Healthcare Workers' Resilience Mediates the Influence of Organizational Commitment and Anxiety Response to Viral Epidemic on Their Quality of Life in the COVID-19 Pandemic

Nurses' Sleep Quality and Its Influencing Factors During the First Explosive COVID-19 Outbreak in Zhejiang, China, After the Relaxation of Epidemic Prevention and Control Measures: A Multicentre Cross-Sectional Study

AIM

To investigate the sleep quality and its influencing factors among nurses in hospitals in Zhejiang, China, during the first explosive COVID-19 outbreak following the relaxation of prevention and control measures.

DESIGN

A multicentre cross-sectional study.

METHODS

Between 10 January and 20 January 2023-approximately 1 month after the policy was loosened-a total of 573 nurses from tertiary and community hospitals in Zhejiang participated in an online, self-administered survey. The participants were recruited using convenience sampling, and the survey was distributed via the WeChat platform. The survey included a general information form; the Self-Rating Scale of Sleep (SRSS); the Depression, Anxiety, and Stress Scale-21 (DASS-21); the Perceived Social Support Scale (PSSS); and the Brief Resilience Scale (BRS). Data analysis was conducted using SPSS version 26.0. Statistical methods employed included t-tests, one-way analysis of variance (ANOVA), chi-square tests and Mann-Whitney U-tests for comparisons between groups. Pearson correlation coefficients were calculated to analyse the relationship between the SRSS score and the DASS-21, PSSS and BRS scores. A multiple linear stepwise regression analysis was conducted to determine the independent influencing factors of sleep quality.

RESULTS

More than 90% of the nurses were infected with COVID-19, and 60.6% had sleep disorders. The regression analysis revealed that anxiety, the BRS score, comorbidities, hospital grade, clinical front-line, age and COVID-19 infection independently predicted sleep quality. The scores for several SRSS items were higher than the Chinese norm, especially for the nurses in tertiary hospitals.

PATIENT AND PUBLIC CONTRIBUTION

No patient or public contribution.

Emotional Responses of Hospital Staff to the DASS-21 Survey During Mass COVID-19 Testing After the Relaxation of Prevention and Control Measures in Zhejiang, China, and Their Change Trajectory

Aim

To investigate the emotional response of hospital staff to the Depression Anxiety Stress Scale-21 (DASS-21) over the COVID-19 pandemic and after the relaxation of prevention and control measures in Zhejiang Province, China, and identify influencing factors.

Design

Multicenter online cross-sectional design.

Methods

From January 10, 2023, to January 20, 2023, 1054 hospital employees in Zhejiang, China, were recruited using WeChat. Data was gathered via online, self-administered surveys. T-tests and one-way analyses of variance, Pearson's correlation analysis, and multiple linear stepwise regression analyses were used to examine the data.

Results

More than 90% of hospital employees were infected with COVID-19. Through regression analysis, the following variables were found to be independent predictors of emotional response to DASS-21: resilience (-13.346, P < 0.0001), sleep (14.689, P < 0.0001), friend support (-4.278, P < 0.0001), education level (2.699, P = 0.007), and marriage (-2.214, P = 0.027). The emotional responses were not as severe as predicted, but they were still well above the Chinese norm. A longitudinal comparison of DASS-21 emotional responses with similar studies showed a parabolic downward trend over time.

Conclusion

Our results identified education level, marriage, friend support, resilience, and sleep as independent predictors of emotional responses to the DASS-21 among hospital workers in this outbreak. Improving the mental resilience and sleep status of staff is a key target. Unmarried medical personnel with higher education should be given greater attention and support by management. In addition, there is still room for further improvement in the government and societal responses to similar outbreaks. The study also found a parabolic downward trend in DASS-21 emotional responses among hospital workers during the COVID-19 outbreak over time.

Anxiety among Japanese nursing researchers before and after dispatch for COVID-19 pandemic support: Effects of anxiety-enhancing and buffering factors

AIM

We investigated the levels of anxiety and the factors influencing it among Japanese nursing researchers before and after engaging in dispatch support activities during the COVID-19 pandemic. This study also tested the relationships between pre- and post-relief anxiety and their enhancing and buffering factors.

METHODS

A web-based survey was conducted with 9832 members from the Japan Academy of Nursing Science, covering 15 items related to participant attributes such as age and disaster relief qualifications, factors affecting anxiety about support activities such as the content and duration of one activity, and the level of anxiety before and after activities. After performing multiple regression analyses on the effects of the attributes and the factors influencing anxiety before and after support activities, path analysis was conducted on the adopted independent variables to examine their influence on anxiety before and after support activities.

RESULTS

Of the 886 participants, 82.3% were affiliated with educational institutions and 94.8% had no qualifications in disaster relief. Most of the support involved vaccination and activities at health centers. The relationship between pre- and post-relief activities and factors influencing anxiety constituted a high goodness-of-fit, with health center assistance being both a direct and indirect reinforcer of post-relief anxiety.

CONCLUSIONS

Participants expressed anxiety enhanced by activities at the health center both before and after support activities in the wake of the COVID-19 pandemic. Intervention research should examine anxiety-buffering and -enhancing factors, and a support system to respond to rapidly increasing medical needs is necessary.

Longitudinal measurement invariance and growth curve modeling of psychological resilience across the deployment cycle

The concept of resilience is embedded within military culture and professional identity. To date, temporal changes in individuals' perceptions of their own resilience have not been systematically assessed in highstakes occupational contexts, like the military. The current study examined change in selfreported resilience over time by: (1) examining the longitudinal measurement invariance of the Brief Resilience Scale (BRS); (2) assessing the longitudinal pattern of resilience across a combat deployment cycle; and (3) examining predictors of postdeployment resilience and change in resilience scores across time. U.S. Army soldiers assigned to a combat brigade completed a survey at four time points over the course of a deployment cycle: (a) prior to deployment to Afghanistan; (b) during deployment; (c) immediately following return to home station; and (d) approximately 2-3 months thereafter. The longitudinal measurement invariance of the BRS was established. Growth curve modeling indicated that, on average, self-reported resilience decreased across the deployment cycle, but there was considerable individual variation in the rate of change. Of note, loneliness, as measured during deployment, predicted the rate of change in self-reported resilience over time. Results have implications for the longitudinal analysis of resilience and for the development of interventions with military personnel.

Does physical activity influence health behavior, mental health, and psychological resilience under the moderating role of quality of life?

BACKGROUND

Physical activity significantly influences health-related behaviors, encompassing physical and mental well-being. Physical activity has been linked to enhancing health behavior, mental health, and psychological resilience. The current study is based on participants who were active in physical activity to improve health and well-being.

OBJECTIVES

To examine the influences of physical activity on health behavior, mental health, and psychological resilience, considering the moderating role of quality of life.

METHOD

A thorough cross-sectional online survey was conducted from April 15, 2023, to October 15, 2023. The survey was comprehensive and lasted for six months. The online poll received more than one thousand responses under convenience sampling. The selection criteria for the study were above 21 years old, and participants were active in physical activity to improve health and well-being. The collected data were analyzed using appropriate statistical SPSS-25 and SmartPLS 4.0 software to investigate the proposed research paradigm.

RESULTS

SEM results of model 1 (direct coefficients) show that PA has a positive effect on HeB, MeH, PsR, HeB on MeH, HeB on PsR. Out of six (in model 2), four moderating effects of QOL were significant, and two were statistically insignificant.

CONCLUSION

It has been observed that the quality of life has a moderating role in the relationships between physical exercise and several aspects, such as psychological resilience, mental health, and health-related behavior. It is imperative to emphasize the importance of fostering consistent engagement in physical activity to cultivate a well-balanced and health-conscious way of life.

Relationships between team characteristics and soldiers' organizational commitment and well-being: the mediating role of psychological resilience

Background

Military operations call for a great deal of readiness and resilience on the part of the soldiers, once confronted with high-stress scenarios. Resilience, in this context, has to do with the ability to effectively cope with the adverse impacts of setbacks and the accompanying stressors, ensuring that overall performance and combat effectiveness remain unhampered. In the modern military context, it is relevant to examine more deeply the phenomenon of soldiers' resilience, its importance in positive organizational and personal outcomes as well as the role of team factors for the improving of soldiers' resilience. The study aimed to examine team-level factors that determine soldiers' psychological resilience and to reveal the mediating role of resilience in the relationships between team factors and organizational commitment and well-being.

Sample

A cross-sectional convenience sample included 422 soldiers on professional military duty in the Lithuanian Armed Forces.

Methods

Data were collected using self-administered questionnaire. We applied structural equation modeling to assess the research models.

Results

Team cohesion and colleague support proved to be reliable predictors of increased psychological resilience; individuals with higher resilience were more committed to the organization and experienced higher well-being; the results confirmed the hypotheses that soldier resilience has a mediating effect on the relationships between team characteristics and their commitment, and well-being.

Conclusion

The findings help clarify the relationships between team characteristics, soldiers' resilience, commitment and well-being. They may be useful for improving soldier resilience through team cohesion, mutual support, cooperation, and for integrating team-building interventions into military resilience training programs.

Perceived risk of infection, ethical challenges and motivational factors among frontline nurses in Covid-19 pandemic: prerequisites and lessons for future pandemic

BACKGROUND

Infection risk was significant for front-line nurses during the Covid-19 outbreak. The pandemic presented several ethical difficulties and sapped nurses' drive to labor harder for longer periods. This study evaluates registered nurses' perceptions of Covid-19 infection risk, ethical dilemmas, and motivating factors.

MATERIALS AND METHODS

During March and April 2022, 400 registered nurses from a newly established tertiary care hospital participated in this cross-sectional exploratory survey. The risk assessment scale, motivation to work scale, and ethical dilemma scale were used to assess the perceived risk of infection, motivational factors and ethical challenges experienced by the nurses. Appropriate descriptive and inferential statistics were applied to compute the results.

RESULTS

76.4% of nurses feared working as a nurse put them at higher risk of infection. Besides the fear of contracting infection, nurses believed they were the source of infection to family members (70.8%) and people around (67.5%). 63.3% of nurses agree that they do not have the right to refuse treatment and every patient has the right to receive optimal care, regardless of age, gender, and medical conditions. Professional obligation to treat patients (72.3%) and sound professional knowledge and experience (83.5%) are important motivating factors to work during the pandemic. Multilinear regression analysis revealed that professional education (95% CI, 3.845 - 0.694, p = 0.005), Covid-19 positive status (95% CI,0.455-2.756, p = 0.006), and post-Covid-19 hospitalization (95% CI, 1.395-6.978, p = 0.003) and duration of hospitalization (95% CI, 0.754-0.058, p = 0.022) are independent predictors of higher perceived risk of infection among nurses.

CONCLUSIONS

During the pandemic, nurses were afraid to work and faced personal and family risks of contracting the virus. Despite these challenges, they still feel a strong sense of commitment and dedication to providing the best possible care. Nurse administrators need to create a supportive environment that follows ethical principles and meets the needs of nurses to boost their motivation and encourage them to continue working for longer periods.

Association between Posttraumatic Stress Symptoms and Resilience in Frontline Healthcare Workers during the COVID-19 Pandemic in Vietnam

The COVID-19 pandemic has placed a considerable burden on frontline healthcare workers (HCWs), thus increasing their vulnerability to developing posttraumatic stress disorder (PTSD). Our study aimed to examine the relationship between possible PTSD symptoms and resilience and identify associated factors with possible PTSD symptoms among Vietnamese frontline HCWs during the COVID-19 pandemic in 2021. We conducted a cross-sectional study across medical facilities at three administrative levels: provincial, district, and commune levels of Vietnam's healthcare service and management systems. The Item of Event Scale-Revised (IES-R) and Brief Resilience Scale (BRS) were used to measure possible PTSD symptoms and psychological resilience accordingly. In the sample of 763 HCWs, two-thirds were women, their median age was 34, and nearly half were nurses. 15.9% of HCWs reported having possible PTSD symptoms. Several variables, including COVID-19 concerns: worried about being infected with COVID-19, lacking personal protective equipment (PPE), about an uncontrollable pandemic, feeling lonely about being isolated from family, and resilience capacity were statistically significant with having possible PTSD symptoms. Multiple logistic regression showed that reused PPE, concerns about lacking PPE, and low levels of resilience were significantly associated with an increased likelihood of possible PTSD symptoms. It is suggested that greater priority should be given to improving healthcare plans to mitigate HCWs' PTSD symptoms and improve their resilience trait.

Wellbeing and mental health outcomes amongst hospital healthcare workers during COVID-19

BACKGROUND

Global healthcare systems have been particularly impacted by the COVID-19 pandemic. Healthcare workers (HCWs) are widely reported to have experienced increased levels of baseline psychological distress relative to the general population, and the COVID-19 pandemic may have had an additive effect. However, previous studies are typically restricted to physicians and nurses with limited data available on hospital HCWs. We aimed to conduct a cross-sectional, psychological evaluation of Irish HCWs during COVID-19.

METHODS

HCWs across five adult acute level-4 Dublin-based hospitals completed an online survey of wellbeing and COVID-19 experience.

RESULTS

There were 1898 HCWs who commenced the survey representing 10% of the total employee base. The sample comprised nurses (33%), doctors (21%), Health and Social Care Professionals (HSCPs) (24%) and 'Other' disciplines (22%), and 81% identified as female. Clinical levels of depression, anxiety and PTSD symptoms were endorsed by 31%, 34% and 28% of respondents, respectively. Professional grouping effects included: nurses reporting significantly greater levels of COVID-19 exposure, infection, COVID-fear, moral injury, and post-traumatic distress; HSCPs were significantly less likely to report mood dysfunction. In terms of gender, males were significantly less likely to report negative pandemic experiences, low resilience, and significantly more likely to endorse 'minimal' depression, anxiety, and traumatic distress. Logistic regression modelling revealed mental health outcomes (depression, anxiety and PTSD symptoms) were associated with increased frontline exposure, fewer career years' experience, elevated pre-pandemic stress, and female gender.

DISCUSSION

To our knowledge, this is the largest evaluation of psychological wellbeing amongst HCWs in acute hospitals in the Dublin region. Our findings have implications for healthcare workforce wellbeing and future service delivery.

The COVID-19 pandemic impact on the Polish medical personnel work: a survey and in-depth interviews study

Objective

The objective of the study was to examine the impact of the COVID-19 pandemic on the work of medical personnel in terms of: task scope, preparation to perform medical tasks related to the pandemic, team collaboration, involvement in tasks performed, concerns about performing tasks related to the pandemic, stress levels.

Methods

The mixed-method approach was applied to this cross-sectional study. The online questionnaire which included 40 questions was completed via Google among medical personnel in Poland. Eight semi-structured, in-depth interviews were conducted to deepen the data obtained with the questionnaires.

Participants

The questionnaire was completed by 215 healthcare professionals, with the largest group being nurses (56.3%) followed by physicians (22.3%), midwives (11.6%) and other healthcare professionals (e.g., physiotherapists, paramedics, nutritionists - 9.8%). Among the respondents were people who worked in the hospital in the so-called "covid wards" (31.2%) and other hospital wards (60%) as well as people who were employed outside the hospital (8.8%).

Results

The pandemic affected the nature and range of tasks performed by health professionals. Initially, respondents felt unprepared to work under pandemic conditions, but over time their ratings increased in all areas studied. More than half of respondents reported no change in interpersonal relationship within the team, but nearly 35% noted a worsening and only one in 10 claimed improvement. Study participants rated their own commitment to tasks slightly higher than that of their colleagues (mean 4.9 and 4.4 respectively) but the overall rating was high. The mean self-rating of work stress increased from 3.7 before the pandemic to 5.1 during the pandemic. Most of the respondents were afraid of transmission of the infection to their relatives. Other fears included the possibility of making a medical error, not being able to help the patient, not having enough personal protective equipment (PPE) and contracting SARS-CoV-2.

Conclusion

The conducted study revealed that the organization of medical care in the initial period of the pandemic, especially the hospital care of patients infected with SARS-CoV-2, was quite chaotic. The most affected were the people who were transferred to work in the covid wards. Not all medical professionals were prepared to work with the COVID-19 patients, as they lacked experience working in such facilities, especially in intensive care units (ICU). Working under time pressure and under new conditions led mainly to an increase in perceived stress and conflicts between staff.

Resilience Improves the Quality of Life and Subjective Happiness of Physiotherapists during the COVID-19 Pandemic

Resilience is an individual characteristic that protects mental health. However, its impact on the lives of Brazilian physiotherapists during COVID-19 is not known. This study aimed to analyze whether resilience modulates the perceived quality of life (QoL) and subjective happiness (SH) of physiotherapists who work with COVID-19 patients, compared with those who do not. A cross-sectional study was conducted between 22 August and 22 October 2020. Physiotherapists working in critical and non-critical hospital sectors were invited to participate in the study. The participants completed sociodemographic questionnaires and were graded on the 14-item Resilience Scale, 36-item Short-Form Health Survey (SF-36), and the Subjective Happiness Scale. In total, 519 physiotherapists were enrolled in the study. Physiotherapists with low resilience who worked with COVID-19 patients reported lower scores on the SF-36 subscales (except for social functioning) and the Subjective Happiness Scale, compared with those with high resilience who did not work with COVID-19 patients. These responses were modulated by age, sex, absence from work, receipt of personal protective equipment, host leadership, and practice and maintenance of regular physical activity. In conclusion, physiotherapists with low resilience who worked with COVID-19 patients presented lower perceptions of QoL and SH, compared with the other study participants.