Factors associated with motivation and hesitation to work among health professionals during a public crisis: a cross sectional study of hospital workers in Japan during the pandemic (H1N1) 2009

Stress, Burnout, and Coping Strategies of Frontline Nurses During the COVID-19 Epidemic in Wuhan and Shanghai, China

Background: Nurses at the frontline of caring for COVID-19 patients might experience mental health challenges and supportive coping strategies are needed to reduce their stress and burnout. The aim of this study was to identify stressors and burnout among frontline nurses caring for COVID-19 patients in Wuhan and Shanghai and to explore perceived effective morale support strategies. Method: A cross-sectional survey was conducted in March 2020 among 110 nurses from Zhongshan Hospital, Shanghai, who were deployed at COVID-19 units in Wuhan and Shanghai. A COVID-19 questionnaire was adapted from the previous developed "psychological impacts of SARS" questionnaire and included stressors (31 items), coping strategies (17 items), and effective support measures (16 items). Burnout was measured with the Maslach Burnout Inventory. Results: Totally, 107 (97%) nurses responded. Participants mean age was 30.28 years and 90.7% were females. Homesickness was most frequently reported as a stressor (96.3%). Seven of the 17 items related to coping strategies were undertaken by all participants. Burnout was observed in the emotional exhaustion and depersonalization subscales, with 78.5 and 92.5% of participants presenting mild levels of burnout, respectively. However, 52 (48.6%) participants experienced a severe lack of personal accomplishment. Participants with longer working hours in COVID-19 quarantine units presented higher emotional exhaustion (OR = 2.72, 95% CI 0.02-5.42; p = 0.049) and depersonalization (OR = 1.14, 95% CI 0.10-2.19; p = 0.033). Participants with younger age experienced higher emotional exhaustion (OR = 2.96, 95% CI 0.11-5.82; p = 0.042) and less personal accomplishment (OR = 3.80, 95% CI 0.47-7.13; p = 0.033). Conclusions: Nurses in this study experienced considerable stress and the most frequently reported stressors were related to families. Nurses who were younger and those working longer shift-time tended to present higher burnout levels. Psychological support strategies need to be organized and implemented to improve mental health among nurses during the COVID-19 pandemic.

Anxiety and Depression Symptoms in COVID-19 Isolated Patients and in Their Relatives

Background: While focusing on the management and care of COVID-19 patients, the mental health of these patients and their relatives is being overlooked. The aim of the current study was to measure anxiety and depression, and to assess their association with socio-demographic and pandemic-related stress factors in COVID-19 patients and their relatives during the initial stage of hospitalization. Methods: We assessed isolated hospitalized patients (N = 90) and their relatives (adults and children, N = 125) by phone, 25-72 h following patients' admission. The quantitative measures included the Anxiety and Depression modules of the Patient-Reported Outcomes Measurement Information System (PROMIS) and pandemic-related stress factors. Qualitative measures included questions exploring worries, sadness, and coping modes. Results: Both patients and relatives suffer from high levels of anxiety and related pandemic worries, with lower levels of depressive symptoms. Compared to adult relatives, child relatives reported significantly lower anxiety. The multivariable logistic regression analysis revealed an increased risk for anxiety among females and a decreased risk among ultra-orthodox participants. While increased anxiety among patients was associated with feelings of isolation, increased anxiety among relatives was associated with a feeling of not being protected by the hospital. Conclusions: Patients and relatives experience similar high anxiety levels which are more robust in women and lower in ultra-orthodox participants. Our findings indicate that anxiety symptoms of both patients and adult relatives should be addressed.

Anxiety, pandemic-related stress and resilience among physicians during the COVID-19 pandemic

BACKGROUND

Physicians play a crucial frontline role in the COVID-19 pandemic, which may involve high levels of anxiety. We aimed to investigate the association between pandemic-related stress factors (PRSF) and anxiety and to evaluate the potential effect of resilience on anxiety among physicians.

METHODS

A self-report digital survey was completed by 1106 Israeli physicians (564 males and 542 females) during the COVID-19 outbreak. Anxiety was measured by the 8-item version of the Patient-Reported Outcomes Measurement Information System. Resilience was evaluated by the 10-item Connor-Davidson Resilience Scale. Stress was assessed using a PRSF inventory.

RESULTS

Physicians reported high levels of anxiety with a mean score of 59.20 ± 7.95. We found an inverse association between resilience and anxiety. Four salient PRSF (mental exhaustion, anxiety about being infected, anxiety infecting family members, and sleep difficulties) positively associated with anxiety scores.

CONCLUSIONS

Our study identified specific PRSF including workload burden and fear of infection that are associated with increased anxiety and resilience that is associated with reduced anxiety among physicians.

Association among income loss, financial strain and depressive symptoms during COVID-19: evidence from two longitudinal studies

Background.

The COVID-19 pandemic has major ramifications for global health and the economy, with growing concerns about economic recession and implications for mental health. Here we investigated the associations between COVID-19 pandemic-related income loss with financial strain and mental health trajectories over a 1-month course.

Methods.

Two independent studies were conducted in the U.S and in Israel at the beginning of the outbreak (March-April 2020, T1; N = 4 171) and at a 1-month follow-up (T2; N = 1 559). Mixed-effects models were applied to assess associations among COVID-19-related income loss, financial strain, and pandemic-related worries about health, with anxiety and depression, controlling for multiple covariates including pre-COVID-19 income.

Findings.

In both studies, income loss and financial strain were associated with greater depressive symptoms at T1, above and beyond T1 anxiety, worries about health, and pre-COVID-19 income. Worsening of income loss was associated with exacerbation of depression at T2 in both studies. Worsening of subjective financial strain was associated with exacerbation of depression at T2 in one study (US).

Interpretation.

Income loss and financial strain were uniquely associated with depressive symptoms and the exacerbation of symptoms over time, above and beyond pandemic-related anxiety. Considering the painful dilemma of lockdown versus reopening, with the tradeoff between public health and economic wellbeing, our findings provide evidence that the economic impact of COVID-19 has negative implications for mental health.

Funding.

This study was supported by grants from the National Institute of Mental Health, the US-Israel Binational Science Foundation, Foundation Dora and Kirsh Foundation.

Responding to the Psychological Needs of Health Workers During Pandemic: Ten Lessons From Humanitarian Work

When a complex emergency (CE) overwhelms infrastructure, the ability of health-care providers to work efficiently under duress saves lives. The author uses her experience of providing mental health supports to humanitarian aid workers and the pieces of training conducted for internal medicine practitioners to offer guidance on how to manage severe job-related stresses during the response to the coronavirus disease 2019 (COVID-19) pandemic. This work reminds responders about their professional mission and purpose, but its extreme physical and mental demands can take a toll on their well-being and health. In CEs, the sheer volume of work and the emotional over-engagement tend to produce toxic fantasies (eg, rescuer or helper fantasies), acting upon which threatens integrity of care and increases risks for both patients and providers. Accumulated fatigue and exposure to mass suffering and mortality can change the perceived value of life and increase reckless, risk-taking, and suicidal behaviors. Introducing a self-awareness framework prioritizes the awareness of the available choices and making situation-appropriate and informed decisions about balancing one's own and others' needs. The COVID-19 response has demonstrated that fostering peer supports, changing organizational culture, addressing self-awareness within a training and supervisory context, and strengthening supports for managers are important parts of disaster preparedness. It also revealed that more research is needed to better understand and meet the special psychological needs of health-care responders.

Factors Affecting the Psychological Well-being of Health Care Workers During an Epidemic: A Thematic Review

BACKGROUND

Health care workers (HCWs) constitute a vulnerable group in terms of physical, mental, and emotional health setbacks during an epidemic. An in-depth understanding of the effects of epidemics on HCWs is of utmost importance, in order to put in place measures for their well-being. The purpose of the review was to compile, compare, and contrast the available information so as to produce a lucid picture of how HCWs are impacted during an epidemic, and the factors that affect their mental health.

METHODS

A literature search of MEDLINE and Google Scholar databases was conducted to uncover research pertaining to four major epidemic outbreaks over the last two decades. The search was carried out at three levels using pertinent key words. The records thus identified were narrowed down at three further levels, that is, by screening of the title, abstract, and full text, to obtain articles most relevant to the subject matter. Data extraction was done using a spreadsheet to compile the relevant data. Data synthesis was done by studying those factors found to affect psychological well-being of HCWs and separating them into suitable sub-groups. Recommendations to mitigate the psychological impact were proposed.

RESULTS

Thirteen factors were identified, which were grouped under the broad categories of socio-demographic variables, individual characteristics, social characteristics, and psychological constructs.

CONCLUSION

Epidemics have a profound impact on psychological well-being of HCWs. There is a pressing need to address the issue of the psychological health of this vulnerable group.

Face to Face with Coronavirus Disease 19: Maintaining Motivation, Psychological Safety, and Wellness

Emerging infectious diseases have the potential to spread across borders extremely quickly. This was seen during the severe acute respiratory syndrome (SARS) outbreak and now, coronavirus disease (COVID 19) (novel coronavirus) pandemic. For outbreaks and pandemics, there will be behavioral, affective, and cognitive changes and adaptation seen. This may be prominent in frontline workers and healthcare workers (HCWs), who work in high-risk areas, as well as people in general. What represents the psychology and mindset of people during a pandemic? What is needed to allay anxieties and instill calm? What will be needed to keep the motivation levels of people and HCW high so that they continue to function optimally? Which motivation theory can be used to explain this and how do employers and management utilize this in their approach/strategies in planning for an outbreak? Finally, the impact of culture, in the various contexts, cannot be overlooked in crisis and pandemic management. The author is a senior emergency physician in Singapore, who has been through SARS and now the COVID pandemic. She has been instrumental in sharing some of the changes and practices implemented in Singapore, since SARS 17 years ago, until now. Besides being a full-time practicing emergency physician, the author is also an elected Member of the Singapore Parliament for the last 14 years. She shares her views on an aspect often overlooked during a pandemic: psychological wellness and motivations of people, including for HCW at the frontline.

The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence

PURPOSE OF REVIEW

We aim to provide quantitative evidence on the psychological impact of epidemic/pandemic outbreaks (i.e., SARS, MERS, COVID-19, ebola, and influenza A) on healthcare workers (HCWs).

RECENT FINDINGS

Forty-four studies are included in this review. Between 11 and 73.4% of HCWs, mainly including physicians, nurses, and auxiliary staff, reported post-traumatic stress symptoms during outbreaks, with symptoms lasting after 1-3 years in 10-40%. Depressive symptoms are reported in 27.5-50.7%, insomnia symptoms in 34-36.1%, and severe anxiety symptoms in 45%. General psychiatric symptoms during outbreaks have a range comprised between 17.3 and 75.3%; high levels of stress related to working are reported in 18.1 to 80.1%. Several individual and work-related features can be considered risk or protective factors, such as personality characteristics, the level of exposure to affected patients, and organizational support. Empirical evidence underlines the need to address the detrimental effects of epidemic/pandemic outbreaks on HCWs' mental health. Recommendations should include the assessment and promotion of coping strategies and resilience, special attention to frontline HCWs, provision of adequate protective supplies, and organization of online support services.

Perceived Benefits and Challenges of Ebola Preparation Among Hospitals in Developed Countries: A Systematic Literature Review

The 2014–2016 Ebola epidemic in West Africa provided an opportunity to improve our response to highly infectious diseases. We performed a systematic literature review in PubMed, Cochrane Library, CINAHL, EMBASE, and Web of Science of research articles that evaluated benefits and challenges of hospital Ebola preparation in developed countries. We excluded studies performed in non-developed countries, and those limited to primary care settings, the public health sector, and pediatric populations. Thirty-five articles were included. Preparedness activities were beneficial for identifying gaps in hospital readiness. Training improved health-care workers’ (HCW) infection control practices and personal protective equipment (PPE) use. The biggest challenge was related to PPE, followed by problems with hospital infrastructure and resources. HCWs feared managing Ebola patients, affecting their willingness to care for them. Standardizing protocols, PPE types, and frequency of training and providing financial support will improve future preparedness. It is unclear whether preparations resulted in sustained improvements.

Prospero Registration. CRD42018090988.

Health workers' experiences of coping with the Ebola epidemic in Sierra Leone's health system: a qualitative study

Background

The 2014 Ebola Virus Disease epidemic evolved in alarming ways in Sierra Leone spreading to all districts. The country struggled to control it against a backdrop of a health system that was already over-burdened. Health workers play an important role during epidemics but there is limited research on how they cope during health epidemics in fragile states. This paper explores the challenges faced by health workers and their coping strategies during the Ebola outbreak in four districts – Bonthe, Kenema, Koinadugu and Western Area - of Sierra Leone.

Methods

We used a qualitative study design: key informant interviews (n = 19) with members of the District Health Management Teams and local councils, health facility managers and international partners; and in depth interviews with health workers (n = 25) working in public health facilities and international health workers involved with the treatment of Ebola patients.

Results

There were several important coping strategies including those that drew upon existing mechanisms: being sustained by religion, a sense of serving their country and community, and peer and family support. Externally derived strategies included: training which built health worker confidence in providing care; provision of equipment to do their job safely; a social media platform which helped health workers deal with challenges; workshops that provided ways to deal with the stigma associated with being a health worker; and the risk allowance, which motivated staff to work in facilities and provided an additional income source.

Conclusions

Supportive supervision, peer support networks and better use of communication technology should be pursued, alongside a programme for rebuilding trusting relations with community structures. The challenge is building these mechanisms into routine systems, pre-empting shocks, rather than waiting to respond belatedly to crises.

What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal

BACKGROUND

Health workers are critical to the performance of health systems; yet, evidence about their coping strategies and support needs during and post crisis is lacking. There is very limited discussion about how research teams should respond when unexpected crises occur during on-going research. This paper critically presents the approaches and findings of two health systems research projects that explored and evaluated health worker performance and were adapted during crises, and provides lessons learnt on re-orientating research when the unexpected occurs.

METHODS

Health systems research was adapted post crisis to assess health workers' experiences and coping strategies. Qualitative in-depth interviews were conducted with 14 health workers in a heavily affected earthquake district in Nepal and 25 frontline health workers in four districts in Ebola-affected Sierra Leone. All data were transcribed and analysed using the framework approach, which included developing coding frameworks for each study, applying the frameworks, developing charts and describing the themes. A second layer of analysis included analysis across the two contexts, whereas a third layer involved the research teams reflecting on the approaches used to adapt the research during these crises and what was learned as individuals and research teams.

RESULTS

In Sierra Leone, health workers were heavily stigmatised by the epidemic, leading to a breakdown of trust. Coping strategies included finding renewed purpose in continuing to serve their community, peer and family support (in some cases), and religion. In Nepal, individual determination, a sense of responsibility to the community and professional duty compelled staff to stay or return to their workplace. The research teams had trusting relationships with policy-makers and practitioners, which brought credibility and legitimacy to the change of research direction as well as the relationships to maximise the opportunity for findings to inform practice.

CONCLUSIONS

In both contexts, health workers demonstrated considerable resilience in continuing to provide services despite limited support. Embedded researchers and institutions are arguably best placed to navigate emerging ethical and social justice challenges and are strategically positioned to support the co-production of knowledge and ensure research findings have impact.

Acute Ebola virus disease patient treatment and health-related quality of life in health care professionals: A controlled study

OBJECTIVE

This study aimed to identify predictors of health-related quality of life (HrQoL) and to investigate infection-related concerns in health professionals during the acute treatment episode for one Ebola virus disease (EVD) patient in tertiary care.

METHODS

In a cross-sectional controlled study, validated self-report questionnaires were completed by three groups of health care professionals: (1) staff from standard internal medicine inpatient wards of a tertiary care center, (2) staff from the isolation unit of the same center responsible for Ebola patient treatment, and (3) staff from a research laboratory with contact to the Ebola virus and other highly infectious pathogens. Outcomes were HrQoL (SF-12), infection-related concerns, global health status, fatigue (FACIT), depression (PHQ-9), anxiety (GAD-7), and somatic symptoms (SSS-8).

RESULTS

Comparisons between groups (n1=42, n2=32, n3=12) yielded no significant differences in HrQoL, subjective risk of infection, and most other psychosocial variables. However, the Ebola patient treatment group experienced significantly higher levels of social isolation than both other groups. The best predictors of poor physical and mental HrQoL were perceived lack of knowledge about the Ebola virus disease (physical: B=-1.2, p=0.05; mental: B=-1.3, p=0.03) and fatigue (physical: B=-0.3, p=0.02; mental: B=-0.53, p<0.001).

CONCLUSION

Ebola patient treatment in tertiary care does not seem to be associated with lower HrQoL and enhanced subjective risk of infection, but seems to yield feelings of social isolation in health-care professionals.

Willingness of Future Nursing Workforce to Report for Duty During an Avian Influenza Pandemic

Nursing students are the future nursing workforce. Exploring factors associated with nursing students' willingness to report for duty during an avian influenza (flu) pandemic, might help nurse managers develop strategies in advance for efficient management of personnel during a pandemic of avian flu.

AIM

To examine the factors associated with the willingness of future nursing workforce to report for duty during an avian flu pandemic, using the theory of self-efficacy.

METHODS

The study employed a cross-sectional quantitative correlational design. A convenience sample of 200 Israeli nursing students completed a questionnaire based on the theory and the literature review.

RESULTS

Approximately one-half (49%) of the students intended to report for duty during an avian flu pandemic in the future. Perceived self-efficacy and working conditions were found associated with this willingness. Male students and students from the Arab Muslim sector were more willing to report for duty during a pandemic than female students or students from the Jewish sector.

DISCUSSION

These finding may have implications for disaster planning and staffing management in health care settings during an avian flu pandemic, with the aim to ensure optimal nursing care and an efficient functioning of the entire health care system.

Healthcare workers' willingness to work during an influenza pandemic: a systematic review and meta-analysis

To estimate the proportion of healthcare workers (HCWs) willing to work during an influenza pandemic and identify associated risk factors, we undertook a systematic review and meta-analysis compliant with PRISMA guidance. Databases and grey literature were searched to April 2013, and records were screened against protocol eligibility criteria. Data extraction and risk of bias assessments were undertaken using a piloted form. Random-effects meta-analyses estimated (i) pooled proportion of HCWs willing to work and (ii) pooled odds ratios of risk factors associated with willingness to work. Heterogeneity was quantified using the I(2) statistic, and publication bias was assessed using funnel plots and Egger's test. Data were synthesized narratively where meta-analyses were not possible. Forty-three studies met our inclusion criteria. Meta-analysis of the proportion of HCWs willing to work was abandoned due to excessive heterogeneity (I(2) = 99.2%). Narrative synthesis showed study estimates ranged from 23.1% to 95.8% willingness to work, depending on context. Meta-analyses of specific factors showed that male HCWs, physicians and nurses, full-time employment, perceived personal safety, awareness of pandemic risk and clinical knowledge of influenza pandemics, role-specific knowledge, pandemic response training, and confidence in personal skills were statistically significantly associated with increased willingness. Childcare obligations were significantly associated with decreased willingness. HCWs' willingness to work during an influenza pandemic was moderately high, albeit highly variable. Numerous risk factors showed a statistically significant association with willingness to work despite significant heterogeneity between studies. None of the included studies were based on appropriate theoretical constructs of population behaviour.

Do shared barriers when reporting to work during an influenza pandemic influence hospital workers' willingness to work? A multilevel framework

OBJECTIVE

Characteristics associated with interventions and barriers that influence health care workers' willingness to report for duty during an influenza pandemic were identified. Additionally, this study examined whether workers who live in proximal geographic regions shared the same barriers and would respond to the same interventions.

METHODS

Hospital employees (n=2965) recorded changes in willingness to work during an influenza pandemic on the basis of interventions aimed at mitigating barriers. Distance from work, hospital type, job role, and family composition were examined by clustering the effects of barriers from reporting for duty and region of residence.

RESULTS

Across all workers, providing protection for the family was the greatest motivator for willingness to work during a pandemic. Respondents who expressed the same barriers and lived nearby shared common responses in their willingness to work. Younger employees and clinical support staff were more receptive to interventions. Increasing distance from home to work was significantly associated with a greater likelihood to report to work for employees who received time off.

CONCLUSIONS

Hospital administrators should consider the implications of barriers and areas of residence on the disaster response capacity of their workforce. Our findings underscore communication and development of preparedness plans to improve the resilience of hospital workers to mitigate absenteeism.

Exploring the influence of trust relationships on motivation in the health sector: a systematic review

BACKGROUND

Dedicated and motivated health workers (HWs) play a major role in delivering efficient and effective health services that improve patients' experience of health care. Growing interest in HW motivation has led to a global focus on pay for performance strategies, but less attention has been paid to nurturing intrinsic motivation. Workplace trust relationships involve fair treatment and respectful interactions between individuals. Such relationships enable cooperation among HWs and their colleagues, supervisors, managers and patients and may act as a source of intrinsic motivation. This paper presents findings from a qualitative systematic review of empirical studies providing evidence on HW motivation, to consider what these studies suggest about the possible influence of workplace trust relationships over motivation.

METHODS

Five electronic databases were searched for articles reporting research findings about HW motivation for various cadres published in the 10-year period 2003 to 2013 and with available full free text in the English language. Data extraction involved consideration of the links between trust relationships and motivation, by identifying how studies directly or indirectly mention and discuss relevant factors.

RESULTS

Twenty-three articles from low- and middle-income countries and eight from high-income countries that met predetermined quality and inclusion criteria were appraised and subjected to thematic synthesis. Workplace trust relationships with colleagues, supervisors and managers, employing organisation and patients directly and indirectly influence HW motivation. Motivational factors identified as linked to trust include respect; recognition, appreciation and rewards; supervision; teamwork; management support; autonomy; communication, feedback and openness; and staff shortages and resource inadequacy.

CONCLUSION

To the authors' knowledge, this is the first systematic review on trust and motivation in the health sector. Evidence indicates that workplace trust relationships encourage social interactions and cooperation among HWs, have impact on the intrinsic motivation of HWs and have consequences for retention, performance and quality of care. Human resource management and organisational practices are critical in sustaining workplace trust and HW motivation. Research and assessment of the levels of motivation and factors that encourage workplace trust relationships should include how trust and motivation interact and operate for retention, performance and quality of care.

Knowledge, attitudes, experience and behaviour of frontline health care workers during the early phase of 2009 influenza A(H1N1) pandemic, Birmingham, UK

OBJECTIVES

During the early ('containment') phase of the influenza A(H1N1) pandemic, when the severity of the pandemic was unclear, health care workers (HCWs) across the UK were deployed to swab and prescribe antiviral drugs to suspected cases. This study describes the knowledge, attitudes, experience and behaviour of frontline HCWs in Birmingham, West Midlands, during this period.

METHODS

During June 2009, a 25-item semi-structured questionnaire was used to survey HCWs who undertook defined clinical duties as part of the public health response during the early phase of the pandemic. Participants were clinical staff based in a primary care out-of-hours service provider.

RESULTS

The response rate was 50% (n = 20). All respondents provided direct clinical care that necessitated prolonged close contact with potentially infectious cases. Knowledge and use of personal protective equipment and infection control procedures was consistently high. However, the main source of infection control advice was local guidance. Uptake of, and attitude towards, vaccination as a preventive measure and antiviral prophylaxis was poor.

CONCLUSIONS

HCWs were prepared to provide an essential health care response during the pandemic even when the severity of disease was unclear. However, more needs to be done to change health care workers' negative attitudes towards taking antivirals and receiving influenza vaccination.

When and why health care personnel respond to a disaster: the state of the science

OBJECTIVE

Emergency response relies on the assumption that essential health care services will continue to operate and be available to provide quality patient care during and after a patient surge. The observed successes and failures of health care systems during recent mass-casualty events and the concern that these assumptions are not evidence based prompted this review.

METHOD

The aims of this systematic review were to explore the factors associated with the intention of health care personnel (HCP) to respond to uncommon events, such as a natural disaster or pandemic, determine the state of the science, and bolster evidence-based measures that have been shown to facilitate staff response.

RESULTS

Authors of the 70 studies (five mixed-methods, 49 quantitative, 16 qualitative) that met inclusion criteria reported a variety of variables that influenced the intent of HCP to respond. Current evidence suggests that four primary factors emerged as either facilitating or hindering the willingness of HCP to respond to an event: (1) the nature of the event; (2) competing obligations; (3) the work environment and climate; and (4) the relationship between knowledge and perceptions of efficacy.

CONCLUSIONS

Findings of this study could influence and strengthen policy making by emergency response planners, staffing coordinators, health educators, and health system administrators.

Impact of the 2009 influenza A (H1N1) pandemic on healthcare workers at a tertiary care center in New York City

BACKGROUND AND OBJECTIVE

Assessing the impact of 2009 influenza A (H1N1) on healthcare workers (HCWs) is important for pandemic planning.

METHODS

We retrospectively analyzed employee health records of HCWs at a tertiary care center in New York City with influenza-like illnesses (ILI) and confirmed influenza from March 31, 2009, to February 28, 2010. We evaluated HCWs' clinical presentations during the first and second wave of the pandemic, staff absenteeism, exposures among HCWs, and association between high-risk occupational exposures to respiratory secretions and infection.

RESULTS

During the pandemic, 40% (141/352) of HCWs with ILI tested positive for influenza, representing a 1% attack rate among our 13,066 employees. HCWs with influenza were more likely to have fever, cough, and tachycardia. When compared with the second wave, cases in the first wave were sicker and at higher risk of exposure to patients' respiratory secretions (P=.049). HCWs with ILI--with and without confirmed influenza--missed on average 4.7 and 2.7 work days, respectively (P=.001). Among HCWs asked about working while ill, 65% (153/235) reported they did so (mean, 2 days).

CONCLUSIONS

HCWs in the first wave had more severe ILI than those in the second wave and were more likely to be exposed to patients' respiratory secretions. HCWs with ILI often worked while ill. Timely strategies to educate and support HCWs were critical to managing this population during the pandemic.

Psychological impact of the pandemic (H1N1) 2009 on general hospital workers in Kobe

AIMS

In order for hospitals to work efficiently in a pandemic, it is important to know how a pandemic affects the hospital staff. The aim of the present study was to investigate the psychological impact of the pandemic (H1N1) 2009 on hospital workers and how it was affected by the characteristics of the hospital, gender, age, job and work environment.

METHODS

In late June 2009, soon after the pandemic had ended in Kobe city, Japan, a questionnaire was distributed consisting of questions on sociodemographic characteristics, 19 stress-related questions and the Impact of Event Scale (IES) to all 3635 employees at three core general hospitals in Kobe. Exploratory factor analysis was applied to the 19 stress-related questions, and this produced four factors for evaluation (anxiety about infection, exhaustion, workload, and feeling of being protected). Multiple regression models were used to evaluate the association of personal characteristics with each score of the four factors and the IES.

RESULTS

Valid answers were received from 1625 employees. Workers at a hospital with intense liaison psychiatric services felt less psychological impact. Workers at a hospital that provided staff with information about the pandemic less frequently, felt unprotected. Workers in work environments that had a high risk of infection felt more anxious and more exhausted. The total IES score was higher in workers in high-risk work environments.

CONCLUSIONS

It is important for hospitals to protect hospital workers during a pandemic and to rapidly share information about the pandemic. Liaison psychiatric services can help to reduce the impact of the pandemic on hospital workers.