Psychological Responses and Strategies Towards the COVID-19 Pandemic Among Higher Education Students in Portugal and Switzerland: A Mixed-Methods Study

Background

The COVID-19 pandemic has caused overwhelming changes in individual and community daily-life, resulting from the public health measures implemented to contain it, and also from its psychological and socio-economic consequences. These shifts and consequences impacted the entire population, but some groups are more likely to be affected by these changes, including higher education students.

Objectives

a) to investigate mental health status and its determinants among higher-education students in Portugal and Switzerland; and b) to explore adjustment patterns used by these students to overcome the impact of the COVID-19 pandemic.

Methods

A cross-sectional study with a mixed-methods sequential explanatory design was conducted in two phases. First, an online survey was conducted among higher education students in Portugal and Switzerland, in Portuguese and French respectively. A convenience sampling method was used. Second, some participants from the first phase were invited to participate in four online focus group discussions (two in each country) using a maximum variation sampling method.

Results

The survey was answered by 1,880 students. Portuguese students revealed higher levels of stress and anxiety, but lower depression symptoms and less resilient coping compared to Swiss respondents. Hope was identified as an explanatory variable for mental health symptoms in students from both countries. In the focus groups (n = 27), 13 adjustment strategies were found, which were subdivided into three spheres: personal, social, and contextual.

Conclusions

The results suggest that the COVID-19 pandemic had a mild to moderate impact on most of the evaluated mental health variables. Nevertheless, the students reacted and mobilized positive short-term strategies, which need to be reinforced in order to prevent long-term psychological harm. In addition, our results can inform psychosocial interventions to minimize psychological impact, anxiety, depression, and stress due to sanitary crises or other population-wide problems or disasters.

Positive Mental Health Literacy: A Concept Analysis

Background

The positive component of Mental Health Literacy (PMeHL) refers to a person’s awareness of how to achieve and maintain good mental health. Although explored recently, the term still lacks a clear definition among healthcare practitioners.

Aim

To identify the attributes and characteristics of PMeHL, as well as its theoretical and practical applications.

Methods

Literature search (using the Medline and CINAHL databases) and review, covering the last 21 years, followed by concept analysis according to the steps described by Walker and Avant approach.

Results

Positive component of Mental Health Literacy is considered one component of MHL, integrating positive mental health. The concept’s attributes include: (a) competence in problem-solving and self-actualization; (b) personal satisfaction; (c) autonomy; (d) relatedness and interpersonal relationship skills; (e) self-control; and (f) prosocial attitude. Four case scenarios (model, borderline, related and contrary cases) were used to clarify the antecedents (individual factors and social/contextual factors) and consequences (individual sphere; relational/social sphere; contextual/organizational sphere) of PMeHL.

Conclusion

Positive component of Mental Health Literacy is considered a component of MHL, which deserves attention throughout the lifespan, in different contexts and intervention levels. Considering PMeHL as a multi-faceted and dynamic construct will help understand the mechanisms that improve mental health and promote healthy behaviors. Priority should be given to robust primary research focused on nursing interventions that enhance and sustain PMeHL in people and families.

Building Bridges for "Palliative Care-in-Place": Development of a mHealth Intervention for Informal Home Care

Background

In Palliative Care (PC), family and close people are an essential part of provision of care. They assume highly complex tasks for which they are not prepared, with considerable physical, psychological, social and economic impact. Informal Caregivers (ICs) often falter in the final stage of life and develop distress, enhancing emotional burden and complicated grief. The lack of available and accessible in-person counselling resources is often reported by ICs. Online resources can promote early access to help and support for patient-IC dyads in palliative care. The primary aim of this research is to co-design, develop and test the feasibility of the Help2Care-PAL mHealth app that addresses the needs of ICs of palliative patients cared for at home. This Digital Health Intervention (DHI) in palliative care will be used for education, symptom management, communication and decision-making, to enhance Quality of Life (QoL) of patients and ICs, fostering anticipatory grief and the reach and efficiency of services.

Methods

This study will use an iterative co-design process and convergent mixed-methods design, following the MORECare consensus for developing a complex intervention. Construction of the DHI will follow four main phases: (I) a needs assessment (a cross-sectional survey, individual interviews with ICs and focus groups with professionals with community palliative care experience); (II) design and co-production of mHealth materials and interventions to support ICs; (III) the development of a mHealth app; and (IV) usability and feasibility of the mHealth app. The Help2Care-PAL platform seeks to build resources from the perspectives and needs of both family dyads and nursing professionals working in the field of community palliative care. User-centeredness will be ensured by the active participation of patient-IC dyads and professionals of the palliative care community.

Discussion

This mixed-method study will offer new insights on needs and expectations of patient-IC dyads and nurses in community palliative care regarding caregiving preparedness and online health resources. Through the implementation of an adaptive digital tool, we aim to improve access to palliative care family support, which is highly linked with the wellbeing of patients and especially new ICs.

Family bereavement care interventions during the COVID-19 pandemic: a scoping review protocol

INTRODUCTION

The COVID-19 pandemic has caused significant disruptions to daily social routines and to the lived experience of bereaved families. This article outlines the protocol for a scoping review of published studies to evaluate psychosocial and psychotherapeutic interventions intended to help family carers adjust to grief, loss and bereavement due to COVID-19. This review addresses one broad research question: 'What do we know about bereavement support interventions for family carers of COVID-19 victims?'

METHODS AND ANALYSIS

The seminal framework by Arksey and O'Malley will guide the review process, which will cover both the qualitative and quantitative scientific literature on grief support during COVID-19. We will search for relevant studies in several databases, namely PubMed, Web of Science, CINAHL Complete, PsycINFO, Scopus and Directory of Open Access Journals. Moreover, we will search the reference lists of included studies and grey literature sources. The database search will be limited to studies from February 2020 (first death by COVID-19) to 1 January 2022. Only literature written in English, Portuguese and Spanish shall be included. Two independent reviewers will screen the literature, select articles and extract data, in an iterative process. Any disagreements will be solved through consensus-based discussion. Results will be reported with descriptive statistics, accompanied by a thematic analysis.

ETHICS AND DISSEMINATION

The study will use information acquired from previously published papers and hence does not require ethical approval. This protocol is registered with the Open Science Framework (https://osf.io/bw7fn/). Scoping results will be disseminated via posters and oral presentations to both academic and clinical audiences, as well as through peer-reviewed journals.

Psychometric Properties of the European Portuguese Version of the Memorial Emergency Department Fall Risk Assessment Tool

Falls are a public health problem that cause serious damage to people’s health and health systems. This study aims to estimate the validity and reliability of the Memorial Emergency Department Fall Risk Assessment Tool for the European Portuguese population. The sample included 186 adults from an emergency department of a District Hospital in Portugal. Reliability and precision (inter-rater reliability) are assessed by two independent raters. The relationship between MEDFRAT and the Morse Fall Risk Scale is evaluated. All items presented a high Kappa index. The MEDFRAT showed a high and significant correlation with the Morse Fall Risk Scale. The influence of sociodemographic and clinical data was also checked. The MEDFRAT is adequate, valid and reliable for the European Portuguese population to assess the risk of falling of emergency department patients.

Coaching as a Model for Facilitating the Performance, Learning, and Development of Palliative Care Nurses

Palliative care nurses experience huge pressures, which only increased with coronavirus disease 2019 (COVID-19). A reflection on the new demands for nursing care should include an evaluation of which evidence-based practices should be implemented in clinical settings. This paper discusses the impacts and challenges of incorporating coaching strategies into palliative care nursing. Evidence suggests that coaching strategies can foster emotional self-management and self-adjustment to daily life among nurses. The current challenge is incorporating this expanded knowledge into nurses’ coping strategies. Coaching strategies can contribute to nurses’ well-being, empower them, and consequently bring clinical benefits to patients, through humanized care focused on the particularities of end-of-life patients and their families.

Mental Health and Psychological Impact during COVID-19 Pandemic: An Online Survey of Portuguese Higher Education Students

The COVID-19 pandemic has had significant psychological impact on vulnerable groups, particularly students. The present study aims to investigate the mental and psychological impact of the COVID-19 pandemic and associated factors in a sample of Portuguese higher education students. An online cross-sectional study was conducted among 1522 higher education students selected by convenience sampling. The survey assessed mental health symptoms as well as sociodemographic variables, health-related perceptions, and psychological factors. Results were fitted to binary and multivariable logistic regression models. The overall prevalences of stress, anxiety, and depression were 35.7%, 36.2%, and 28.5%, respectively. Poor mental health outcomes were related with being female, having no children, living with someone with chronic disease, facing hopelessness, and lacking resilient coping. Future studies focusing on better ways to promote mental health and wellbeing among students are warranted. It is necessary to gather more evidence on the post-pandemic mental health using robust study designs and standardized assessment tools.

Digital Storytelling: Art-Based Pedagogy to Improve Professional Development for Nurses

Digital storytelling (DST) is a collaborative and participatory art-based approach based on experiential narratives. This column provides strategies and tips for using DST. As part of continuing education, DST training should provide information about health care experiences to enhance learning for nurses. The use of DST can foster self-knowledge and professional identity. [J Contin Educ Nurs. 2021;52(10):454-456.].

Evaluation of an e-health platform for informal caregivers and health professionals: the case study of Help2Care

The Help2Care e-Health platform was developed in order to capacitate informal caregivers with digital, multimedia training materials. Health professionals select these materials according to the needs of the homebound patients under the supervision of these caregivers. In turn, caregiver can then use their smartphones to consult and apply the care procedures illustrated by these materials. In this paper, we present the results of performed usability tests for both web and mobile software applications of the Help2Care platform. These indicate an overall positive outcome, revealing less usable aspects such as the navigation flow in the web application and some design elements in the mobile application. Important written feedback was also collected, which we took into consideration to improve the software features of the platform.

Therapeutic letters: A qualitative study exploring their influence on the hope of parents of children receiving pediatric palliative care in Portugal

PURPOSE

The purpose of this qualitative descriptive study was to explore the hope experiences of parents of children diagnosed with complex chronic conditions (CCCs) who received therapeutic letters.

DESIGN AND METHODS

A purposive sample of 10 parents of inpatient children with CCCs was recruited from a pediatric palliative care unit in a Portuguese public hospital. A demographic form and audio-recorded semi-structured, face-to-face interviews were conducted with each participant to explore the experiences, processes, and meanings of hope, and to describe how parents of children receiving pediatric palliative care perceived the usefulness of receiving therapeutic letters. The interviews were transcribed verbatim, and using a thematic analysis, a systematic approach to data analysis was completed.

FINDINGS

Data analysis resulted in three main themes including Trust in the Future; Strengthening Hope; and Moments of Hope. Findings highlight the positive influence of therapeutic letters including supporting parental hope, facilitating personal inner-strengthening, recognition of parental skills, and promotion of self-efficacy during hospitalization. The themes and related subthemes add value to the existing literature and highlight the need for supportive palliative nursing care aimed at promoting parental hope.

PRACTICE IMPLICATIONS

To optimize the value of supporting parental hope, therapeutic letters can be delivered at the time of diagnosis, during times of celebration, and when learning the difficult tasks of daily childcare. Additional research can inform the development of a formal hope-based intervention to provide an evidence base from which to enhance the well-being of parental caregivers of children who have CCCs.

Psychological Impacts of the COVID-19 Pandemic Among Portuguese and Swiss Higher-Education Students: Protocol for a Mixed Methods Study

BACKGROUND

Higher-education students are particularly vulnerable to both everyday stressors and mental health problems. Public health emergencies may generate a range of unforeseen potential stressors for vulnerable individuals and communities. The current pandemic has apparently led to an increase in psychiatric symptoms among these students.

OBJECTIVE

The goal of this study is to characterize the psychological impact of the COVID-19 pandemic among Portuguese and Swiss higher-education students.

METHODS

This project will use a mixed methods sequential explanatory design in Portugal and Switzerland, with two consecutive phases. During Phase I, a quantitative study will assess the psychological responses of higher-education students during the COVID-19 pandemic. A convenience sampling method will be used for collecting information from students. The association between variables will be determined with univariable and multivariable analyses. During Phase II, qualitative data will be collected in order to understand the determinants of psychological stress and the strategies adopted by students as a result of the COVID-19 pandemic, as well as to identify their opinions and feelings about the teaching-learning process during quarantine. In this phase, participants will be selected using a maximum-variation sampling method. Data from focus group discussions will be coded and inductively analyzed using a thematic analysis approach. Finally, quantitative and qualitative results will be merged during interpretation to provide complementary perspectives.

RESULTS

This paper describes and discusses the protocol for this mixed methods study, which will be completed in December 2021. This study was formally approved by the local ethics committee (CE/IPLEIRIA/22/2020) in Portugal and authorized by the Swiss Association of Research Ethics Committees, swissethics (CER-VD-2020-02889).

CONCLUSIONS

This research can contribute to the development of teaching tools and methods that reinforce positive mental health strategies, hope, and adaptive coping among students, and to the development of a class on mental health interventions in the context of catastrophic and traumatic events. This project will also help government stakeholders as well as health and education professionals safeguard the psychological well-being of students facing an expanding COVID-19 pandemic.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/28757.

COVID-19 pandemic and its psychological impact among healthy Portuguese and Spanish nursing students

Few studies have explored the impacts of COVID-19 and lockdown on the mental health of undergraduate nursing students. This study aimed: a) to explore perceived stress among undergraduate nursing students in Portugal and Spain during the COVID-19 pandemic outbreak; and b) to analyze several COVID-19 related factors and psychological issues that may be associated with perceived stress. A cross-sectional study was conducted with a convenience sample of Portuguese and Spanish undergraduate nursing students (n=1075). The data gathered included demographic information, questions about COVID-19 related factors, and psychological issues. Data were analyzed using multiple logistic regression with a degree of significance at p<0.05. High perceived stress scores were found in 558 participants (51.9%). Students with high perceived stress most likely had a COVID-19 diagnosis in their household; their household income had been affected by the COVID-19 pandemic; experienced difficulty falling asleep or sleeping all night; consumed junk food in excess; neglected their appearance; felt headaches, stomach aches, and back pain; and lacked the patience or desire to exercise. Additionally, high perceived stress was negatively associated with life satisfaction. The results provide evidence that infectious diseases, such as COVID-19, may significantly influence mental health. Further research should explore the long-term psychological effects of the COVID-19 pandemic among nursing students.

Hope in palliative care nursing: concept analysis

BACKGROUND

Hope has long been considered essential to humans in several disciplines, nursing included. At the end-of-life, hope is a complex and dynamic emotion, and there have been different interpretations and conceptions of hope.

AIM

To develop hope in palliative care as an evidenced-based nursing concept: analyse its attributes, antecedents and consequences.

METHOD

This study follows Walker and Avant's concept analysis: (a) select a concept; (b) determine the aims or purposes of analysis; (c) identify as many uses of the concept as possible; (d) determine the defining attributes; (e) identify a model case; (f) identify borderline and contrary cases; (g) identify antecedents and consequences; and finally (h) define the empirical referents.

FINDINGS

Antecedents included symptom control, existential suffering, interpersonal relationships and the establishment of realistic goals. The synthetic attributes were a positive outcome expectancy and a process oriented towards the present and future. The concept's consequences were quality of life, survival, acceptance and a peaceful death.

CONCLUSION

This study revealed a strong history of publications on the subject. The analysis of attributes, antecedents and consequences of the concept of hope contributed to understanding its relevance to palliative care nursing and provided suggestions for effective interventions and future research.

Awareness and Attitudes towards Advance Care Directives (ACDs): An Online Survey of Portuguese Adults

(1) Background: Evidence shows that facilitated advance decisions can increase the number of meaningful and valid Advance Care Directives (ACDs) and improve the quality of care when End-Of-Life (EOL) is near. Little is known about the awareness and attitudes of Portuguese adults towards ACDs. The present study aims to assess the knowledge, attitudes, and preferences of a sample of Portuguese adults regarding EOL care decisions and ACDs. (2) Methods: A total of 1024 adults were assessed with an online cross-sectional survey collecting information on sociodemographic factors, knowledge, attitudes and preferences regarding advance decisions and EOL care. (3) Results: Participants had a mean age of 40.28 ± 11.41 years. Most were female and had a professional background related to healthcare. While 76.37% of participants had heard of ACDs, only a small percentage (2.34%) had actually ever made an ACD. Knowledge levels were weakly correlated with attitudes regarding ACDs (r = -0.344; p < 0.01). (4) Conclusions: Participants lacked a comprehensive understanding about ACDs, but revealed positive attitudes towards their use and usefulness. Further research can inform efforts to improve ACD engagement in this population. The discussion about ACDs should be part of health promotion education with a focus on planning for a comfortable and peaceful death.

Evidence-based practice a relevant piece to update knowledge in mental health nursing

Introduction

Web Journal Club as a collaborative learning method, is an effective method to enhance the knowledge base of nursing students, their presentation skills, problem-solving skills and ability to critically appraise literature.

Objectives

To describe the experience of a online journal club on education of MHN undergraduate students.

Methods

We implemented a journal club in the online classroom with a total of 24 portuguese undergraduate students enrolled in clinical training of MHN (sixth semester). Over a two-week period, five 2-hour online journal club sessions were conducted in April 2020. During each session, five journal articles were presented synchronously to a live online audience via the Zoom Classroom technology. After all sessions, students were invited by e-mail to complete an anonymous and voluntary online questionnaire via Google Forms.

Results

All students were all very positive about the journal club sessions and found the opportunity to discuss and reflect on practice issues in depth very helpful. They found the sessions supportive, they helped to bond the group, they learnt a great deal from each others experiences, and they felt that they gained in confidence as a group. Survey results also indicated that few participants experienced technical difficulties during sessions.

Conclusions

This pedagogical practice enhances gains in the various actors involved: 1) in students, contributing to their learning process and acquisition of competences, articulating research and clinical practice; and 2) lastly, even more indirectly, in people receiving care, since a evidence-based practice ensures safe and quality of nursing care delivery.

Personality and coping as gendered predictors of distress and well-being in nursing students

Introduction

Previous studies about relationship between personality factors and stress related processes mainly focus on relation between these factors and application of coping strategies.

Objectives

This study expanded previous research by examining the combined contribution of personality traits (NEO-FFI) and coping strategies (Brief COPE) in the prediction of stress, depressive symptoms, anxiety symptoms (DASS-21), and psychological well-being (WHO-5) among undergraduate nursing students.

Methods

This cross-sectional study was performed in 2017. Participants of this study were 75 nursing students (men=37, women=38) from one Portuguese School of Health Sciences. The students who agreed to participate filled out an informed consent. Then the questionnaires were administered in a random order to avoid order effects in the data.

Results

Regarding personality, women reported higher conscientiousness and agreeableness than men. There were no gender differences in coping. Among men, openness and agreeableness (inversely) and neuroticism predicted stress. In women, neuroticism and venting predicted stress. Regarding depression, conscientiousness and extraversion (inversely) and neuroticism were predictors for men, whereas neuroticism, self-blame, and denial were predictors for women. Conscientiousness and extraversion (inversely) and venting and denial predicted anxiety in men, as did neuroticism and venting in women. For well-being, conscientiousness and extraversion were predictors among men; neuroticism and seeking instrumental support (inversely) and extraversion were predictors among women. Personality traits dominated the prediction of distress and well-being in men, while both personality and coping were predictors in women.

Conclusions

These findings indicate that it is not the degree of each personality trait or coping strategy but the pattern of relationship between these phenomena and psychological outcomes that is of relevance. The results could inform gendered preventive and treatment interventions for college students.

Burden of the family caregivers of the person with mental illness in portugal: A cross sectional study

Introduction

The provision of mental health care should be promoted at the community level, in order to facilitate their recovery process. Thus, the people who care for these individuals go through a situational transition, as they have to play the role of Family Caregivers (FC).

Objectives

a) to characterize the FC burden of the person with Mental Illness; and b) to correlate FC overload with the variables age, gender, cohabitation, degree of kinship and level of education.

Methods

A cross-sectional correlational study was conducted. The sample consisted of FC who went to consultations and to the inpatient psychiatric unit of a portuguese hospital. Data were collected through a questionnaire which included sociodemographic data, the Lawton-Brody Index and the Zarit Burden Interview (ZBI).

Results

Of the 119 FC, 66.4% were female, with an average age of 53.8 years. 73.1% of FC cohabited with the person they care for, in which the majority was cared for by their child or spouse, 45.2% and 36.1%, respectively. It should also be noted that 71.4% felt the need for more support from health professionals. As for autonomy, 52% of the individuals cared for by FC were moderately dependent. It was verified that about 45% of the FC had an intense overload. Female gender has greater overload and that there are no significant differences between the level of education and cohabitation.

Conclusions

Considering the results, it is understood the importance of valuing FC, as a target and care partners, in order to reduce the burden, they feel when caring for people with MI.

Mental health in time of pandemics: Study protocol to incorporate risk and protective factors contributing to psychological stress among portuguese and swiss higher education students

Introduction

The ongoing COVID-19 pandemic is inducing fear, and a timely understanding of mental health status is urgently needed for society. Previous research has revealed a profound and wide range of psychosocial impacts on people at the individual, community, and international levels. On an individual level, people are likely to experience fear of falling sick or dying themselves, feelings of helplessness, and stigma. Currently, there is little understanding of mental well-being assessment under scenarios of pandemics that oblige to social isolation and quarantine.

Objectives

This study aims to: a) establish the prevalence of psychiatric symptoms; b) identify risk and protective factors contributing to psychological stress; and c) identify coping strategies to promote better adjustment during and after the pandemic crisis.

Methods

We will adopt a mixed-method approach, firstly with a cross-sectional survey design (in both Portugal and Swiss context) to assess the higher education student’s psychosocial response during and after the pandemic, by using an anonymous online questionnaire. In a 2nd phase, and in order to gain more insight into the psychological stress faced by the students as a result of pandemic, a qualitative approach was chosen, focusing on the experiences of the participants.

Results

This study has received ethical approval from both international and local institutional review boards. Data collection will start in November 2020 and will be completed at February 2021.

Conclusions

The findings of this study will provide important data to assist government agencies and healthcare professionals in safeguarding the psychosocial wellbeing of the community in the face of COVID-19 outbreak expansion.

Development and psychometric properties of the general public's attitudes toward advance care directives scale in Portugal

Background: To date, no instrument in Portugal has evaluated the attitudes of the population about advance care directives. This paper describes the development and testing of the General Public's Attitudes Toward Advance Care Directives (GPATACD) Scale. Design and Methods: Methodological study. The development of the instrument was based on a literature review, updated in 2018. Face and content validity were verified by an expert panel and piloted among six participants. Data were collected in an online survey of 1024 Portuguese adults. The obtained data were analyzed using Varimax rotation, while the reliability was evaluated by calculating Cronbach's alpha. Results: The scale achieves good Item-Content Validity Index (I-CVI) values, between 0.89 and 1.00, and scale-CVI values of 0.91. A principal component analysis generated four dimensions with 26 items as a final scale, with overall Cronbach's alpha of 0.848. Conclusions: The findings demonstrate that the scale is valid and reliable as a vehicle for assessment of the general public's attitudes toward advance care directives.

Knowledge and Myths about Palliative Care among the General Public and Health Care Professionals in Portugal

Background: International research has shown that healthcare professionals (HCPs) and nonhealthcare professionals (NHCPs) are unaware of the goals and purposes of palliative care. This study evaluates the knowledge of palliative care among a sample of Portuguese adults and correlates their level of knowledge with age, gender, profession, and experience of family member’s palliative care. Method: A cross-sectional online survey was carried out on a sample of 152 HCPs and 440 NHCPs who completed an anonymous questionnaire of sociodemographic, family, and professional data, and an instrument of 26 dichotomous (true or false) questions focusing on palliative care goals and purposes. Results: The 592 participants had a mean age of 31.3 ± 11.1 years, and most were female. Statistically significant differences between statements considered as correct by HCPs and NHCPs were found in 24 statements; HCPs had the highest percentage of correct answers. The terms most frequently associated with palliative care mentioned by NHCPs were chronic and progressive disease (n = 76), while HCPs mostly mentioned quality-of-life promotion (n = 29). Women, the elderly, and HCPs had a higher level of knowledge regarding palliative care (p < 0.001). Conclusions: Results clearly show gaps in knowledge of palliative care, especially among NHCPs. An integrated approach is needed to inform and clarify the philosophy and goals of palliative care in different settings in order to improve knowledge.