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Mavragani A, Duan Y, Slubik S, Estabrooks CA. Impact of the COVID-19 Pandemic on Health, Well-being, and Quality of Work-Life Outcomes Among Direct Care Nursing Staff Working in Nursing Home Settings: Protocol for a Systematic Review. JMIR Res Protoc 2023; 12:e40390. [PMID: 36853752 PMCID: PMC9976775 DOI: 10.2196/40390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Increased workload, lack of resources, fear of infection, and the suffering and loss of residents have placed a significant emotional burden on regulated and unregulated direct care nursing staff (eg, registered nurses, licensed practical nurses, and care aides) in nursing homes (residential long-term care homes). Psychological distress and burnout related to COVID-19 have been cited among direct care staff within nursing homes. Studies have also emphasized the resilience of direct care staff, who, despite the significant challenges created by the pandemic, remained committed to providing quality care. To date, only one nursing home-specific review has synthesized evidence from 15 studies conducted early in the pandemic, which reported anxiety, posttraumatic stress disorder, and depression among direct care staff. OBJECTIVE The objectives of this systematic review are to (1) synthesize all empirical evidence on the impact of the COVID-19 pandemic on direct care staffs' mental health, physical health, and work-life outcomes; (2) identify specific risks and protective factors; and (3) examine the effect of strategies or interventions that have been developed to improve these outcomes. METHODS We will include all study designs reporting objective or subjective measurements of direct care staffs' mental health, physical health, and quality of work-life in nursing home settings during the COVID-19 pandemic (January 2020 onward). We will search multiple databases (MEDLINE, CINAHL, Embase, Scopus, and PsycINFO) and gray literature sources with no language restrictions. Two authors will independently screen, assess data quality, and extract data for synthesis. Given the heterogeneity in research designs, we will use multiple data synthesis methods that are suitable for quantitative and qualitative studies. RESULTS As of December 2022, full text screening has been completed and data extraction is underway. The expected completion date is June 30, 2023. CONCLUSIONS This systematic review will uncover gaps in current knowledge, increase our understanding of the disparate findings to date, identify risks and factors that protect against the sustained effects of the pandemic, and elucidate the feasibility and effects of interventions to support the mental health, physical health, and quality of work-life of frontline nursing staff. This study will inform future research exploring how the health care system can be more proactive in improving quality of work-life and supporting the health and psychological needs of frontline staff amid extreme stressors such as the pandemic and within the wider context of prepandemic conditions. TRIAL REGISTRATION PROSPERO CRD42021248420; https://tinyurl.com/4djk7rpm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40390.
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Affiliation(s)
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Sydney Slubik
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Arble E, Manning D, Arnetz BB, Arnetz JE. Increased Substance Use among Nurses during the COVID-19 Pandemic. Int J Environ Res Public Health 2023; 20:2674. [PMID: 36768040 PMCID: PMC9915151 DOI: 10.3390/ijerph20032674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
There is growing evidence that the COVID-19 pandemic has had a severe impact on the nursing profession worldwide. Occupational strain has disrupted nurses' emotional wellbeing and may have led to negative coping behaviors, such as increased substance use, which could impair cognitive functioning. The aim of this study was to examine whether increased substance use in a sample of U.S. nurses during the pandemic was related to greater workplace cognitive failure. An online questionnaire was administered in May 2020 to Michigan nurses statewide via three nursing organizations (n = 695 respondents). A path model was used to test the direct effects of reported increased substance use on workplace cognitive failure and via parallel psychological mediators. The model had excellent fit to the observed data, with statistically significant, unique mediating effects of greater symptoms of anxiety (b = 0.236, z = 2.22, p = 0.027), posttraumatic stress disorder (b = 0.507, z = 4.62, p < 0.001) and secondary trauma (b = 1.10, z = 2.82, p = 0.005). Importantly, the direct effect of increased substance use on workplace cognitive failure was not statistically significant independent of the mediators (b = 0.133, z = 0.56, p = 0.576; 95% confidence interval: -0.33, 0.60). These results point to the importance of further delineating the mechanistic pathways linking adverse stress to workplace cognitive failure. As we emerge from the pandemic, healthcare systems should focus resources on supporting cognitive health by addressing the psychological and emotional welfare of nurses, many of whom may be struggling with residual trauma and increased substance use.
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Affiliation(s)
- Eamonn Arble
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI 48197, USA
| | - Dana Manning
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI 48197, USA
| | - Bengt B. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Judith E. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
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Lev S, Dolberg P. "You Killed the Hospital, They Have No Place Left": The Experience of Nursing Home Multidisciplinary Staff in Israel during the COVID-19 Pandemic. J Aging Soc Policy 2022:1-21. [PMID: 35946925 DOI: 10.1080/08959420.2022.2111167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/02/2022] [Indexed: 10/15/2022]
Abstract
The purpose of the present study is to examine how multidisciplinary staffs experienced and coped with the COVID-19 pandemic crisis in nursing homes. The research included six in-depth online focus groups consisting of 21 multidisciplinary staff members from 14 Israeli nursing homes. The qualitative analysis was encoded in stages with repeated comparisons between individual participants and within groups and led to four main themes: (a) Multidisciplinary staff perceptions of nursing home management's performance in relation to them, which was experienced as insufficient appreciation and feelings of abandonment among the non-medical staff; (b) Multidisciplinary staff perceptions of the Ministry of Health's performance, which was experienced as chaotic and disconnected albeit supportive on the personal level; (c)The nursing home multidisciplinary staff experience during the COVID-19 pandemic, in terms of perceived stress and burnout, as well as development of a routine; (d) The multidisciplinary staff's coping strategies, which included commitment to work despite risk, redefinition of their role, and staff insights about the need to take responsibility for their role and not rely on outside help. The findings indicate the importance of relationships that promote support and mutual communication between multidisciplinary staff, and both nursing home management and Ministry of Health.KEY POINTS Nursing home multidisciplinary staff experienced disconnection from and abandonment by nursing home management and Ministry of Health during the Covid-19 pandemic.Nursing home multidisciplinary staff experienced stress and burnout but also developed a routine.Despite intensified negative emotional feelings, multidisciplinary staff also underwent processes of redefining their role and gaining greater independence.Findings indicate the importance of creating a climate that facilitates mutual sharing, listening and learning.
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Affiliation(s)
- Sagit Lev
- School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
| | - Pnina Dolberg
- Department of Social Work, Ruppin Academic Center, Emek- Hefer, Israel
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Hering C, Gangnus A, Budnick A, Kohl R, Steinhagen-Thiessen E, Kuhlmey A, Gellert P. Psychosocial burden and associated factors among nurses in care homes during the COVID-19 pandemic: findings from a retrospective survey in Germany. BMC Nurs 2022; 21:41. [PMID: 35139842 PMCID: PMC8830035 DOI: 10.1186/s12912-022-00807-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background Care homes were hit hard by the COVID-19 pandemic. Although high levels of psychosocial burden (i.e., anxiety, depression and stress) during the pandemic have been described for healthcare workers in hospitals, evidence on the psychosocial burden for nurses in care homes during the pandemic is scarce. Methods A total of 811 nurses participated in a retrospective online survey between November 2020 and February 2021. Information about the COVID-19 situation (i.e., working demands, COVID-19 cases in their facility, and COVID-19-related burden) of nurses in German care homes during the first wave of the pandemic (March 2020 to June 2020) was gathered. The Stress Scale of the Depression Anxiety and Stress Scales (SDASS-21), the Generalized Anxiety Disorder Scale-2 (GAD-2), the Patients-Health-Questionnaire-2 (PHQ-2), and the Copenhagen Psychosocial Questionnaire (COPSOQ) were used to screen for psychosocial burden. Results Among nurses, 94.2% stated that working demands since the COVID-19 pandemic increased. Further, 59.1% showed clinically relevant levels of either stress, anxiety, and/or depression. Multiple regression analysis showed significant associations between COVID-19-related burden and qualification (p < .01), dissatisfaction with COVID-19 management of care home manager (p < .05), COVID-19-related anxiety (p < .001), and dementia as a focus of care (p < .05). Stress, depression, and anxiety showed associations with COVID-19 related burden at work (p < .01), COVID-19-related anxiety (p < .001), social support (p < .01), and sense of community (p < .05). Stress was also associated with COVID-19 cases among residents (p < .05), and size of care home (p < .05). Conclusion Short- and long-term strategies (i.e., psychosocial counseling, mandatory team meetings, more highly qualified nurses, additional training) in the work environment of nursing, in crises, but beyond, should be encouraged to reduce the burden on nursing staff in care homes. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00807-3.
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Affiliation(s)
- Christian Hering
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Germany, Virchowweg 22, 10117, Berlin, Germany.
| | - Annabell Gangnus
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Germany, Virchowweg 22, 10117, Berlin, Germany
| | - Andrea Budnick
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Germany, Virchowweg 22, 10117, Berlin, Germany
| | - Raphael Kohl
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Germany, Virchowweg 22, 10117, Berlin, Germany
| | | | - Adelheid Kuhlmey
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Germany, Virchowweg 22, 10117, Berlin, Germany
| | - Paul Gellert
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Germany, Virchowweg 22, 10117, Berlin, Germany
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Blanco‐Donoso LM, Moreno‐Jiménez J, Gallego‐Alberto L, Amutio A, Moreno‐Jiménez B, Garrosa E. Satisfied as professionals, but also exhausted and worried!!: The role of job demands, resources and emotional experiences of Spanish nursing home workers during the COVID-19 pandemic. Health Soc Care Community 2022; 30:e148-e160. [PMID: 34013986 PMCID: PMC8239566 DOI: 10.1111/hsc.13422] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 05/07/2023]
Abstract
Nursing home workers have been exposed to great physical and mental burdens during the COVID-19 pandemic. Although this has generated high levels of exhaustion, it may also have contributed to feelings of professional satisfaction. The objective of this study was to explore the levels of satisfaction among nursing home workers during the COVID-19 pandemic, as well as the role of job demands, resources and emotional experiences in explaining their levels of satisfaction. This cross-sectional study was conducted in Spain between March and May 2020. Three hundred and thirty-five nursing home workers participated. A quantitative analysis was conducted, as was a content analysis of the responses to an open-ended question about the respondents' perceptions of job demands and resources during the crisis. The results showed that workers had very high levels of satisfaction. Social pressure from work, contact with death and suffering, and emotional exhaustion were negatively associated with satisfaction. Moreover, under conditions of extensive contact with suffering people and great fear of contagion, social support at work was shown to promote professional satisfaction. In conclusion, nursing home workers in Spain experienced high rates of satisfaction during the COVID-19 crisis despite the high job demands, lack of job resources, fear of contagion and exhaustion. The main practical implication of this study is the importance of ensuring optimal working conditions in the nursing home sector in order to guarantee professional satisfaction, prevent burnout, reduce turnover and promote post-crisis resilience.
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Affiliation(s)
| | | | | | - Alberto Amutio
- Social PsychologyFaculty of Labor Relations and Social WorkUniversity of the Basque Country (UPV/EHU)BilbaoSpain
- Facultad de Educación y Ciencias SocialesUniversidad Andres BelloSantiagoChile
| | | | - Eva Garrosa
- Faculty of PsychologyAutonomous University of MadridMadridSpain
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Martín J, Padierna Á, Villanueva A, Quintana JM. Evaluation of the mental health of care home staff in the Covid-19 era. What price did care home workers pay for standing by their patients? Int J Geriatr Psychiatry 2021; 36:1810-1819. [PMID: 34251057 PMCID: PMC8420212 DOI: 10.1002/gps.5602] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The characteristics of this pandemic increase the potential psychological impact on care homes workers (CHWs). The aims of this study were to analyse the mental health and health-related quality of life (HRQoL) of a broad sample of CHWs in Spain and to identify potential factors that have a significant effect on their mental health and HRQoL. METHOD This descriptive study comprised 210 CHWs who completed the Generalized Anxiety Disorder 7-item Scale, the Patient Health Questionnaire-9, the Impact Event Scale-Revised, the Insomnia Severity Index, and the Health-related Quality of Life Questionnaire. Sociodemographic and clinical data in relation to COVID-19 were also recorded. Descriptive statistics, univariable analysis and multivariable linear regression models were applied to identify factors associated with mental health and HRQoL. RESULTS Of total, 86.19% of participants were female; 86.67% were aged under 55 years; 11% were physicians and 64.19% were nurses or auxiliaries; 77.62% have themselves tested positive for Covid-19; and 67.94% of CHWs have directly treated patients with Covid-19. 49.28% had clinical depression; over half (58.57%) had clinical anxiety; 70.95% had clinical stress; and 28.57% had clinical insomnia. Increased use of tranquilizers/sedatives appears to be an explanatory variable of suffering greater anxiety, depression, stress and insomnia, and of having a worse HRQoL amongst our CHWs. CONCLUSIONS Our study confirms that symptomatology of anxiety, depression, stress, insomnia and HRQoL were affected amongst CHWs during the Covid-19 pandemic.
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Affiliation(s)
- Josune Martín
- Research UnitGaldakao‐Usansolo HospitalGaldakaoSpain,Kronikgune Institute for Health Services ResearchBarakaldoSpain,Health Services Research on Chronic Diseases Network—REDISSECGaldakaoSpain
| | - Ángel Padierna
- Department of PsychiatryGaldakao‐Usansolo HospitalGaldakaoSpain
| | - Ane Villanueva
- Research UnitGaldakao‐Usansolo HospitalGaldakaoSpain,Kronikgune Institute for Health Services ResearchBarakaldoSpain
| | - José M. Quintana
- Research UnitGaldakao‐Usansolo HospitalGaldakaoSpain,Health Services Research on Chronic Diseases Network—REDISSECGaldakaoSpain
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Salerno S, Sun Y, Morris EL, He X, Li Y, Pan Z, Han P, Kang J, Sjoding MW, Li Y. Comprehensive evaluation of COVID-19 patient short- and long-term outcomes: Disparities in healthcare utilization and post-hospitalization outcomes. PLoS One 2021; 16:e0258278. [PMID: 34614008 PMCID: PMC8494298 DOI: 10.1371/journal.pone.0258278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Understanding risk factors for short- and long-term COVID-19 outcomes have implications for current guidelines and practice. We study whether early identified risk factors for COVID-19 persist one year later and through varying disease progression trajectories. METHODS This was a retrospective study of 6,731 COVID-19 patients presenting to Michigan Medicine between March 10, 2020 and March 10, 2021. We describe disease progression trajectories from diagnosis to potential hospital admission, discharge, readmission, or death. Outcomes pertained to all patients: rate of medical encounters, hospitalization-free survival, and overall survival, and hospitalized patients: discharge versus in-hospital death and readmission. Risk factors included patient age, sex, race, body mass index, and 29 comorbidity conditions. RESULTS Younger, non-Black patients utilized healthcare resources at higher rates, while older, male, and Black patients had higher rates of hospitalization and mortality. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss anemia were risk factors for these outcomes. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss were associated with lower discharge and higher inpatient mortality rates. CONCLUSIONS This study found differences in healthcare utilization and adverse COVID-19 outcomes, as well as differing risk factors for short- and long-term outcomes throughout disease progression. These findings may inform providers in emergency departments or critical care settings of treatment priorities, empower healthcare stakeholders with effective disease management strategies, and aid health policy makers in optimizing allocations of medical resources.
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Affiliation(s)
- Stephen Salerno
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Yuming Sun
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Emily L. Morris
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Xinwei He
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Yajing Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Ziyang Pan
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Peisong Han
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Jian Kang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Michael W. Sjoding
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
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Berardelli I, Vaia A, Pompili M. Thoughts of Death, Depression and Guilt in a Healthcare Worker Who Infected Her Husband with SARS-CoV-2: A Case Report. CNS Neurol Disord Drug Targets 2020; 20:385-388. [PMID: 33357200 DOI: 10.2174/1871527319666201223155533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/05/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The worldwide spread of the novel coronavirus (SARS-CoV-2) has exposed healthcare workers (HCWs) to physical and mental disorders both directly and indirectly related to the pandemic. Italy was the first European country affected by the SARS-CoV-2 pandemic, and Italian HCWs have presented adverse psychological outcomes related to work and emotional overload and the fears of becoming infected and infecting others, particularly loved ones. CASE PRESENTATION We report the case of a 61-year-old HCW who likely infected her husband with SARS-CoV-2, leading to his death. We assessed the depressive and anxious symptoms that the patient experienced after the death of her husband, which were characterized by a deep sense of guilt, psychological pain, and thoughts of death. CONCLUSION In our opinion, our case emphasizes the fact that HCWs need greater mental health assistance, particularly those who are heavily involved in the care of patients and who have possible risk factors for psychiatric symptoms.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio Vaia
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Liu Y, Long Y, Cheng Y, Guo Q, Yang L, Lin Y, Cao Y, Ye L, Jiang Y, Li K, Tian K, A X, Sun C, Zhang F, Song X, Liao G, Huang J, Du L. Psychological Impact of the COVID-19 Outbreak on Nurses in China: A Nationwide Survey During the Outbreak. Front Psychiatry 2020; 11:598712. [PMID: 33362609 PMCID: PMC7759517 DOI: 10.3389/fpsyt.2020.598712] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/05/2020] [Indexed: 02/05/2023] Open
Abstract
Background: The COVID-19 pandemic is a major public health issue and challenge to health professionals. In similar epidemics, nurses experienced more distress than other providers. Methods: We surveyed both on-duty nurses caring for infected patients and second-line nurses caring for uninfected patients from Hubei and other provinces throughout China. Results: We received completed surveys from 1,364 nurses from 22 provinces: 658 front-line and 706 second-line nurses. The median (IQR) GHQ-28 score of all nurses was 17 (IQR 11-24). The overall incidence of mild-to-moderate distress (GHQ score > 5) was 28%; that for severe distress (GHQ score > 11) was 6%. The incidence of mild-to-moderate distress in the second-line nurses was higher than that in the front-line nurses (31 vs. 25%; OR, 0.74; 95 CI, 0.58-0.94). Living alone (OR, 0.62; 95% CI, 0.44-0.86) and feeling supported (OR, 0.82, 95% CI, 0.74-0.90) independently predicted lower anxiety. Conclusions: During the COVID-19 pandemic, the psychological problems of all nurses were generally serious. The interviewed second-line nurses face more serious issues than the front-line nurses.
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Affiliation(s)
- Yan Liu
- Emergency Department of West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Institute of Disaster Medicine, Sichuan University, Chengdu, China
| | - Youlin Long
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yifan Cheng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qiong Guo
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Liu Yang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yifei Lin
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Cao
- Institute of Disaster Medicine, Sichuan University, Chengdu, China.,Department of Emergency, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Ye
- Emergency Department of West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Institute of Disaster Medicine, Sichuan University, Chengdu, China
| | - Yan Jiang
- Nursing Department, West China Hospital, Sichuan University, Chengdu, China
| | - Ka Li
- West China School of Nursing, Sichuan University, Chengdu, China.,West China Hospital, Sichuan University, Chengdu, China
| | - Kun Tian
- Neuro-Intensive Care Unit, Affiliated Hospital of Chifeng University, Chifeng, China
| | - Xiaoming A
- Emergency Intensive Care Unit, The First People's Hospital of Yunnan Province/The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Cheng Sun
- Department of Cardiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Fang Zhang
- Department of Rheumatology and Immunology, Union Hospital Affiliated With Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoxia Song
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
| | - Ga Liao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jin Huang
- West China Hospital, Sichuan University, Chengdu, China
| | - Liang Du
- West China School of Medicine, Sichuan University, Chengdu, China.,West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, China
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