Impact of the COVID-19 Pandemic on the Mental Health of Nurses and Auxiliary Nursing Care Technicians-A Voluntary Online Survey

Impacts for health and care workers of Covid-19 and other public health emergencies of international concern: living systematic review, meta-analysis and policy recommendations

BACKGROUND

Health and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR).

METHODS

We reviewed literature retrieved from MEDLINE-PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes.

RESULTS

The 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted.

DISCUSSION

PHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.

Generalized anxiety disorder and associated factors in primary health care workers in Minas Gerais, Brazil

BACKGROUND

The COVID-19 pandemic had direct and indirect impacts on public health, also affecting the mental health of the population.

OBJECTIVE

To analyze symptoms of generalized anxiety disorder (GAD) and associated factors, in primary health care (PHC) professionals.

METHODS

Cross-sectional and analytical study conducted with professionals who work in the Primary Health Care (PHC) of the Northern health macro-region of the state of Minas Gerais, Brazil. Data collection was carried out through an online, self-administered questionnaire, made available from August 27, 2021, to October 30, 2021 using the Google Forms tool. The questionnaire included sociodemographic questions as well as questions related to the history of anxiety and work during the pandemic. To assess anxiety symptoms, the General Anxiety Disorder-7 (GAD-7) instrument was used. Data treatment consisted of descriptive analysis of the variables, bivariate analysis followed by multivariate Poisson Regression with robust variance.

RESULTS

702 health professionals participated in the study and the general prevalence of GAD was 32.2%. Current anxiety symptoms were self-reported by 37.6% of the participants. In the final model, the associated factors identified were: female sex (PR = 1.82; 95% CI = 1.17-2.84; p = 0.007), previous symptoms (PR = 1.58; 95% CI = 1.19-2.10; p = 0.002) and (PR = 2.68; 95% CI = 2.00-3.62; p < 0.001) current self-reported anxiety.

CONCLUSION

The results show the need to implement actions in mental health promotion and anxiety prevention, through the dissemination of information about mental health care, health education activities, encouraging the adoption of healthy habits and professional monitoring when necessary.

Euro-Burn I: Assessment of burnout syndrome in health workers in a mediterranean country during the SARS-CoV-2 pandemic

BACKGROUND

Burnout syndrome (BS) has a negative impact among health professionals.

AIMS

Our research objective is to quantify the level of burnout in health workers of the Spanish National Health System during the COVID-19 pandemic using and comparing two independent measurement instruments.

METHODS

Cross-sectional, descriptive and multicenter study conducted through an anonymous online survey among health workers of the National Health System, measuring the level of burnout using the Maslach Burnout Inventory (MBI) and the Copenhagen Burnout Inventory (CBI).

RESULTS

A total of 448 questionnaires were analyzed, the mean age of the participants was 43.53 years (range: 20-64), 365 (81.5%) women. 161 (35.9%) participants presented BS measured with the MBI and 304 (67.9%) measured with the CBI. Regarding work contract, those who had greater job stability presented a higher degree of cynicism with respect to the eventual ones (p = .010), the eventual ones presenting higher mean scores in professional efficacy (p = .034). Urban workers had higher scores of exhaustion (p < .001) and cynicism (p < .001) than those living in rural areas. When comparing both tests, a high predictive value for exhaustion and cynicism was found to measure BS through the CBI (AUC = 0.92 and 0.84, respectively) and a low AUC with respect to the predictive value for efficacy (AUC = 0, 59).

CONCLUSIONS

The results obtained show a high level of BS among the health workers who participated in our study. Both tests have an excellent correlation in the degree of exhaustion and cynicism, but not in efficacy. The BS measurement must be performed with at least two validated instruments to increase its reliability.

The role of employee assistance programs under COVID-19-induced work-family conflict: Effects on service employees' work engagement and burnout

The COVID-19 pandemic places substantial stress on service employees' work and home lives. Little research has explored the negative effects of perceived stress from COVID-19 on work and home domains in terms of employees' attitudes toward work. We adopt a job demands-resources perspective to examine how perceived stress from COVID-19 affects employees' work (i.e., work engagement and burnout) and home life (i.e., work-family conflict and family-work conflict). In particular, we address whether organizational employee assistance programs can buffer these negative effects. We sampled service employees (n = 248), and results show that perceived stress from COVID-19 increases work engagement and burnout through work-family conflict and family-work conflict. Furthermore, employee assistance programs mean that employees are less likely to experience work-family conflict and family-work conflict when faced with perceived stress from COVID-19. We discuss the theoretical and practical implications of these findings and propose directions for future research.

Life Habits of Healthcare Professionals during the Third Wave of COVID-19: A Cross-Sectional Study in a Spanish Hospital

(1) Background: To describe sleep quality, eating behaviour and alcohol, tobacco and illicit drug use among healthcare staff in a Spanish public hospital. (2) Methods: Cross-sectional descriptive study examining sleep quality (Pittsburg Sleep Quality Index), eating behaviour (Three Factor Eating Questionnaire (R18)), tobacco and drug use (ESTUDES questionnaire) and alcohol use (Cut down, Annoyed, Guilty, Eye-opener). (3) Results: 178 people, of whom 87.1% (155) were women, with an average age of 41.59 ± 10.9 years. A total of 59.6% of the healthcare workers had sleep problems, to a greater or lesser degree. The average daily consumption was 10.56 ± 6.74 cigarettes. The most commonly used drugs included cannabis, occasionally used by 88.37%, cocaine (4.75%), ecstasy (4.65%) and amphetamines (2.33%). A total of 22.73% of participants had increased their drug use, and 22.73% had increased their consumption during the pandemic, with beer and wine accounting for 87.2% of drinks consumed during this period. (4) Conclusions: In addition to the psychological and emotional impact already demonstrated, the COVID-19 crisis has repercussions on sleep quality, eating behaviour and alcohol, tobacco and drug consumption. Psychological disturbances have repercussions on physical and functional aspects of healthcare workers. It is feasible that these alterations are due to stress, and it is necessary to act through treatment and prevention as well as promote healthy habits.

Levels of Anxiety and Fear among Nurses During the COVID-19 Pandemic: A Systematic Review

Aim

The aim of this review is to find out what levels of anxiety and fear have been shown by nurses during the COVID-19 pandemic.

Background

Health security crises affect not only physical health but also the mental health and wellbeing of healthcare professionals due to a higher level of exposure. Evaluation. A systematic review was carried out following the PRISMA statement. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. The literature search was carried out in the PubMed, Scopus, and Web of Science (WoS) electronic databases based on the keywords that the research question yielded following the PECOT strategy. For the selection of articles, original articles, meta-analyses, systematic reviews, short communication articles, and case reports were included. Then, a series of inclusion and exclusion criteria were applied, screening the results to obtain a total of 18 articles, which were used to elaborate the study. Key Issues. Fear and anxiety levels were described in a total of 18 selected studies. The main fear-related concerns of the nurses were associated with the fear of infecting their family or friends and the fear of the death of a family member or friend.

Conclusions

The main psychological impact on nurses during the COVID-19 pandemic was related to fear, anxiety, stress, and depression. Fear of infecting family members or of being infected were the main impacts perceived by nurses. Implications for Nursing Management. In general, high scores were found for levels of fear and anxiety, although the figures varied by country and time of data collection. Resilience was considered the main tool for coping with the loss and trauma experienced by nurses.

The social and mental impact on healthcare workers: A comparative and cross-sectional study during two waves of the COVID-19 pandemic in Taiwan

The coronavirus disease 2019 (COVID-19) pandemic has caused a heavily burden on healthcare workers (HCWs) worldwide. The aim of this study was to compare differences in psychological and social impact between two waves of the pandemic among first- and second-line HCWs in Taiwan. The current study derived data from two cross-sectional surveys conducted in 2020 and 2021. Levels of depression, sleep disturbance, psychological distress, social impact, and demographic variables were collected through self-reported questionnaires. The independent t test was used to compare differences in scores between the first and second wave of the pandemic. Differences between first- and second-line HCWs were also analyzed. A total of 711 HCWs in the first wave and 560 HCWs in the second wave were recruited. For the first- and second-line HCWs, the social impact during the second wave was higher than during the first wave, and they expressed a higher intention to maintain social distancing and were more aware of the pandemic overseas in the second wave. The first-line HCWs had a trend of worse sleep quality during the second wave. In addition, sleep quality was worse in the first-line HCWs than in the second-line HCWs during both waves. The second-line HCWs expressed a greater desire to seek COVID-19-related information than the first-line HCWs during the first wave, and more intended to maintain social distancing during the second wave. Our results show the importance of evaluating the social and mental health burden of HCWs, and especially first-line workers.

Working with patients and the mental health of health care workers during the COVID-19 pandemic

BACKGROUND: Anxiety and concern are among the most common problems facing healthcare workers (HCWs) during epidemic diseases. OBJECTIVE: To identify the predictive factors of anxiety, fears, and psychological distress among healthcare workers during the COVID-19 pandemic. METHODS: An online survey method was used on a sample of 153 of HCWs; (110) frontline and (43) non-frontline HCWs. They answered on the Hamilton anxiety rating scale, the Kessler psychological distress scale (K10), and the COVID-19 Concerns Questionnaire. RESULTS: The results demonstrated that 47.05% of HCWs have a severe level of fear related to COVID-19, 43.13% have very severe anxiety, and 30.71% experience severe psychological distress. The differences between frontline and non-frontline HCWs, female and male HCWs, and HCWs working in medical clinics, on quarantine, or in another place were significant in the three scales. Predictive factors of anxiety, fear, and psychological distress include working on the front lines, being female, and being over 50 years old. Meanwhile, working in a workplace with COVID-19 patients predicted anxiety and psychological distress, but not fears associated with COVID-19. CONCLUSION: HCWs have a high prevalence of symptoms of mental disorders that may interfere with their work. These results may have therapeutic applications during pandemics.

Impact of SARS-CoV-2 Pandemic on Psychosocial Burden and Job Satisfaction of Long-Term Care Nurses in Poland

Psychosocial consequences of the coronavirus pandemic are severe for health care workers due to their higher levels of exposure. Nurses often experience tremendous psychological pressure as a result of their workload in a high-risk environment. The purpose of this study was to determine the impact of the SARS-CoV-2 pandemic on the psychosocial burden and job satisfaction of nurses employed in long-term care. One hundred thirty-eight nurses employed in long-term care participated in the study. The respondents were 96.4% female and 3.6% male. The mean age of the respondents was 53.99 (standard deviation-4.01). The study was conducted between February and June 2021. The research tool was a standardized psychosocial risk scale questionnaire, which is a scientifically validated diagnostic tool with high reliability and accuracy coefficients. The primary tests used during the statistical analyses were non-parametric Mann-Whitney U (for two samples) and Kruskal-Wallis (for more than two samples) tests for assessing differences. During these analyses, in addition to standard statistical significance, appropriate p-values were calculated using the Monte Carlo method. Correlations between ordinal or quantitative variables were made using Spearman's rho coefficient. The results obtained allow us to conclude that the respondents rated the characteristics present in the workplace that constitute psychosocial risks at an average level. Emotional commitment and continuance-type commitment to the respondents' job position were also at a medium level. Respondents' self-rated ability to work for nurses employed in long-term care during the SARS-CoV-2 pandemic and commitment to patient care was high at 4.0 and 4.18, with a maximum of 5 points.

A tranquil virtual reality experience to reduce subjective stress among COVID-19 frontline healthcare workers

OBJECTIVE

The novel coronavirus-19 (COVID-19) has taken an immense physical, social, and emotional toll on frontline healthcare workers. Research has documented higher levels of anxiety, depression, and burnout among healthcare workers during the pandemic. Thus, creative interventions are needed now more than ever to provide brief, accessible support to frontline workers. Virtual reality is a rapidly growing technology with potential psychological applications. In this study, we piloted a three-minute Tranquil Cinematic-VR simulation of a nature scene to lower subjective stress among frontline healthcare workers in COVID-19 treatment units. We chose to film a nature scene because of the extensive empirical literature documenting the benefits of nature exposure and health.

METHODS

A convenience sample of frontline healthcare workers, including direct care providers, indirect care providers, and support or administrative services, were recruited from three COVID-19 units located in the United States. Inclusion criteria for participation included adults aged 18 years and older who could read and speak in English and were currently employed by the healthcare system. Participants viewed a 360-degree video capture of a lush, green nature preserve in an Oculus Go or Pico G2 4K head-mounted display. Prior to viewing the simulation, participants completed a brief demographic questionnaire and the visual analogue scale to rate their subjective stress on a 10-point scale, with 1 = 'Not at all stressed' to 10 = 'Extremely stressed.' We conducted paired t-tests to examine pre- and post-simulation changes in subjective stress as well as Kruskal-Wallis tests and Mann-Whitney U tests to examine differences by demographic variables. All analyses were conducted in SPSS statistical software version 28.0. We defined statistical significance as a p-value less than .05.

RESULTS

A total of 102 individuals consented to participate in the study. Eighty-four (82.4%) participants reported providing direct patient care, 73 (71.6%) identified as women, 49 (48.0%) were between the ages of 25-34 years old, and 35 (34.3%) had prior experience with VR. The pre-simulation mean stress score was 5.5±2.2, with a range of 1 to 10. Thirty-three (32.4%) participants met the 6.8 cutoff for high stress pre-simulation. Pre-simulation stress scores did not differ by any demographic variables. Post-simulation, we observed a significant reduction in subjective stress scores from pre- to post-simulation (mean change = -2.2±1.7, t = 12.749, p < .001), with a Cohen's d of 1.08, indicating a very large effect. Further, only four (3.9%) participants met the cutoff for high stress after the simulation. Post-simulations scores did not differ by provider type, age range, gender, or prior experience with virtual reality.

CONCLUSIONS

Findings from this pilot study suggest that the application of this Tranquil Cinematic-VR simulation was effective in reducing subjective stress among frontline healthcare workers in the short-term. More research is needed to compare the Tranquil Cinematic-VR simulation to a control condition and assess subjective and objective measures of stress over time.

Stress and Coping Strategies of Nurses Working with Patients Infected with and Not Infected with SARS-CoV-2 Virus

INTRODUCTION

Working during the COVID-19 pandemic is a particular challenge for nurses because, while performing their daily routines, they are exposed to physical and social consequences of the SARS-CoV-2 virus, which is accompanied by intensified stress. The aim of this study was to assess the intensity of stress and coping strategies applied by nurses working with both infected and non-infected patients with SARS-CoV-2 virus during the COVID-19 pandemic.

MATERIALS AND METHODS

The study was conducted between January and March 2021. Due to the epidemiological situation, the questionnaire was posted on Facebook in nurses' groups and sent out via the "Messenger" and "WhatsApp" applications. Stress intensity was assessed by means of the Perceived Stress Scale (PSS-10), whereas coping strategies were assessed using the Mini-COPE stress coping inventory.

RESULTS

Among 151 surveyed nurses, more than half (52.3%) worked with infected patients and the remaining ones (47.7%) worked with non-infected patients. The level of stress perceived by nurses working with infected patients was higher than among nurses working with patients without SARS-CoV-2 infection (22.22 ± 5.94 vs. 20.21 ± 5.68, p = 0.03). The nurses working with infected patients were most likely to choose coping strategies focused on the problem (2.00 ± 0.62) and emotions (2.01 ± 0.69), whereas those working with non-infected patients usually chose strategies focused only on the problem (2.11 ± 0.58).

CONCLUSIONS

During the COVID-19 pandemic, nurses working with SARS-CoV-2 patients experienced more intense stress than those working with non-infected patients. Nurses working with SARS-CoV-2 patients tended to cope with stress using strategies focused on the problem and on emotions, while those working with non-infected patients were more likely to choose strategies focused only on the problem.