The Psychological Impact of COVID-19 Disease is more Severe on Intensive Care Unit Healthcare Providers: A Cross-sectional Study

Assessing the impact of the coronavirus pandemic on the mental health status of intensive care unit nurses: a systematic review

INTRODUCTION

The Coronavirus pandemic (COVID-19) was first identified in December 2019 in Wuhan, China, and later caused a severe health crisis, causing massive disruptions to most healthcare systems worldwide. During this pandemic period, the structure of the Intensive Care Unit (ICU) activities changed fast. It was observed that the mental health of ICU nurses reached levels of extreme clinical and psychological concern. This paper aims to shed light on how COVID-19 affected ICU nurses' mental health.

METHODS

A literature review of articles published on this topic from January 2020 to December 2024. English-language, peer-reviewed, mixed-methods, qualitative, and quantitative research on the mental health outcomes of ICU nurses were included while studies without primary data, non-ICU nurses, and non-peer-reviewed publications were excluded. To identify relevant literature, we searched five databases, including PubMed, MEDLINE, CINAHL, Web of Science, and Embase. Additionally, grey literature sources, including Google Scholar and Research Gate, were also searched. Narrative synthesis was used to evaluate both quantitative and qualitative data.

RESULTS

A total of 23 articles were reviewed. The most prevalent mental health issues were depression, anxiety, fear, and post-traumatic stress disorder (PTSD). The effects of burnout, illness, exhaustion, physical strain, sleep disturbances, and ongoing job stress were equally detrimental to the health of ICU nurses. The nurses' health declined as a result of the new procedures and working environment, the enormous workload, the continued exhaustion, the concerns for their families and themselves being infected by COVID-19, the social reaction, and seeing the death toll rise.

CONCLUSION

The COVID-19 pandemic had a negative impact on nurses' mental health well-being such as stress, depression, post-traumatic stress disorder, insomnia, anxiety, and fear. Sustainable support systems, networks and plans ought to be made available. Due to unique working conditions of ICU nurses and in readiness for similar pandemics in future, legislators should focus on the mental health of ICU nurses because they play a critical role in managing public health crises as frontline health solders.

The relationship between post-traumatic stress disorder and sleep quality in intensive care unit professionals

BACKGROUND

Intensive care units (ICUs) have impact on physical and mental health not only for patients but also for health professionals. Post-traumatic stress disorder that may occur in ICU professionals may negatively affect the treatment and care process by affecting their sleep quality.

AIM

This study aims to evaluate the relationship between post-traumatic stress disorder and sleep quality in intensive care unit professionals.

STUDY DESIGN

The cross-sectional study conducted with 341 (nurses, physicians and others) professionals working in the ICUs in Turkey. Data were collected with a socio-demographic form, Posttraumatic Stress Disorder-Short Scale (PTSD-SS) and Richard-Campbell Sleep Questionnaire (RCSQ).

RESULTS

The mean PTSD-SS and RCSQ scale scores of the participants were 15.37 ± 6.72 (min: 0, max: 35) and 46.61 ± 22.46 (min: 0, max: 100). When the cutoff points of the scores obtained from PTSD-SS was examined, 12.9% (n = 33) of ICU nurses, 11.3% (n = 6) of the physicians and 3.4% (n = 1) of the other health professionals had post-traumatic stress disorder symptoms, and it was determined that the prevalence of PTSD in all ICU professionals was 12% (n = 40). In addition, there was a statistically significant negative weak correlation between PTSD-SS and RCSQ (r = -0.207) (p < .05).

CONCLUSIONS

The results of this study show that increasing the level of PTSD causes sleep quality to deteriorate. Therefore, evaluation and recognition of PTSD symptoms in ICU professionals and interventions to be important in maintaining sleep quality. Additionally, the results of this study can be used in planning to improve the mental health of ICU nurses. Therefore, greater support for ICU nurses to prevent PTSD is recommended.

RELEVANCE TO CLINICAL PRACTICE

It is important and necessary to prevent the development of PTSD in ICU nurses and to reduce its negative impact on sleep quality.

Assessment of Nurses Fear Working in COVID-19 Pandemic Hospitals

Introduction

Nurses play pivotal roles in various facets of managing the COVID-19 epidemic, encompassing tasks such as identifying potential cases with infections, managing suspected patients, conducting patient assessments, and providing critical care to individuals afflicted with COVID-19.

Objective

The objective of this study was to assess the level of COVID-19 fear among nurses who care for infected or suspected COVID-19 patients in pandemic hospitals.

Methods

A cross-sectional study was conducted on 260 nurses employed at COVID-19 hospitals in Palestine. The Fear of COVID-19 Scale (FCV-19S) was employed to measure participants' fear levels. The scale's potential values range from 7 to 35, with higher scores indicating a greater fear of COVID-19. Independent t-tests and ANOVA tests were utilized to evaluate differences between the variables.

Results

The analysis revealed that the mean total fear score of the nurses was 25.22 ± 5.07 (ranging from 7 to 35), indicating a high level of fear. Married nurses exhibited a fear mean score of 27.0 ± 4.9 (p < 0.05). Similarly, nurses with children scored a mean fear level of 29.0 ± 4.6 (p < 0.05). Additionally, nurses engaged in rotating shift work reported a fear mean score of 27.9 ± 4.4 (p < 0.05). Furthermore, nurses who received COVID-19 training exhibited a fear mean score of 24.6 ± 4.8 (p < 0.05). Likewise, nurses who experienced patient loss due to COVID-19 reported a fear mean score of 23.2 ± 4.5 (p < 0.05).

Conclusion

The study confirmed that nurses in Palestine exhibit a significant level of fear concerning COVID-19. Marital status, having children, working schedule, experiencing the loss of a patient due to COVID-19, and receiving training related to COVID-19 were identified as factors associated with the fear of COVID-19 among nurses.

Inhalation of Origanum majorana L. essential oil while working reduces perceived stress and anxiety levels of nurses in a COVID-19 intensive care unit: a randomized controlled trial

Background

Nurses caring for patients with coronavirus disease 2019 (COVID-19) experience higher psychosocial distress than other healthcare workers, and this can adversely affect the quality of patient care. There is evidence that inhalation of essential oil from marjoram (Origanum majorana L.) has calming effects, suggesting this intervention may help to reduce the stress and anxiety of nurses working in a COVID-19 intensive care unit (ICU). This study aimed to investigate the effect of inhalation of marjoram essential oil at work on the stress and anxiety levels of nurses in a COVID-19 ICU.

Methods

Nurses (n = 57) working in a single COVID-19 ICU were randomly assigned to inhale 3% marjoram essential oil (marjoram group, n = 29) or almond oil (control group, n = 28) for 2 h while at work. Mean arterial pressure (MAP), heart rate, state anxiety score, and score on a visual analog scale for anxiety (VAS-anxiety) and stress (VAS-stress) were measured before and after the intervention.

Results

The two groups had similar baseline variables. MAP did not have within-group or between-group differences. Heart rate increased significantly in the marjoram group after the intervention (p = 0.031), but it remained within the normal range and the increase was not clinically meaningful. There was no significant between-group difference in the state-anxiety or VAS-anxiety score after the intervention, but the marjoram group had a significantly lower state-anxiety (p = 0.001) and VAS-anxiety (p = 0.037) score at posttest vs. pretest. The VAS-stress score was significantly lower in the marjoram group at the posttest vs. the pretest (p = 0.026).

Conclusion

Nurses caring for patients in a COVID-19 ICU experience significant stress, and strategies are needed to address this important issue. Inhalation of 3% marjoram essential oil while caring for patients in a COVID-19 ICU may be a simple and effective intervention that reduces perceived stress and anxiety in nurses.Clinical Trial Registration: https://cris.nih.go.kr/, KCT0007543.

Telehealth in palliative care during the COVID-19 pandemic: A systematic mixed studies review

BACKGROUND

The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented disruption to healthcare delivery worldwide. The use of telehealth practices rapidly expanded during the pandemic, while its application in palliative care remains a conflicted issue.

AIMS

The aims of this study were to evaluate users' reports of their satisfaction with telehealth palliative care during COVID-19 and to identify facilitators and barriers to telehealth implementation in palliative care during COVID-19.

METHODS

A systematic search of the literature, including studies between January 2020 and June 2022, was conducted using PubMed, MEDLINE, CINAHL Plus, Embase, and Google Scholar. Empirical studies of telehealth in palliative care during COVID-19 were included.

RESULTS

A total of 18 studies were included in the review, of which nine were outpatient consultations, four were family meetings, two were remote volunteering programs, two were inpatient care, and one was a residential care home needs assessment. The satisfaction rates were high (66%-99%) among patients and family members who participated in telehealth consultations, but the satisfaction with family meetings was mixed. Compared with their clients, healthcare professionals were less likely to assess telehealth as satisfactory. The authors identified four barriers and four facilitators. The barriers were technological challenges, lack of nonverbal communication, ethical concerns, and limitations for clinical practice. The facilitators were accessibility and convenience, visual cues, facilitation and training, and family engagement.

LINKING EVIDENCE TO ACTION

This systematic mixed studies review suggests that current evidence supports the feasibility of telehealth implementation in palliative care for outpatient consultations and routine follow-up appointments. This review also identified facilitators and barriers to telehealth in palliative care, and the findings can inform the implementation of future palliative care services. Future attention should be paid to the effectiveness of telehealth implementation in palliative care patients.

Effects of Taekwondo Training on Growth Factors in Normal Korean Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The growth of children and adolescents is both an important health indicator and a major public health issue. Many recent studies have investigated the effects of taekwondo on growth factors, but no consensus has yet been reached. This meta-analysis aimed to determine the effects of taekwondo on the growth factors in children and adolescents (aged 8 to 16 years). Randomized controlled trials from PubMed, Web of Science, Cochrane Library, the Research Information Sharing Service, the Korea Citation Index, and the Korean-studies Information Service System were analyzed. The effect sizes (standardized mean differences, SMD) were calculated, the risk of bias and publication bias were assessed, and the effect size and subgroup analyses were pooled. We found that the taekwondo group had significantly higher levels of growth hormones (SMD 1.78, 95% confidence interval [CI] 0.98-2.58, and p < 0.001) and insulin-like growth factors (SMD 1.76, 95% CI 0.60-2.92, and p < 0.001) than the control group. For height, a medium effect size was observed (SMD 0.62, 95% CI -0.56-1.80, and p = 0.300), but the between-group difference was not significant. Thus, taekwondo had significant positive effects on the secretion of growth hormones and insulin-like growth factors in Korean children and adolescents. A longitudinal follow-up is necessary to determine the effect on height. This suggests that taekwondo can be recommended as an appropriate physical exercise for maintaining normal growth in children and adolescents.

Mental well-being of intensive care unit nurses after the second surge of the COVID-19 pandemic: A cross-sectional and longitudinal study

OBJECTIVES

To determine the impact of the second surge of the COVID-19 pandemic (October 2020 to June 2021) on mental well-being of intensive care unit nurses and factors associated with mental health outcomes.

METHODS

An online survey was available for Dutch intensive care unit nurses in October 2021, measuring mental health symptoms; anxiety, depression (Hospital Anxiety and Depression Scale), and post-traumatic stress disorder (Impact of Event Scale-6). Additionally, work-related fatigue was measured using the Need For Recovery-11 questionnaire. Previous data from the first surge (March until June 2020) were used to study mental well-being longitudinally in a subgroup of intensive care unit nurses. Logistic regression analyses were performed to determine factors associated with mental health symptoms.

RESULTS

In total, 589 nurses (mean age 44.8 [SD, 11.9], 430 [73.8 %] females) participated, of whom 164 also completed the questionnaire in 2020. After the second surge, 225/589 (38.2 %) nurses experienced one or more mental health symptoms and 294/589 (49.9 %) experienced work-related fatigue. Compared to the first measurement, the occurrence of mental health symptoms remained high (55/164 [33.5 %] vs 63/164 [38.4 %], p = 0.36) and work-related fatigue was significantly higher (66/164 [40.2 %] vs 83/164 [50.6 %], p = 0.02). Granted holidays as requested (aOR, 0.54; 95 % CI, 0.37-0.79), being more confident about the future (aOR, 0.59; 95 % CI, 0.37-0.93) and a better perceived work-life balance (aOR, 0.42; 95 % CI, 0.27-0.65) were significantly associated with less symptoms.

CONCLUSION

The second surge of the COVID-19 pandemic further drained the mental reserves of intensive care unit nurses, resulting in more work-related fatigue.

Mental health and well-being of anaesthetists during the COVID-19 pandemic: a scoping review

The COVID-19 pandemic has imposed substantial burdens on clinicians and there is a need to better understand the impact on mental health and well-being. This scoping review investigates the prevalence of mental health concerns in anaesthetists, risk and protective factors for mental well-being, and anaesthetists' pandemic-related concerns and support. We searched online databases for articles published between January 2020 and May 2022, using search terms related to: anaesthesia; burnout, well-being, mental health or stress; and COVID-19. We identified 20 articles comprising 19 different populations of anaesthetists (n = 8680) from 14 countries. Studies identified the prevalence of the following condition in anaesthetists: burnout (14-59%); stress (50-71%); anxiety (11-74%); depression (12-67%); post-traumatic stress (17-25%); psychological distress (52%); and insomnia (17-61%). Significant risk factors for poorer mental health included: direct COVID-19-related issues (fear of self and family exposure to infection; requirement for quarantine); practitioner health factors (insomnia; comorbidities); psychosocial factors (loneliness; isolation; perceived lack of support at home and work); demographic factors (female gender; non-white ethnicity; LGBTQIA+); and workplace factors (redeployment outside area of clinical practice; increased work effort; personal protective equipment shortages). Protective factors identified included: job satisfaction; perceived organisational justice; older age; and male sex. Anaesthetists' self-reported concerns related to: personal protective equipment; resource allocation; fear of infection; fear of financial loss; increased workload; and effective communication of protocols for patient treatment. Support from family, colleagues and hospital management was identified as an important coping mechanism. Findings from this review may support the design of interventions to enhance anaesthetists' psychological health during pandemic conditions and beyond. Future research should include consistent psychological outcome measures and rigorous experimental design beyond cross-sectional studies.

The Effect of Personality Traits of Surgical Nurses on COVID-19 Fear, Work Stress and Psychological Resilience in the Pandemic

PURPOSE

This research was carried out to determine the effects of the personality traits of surgical nurses on covid-19 fear, work stress and psychological resilience in the pandemic.

DESIGN

The research was descriptive and cross-sectional types.

METHODS

The study was conducted between February 2021 and May 2021 at a State University Research Hospital. The research aimed to reach all surgery nurses (357) working in surgical units without selecting a sample. The sample included 325 participants. At the end of the study, the participation rate was 91.03%. Study reporting adheres to STROBE checklist.

FINDINGS

It was determined that 43.4% of the nurses participating in the study were in the age range of 26-30, 64.9% were women The correlation values between the COVID-19 Fear Scale and the Nurse Stress Scale scores were found to be significant in the positive direction. The correlation values between the Eysenck Personality Questionnaire neuroticism sub-dimension and the Nurse Stress Scale, and Fear of COVID-19 Scale scores were found to be positive.

CONCLUSION

During the pandemic, it is suggested that nurses' work stress and psychological resilience levels should be evaluated at regular intervals and that in-service trainings on coping with stress and stress management should be organized. Taking the necessary precautions and improving working conditions will have positive effects on both the health of nurses and patient care.

Strengthening the ICUs' human resource-related responses to Covid-19: A rapid review of the experience during the first year of public health emergency

By drawing on macro-categories of key human resource (HR) management interventions recommended by the Organization for Economic Co-operation and Development (OECD) during the Covid-19 pandemic, this study aimed to explore whether and how Intensive Care Units (ICU) have strengthened their HRs during the first year of Covid-19 emergency. A rapid review was conducted to provide a quick synthesis of the literature in English identified in the Web of Science Core Collection (WoS), PubMed, and Scopus databases. A total of 68 articles qualified for the final analysis. The findings illustrated that health organisations were often guided by staffing ratios to estimate capacity to care, aimed to modify the scope of practice of providers, redeployed both internal and external staff to ICUs, created and adapted the Covid-19-specific staffing models, and implemented technological innovations to provide services to the unprecedented number of patients while protecting the physical and mental health of their staff. The insights of this research should be helpful for health leaders, HR Managers, and policymakers who have faced unprecedented challenges and tough decisions during this emergency. The findings could also inform beyond-Covid-19 ICU policies and guide future research.

Investigation of Psychological Stress and Sleep Quality of Emergency Medical Technicians in Taiwan Fire Department during the COVID-19 Pandemic

When the coronavirus disease 2019 (COVID-19) began to ravage the world in 2019, the World Health Organization became concerned. The epidemic has a high mortality and contagion rate, with severe health and psychological impacts on frontline emergency medical service system practitioners. There are many hospital staff surveys, but few have covered the stress among emergency medical technicians. DASS-21, PSQI, and AUDIT questionnaires were used to evaluate the sources of psychological stress factors of firefighters in Taiwan. Multiple logistic regression was used to analyze the questionnaire content. We conducted questionnaire surveys from May 2022 to July 2022. Our sample comprised 688 participants. The odds ratios of increased depression, anxiety, and stress levels due to reduced family or peer understanding and support were 2.72 (95% CI: 1.50−4.92), p = 0.001; 2.03 (95% CI: 1.11−3.68), p = 0.021; and 3.27 (95% CI: 1.83−5.86), p < 0.001, respectively. The odds ratios of poor sleep quality due to depression, anxiety, and increased stress levels were 5.04 (3.18−7.99), p < 0.001; 2.44 (95% CI: 1.57−3.81), p < 0.001; and 4.34 (95% CI: 2.76−6.82), p-value < 0.001, respectively. During the COVID-19 pandemic, poor sleep quality and a lack of understanding and support from the Taiwan firefighting agency staff, family, or peers resulted in increased depression, anxiety, and stress levels.

Subjective sleep alterations in healthy subjects worldwide during COVID-19 pandemic: A systematic review, meta-analysis and meta-regression

OBJECTIVE

We conducted a systematic review and meta-analysis to provide an update on sleep quality in different world areas and better characterize subjective sleep alterations during the COVID-19 pandemic. Considering gender distribution and specific pandemic-related parameters, we also intend to identify significant predictors of sleep problems.

METHODS

Six electronic databases were searched from December 2019 to November 2021 for studies investigating sleep during COVID-19 employing the Pittsburgh Sleep Quality Index, the Medical Outcomes Study Sleep, the Insomnia Severity Index or the Epworth Sleepiness Scale. Random-effects models were implemented to estimate the pooled raw means of subjective sleep alterations. Also, we considered the role of several pandemic-related parameters (i.e., days from the first COVID-19 case, government stringency index, new cases for a million people, new deaths for a million people) by means of meta-regression analyses.

RESULTS

A total of 139 studies were selected. The pooled mean of the global Pittsburgh Sleep Quality Index score (PSQIgen) was 6.73 (95% CI, 6.61-6.85). The insomnia severity index score was reported from 50 studies with a pooled mean of 8.44 (95% CI, 7.53-9.26). Subgroup analyses confirmed that most subcategories had poor sleep quality and subclinical insomnia. Meta-regressions showed that PSQIgen was predicted by days from the first COVID-19 case and government restrictions with a negative slope and by female gender with a positive slope. The government stringency index was positively correlated with the direct subjective evaluation of sleep quality.

CONCLUSIONS

We found an overall impaired sleep and widespread subthreshold insomnia during the COVID-19 pandemic. The female percentage seems to be the best predictor of impaired sleep quality, consistently to the available literature. Noteworthy, sleep alterations were inversely associated with governmental restrictions and decreased during the pandemic. Our results give a contribution to critically orienting further studies on sleep since COVID-19 pandemic.

Coronavirus disease 2019 aftermath: psychological trauma in ICU healthcare workers

PURPOSE OF REVIEW

We aim to describe the extent of psychological trauma and moral distress in healthcare workers (HCW) working in the intensive care unit (ICU) during the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we review reports on prevalence of mental health symptoms, highlight vulnerable populations and summarize modifiable risk factors associated with mental health symptoms in ICU HCW.

RECENT FINDINGS

The pandemic has resulted in a multitude of closely intertwined professional and personal challenges for ICU HCW. High rates of posttraumatic stress disorder (14-47%), burnout (45-85%), anxiety (31-60%), and depression (16-65%) have been reported, and these mental health symptoms are often interrelated. Most studies suggest that nurses and female HCW are at highest risk for developing mental health symptoms. The main personal concerns associated with reporting mental health symptoms among ICU HCW were worries about transmitting COVID-19 to their families, worries about their own health, witnessing colleagues contract the disease, and experiencing stigma from their communities. Major modifiable work-related risk factors were experiencing poor communication from supervisors, perceived lack of support from administrative leadership, and concerns about insufficient access to personal protective equipment, inability to rest, witnessing hasty end-of-life decisions, and restriction of family visitation policies.

SUMMARY

The COVID-19 pandemic has severely impacted ICU HCW worldwide. The psychological trauma, manifesting as posttraumatic stress disorder, burnout, anxiety, and depression, is substantial and concerning. Urgent action by lawmakers and healthcare administrators is required to protect ICU HCW and sustain a healthy workforce.

The explanatory ability of COVID-19 life changes on quality of life: A comparison of those who have had and not had COVID-19

The COVID-19 pandemic has undoubtedly negatively affected individuals' quality of life through multiple means such as social isolation, exacerbated mental health conditions, and financial instability. Multiple studies have demonstrated that one of the negative correlates of quality of life is the perceived danger of COVID-19 (i.e., fear of and anxiety about COVID-19). The current study addresses limitations in the literature by testing how life changes from COVID-19 explain the direct effect of the perceived danger of COVID-19 on quality of life using a United States sample between those who have had COVID-19 compared to those who have not had COVID-19. Undergraduate students (n = 196) from a Midwestern University in the United States participated in this study for course credit (White: n = 109; 55.61%; Male: n = 94; 48.0%). Participants completed this study online and at home where they responded to a demographic form and several measures of the effects of COVID-19 and quality of life. The results suggest that COVID-19 life changes fully explain the negative relationship between the perceived danger of COVID-19 and quality of life, but only in those who have had COVID-19. In the group that has never had COVID-19, the only significant relationship was the positive relationship between the perceived danger of COVID-19 on COVID-19 life changes. The results suggest that researchers may consider steering research away from the perceived danger of COVID-19 and onto remedying life changes from COVID-19 to improve individuals' quality of life. I further discuss the theoretical findings, implications, limitations, and future directions.

Sleep of Healthcare Workers During the COVID-19 Pandemic and the Role of Atypical Work Schedules: A Scoping Review

The COVID-19 pandemic has negatively impacted the well-being of healthcare workers (HCWs). HCWs are highly exposed to shift work and their work schedules have been subject to increasing unpredictability since the start of the pandemic. This review aims to: (1) map the studies providing information about factors associated with sleep characteristics in HCWs working in the context of the COVID-19 pandemic during the first and second waves and (2) examine the state of the evidence base in terms of the availability of information on the influence of atypical work schedules. A literature search was performed in PubMed. Studies containing information about factors (demographic; psychological; occupational; COVID-19-specific; work schedule; lifestyle; medical; or other) associated with various sleep characteristics among HCWs working in the context of the COVID-19 pandemic were included. Particular attention was paid to the availability of information on the role of atypical work schedules on HCW sleep. Fifty-seven articles met the inclusion criteria. Most studies were reports of quantitative cross-sectional surveys using self-report measures. Associations between female sex, frontline HCW status, psychological factors, and poorer sleep were observed. Six studies included a measure of shift work in their analyses, 5 of which reported an association between shift work status and sleep. A wide range of factors were investigated, with female sex, frontline HCW status, and psychological factors repeatedly demonstrating associations with poorer sleep. Sleep was predominantly measured in terms of self-reported sleep quality or insomnia symptoms. Few studies investigated the influence of atypical work schedules on HCW sleep in the context of the COVID-19 pandemic. Research on this topic is lacking in terms of reliable and consistent measurements of sleep outcomes, longitudinal data, and knowledge about the influence of covariates such atypical work schedules, comorbidity, and medical history on HCW sleep.

Changes in blood pressure and related risk factors among nurses working in a negative pressure isolation ward

Objective

To observe changes in blood pressure (ΔBP) and explore potential risk factors for high ΔBP among nurses working in a negative pressure isolation ward (NPIW).

Methods

Data from the single-center prospective observational study were used. Based on a routine practice plan, female nurses working in NPIW were scheduled to work for 4 days/week in different shifts, with each day working continuously for either 5 or 6 h. BP was measured when they entered and left NPIW. Multivariable logistic regression was used to assess potential risk factors in relation to ΔBP ≥ 5 mm Hg.

Results

A total of 84 nurses were included in the analysis. The ΔBP was found to fluctuate on different working days; no significant difference in ΔBP was observed between the schedules of 5 and 6 h/day. The standardized score from the self-rating anxiety scale (SAS) was significantly associated with an increased risk of ΔBP ≥ 5 mm Hg (odds ratio [OR] = 1.12, 95% CI: 1.00–1.24). Working 6 h/day (vs. 5 h/day) in NPIW was non-significantly related to decreased risk of ΔBP (OR = 0.70), while ≥ 2 consecutive working days (vs. 1 working day) was non-significantly associated with increased risk of ΔBP (OR = 1.50).

Conclusion

This study revealed no significant trend for ΔBP by working days or working time. Anxiety was found to be significantly associated with increased ΔBP, while no &lt;2 consecutive working days were non-significantly related to ΔBP. These findings may provide some preliminary evidence for BP control in nurses who are working in NPIW for Coronavirus Disease 2019 (COVID-19).

Sleep disturbances during the COVID-19 pandemic: A systematic review, meta-analysis, and meta-regression

This systematic review and meta-analysis evaluated the extent of sleep disturbances during the COVID-19 pandemic. Eleven databases and six preprint repositories were searched for the period from November 1, 2019, to July 15, 2021. The DerSimonian and Laird method was used to develop random-effect meta-analyses. Two hundred and fifty studies comprising 493,475 participants from 49 countries were included. During COVID-19, the estimated global prevalence of sleep disturbances was 40.49% [37.56; 43.48%]. Bayesian meta-analysis revealed an odds of 0.68 [0.59; 0.77] which translates to a rate of approximately 41%. This provides reassurance that the estimated rate using classical meta-analysis is robust. Six major populations were identified; the estimated prevalence of sleep problem was 52.39% [41.69; 62.88%] among patients infected with COVID-19, 45.96% [36.90; 55.30%] among children and adolescents, 42.47% [37.95; 47.12%] among healthcare workers, 41.50% [32.98; 50.56%] among special populations with healthcare needs, 41.16% [28.76; 54.79%] among university students, and 36.73% [32.32; 41.38%] among the general population. Sleep disturbances were higher during lockdown compared to no lockdown, 42.49% versus 37.97%. Four in every ten individuals reported a sleep problem during the COVID-19 pandemic. Patients infected with the disease, children, and adolescents appeared to be the most affected groups.

Fear of COVID-19 and its association with mental health-related factors: systematic review and meta-analysis

BACKGROUND

The severity of COVID-19 remains high worldwide. Therefore, millions of individuals are likely to suffer from fear of COVID-19 and related mental health factors.

AIMS

The present systematic review and meta-analysis aimed to synthesize empirical evidence to understand fear of COVID-19 and its associations with mental health-related problems during this pandemic period.

METHOD

Relevant studies were searched for on five databases (Scopus, ProQuest, EMBASE, PubMed Central, and ISI Web of Knowledge), using relevant terms (COVID-19-related fear, anxiety, depression, mental health-related factors, mental well-being and sleep problems). All studies were included for analyses irrespective of their methodological quality, and the impact of quality on pooled effect size was examined by subgroup analysis.

RESULTS

The meta-analysis pooled data from 91 studies comprising 88 320 participants (mean age 38.88 years; 60.66% females) from 36 countries. The pooled estimated mean of fear of COVID-19 was 13.11 (out of 35), using the Fear of COVID-19 Scale. The associations between fear of COVID-19 and mental health-related factors were mostly moderate (Fisher's z = 0.56 for mental health-related factors; 0.54 for anxiety; 0.42 for stress; 0.40 for depression; 0.29 for sleep problems and -0.24 for mental well-being). Methodological quality did not affect these associations.

CONCLUSIONS

Fear of COVID-19 has associations with various mental health-related factors. Therefore, programmes for reducing fear of COVID-19 and improving mental health are needed.

Anxiety, Depression and Burnout Levels of Turkish Healthcare Workers at the End of the First Period of COVID-19 Pandemic in Turkey

OBJECTIVE

COVID-19 pandemic affected the mental health of healthcare workers (HCWs) as well as their physical health. In this study, we aimed to evaluate the anxiety, depression and burnout levels of Turkish HCWs after the first period of the pandemic.

METHODS

The participants filled sociodemographic data form, Hospital Anxiety and Depression Scale (HADS) and Maslach Burnout Inventory (MBI).

RESULTS

In this study, 221 HCWs (68.8% female) with a median age of 28 (20-66) years were included. Concerning HADS cut-off points, 39.8% of the participants scored above the depression cut-off point, while 26.2% scored above the cut-off point for anxiety. The anxiety (HADS-A) and depression (HADS-D) scores of nurses and medical secretaries were significantly higher than the physicians. Also, the anxiety and depression rates of nurses were higher than both physicians and medical secretaries. Emotional exhaustion (MBI-EE) and depersonalization (MBI-D) scores were highest in nurses, followed by medical secretaries and physicians, respectively. In multivariate analysis, being a nurse (OR: 4.671, p = 0.044) or medical secretary (OR: 4.013, p = 0.048), requirement of using a mental health support line (OR: 4.641, p = 0.005), having any kind of addiction (OR: 2.562, p = 0.019) and being under antidepressant therapy (OR: 3.096, p = 0.036) significantly increased the risk of anxiety. However, in multivariate analyses, the only requirement of using a mental health support line significantly increased the risk of depression (OR: 8.542, p = 0.001).

CONCLUSION

Female HCWs, nurses and medical secretaries experienced higher levels of mental health symptoms than male HCWs and physicians.

Reliability and validity of the Pittsburgh Sleep Quality Index among frontline COVID-19 health care workers using classical test theory and item response theory

STUDY OBJECTIVES

The applicability of sleep-related scales to frontline medical staff for the COVID-19 pandemic has not been fully proved, so sleep survey results lack credibility and accuracy, creating difficulties for the guidance and treatment of frontline medical staff with sleep disorders, which is not conducive to the prevention and control of COVID-19. This study sought to analyze the reliability and validity of the Pittsburgh Sleep Quality Index (PSQI) among frontline medical staff fighting the COVID-19 pandemic.

METHODS

A network questionnaire survey was used to investigate the PSQI among frontline medical staff who fought COVID-19 in Wuhan, China from March 19 to April 15, 2020. Combined with classical test theory and item response theory, the content validity, internal consistency, construct validity, and other aspects of the PSQI were evaluated.

RESULTS

According to classical test theory, content validity, criterion validity, and construct validity of the PSQI were good. But the internal consistency was better after the deletion of the "daytime dysfunction" subscale. With regard to item response theory, difficulty, the differential item function, and the Wright map performed well.

CONCLUSIONS

The original PSQI showed acceptable applicability in frontline COVID-19 medical staff, and its characteristics moderately improved after the "daytime dysfunction" subscale was removed.

CITATION

Wang L, Wu Y-X, Lin Y-Q, et al. Reliability and validity of the Pittsburgh Sleep Quality Index among frontline COVID-19 health care workers using classical test theory and item response theory. J Clin Sleep Med. 2022;18(2):541-551.

Evaluation of alarm fatigue of nurses working in the COVID-19 Intensive Care Service: A mixed methods study

AIMS AND OBJECTIVES

To reveal the existence of alarms in COVID-19 intensive care units, where medical devices with alarm function are frequently used, the effects of alarms on nurses, especially their on-the-job performances and social lives, and their coping methods.

METHODOLOGY/METHODS

This was a mixed design, including descriptive and qualitative research methods with two stages, and was carried out between March and April 2021. The study adhered to the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies.

SETTING

Nurses in the COVID-19 intensive care unit of a university hospital constituted the sample. 58 nurses participated in the quantitative data phase, and 18 nurses in the qualitative interviews.

RESULTS

More than half of the nurses worked in the COVID-19 intensive care unit for more than 5 months and overtime, and 87.9 had day and night shifts. The monthly income level of 65.5% was between the hunger and poverty lines, and 12.1 % received psychiatric support in the last 6 months. A positive and significant relationship was found between the mean score obtained from the alarm fatigue questionnaire and the level of discomfort felt due to the alarms (1-10 points) (p = 0.001). Five themes and thirty sub-themes were emerged in the focus group interviews.

CONCLUSION

The number of alarms of the medical devices in the COVID-19 intensive care units was more than the other intensive care units, resulting in fatigue in nurses. Since alarm fatigue is directly related to patient safety, the effective management of medical device alarms can reduce alarm fatigue and prevent potentially dangerous outcomes.

RELEVANCE TO CLINICAL PRACTICE

Nurses care for patients with severe clinical conditions in COVID-19 intensive care units. This situation caused them to be exposed to more alarms. Nurses should make efforts to reduce their alarm intensity.

Trazodone Add-on in COVID-19-related Selective Serotonin Reuptake Inhibitor-resistant Post-traumatic Stress Disorder in Healthcare Workers: Two Case Reports

COVID-19 represents a significant stress factor for all people worldwide due to several factors, including quarantine, lockdowns, fear of contagion, deaths, and other traumatic events. However, the healthcare workers (HCWs) have paid the higher price of this pandemic in terms of fatalities, contagions, and psychological well-being. Studies suggest that this particular population is at increased risk of developing a severe post-traumatic stress disorder (PTSD). The early diagnosis and timely treatment of PTSD in HCWs may restore well-being and significantly impact health services functioning, reducing burnout, days spent far from work, disrupted personal and team empowerment, and worse job performances. In the present article, we reported on two cases of HCWs directly involved in the treatment of COVID-19 patients who showed selective serotonin reuptake inhibitor-resistant PTSD, which was successfully treated with extended-release trazodone TRZ Contramid^Ⓡ add-on.

Association of Moral Distress with Anxiety, Depression, and an Intention to Leave among Nurses Working in Intensive Care Units during the COVID-19 Pandemic

BACKGROUND

Wide geographical variations in depression and anxiety rates related to the ethical climate have been reported during the COVID-19 pandemic in intensive care units (ICUs). The objective was to investigate whether moral distress is associated and has predictive values for depression, anxiety, and intention to resign.

METHODS

79 consenting ICU nurses completed MMD-HP and PHQ-4 scales in this cross-sectional study between October 2020-February 2021, after ethical approval. The association between MMD-HP and PHQ-4, and the predictive value of MMD-HP for anxiety, depression, and an intention to leave were analyzed (linear regression and receiver operating characteristics curve analysis).

RESULTS

From MMD-HP items, system related factors had highest scores (Kruskal-Wallis test, p < 0.0001). MMD-HP and PHQ-4 were weakly correlated (r = 0.41 [0.21-0.58]). MMD-HP and its system-related factors discriminate between nurses with and without depression or anxiety, while system-related factors differentiate those intending to resign (p < 0.05). The MMD-HP score had 50 [37.54-62.46] sensitivity with 80.95 [60-92.33] specificity to predict the intention to leave, and 76.12 [64.67-84.73] sensitivity with 58.33 [31.95-80.67] specificity to detect anxiety or depression symptoms.

CONCLUSIONS

During the COVID-19 pandemic, system-associated factors seem to be the most important root factors inducing moral distress. Moral distress is associated with negative psychological outcomes.

A One-Year Prospective Study of Work-Related Mental Health in the Intensivists of a COVID-19 Hub Hospital

The COVID-19 pandemic has severely tested the physical and mental health of health care workers (HCWs). The various stages of the epidemic have posed different problems; consequently, only a prospective study can effectively describe the changes in the workers' health. This repeated cross-sectional study is based on a one-year investigation (spring 2020 to spring 2021) of intensive care physicians in one of the two COVID-19 hub hospitals in Central Italy and aims to study the evolution of the mental health status of intensivists during the pandemic. Changes in their work activity due to the pandemic were studied anonymously together with their perception of organisational justice, occupational stress, sleep quality, anxiety, depression, burnout, job satisfaction, happiness, and intention to quit. In May-June 2021, one year after the baseline, doctors reported an increased workload, isolation at work and in their social life, a lack of time for physical activity and meditation, and compassion fatigue. Stress was inversely associated with the perception of justice in safety procedures and directly correlated with work isolation. Occupational stress was significantly associated with anxiety, depression, burnout, dissatisfaction, and their intention to quit. Procedural justice was significantly associated with happiness. Doctors believed vaccinations would help control the problem; however, this positive attitude had not yet resulted in improved mental health. Doctors reported high levels of distress (73%), sleep problems (28%), anxiety (25%), and depression (64%). Interventions to correct the situation are urgently needed.

Prevalence of Insomnia in Various Industries and Associated Demographic Factors in Night-Shift Workers Using Workers' Specific Health Examination Data

This study aimed to investigate the prevalence of insomnia in various industries and the associated demographic factors. We searched the nationwide night-shift Workers’ Specific Health Examination (nsWSHE) data extracted in 2015 information on factors associated with insomnia, including sex, age, and the number of workers in the workplace. The prevalence of moderate insomnia in the total industry was 4.6%. Industries with a high prevalence of insomnia included the arts, sports, and recreation-related services industry, followed by the activities of household as employers industry, financial and insurance activities industry, human health and social welfare industry, and accommodation and food services activities industry. The prevalence of insomnia was higher in women. Age was a significant factor. In general, insomnia was highest among those aged ≥60 years. Insomnia was highest in small-sized companies with fewer than five employees compared to large enterprises with more than 1000 employees. This study is the first to analyze the prevalence of insomnia among night-shift workers who participated in the WSHEs. The findings of this study can be used to prioritize intervention policies for insomnia among night-shift workers.

Translation of the Fear of COVID-19 Scale into French-Canadian and English-Canadian and Validation in the Nursing Staff of Quebec

Introduction: During the COVID-19 pandemic, Quebec has been one of the most affected provinces in Canada. Rising fear of COVID-19 is inevitable among healthcare workers, and a new scale was developed to measure this type of fear, the Fear of COVID-19 Scale (FCV-19S). Aims: To translate the FCV-19S into French-Canadian and English-Canadian, and to validate both versions in the nursing staff from Quebec. Methods: A cross-sectional online survey was sent to approximately 15 000 nursing staff including nurses and licensed practical nurses among those who had consented to their respective Order to be contacted for research. The forward-backward method was used to translate the FCV-19S into French-Canadian and English-Canadian. Both versions along with stress and work-related questionnaires, were used to establish validity. Results: A total of 1708 nursing staff, with a majority of women, completed the survey (1517 and 191 completed the French-Canadian and English-Canadian versions). A unidimensional scale was confirmed for both versions with Cronbach alphas of 0.90 and 0.88. Discriminative values showed higher fear levels in women, and in generation X (40-56 years old). Higher fear levels were also found in nursing staff working in long-term care facilities, provided care to COVID-19 patients who died, and those who felt less prepared to provide safe care. Convergent associations were found between fear levels, stress, work satisfaction, and turnover intention. Discussion and conclusion: A rigorous approach was used to translate the fear of COVID-19 scale into French-Canadian and English-Canadian. Both Canadian versions of the FCV-19S supported a valid unidimensional scale in Quebec nursing staff.

Burnout in Intensive Care Unit Workers during the Second Wave of the COVID-19 Pandemic: A Single Center Cross-Sectional Italian Study

The COVID-19 pandemic had a massive impact on the Italian healthcare systems, which became overwhelmed, leading to an increased risk of psychological pressure on ICU workers. The present study aimed to investigate the prevalence of distress (anxiety, depression and insomnia symptoms), burnout syndrome and resilience in healthcare workers during the COVID-19 pandemic and to detect potential factors associated with their psychological response. This cross-sectional, survey-based study enrolled 136 healthcare workers assisting COVID-19 patients in the new COVID-19 ward (Intensive Care Unit), at Milano Fiera, Lombardy. Participants completed an online survey that comprised different validated and standardized questionnaires: Maslach Burnout Inventory (MBI), Resilience Scale for adults (RSA), Hospital Anxiety and Depression scale (HADS) and Insomnia Severity Index (ISI). Socio-demographic and work characteristics were also collected. Out of 136 ICU specialists, there were 84 nurses (62%) and 52 physicians (38%). Over half (60%) met the criteria for burnout, with nearly the same percentages among nurses and physicians. Nurses reported significantly higher scores of anxiety and insomnia levels. Forty-five percent of participants reported symptoms of depression (of whom 13.9% in the clinical range) and most of the staff showed moderate to high levels (82.4%) of resilience. The COVID-19 pandemic can have a significant impact on ICU staff. Effective interventions are needed to maintain healthcare professionals' mental health and relieve burnout. Follow-up and tailored procedures should be provided to alleviate the psychological burden in the frontline staff at highest risk.

Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis

BACKGROUND

The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress.

METHODS

Five academic databases (Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644.

FINDINGS

168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively.

INTERPRETATION

Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced.

FUNDING

The present study received no funding.

COVID-19 Fear Level of Surgical Nurses Working in Pandemic and Surgical Units

Purpose

Nurses who care for COVID-19 patients are more likely to be affected psychologically than nurses who do not, and reactions such as increased fear may lead to psychological problems among nurses. The aim of this study was to determine the COVID-19 fear level of surgical nurses by using the Fear of COVID-19 Scale.

Design

A descriptive and cross-sectional study.

Methods

Totally, 202 surgical nurses who take care of suspected or infected COVID-19 patients working in pandemic and surgical units of a university hospital were included in the study. For data collection, “Nurse Characteristics Form” and “Fear of COVID-19 Scale” were used. Study data was analyzed with the descriptive statistics, Mann-Whitney U test, Spearman Correlation test.

Findings

The mean total COVID-19 fear score of the nurses was 25.09 ± 7.29 (min: 7, max: 35) and nurses who received training related to COVID-19 had statistically lower fear than those who did not (U = 3773.500; P= .027). Losing a patient because of COVID-19, being older and experienced in nursing significantly affected the total fear score of nurses (respectively, U = 3899.000; P= .004; r_s = 0.152; P = .031, r_s = 0.205; P = .003).

Conclusions

Surgical nurses have a moderate level of COVID-19 fear and it is recommended to conduct appropriate on-line training programs to develop psychological support strategies.

Experiences and management of physician psychological symptoms during infectious disease outbreaks: a rapid review

BACKGROUND

Prior to the COVID-19 pandemic, physicians experienced unprecedented levels of burnout. The uncertainty of the ongoing COVID-19 pandemic along with increased workload and difficult medical triage decisions may lead to a further decline in physician psychological health.

METHODS

We searched Medline, EMBASE, and PsycINFO for primary research from database inception (Medline [1946], EMBASE [1974], PsycINFO [1806]) to November 17, 2020. Titles and abstracts were screened by one of three reviewers and full-text article screening and data abstraction were conducted independently, and in duplicate, by three reviewers.

RESULTS

From 6223 unique citations, 480 articles were reviewed in full-text, with 193 studies (of 90,499 physicians) included in the final review. Studies reported on physician psychological symptoms and management during seven infectious disease outbreaks (severe acute respiratory syndrome [SARS], three strains of Influenza A virus [H1N1, H5N1, H7N9], Ebola, Middle East respiratory syndrome [MERS], and COVID-19) in 57 countries. Psychological symptoms of anxiety (14.3-92.3%), stress (11.9-93.7%), depression (17-80.5%), post-traumatic stress disorder (13.2-75.2%) and burnout (14.7-76%) were commonly reported among physicians, regardless of infectious disease outbreak or country. Younger, female (vs. male), single (vs. married), early career physicians, and those providing direct care to infected patients were associated with worse psychological symptoms.

INTERPRETATION

Physicians should be aware that psychological symptoms of anxiety, depression, fear and distress are common, manifest differently and self-management strategies to improve psychological well-being exist. Health systems should implement short and long-term psychological supports for physicians caring for patients with COVID-19.