environment of emergency nurses was inadequate in terms of resting areas, ventilation and separation of clean and infected areas, and they stated that they had not received adequate support from their managers and encountered difficulties due to equipment shortage, particularly in the early stages of COVID-19. It was also determined that the work environment caused psychological and ergonomic health issues.

Conclusions

It is important to provide adequate managerial support and to make arrangements that resolve the physical and mental obstacles in improving the work environment of emergency nurses.

Stress Management in Healthcare Organizations: The Nigerian Context

Occupational psychosocial stress can increase the risk of several cardiometabolic diseases. Healthcare workers worldwide experience exceptionally high levels of occupational stress, leading to serious individual, organizational, and societal problems. This narrative review seeks to provide information about the overall consequences of having over-stressed healthcare workers and ascertain how it eventually holds back the advancement of healthcare. In addition, we present a review of the concept, study, and theories related to stress management in order to deeply understand this issue, providing a theoretical perspective of stress management and the subtle concepts of stress, stress management, healthcare structure, and organization in Nigeria. The current literature has shown that Nigerian healthcare workers are more stressed due to long working hours, caregiving responsibilities, and psychological contact with patients. Healthcare workers are more likely to experience stress and burnout than other professions. The level of stress in the healthcare sector has garnered a lot of attention in this regard because of the negative impact of stress on both staff and patients. However, health policies and better working conditions need to be adopted. Collaborative efforts from policymakers, healthcare institutions, and other stakeholders are necessary to prioritize the well-being and productivity of healthcare professionals in the journey toward a more robust and equitable healthcare system.

COVID-19 risk, course and outcome in people with mental disorders: a systematic review and meta-analyses

AIMS

It has been suggested that people with mental disorders have an elevated risk to acquire severe acute respiratory syndrome coronavirus 2 and to be disproportionally affected by coronavirus disease 19 (COVID-19) once infected. We aimed to analyse the COVID-19 infection rate, course and outcome, including mortality and long COVID, in people with anxiety, depressive, neurodevelopmental, schizophrenia spectrum and substance use disorders relative to control subjects without these disorders.

METHODS

This study constitutes a preregistered systematic review and random-effects frequentist and Bayesian meta-analyses. Major databases were searched up until 27 June 2023.

RESULTS

Eighty-one original articles were included reporting 304 cross-sectional and prospective effect size estimates (median n per effect-size = 114837) regarding associations of interest. Infection risk was not significantly increased for any mental disorder that we investigated relative to samples of people without these disorders. The course of COVID-19, however, is relatively severe, and long COVID and COVID-19-related hospitalization are more likely in all patient samples that we investigated. The odds of dying from COVID-19 were high in people with most types of mental disorders, except for those with anxiety and neurodevelopmental disorders relative to non-patient samples (pooled ORs range, 1.26-2.57). Bayesian analyses confirmed the findings from the frequentist approach and complemented them with estimates of the strength of evidence.

CONCLUSIONS

Once infected, people with pre-existing mental disorders are at an elevated risk for a severe COVID-19 course and outcome, including long COVID and mortality, relative to people without pre-existing mental disorders, despite an infection risk not significantly increased.

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.

Stress overload, influencing factors, and psychological experiences of nurse managers during early stages of the COVID-19 pandemic: a sequential explanatory mixed method study

Background

Healthcare systems had an exceptionally difficult time during the early COVID-19 pandemic. Nurse managers in particular made enormous contributions to ensuring the safety of patients and front-line nurses while being under excessive psychological stress. However, little is known about their experiences during this time.

Objective

The aim of this study was thus to assess the level of stress overload and psychological feelings of nurse managers during the early COVID-19 pandemic.

Methods

A mixed methods sequential explanatory design study with non-random convenience sampling was performed, following the STROBE and COREQ checklists. The study was conducted at the Affiliated Dongyang Hospital, Wenzhou Medical University, with data collected from six provinces in southern China (Zhejiang, Hubei, Shanghai, Jiangsu, Hunan and Jiangxi) during March 2020 and June 2020. A total of 966 nurse managers completed the Stress Overload Scale and Work-Family Support Scale. In addition, a nested sample of nurse managers participated in semi-structured face-to-face interviews. The data were then analyzed using qualitative content analysis, Pearson correlation, and multiple linear regression.

Results

The quantitative results showed that nurse managers experienced a moderate level of stress load. There was a significant negative correlation between work-family support and stress load (r = -0.551, p < 0.01). Concerns about protecting front-line nurses and work-family support were the main factors affecting the stress load, which accounted for 34.0% of the total variation. Qualitative analysis identified four main thematic analyses that explained stress load: (1) great responsibility and great stress, (2) unprecedented stress-induced stress response, (3) invisible stress: the unknown was even more frightening, and (4) stress relief from love and support. Taken together these findings indicate that concern about protecting front-line nurses and negative work-family support of nurse managers were the main factors causing stress overload.

Conclusion

Implementing measures focused on individual psychological adjustment combined with community and family support and belongingness is one potential strategy to reduce psychological stress among nurse managers.

Coping mechanisms used by pharmacists to deal with stress, what is helpful and what is harmful?

Background

Australian pharmacists encountered increased stressors during the COVID-19 pandemic. This has raised questions regarding the effectiveness of the coping mechanisms used to manage this high work-related stress. Identifying useful and harmful coping mechanisms is critical for providing advice regarding addressing pharmacists' future work-related stress.

Objectives

This study aimed to explore the impact of pharmacy work on stress experienced by Australian pharmacists and the coping mechanisms used during the COVID-19 pandemic. This study also aimed to evaluate the pharmacists' perceptions of the impact of these coping mechanisms on their stress.

Methods

A cross-sectional study was conducted. Practising pharmacists and interns were recruited to complete an online survey that included the Perceived Stress Scale (PSS), which was used to measure pharmacists' work-related stress, and the Brief-COPE scale, used to assess the coping mechanisms used during the COVID-19 pandemic. The key outcome measure was the PSS score. A multiple regression analysis was used to evaluate the relationship between coping mechanisms and stress levels in a sample of Australian pharmacists.

Results

A total of 173 pharmacists and interns were recruited. The mean PSS was 18.02 (SD = 6.7). Avoidant coping mechanisms such as social withdrawal (β = 0.31; p = 0.0001) were significantly positively associated with work-related stress. In contrast, exercise was significantly negatively associated with work-related stress (β = -0.21; p = 0.009). The most frequently reported perceived barrier to seeking help was feeling burnt out and underappreciated.

Conclusions

This study highlights the association of coping mechanisms used by pharmacists during the COVID-19 pandemic with work-related stress. The study results demonstrate the importance of physical activity and spending time with pets in reducing work-related stress levels. Avoiding harmful coping mechanisms such as social withdrawal and drinking alcohol is recommended. This study also highlights the need for interventional studies to reduce work-related stress levels among pharmacists by addressing useful coping mechanisms.

Barriers and enablers to accessing support services offered by staff wellbeing hubs: A qualitative study

Background

International efforts have been made to develop appropriate interventions to support the mental health needs of healthcare professionals in response to COVID-19. However, fewer staff have accessed these than expected, despite experiencing elevated levels of mental distress since the onset of the pandemic. Consequently, we aimed to examine the barriers and enablers for healthcare professionals in accessing interventions offered by a Staff Mental Health and Wellbeing Hub.

Methods

Twenty-five semi-structured interviews were conducted with healthcare, social care and voluntary, community and social enterprise (VCSE) sector staff. Data were analysed using thematic analysis.

Results

Four key themes were identified: (1) Environment and Atmosphere in the Workplace; (2) The Impacts of COVID-19; (3) Confidentiality; and (4) Awareness and Communication of Resources. Organisational environments were perceived as an important enabler of accessing the hub services for mental health and wellbeing support. This included the importance of recognising and responding to the ongoing pressures of COVID-19- specific challenges. Ensuring and communicating aspects of confidentiality, and ensuring clear and consistent communication of the benefits of the Hub may encourage help-seeking for mental health challenges among healthcare professionals.

Discussion

Our findings highlight important considerations to increase uptake and engagement with services to support the mental health and wellbeing of healthcare professionals and associated staff and volunteers. Organisations aiming to increase employee uptake of these services should regularly circulate consistent and clear emails about what these services offer, provide training and information for managers so they can support staff to access these services and ensure access is confidential.

Using PhotoVoice to understand mindfulness in health care practitioners

Background

The disruptions of the coronavirus disease 2019 (COVID-19) pandemic have placed added stress on health care practitioners’ (HCPs) mental health. Mindfulness-based interventions (MBIs) have been reported to increase the awareness of burnout and promote self-care practices that enhance mental well-being.

Aim

To gain insight into the use of mindfulness through the lens of PhotoVoice on how HCPs reflected on their stressors and sense of self whilst working as frontline workers during the COVID-19 pandemic.

Setting

This study was conducted online with HCPs working in South Africa during the first wave of COVID-19.

Method

A four-week MBI intervention was implemented using Zoom. An exploratory qualitative analysis was conducted using a PhotoVoice methodology. Interpretative phenomenological analysis was used to generate themes. Fifty-five HCPs consented to participate in this study.

Results

The major themes identified were operating on autopilot, feeling a sense of overwhelm because of COVID-19, using faith to cope and being able to attain a sense of self-compassion by the end of the intervention.

Conclusions

Using visual representations, HCPs were able to share the development of their reperceived lived experiences of increased self-compassion as they navigated the dilemmas and disruptions of the pandemic.

Contribution

A brief online MBI was impactful enough to show a reappraisal of the stressors of COVID-19, such that HCPs felt calmer, more competent and more compassionate. PhotoVoice methodology is recommended for future studies and mindfulness courses. It facilitates a deeper understanding of the practice of imbuing mindfulness and its impact on stressors and the self.

Cognitive appraisals and coping strategies of registered nurses in the emergency department combating COVID-19: A scoping review

OBJECTIVE

Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic.

METHODS

This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings.

FINDINGS

Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively.

CONCLUSION

The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics.

CLINICAL RELEVANCE

EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.

Workplace Stress in Portuguese Oncology Nurses Delivering Palliative Care: A Pilot Study

Oncology nurses often face complex end-of-life issues, underlining their need for specific training in palliative care. In this context, nurses experience several emotional and psychological dilemmas, which are often difficult to manage and result in high levels of workplace stress. This study aimed to determine the levels and work-related factors of workplace stress among oncology nurses. A descriptive baseline study was performed as part of a large four-phase study based on quantitative data collected from Portuguese oncology nurses. Of the 32 participating nurses, most were women, and the mean age was 42.69 ± 10.04 years. Overall, nurses revealed moderate levels of stress. Younger nurses with less professional experience had difficulties dealing with issues related to death and dying. This pilot study supported the development of a program of six Stress Management Training Workshops (SMTW) to reduce stress and increase adaptative strategies. Assessing workplace stress among oncology nurses should be the focus of intervention by managers and institutional leaders.

Psychological Interventions in a Pandemic Emergency: A Systematic Review and Meta-Analysis of SARS-CoV-2 Studies

Background: The study aim was to review the evidence and effectiveness of psychological interventions applied during Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. Methods: A literature search was run from April 2020 to April 2021. The inclusion criteria were: (1) RCTs or observational studies; (2) professional health carers and patients who had contracted coronavirus during the pandemic; (3) adults and elderly people with a viral infection diagnosis; (4) suitable measures to assess intervention effectiveness on clinical status and psychological and behavioral aspects. An internal validity assessment was planned using robvis. Data were synthesized according to PICO criteria. Results: A total of 12 studies were selected. Studies measuring mental health outcomes demonstrated the greatest reduction in symptoms, with eight out of the twelve studies demonstrating a reduction in symptoms that reached statistical significance (p < 0.05) and four of the studies reaching a higher significance level of p < 0.01. The type of psychological intervention was predominantly cognitive behavioral therapy (CBT). All studies except one was run online. Conclusion: Psychological interventions have a benefit on mental health outcomes, even if performed online. In particular, CBT seems to be the psychological intervention that is used more and also seems to have a larger effect size on the mitigation of mental health symptoms and increasing resilience.

Systematic Review of Mind–Body Modalities to Manage the Mental Health of Healthcare Workers during the COVID-19 Era

Healthcare workers (HCWs) have suffered physical and psychological threats since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Mind-body modalities (MBMs) can reduce the long-term adverse health effects associated with COVID-specific chronic stress. This systematic review aims to investigate the role of MBMs in managing the mental health of HCWs during the COVID-19 pandemic. A comprehensive search was conducted using 6 electronic databases, resulting in 18 clinical studies from 2019 to September 2021. Meta-analysis showed that MBMs significantly improved the perceived stress of HCWs (standardized mean difference, −0.37; 95% confidence intervals, −0.53 to −0.21). In addition, some MBMs had significant positive effects on psychological trauma, burnout, insomnia, anxiety, depression, self-compassion, mindfulness, quality of life, resilience, and well-being, but not psychological trauma and self-efficacy of HCWs. This review provides data supporting the potential of some MBMs to improve the mental health of HCWs during COVID-19. However, owing to poor methodological quality and heterogeneity of interventions and outcomes of the included studies, further high-quality clinical trials are needed on this topic in the future.

Alleviating psychological symptoms in nurses during disease outbreaks: An integrative review

AIM

To explore interventions and coping strategies used to treat the psychological symptoms associated with compassion fatigue among nurses.

BACKGROUND

The rapid transmission of infectious diseases (e.g., COVID-19) has put nurses, around the world, at high risk of developing profound psychological health issues due to compassion fatigue. If unrelieved, compassion fatigue can lead to catastrophic psychological symptoms such as depression, stress, anxiety, and insomnia, negatively impacting patient care. This necessitates interventions to prevent or mitigate the psychological symptoms of compassion fatigue.

METHOD

Following Whittemore and Knafl's integrative review method, the literature search comprised three databases: CINAHL, MEDLINE-OVID, and Scopus.

RESULTS

The 11 included studies were categorized into four themes: (1) using relaxation strategies, (2) neutralizing emotional trauma, (3) enhancing nurses' preparedness for confronting disasters, and (4) educating nurses about coping strategies to manage their psychological issues.

CONCLUSION

Researchers studied several coping strategies and interventions. There is a need for policymakers' support and hospital-level interventions. Early interventions may prevent or relieve psychological issues.

IMPLICATIONS

The findings have implications for hospital leaders around the world to initiate interventions that teach nurses strategies to cope with stressful events. Future researchers might consider long-term supports and multiple interventions that target several leading causes of psychological symptoms among nurses before, during, and after high-stress situations. Policymakers around the world could use the findings to initiate policies to facilitate nurses' access to needed resources, hence protecting their mental health and increasing the quality of patient care.

Healthcare Workers' SARS-CoV-2 Omicron Variant Uncertainty-Related Stress, Resilience, and Coping Strategies during the First Week of the World Health Organization's Alert

BACKGROUND

As the SARS-CoV-2 Omicron variant emerged and spread globally at an alarming speed, healthcare workers' (HCWs) uncertainties, worries, resilience, and coping strategies warranted assessment. The COVID-19 pandemic had a severe psychological impact on HCWs, including the development of Post-Traumatic Stress symptoms. Specific subgroups of HCWs, such as front-line and female workers, were more prone to poor mental health outcomes and difficulties facing stress.

METHODS

The responses to an online questionnaire among HCWs in the Kingdom of Saudi Arabia (KSA) were collected from 1 December 2021 to 6 December 2021, aiming to assess their uncertainties, worries, resilience, and coping strategies regarding the Omicron variant. Three validated instruments were used to achieve the study's goals: the Brief Resilient Coping Scale (BRCS), the Standard Stress Scale (SSS), and the Intolerance of Uncertainty Scale (IUS)-Short Form.

RESULTS

The online survey was completed by 1285 HCWs. Females made up the majority of the participants (64%). A total of 1285 HCW's completed the online survey from all regions in KSA. Resilient coping scored by the BRCS was negatively and significantly correlated with stress as scored by the SSS (r = -0.313, p < 0.010). Moreover, intolerance of uncertainty scored by the IUS positively and significantly correlated with stress (r = 0.326, p < 0.010). Increased stress levels were linked to a considerable drop in resilient coping scores. Furthermore, being a Saudi HCW or a nurse was linked to a significant reduction in resilient coping ratings. Coping by following healthcare authorities' preventative instructions and using the WHO website as a source of information was linked to a considerable rise in resilient coping.

CONCLUSIONS

The negative association between resilient coping and stress was clearly shown, as well as how underlying intolerance of uncertainty is linked to higher stress among HCWs quickly following the development of a new infectious threat. The study provides early insights into developing and promoting coping strategies for emerging SARS-CoV-2 variants.

Work-related Stress Management Behaviors of Nurses During COVID-19 Pandemic in the United Arab Emirates

Introduction

Intense psychological and emotional stress experienced by nurses during the COVID-19 pandemic interferes with their wellbeing and work efficiency. Stress-management behaviors are required to enhance coping and ameliorate stress effects. Therefore, it is necessary to examine the management behavior of nurses during the pandemic to suggest ways to improve their wellbeing.

Objective

The study aimed to examine nurses' work-related stress management behaviors during the COVID-19 pandemic in UAE.

Methods

This was a cross-sectional survey of 64 nurses working in the Isolation and Intensive care units of two selected hospitals in the United Arab Emirates. A convenience sampling technique was used for sample selection. Each participant completed an online survey via Google forms of two validated instruments: a 10-item scale to measure perceived stress levels and a 15-item Stress management inventory. The completed questionnaires were analyzed on SPSS version 25.

Results

Respondents (78.1%) reported a moderate level of stress (Mean = 18.03 and SD = 5.33). Stress management behaviors utilized included four elements (eliminating stressors, developing resilience, using short-term coping, and effective delegating) and the mean and SD were 17.62 ± 2.6, 17.42 ± 3.3, 8.88 ± 1.47, and 23.98 ± 3.54 respectively. There was a significant positive correlation between these four elements of stress management inventory (p = 0.00). Findings also showed a significant inverse correlation between the scores on perceived stress, short-term coping, and effective delegation. The overall regression of demographic covariates on stress management behaviors was not statistically significant [F = (1.015), (0.602), (0.909), (1.286), p >0.05].

Conclusions

Effective delegating and developing resilience were effective stress management behavior among nurses. Regular assessment of the psychological needs of nurses is essential to enhance overall wellbeing during stressful situations.

The Psychological Impact of COVID-19 on Front Line Nurses: A Synthesis of Qualitative Evidence

Caring for people with COVID-19 on the front line has psychological impacts for healthcare professionals. Despite the important psychological impacts of the pandemic on nurses, the qualitative evidence on this topic has not been synthesized. Our objective: To analyze and synthesize qualitative studies that investigate the perceptions of nurses about the psychological impacts of treating hospitalized people with COVID-19 on the front line. A systematic review of qualitative studies published in English or Spanish up to March 2021 was carried out in the following databases: The Cochrane Library, Medline (Pubmed), PsycINFO, Web of Science (WOS), Scopus, and CINHAL. The PRISMA statement and the Cochrane recommendations for qualitative evidence synthesis were followed. Results: The main psychological impacts of caring for people with COVID-19 perceived by nurses working on the front line were fear, anxiety, stress, social isolation, depressive symptoms, uncertainty, and frustration. The fear of infecting family members or being infected was the main repercussion perceived by the nurses. Other negative impacts that this review added and that nurses suffer as the COVID-19 pandemic progress were anger, obsessive thoughts, compulsivity, introversion, apprehension, impotence, alteration of space-time perception, somatization, and feeling of betrayal. Resilience was a coping tool used by nurses. Conclusions: Front line care for people with COVID-19 causes fear, anxiety, stress, social isolation, depressive symptoms, uncertainty, frustration, anger, obsessive thoughts, compulsivity, introversion, apprehension, impotence, alteration of space-time perception, somatization, and feeling of betrayal in nurses. It is necessary to provide front line nurses with the necessary support to reduce the psychological impact derived from caring for people with COVID-19, improve training programs for future pandemics, and analyze the long-term impacts.

COVID-19 Mental Health Stressors of Health Care Providers in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Intervention: A Qualitative Study (Preprint)

Background

Objective

Methods

Results

Conclusions

The effects of an emergency nurse-led stress-reduction project during the first 120 days of the COVID-19 pandemic in Taiwan

BACKGROUND

The COVID-19 frontline nurses' stress-reduction programme by the cooperation of manager with the nurses is not-well developed.

AIM

This study aimed to examine the effect of an emergency nurse-led stress-reduction project on reducing stress levels during the COVID-19 pandemic.

METHODS

The action research was conducted using online and person-to-person group brainstorming strategies. The online survey was used to evaluate emergency nurses' stress levels, causes of stress and needs at the 50th, 80th and 110th days of the pandemic from March to May 2020.

RESULTS

The numbers of nurses participating in three-time survey were 160, 166 and 160, respectively. There was a decrease in the nurses' work-related stress after implementing the improvement strategies. Stress from personal protective equipment (PPE), information about infection control and family's worry about being infected reduced across 2 months. Needs regarding PPE, COVID-19 information and a forum for sharing experiences of COVID-19 care decreased whereas needs of allowing more days off increased.

CONCLUSIONS

The stress-reduction project targeting at nurses' views of their needs can reduce their stress during the COVID-19 pandemic.

IMPLICATIONS FOR NURSING MANAGEMENT

The online and person-to-person group brainstorming building a good partnership between nurses and managers can be an effective nursing management.

Increasing Burden of Nursing Care on the Treatment of COVID-19 Patients in the Aging Society: Analyses During the First to the Third Wave of Pandemic in Kyoto City, Japan

Background: The coronavirus disease 2019 (COVID-19) pandemic is associated with a heavy burden on patient's mental and physical health, regional healthcare resources, and global economic activity. An aging society such as Japan has many retirement homes and long-term stay hospitals for the elderly and their inhabitants. During the COVID-19 pandemic, disease clusters are often identified in retirement homes and long-term stay hospitals. Although we hypothesize that additional burdens of nursing care for elderly patients will reinforce the anxiety and exhaustion of medical staff and healthcare resources in the aging society, the actual situation is not well understood. In this study, we aimed to evaluate the current situation and countermeasures of the COVID-19 pandemic in the aging society. Methods: We reviewed COVID-19 patients who required hospitalization at the National Hospital Organization Kyoto Medical Center, a 600-bed capacity hospital located in Kyoto, Japan, between 1 April 2020 and 31 March 2021. We assessed the characteristics of the COVID-19 patients, disease severity, duration of hospitalization, outcome at discharge, degree of activities of daily living (ADLs), and complications unique to elderly patients. Results: We enrolled 118 patients who required hospitalization during the study period. Approximately 40% of the patients were aged ≥ 80 years. Dementia (27.1%) was the most prevalent underlying disease, followed by diabetes mellitus (23.7%) and chronic kidney disease (23.7%). Approximately 60% of hospitalized COVID-19 patients had impaired ADL at admission. The COVID-19 patients aged 80 years or older required significantly more longer-term hospitalization than the COVID-19 patients aged under 80 years (15.5 ± 8.2 vs. 13.1 ± 7.7, P = 0.032). In elderly patients aged 80 years or older, approximately 50% of patients had geriatric mental disorders, and approximately 70% had bedridden status and feeding difficulty. Poor ADL at admission was significantly associated with COVID-19 mortality (Odds ratio, 5.6; 95% confidence interval, 1.04-45.2; p-value = 0.044). Conclusions: The proportion of elderly patients aged 80 years or older was relatively high during the hospitalization for COVID-19. Poor ADL at admission in these elderly patients was significantly associated with poor prognosis of COVID-19. We should keep in mind that healthcare workers are forced to have an additional burden of nursing care in the aging society during the COVID-19 pandemic. Therefore, interventions to reduce the burden are urgently required.

Anxiety and COVID-19 Related Stressors Among Healthcare Workers Who Performed Shift Work at Four COVID-19 Dedicated Hospitals in Korea

OBJECTIVE

To assess the relationship between anxiety and shift work of healthcare workers (HCWs) during COVID-19 pandemic.

METHODS

From four COVID-19-dedicated hospitals in Korea, 381 HCWs were analyzed to estimate anxiety in relation to four COVID-19 job stressors and the impact of shift work on this relationship. Anxiety was measured with a generalized anxiety disorder 7-item scale. Multiple logistic regression models were utilized after stratification by sex, occupation, and shift work, after adjusting for a number of variables.

RESULTS

Anxiety prevalence was 32%. Among female nurses or nursing assistants who performed shift work, anxiety risk was significantly associated with three COVID-19 related job stressors: contact with confirmed cases or patients, dealing with unpleasant patients, and discomfort from wearing protective equipment.

CONCLUSIONS

Special attention is required for mental health of HCWs working shifts during the COVID-19 pandemic.

The Effectiveness and Safety of Mind-Body Modalities for Mental Health of Nurses in Hospital Setting: A Systematic Review

The mental health of nurses including burnout is an important issue. The purpose of this systematic review was to evaluate whether mind-body modalities improve burnout and other mental health aspects of nurses. A comprehensive search was conducted using six electronic databases. Randomized controlled trials using mind-body modalities on the mental health of nurses, up to January 2021, were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool. Seventeen studies were included in the review. Data on mindfulness-based interventions (MBIs) and yoga were available for burnout, and there was no evidence that multimodal resilience programs including MBIs statistically significantly improved burnout levels compared to no intervention or active control groups. However, one study reported that yoga could significantly improve emotional exhaustion and depersonalization, which are subscales of burnout, compared to usual care. In addition, the effects of MBIs, relaxation, yoga, and music on various mental health outcomes and stress-related symptoms have been reported. In conclusion, there was some evidence that yoga was helpful for improvement in burnout of nurses. However, due to the heterogeneity of interventions and outcomes of the studies included, further high-quality clinical trials are needed on this topic in the future.

Mindfully Reframing the Psychological Impact of the COVID-19 Outbreak Through a Social Media Community for Students: A Pragmatic Study

The COVID-19 outbreak and the restrictions that have been enforced by the health authorities are having a profound psychological impact on the population. Many people, including the students, faced forced modifications to their daily lives and this prompted the need for scalable strategies to promote resilience. We designed an online community intervention for psychology students and recent alumni aimed to promote functional coping strategies through openness and cognitive flexibility. This psycho-educational intervention was delivered through a private group on social media (Facebook) during the acute phase of the lockdown period and it involved the publication of exercises and quick lectures. Contents were posted regularly and members of the community were invited to share their comments. The posts included stimuli that promote open and flexible reflections on the current situation. The overall aim of this group was a cognitive reframing on the epidemic effects, promoting creative and flexible thinking. We ran a thematic analysis of the interactions and we collected qualitative feedback at the end of the intervention. The participants' comments dealt with changes in their perspectives, sharing discomfort, encouragement and support, and building a sense of community. Post-intervention comments were highly satisfied and confirmed the helpfulness of the intervention to promote flexibility and openness, eventually helping to manage the negative emotions related to the COVID-19 outbreak. This study provides preliminary evidence that an online psycho-educational community stimulating flexibility and openness can help to reframe the negative psychological impact of the outbreak, improving their management.

Mental health interventions for healthcare workers during the first wave of COVID-19 pandemic in Spain

OBJECTIVE

In order to reduce distress associated with working with COVID-19 patients, several psychological intervention programmes for healthcare workers have been developed in Spain. We aimed to describe the main characteristics and components of these programmes for healthcare workers treating COVID-19 patients in Spanish hospitals.

MATERIAL AND METHODS

An online survey was designed to evaluate the main characteristics of psychological intervention programmes for healthcare workers during the first wave of COVID-19 pandemic.

RESULTS

Valid responses were received from 36 hospitals. Most of these programmes offered both in-person and online therapy. The most common aim of these interventions was emotional regulation, which was treated by psychoeducational and cognitive-behavioural techniques in individual interventions. Group interventions mainly used psychoeducation and mindfulness. Only half of the teams that offered in-person interventions received training in the proper use of personal protective equipment.

CONCLUSIONS

Several hospitals in Spain have developed mental health interventions for healthcare workers during the COVID-19 pandemic, deploying a wide range of therapeutic modalities and techniques. The rapid implementation of these programmes during the pandemic suggests that safety may not have received sufficient attention. The planning and development of interventions for healthcare workers during pandemics merits greater attention by national and regional authorities and institutions.

Stigmatization from Work-Related COVID-19 Exposure: A Systematic Review with Meta-Analysis

Stigmatization from work-related COVID-19 exposure has not been investigated in detail yet. Therefore, we systematically searched three databases: Medline, Embase, and PsychInfo (until October 2020), and performed a grey literature search (until February 2021). We identified 46 suitable articles from 24 quantitative and 11 qualitative studies, 6 systematic reviews, 3 study protocols and 1 intervention. The assessment of stigmatization varied widely, ranging from a single-item question to a 22-item questionnaire. Studies mostly considered perceived self-stigma (27 of 35 original studies) in healthcare workers (HCWs) or hospital-related jobs (29 of 35). All articles reported on stigmatization as a result of work-related COVID-19 exposure. However, most quantitative studies were characterized by convenience sampling (17 of 24), and all studies-also those with an adequate sampling design-were considered of low methodological quality. Therefore, it is not possible to determine prevalence of stigmatization in defined occupational groups. Nevertheless, the work-related stigmatization of occupational groups with or without suspected contact to COVID-19 is a relevant problem and increases the risk for depression (odds ratio (OR) = 1.74; 95% confidence interval CI 1.29-2.36) and anxiety (OR = 1.75; 95% CI 1.29-2.37). For promoting workers' health, anti-stigma strategies and support should be implemented in the workplace.

Comparison of COVID-19 Pandemic-Related Stress among Frontline Medical Personnel in Daegu City, Korea

Background and Objectives: Frontline medical staff usually experience high levels of stress, which could greatly impact their work output. We conducted a survey to investigate the level of stress and its association with job types, work departments, and medical centers among COVID-19 pandemic frontline medical personnel. Materials and Methods: We conducted a cross-sectional survey using a self-administered questionnaire among 307 frontline medical staff who cared for COVID-19 patients in Daegu city. We used a 33-item questionnaire to assess respondents’ general characteristics, job stress, personal effects associated with the COVID-19 pandemic, and their stress level. A general health questionnaire-12 (GHQ-12) was included in our questionnaire. Results: Majority (74.3%) of the respondents were in the stress group. The mean GHQ-12 score was 14.31 ± 4.96. More females (67.4%, p < 0.05) and nurses (73.3%, p = 0.001) were in the stress group compared to males and doctors. Medical staff in the general ward considered the severity of the COVID-19 pandemic situation higher. Nurses perceived work changes (p < 0.05), work burden (p < 0.05), and personal impact (p < 0.05) more serious than doctors. Medical staff in Level 3 emergency department (ED) perceived a lack of real-time information (p = 0.012), a lack of resources, and negative personal impacts associated with the pandemic as more serious than staff in Level 1 and Level 2 EDs. Medical staff in the intensive care unit perceived work changes (p < 0.05), work burden (p < 0.05), and lack of personal protective equipment (p = 0.002) as more serious than staff in the ED and general ward. Conclusion: Providing real-time information and resources for reducing work burden and negative personal impact is central to maximizing the work output of the COVID-19 pandemic frontline medical staff. Supporting their mental health through regular programs and intervention is also imperative.

Mental health interventions for healthcare workers during the first wave of COVID-19 pandemic in Spain

Objective

In order to reduce distress associated with working with COVID-19 patients, several psychological intervention programmes for healthcare workers have been developed in Spain. We aimed to describe the main characteristics and components of these programmes for healthcare workers treating COVID-19 patients in Spanish hospitals.

Material and methods

An online survey was designed to evaluate the main characteristics of psychological intervention programmes for healthcare workers during the first wave of COVID-19 pandemic.

Results

Valid responses were received from 36 hospitals. Most of these programmes offered both in-person and online therapy. The most common aim of these interventions was emotional regulation, which was treated by psychoeducational and cognitive-behavioural techniques in individual interventions. Group interventions mainly used psychoeducation and mindfulness. Only half of the teams that offered in-person interventions received training in the proper use of personal protective equipment.

Conclusions

Several hospitals in Spain have developed mental health interventions for healthcare workers during the COVID-19 pandemic, deploying a wide range of therapeutic modalities and techniques. The rapid implementation of these programmes during the pandemic suggests that safety may not have received sufficient attention. The planning and development of interventions for healthcare workers during pandemics merits greater attention by national and regional authorities and institutions.

A Survey of Psychiatric Healthcare Workers' Perception of Working Environment and Possibility to Recover Before and After the First Wave of COVID-19 in Sweden

Objective: This study aimed to investigate the impact of the first wave of the COVID-19 pandemic on perceived working environment, including the possibility to recover, among psychiatric healthcare workers (PHCWs) in comparison with pre-pandemic measures. Method: A link to an anonymous, web-based COVID-19 related survey was sent via email to all PHCWs at a university hospital in Sweden (n = 1,618) in September 2020. The response rate was 38% (566 of 1,507 eligible participants). Working environment survey responses collected in 2019 were used as pre-pandemic comparators. Statistical analyses were performed to assess overall impact over time on work demands, support, motivation, and recovery, stratified by professional role, and considering variables such as access to personal protective equipment. Results: The percentage of individuals responding negatively to statements about working environment increased significantly for most items after the first wave. Similarly, the increase of five of the investigated factors indicated a more negative perception of recovery during the pandemic. Registered nurses reported a greater negative impact of the pandemic on perceived working conditions and ability to recover than other professional groups. PHCWs working with patients with COVID-19 (35%) who reported being worried about becoming infected (12%) or infecting others (17%), or lacking adequate personal protective equipment (22%) were more negatively impacted regarding work environment-related items than those who did not. Conclusions: PHCWs' working environment and possibility for recovery were impacted by the first wave of the COVID-19 pandemic, nurses being most affected. Although psychiatric services do not directly care for patients with severe COVID-19 infection, the results from this study suggests that mental health services should also prepare for future pandemics.

Physical relaxation for occupational stress in healthcare workers: A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVES

Work related stress is a major occupational health problem that is associated with adverse effects on physical and mental health. Healthcare workers are particularly vulnerable in the era of COVID-19. Physical methods of stress relief such as yoga and massage therapy may reduce occupational stress. The objective of this systematic review and network meta-analysis is to determine the effects of yoga, massage therapy, progressive muscle relaxation, and stretching on alleviating stress and improving physical and mental health in healthcare workers.

METHODS

Databases were searched for randomized controlled trials on the use of physical relaxation methods for occupational stress in healthcare workers with any duration of follow-up. Meta-analysis was performed for standard mean differences in stress measures from baseline between subjects undergoing relaxation vs non-intervention controls. Network meta-analysis was conducted to determine the best relaxation method.

RESULTS

Fifteen trials representing 688 healthcare workers were identified. Random-effects meta-analysis shows that physical relaxation methods overall reduced measures of occupational stress at the longest duration of follow-up vs baseline compared to non-intervention controls (SMD -0.53; 95% CI [-0.74 to -0.33]; p < .00001). On network meta-analysis, only yoga alone (SMD -0.71; 95% CI [-1.01 to -0.41]) and massage therapy alone (SMD -0.43; 95% CI [-0.72 to -0.14]) were more effective than control, with yoga identified as the best method (p-score = .89).

CONCLUSION

Physical relaxation may help reduce occupational stress in healthcare workers. Yoga is particularly effective and offers the convenience of online delivery. Employers should consider implementing these methods into workplace wellness programs.