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

Coping strategies that motivated frontline nurses while caring for the COVID-19 patients during the pandemic: A scoping review

BACKGROUND

The world faced a great health crisis during the COVID-19 pandemic. Consequently, the health care providers struggled and faced tremendous difficulties in treating high-load critical patients. This was particularly true in low- and middle-income countries where the work and patient loads are always higher and nurses at the forefront must deal with emergencies while being at high risk of exposure. However, little is known about the survival strategies of frontline nurses as dealt with the pandemic.

OBJECTIVES

This study catalogued the coping strategies of frontline nurses to deal with caring for the COVID-19 patients during the pandemic.

METHODS

The Arksey O'Malley framework was followed to conduct a scoping review. A systematic literature search was conducted using three databases: Google Scholar, Scopus and PubMed; and out of the 192 studies, 12 met the inclusion criteria set for this review study.

RESULTS

A total of 44 strategies were identified that motivated nurses to deal with the COVID-19 situation, and these strategies could be categorized into five main themes: nurses' self-strategies, nurses' strategies at the ethical level, employers' strategies, nursing leaders' strategies and supplementary strategies.

CONCLUSIONS

The findings of this study will provide guidance for health care workers, employers, policymakers, regulators and other stakeholders to adopt and promote different strategies in managing difficult emergency situations in future.

IMPLICATIONS FOR NURSING MANAGEMENT

This study emphasizes the importance of learning how to deal with adversity by health care workers and organizations in an emergency.

Work related burnout syndrome, information satisfaction, and concern of safety among Greek nurses during the first wave of COVID-19 outbreak

Objective

To determine the levels of burnout among Greek nurses during the first wave of Coronavirus disease 2019 (COVID-19) pandemic and to investigate the relationship among levels of burnout, satisfaction and concern about information, personal protection equipment (PPE), and safety for COVID-19.

Methods

A cross-sectional study was conducted. Data were collected by using the Burnout subscale of the Greek version of the Professional Quality of Life Scale. Questions concerning satisfaction and concern about information, PPE, and safety for COVID-19 were added. Convenience sampling method was employed. Descriptive statistics and multiple linear regression analysis were applied, and distributions were tested for their symmetry using Bloom's method.

Results

The sample comprised of 301 nurses working in public and private hospitals in Greece. A moderate level of burnout was found among the Greek nurses (mean = 29.95, ±4.75). Regarding satisfaction and concern about information, PPE, and safety for COVID-19, nurses expressed overall low satisfaction with a mean score of 1.96 (±0.77), and high levels of concern with a mean score of 3.19 (±0.85). Increased satisfaction regarding the information provided was significantly associated with decreased levels of burnout (β = −1.32, P < 0.001), and increased concern for COVID-19 was significantly associated with increased levels of burnout (β= 0.83, P = 0.010).

Conclusions

Greek nurses expressed low satisfaction concerning information, PPE, and safety for COVID-19 and high levels of concern of possible COVID-19 transmission. Nevertheless, a moderate level of burnout was found.

Psychotherapy and Follow-Up in Health Care Workers After the COVID-19 Epidemic: A Single Center's Experience

Objective

The present study aims to analysis the mental health of high-risk health care workers (HHCWs) and low-risk HCWs (LHCWs) who were respectively exposed to COVID-19 wards and non-COVID-19 wards by following up on mental disorders in HCWs in China for 6 months.

Methods

A multi-psychological assessment questionnaire was used to follow up on the psychological status of HCWs in the Affiliated Hospital of Xuzhou Medical University in Xuzhou City (a non-core epidemic area) at 6 months after the first evaluation conducted during the COVID-19 epidemic. Based on the risk of exposure to COVID-19 patients, the HCWs were divided into two groups: high-risk HCWs, who worked in COVID-19 wards, and low-risk HCWs, who worked in non-COVID-19 wards.

Results

A total of 198 HCWs participated in the study, and 168 questionnaires were selected for evaluation. Among them, 93 (55.4%) were in the HHCW group and 75 (44.5%) were in the LHCW group. Significant differences were observed in salary, profession, and altruistic behavior between the two groups (P < 0.05). There were no significant differences in the anxiety, depression, insomnia, or posttraumatic stress disorder (PTSD) scores between the two groups. Logistic regression revealed that work stress was a major joint risk factor for mental disorders in HCWs. Among all the HCWs, a total of 58 voluntarily participated in psychotherapy; the analysis showed a significant decrease in anxiety, depression, PTSD, work stress, and work risk after attending psychotherapy. There were also significant differences in positive and negative coping styles before and after psychotherapy.

Conclusion

In the present follow-up, work stress was the major contributing factor to mental disorders in HCWs. Psychotherapy is helpful in terms of stress management and should be provided to first-line COVID-19 HCWs.

Validity and Reliability of Cultural Mix Coping Inventory for Stressful Situations among Healthcare Professionals in Ghana Amidst COVID-19

The Cultural Mix Coping Inventory for Stressful Situations is one of the recent coping measures developed to overcome the weaknesses of existing coping scales. Since its development and validation, the inventory has been used by previous studies to measure coping among teachers and students in stressful situations. Health professionals are workers who typically encounter stressful situations due to their work demands. In this study, we assessed the validity and reliability of cultural mix inventory for stressful situations among healthcare professionals in Ghana. The research was guided by three major objectives: (1) to assess the factor structure of the cultural mix coping inventory, (2) to evaluate the construct validity and reliability of the cultural mix coping inventory based on internal structure and (3) to test for evidence of criterion validity based on the external structure of the measure. Approximately 312 health workers were purposefully sampled to participate in the study. The study confirmed the original four-factor solution of the coping inventory with evidence of the construct validity based on the internal structure. Validity evidence based on the external structure of the measure was found to be sufficient. Given the COVID-19 pandemic and coupled with the stressful nature in the line of duty of healthcare professionals, this inventory provides a useful and sound measure of coping options among this cohort.

Global Healthcare Needs Related to COVID-19: An Evidence Map of the First Year of the Pandemic

The COVID-19 pandemic has exposed gaps and areas of need in health systems worldwide. This work aims to map the evidence on COVID-19-related healthcare needs of adult patients, their family members, and the professionals involved in their care during the first year of the pandemic. We searched the databases MEDLINE, Embase, and Web of Science. Two reviewers independently screened titles and abstracts and assessed full texts for eligibility. Disagreements were resolved by consensus. Descriptive data were extracted and inductive qualitative content analysis was used to generate codes and derive overarching themes. Thirty-six studies met inclusion criteria, with the majority reporting needs from the perspective of professionals (35/36). Professionals' needs were grouped into three main clusters (basic, occupational, and psycho-socio-emotional needs); patients' needs into four (basic, healthcare, psycho-socio-emotional, and other support needs); and family members' needs into two (psycho-socio-emotional and communication needs). Transversal needs across subgroups were also identified and grouped into three main clusters (public safety, information and communication, and coordination and support needs). This evidence map provides valuable insight on COVID-19-related healthcare needs. More research is needed to assess first-person perspectives of patients and their families, examine whether needs differ by country or region, and evaluate how needs have evolved over time.

The effect of the COVID-19 social distancing measures on Turkish women's mental well-being and burnout levels: A cross-sectional study

Lockdown and social distancing measures during the COVID-19 pandemic increase women's responsibilities and influence their mental health. This study aimed to assess the effect of COVID-19 social distancing measures on mental well-being and burnout levels of women using an online cross-sectional survey in Turkey. The Warwick-Edinburgh Mental Well-being Scale, The Burnout Measure, and Sociodemographic form were used in this study. All analyses were performed on a sample of 438 women aged between 18 and 65. The mean score of mental well-being was 47.86 (SD = 10.04) and the mean score of burnout was 3.86 (SD = 1.16). Being younger than 30 years old (t = 2.14, P = 0.033), having undergraduate education or above (F = 5.09, P = 0.007), part-time working (F = 5.39, P = 0.005), attending to school (t = 2.68, P = 0.008), having COVID-19 symptoms (t = 6.01, P < 0.001), and perceiving spousal emotional support (F = 3.47, P = 0.016) were the factors associated with high burnout. Being older than 30 years old (z = -3.11, P = 0.002), full time working (H = 11.96, P = 0.003), not attending to school (z = -2.09, P = 0.036), perceiving spousal emotional (H = 13.22, P = 0.004), or social (H = 13.11, P = 0.004) support were the factors associated with higher mental well-being. Age (β = -0.03, P = 0.001), having two or more children (β = 0.42, P = 0.015), and perceiving COVID-19 symptoms (β = -0.73, P < 0.001) were the predictors of women's burnout. This study shows that mental well-being and burnout levels of women in Turkey have been considerably affected as a result of social distancing measures taken with the first wave of the pandemic. Findings signal the immediate need for targeted mental health nursing interventions. Therefore, technology-based mental health support programmes are recommended to be designed and utilized by mental health nurses.

Burnout Among Medical Staff 1 Year After the Beginning of the Major Public Health Emergency in Wuhan, China

Objectives

Wuhan is the city where coronavirus disease (COVID-19) was first reported and developed into a pandemic. However, the impact of the prolonged COVID-19 pandemic on medical staff burnout remains limited. We aimed to identify the prevalence and major determinants of burnout among medical staff 1 year after the beginning of the COVID-19 pandemic in Wuhan, China.

Materials and Methods

A total of 1,602 medical staff from three hospitals in Wuhan, China, were included from November 1–28, 2021. Chi-square tests were conducted to compare the prevalence of burnout across groups based on sociodemographic and professional characteristics. A multivariate analysis was performed using a forward stepwise logistic regression model.

Results

Approximately 37.39% of the medical staff experienced burnout 1 year after COVID-19 pandemic. Emotional exhaustion (EE) was the most common symptom of burnout, with 1,422 (88.76%) participants reporting a severe EE. Burnout was associated with insufficient social support and “neutral” or “dissatisfied” patient-physician relationships. Respondents who participated in the care of COVID-19 patients had a higher risk of burnout symptoms than those who did not participate. In particular, mental resilience was negatively associated with burnout among the medical staff.

Conclusion

Nearly two-fifths of the participants had symptoms of burnout, with reduced personal accomplishment being the predominant symptom 1 year after COVID-19. Healthcare organizations should regularly measure and monitor burnout among the medical staff. In addition, creating positive work environments and improving the mental resilience of medical staff may be effective ways to reduce burnout.

The disaster resilience trajectory of the first batch front-line nurses at fighting the Novel Coronavirus Disease 2019 in Wuhan: A qualitative study

AIM

It is widely accepted that resilience is an essential solution to the challenges caused by disasters or crisis. The resilient individual can actively cope with challenges and maintain a good performance in facing of disastrous events. After the outbreak of Novel Coronavirus Disease 2019 (COVID-19) in Wuhan, China, numerous researchers have engaged in studying the experiences of front-line nurses in Wuhan from different perspectives. However, little is known on how the first batch front-line nurses developed their resilience trajectories during the disastrous events. The purpose of the present study is to explore the disaster resilience trajectory of the first batch front-line nurses at the early-stage of COVID-19 outbreak in Wuhan, Hubei province.

METHOD

Qualitative research method was employed using purposive sampling. Nurses from Sichuan who had anti-epidemic experiences in Wuhan were selected to be conducted in-depth phone interviews. The interviews were transcribed verbatim, and data was analysed by adopting Colaizzi phenomenological approach.

RESULTS

Three theme categories emerged through the data analysis: (1) Challenges and difficulties; (2) Overcoming difficulties; (3) and Personal growth.

CONCLUSION

Nurses have accumulated relevant experiences in dealing with sudden public health events after the rescue task, which can provide psychological and material supports for coping with similar situation in the future. Additionally, multiple support systems were critical elements for front-line nurses to recover from the disaster. Through uncovering front-line nurses' disaster resilience trajectories, it is significant for health care organizations and managers to establish more comprehensive system in handling with public health emergency events.

Fear of COVID-19, emotional exhaustion, and care quality experience in nursing home staff during the COVID-19 pandemic

BACKGROUND

Nursing home staff have been adversely impacted throughout the COVID-19 pandemic, facing difficulties in providing patient care. The aim of this study was to explore health workers' perception regarding their own care quality experience in nursing homes during the COVID-19 pandemic. Amidst the second wave of the pandemic, we investigated the relationships between fear of COVID-19 and care quality experiences in nursing homes with emotional exhaustion (EE) as a mediating role. We hypothesized that EE is associated with fear of COVID-19 and care quality experience among nursing home staff. Furthermore, we predicted that EE would mediate the relationships between fear of COVID-19 and care quality experience.

METHODS

During the second wave of COVID-19 (October to December 2020), we administered surveys to a large sample of 129 French nursing home staff with a mean age of 38.47 ± 10.31 who were directly and repeatedly exposed to COVID-19. We assessed their emotional exhaustion (EE) and care quality experience in the workplace via subjective indicators using self-reported scales.

RESULTS

In the context of COVID-19, low to severe emotional exhaustion levels were found among nursing home staff, and these levels were associated with care quality experience as well as fear of COVID-19. The groups with low and severe levels of EE reported the highest levels of fear of COVID-19. The groups with moderate and severe levels of EE reported the lowest levels of care quality experience. Lastly, the relationships between fear of COVID-19 and care quality experience were mediated by EE.

CONCLUSIONS

The findings made by the present study focused on the role of emotional coping responses to COVID-19. EE was associated positively with fear of COVID-19 and negatively with care quality experience. Furthermore, EE was found to mediate the relationship between fear of COVID-19 and care quality experience. We discuss these findings as they relate to palliative care issues in nursing homes and the manner in which emotional exhaustion ought to be addressed among nursing home staff.

Relationship between perceived threat of COVID-19 and burnout among frontline nurses: A mediation analysis

BACKGROUND

Burnout of nurses during the Coronavirus of 2019 pandemic can end up extremely expensive for societies. It is found that positive religious coping (PRC) and a secure God attachment are effective for shielding against the adverse consequences of being exposed to stressful situations.

METHODS

This research explores the relationships among God attachment, religious coping, and burnout among nurses who are confronted with COVID-19 as a perceived threat through a model based on the combination of attachment theory and the Job Demands-Resources model. Analysis was done using SMART-PLS.

RESULTS

The results reveal that perceived threat of COVID-19 (PTC) positively correlates with burnout among nurses and that secure attachment to God and PRC can buffer this relationship, while insecure attachment to God, including anxious and avoidant attachment, along with negative religious coping positively mediates the relationship between PTC and burnout.

CONCLUSION

Finally, this study suggests managerial implications of these findings for healthcare organizations and a recommendation for helping out staff to help them manage such threats and their attachment to God.

The emotional impact of COVID-19 on Spanish nurses and potential strategies to reduce it

BACKGROUND

Although the emotional and psychological impact of nurses' work had been identified before the COVID-19 pandemic, the pandemic aggravated risk indicators for their mental health.

AIM

The objective of this study was to analyse the levels of anxiety, depression, post-traumatic stress and burnout of nurses in the Balearic Islands (Spain) during the pandemic to identify possible sociodemographic and related occupational factors.

DESIGN

A cross-sectional study of 892 nurses was conducted during four weeks from February to March 2021.

METHODS

Sociodemographic data related to the pandemic were collected and anxiety, depression, burnout and post-traumatic stress were measured with validated scales. A multivariate and predictive analysis was carried out with risk estimates.

FINDINGS

About 75.6% of the nurses had experience in COVID-19 units, and 49.1% had worked for more than 10 months in a COVID-19 unit. Nurses in COVID-19 units (hospital ward or ICU) were more likely to report emotional fatigue (OR 1.9, p < 0.001) and anxiety (OR 1.5, p = 0.021). In general, moderate post-traumatic stress was evident in general nurses (p = 0.027), and severe post-traumatic stress was evident in ICU nurses (p = 0.027). A 1.24-month reduction in COVID-19 patient care predicted reduced levels of emotional fatigue (5.45 points), depersonalisation (1.87 points) and post-traumatic stress (4.65 points) in nurses.

CONCLUSION

Given the occurrence of new waves of COVID-19, the need to establish preventive strategies that focus on the personal and occupational characteristics related to these indicators and to implement urgent psychological support strategies is demonstrated.

IMPACT

Given these findings, it is imperative solutions are urgently applied in order to prevent compounding risk to the health system.

Evaluating the impact of coronavirus disease on burnout among healthcare workers using maslach burnout inventory tool: A systematic review

Background

Burnout has been prevalent among healthcare workers (HCWs). However, the effect of the Coronavirus Disease (COVID-19) pandemic on this phenomenon in HCWs is unclear.

Objective

This systematic review aims to evaluate the impact of COVID-19 on burnout of HCWs using Maslach Burnout Inventory (MBI).

Methods

A systematic search was performed on PubMed database for articles published between 1 December 2019 and 30 June 2021. Search strategy combined terms for HCWs, COVID-19, burnout, and MBI. The main outcome of interest was burnout, including both mean prevalence and MBI scores for high emotional exhaustion (EE), high depersonalisation (DP) and low personal accomplishment (PA).

Results

Four cohort studies, 90 cross-sectional studies and one randomised-controlled trial were included for review. Only one cohort study compared burnout data among HCWs before and during COVID-19. It reported a statistically significant increase in mean EE and PA scores from 21.9 to 24.8 ( p = .001), and 42.7 to 48.7 ( p = .001), respectively. The remaining studies only evaluated burnout data during COVID-19 but were missing burnout data prior to the pandemic for comparison. Across these studies, the overall mean prevalence of burnout among HCWs was 39.95%, with mean MBI EE scores of 22.07, DP scores of 7.83, and PA scores of 32.53. Burnout outcomes were generally comparable across specific healthcare professions such as doctors and nurses.

Conclusion

Whilst quality research elucidating the effect of pandemic on burnout is lacking, current burnout prevalence among HCWs during COVID-19 is notable.

Investigating Frontline Nurse Stress: Perceptions of Job Demands, Organizational Support, and Social Support During the Current COVID-19 Pandemic

Background

While frontline nurses employ coping alternatives to help deal with occupational stress resulting from unprecedented challenges during the COVID-19 pandemic, their access to necessary resources is unclear.

Objective

This study aims to explore nurses' mental health in Alabama hospitals during the COVID-19 outbreak and investigate the impact of organizational and community support on nurse stressor levels, physio-psychosocial responses, and coping strategies employed.

Methods

A cross-sectional survey was developed to bridge our understanding of stress, support, and coping mechanisms and distributed to nurses working with COVID-19-infected patients in hospital settings in Alabama. A total of 232 frontline nurses responded to 79 items in four domains (stressors, physio-psychosocial symptoms, coping, and support) between May 6, 2020, and June 30, 2020. A two-way ANOVA, regression analysis, and mediation of effects were used to analyze the data.

Results

This study found that both social support and use of coping strategies contributed to the reduction of physio-psychosocial symptoms. Differences were found in how older frontline nurses perceived the efficacy of social support and certain coping strategies. This study provides further evidence of the importance of organizational support in addressing the harmful physio-psychosocial symptoms experienced by nurses.

Work‐related stress and coping methods of internists and primary care physicians during the COVID ‐19 pandemic in Japan: A mixed‐method study

Background

The COVID‐19 pandemic has affected the mental health of health care workers. This study aimed to investigate the stress factors that cause burnout in Japanese physicians and their coping methods during the COVID‐19 pandemic.

Methods

We conducted a sequential explanatory mixed‐method study to investigate the psychological responses of physicians in the early stages of the pandemic. A cross‐sectional, web‐based, anonymous survey was conducted among members of the American College of Physicians Japan Chapter to quantitatively investigate the stress factors and prevalence of burnout. An open‐ended questionnaire with questions about stress factors and coping methods was additionally administered. The qualitative data were analyzed using qualitative content analysis.

Results

Among the 1173 physicians surveyed, 214 (18.2%) responded. Among the participants, 107 (50.0%) responded “yes” to the question “I feel or have felt very stressed at work during the COVID‐19 pandemic,” and 68 (31.8%) reported burnout symptoms. Those who reported feeling stress (117 respondents) were asked to select 12 items of the stress factors related to COVID‐19. The most significant stress factor related to COVID‐19 was “Perceived risk of spreading COVID‐19 to family members” (n = 47). Content analysis identified 12 categories for the stress factors and 7 for stress‐coping methods corresponding to COVID‐19 (Cohen's kappa = 0.84 and 0.95, respectively).

Conclusion

Several distinct stressors existed during the COVID‐19 pandemic, which might be related to burnout among physicians. Practicing stress‐coping strategies, as identified in the present study, may help reduce work‐related stress and prevent burnout.

The Communication Challenges and Strength of Nurses' Intensive Corona Care during the Two First Pandemic Waves: A Qualitative Descriptive Phenomenology Study

Intensive care nurses working with patients with severe COVID-19 illness are at the center and frontline of the dynamic pandemic, which poses communication challenges and demands of unusual strength on their part. The study aim was to capture the lived experience of intensive care COVID nurses' communication challenges and strengths as they cared for COVID-19 intensive care patients during the two first pandemic waves. The study used qualitative descriptive-phenomenology research designs. Twenty-two nurses were selected using snowball sampling, and online interviews were conducted with them. Data were recorded and transcribed, then reflexively double-coded for increased rigor. Four major themes emerged from the data. The first two expressed the communication challenges and difficulties communicating with patients due to the extreme protection needed and/or their medical condition. However, the other two themes expressed the nurses' strengths-sharing feelings with other caregivers and family. Accordingly, we recommend using simple language and ensuring patient comprehension, as well as creating an optimistic environment for fostering caregiver bonding.

The Effect of Mindfulness-Based Breathing and Music Therapy Practice on Nurses' Stress, Work-Related Strain, and Psychological Well-being During the COVID-19 Pandemic: A Randomized Controlled Trial

Infectious diseases cause psychological problems for health care workers and especially nurses. Nurses who provided coronavirus disease-2019 (COVID-19) patients with care experience negative feelings such as stress, work-related strain, discomfort, and helplessness related to their high-intensity work. The aims of this study are to investigate the effect of the mindfulness-based breathing and music therapy practice on stress, work-related strain, and psychological well-being levels of nurses who provided COVID-19 patients with care. This randomized controlled trial was conducted in a COVID-19 department at a university hospital in Turkey. Nurses who care for patients infected with COVID-19 were randomly divided into an intervention group (n = 52) and a no-treatment control group (n = 52). The intervention group received mindfulness-based breathing and music therapy. In data collection, the Personal Information Form, State Anxiety Inventory, Work-Related Strain Scale, and Psychological Well-Being Scale were used. The data from the study showed that mindfulness-based breathing and music therapy decreased stress and work-related strain (P < .05) and increased psychological well-being (P < .05). The control group showed no statistically significant changes on these measures (P > .05). The mindfulness-based breathing and music therapy practice reduced nurses' stress and work-related strain and increased psychological well-being during the COVID-19 pandemic.

Rwanda's community health workers at the front line: a mixed-method study on perceived needs and challenges for community-based healthcare delivery during COVID-19 pandemic

OBJECTIVE

During the COVID-19 pandemic, community health workers (CHWs) served as front-line workers in the COVID-19 response while maintaining community health services. We aimed to understand challenges faced by Rwanda's CHWs during a nationwide COVID-19 lockdown that occurred between March and May 2020 by assessing the availability of trainings, supplies and supervision while exploring perceived needs and challenges.

DESIGN AND SETTING

This study was a mixed-method study conducted in three Rwandan districts: Burera, Kirehe and Kayonza.

MAIN OUTCOME AND MEASURE

Using data collected via telephone, we assessed the availability of trainings, supplies and supervision during the first national lockdown, while exploring perceived needs and challenges of CHWs who were engaged in COVID-19 response, in addition to their existing duties of delivering health services in the community.

RESULTS

Among the 292 quantitative survey participants, CHWs were responsible for a median of 55 households (IQR: 42-79) and visited a median of 30 households (IQR: 11-52) in the month prior to the survey (July 2020). In the previous 12 months, only 164 (56.2%) CHWs reported being trained on any health topic. Gaps in supply availability, particularly for commodities, existed at the start of the lockdown and worsened over the course of the lockdown. Supervision during the lockdown was low, with nearly 10% of CHWs never receiving supervision and only 24% receiving at least three supervision visits during the 3-month lockdown. In qualitative interviews, CHWs additionally described increases in workload, lack of personal protective equipment and COVID-specific training, fear of COVID-19, and difficult working conditions.

CONCLUSION

Many challenges faced by CHWs during the lockdown predated COVID-19 and persisted or were exacerbated during the pandemic. To promote the resilience of Rwanda's CHW system, we recommend increased access to PPE; investment in training, supervision and supply chain management; and financial compensation for CHWs.

Impact of nurses' roles and burden on burnout during the COVID-19 pandemic: multicenter cross-sectional survey

AIM

To identify groups of nurses engaging in coronavirus disease (COVID-19) care who are most in need of organizational support.

BACKGROUND

Overwhelming stress and susceptibility to burn-out have been reported in nurses during the COVID-19 pandemic.

METHODS

Nurses working at five hospitals which accepted COVID-19 patients answered the questionnaire. The Tokyo Metropolitan Distress Scale for Pandemic, Self-Diagnosis Check List for Assessment of Workers' Accumulated Fatigue, and Japanese Burnout Scale were evaluated. Multiple regression analysis was performed to examine the relationship between engaging in COVID-19 care and psychosocial/physical burden.

RESULTS

In total, 895 questionnaires were analyzed. With experience in caring for COVID-19 patients as the independent variable, nurses caring for suspected cases had significantly higher standardized Tokyo Metropolitan Distress Scale for Pandemic scores for "concerns for infection" (standardized partial regression coefficient β = 0.921, P = 0.004), Assessment of Workers' Accumulated Fatigue (β = 0.445, P = 0.022), and Japanese Burnout Scale "emotional exhaustion" (β = 0.136, P = 0.021) than those caring for confirmed cases.

CONCLUSIONS

Nurses caring for suspected COVID-19 patients have the highest psychological/physical burden and propensity for burnout.

IMPLICATIONS FOR NURSING MANAGEMENT

Extensive support systems are required for nurses caring for confirmed and suspected COVID-19 cases.

Modulating Elements of Nurse Resilience in Population Care during the COVID-19 Pandemic

COVID-19 has significantly affected the work environment of nurses. In the face of the challenges posed by stressors in clinical practice, some nurses adapt and prove to be resilient. In the face of the COVID-19 pandemic, the nature of care itself and the new ways of working are potentially very stressful. We aim to analyze the resilience of care nurses to the psychological impact of the COVID-19 pandemic. This study is a systematic review of nurse caregiver resilience to the COVID-19 pandemic in 2021. Our search was conducted in the WOS, Medline/PubMed, Cochrane, BVS/LILACS, and Cuiden databases. The inclusion criteria were: studies published in Spanish or English; carried out from March 2020 to May 2021 on nurses caring for patients with COVID-19; and investigating the factors influencing the psychological impact, resilience, strategies to develop it, and interventions to promote it during this pandemic and others, such as SARS, MERS, or ebola. The quality of the studies and the risk of bias were evaluated following ICROMS, STROBE and AMSTAR-2 criteria. Twenty-two studies were selected. Most of the studies highlighted the presence of stressors in nurses, emphasizing those of the environment, which converged in dysfunctional responses that hurt their resilience. The most persuasive factors were social and organizational support. Coping strategies developed by nurses and especially interventions by organizations were detected as instruments to foster resilience, but have not been well researched. Resilience has a key moderating role in mitigating the psychological impact of nurses in the face of the COVID-19 pandemic.

Perceived Stress and Coping Behavior of Nurses Caring for Critical Patients with COVID-19 Outbreak in Taiwan: A Mixed-Methods Study

Severe pneumonia with novel pathogens, also called COVID-19, caused a pandemic in Taiwan as well as in the rest of the world in May 2021. Nurses are under great stress when caring for critically ill patients with COVID-19. This study aimed to explore the perceived stress and coping behaviors of nurses caring for critically ill patients with COVID-19 using a mixed-methods approach. We recruited 85 nurses from a special intensive care unit (ICU) of a medical center in Taiwan between May and June 2021. To gather data, we used a questionnaire on basic characteristics, the perceived stress scale (PSS-14), and the brief coping orientation to problems experienced inventory (B-COPE), then conducted a qualitative interview. The results showed that the average perceived stress level among nurses was 25.4 points, and most of them perceived moderate stress. The top three coping behaviors practiced by the nurses were active coping, planning, and acceptance. Nurses who received less perceived support from their friends or families and who had shorter working experience in nursing had significantly higher stress levels. The qualitative results revealed that the nurses' perceived stress came from fear, worry, and the increased burden caused by caring for critical patients with COVID-19. Coping behaviors included rest, seeking support, and affirmative fighting. Based on these findings, it is suggested that the support nurses receive from their families is an important predictor of perceived stress. Therefore, it is suggested that nurses be provided with more support in dealing with stress caused by caring for critical patients with COVID-19 in special ICUs.

How did the COVID-19 pandemic impact the stress vulnerability of employed and non-employed nursing students in Romania?

In the light of the current COVID-19 pandemic, being considered a present challenge for public health, the main purpose of this work is to analyze the vulnerability to stress of a sample of nursing students in Romania considering their status on labour market (employed students in the medical system and non-employed students) before and during the COVID-19 pandemic. Employed students were more vulnerable to stress comparing to non-employed ones during the pandemic. In addition to this, the nursing students working in the medical system experienced medium vulnerability to stress during the pandemic comparing to those working before the pandemic who experienced a low vulnerability to stress. Excepting the non-employed students before the pandemic, the females were more vulnerable to stress comparing to the males in the sample and the students living in the country experienced a higher level of stress comparing to those living in the urban area. During the pandemic, most of the employed nursing students expressed their fear of getting infected with COVID-19, this representing the most stressful factor for them, while most of them mentioned the self-control as being the most proper strategy for them to cope with stress. These empirical findings have practical implications for stress control among present and future nurses, for management of medical units and for higher education nursing.

A scoping review of COVID-19-related stress coping resources among nurses

Objective

The entire mental health hazard among the nurses dealing with COVID-19 is just the tip of the iceberg. The goal of this study was to find acceptable and adaptive coping techniques for nurses in order to keep the healthcare system resilient during and after the COVID-19 pandemic.

Method

The scoping review search took place from January 2020 to May 2021 published articles, and the results were saved in Endnote software. For data synthesis and review, the Joanna Briggs Institute manual and PRISMA-ScR principles were followed. Following backward and forward screening to exclude redundant, irrelevant, and ineligible studies, 13 studies (3,613 nurses) were finally selected for this review.

Results

The majorities of participants in these studies were female and had children, and worked in departments of critical care, emergency, and fever clinics. Safety concerns for family or colleagues, as well as a lack of safe working environment, were the primary causes of the mental illness. Professional responsibility attitude, COVID-19 training, workplace safety, team spirit, and a few relaxation activities such as deep breathing, reading books, watching movies, and praying, on the other hand, were found to be beneficial for stress coping among nurses.

Conclusion

Mentally fit nurses are more capable and flexible in the face of any life-threatening outbreak, even if it is very contagious. Several coping strategies were found to be effective for nurses during the COVID-19 pandemic, whereas problem-specific intervention trials might yield even better results. We should not delay specific mental health interventions to keep them viable and more efficient during a pandemic battlefield, whereas Post-Traumatic Stress Disorder and suicide rates can destroy the entire health care system.

[A qualitative study on nurses' experiences with social stigma in the context of COVID-19]

Aim

This study aimed to examine the social stigma experienced by healthcare workers caring for people diagnosed with COVID-19.

Methods

This research employed a qualitative-phenomenological approach. It was conducted at the COVID centers of the Hail region, Kingdom of Saudi Arabia. Both purposive and snowball sampling were used, resulting in 15 participants. However, saturation was identified in the 11th participant. Interviews were conducted online through a Zoom platform, with at least 50 min per participant. Thematic analysis was used in analysing the data.

Results

The nurses recorded four themes and three subthemes based on one-on-one interviews. These themes included (1) Labeling nurses as "COVID Nurses," with a subtheme of frustration, (2) "Fear of the unknown," with a subtheme of "uncertainties," (3) Nurses' need for support, and (4) the Love for the profession, with a subtheme of "nurses' worth."

Conclusion

Nurses who cared for patients diagnosed with COVID-19 experienced stigma. They were labeled "COVID Nurses." They experienced fear of the unknown and uncertainties and felt they needed support. Despite these experiences, the nurses felt fulfilled as they have a high regard for their profession. The experiences of these nurses call for intervention to help them before, during, and after any health-related crisis. In this context, nurses will be prepared mentally and emotionally to face the challenges in their career.

Factors associated with burnout among Chinese nurses during COVID-19 epidemic: a cross-sectional study

BACKGROUND

The coronavirus disease 2019 (COVID-19) epidemic has broken out and even spread globally. The healthcare system worldwide faces enormous challenges, and nurses are at the highest risk as one of the leading forces. It's worth paying attention to nurses' anxiety and job burnout. This study aimed to investigate nurses' levels of burnout and anxiety during the epidemic of COVID-19 and to analyze influencing factors of burnout.

METHODS

A cross-sectional survey was conducted from 19 to 25 February 2020. Questionnaires such as the basic information questionnaire, Maslach Burnout Inventory-General Survey (MBI-GS), and State-Trait Anxiety Inventory (STAI) were used among 1011 nurses in Wuhan tertiary hospitals via the online survey. The final number of valid questionnaires was 885. The effective response rate was 87.5%.

RESULTS

The average score of MBI-GS was 11.50, 6.02, 24.47, respectively. The average score for state anxiety was 45.52 and trait anxiety, 43.78. Anxiety was positively associated with emotional exhaustion and cynicism, and negatively related to personal accomplishment. The protective factors of burnout were personnel agency, five years or less work experience, living in hospital dormitory, Wuhan medical team, working time exceeding 9 h, and the best knowledge of COVID-19. The absence of siblings, median job title, working in isolation wards, three or more night shifts per week, living in hotels, and being surrounded by confirmed or suspected medical staff were all negative factors.

CONCLUSIONS

Nurses had high anxiety levels during the COVID-19 period, but the level of burnout was mild to moderate. Managers should continue to pay attention to nurses' psychological state and related factors and intervene to stabilize the nursing team.

Need for support among healthcare professionals during the COVID-19 pandemic: a qualitative study at an academic hospital in the Netherlands

OBJECTIVES

The aim of the current study is to gain insight into the factors that benefit vitality and resilience of healthcare workers during the COVID-19 pandemic, to develop and direct specific support strategies.

DESIGN, SETTING AND PARTICIPANTS

This study applies a qualitative design, consisting of six focus groups and five interviews among 38 frontline healthcare workers in a large Dutch academic hospital. Included were professionals of the intensive care unit, COVID-19 departments, infection prevention units and facility management services. The study was conducted in October and November 2020, during the second wave of the COVID-19 pandemic.

DATA ANALYSIS

Thematic analysis was applied to focus group and interview data to gain insight into the factors that contribute to maintaining vitality and resilience, and to assess specific support needs.

RESULTS

Data analysis of the focus groups and individual interviews resulted in a thematic map of the factors that contribute to maintaining resilience and vitality. The map stretches over two axes: one ranging from a healthy basis to adequate professional functioning and the other from individual to organisation, resulting in four quadrants: recharge and recover (healthy basis, individual), safety and connectedness at work (healthy basis, organisational), collaboration (professional functioning, organisational) and professional identity (professional functioning, individual).

CONCLUSION

Areas for organisational support strategies to increase vitality and resilience among healthcare professionals are: consistent communication, realistic job performance expectations, monitor and improve mental resilience, showing appreciation and act upon practical support requests.

The Impact of the COVID-19 Pandemic on Burnout, Compassion Fatigue, and Compassion Satisfaction in Healthcare Personnel: A Systematic Review of the Literature Published during the First Year of the Pandemic

This literature review aimed to determine the level of burnout, compassion fatigue, and compassion satisfaction, as well as their associated risks and protective factors, in healthcare professionals during the first year of the COVID-19 pandemic. We reviewed 2858 records obtained from the CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, and Web of Science databases, and finally included 76 in this review. The main results we found showed an increase in the rate of burnout, dimensions of emotional exhaustion, depersonalization, and compassion fatigue; a reduction in personal accomplishment; and levels of compassion satisfaction similar to those before the pandemic. The main risk factors associated with burnout were anxiety, depression, and insomnia, along with some sociodemographic variables such as being a woman or a nurse or working directly with COVID-19 patients. Comparable results were found for compassion fatigue, but information regarding compassion satisfaction was lacking. The main protective factors were resilience and social support.

Demographic Factors and Job Characteristics Associated With Burnout in Chinese Female Nurses During Controlled COVID-19 Period: A Cross-Sectional Study

Background: To investigate the prevalence of burnout syndrome among Chinese female nurses during the controlled coronavirus disease 2019 (COVID-19) period and explore its associated socio-demographic factors and job characteristics. Methods: With the multistage, stratified sampling method, a cross-sectional online survey was conducted from September to October 2020 in China. The survey tool included revised Maslach Burnout Inventory (MBI) with 15 items, socio-demographic and job characteristics. Univariate logistic regression analysis and multivariate factor logistic regression analysis were used to identify the risk factors for burnout of female nurses. Results: During controlled COVID-19 period in China, the overall prevalence of burnout symptoms among Chinese female nurses was 60.2% with a breakdown in severity as follows: 451 (39.8 %) mild, 163 (14.4%) moderate, and 68 (6.0%) severe burnout. Little variance was reported for burnout symptoms according to job tenure (Waldχ ² = 14.828, P < 0.05,odds ratio [OR] <1), monthly salary income (Waldχ ² = 12.460, P < 0.05, OR <1), and night shift (Waldχ ² = 3.821, P < 0.05, OR > 1). Conclusion: Burnout symptoms among Chinese female nurses were prevalent and associated with job tenure, monthly salary income, and night shift. Female nurses who were with shorter job tenure, worked at night shifts, and had lower monthly salaries tended to exhibit increasing high-level burnout than their counterparts. This study serves as an implication for administrators and policy-makers to improve the work conditions of nurses for promoting overall healthcare service quality.

Difference in Pandemic-Related Experiences and Factors Associated with Sickness Absence among Nurses Working in COVID-19 and Non-COVID-19 Departments

Background: The aim of this study is to determine the main variables associated with nurses’ sickness absence (SA) and to improve the prediction of SA based on pandemic-related experiences. The second aim is to examine the differences between COVID-19 (CoV) and non-COVID-19 (non-CoV) nurses in levels of post-traumatic stress disorder (PTSD) symptoms, personality traits, coping strategies and professional stressors experienced. Methods: This historical prospective study enrolled 1305 nurses from the University Hospital of Split, Croatia. A total of 380 subjects participated in the study, 163 non-CoV and 217 CoV subjects. Nurses’ pandemic-related experience questionnaires, Big Five Inventory (BFI), Post-traumatic Stress Disorder Checklist (PCL-5), Coping Inventory for Stressful Situations (CISS) and Occupational Stress Questionnaire, were used for evaluation. Results: Non-CoV nurses felt more fear of infection, were more socially distanced, had more PTSD symptoms and neuroticism and felt more stress due to public criticism and job requirements compared to CoV nurses; p < 0.001. The groups of SA users and non-SA users could be distinguished based on predictor variables in CoV and non-CoV nurses, with a correct classification of 84.8% vs. 79.1%. Conclusions: It was possible to predict the probability of using SA among nurses due to pandemic professional experience, personality traits and coping strategies.

Cost Analysis of Providing Overtime to Current Nurses Versus Hiring a Dedicated Nurse for COVID-19 Management in a Processing Plant

BACKGROUND

U.S. meat and poultry processing workers experienced a disproportionate burden of COVID-19 illness following the declaration of the COVID-19 pandemic. Managing prevention and surveillance activities for COVID-19 prevention required additional work for occupational health nurses. The purpose of this project was to conduct a cost analysis for two staffing options to address the increased workload for occupational health nurses.

METHODS

An economic quality improvement design was used for this study. The project was performed at a meat and poultry processing plant with 1,800 employees and six occupational health nurses. Two staffing options were considered. Option 1 was to continue to pay current occupational health nurses overtime, and Option 2 was to hire a COVID-dedicated nurse to manage the increased workload. A cost analysis was conducted for wages per hour plus benefits at three time points: 3 months, 1 year, and 3 years.

FINDINGS

Costs for Option 1 (continuing overtime) at 3 months, 1 year, and 3 years were estimated at US$27,370, US$109,517, and US$328,550, respectively. Costs for Option 2 (hiring a COVID-dedicated nurse) at 3 months, 1 year, and 3 years were estimated at US$44,279, US$94,979, and US$230,179, respectively.

CONCLUSIONS/APPLICATION TO PRACTICE

Hiring a dedicated COVID nurse would save the processing plant extensive salary costs by Year 3. Reducing overtime had the potential to decrease the COVID-19-related workload and potential experiences of fatigue and burnout in occupational health nurses.

Investigating #covidnurse Messages on TikTok: Descriptive Study

Background

During a time of high stress and decreased social interaction, nurses have turned to social media platforms like TikTok as an outlet for expression, entertainment, and communication.

Objective

The purpose of this cross-sectional content analysis study is to describe the content of videos with the hashtag #covidnurse on TikTok, which included 100 videos in the English language.

Methods

At the time of the study, this hashtag had 116.9 million views. Each video was coded for content-related to what nurses encountered and were feeling during the COVID-19 pandemic.

Results

Combined, the 100 videos sampled received 47,056,700 views; 76,856 comments; and 5,996,676 likes. There were 4 content categories that appeared in a majority (>50) of the videos: 83 showed the individual as a nurse, 72 showed the individual in professional attire, 58 mentioned/suggested stress, 55 used music, and 53 mentioned/suggested frustration. Those that mentioned stress and those that mentioned frustration received less than 50% of the total views (n=21,726,800, 46.17% and n=16,326,300, 34.69%, respectively). Although not a majority, 49 of the 100 videos mentioned the importance of nursing. These videos garnered 37.41% (n=17,606,000) of the total views, 34.82% (n=26,759) of the total comments, and 23.85% (n=1,430,213) of the total likes. So, despite nearly half of the total videos mentioning how important nurses are, these videos received less than half of the total views, comments, and likes.

Conclusions

Social media and increasingly video-related online messaging such as TikTok are important platforms for social networking, social support, entertainment, and education on diverse topics, including health in general and COVID-19 specifically. This presents an opportunity for future research to assess the utility of the TikTok platform for meaningful engagement and health communication on important public health issues.

Exploring the experiences of nurses caring for patients with COVID-19: a qualitative study in Iran

BACKGROUND

The coronavirus disease (COVID-19) is now a major public health emergency in the world. Nurses as key members of the COVID-19 patient care team are exposed to most challenges caused by the disease. As exploring the experiences of nurses as patient supporters and caregivers can play an important role in improving the quality of care for patients with COVID-19 disease, the present study explored the experiences of nurses caring for patients with COVID-19.

METHODS

The study employed a qualitative design. This study employed purposive sampling to select 10 nurses with bachelors and master's degrees in nursing who were taking care of patients with COVID-19 in ICUs or inpatient wards in southern Iran. Data were collected through semi-structured interviews. The collected data were analyzed using the qualitative content analysis procedure proposed by Graneheim and Lundman.

RESULTS

The analysis of the data revealed four main themes and ten sub-themes: A) physical, psychological, and social burden of care (excessive workload; fear, anxiety, worry; unpleasant social experiences; compassion fatigue) B) unmet needs (personal needs and professional needs) C) positive experiences (pleasant social experiences and inner satisfaction), and D) strategies (problem-solving strategies and stress symptom mitigation strategies).

CONCLUSIONS

An analysis of the themes and subthemes extracted in this study suggested that the nurses who participated in this study faced many personal and professional challenges. Therefore, health officials and specialists need to pay special attention to nurses' challenges and needs.

Perceived Occupational Stressors and the General Health of Critical Care Nurses During COVID-19 Pandemic

Introduction

The COVID-19 situation is placing nurses under great stress which may negatively influence their health.

Objective

The purpose of this study was to examine the association between occupational stress and general health of critical care nurses during COVID-19 pandemic.

Methods

A descriptive, cross-sectional design was used. A convenience sample of 150 Jordanian critical care nurses completed the study.

Results

Occupational stress was a significant predictor of nurses' general health. Female gender, young, living with elderly or persons having chronic diseases, and little nursing experience were associated with worse general health, while living with elderly or persons having chronic diseases were associated with more occupational stress.

Conclusion

Providing psychological support services for critical care nurses is required to reduce the impact of occupational stress on nurses' poor general health.

Strategies for Coping With Stress Used by Nurses in Poland and Belarus During the COVID-19 Pandemic

INTRODUCTION

Stress is an inseparable element of nurses' work. It is also the cause of wellbeing disorders and the source of various diseases. The wellbeing and health of nurses has a direct impact on the quality of care and health outcomes for patients. An appropriate stress coping strategy can reduce the impact of stress and mitigate its negative consequences. The COVID-19 pandemic, especially in its initial period, was a source of enormous additional stress for nurses. In Poland and Belarus: two neighboring countries with common history and similar culture, the authorities took a completely different approach to fighting the COVID-19 pandemic.

AIM

The purpose of this study was to investigate and compare how nurses in Poland and Belarus cope with stress during the COVID-19 pandemic.

MATERIALS AND METHOD

The cross-sectional study was conducted among 284 nurses working in hospital in Bialystok, Poland (158) and in Grodno, Belarus (126). Mini-Cope inventory - the polish adaptation of Carver's BriefCope was used for measuring coping with stress.

RESULTS

Only 17.5% of Belarusian nurses were tested for the presence of the virus and only 4.8% were infected, while in Poland it was 50.6 and 31.0%, respectively. The most frequent used coping strategies were active strategies (active coping, planning) and the least-used were avoidance strategies (behavioral disengagement, substance use) in both countries. Polish nurses significantly more often than Belorussian used support-seeking/emotion-oriented strategies, as well as avoidance strategies. No differences were found for active coping strategies between the both groups. Contact with a patient infected with the SARS-CoV2 virus did not influence the choice of stress coping strategies by nurses in both countries. Staying in quarantine or home isolation favored more active coping strategies, especially in the case of Belarusian nurses. Taking a SARS-CoV-2 test did not statistically differentiate the choice of coping strategies in the Belarusian group. In the Polish group, nurses with a positive SARS-CoV-2 test result used both use of instrumental support and use of emotional support strategies less frequently. SARS-CoV-2 virus infection did not statistically differentiated how stressful situations were handled in Polish group.

CONCLUSIONS

Polish and Belorussian nurses used similar strategies to cope with stress in the face of the COVID-19 pandemic. The social and demographic differences between Polish and Belorussian nurses differentiated the choice of coping strategies among the respondents to a greater extent than the completely different approach of the media and authorities to the COVID-19 pandemic in the two countries. The threat of the COVID-19 pandemic does not affect the choice of stress coping strategies by nurses in Poland and Belarus. Being in quarantine or home isolation favored the use of active coping strategies among Belorussian nurses. Polish nurses, on the other hand, were more likely to turn to religion after being quarantined.

Factors Associated With Prolonged Psychological Distress Among Nurses and Physicians Engaged in COVID-19 Patient Care in Singapore and Japan

This study explores the factors contributing to the prolonged psychological distress of frontline nurses and physicians caring for COVID-19 patients in hospitals in Singapore and Japan. A cross-sectional survey between September and December 2020 yielded 1,644 responses (23.8%), from 62 nurses and 64 physicians in Singapore and 1,280 nurses and 238 physicians in Japan. Multivariate logistic regression analysis revealed that significant risk factors for prolonged psychological distress included being a frontline nurse [adjusted odds ratio (aOR) = 2.40, 95% confidence interval (CI): 1.24-4.66], having an underlying medical condition (aOR = 1.74, 95% CI: 1.22-2.46), experiencing prejudice because they undertook COVID-19 patient care (aOR = 3.05, 95% CI: 2.23-4.18), having trouble dealing with panicked or uncooperative patients (aOR = 2.36, 95% CI: 1.71-3.25), and experiencing an outbreak of COVID-19 in the hospital (aOR = 2.05, 95% CI: 1.38-3.04). Factors inversely associated with psychological distress included age (OR = 0.98, 95% CI: 0.97-1.00), number of beds in the hospital (aOR = 0.73, 95% CI: 0.57-0.94), clinical practice of carefully putting on and taking off personal protective equipment in daily COVID-19 patient care (aOR = 0.52, 95% CI: 0.37-0.73), and knowledge on COVID-19 (aOR = 0.82, 95% CI: 0.72-0.94). These results could help us identify vulnerable healthcare providers who need urgent mental care during the COVID-19 pandemic. Measures that may reduce psychological strain include adequate supply of medical resources, education on precautionary measures, and communication strategies to combat discrimination against frontline healthcare providers.

Women, Younger Clinicians', and Caregivers' Experiences of Burnout and Well-being During COVID-19 in a US Healthcare System

BACKGROUND

The COVID-19 pandemic brought rapid changes to the work and personal lives of clinicians.

OBJECTIVE

To assess clinician burnout and well-being during the COVID-19 pandemic and guide healthcare system improvement efforts.

DESIGN

A survey asking about clinician burnout, well-being, and work experiences.

PARTICIPANTS

Surveys distributed to 8141 clinicians from June to August 2020 in 9 medical groups and 17 hospitals at Sutter Health, a large healthcare system in Northern California.

MAIN MEASURES

Burnout was the primary outcome, and other indicators of well-being and work experience were also measured. Descriptive statistics and multivariate logistic regression analyses were performed. All statistical inferences were based on weighted estimates adjusting for response bias.

KEY RESULTS

A total of 3176 clinicians (39.0%) responded to the survey. Weighted results showed 29.2% reported burnout, and burnout was more common among women than among men (39.0% vs. 22.7%, p<0.01). In multivariate models, being a woman was associated with increased odds of reporting burnout (OR=2.19, 95% CI: 1.51-3.17) and being 55+ years old with lower odds (OR=0.54, 95% CI: 0.34-0.87). More women than men reported that childcare/caregiving was impacting work (32.9% vs. 19.0%, p<0.01). Even after controlling for age and gender, clinicians who reported childcare/caregiving responsibilities impacted their work had substantially higher odds of reporting burnout (OR=2.19, 95% CI: 1.54-3.11). Other factors associated with higher burnout included worrying about safety at work, being given additional work tasks, concern about losing one's job, and working in emergency medicine or radiology. Protective factors included believing one's concerns will be acted upon and feeling highly valued.

CONCLUSIONS

This large survey found the pandemic disproportionally impacted women, younger clinicians, and those whose caregiving responsibilities impacted their work. These results highlight the need for a holistic and targeted strategy for improving clinician well-being that addresses the needs of women, younger clinicians, and those with caregiving responsibilities.

Nurses' mental health from early COVID-19 pandemic to vaccination

AIMS

The influence of the COVID-19 vaccine and the evolution of the pandemic over time on nurses' mental health have not been thoroughly examined. This study aimed to explore the changes in nurses' mental health from the early pandemic to the early vaccination period over a 1-year time span and examine vaccination and coping mechanisms as predictors of nurses' poor mental health and burnout.

METHODS

Three cross-sectional surveys were conducted: Early-pandemic (n = 320), pre-vaccination (n = 228), and early-vaccination cohorts (n = 292).

FINDINGS

About 72% of nurses in the early-vaccination cohort were fully vaccinated with two doses of mRNA COVID-19 vaccines. There were significant decreases in moderate/severe anxiety and moderate/severe depression for the early-vaccination cohort compared to the other cohorts. In multivariate analyses, vaccination had almost three-fold higher odds of moderate/severe anxiety (Odds Ratio [OR] = 2.87; 95% Confidence Interval [CI] = 1.28-6.44). High resilience, family functioning, and spirituality were associated with two- to five-fold lower odds of poor mental health and burnout.

CONCLUSIONS

Although nurses in the early-vaccination cohort had lower anxiety and depression than earlier cohorts, COVID-19 vaccination had minimal associations with nurses' mental health. Coping mechanisms and organizational support appear to be important predictors of nurses' poor mental health and burnout.

CLINICAL RELEVANCE

The evidence gathered over 1 year of the pandemic may be helpful for a better understanding of the challenges facing frontline nurses and preparing for future healthcare crises. As a part of the preparedness plan for the future, evidence-based interventions that raise frontline nurses' resilience, as well as family and spiritual support, should be considered.

Emergency Care Gap in Brazil: Geographical Accessibility as a Proxy of Response Capacity to Tackle COVID-19

Background: The new coronavirus disease (COVID-19) has claimed thousands of lives worldwide and disrupted the health system in many countries. As the national emergency care capacity is a crucial part of the COVID-19 response, we evaluated the Brazilian Health Care System response preparedness against the COVID-19 pandemic.

Methods: A retrospective and ecological study was performed with data retrieved from the Brazilian Information Technology Department of the Public Health Care System. The numbers of intensive care (ICU) and hospital beds, general or intensivist physicians, nurses, nursing technicians, physiotherapists, and ventilators from each health region were extracted. Beds per health professionals and ventilators per population rates were assessed. A health service accessibility index was created using a two-step floating catchment area (2SFCA). A spatial analysis using Getis-Ord Gi^* was performed to identify areas lacking access to high-complexity centers (HCC).

Results: As of February 2020, Brazil had 35,682 ICU beds, 426,388 hospital beds, and 65,411 ventilators. In addition, 17,240 new ICU beds were created in June 2020. The South and Southeast regions have the highest rates of professionals and infrastructure to attend patients with COVID-19 compared with the northern region. The north region has the lowest accessibility to ICUs.

Conclusions: The Brazilian Health Care System is unevenly distributed across the country. The inequitable distribution of health facilities, equipment, and human resources led to inadequate preparedness to manage the COVID-19 pandemic. In addition, the ineffectiveness of public measures of the municipal and federal administrations aggravated the pandemic in Brazil.

Exploring Global Research Trends in Burnout among Nursing Professionals: A Bibliometric Analysis

Nursing professionals are constantly exposed to several risk factors and high levels of stress that can affect their mental, emotional, and physical health, which can trigger burnout syndrome. This article aims to use bibliometric analysis to investigate burnout research trends among nursing professionals worldwide and to compare the contributions of different countries/institutions, scientific journals, authors, keywords, and citations. A bibliometric study was performed using the Scopus and Web of Science databases, in the period up to November 2021, aiming to search original and review articles in the English language regarding burnout in nursing professionals. The analysis was performed with a sample of 1406 articles. The most cited article indicated that 43% of nurses had high burnout scores, and a similar percentage were dissatisfied with their work. The most productive and most cited country in the world was the United States of America. Regarding the 10 most cited documents, there were no studies that could provide interventions to reduce burnout in nursing professionals, which can result in a need to develop studies on prevention capable of mitigating the problem, in view of the impacts generated on their mental, emotional, and physical health.

Professional burnout of nursing team working to fight the new coronavirus pandemic

OBJECTIVE

to identify burnout and associated factors among nursing workers working in coping with COVID-19.

METHODS

a cross-sectional study, developed in four hospitals in a capital in southern Brazil. Sample (n=499) composed of nurses and nursing technicians/assistants, who answered an online form containing socio-occupational characterization and the Maslach Burnout Inventory. Descriptive and inferential statistical analysis was performed, including multiple comparison tests.

RESULTS

burnout was identified in 60 (12%) workers, with no significant difference between hospitals, but with a difference in dimensions between them. In the emotional exhaustion dimension, a higher proportion (52.9%) was found at a moderate level. Prevalence of high level of professional achievement of 95.4% was identified.

CONCLUSION

the presence of burnout was significantly prevalent among nurses and females. It reinforces the need to develop strategies to promote the health of nursing workers, providing improvement in health services and reduction of care and labor risks.

Perceived and sources of occupational stress in intensive care nurses during the COVID-19 pandemic

OBJECTIVE

To determine the level of occupational stress in intensive care nurses during the COVID-19 pandemic and factors of perceived stress.

METHODS

The study had a descriptive design. A total of 262 nurses working in adult intensive care units (ICUs) across Turkey during the COVID-19 pandemic constituted the sample. Data were collected by an online survey and the Perceived Stress Scale-14. Descriptive statistics, independent t-test, one- way analysis of variance, regression analysis and Bonferroni test were used for data analysis.

RESULTS

Percentage of nurses with moderate level of occupational stress was 62%. High working hours and nurse:patient ratios, heavy workload and failure in patient treatment were the main factors of occupational stress. Level of occupational stress was affected by gender, number of children, years of experience in intensive care and the type of work shift.

CONCLUSION

Intensive care nurses in Turkey experienced moderate stress during the COVID-19 pandemic. Interventions to prevent occupational stress among intensive care nurses in the long run might be implemented.

Quality of Life among Pediatric Neurocognitive, Speech, and Psychomotor Rehabilitation Professionals during the COVID-19 Pandemic: A Longitudinal Study on an Italian Sample

Objective: The aim was to estimate the perceived quality of life and its relationship with sociodemographic and professional factors, perception of susceptibility to COVID-19, and stress. Design: It was a longitudinal study. Subjects: Professionals, working in Italian centers for pediatric neurocognitive, speech, and psychomotor rehabilitation. Methods: Participants were interviewed online twice during the COVID-19 outbreak in Italy. The questionnaire included: (i) The measures of health-related quality of life to perform the Summary Index of Unhealthy Days, (ii) modified items from the “Standard questionnaire on risk perception of an infectious disease outbreak” and (iii) the items of the General Health Questionnaire. Results: One hundred and thirty professionals out of 130 participated in the first interview, while only 50 therapists took part in the second interview (dropout rate: 61%). The Summary Index of Unhealthy Days was 8 days at the first interview, and it decreased to 6 days at the second interview; however, the reduction was not significant (F = 3.22; p = 0.079). The multivariable analysis showed that the rehabilitation providers with moderate or severe stress level were more likely to have a negative perception of the quality of life (ORadj = 7.155; 95% CI: 2.8–18.2), and this result was confirmed at the second interview. Conclusions: Our results showed that in a severe public health emergency, the mental health and quality of life of rehabilitation professionals must be a topic of focus to enhance psychological resilience, to prevent burnout and to reduce rehabilitation errors.

Determinant of Stress and Burnout among Nurses at the Second Wave of the Indonesian COVID-19 Pandemic: A National Web-based Survey

BACKGROUND: COVID-19 pandemic has developed into a major public health threat. Nurses who work to combat COVID-19 are frequently under pressure. The high stresses caused by the consequences of transmission of the COVID-19 put nurses at risk of developing burnout syndrome. AIM: The purpose of this study was to evaluate the level of anxiety and burnout experienced by nurses during the COVID-19 pandemic. METHODS: This study was conducted using a cross-sectional design. An online web-based survey was used to collected data in the national sample of nurses (n = 243, response rate = 78.6%). This study used a convenience sampling technique. The Hamilton Anxiety Rating Scale and the Maslach Burnout Inventory were also employed. Multiple linear regressions were used to determine characteristics associated with burnout. RESULTS: The participants’ average age was 34.62 years (SD = 7.91). The mean anxiety score was 7.89 (SD = 2.94). The mean score of emotional exhaustion was 14.35 (SD = 7.72), the depersonalization means score was 8.81 (SD = 5.11), and the professional accomplishment mean score was 13.51 (SD = 7.51). Education and job experience had a substantial effect on emotional exhaustion and depersonalization, with R2 values of 10.8% and 18.5%, respectively. When anxiety was included in the model, the R2 for emotional exhaustion increased to 20.4% and the R2 for depersonalization increased to 22.2%, respectively. Work experience had a little effect on professional accomplishment (R2 = 10.3%) but had a much larger effect when the variable of anxiety was included in the model (R2 = 18.3%). CONCLUSION: This study revealed that during the COVID-19 epidemic, nurses experienced many emotional states, including exhaustion, depersonalization, and anxiety. Efforts should be made by governments and policymakers in this regard in better preparing health-care systems, persons, and nursing to respond to the COVID-19 pandemic in the future.

Dependence of emotional burnout on personality typology in the COVID-19 pandemic

BACKGROUND

Under the conditions of the COVID-19 pandemic, the problem of emotional burnout syndrome among nurses working under extremely stressful conditions has become particularly acute. It is therefore necessary to examine the characteristics of emotional burnout syndrome in nurses during the COVID-19 pandemic to develop effective measures to prevent and enhance their mental health.

OBJECTIVE

The study aimed to establish the features of emotional burnout syndrome and its connection with typological characteristics of the personality in nurses working with COVID-19 patients.

METHODS

A total of 120 female nurses who worked with COVID-19 patients were surveyed, of whom 60 (50.0%) worked in outpatient settings along with general practitioners and 60 (50.0%) worked in the intensive care unit. The average age of the participants was 40.86±3.20 years, and the average length of medical service was 13.64±1.73 years.

RESULTS

A burnout syndrome of varying severity was present in 50.0%of outpatient nurses and 73.3%of intensive care nurses (OR = 2.44, 95%CI [1.16-5.16]; p < 0.05). The tension phase predominated in outpatient nurses (53.3%), and the resistance phase was more typical for intensive care nurses (63.3%).

CONCLUSIONS

The practice of nurses under COVID-19 pandemic conditions is characterized by the high prevalence of emotional burnout syndrome.

Psychological distress among healthcare providers during COVID-19 in Asia: Systematic review and meta-analysis

INTRODUCTION

COVID-19 pandemic is having a devastating effect on the mental health and wellbeing of healthcare providers (HCPs) globally. This review is aimed at determining the prevalence of depression, anxiety, stress, fear, burnout and resilience and its associated factors among HCPs in Asia during the COVID-19 pandemic.

MATERIAL AND METHODS

We performed literature search using 4 databases from Medline, Cinahl, PubMed and Scopus from inception up to March 15, 2021 and selected relevant cross-sectional studies. Publication bias was assessed using funnel plot. Random effects model was used to estimate the pooled prevalence while risk factors were reported in odds ratio (OR) with 95% CI.

RESULTS

We included 148 studies with 159,194 HCPs and the pooled prevalence for depression was 37.5% (95%CI: 33.8-41.3), anxiety 39.7(95%CI: 34.3-45.1), stress 36.4% (95%CI: 23.2-49.7), fear 71.3% (95%CI: 54.6-88.0), burnout 68.3% (95%CI: 54.0-82.5), and low resilience was 16.1% (95%CI: 12.8-19.4), respectively. The heterogeneity was high (I2>99.4%). Meta-analysis reported that both females (OR = 1.48; 95% CI = 1.30-1.68) and nurses (OR = 1.21; 95%CI = 1.02-1.45) were at increased risk of having depression and anxiety [(Female: OR = 1.66; 95% CI = 1.49-1.85), (Nurse: OR = 1.36; 95%CI = 1.16-1.58)]. Females were at increased risk of getting stress (OR = 1.59; 95%CI = 1.28-1.97).

CONCLUSION

In conclusion, one third of HCPs suffered from depression, anxiety and stress and more than two third of HCPs suffered from fear and burnout during the COVID-19 pandemic in Asia.

Vitality, resilience and the need for support among hospital employees during the COVID-19 pandemic: study protocol of a mixed-methods study

INTRODUCTION

The COVID-19 pandemic has had a significant impact on the physical and mental functioning of healthcare professionals, especially those working on the 'frontline', and other hospital workers. At the onset of the crisis, various interventions were introduced to promote resilience and offer mental support to these professionals. However, it is unknown whether the interventions will meet the needs of professionals as the COVID-19 pandemic continues.The goal of this exploratory study is to gain insight in factors that protect the vitality and resilience of Dutch hospital employees during the so-called 'second wave' of the COVID-19 pandemic. This paper describes the study protocol.

METHODS AND ANALYSIS

This exploratory study applies a mixed-methods design, using both quantitative and qualitative methods of data collection and analysis. The first part of the study (substudy I) consists of surveys among doctors and nurses in COVID-19 departments and non-COVID-19 departments, and other professionals in the hospital (ie, managers and homeworkers) in 2020 and 2021. The second part of the study (substudy II) consists of focus groups and interviews among professionals of the intensive care unit, COVID-19 departments and infection prevention units.

ETHICS AND DISSEMINATION

The research protocol for this study has been approved by the Medical Ethics Committee (MEC-2020-0705). The outcomes of this study will be used to develop and implement interventions to support hospital employees maintaining their vitality and resilience during and after the COVID-19 pandemic. Employees with vitality experience less work-related stress and make a positive contribution to healthcare quality.