Longitudinal Study of the Mental Health, Resilience, and Post-Traumatic Stress of Senior Nursing Students to Nursing Graduates during the COVID-19 Pandemic

Anxiety Evolution among Healthcare Workers-A Prospective Study Two Years after the Onset of the COVID-19 Pandemic Including Occupational and Psychoemotional Variables

Background and objectives: Although previous research has found a high prevalence of anxiety during the COVID-19 pandemic among healthcare workers, longitudinal studies on post-pandemic anxiety and predictor variables have been less abundant. To examine the evolution of anxiety in healthcare workers from the beginning of the pandemic until one and a half years later, analyzing the influence of occupational and psychosocial variables, as well as their possible predictors. Materials and Methods: This was a prospective longitudinal design with three periods of data collection: (1) between 5 May and 21 June 2020, (2) six months after the end of the state of alarm (January-March 2021), and (3) one year after this second assessment (April-July 2022), in which generalized anxiety (GAD-7) was evaluated, as well as occupational and psycho-emotional variables (i.e., social support, self-efficacy, resilience, and cognitive fusion) in healthcare workers in direct contact with COVID-19 patients in Spain. Results: A high prevalence of anxiety was found, with a clear decrease over time. Associations were found between anxiety and certain sociodemographic and work variables (i.e., years of experience, p = 0.046; COVID-19 symptoms, p = 0.001; availability of PPE, p = 0.002; workload, p < 0.001; family contagion concern, p = 0.009). Anxiety maintained negative relationships with social support (p < 0.001), self-efficacy (p < 0.001), and resilience (p < 0.001) and positive associations with cognitive fusion (p < 0.001). Cognitive fusion seemed to be a clear predictor of anxiety. Conclusions: Our findings suggest that social support, self-efficacy, and resilience act as buffers for anxiety, whilst cognitive fusion was found to be a clear risk factor for anxiety. It is important to emphasize the risk role played by cognitive fusion on HCWs as a clear risk factor for stressful work events. The findings emphasize the need to implement specific interventions to promote the mental well-being of healthcare workers, particularly in crisis contexts such as the COVID-19 pandemic.

Headache and Associated Psychological Variables in Intensive Care Unit Nurses during the COVID-19 Pandemic: A Prospective Study

(1) Background: Headaches in health professionals have been studied over the years. This has become even more relevant during the COVID-19 pandemic, due to their link with the use of masks, being female or working in highly complex units. However, their association with different personality traits has not been studied in healthcare workers (HCWs). The aim of this study was to assess the prevalence and evolution of headaches throughout the pandemic in Intensive Care Unit (ICU) nurses and to analyze their association with sociodemographic, occupational and personality variables as well as with other symptoms. (2) Methods: This was an observational, descriptive, longitudinal, prospective study with two periods of data collection (at the end of the containment phase and six months thereafter). A non-probabilistic convenience sampling was performed (n = 131). (3) Results: A high percentage of ICU nurses reported headaches during the first (71%) or second (79.4%) time point; more than half of the sample (58.8%) reported headaches over time (chronic headache). Although a higher prevalence of headaches was observed in women at both assessment points, no significant gender-related relationships were observed for headaches maintained across the two time points. Regarding the symptoms and personality variables, positive relationships were found between headaches and anxiety (p = 0.005), insomnia (p = 0.030) and emotional exhaustion (p = 0.022), and a negative relationship was found between headaches and hardiness (p = 0.031). (4) Conclusions: Our study highlights the importance of assessing occupational, psychological and emotional aspects in order to decrease the prevalence of headaches and thus improve the quality of the work life of nurses in such demanding environments as the ICU.

Post-Pandemic Insomnia in Healthcare Workers: A Prospective Study including Sociodemographic, Occupational and Psychosocial Variables

Background/Objectives: Previous research points to the prevalence of insomnia during the COVID-19 pandemic among healthcare workers (HCWs). However, longitudinal studies on its evolution, including the post-pandemic stage, are less abundant, with a special lack of research about possible psychosocial risk factors. The aim of the current study is to analyze the evolution of insomnia in Spanish HCWs from the beginning of the pandemic until two years later, examining the influence of sociodemographic, occupational and psychosocial variables. Methods: This was a prospective longitudinal design with three data collection periods in which insomnia was assessed using the Insomnia Severity Index (ISI), in addition to sociodemographic, occupational and psychosocial (i.e., social support, self-efficacy, resilience and cognitive fusion) variables in HCWs (n = 216) who were in direct contact with COVID-19 patients. Results: High scores were observed for insomnia, with a clear decrease throughout the periods studied (F = 30.198, p < 0.001). An association was observed between insomnia and certain sociodemographic and occupational variables (i.e., work category, p = 0.001; availability of Personal Protective Equipment (PPE), p < 0.001; workload, p < 0.001; worry about self or family contagion, p = 0.002, p = 0.003, respectively). Insomnia had negative relationships with social support (p = 0.014), self-efficacy (p < 0.001) and resilience (p < 0.001) and positive relationships with cognitive fusion (p < 0.001). Interaction effects between the evolution of insomnia and social support from friends (p = 0.024, ƞ2 = 0.34) and between the evolution of insomnia and cognitive fusion (p = 0.047; ƞ2 = 0.25) were found. Conclusions: Social support, self-efficacy and resilience act as buffers for insomnia. Cognitive fusion acts as a clear precipitator of insomnia as well as directly influencing its evolution. Social support from friends also affects the evolution of insomnia. Within the specific circumstances of the COVID-19 pandemic, a long-term effect of social support from friends and a short-term effect of cognitive fusion on the evolution of insomnia was observed. The findings emphasize the need to implement specific interventions to promote the mental well-being of HCWs, particularly in crisis contexts that involve an increase in occupational stress, emphasizing the role of certain psychosocial variables as protective factors.

Exploring the associations between resilience and psychological well-being among South Africans during COVID-19

Resilience pertains to an individual's ability to withstand, adapt, and recuperate from adversity and stress. As the world grapples with unprecedented challenges such as the COVID-19 pandemic, understanding the relationship between resilience and psychological well-being becomes essential. Preliminary observations suggest that those with a higher resilience tend to have better psychological well-being, indicating a possible symbiotic relationship between the two. This study was structured using a cross-sectional survey design. A convenience sampling technique was employed, including 631 respondents in South Africa. Data collection took place between June 11 and July 9, 2022, facilitated through a Google Forms questionnaire. This questionnaire encompassed various instruments, namely a biographical questionnaire, the CD-RISC 10, the WHO Well-being Index, the FACIT-Sp-12, and the PMHS. The findings from the collected data highlighted a strong correlation between resilience and overall well-being during the COVID-19 pandemic. This elevation in resilience can be instrumental in augmenting psychological well-being. As such, interventions or programs aimed at enhancing individual and community well-being might benefit from incorporating elements that bolster resilience, especially during periods of global adversity.

From Anxiety to Hardiness: The Role of Self-Efficacy in Spanish CCU Nurses in the COVID-19 Pandemic

Background and Objectives: Evidence shows that throughout the COVID-19 pandemic, nurses suffered from emotional symptoms, yet in spite of this, few studies within "positive psychology" have analyzed the emergence/promotion of positive traits, such as hardiness. In this context, the present study aimed to test a model regarding the mediating role of self-efficacy between anxiety experienced at the beginning of the COVID-19 pandemic and hardiness assessed six months later among nurses in critical care units (CCU) in Spain. Materials and Methods: An observational, descriptive, prospective longitudinal study with two data collection periods: (1) from the 1 to the 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March) in which socio-demographic and occupational variables, anxiety (Depression, Anxiety and Stress Scale, DASS-21), self-efficacy (General Self-Efficacy Scale, GSES) and basal resilience (Resilience Scale-14, RS-14) were assessed, and (2) a follow-up 6 months later (January-March 2021) in which hardiness (Occupational Hardiness Questionnaire, OHQ) was evaluated. To analyze the data, multivariate regressions were performed using the PROCESS macro (simple mediation, model 4). Results: A total of 131 Spanish nurses from CCUs, with a mean age of 40.54 years (88.5% women) participated in the study. Moderate and severe levels of anxiety were observed in 19.1% of the sample. Significant and positive correlations were observed between self-efficacy, hardiness and resilience (all p < 0.001). Significant negative correlations were observed between anxiety and self-efficacy (p < 0.001), hardiness (p = 0.027) and resilience (p = 0.005). The indirect effect of anxiety on hardiness through self-efficacy was significant (Effect (SE) = -0.275 (0.100); LLCI = -0.487, ULCI = -0.097), contributing to 28% of the variance, including resilience (p = 0.015), age (p = 0.784), gender (p = 0.294) and years of experience (p = 0.652) as covariates. A total mediation was observed (non-significant anxiety-hardiness direct effect; Effect (SE) = -0.053 (0.215), t = 0.248, p = 0.804, LLCI = -0.372, ULCI = 0.479). Conclusions: The results suggest that in Spanish CCU nurses, anxiety experienced at the beginning of the COVID-19 pandemic may contribute to the development of hardiness through positive resources such as self-efficacy.

Symptoms of post-traumatic stress disorder in early career nurses during the COVID-19 pandemic: A longitudinal survey study

AIM

To investigate the mental well-being of early career nurses working in the United Kingdom during the COVID-19 pandemic, with a particular emphasis on symptoms related to post-traumatic stress disorder.

DESIGN

A longitudinal survey study.

METHODS

Data were acquired at three timepoints during the COVID-19 pandemic (between May 2020 and March 2021) to determine whether symptoms of post-traumatic stress disorder persisted over time. Quantitative measures of well-being were supplemented with survey data on the nurses' experiences of working during the pandemic.

RESULTS

Twenty-seven per cent of participants suffered from persistent symptoms of post-traumatic stress while working as nurses during the pandemic. The nurses' baseline resilience, as well as their perception of the quality of their work environment, were significant negative predictors of symptoms of post-traumatic stress. Participants identified a range of strategies that would have helped them during the crisis, including visible, consistent and empathetic leadership, adequate training and a supportive work environment.

CONCLUSION

The context of the pandemic has highlighted the vulnerability of the psychological well-being of early career nurses in the workforce. Immediate implementation of some of the more simple interventions suggested in this paper would provide early career nurses with rapid support. More complex support mechanisms should be given immediate consideration, with a view to implementation in the longer term.

IMPLICATIONS FOR THE PROFESSION

This study contributes new knowledge about the psychological well-being of early career nurses working during the pandemic and suggests support mechanisms that will be crucial for the retention of these nurses in the profession. A measurement of resilience may be useful for determining the appropriate level of support to provide to early career nurses.

IMPACT

Early career nurses are vulnerable to attrition from the profession. This could be exacerbated if the psychological well-being of these nurses is not being supported. Around 25% of early career nurses suffered from persistent symptoms of post-traumatic stress disorder while working as nurses during the height of the pandemic, which is a novel finding compared to other longitudinal studies. Understanding the psychological well-being of early career nurses working during a crisis period (such as a pandemic) equips nurse managers with appropriate strategies to improve nurses' emotional health and to enhance their retention within the workforce. The current findings may be of interest to clinical practitioners who have responsibility for the retention of nursing staff. No patient or public contribution. One of the authors is a statistician.

The impact of COVID-19 on stress and resilience in undergraduate nursing students: A scoping review

BACKGROUND

Being a nursing student can be a stressful experience, faced with considerable academic and clinical demands. It has been suggested that the Coronavirus Disease 2019 (COVID-19) may have further exacerbated the pressure nursing students face. It has been posited that resilience, a complex psychological concept, may help nursing students overcome stressful situations.

AIMS

The aim of this scoping review was to examine the relationship between resilience and stress in nursing students during the COVID-19 pandemic.

METHODS

Relevant publications were identified by a comprehensive search of the literature from January 2019 to September 2022 to capture relevant publications during the COVID-19 global pandemic period from the following databases: CINAHL, Medline Complete, APA PsycInfo, Ovid EmCare and Web of Science. Fifteen studies met our inclusion criteria and were included in the review using Arskey & O'Malley's (2005) methodological framework for scoping reviews.

RESULTS

Our findings suggest that nursing students from all around the world have experienced high levels of stress during the COVID-19 pandemic. Almost unanimously, resilience was identified as a key protective factor against stress and the development of psychological morbidity. Those nursing students with higher levels of resilience were deemed more likely to stay on track with their studies, despite COVID-related challenges.

CONCLUSION

In conclusion, this scoping review adds to the well-established argument to incorporate resilience-building activities in undergraduate nursing curricula. Developing levels of resilience has the potential to empower nursing students for academic and clinical success, whilst facing the challenges of an ever-changing world.

The experience of resilience in newly graduated nurses: A qualitative metasynthesis

AIM

The aim of the present study was to understand the experiences and perceptions of newly graduated nurses in relation to resilience by providing an interpretive synthesis of the existing qualitative literature on this topic.

BACKGROUND

Resilience in newly graduated nurses has been associated with increased satisfaction and decreased turnover. As the experience of resilience is unique to each individual, qualitative studies are well suited to explore this concept, yet the existing data is heterogenous.

DESIGN

A qualitative metasynthesis was conducted using a meta-ethnographic approach.

METHODS

The search was performed using PubMed, CINAHL, Embase, PsycINFO, ProQuest Dissertations and Theses Global for the English literature and NDSL, KCI, RISS, KISS and DBpia for the Korean literature. The JBI Critical Appraisal Checklist for Qualitative Research was used to assess the quality of studies. An a priori protocol was created and registered on the Open Science Framework (Randall & De Gagne, 2022).

RESULTS

The final review included seven articles published between 2008 and 2021. Three main themes were identified: (1) internal experience of resilience; (2) external sources of resilience; and (3) building resilience over time. Subthemes were also identified.

CONCLUSIONS

This study indicates that resilience can be developed over time during the period of transition from student nurse to professional nurse and is impacted by personal and organizational influences. The promotion of resilience presents considerations and opportunities for health care leaders and administrators.

Mediating effect of resilience and fear of COVID-19 on the relationship between social support and post-traumatic stress disorder among campus-quarantined nursing students: a cross-sectional study

BACKGROUND

The emergency of Omicron variants, spreading in China and worldwide, has sparked a new wave of the coronavirus disease 2019 (COVID-19) pandemic. The high infectivity and persistence of the pandemic may trigger some degrees of post-traumatic stress disorder (PTSD) for nursing students experiencing indirect trauma exposure to the epidemic, which hinders the role transition from students to qualified nurses and exacerbates the health workforce shortage. Thus, it's well worth an exploration to understand PTSD and its underlying mechanism. Specifically, PTSD, social support, resilience, and fear of COVID-19 were selected after widely literature review. This study aimed to investigate the relationship between social support and PTSD among nursing students during COVID-19, to address the mediating role of resilience and fear of COVID-19 between social support and PTSD, and to provide practical guidance for nursing students' psychological intervention.

METHODS

From April 26 to April 30, 2022, 966 nursing students from Wannan Medical College were selected by the multistage sampling method to fill the Primary Care PTSD Screen for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Brief Resilience Scale, Fear of COVID-19 Scale, and Oslo 3 Items Social Support Scale. Data were analyzed by descriptive statistics, spearman's correlation analysis, regression analysis, and path analysis.

RESULTS

15.42% of nursing students had PTSD. There were significant correlations between social support, resilience, fear of COVID-19, and PTSD (r =-0.291 ~ 0.353, P <0.001). Social support had a direct negative effect on PTSD (β =-0.216; 95% confidence interval, CI: -0.309~-0.117), accounting for 72.48% of the total effect. Analysis of mediating effects revealed that social support influenced PTSD through three indirect pathways: the mediated effect of resilience was statistically significant (β =-0.053; 95% CI: -0.077~-0.031), accounting for 17.79% of the total effect; the mediated effect of fear of COVID-19 was statistically significant (β =-0.016; 95% CI: -0.031~-0.003), accounting for 5.37% of the total effect; the chain mediating effect of resilience and fear of COVID-19 was statistically significant (β =-0.013; 95% CI: -0.022~-0.006), accounting for 4.36% of the total effect.

CONCLUSION

The social support of nursing students not only directly affects PTSD, but also indirectly affects PTSD through the separate and chain mediating effect of resilience and fear of COVID-19. The compound strategies targeted at boosting perceived social support, fostering resilience, and controlling fear of COVID-19 are warranted for reducing PTSD.

Predictors of resilience in healthcare workers during the COVID-19 pandemic: a longitudinal study comparing the first and second waves

Few studies have investigated the effects of the pandemic caused by COVID-19 on health professionals, especially nurses, from the point of view of the protective factors of mental health. The aim of this study was to assess the level of resilience in healthcare workers, to determine whether there were differences between two moments of the pandemic. Applying a longitudinal study, participants (N = 590) from healthcare workers completed surveys in the first wave of the COVID-19 pandemic and the second wave. Socio-demographic and psychosocial variables such as resilience, emotional intelligence, optimism, self-efficacy, anxiety, and depression are used. There were differences between the two waves in all protective and risk variables except anxiety. In the first wave, there were three socio-demographic and psychosocial variables that explained 67.1% of the variance in resilience. In the first wave, three sociodemographic and psychosocial variables explained 67.1% of the variance in resilience in healthcare professionals. The enhancement of specific protective variables in healthcare professionals exposed to situations of high emotional stress can minimise the negative impact of the situation and promote more resilient responses in this professional group as a result.

Anxiety Levels and Coping Strategies to Deal with COVID-19: A Cross-Cultural Study among the Spanish and Latin American Healthcare Populations

Given its impact, COVID-19 has engendered great challenges in terms of health, highlighting the key role of health personnel. This study aims to analyze the level of anxiety, as well as coping strategies, among the health personnel in Latin American countries and Spain. An exploratory, descriptive, quantitative, cross-sectional study was conducted with 584 participants from the healthcare population. No significant differences were observed in anxiety levels due to COVID-19 between Latin American countries and Spain. In Spain, an active and passive coping style is used, while in Latin American countries, an avoidance coping style is employed; there is a direct correlation between anxiety levels and the avoidance coping style. There exists an inverse correlation between anxiety levels and the use of an active coping style; moreover, there are no significant differences in the anxiety level of health personnel depending on whether they have cared for patients with COVID-19. Low cognitive activity, use of the avoidance method and Spanish geography were the main predictive coping styles of anxiety. Effective measures are required for preserving the mental health of health professionals during pandemics.