Stress coping strategies used by nurses during the COVID-19 pandemic

Perceived Trauma Among Nurses During the COVID-19 Pandemic: A Qualitative Descriptive Study

The COVID-19 pandemic has caused disruption to healthcare services worldwide, and although the pandemic was declared over, nurses continue to experience burnout and mental health implications because of events experienced since 2020. The aim of this study was to explore the experiences of trauma among nurses during the COVID-19 pandemic, using a qualitative descriptive study design. This paper used secondary analysis of qualitative, semi-structured interviews conducted with 55 Australian nurses exploring their alcohol consumption, due to the frequent narratives of trauma and traumatic events arising during this process. Data were analysed using structural coding and reported in accordance with the Consolidated Checklist for Reporting Qualitative Data (CORE-Q guidelines). Four themes emerged during data analysis: managing the traumatic stress of the clinical environment in COVID ('it doesn't feel like it's gone away'), post-pandemic trauma ('it was like war, wasn't it?'), bonding over shared trauma ('I was not expecting the camaraderie that developed') and managing trauma after the event ('If something bad happens whilst you're on shift, you just have to pretend like it hasn't happened'). Participants in this study described lasting mental health effects from working clinically during the COVID-19 pandemic that they described as trauma. These effects have lasted since governments worldwide have announced an end to the pandemic, and although participants described bonding over these shared experiences, they continue to have a detrimental impact on workforce well-being and sustainability.

Relationship between second victim syndrome and fear of missing out among nurses in Oman: Implications for nursing practice

BACKGROUND

Second victim syndrome (SVS) and fear of missing out (FOMO) are two psychological phenomena affecting health care professionals, particularly nurses who are involved in adverse patient events. SVS describes the psychological burden experienced by health care providers involved in patient safety incidents, such as errors or adverse events. Concurrently, FOMO is characterized by an apprehension of missing out on rewarding experiences, often exacerbated by social media, which can lead to further emotional distress. This interplay can intensify feelings of isolation among nurses, especially those in high-stress environments like critical care.

AIM

This study examines the relationship between SVS and FOMO among critical care nurses in Oman.

STUDY DESIGN

This study used a cross-sectional design with a convenience sampling approach. A total of 189 nurses working in Oman completed the study questionnaires consisting of the fear of missing out scale (FOMO) and the second victim experience and support survey (SVEST). The data were collected between April and June 2024.

RESULTS

The findings revealed that most nurses experience moderate SVS and FOMO, with significant differences based on age, marital status and education level. A linear regression analysis indicated a positive association between higher SVS and increased FOMO, suggesting that SVS significantly contributes to the experience of FOMO among critical care nurses in Oman.

CONCLUSIONS

This study highlights the significant relationship between FOMO and SVS among critical care nurses in Oman. The emotional strain from SVS, characterized by guilt and self-blame, is intensified by FOMO related to professional growth and social comparison. To enhance nurses' well-being, health care institutions must implement supportive measures and mental health resources. Addressing these challenges will ultimately improve both nurse satisfaction and patient care outcomes.

RELEVANCE TO CLINICAL PRACTICE

Understanding the interplay between FOMO and SVS among critical care nurses has significant implications for clinical practice worldwide. This research can inform evidence-based strategies to enhance nurses' well-being, leading to improved patient care outcomes and reduced burnout rates. Additionally, the findings can help develop targeted interventions to mitigate the effects of FOMO and SVS, fostering a healthier work environment and promoting resilience in critical care nursing. By exploring these relationships, this research aims to provide insights into the factors contributing to FOMO and SVS, facilitating the development of effective support systems to promote nurses' well-being across diverse health care settings.

"The leadership shown by nurses gave me such a boost": health resources used by nurses who experienced COVID-19 pandemic stressors

PURPOSE

To thoroughly describe 1) the stressors experienced by nurses during the first waves of the COVID-19 pandemic, 2) the extent to which experiencing these stressors affected nurses' psychological and physical health and 3) the health resources nurses used to protect and maintain their psychological and physical health during this period.

METHOD

We used a theory-driven descriptive qualitative design and conducted seven focus groups of 2-5 nurses (total = 23 nurses) distinguished by their degree of contact with COVID-19 patients hospitalized in Switzerland.

RESULTS

A thematic analysis identified three main themes and their respective sub-themes: 1) Lived experiences and stressors (Living in a strange world; Hard work alone behind closed doors; Contaminating or being contaminated; Living at home behind closed doors; A war of attrition after the first wave); 2) Health (Everything is fine; Multiple traumas; Stress; Long-term exhaustion); 3) Resources (Societal and institutional resources; Direct relational resources; Resources specific to individuals).

CONCLUSIONS

All the nurses interviewed had been ceaselessly and intensely exposed to stressors in their professional and private lives. However, the repercussions of these stressors on their mental or physical health differed. Indeed, some nurses reported having used resources to protect and maintain their health.

Trends and determinants of nurses' mental health following the COVID-19 pandemic in China: a longitudinal, comparative study over a two-year period

Introduction

The COVID-19 pandemic has placed nurses at the forefront of healthcare, exposing them to various mental health challenges such as depression, anxiety, and post-traumatic stress disorder (PTSD). However the long-term effects and risk factors of the COVID-19 pandemic on nurses' mental health are unknown. The objective of our study is to investigate the enduring impact of the COVID-19 pandemic on the psychological distress and PTSD of nurses, while also identifying the factors that influence these outcomes.

Methods

To investigate this question, we conducted a self-reported questionnaire survey of 8785 registered nurses recruited using snowball sampling methodology from 22 provinces in China, at five time points (T0-T4). At all times, we took measures of general health, while at the last four times we also measured PTSD. And we used logistic regression analysis to explore their impacts.

Results

The incidence of whole levels psychological distress among nurses was 27.7% at T0, peaking at 57.6% at T4. For severe psychological distress, it began at 5.5% at T0 and rose to 9.5% at T4. PTSD rates among nurses were recorded at 7.8% in T1, reaching a maximum of 14.7% in T4. They all got progressively worse in the volatility. In all times, coping strategies are independent factors for various levels of psychological distress and PTSD, while social support is a key factor for severe psychological distress and PTSD.

Conclusions

Our findings indicated a gradual deterioration in the mental health of nurses following the COVID-19 outbreak. In all instances, coping strategies exhibit an independent correlation with all grades of psychological distress and post-traumatic stress disorder (PTSD), whereas social support emerges as an independent protective factor mitigating the risk of severe psychological distress and PTSD.

Psychological distress among healthcare providers during the COVID-19 pandemic: patterns over time

BACKGROUND

COVID-19 added to healthcare provider (HCP) distress, but patterns of change remain unclear. This study sought to determine if and how emotional distress varied among HCP between March 28, 2021 and December 1, 2023.

METHODS

This longitudinal study was embedded within the 42-month prospective COVID-19 Cohort Study that recruited HCP from four Canadian provinces. Information was collected at enrollment, from annual exposure surveys, and vaccination and illness surveys. The 10-item Kessler Psychological Distress Scale (K10) was completed approximately every six months after March 28, 2021. Linear mixed effects models, specifically random intercept models, were generated to determine the impact of time on emotional distress while accounting for demographic and work-related factors.

RESULTS

Between 2021 and 2023, the mean K10 score fell by 3.1 points, indicating decreased distress, but scores increased during periods of high levels of mitigation strategies against transmission of SARS-CoV-2, during winter months, and if taking antidepression, anti-anxiety or anti-insomnia medications. K10 scores were significantly lower for HCP who were male, older, had more children in their household, experienced prior COVID-19 illness(es), and for non-physician but regulated HCP versus nurses. A sensitivity analysis that included only those who had submitted at least five K10 surveys consisted of the factors in the full model excluding previous COVID-19 illness, occupation, and season, after adjustment. Models were also created for K10 anxiety and depression subscales.

CONCLUSIONS

K10 scores decreased as the COVID-19 pandemic continued but increased during periods of high mitigation and the winter months. Personal and work-place factors also impacted HCP distress scores. Further research into best practices in distress identification and remediation is warranted to ensure future public health disasters are met with healthcare systems that are able to buffer HCP against short- and long-term mental health issues.

Health Workers' Mindfulness-Based Stress Reduction and Resilience During COVID-19 Pandemic

Background

Research indicates that a significant number of healthcare workers accounted for all confirmed Coronavirus disease 2019 (COVID-19) cases, and many of the infected healthcare workers were asymptomatic. During the COVID-19 outbreak, a considerable number of people in Taiwan contracted the disease. Therefore, health workers in Taiwan often experienced lack of medical resources, and this problem is worse for outer island areas. In terms of stress and mental health, this study investigated the effect of poor healthcare capacity and high workload on health workers during the COVID-19 pandemic. This study also explored mindfulness-based stress reduction and resilience in health workers.

Methods

This study conducted an in-depth interview to investigate stress perceived by health workers in a hospital located on an outer island of Taiwan as well as their mental health and stress relieving strategies.

Results

It was found that during the COVID-19 outbreak, some common sources of stress for health workers included exposure to infectious diseases, heavy workloads, facing ethical dilemma in clinical decision-making, and unfamiliar problems from the pandemic. These types of stress cause worries, anxiety, and depression in health workers, which affects their mental and physical health as well as their patient-care performance.

Conclusion

This study proposed that mindfulness-based stress reduction and protecting mental health are important for health workers.

Consequences of the COVID-19 pandemic on the mental health of nurses in the Spanish out-of-hospital Emergency Service

OBJECTIVE

To analyse the impact of the COVID-19 pandemic on the mental health of nurses in Spanish out-of-hospital Emergency Services, identifying predictor factors of greater severity.

METHOD

A multicentre cross-sectional descriptive study was designed, including all nurses working in any Spanish out-of-hospital Emergency Services between 01/02/2021 and 30/04/2021. The main outcomes were the level of depression, anxiety and stress assessed through the DASS-21 scale. Sociodemographic, clinical, and occupational information was also collected. Univariate and multivariate analyses were conducted to determine possible associations between variables.

RESULTS

The sample included 474 nurses. 32.91%, 32.70% and 26.33% of the participants had severe or extremely severe levels of depression, anxiety and stress, respectively. Professionals with fewer competencies to handle stressful situations, those who had used psychotropic drugs and/or psychotherapy on some occasion before the pandemic onset, or those who had changed their working conditions presented more likelihood of developing more severe levels of depression, anxiety and/or stress.

CONCLUSION

Nurses in Spanish out-of-hospital Emergency Services have presented medium levels of depression, anxiety and stress during the pandemic. Clinical and occupational factors have been associated with a higher degree of psychological distress. It is necessary to adopt strategies that promote professionals' self-efficacy and mitigate the triggers of negative emotional states.

Job satisfaction, professional competence, and self-efficacy: a multicenter cross-sectional study among registered nurses in Sweden and Norway

BACKGROUND

Healthcare organizations worldwide face persistent challenges relating to turnover and intention to leave the nursing profession among registered nurses. Factors contributing to their retention and well-being at work include high job satisfaction, professional competence, and self-efficacy. Few multicenter studies have investigated these factors in relation to work experience in a Nordic context. Therefore, this study aimed to investigate job satisfaction, professional competence, and self-efficacy among registered nurses.

METHODS

This multicenter cross-sectional study survey was part of a larger overarching Swedish-Norwegian project, and was conducted among registered nurses (n = 1137) in September 2021. The participants worked in a variety of health care units, e.g., hospital units, primary health care, and home care. Data was subjected to descriptive and comparative statistical analysis; chi-square test, one-way between-groups analysis of variance (ANOVA) and Kruskal-Wallis test.

RESULTS

The findings show that job satisfaction is reported as lowest in registered nurses with medium-term work experience as compared to newly qualified and long-term work-experienced registered nurses. Professional competence and self-efficacy are reported as higher among registered nurses with long-term work experience as compared to those with medium-term work experience and newly qualified registered nurses. However, the participants reported their professional competence as highest in relation to the same factor - "Value-based nursing care" - regardless of their work experience.

CONCLUSIONS AND IMPLICATIONS

This study underscores the need for continuous support and professional development for registered nurses throughout their careers. Proactive support for newly qualified nurses may improve job satisfaction as they progress to being registered nurses with medium-term work experience. Tailored interventions to address the distinct needs of both newly qualified and medium-term work-experienced registered nurses are crucial for nurturing a sustainable nursing workforce.

A retrospective analysis of coping competence among community health centers during the COVID-19 pandemic in Shanghai, China: Coping strategies for future public health emergency events

This study aims to investigate the coping competence of 12 community health centers through nursing workforce, emergency preparation, emergency response training, and emergency support in a district of Shanghai during the coronavirus disease 2019 (COVID-19) pandemic in 2022 to propose coping strategies and implication for Future Public Health Emergency Events for community health centers. A cross-sectional survey was conducted on June 2022, and 12 community health centers (servicing a population of 104,472.67 ± 41,421.18, with 125 ± 36 health care providers per center) were then divided into group A (n = 5, medical care ratio ≥ 1:1) and group B (n = 7, medical care ratio < 1:1) according to collected data, and the nursing human resources management and coping competence of the centers with COVID-19 of both groups were retrospectively analyzed. Nursing shortages were obvious across all 12 centers. Certain deficiencies in the coping competence of community health centers with emergencies must be addressed (possession rate < 70% in both groups, p > 0.05). Community health centers need to enhance hospital-to-hospital collaboration and the ability to transport emergency staff to the post promptly during outbreaks. Emergency coping assessments, emergency drills at different levels, and mental health support need to be implemented regularly among community health centers, and effective donation management should be pursued as well. We expect that this study could support efforts by leaders of community health centers to conclude coping strategies including increasing nursing workforce, optimizing human recourse management, and identifying areas of improvement of centers for emergency coping during public health events.

Nurses' Perceptions of Ethical Conflicts When Caring for Patients with COVID-19

The COVID-19 pandemic has caused ethical challenges and dilemmas in care decisions colliding with nurses' ethical values. This study sought to understand the perceptions and ethical conflicts faced by nurses working on the frontline during the first and second waves of the COVID-19 pandemic and the main coping strategies. A qualitative phenomenological study was carried out following Giorgi's descriptive phenomenological approach. Data were collected through semi-structured interviews until data saturation. The theoretical sample included 14 nurses from inpatient and intensive care units during the first and second waves of the pandemic. An interview script was used to guide the interviews. Data were analyzed following Giorgi's phenomenological method using Atlas-Ti software. Two themes were identified: (1) ethical conflicts on a personal and professional level; and (2) coping strategies (active and autonomous learning, peer support and teamwork, catharsis, focusing on care, accepting the pandemic as just another work situation, forgetting the bad situations, valuing the positive reinforcement, and humanizing the situation). The strong professional commitment, teamwork, humanization of care, and continuous education have helped nurses to deal with ethical conflicts. It is necessary to address ethical conflicts and provide psychological and emotional support for nurses who have experienced personal and professional ethical conflicts during COVID-19.

Reducing Staff Turnover and Clinician Burnout With a Structured Support Group During the COVID-19 Pandemic

Retention and burnout have always been a challenge for nurse leaders, but the pandemic brought these concerns to a whole new level. And now the Great Resignation is affecting health care. So how can nurse leaders at hospitals and health care systems create a supportive environment for staff during a public health emergency? Structured support groups are a viable option for emphasizing self-care and wellness. We explain why we decided to form a structured support group for our intensive care unit nurses and illustrate the results from our clinical research team. In addition, we share feedback we received from participating nurses and offer advice on forming a structured support group in acute care settings. This strategy resulted in a change in the participant's behaviors after attending the structured emotional support group. This finding aligns with the literature, which supports strategies to protect nurses' mental well-being and to take preventive measures in critical situations. Using this as a foundation, a structured emotional support group can change nurse engagement and involvement in their process and practice, during times of crisis. Many other benefits could be realized from this strategy such as improved nursing practice and processes, improved nurse satisfaction, and improved recruitment and retention.

Primary care nurses during the coronavirus disaster and their struggle: Qualitative research

Background

Coronavirus disease 2019 (COVID-19) has substantially affected the health and lives of medical professionals. However, the experiences of nurses engaged in primary care remain unclear. We explored how nurses working in primary care were psychologically and socially affected by the COVID-19 disaster and how they overcame the difficulties experienced.

Methods

We conducted a qualitative study of seven Japanese nurses working in primary care. Data collection was performed before, during, and after a workshop based on the Tojisha-Kenkyu (user-led research) framework to explore how the COVID-19 disaster affected the nurses and how they coped. Data were analyzed using inductive thematic analysis.

Results

Three themes emerged from the analysis: effects of the COVID-19 disaster on nurses, nurses' newly found strength during the pandemic, and their changes and achievements through the Tojisha-Kenkyu framework. The first theme comprised four subthemes: fear of the unknown; difficulty in adaptation; dysfunction in patient care; and defilement and oppression. The second theme involved feeling in control and professionalism. The third theme, which was based on participants' discovery of "same and different" fellowships, showed work reconstruction and self-understanding, which alleviated their difficulties.

Conclusions

The effect of the pandemic on nurses working in primary care ranges from work-related frustration to daily life issues. The Tojisha-Kenkyu method can help nurses to alleviate difficulties. Further research should be conducted to elucidate the constant burden on primary care professionals and establish appropriate occupational and daily life support during pandemics.

The Impact of Sociodemographic Characteristics on Coping Strategies Used by Nurses Working at COVID and Non-COVID Hospital Departments during COVID-19 Pandemic: A Cross-Sectional Study

Background: The aim of our study was to compare coping strategies applied by nurses working during the COVID-19 pandemic at COVID-19 (CoV) and non-COVID-19 (non-CoV) hospital departments with regards to their sociodemographic characteristics in order that the system can provide them better support in future similar situations. Methods: A total of 380 out of 1305 nurses participated in the survey during December 2020. Coping Inventory for Stressful Situations (CISS) was used. Stepwise regression analysis was used to determine the interaction between sociodemographic characteristics and coping strategies. Results: The CoV married nurses (62.2%) used problem- (p = 0.010) and emotion- (p = 0.003) focused coping more and avoidance coping less (p = 0.007). CoV nurses with master’s degrees (11.1%) used both problem- and emotion-focused coping less (p < 0.01), and older nurses used emotional coping more than the younger nurses (p = 0.027), whereas younger nurses used more avoidance coping (p < 0.01). CoV nurses without children (41%) used avoidance strategies more than nurses who had 2−3 children (p < 0.001). Among non-CoV nurses, less use of emotional coping was recorded in nurses with master’s degrees (4%) than in those with a high school diploma (44.2%) (p = 0.002). Avoidance coping was also used more by married non-CoV nurses (79.1%) (p < 0.001) and those without children (p < 0.001). Conclusions: Sociodemographic factors such as working experience, age, level of education and marital status influenced chosen coping strategies during the health crisis.