Mental Health Disorders in Nurses During the COVID-19 Pandemic: Implications and Coping Strategies

Harnessing strengths from trauma: examining the impact of strength use on nurses' job satisfaction, positive mental health, and thriving at work through post-traumatic growth

BACKGROUND

While strength use has been shown to foster post-traumatic growth, few studies have examined whether it also influences outcomes such as job satisfaction, work thriving, and positive mental health. Addressing this gap is essential for improving the well-being of healthcare workers under ongoing stress.

AIM

This study aimed to explore the relationships between strength use, post-traumatic growth, and well-being among nurses, specifically investigating how strength use influences key well-being outcomes such as positive mental health, job satisfaction, and thriving at work. Additionally, the study examined whether post-traumatic growth mediates these relationships.

SETTING/PARTICIPANTS

1,523 registered nurses from a tertiary hospital in Henan Province, China, who participated in frontline COVID-19 efforts.

METHODS

Data were collected using validated scales to measure strength use, post-traumatic growth, positive mental health, job satisfaction, and thriving at work. Structural equation modeling was used to analyze the relationships among these variables, with bootstrapping methods employed to test the mediation effects.

RESULTS

The findings demonstrated that strength use is positively associated with job satisfaction (r = 0.48, p < 0.001), positive mental health (r = 0.49, p < 0.001), and thriving at work (r = 0.48, p < 0.001). Additionally, post-traumatic growth was found to mediate the relationship between strength use and these well-being outcomes, with indirect effects observed for job satisfaction(β = 0.19, 95% CI [0.157, 0.225]), thriving at work (β = 0.19, 95% CI [0.161, 0.227]), and positive mental health(β = 0.17, 95% CI [0.140, 0.208]).

CONCLUSION

This study underscores the critical role of strength use and post-traumatic growth in promoting well-being among nurses. By illustrating how leveraging personal strengths can foster resilience and psychological growth in high-stress environments, the findings provide valuable insights for developing strengths-based interventions aimed at enhancing well-being in demanding professional contexts like nursing.

CLINICAL TRIAL NUMBER

Not applicable.

Cognitive vulnerability factors associated with antenatal depression among Chinese pregnant women: A cross-sectional study

It has been recognized that cognitive processes play an important role in the onset and maintenance of depression. However, little research has tested whether this predictive role of the same processes holds in the antenatal period, a time of tremendous, complex change and adjustment for an expectant mother. The aim of this study was to determine the cognitive influencing factors that may increase the risk of developing antenatal depression (AND) at the third trimester of pregnancy. It was a cross-sectional study, in which women completed questionnaire measures at their third trimester of pregnancy between February to May 2023. The Edinburgh Postnatal Depression Scale (EPDS), Big Five Inventory-2 (BFI-2), Ruminative Responses Scale (RRS), Perceived Stress Scale-14 (PSS-14) and Cognitive Fusion Questionnaire (CFQ) were administered to assess levels of AND, personality traits, rumination, perceived stress and cognitive fusion respectively. Multivariate logistic regression was used to identify associations between these measures and AND. The prevalence of AND among women at their third trimester of pregnancy was 35.1 %. A multivariate logistic regression model identified significant influencing factors as: neuroticism, brooding, perceived stress and cognitive fusion. A tendency of extraversion was a protective factor. This study highlighted the predictive role of cognitive process in the development of AND. Early detection of these modifiable influencing factors is fundamental to provide targeted psychological interventions during pregnancy.

Work-related stress of nurses in Poland and Lithuania: countries under the influence of war circumstances in Ukraine

BACKGROUND

Nursing is a challenging profession, often associated with high levels of work-related stress. Recent geopolitical events, such as the conflict in Ukraine, may further exacerbate stress among healthcare workers in neighbouring regions. Understanding stress levels among nurses is crucial for enhancing patient care and improving the well-being of medical staff.

OBJECTIVE

This study aims to assess work-related stress among nurses in Poland and Lithuania, taking into account the potential impact of regional geopolitical factors.

METHODOLOGY

This cross-sectional study was conducted among 482 Polish and 380 Lithuanian nurses. The online survey was performed using the standardized Expanded Nursing Stress Scale (ENSS). To compare quantitative variables between groups, the Mann-Whitney and the Kruskal-Wallis test (with Dunn's post-hoc test) were used. The significance level was set at 0.05, and effect sizes were calculated using Pearson's correlation coefficient (r) and eta-squared (η²).

RESULTS

The overall stress level (ENSS total score), as well as scores across all analyzed subscales, were significantly higher among Lithuanian nurses (mean = 168.44, SD = 38.56), compared to Polish nurses (mean = 144.13, SD = 34.15), with a statistically significant difference (p < 0.001). In Lithuania, significant factors influencing stress levels included age (p = 0.049) and place of work (p = 0.026), while in Poland, gender (p = 0.034), seniority (p = 0.002), education (p = 0.01), shift work (p = 0.004), and workload (p = 0.001) were notable factors.

CONCLUSIONS

Increased stress among nurses in both countries impacts their well-being and patient care quality, highlighting the need for targeted psychological support and better working conditions.

IMPLICATIONS FOR NURSING

Nurses play a critical role in healthcare, and mitigating stress through workplace improvements can enhance both their well-being and the quality of care they provide, especially during geopolitical crises. Implementing stress management programs and providing mental health resources are crucial steps to support nurses in high-stress environments.

Leveraging a Global Partnership to Address COVID-19-Related Mental Health Challenges

INTRODUCTION

The COVID-19 pandemic profoundly affected nurses globally. As frontline workers, nurses faced increased responsibilities amid challenges such as isolation, infection risks, family obligations and disrupted social support systems. Coping with these challenges was associated with adverse mental health outcomes.

AIM/QUESTION

This perspective paper examines a collaboration between two schools of nursing in the United States and India to address these mental health challenges.

METHODS

Faculty from both institutions identified key mental health topics, leading to five webinars that delved into topics such as acute and long-term impacts of COVID-19 on nurse mental health, coping mechanisms, caregiving responsibilities and children's needs during the pandemic.

RESULTS

Impressively, over 11,000 nurses from 60 countries engaged, fostering a global platform for sharing evidence-based knowledge, experiences and strategies.

IMPLICATIONS FOR PRACTICE

This partnership exemplifies the value of international collaboration. By pooling resources and expertise across cultural contexts, the initiative not only disseminated crucial knowledge but also cultivated a sense of global community among nurses. The success of this collaboration underscores the potential of such global partnerships for healthcare institutions worldwide, offering avenues to share best practices and enhance support systems for nurses confronting similar crises globally.

Mental Health Status and the Intention to Leave the Profession of Nurses Employed Across Catalonia, Spain: A Cross-Sectional Study

INTRODUCTION

The relationship between nurses' mental well-being and intention to leave the profession remains a pressing issue.

AIM

To determine the mental health status and the intention to leave the profession of nurses employed across diverse healthcare sectors in Catalonia, Spain.

METHODS

This cross-sectional study included 1051 Registered Nurses in Catalonia, Spain, using convenience sampling through social media platforms and personal contacts. Participants completed four standardised instruments online to measure anxiety, insomnia, depression and posttraumatic stress disorder, along with an ad hoc sociodemographic questionnaire. The methodology of this study was guided by the STROBE checklist.

RESULTS

The analysis revealed that a significant proportion of participants exhibited mental health issues: 44% showed moderate to severe anxiety, 31% experienced moderate to severe insomnia, 40% suffered from moderate to severe depression and 42% had moderate to severe posttraumatic stress disorder. Participants who had worked in COVID hospital units were 1.38 times more likely to experience poor mental health status. Although not all associations were statistically significant, nurses working in primary healthcare, intensive care units and nursing homes had increased odds of poor mental health. Additionally, 53% of participants had reconsidered their working status, with 69% of them expressing an intention to leave the nursing profession.

LIMITATIONS

The evolving nature of the pandemic and the adaptation of healthcare workers to the new scenario may have influenced their experiences during data collection.

IMPLICATIONS

Highlights the increase in mental health-related needs and high rates of psychiatric symptoms among nurses nowadays.

RECOMMENDATIONS

Addressing mental health needs is crucial to mitigate the intention of nurses to abandon the profession.

Personality disorder functioning styles and empathy in trainee nurses: the mediating and moderating roles of death attitudes

BACKGROUND

There is abundant evidence that an individual's personality traits may influence their level of empathy. However, the role of death attitudes in the relationship between personality disorder functioning styles of nurses and their empathy remains to be elucidated.

METHODS

Personality disorder functioning styles, death attitudes, and empathy levels were assessed in 614 Chinese trainee nurses using the Parker Personality Measure (PERM), the Death Attitude Scale-Revised (DAP-R), and the Jefferson Scale of Empathy-Health Professionals (JSE-HP).

RESULTS

Among the trainee nurses, DAP-R Fear of Death, Death Avoidance, Escape Acceptance, Approach Acceptance, and Neutral Acceptance(-) partially mediated the negative correlations between all PERM styles except Obsessive-compulsive style and empathy. Furthermore, DAP-R Fear of Death, Escape Acceptance, and Approach Acceptance fully mediated that between Obsessive-compulsive style and empathy. Fear of Death and Death Avoidance attenuated empathy among those with higher Narcissistic and Dependent styles, respectively.

CONCLUSION

Death attitudes served as a mediator and moderator in the relationships between personality disorder functioning styles and empathy among trainee nurses, suggesting the need for targeted death education among early-career nurses with personality dysfunctions.

Mediating Role of Resilience in the Relationships Between Objective Physical Activity With Depression and Stress Among Nurses in Türkiye

OBJECTIVE

Nurses belong to a professional cohort that frequently experiences depression and stress. The objective of this research was to examine the correlation between objective physical activity (PA) with depression and stress among nurses, with a specific focus on the mediating role of resilience.

METHODS

This study employed the descriptive-correlation method. One-hundred twenty-seven nurses (76 women) working in hospitals in Bitlis province, Türkiye in 2023 were selected using a convenience sampling. To measure PA, depression, stress, and resilience, ActiGraph GT3X-BT accelerometer, Beck Depression Inventory, Perceived Stress Scale, and Connor-Davidson Resilience Scale were utilized, respectively. Data analysis was conducted using Pearson correlation test and structural equation modeling.

RESULTS

Nurses, particularly women, experienced a moderate level of depression and stress. Moreover, the number of step counts was significantly higher in day vs. night shift. Overall, the nurses in this study, especially women, engaged in PA levels that were significantly below the international guidelines for adults (p<0.001). Additionally, higher intensity levels of PA (i.e., moderate PA [MPA] and vigorous PA [VPA]) were found to be linked with reduced levels of depression (β=-0.528, β=-0.410, respectively) and stress (β=-0.605, β=-0.531, respectively). Lastly, resilience was identified as a significant mediator in the correlation between MPA and VPA with depression and stress (p<0.05).

CONCLUSION

These findings hold great significance as they demonstrate the positive impact of both resilience and PA on the mental well-being of nurses. It is advisable for healthcare authorities to formulate policies and strategies aimed at enhancing the overall stability and performance of the healthcare sector.

Influence of sleep duration and quality on depression symptoms among nurses during the Omicron outbreak: a cross-sectional survey

BACKGROUND

Nurses who work during the global pandemic are known to experience physical and psychological exhaustion, as well as severe anxiety and depression symptoms. This study aimed to explore the relationships between sleep duration, sleep quality, and depression symptoms among nurses during the outbreak of the Omicron variant.

METHODS

A cross-sectional study was conducted between August 2022 and September 2022. Participants (N = 2140) were evaluated for depression symptoms via the Hospital Anxiety and Depression Scale (HADS), and sleep was evaluated via the Pittsburgh Sleep Quality Index (PSQI), and "short sleep duration" was defined as ≤ 5 h per day. Demographic information was also collected. Binary and multivariate logistic regression was performed to assess the relationships between sleep duration, sleep quality, and depression symptoms.

RESULTS

In total, 2140 nurses were included in this study; 1481 (69.2%) had poor sleep quality, while 866 (40.4%) had depression symptom scores > 7 according to the HADS criteria. Both duration and quality of sleep were significantly correlated with depression symptoms among nurses (P < 0.001). In multivariable analyses adjusted for potential confounders, short sleep duration (≤ 5 h) was associated with an odds ratio (OR) of 2.26 (95% confidence interval [CI] 1.25-4.07), whereas poorer sleep quality was associated with an OR of 1.97 (95% CI 1.32-2.94) for experiencing depression symptoms.

CONCLUSIONS

Following the COVID-19 pandemic, there was a strong association between the sleep quality, sleep duration and depression symptoms among nurses. We recommend the development of targeted interventions to increase sleep duration, enhance sleep quality and alleviate depression symptoms.

Sleep disorders among frontline nurses after the COVID-19 outbreak: a large-scale cross-sectional study

This large-scale cross-sectional multicenter study aims to investigate the prevalence of sleep disorders among frontline nurses in China after the COVID-19 pandemic and to identify potential influencing factors contributing to these sleep disturbances. A total of 2065 frontline nurses from 27 provinces in China participated in an online survey conducted through the Wenjuan Xing platform. Data on demographic characteristics, work-related factors, and mental health assessments, including the Pittsburgh Sleep Quality Index (PSQI), Zung Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS), were collected. Statistical analyses, including chi-square tests, t-tests, binary logistic regression, and ROC analysis, were conducted to explore the relationships between various factors and sleep disorders. Over half (52.7%) of the surveyed nurses exhibited sleep disorders, reflecting a considerable post-pandemic impact on sleep quality. Factors such as nursing titles, personality traits, COVID-19 infection status, and exercise frequency showed statistically significant associations with sleep disorders. Extraverted nurses and those who had recovered from COVID-19 displayed a lower risk of sleep disorders, while anxiety was identified as an independent risk factor. The study also identified a nuanced relationship between exercise frequency and sleep quality. The study highlights a high prevalence of sleep disorders among frontline nurses post-COVID-19, emphasizing the need for targeted interventions. Factors such as nursing titles, personality traits, COVID-19 infection status, exercise habits, and anxiety levels were found to influence sleep quality. Comprehensive support strategies addressing these factors are essential for improving the overall well-being of frontline nurses and, subsequently, sustaining a resilient healthcare workforce. Further research is recommended to explore additional influencing factors and consider diverse nurse populations.

A matched case-control study on the attributable risk of CES-D positivity to the incidence of COVID-19 breakthrough infections

Objectives

To investigate whether the Center for Epidemiologic Studies Depression Scale (CES-D) positivity (16 and above) is a risk factor for breakthrough infections of coronavirus disease 2019 (COVID-19), a matched case-control study was conducted among hospital employees.

Methods

Participants were matched based on known risk factors, including serum SARS-CoV-2 anti-S antibodies. A multivariate logistic regression analysis was conducted with CES-D score measured at baseline as the explanatory variable and the presence of breakthrough infection after a specified period as the outcome variable, and gender, age, and other covariates were included.

Results

Logistic regression analysis showed that CES-D positivity was significantly associated with the breakthrough COVID-19 infections (odds ratio 4.393; 95% confidence interval, 1.318-14.642, P=0.016).

Conclusions

An increase in the number of hospital employees with CES-D positivity during the pandemic might contribute to a rise in breakthrough infections. It is considered necessary to alleviate people's stress levels through the enhancement of mental health care interventions, complementing infection control measures.

Using journalling to support nurses' mental well-being and self-care in challenging times

Nurses frequently experience multiple challenges and face numerous demands in their professional role, which may lead to adverse effects such as stress, depression, anxiety and burnout. Therefore, it is important to identify effective and accessible strategies that can support them. This article explores how nurses can use journalling as a tool for navigating the challenges they experience in their practice. It offers a step-by-step guide that provides nurses with an accessible and effective approach to journalling, which they can use to support their mental well-being and self-care.

Long-Term Impact of Psychological Rehabilitation on Isolated Hospitalization Patients With COVID-19: A Longitudinal Study

OBJECTIVE

This study aimed to investigate the long-term effects of a psychological rehabilitation program that was effective on anxiety, depression, and quality of sleep in hospitalized COVID-19 patients.

DESIGN

This is longitudinal study. Thirteen patients in the experimental group who received a psychological rehabilitation program during hospitalization and 16 patients in the control group who received conservative treatment completed the questionnaire 6 mos after discharge. Questionnaires are the Zung Self-Rating Anxiety Scale, Zung Self-Rating Depression Scale, Patient Health Questionnaire-9, Visual Analysis Scale, and the Korean version of the Insomnia Severity Index.

RESULTS

The Visual Analysis Scale for depression significantly improved in the experimental group compared with control group at discharge (E = -2.40, P < 0.001) and follow-up (E = -3.36, P < 0.001). The Zung Self-Rating Depression Scale and Patient Health Questionnaire-9 scores significantly improved at discharge (E = -4.05, P = 0.01 and E = -2.29, P = 0.01) but not at follow-up (E = -4.64, P = 0.12 and E = -1.81, P = 0.22). There are no significant interactions for Visual Analysis Scale for anxiety (E = -0.27, P = 0.79), Zung Self-Rating Anxiety Scale scores (E = -1.48, P = 0.51), and insomnia (E = -0.69, P = 0.63) scores during the follow-up.

CONCLUSIONS

Psychological rehabilitation showed a significant long-term reduction in depression, but not in anxiety. Therefore, continuous intervention and management of mental health are required after discharge.

The association between perceive social support and post-traumatic stress disorder symptoms among medical staff in Hubei, China: a chain mediating effect of resilience and positive coping

BACKGROUND

Evidence suggests that PTSD symptoms following public health emergencies are influenced by many factors. The aim of this study was to investigate the relationship between perceived social support and Post-traumatic stress disorder symptoms and to explore the chain-mediated role of resilience and positive coping style, among medical staff in Hubei Province, China, during a public health emergency.

METHODS

Convenience sampling was used to select medical staff from two general hospitals in Hubei Province in July 2022 for this study. A total of 2,751 medical staff were included in the study. Multidimensional Scale of Perceived Social Support, 10- itemConnor- Davidson resilience scale, Simplified Coping Style Questionnaire and The Post-traumatic stress disorder Checklist for DSM-5 were used to assess the levels of perceived social support, resilience, coping style and Post-traumatic stress disorder symptoms of medical staff two years after the public health emergency. Statistical descriptions were conducted using SPSS, and a structural equation model was established using AMOS to analyze the chain-mediated roles of resilience and positive coping style between perceived social support and Post-traumatic stress disorder symptoms.

RESULTS

Structural equation modeling results showed a standardized total effect of perceived social support on Post-traumatic stress disorder symptoms of -0.416 (95%CI [-0.456, -0.374], P < 0.001). Resilience mediated the effect of perceived social support and Post-traumatic stress disorder, with an indirect effect of -0.016 ( 95%CI [0.031, 0.001], P = 0.038). Positive coping mediated the effect of perceived social support and Post-traumatic stress disorder, with an indirect effect of -0.024 (95%CI [-0.035, -0.014], P < 0.001). Resilience and positive coping style chain-mediated between perceived social support and Post-traumatic stress disorder symptoms, mediating 17.1% of the total effect.

CONCLUSION

Perceived social support has significant direct and indirect effects on Post-traumatic stress disorder symptoms and resilience. In addition, positive coping style act as chain mediators between perceived social support and Post-traumatic stress disorder symptoms. We suggest that strengthening perceived social support for medical staff can enhance their resilience, encouraging them to adopt positive coping, which in turn reduces the level of post-traumatic stress symptoms among medical staff following public health emergencies.

Testing the Effectiveness of a Mindfulness- and Acceptance-Based Smartphone App for Nurses Traumatized by the COVID-19 Pandemic: A Pilot Study

A significant proportion of frontline nurses developed post-traumatic stress disorder (PTSD) symptoms as a result of working during the COVID-19 pandemic. This study aimed to determine the efficacy of a mindfulness- and acceptance-based smartphone app intervention among nurses traumatized by the COVID-19 pandemic. This was a two-arm, randomized controlled trial. We randomly assigned 60 frontline nurses working in various clinical settings in the United States during the pandemic to either the intervention group (i.e. participants used the mindfulness app for 6 wk) or the wait-list control group. We assessed the app's efficacy through outcome measures of PTSD symptom severity, experiential avoidance, rumination, mindfulness, and resilience, measured at pre-, mid-, and post-intervention periods and a 1-month follow-up. Intervention satisfaction and perceived usability of the app were assessed within the intervention group. There was strong evidence of within-between interaction for PTSD, experiential avoidance, and rumination, implying significant improvement of these outcomes for the intervention group as compared to the control group. We only found a within-group interaction effect for mindfulness, indicating significant improvement of mindfulness within the intervention group only. Participants in the intervention group reported high satisfaction levels and perceived usability with the app. Findings highlight that mindfulness- and acceptance-based smartphone apps can improve PTSD symptoms of nurses traumatized by the pandemic. Healthcare organizations should provide nurses with accessible interventions (e.g. mindfulness apps) to treat and prevent secondary behavioral consequences of the pandemic, such as PTSD.

Work Motivation: A Wall That Not Even the COVID-19 Pandemic Could Knock Down: Research Article

The emergence of the coronavirus pandemic in 2020 posed a new challenge, imposing extraordinary physical and psychological burdens on healthcare workers, clearly exacerbating and intensifying career abandonment. Objectives: The aim of our study was to explore the motivating factors among nurses serving during the coronavirus pandemic that they considered important in their profession despite the mental and physical stress brought about by the pandemic. Methods: A descriptive, cross-sectional study was conducted at the University of Pécs-Clinical Center-Regional Coronavirus Care Center between September 2022 and December 2022. We used non-random, expert, purposive sampling, recruiting healthcare workers who had spent at least 3 months working in a COVID ward (n = 196). Data collection was conducted by using an online, anonymous questionnaire, which included sociodemographic questions, the "Motivation at Work Scale", and a self-edited six-item questionnaire. Results: Regarding the 5-year probability of remaining in the healthcare field, nine participants (4.5%) will definitely leave the healthcare sector, twenty-seven participants (13.7%) are undecided, and seventy-eight participants (39.7%) will definitely stay in the healthcare field over the next 5 years. There is a positive, weak, but significant correlation between intrinsic motivation and the probability of leaving the profession within 5 years (r = 0.281; p < 0.05). We identified a significant, negative, and weak correlation between the number of revisited waves of the coronavirus and the fear of redeployment to the COVID ward (r = -0.273; p < 0.05). Conclusions: Despite the challenges posed by the coronavirus pandemic, only a small percentage of nurses consider leaving the healthcare profession. Joy and enjoyment in their work were dominant factors even during the pandemic.

Anxiety and Depression Among Pediatric Emergency Nurses and Physicians During the Coronavirus Disease 2019 Pandemic

INTRODUCTION

To determine anxiety and depression levels among pediatric acute care nurses and physicians before and after vaccine implementation during the coronavirus disease 2019 pandemic.

METHODS

Prospective cross-sectional study of emergency medicine and urgent care providers at a metropolitan quaternary pediatric emergency department, including 2 satellite emergency departments and 7 urgent care sites. Anxiety and depression symptoms were assessed using the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-2. Nurses and physicians were surveyed twice using the Generalized Anxiety Disorder-7 in May 2020 and March 2021 and once with the Patient Health Questionnaire-2 in March 2021.

RESULTS

In total, 189 surveys were completed in May 2020 (response rate 48%), and 243 surveys were completed in March 2021 (response rate 52%). Nurses reported higher Generalized Anxiety Disorder-7 scores compared to physicians for both years, though Patient Health Questionnaire-2 scores were similar. Mean Generalized Anxiety Disorder-7 scores decreased for both nurses and physicians between the 2 response periods. Amongst those who had a history of anxiety, chronic medical conditions, or were living with a high-risk individual, higher rates of anxiety were observed. Respondents endorsed the need for increased psychological support during a pandemic, with adequate and timely psychological support provided by the hospital, and stated their households were financially affected by the pandemic. Respondents reported fewer feelings of anxiety after self and public vaccination.

DISCUSSION

Study findings support increased psychological support for frontline nurses and physicians during a pandemic, particularly for those with a history of anxiety or chronic medical conditions, or those living with a high-risk individual.

Supporting and Retaining Nurses in Trying Times

The nursing profession has witnessed its share of challenging and trying times including toxic or unhealthy work environments, unsustainable workloads, an aging workforce, inadequate staffing, nurse burnout, staff retention, inadequately trained staff, an increase in workplace violence, and several pandemics. Both individually and collectively, these thorny issues have placed a heavy burden on nurses. Unfortunately, many capable and competent nurses have left the profession altogether, which further compounds an already problematic situation. This article highlights several important strategies for recruiting, retaining, and supporting a high functioning nursing workforce in challenging and trying times.

Impact of Nursing Professional Values on Depression, Stress, and Anxiety among Nurses during the COVID-19 Pandemic

Aim

The aim was to explore the association between nursing professional values (NPV) and mental health among registered nurses (RN) in Spain.

Background

Nursing is a profession rooted in strong professional values, which guide and shape clinical practice and occupational behaviors. NPV should serve as a source of support in situations of great uncertainty.

Methods

A cross-sectional study was conducted during the remission phase of the second wave of the COVID-19 pandemic (December 2020-January 2021) among a sample of Spanish RN (n = 420). NPV were assessed using the Nursing Professional Values Scale (NPVS-R), comprising 26 items grouped into five factors: caring, activism, trust, professionalism, and justice. Perceived stress, anxiety, and depression were measured by the Perceived Stress Scale (PSS-14) and the Hospital Anxiety and Depression Scale (HADS). Adjusted linear regressions were used to estimate b coefficients for the associations between NPV scores and the three mental health indicators.

Results

The fully-adjusted analysis, including sociodemographic and occupational variables, revealed that higher activism scores were associated with higher scores of stress (b coefficient: 0.46; 95% confidence interval: 0.03-0.88; p value: 0.035), anxiety (0.24; 0.05-0.43; 0.014), and depression (0.19; 0.01-0.36; 0.035). No other NPV was associated with mental health.

Conclusion

Organizational policies and programs should be established to protect the most activist RNs and to mitigate the potential detrimental effect of activism on mental health at times and/or circumstances of high workloads and personal stress.

The interaction between mental resilience and insomnia disorder on negative emotions in nurses in Guangdong Province, China

Objective

To investigate the current status of psychological resilience, insomnia and negative emotions among nurses in Guangdong Province, China. And to explore the effects of the interaction between psychological resilience and insomnia on negative emotions.

Methods

A cross-sectional survey method was used to select 1874 nurses in Guangdong Province from February 2023 to April 2023 for the survey. The Chinese version of the Psychological Resilience Scale (PRS), Insomnia Severity Index (ISI), Depression Anxiety and Stress Scale-21(DASS-21)were used in this study. We use SPSS 26.0 for statistical analysis. A simple effect analysis was established to analyze the association between psychological resilience, insomnia and negative emotions by using psychological resilience, insomnia and the interaction term.

Results

The overall PRS and ISI scores were (59.79 ± 17.29) and (9.83 ± 5.97). The scores of DASS-21 each dimension were (8.19 ± 9.02) for depression emotion,(7.93 ± 7.66) for anxiety emotion and (10.58 ± 9.77) for stress emotion. The results of the interaction effect analysis indicated that psychological resilience and insomnia exhibited statistically significant differences in the between-subjects effect test for depression emotion (r2 = 0.136, P<0.01), anxiety emotion (r2 = 0.127, P<0.01), and stress emotion (r2 = 0.142, P<0.01).

Conclusion

The nurses exhibited moderate levels of psychological resilience. Most of them have varying degrees of insomnia, with majority being classified as mild insomnia. Additionally, they demonstrated varying degrees of negative emotions. There was a negative correlation between psychological resilience and insomnia. Psychological resilience was negatively correlated with depression, anxiety and stress emotions. Insomnia was positively correlated with depression, anxiety and stress emotions. Furthermore, the interaction between psychological resilience and insomnia had an effect on all three dimensions of negative emotions. Consequently, hospital administrators may implement efficacious intervention strategies such as cognitive behavioral therapy and improving workplace climate in a timely manner according to the different psychological tolerance and severity of insomnia of nurses in order to reduce the occurrence of negative emotions among nurses and improve their mental health.

Enhancing psychological well-being in college students: the mediating role of perceived social support and resilience in coping styles

BACKGROUND

The prevalence of depression among college students is higher than that of the general population. Although a growing body of research suggests that depression in college students and their potential risk factors, few studies have focused on the correlation between depression and risk factors. This study aims to explore the mediating role of perceived social support and resilience in the relationship between trait coping styles and depression among college students.

METHODS

A total of 1262 college students completed questionnaires including the Trait Coping Styles Questionnaire (TCSQ), the Patient Health Questionnaire-9 (PHQ-9), the Perceived Social Support Scale (PSSS), and the Resilience Scale-14 (RS-14). Common method bias tests and spearman were conducted, then regressions and bootstrap tests were used to examine the mediating effects.

RESULTS

In college students, there was a negative correlation between perceived control PC and depression, with a significant direct predictive effect on depression (β = -0.067, P < 0.01); in contrast, negative control NC showed the opposite relationship (β = 0.057, P < 0.01). PC significantly positively predicted perceived social support (β = 0.575, P < 0.01) and psychological resilience (β = 1.363, P < 0.01); conversely, NC exerted a significant negative impact. Perceived social support could positively predict psychological resilience (β = 0.303, P < 0.01), and both factors had a significant negative predictive effect on depression. Additionally, Perceived social support and resilience played a significant mediating role in the relationship between trait coping styles and depression among college students, with three mediating paths: PC/NC → perceived social support → depression among college students (-0.049/0.033), PC/NC→ resilience → depression among college students (-0.122/-0.021), and PC/NC → perceived social support → resilience → depression among college students (-0.016/0.026).

CONCLUSION

The results indicate that trait coping styles among college students not only directly predict lower depression but also indirectly influence them through perceived social support and resilience. This suggests that guiding students to confront and solve problems can alleviate their depression.

Cognitive changes in professional value and career development amid the COVID-19 pandemic: A qualitative study of nurses' experiences

AIM

To explore cognitions in nurses' professional value and career development amid the COVID-19 pandemic and to analyse influencing factors.

DESIGN

A qualitative descriptive study design was employed.

METHODS

Thirty practising nurses from three general hospitals in Chengdu, China, were purposively recruited. Face-to-face semi-structured interviews were conducted. The content analysis was used for data analysis.

RESULTS

After the outbreak of the COVID-19 pandemic, there were obvious cognitive changes in nurses' professional value, including improvement in the cognition of professional value, awareness of the broadening of the field of acting professional value, and realization of increasingly high requirements in careers. Approval and gratitude of patients, social recognition and attention, self-awareness of nurses were main influencing factors. For cognitive changes in career development, nurses became more motivated to develop their careers, had a clearer understanding of career development environment, and acquired a clearer understanding of what was needed to advance careers. Hospital support, social respect, family support, and team atmosphere were key influencing factors.

CONCLUSIONS

The contributions made by nurses in the prevention and control of the COVID-19 pandemic have prompted positive changes in their cognition of professional value and career development. To promote nurses' positive understanding and approach to career development, measures should be taken by hospitals. Further, social respect, family support and team cooperation can enhance nurses' enthusiasm for career development.

Stress First Aid for Health-care Workers: An Indicated Mental Illness Prevention Program for Nursing Education

Spurred by a global pandemic, the incidence and prevalence of stress-related injury and illness continues to increase amid an overburdened nursing workforce that has remarkably and reliably performed on the frontlines of health care. Indicated mental illness prevention programs such as Stress First Aid for Healthcare Workers create an opportunity to target the acute and chronic expressions of stress experienced by nurses earlier through coordinated peer support with the goals of preserving life, preventing further harm, and promoting recovery. This article will describe how a Stress First Aid program was operationalized at a school of nursing at a private university.

Pathophysiological, immunological, and inflammatory features of long COVID

The COVID-19 pandemic continues to cause severe global disruption, resulting in significant excess mortality, overwhelming healthcare systems, and imposing substantial social and economic burdens on nations. While most of the attention and therapeutic efforts have concentrated on the acute phase of the disease, a notable proportion of survivors experience persistent symptoms post-infection clearance. This diverse set of symptoms, loosely categorized as long COVID, presents a potential additional public health crisis. It is estimated that 1 in 5 COVID-19 survivors exhibit clinical manifestations consistent with long COVID. Despite this prevalence, the mechanisms and pathophysiology of long COVID remain poorly understood. Alarmingly, evidence suggests that a significant proportion of cases within this clinical condition develop debilitating or disabling symptoms. Hence, urgent priority should be given to further studies on this condition to equip global public health systems for its management. This review provides an overview of available information on this emerging clinical condition, focusing on the affected individuals' epidemiology, pathophysiological mechanisms, and immunological and inflammatory profiles.

Mediating effects of social support and presenteeism on turnover intention and post-traumatic stress disorder among Chinese nurses in the post-pandemic era: a cross-sectional study

Background

The shift in national policies for epidemic prevention and control in the post-pandemic era is undoubtedly a challenge for health care professionals. Nurses, as an important part of the health care professional population, have an even greater impact on their mental health and occupational safety. This may expose nurses to post-traumatic stress disorder (PTSD) and presenteeism, and ultimately lead to their turnover.

Objective

This study aimed to investigate the relationship between turnover intention and post-traumatic stress disorder among Chinese nurses during post-pandemic era, and the mediating role of social support and presenteeism.

Methods

In this study, a multicentre cross-sectional survey was conducted in April 2023 among nursing staff in several tertiary general hospitals in northern China, with online data collection using the Turnover intention Scale (PTSD), the Impact of Events Scale (IES), the Social Support Scale (SSS), and the Stanford presenteeism Scale (STAS) and the relationship between variables was analyzed using hierarchical multivariate regression, and Structural Equation Modeling (SEM) was used to analyze the relationship between post-traumatic stress disorder and the Turnover intention from the pathway between.

Results

Data were collected from 2,513 nurses who met the inclusion criteria, in which general information such as age, department, specific department, Professional title, history of alcohol consumption, form of employment, Years of working, and Average working hours per day were statistically significant with the difference in the turnover intention. The results of the study showed a 32% high turnover intention among nurses in the post-pandemic era, which was lower than the turnover intention during the pandemic. The results of hierarchical multiple regression analysis showed that post-traumatic stress disorder, social support, and presenteeism were significant predictors of turnover intention. The total effect of post-traumatic stress disorder on turnover intention to work was 0.472 [bias modified 95% confidence interval (0.415-0.483), p < 0.001]. Social support and attendance played a partially intermediate role in post-traumatic stress disorder and propensity to leave (an indirect effect of 26% of the total effect).

Conclusion

Turnover intention and post-traumatic stress disorder levels are high and social support plays an important role in the tendency to leave the job and post-traumatic stress disorder, healthcare institution can be achieved by strengthening social support for nurses in the post-epidemic era and preventing the occurrence of presenteeism.

COVID-19 prevention and control measures and experiences during the 14th National Games of China: a qualitative interview study

Background

The 14th National Games was the first sporting mass gathering to be held in China in the context of the COVID-19 pandemic. It may increase the risk of severe acute respiratory syndrome coronavirus 2 transmission. In order to reduce the spread of the virus during the 14th National Games, the Chinese government took a series of public health measures, and ultimately no confirmed cases were found in the 14th National Games venues.

Objective

This study aimed to discuss preventive and control measures used to respond to the COVID-19 pandemic during the 14th National Games.

Methods

Five experts were selected for this study using a snowball sampling method, and semistructured and in-depth interviews were conducted. Based on grounded theory, the transcriptions were analysed and coded using Nvivo 12 software.

Results

A theoretical model of the COVID-19 prevention and control measures at the 14th National Games of China was constructed. The model contains seven main components: the health risks of mass gatherings, crowd management, emergency medical care, allocation of emergency medical resources, pandemic emergency drills, the pandemic prevention and control management platform (Quanyuntong app), and emergency response plans.

Conclusion

The study showed that the deployment of emergency medical resources was the most important for mass gatherings. This study not only expanded the applications of grounded theory but also serves as a reference for future scholars when conducting more in-depth empirical studies on public health countermeasures for mass gatherings and can inform organizers when holding mass gatherings.

Occupational Stress Levels among Radiologists and Radiographers in Hungary during the COVID-19 Era

The COVID-19 pandemic has heightened stress levels, potentially affecting the occupational wellbeing of radiographers and radiologists. Our study aimed to assess occupational stress levels within the radiology department and identify contributing factors. A cross-sectional survey was conducted between September and November 2022, with participants comprising radiographers and radiologists affiliated with the Hungarian Society of Radiographers and the Hungarian Society of Radiologists. The online survey collected socio-demographic and COVID-19 data, and the participants completed an effort-reward imbalance questionnaire. The analysis of 406 responses revealed significantly higher effort-reward imbalance (ERI) levels among the radiologists compared to the radiographers (p < 0.05). The healthcare professionals with over 30 years of experience exhibited significantly lower ERI levels than those with 1-9 years, 10-19 years, or 20-29 years of experience (p < 0.05). Additionally, the individuals aged 31-40 demonstrated higher ERI levels compared to their counterparts aged 19-30, 41-50, and over 51 (p < 0.05). The respondents cohabiting with a spouse/partner reported significantly higher stress levels than their single colleagues (p < 0.05), while the dog owners exhibited significantly lower ERI levels (p < 0.05). Elevated occupational stress highlights specific groups requiring targeted interventions to reduce stress and mitigate burnout among radiologists and radiographers.

Reframing care while enduring the traumatic nature of witnessing disrupted family-patient-nurses' relationships during COVID-19

AIM

To describe the lived experiences of nurses caring for patients and families in the context of COVID-19 in Brazil and United States.

DESIGN

A phenomenological philosophical approach following the van Manen analysis method.

METHODS

Participants were recruited in Brazil and the United States, including nurses working in health care settings caring for COVID-19 patients. Recruitment used purposive and snowball sampling. Participants completed a demographic survey and semi-structured interviews that were audio-recorded and transcribed for analysis. A cross-cultural examination occurred among researchers from each country.

RESULTS

The result was described (n = 35) by the themes, representing the essences of each lifeworld (relationship, time, space and body). The nurses' lived experience was one of reframing care while enduring repeated trauma of witnessing disrupted patient-family-nurse relationships. Themes were as follows: (a) Living a silent and lonely experience; (b) Providing connectedness for disrupted patient and family relationships; (c) Feeling the burden of the demands; (d) Being a helping connector; (e) Reshaping spaces amidst evolving interventions and policies; (f) Creating safe spaces, surrounded by turmoil, threat, and distress within an unsafe environment; (g) Reorganizing care and reframing time; (h) Reconciling losses, regrets, victories and lessons.

CONCLUSION

The nurses' lived experience of caring for patients and families during the COVID-19 pandemic prompted the need to respond to repeated traumas and distress posed by interrupted patient-family and nurse-own family relationships, vulnerable bodies, threatened space and dynamic and volatile time.

IMPACT

Cultural nuances were discovered depending on the practice setting, political discourse and the autonomy of the nurse. Innovative models of care that create structures and processes to support nurses in caring for patients in threatening environments and the commitment to connecting family members have potential to contribute to the ongoing health of the nursing profession.

Changes in the diagnosis of depression among nursing professionals during the COVID-19 pandemic: A longitudinal study

AIMS

To identify changes in mental health status among nursing professionals in a Brazilian municipality during the COVID-19 pandemic.

DESIGN

An observational and longitudinal study.

METHODS

Using the Patient Health Questionnaire-9, the presence of depressive symptoms was evaluated among 690 nursing professionals in the city of Pelotas, Brazil, at two moments: June/July 2020 and June/July 2021.

RESULTS

13.0% incidence of depressive symptoms was identified; as well as 12.2% remission; 24.1% persistence and 50.7% absence. Among the factors associated with the worst prognoses we can mention female gender, greater workload, feeling of overload, illness of family members or friends due to COVID-19 and use of psychotropic drugs CONCLUSIONS: There was significant mobility in the diagnosis of depression among the professionals studied during the period analysed, with incidence of new cases of significant depression and greater than the number of remissions. In addition to sociodemographic aspects, traumatic experiences and exposure to continuous overload were associated with persistence and incidence of new cases.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

With the advent of the COVID-19 pandemic, several studies have shown an increase in depressive symptoms among nursing professionals; however, understanding the long-term effects of this scenario is still a challenge.

IMPACT

What problem did the study address? This study investigates changes in the mental health status of nursing professionals working at different care levels, taking the prevalence of screening for depression as a proxy, during a period of a year during the COVID-19 pandemic. What were the main findings? Between both data collection moments, 2020 e 2021, there was a significant percentage of professionals with persistent depression, in addition to a significant proportion of incident cases that slightly exceeded the number of remissions and the factors associated with the worst prognoses were sociodemographic aspects such as gender and emotional stressors like illness of family members or close friends due to COVID-19, in addition to those related to the organisation and support provided by the services, such as workload and feeling of overload. Where and on whom will the research have an impact? This study will impact the nursing professionals and in role of the health services in order to establishing actions that contribute to minimising the deleterious effects of the pandemic on the mental health of their Nursing teams.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Post-traumatic stress symptoms in mental healthcare workers during the COVID-19 outbreak

Background

In the context of disease outbreaks, healthcare workers are exposed to multiple physical and psychological stressors, which may result in severe mental health outcomes. Although existing literature explores this impact, it is focused on frontline workers, with limited evidence exploring the mental well-being of mental healthcare workers (MHCWs).

Aim

To explore post-traumatic stress symptoms (PTSS) and associated factors among MHCWs within the context of the coronavirus disease 2019 (COVID-19) pandemic.

Setting

Four academic hospitals in the Gauteng province, South Africa, with specialised psychiatric units.

Methods

A cross-sectional study design was used. Participants were selected using a simple random sampling technique and invited to participate in structured interviews. Measurement tools included a demographic questionnaire, the post-traumatic stress disorder checklist for DSM-5 and the Brief Resilient Coping Scale.

Results

A total of 120 MHCWs participated. The prevalence of PTSS was 11.7%. The MHCWs' profession was a significant predictor of the occurrence of PTSS (p = 0.046), with nurses being the most affected. Other socio-demographic, employment, COVID-19-related factors and coping skills were not predictors of PTSS.

Conclusion

An elevated prevalence of PTSS has been found and was significantly associated with the profession of the MHCW. It is recommended that existing employee wellness programmes be strengthened to promote mental well-being and improve resilience among MHCWs, particularly vulnerable employee groups.

Contribution

This study provides insight into the prevalence of PTSS among MHCWs following the COVID-19 outbreak, as well as associated factors.

The relationship between ethical leadership and nurse well-being: The mediating role of workplace mindfulness

AIM

The purpose of this study was to explore the relationship between nurses' well-being and their ethical leadership, and the mediating role of workplace mindfulness in this relationship.

DESIGN

This was a quantitative cross-sectional study.

METHODS

This cross-sectional study was conducted in three tertiary hospitals in central China from May 2022 to July 2022, and the Nurses' Workplace Mindfulness, Ethical Leadership and Well-Being Scale were distributed and collected via the Internet. A total of 1579 nurses volunteered to participate in this study. SPSS 26.0 statistical software was used to analyse the data by Z-test and Spearman's rank correlation; the internal mechanism of workplace mindfulness and ethical leadership on nurses' well-being was completed by AMOS 23.0 statistical software.

RESULTS

The scores of nurses' well-being, workplace mindfulness and ethical leadership were 93.00 (81.00, 108.00), 96.00 (80.00, 112.00) and 73.00 (67.00, 81.00) respectively. The professional title, age and department atmosphere affect their well-being. Spearman's analysis showed that nurses' well-being was positively correlated with ethical leadership (r = .507, p < .01) and workplace mindfulness (r = .600, p < .01); workplace mindfulness partially mediated the relationship between ethical leadership and nurses' well-being accounting for 38.5% of the total effect ratio [p < .001, 95% CI = (0.215, 0.316)].

CONCLUSION

Nurses' well-being was at a medium level, and had a higher score in ethical leadership and workplace mindfulness, and workplace mindfulness played a partial mediating role between ethical leadership and nurses' well-being.

IMPACT

This suggests that nursing managers need to pay attention to clinical nurses' well-being experience, actively focus on the relationship among ethical leadership, workplace mindfulness and well-being and integrate core values such as positivity and morality into nurses' daily routines, so as to improve the work enthusiasm and well-being experience of clinical nurses, enhancing the nursing quality and stabilizing the nursing team.

Depressive symptoms are more influenced by personality traits and styles than working in nursing-a study during the COVID-19 pandemic

Background

According to literature, the COVID-19 pandemic caused stressful working conditions for nurses, which may have a negative impact on their Well-Being and mental health.

Aim

To investigate whether nurses and non-helping professionals differ in their Well-Being. Furthermore, we analyzed, for the first time, which personality traits and styles are a risk factor for nurses' wellbeing during COVID-19 pandemic.

Methods

In an online survey, the following psychological tests were used on nursing staff (n = 518) and non-helping professionals (n = 335): WHO-Five (WHO-5), the Personality, Style and Disorder Inventory (PSSI), and the Freiburg Personality Inventory-Revised (FPI-R).

Results

Nurses and non-helping professionals did not differ significantly in terms of Well-Being. The Well-Being of nurses was correlated with the following personality traits and styles, namely Spontaneous-Borderline Personality Style, Silent-Depressive Personality Style, Strain, Emotionality, and Life Satisfaction. According to our results, 33% of participants suffered from clinically significant depressive symptoms.

Discussion

According to our results, nurses are not more at risk for depression. However, it was shown that Well-Being during the pandemic is highly dependent on personality.

Conclusion

Specific personality traits and styles are a greater predictor of depressive symptoms than profession. The stressful occupational environment during COVID-19 pandemic is not the only cause for depressive symptoms in nurses. Psychotherapeutic interventions are especially important for particular individuals and are necessary to prevent depressive symptoms during COVID-19 pandemic.

Effect of the COVID-19 pandemic on women's fertility intentions and its policy implications for China and the rest of the world: a perspective essay

The COVID-19 pandemic and its social, economic, and health implications have generally reduced women's fertility intentions in different countries. In this article, we aimed to review studies of the impact of COVID-19 infection on women's fertility intentions and interventions to provide a theoretical basis and practical benchmark for the development of effective intervention strategies in China, which lifted its zero COVID system in early December 2022.

The mediating role of coping strategies between depression and social support and the moderating effect of the parent-child relationship in college students returning to school: During the period of the regular prevention and control of COVID-19

Objective

According to the WHO, compared to before the COVID-19 pandemic, young people showed a significant increase in depressive symptoms. In light of the recent coronavirus pneumonia pandemic, this study was conducted to determine how social support, coping style, parent-child relationships, and depression are associated. We investigated how these factors interacted and affected the prevalence of depression during this challenging and unheard-of time. Our research may help both individuals and healthcare professionals better comprehend and assist those who are coping with the pandemic's psychological effects.

Design and main outcome measures

3,763 students from a medical college in Anhui Province were investigated with Social Support Rate Scale, Trait Coping Style Questionnaire, and Self-rating Depression Scale.

Results

When the pandemic situation was normalizing, social support was associated with depression and the coping style of college students (p < 0.01). During the period of pandemic normalization, the parent-child relationship moderated the relationship between social support and positive coping (t = -2.45, p < 0.05); the parent-child relationship moderated the relationship between social support and negative coping (t = -4.29, p < 0.01); and the parent-child relationship moderated the association between negative coping and depression (t = 2.08, p < 0.05).

Conclusion

Social support has an impact on depression in the period of the regular prevention and control of COVID-19 through the mediating role of coping style and the moderating effect of the parent-child relationship.

Influence of empathy on work alienation among Chinese nurses during the COVID-19 pandemic: The mediating effect of ego depletion

Background

Nurses' work alienation has become increasingly serious due to the increase in workload and risk during the coronavirus disease 2019 (COVID-19). However, no studies have investigated the link between empathy, ego depletion, and work alienation among Chinese nurses. The present study aimed to evaluate Chinese nurses' empathy, ego depletion, and work alienation and to examine whether nurses' ego depletion mediates the relationship between empathy and work alienation.

Methods

This was a descriptive, cross-sectional study involving 353 nurses from Shaanxi. The Jefferson Scale of Empathy-Health Professionals, Self-Regulating Fatigue Scale and Work Alienation Questionnaire were used to collect data through an online survey. Structural equation modeling was conducted to analyze the mediating model.

Results

Work alienation was negatively correlated with empathy (r = -0.305, p < 0.01) and positively correlated with ego depletion (r = 0.652, p < 0.01). Empathy was negatively correlated with ego depletion (r = -0.325, p < 0.01). Empathy can directly predict work alienation (β = -0.263, p < 0.01), while ego depletion has a mediating effect between empathy and work alienation (β = -0.309, p < 0.01), and the mediating effect accounts for 54.02% of the total effect.

Conclusion

Nurses' work alienation was at a moderate-to-high level. Improving empathy can reduce work alienation through less ego depletion. Nursing managers should discover nurses' work alienation as soon as possible. Interventions to improve empathy can help replenish nurses' psychological resources, thereby reducing ego depletion and work alienation.

Prevalence of psychological symptoms and associated risk factors among nurses in 30 provinces during the COVID-19 pandemic in China

BACKGROUND

With the outbreak of the coronavirus disease 2019 (COVID-19), nurses have won well-deserved recognition for their indispensable roles in providing humane and professional healthcare for patients. However, by the nature of their role working at the forefront of patient care, nurses are prone to experiencing mental health consequences. Therefore, we pay attention to measuring the magnitude of psychological symptoms and identifying associated factors among nurses in China.

METHODS

We launched a nationwide, cross-sectional survey of nurses who worked in secondary or tertiary hospitals and public or private hospitals from 30 provinces in China. The prevalence and severity of symptoms of burnout, depression, and anxiety were investigated, respectively. Multivariable logistic regression analyses were performed to identify factors associated with each psychological symptom.

FINDINGS

A total of 138 279 respondents who worked in 243 hospitals completed this survey. A substantial proportion of nurses reported symptoms of burnout (34%), depression (55·5%), and anxiety (41·8%). In line with the disproportionality of economic development, we noted that the middle or western region was an independent risk factor for depression and anxiety. Compared with those working in the secondary hospital, nurses who worked in tertiary hospitals were associated with a higher likelihood of burnout and depression.

INTERPRETATION

Nurses are experiencing emotional, physical, and mental exhaustion during the COVID-19 epidemic. Governments and health policymakers need to draw attention to reinforcing prevention and ameliorating countermeasures to safeguard nurses' health.

FUNDING

The strategic consulting project of the Chinese Academy of Engineering [2021-32-5]. Advanced Institute of Infomation Technology, Peking University, Zhejiang Province [2020-Z-17].

Impact of the eHealth literacy, knowledge and attitudes on COVID-19 prevention behavior among residents in the second year of the COVID-19 pandemic: A cross-sectional study in Anhui Province, China

Objective

The pandemic of COVID-19 continues to challenge people's health worldwide. In the second year of the pandemic, adherence to COVID-19 preventive behavior is key to continuing efforts to overcome the epidemic. This study aims to assess the COVID-19-related knowledge, attitude, and prevention behavior (KAP) and electronic health literacy (eHealth literacy) among Anhui residents in China.

Methods

From January 30 to March 27, 2021, the cross-sectional study was performed among Anhui residents in China, including 16 cities. An online survey was adopted to assess KAP regarding COVID-19, and eHealth, involving a total of 2,122 citizens. Following informed consent, residents were recruited by convenience sampling. Frequencies and proportions were calculated. Additionally, Mann-Whitney U tests were used to analyze the variables. Independent predictors of preventive behavior of COVID-19 were ascertained using a multivariable logistic regression model.

Result

Residents demonstrated good knowledge, positive attitudes, acceptable practices, and good eHealth literacy. Online news and WeChat are the main health information resources. Citizens who had good knowledge, a positive attitude, good eHealth, and did not participate in the online lectures or training COVID-19 were more likely to take preventive measures. Those with poor health, who were male, did not have family members working in health care facilities, and did not work in a face-to-face environment were less likely to take precautions. Compared with a master's degree and above, participants with middle school education level and below took preventive behavior sometimes. Residents who browse the COVID-19 webpage <15 min weekly seldom took preventive actions.

Conclusion

The study showed that in the second year of the COVID-19 pandemic, Chinese residents had adequate knowledge of COVID-19, positive attitudes, appropriate preventive practices, and basic eHealth literacy. To prevent the rebound of the COVID-19 epidemic, the government and health agencies should inform citizens concerning which information channels or websites to use and assist the underprivileged population who lacks basic infrastructure. In addition, increasing the level of knowledge and attitude, enhancing eHealth literacy and the Health Belief Model (HBM), and implementing the Health Code were seen as ways to reinforce adherence to preventive behavior. Targeting men, implementing public awareness campaigns, community engagement strategies, and health education programs are recommended.

Coping strategies used by health-care workers during the SARS-COV2 crisis. A real-world analysis

The aim of this paper is to analyze the main coping strategies used by frontline teams during the first days of the COVID pandemic confinement in Spain. This information could be necessary in order to carry out training programs that allow a better handling of future emergency situations, as well as acting more effectively and with less negative emotional impact. A questionnaire was used to identify different psychological profiles for coping, and in turn, other relevant variables were analyzed. The most used strategies by health professionals were problem solving, desiderative thinking and social support. Emotional expression and social support were used more by women. Significantly different behaviors were found in desiderative thinking (lower in people of 35-50 years old, and social support, higher in people 35 years old). The symptoms most commonly experienced by medical personnel were: sleep disorders, anxiety, tension, depressive symptoms, gastrointestinal symptoms and general somatic muscular symptoms. A relationship could be determined between the age/gender of the workers and the participants' overall assessment of their ability to cope with the COVID-19 stress situation they had experienced (men 50 years old and women between 35 and 50 years old, who felt able or very able to cope with the stress caused by the health emergency. However, women <35 years old and >50 years old believed they were able to cope poorly with the circumstances. The advantage of specific training plans in order to help with some stress symptoms could be suggested, aimed at the acquisition of tools based on problem solving, and emotional management in stressful and emergency situations.

Practical resiliency training for healthcare workers during COVID-19: results from a randomised controlled trial testing the Community Resiliency Model for well-being support

Objective

To introduce the Community Resiliency Model (CRM) as mental well-being support for healthcare workers working through the height of the COVID-19 pandemic.

Design

Randomised controlled trial with a no treatment control group.

Setting

Two large urban health systems in the Southern United States between October 2020 and June 2021.

Participants

Eligible participants were currently employed as healthcare workers within the participating healthcare systems. 275 employees registered and consented electronically in response to email invitations. 253 participants completed the baseline survey necessary to be randomised and included in analyses.

Intervention

Participants were assigned 1:1 to the control or intervention group at the time of registration. Intervention participants were then invited to 1-hour virtual CRM class teaching skills to increase somatic awareness in the context of self and other care.

Main outcome measures

Self-reported data were collected rating somatic awareness, well-being, symptoms of stress, work engagement and interprofessional teamwork.

Results

Baseline data on the total sample of 275 (53% nurses) revealed higher symptoms of stress and lower well-being than the general population. The intervention participants who attended a CRM class (56) provided follow-up survey data at 1 week (44) and 3 months (36). Significant improvement for the intervention group at 3 months was reported for the well-being measures (WHO-5, p<0.0087, d=0.66; Warwick-Edinburgh Mental Well-Being Scale, p<0.0004, d=0.66), teamwork measure (p≤0.0002, d=0.41) and stress (Secondary Traumatic Stress Scale, p=0.0058, d=46).

Conclusion

Baseline results indicate mental health is a concern for healthcare workers. Post intervention findings suggest that CRM is a practical approach to support well-being for healthcare workers during a crisis such as this pandemic. The simple tools that comprise the model can serve as a starting point for or complement self-care strategies to enhance individual resilience and buffer the effects of working in an increasingly stressful work environment.

Posttraumatic stress disorder and depression of Chinese medical staff after 2 years of COVID-19: A multicenter study

BACKGROUND

In December 2019, coronavirus disease (COVID-19) was first reported in Wuhan, China, and has had a negative psychological impact on the medical staff. However, the long-term psychological effects of COVID-19 were still unclear. We aimed to assess the posttraumatic stress disorder (PTSD) and depression among medical staff 2 years after COVID-19 pandemic in Wuhan, China.

METHODS

We conducted a multicenter study in five general hospitals in Wuhan, China. PTSD was assessed using the PTSD Checklist-5. Depression was measured by the Center for Epidemiologic Studies Depression Scale. Multivariate adjusted logistic regression models were used to evaluate the association among demographic variables, depressive indicators, and PTSD.

RESULTS

In a sample of 1795 medical staff, 295 (16.40%) participants reported PTSD and 329 (18.30%) reported depression. After multivariate adjusted logistic regression analyses, participants involved in COVID-19 clinical work, unsafe working environment, poor doctor-patient relationship, unhealth status, work dissatisfaction, and low family support were at a high risk for PTSD and depression 2 years after the outbreak of COVID-19 pandemic.

CONCLUSIONS

Although it has been more than 2 years after the COVID-19 pandemic outbreak, the mental health of medical staff remains a concern. In particular, medical staff involved in the clinical care of COVID-19 patients showed a higher risk of PTSD and depression 2 years after the COVID-19 pandemic. This study may provide some useful suggestions for psychological interventions for medical staff.

Post-traumatic growth experience of first-line emergency nurses infected with COVID-19 during the epidemic period-A qualitative study in Shanghai, China

Background

In March 2022, Shanghai, China, was hit by a severe wave of SARS-CoV-2 transmission caused by the Omicron variant strain. The medical staff was greatly infected during this period, which posed a traumatic event for them. Meanwhile, they also experience post-traumatic growth under introspection and positive change. However, the psychological coping and growth after infection with COVID-19 among medical staff have rarely been investigated.

Objectives

To explore the process and influencing factors of post-traumatic growth among emergency nurses infected with coronavirus disease (COVID-19) so as to provide a new perspective and theoretical basis for psychological rehabilitation or intervention for medical staff who experienced traumatic events.

Methods

The study used a qualitative design based on the phenomenological approach. A purposive sampling method was used to explore the subjective feelings and post-traumatic growth among 13 first-line emergency nurses infected with COVID-19 in Shanghai, China. Semi-structured face-to-face interviews were conducted in June 2022. A Seven-step Colaizzi process was used for data analysis.

Results

Themes were described and extracted from the experience and insights at different stages during the fight against the virus. Three main themes, i.e., stress period, adjustment period, and growth period, as well as several sub-themes, were identified.

Conclusion

First-line emergency nurses infected with COVID-19 are a sensitive group that should be given more attention. Investigating how they achieve psychological adjustment and growth in the case of severe trauma can provide valuable references for nursing management and education in the future. Society, hospital and nursing managers should pay more attention to the PTG of nurses and establish supportive PTG strategies, which will benefit the retention rate and career development of nurses.

The Impact of Changes regarding Working Circumstances during COVID-19 Pandemic upon Patients Evaluated for Thyroid Dysfunction

We evaluated patients who presented with thyroid dysfunction correlated symptoms that started when the Government took important measures to reduce the spread of COVID-19. These measures have influenced the safety of many people’s jobs. Data were collected from 378 patients that were clinically evaluated at the Endocrinology Department, between September 2020 and January 2021. Their health status modifications were statistically analyzed in correlation with their life and work changes. These changes were induced by measures associated with the COVID-19 pandemic. The lifestyle changes correlated with the COVID-19 pandemic have been present in both categories of patients: euthyroid and dysthyroid patients; 87.50% of euthyroid patients physically felt the pandemic-induced changes in their lives. It resulted in changes in lifestyle and job insecurity has a statistically significant influence (p < 0.01) on their state of health. The presence of life/work changes in men is strongly reflected in their state of health (p = 0.0004). Work instability that occurred as a side effect of the COVID-19 pandemic induced symptoms that made many people believe they have an endocrinology disorder.

Cultivating Psychological Resilience of Israeli Medical Directors of COVID-19 Divisions: The Dynamic Spheres of Salutogenics

Purpose

There are a few qualitative studies on the psychological resilience of COVID-19 medical directors upon outbreaks of pandemics. Psychological resilience is essential to providing quality care through the pandemic.

Materials and Methods

We conducted narrative interviews with 14 out of 21 medical directors of COVID-19 divisions in Israeli public hospitals upon the outbreak of the pandemic and through its first wave. We adopted the Salutogenic paradigm to identify personal and organizational resources that both deterred and promoted resilience of front-line medical directors. Thematic analysis was performed based on the Sense of coherence construct, an anchor of Salutogenics.

Results

Low comprehensibility was compensated by ethical boundaries and managerial experience. A few organizational and personal resources promoted manageability. The hospital management both deterred and promoted resilience. In contrast to Salutogenics theory, meaningfulness was driven by the occupational calling rather than by comprehensibility and manageability. Gaps in personal resources inhibited resilience.

Conclusions

Our study adds to the scant qualitative research performed upon the outbreak of the pandemic and extends the Salutogenic paradigm suggesting that the three axes of sense of coherence are multi-layered, intertwined, and evolving. We introduce the dynamic spheres model that we adopted from Physics to illustrate the findings. We propose interventions to build resilience in front-line medical directors.