Depression, Anxiety and Symptoms of Stress among Hong Kong Nurses: A Cross-sectional Study

Nonattachment at Work on Well-being Among Working Adults in Hong Kong

Objectives

Nonattachment has been found to be a potentially important mental quality in mitigating psychological distress and promoting well-being across student and community adult populations. This study investigated the relationships between nonattachment and three workplace-related variables, namely control at work, psychological safety, and supervisor support, on mental well-being of a representative sample of working adults in Hong Kong.

Methods

This is a cross-sectional investigation using the data provided by 1008 working adults who participated in a population-based telephone survey. Structural equation modeling (SEM) was performed to test how nonattachment may be related to mental well-being of working adults, with the relationship being mediated by three workplace-related variables.

Results

Results indicated that nonattachment was positively associated with flourishing. This association was mediated by perceived supervisor support and control at work. In addition, nonattachment was negatively related to depression and anxiety symptoms and the association was only mediated by perceived supervisor support. Psychological safety did not significantly mediate the effect of nonattachment on mental well-being.

Conclusions

This study provides suggestive evidence that staff’s perception towards supervisors and level of control at work can bridge the relationship between nonattachment and employee well-being. Potential cultural nuance that may have contributed to the nonsignificance of psychological safety was discussed.

Relationship between serum 25 hydroxyvitamin D (25(OH)D) levels and mental health in shift female nurses

The nurses work long hours and in various shifts, and often accompanied by depression, fatigue, and sleep disorders. Many studies have found that 25 hydroxyvitamin D (25(OH)D) is related to mental health. We aimed to investigate the relationship between depression, sleep problems, fatigue, and serum 25(OH)D levels in shift nurses. We recruited 34 day-shift, 30 evening-shift and 31 night-shift nurses. The Beck Depression Inventory II (BDI-II), Numerical Rating Scale and General Sleep Disturbance Scale to evaluate the levels of depression, sleep problems, fatigue. Blood samples (20 ml) were collected under a fasting state to determine basic biochemistry and inflammatory parameters. In central of Taiwan, approximately 96.1% of shift nurses had deficient (< 20 ng/ml) (45 females and 1 male) and inadequate (20-29 ng/ml) (39 females and 2 male) 25(OH)D levels. Approximately 84.2% of shift nurses experienced fatigue. In sleep disturbance, night-shift nurses experienced significantly more severe sleep disturbance than day-shift and evening-shift nurses. However, no significant correlation was observed between 25(OH)D levels and mental health when the 25(OH)D level was categorized. 25(OH)D deficiency, sleep disturbance, depression, and fatigue were common in shift female nurses, but it was not possible to demonstrate the impact of 25(OH)D deficiency on the mental health of shift nurses in Taiwan.

Factors Associated with Gastrointestinal Symptoms among Rotating Shift Nurses in South Korea: A Cross-Sectional Study

Rotating shift work places a serious burden on nurses' physical and psychological health. Gastrointestinal (GI) symptoms are a common complaint among shift workers. This study assessed GI symptoms and identified the associations between dietary habits, psychological status, and sleep quality among rotating shift nurses. Data from 125 female nurses in rotating shifts who worked at two tertiary hospitals in South Korea were collected using a questionnaire that included the Gastrointestinal Symptoms Questionnaire; the Dietary Habit Questionnaire; the Depression, Anxiety, Stress Scale (DASS)-21; and the Pittsburgh Sleep Quality Index (PSQI). All participants experienced various GI symptoms, and 47% of them complained of at least one severe GI symptom. There were significant differences in GI symptom scores according to the status of depression, anxiety, stress, and sleep quality. In multiple linear regression analysis, the factors associated with an increase in the occurrence and severity of GI symptoms were poor sleep quality and morbid anxiety and stress. The model explained power at 43.2%. As most nurses in rotating shifts experience GI symptoms, they should receive counseling and training programs at work to alleviate psychological symptoms, improve sleep quality, and pay more attention to their health status as well as GI symptom management.

Work Conditions of Italian Nurses and Their Related Risk Factors: A Cohort Investigatory Study

(1) Background: Nursing is a satisfying employment pathway, as nurses preserve lives, but it is also considered one of the most stressful care professions. Nursing is a lifesaving and highly satisfying profession, yet it is considered one of the most stressful occupations. This study aimed to assess differences in anxiety, depression and stress states among nurses according to gender, work history, shift and body mass index (BMI) characteristics. (2) Methods: An online questionnaire was addressed to all Italian nurses during May 2022, investigating anxiety, depression and stress conditions according to the Depression, Anxiety and Stress Scale-21 Items (DASS-21) and sampling characteristics, such as sex, work experience, shift and BMI values. (3) Results: A total of 408 Italian nurses answered the questionnaire. Significant differences between the following were reported: anxiety levels and work experience, since nurses employed over 6 years reported higher anxiety levels than their younger colleagues (p = 0.035); depression levels and sex (p = 0.017), as females reported higher depression levels than males; and also between depression levels and BMI levels (p = 0.003), as 5.90% of overweight and 2.50% of obese participants reported extremely severe depression. By considering stress levels according to sampling characteristics, significant differences were registered according to BMI levels (p < 0.001), as overweight subjects reported higher stress levels (7.40%) than the other subgroups. Finally, significant associations were recorded between anxiety, depression and stress conditions with sex, work experience, shift and BMI. (4) Conclusions: The data were in agreement with the current literature, indicating that nurses might take care not only of their patients but also of themselves, in both the physical and mental aspects.

Prevalence of depressive symptoms in nurses compared to the general population based on Propensity Score Matching: A nationwide cross-sectional study in China

BACKGROUND

Depressive symptoms have a series of negative effects and are considered especially severe among nurses, whereas there is a lack of quantitative studies comparing the risk of depressive symptoms between nurses and the general population.

METHODS

We respectively conducted a nationwide cross-sectional online survey among 17,582 Chinese nurses from July to August 2018, and 101,120 Chinese community residents from January to February 2019. The questionnaire covered social-demographic characteristics and depressive symptoms for both, work-related factors and life-related factors for nurses. Propensity Score Matching was performed to match nurses and residents by gender, age, educational level, marital status, and habitual residence.

RESULTS

Before Propensity Score Matching, the risk of depressive symptoms in nurses was higher than residents (OR, 2.16; 95% CI, 2.07-2.26). After matching, there were 15,256 nurses and residents respectively, and the risk in nurses was higher (OR, 2.14; 95% CI, 2.02-2.27). Logistic regression showed that longer years of service (OR, 1.54; 95% CI, 1.30-1.83), higher night shift frequency (OR, 1.48; 95% CI, 1.35-1.64), perceived shortage of nurses (OR, 1.98; 95% CI, 1.84-2.13), suffered verbal violence (OR, 2.43; 95% CI, 2.21-2.66) and physical violence (OR, 1.80; 95% CI, 1.64-1.98) were risk factors for depressive symptoms in nurses.

LIMITATIONS

Convenience sampling and online survey were adopted in this cross-sectional study, which may diminish the representativeness of samples.

CONCLUSIONS

Compared with the general population, nurses have a higher risk of depressive symptoms in China. Reasonable work allocation, adequate staffing, scientific shift system and violence emergency system should be implemented.

Prevalence and determinants of depression, anxiety and stress among psychiatric nurses in Ghana: a cross-sectional study

Background

The job demand and stress associated with the nursing profession expose nurses to an increased risk of psychiatric morbidities such as anxiety and depression. This study assessed the prevalence of depression, anxiety and stress among psychiatric nurses in Ghana.

Methods

A cross-sectional survey was conducted in three psychiatric hospitals in Ghana between March 2020 and May 2021. Simple random sampling technique were used to select 311 psychiatric nurses. Beck’s Depression Inventory, Beck’s Anxiety Inventory and Perceived Stress Scale were used to assess depression, anxiety and stress, respectively. Data were analysed using SPSS version 23.0.

Results

The results showed that 19.6% of psychiatric nurses experienced mild to severe depression, 27% mild to severe anxiety and 42% mild to high stress. Regression analysis showed that participants with a diploma qualification had higher odds of having moderate depression compared to those with a master’s degree. In terms of stress, participants with a diploma qualification were 29.6% less likely to have moderate stress compared to those with a master’s degree. Those with a bachelor’s degree were 7.1% less likely to have moderate stress compared to those with a master’s degree.

Conclusion

Psychiatric nurses experience depression, anxiety and stress to varying degrees. Education level was identified as a determinant of depression, anxiety and stress. Therefore, preventive strategies should be designed to reduce the risk of these conditions.

Prevalence and associated factors depressive symptoms among healthcare professionals at Dessie comprehensive specialized hospital, Ethiopia

BACKGROUND

Depression among healthcare professionals results in adverse effects which might include decreased impairment of work performance, an increased turnover rate, and vulnerability to clinical error. Despite that, there is a paucity of information concerning depression among healthcare professionals in Ethiopia. This study aimed to assess the prevalence and identifying the associated factors of depression among health care professionals working at Dessie Comprehensive specialized hospital, Ethiopia.

METHOD

A cross-sectional study was conducted on 252 healthcare professionals at Dessie Comprehensive Specialized Hospital, Northeast, Ethiopia. They were randomly selected and depression was measured by the Patient Health Questionnaire (PHQ-9) with a score of 5 and above. A multivariable logistic regression analysis was used to explore the potential determinants of depressive symptoms among the participants. A p-value less than 0.05 was considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association.

RESULT

The prevalence of depressive symptoms among healthcare professionals was 27.8% (95% CI: 22.6,33.7). Among participants who had reported depressive symptoms, 72.2, 20.2, 6, and 1.6% reported no, mild, moderate, and severe depressive symptoms, respectively. In multivariable analysis, being female (AOR = 1.94; 95% CI: 1.12,3.67), unmarried (AOR = 2.16; 95% CI: 1.12,4.15), having a family history of mental illness (AOR = 7.31; 95% CI: 2.27,23.49), and current substance use (AOR = 2.67; 95% CI: 1.36,5.24) were found to be significant predictors of depressive symptoms.

CONCLUSION

Depressive symptoms were highly prevalent among primary health care professionals. Being female, unmarried, family history of mental illness, and current substance use had a significant association with depressive symptoms among healthcare professionals. They should be promptly screened and managed at a healthcare institution.

Prevalence and Risk Factors for Periodontal Disease Among Women Attending Antenatal Care in Public Hospitals, Southwest Ethiopia, 2022: A Multicenter Cross-Sectional Study

Background

Periodontal disease is characterized by the inflammation of all tissues that surround and support the teeth, and it is the most common public health problem worldwide. It has many different contributing factors, such as poor oral hygiene, smoking, anemia, bacterial plaque, poor economic status, and nutritional deficiency. It also causes different feto-maternal complications like preeclampsia, gestational diabetes, preterm labor, low birth weight, and early abortion. Thus, this study aimed to assess the prevalence and associated factors of periodontal disease among pregnant women.

Methods

A cross-sectional study was conducted among 618 women at public hospitals in the Southwest Ethiopia. Data were collected using a systematic random sampling method and a structured interviewer administered questionnaire. The data were entered into Epi-Data Manager 4.2 and then transferred to a statistical package for social science (SPSS) version 21 for analysis. The logistic regression analysis was done to see the significant association between each predictor with periodontal disease by considering a p-value of <0.05 and a CI of 95%.

Results

A total of 618 women attending ANC with a 100% response rate were enrolled in this study. The mean and standard deviation of the age of the study participants was 31.07 ± 7.8 years. The periodontal disease was observed among 240 (38.8%) of the total participants with 95% C.I of (35%, 43%). Predictors like rural residency, women who could not read and write, women with poor wealth index, nutritional status of underweight, had no information about periodontal disease, depression, history of diabetes mellitus, self-perceived halitosis, no history of ANC, and lower gestational age were found to be significantly associated with periodontal disease.

Conclusion

In this study, the prevalence of periodontal disease was found to be significantly higher. Therefore, in order to minimize the burden of periodontal disease among pregnant women, oral, medical, and mental health education should be promoted.

Individual and Work Factors Associated with Psychosocial Health of Registered Nurses During the Covid-19 Pandemic: A Mixed Methods Study

OBJECTIVE

To describe the initial influence of the Covid-19 pandemic on U.S. nurses' psychosocial health, and to identify factors associated with poor psychosocial health outcomes.

METHODS

We conducted a convergent (QUAN+qual) mixed methods study. From June to August 2020, we administered surveys (N = 629) and conducted semi-structured interviews (N = 34) among nurses working across healthcare settings in 18 states. We developed separate multivariable logistic regression models for three psychosocial outcomes (anxiety, depressive symptoms, insomnia). We used content analysis to process and analyze qualitative data, and integrated results in the final analysis step.

RESULTS

Nurses reported high rates of depressive symptoms (22%), anxiety (52%), and insomnia (55%). Disturbances to sleep were both a contributing factor to, and an outcome of, poor psychosocial health.

CONCLUSIONS

Evidence-based interventions addressing work stress and sleep, and proactive monitoring of nurses' psychosocial health by employers are urgently needed.

Factors affecting the caring performance of newly graduated Nurses' working in critical care units

BACKGROUND

Although many studies have discussed nurses' caring performance, few have focussed on critical care nurses. Also, none have studied this among newly graduated nurses despite their very different circumstances.

AIM

The purpose of this study was to examine factors affecting the caring performance of newly graduated nurses in critical care units.

METHOD

A descriptive cross-sectional design, using self-reported questionnaires, was used among a sample of 209 nurses interviewed in Jordanian hospitals. The Mental Health Professionals Stress Scale was used for measuring work-related stress and the Caring Behaviours Assessment tool to assess caring performance. Data collection was conducted from March to May 2018.

RESULTS

The participants had moderate levels of caring performance (M = 182.6/315, SD = 15.46). The highest score was reported for 'Supportive/Protective/Corrective Environment' subscale, while the lowest for 'Teaching/Learning' subscale. Many significant differences were noticed in caring performance based on participants' demographics. Only working in private hospitals was a significant predictor for caring performance (P < .05) predicting 14% of variance.

CONCLUSION

Caring performance of newly graduated nurses in critical care units was affected by many factors including workload, self-doubt, income and area of working. The significance was flagged of developing nursing policies concerned with stress relief and improvement of caring performance.

A Study on the Relationship between Mental Resilience, Work-Family Conflict, and Anxiety of Nurses in Shandong, China

Based on Freud's personality theory, 839 nurses from 5 public hospitals in Shandong Province were selected by the convenience sampling method. A cross-sectional survey was conducted to investigate the correlation among resilience, work-family conflict (WFC), and anxiety (SAS). The purpose of this study was to explore the relationship among resilience, WFC, and SAS of these nurses and to provide evidence with reducing WFC and SAS for the nurses. The results showed that the total score of resilience, WFC, and SAS was 58.00 ± 18.27, 53.46 ± 13.29, and 49.98 ± 14.73, respectively. There was 47.68% of the nurses that had anxiety, and 10.97% of the nurses had severe anxiety. There were significant differences in the score of SAS among the length of service, self-perceived health status, confidence in nursing professional development, WFC, and resilience (P < 0.05). This study draws the following conclusions: the proportion of anxiety is high, and the level of resilience is lower than the domestic norm. Length of service, self-perceived health status, confidence in nursing professional development, WFC, and resilience were the important influencing factors of anxiety. It is suggested that hospital managers should pay attention to the mental health of nurses, take active intervention measures according to the influencing factors of SAS, improve nurses' psychological resilience, reduce WFC and anxiety, improve nurses' mental health and well-being, and ensure nursing safety.

What are the prevalence of and factors independently associated with depression and anxiety among patients with posttraumatic elbow stiffness? A cross-sectional, multicenter study

BACKGROUND

Joint stiffness is a common complication after articular-related trauma in the elbow, resulting in significant limb disability, psychological stress, and a negative impact on daily life. No previous study has reported the impact of post-traumatic elbow stiffness (PTES) on psychological health. This study aims to (1) investigate the depression and anxiety levels and (2) identify factors independently associated with depression and anxiety symptoms in patients with PTES.

METHODS

A total of 108 patients with PTES presenting to 4 collaborative municipal hospitals were consecutively enrolled from September to December 2020. Sociodemographic and clinical characteristics were collected through questionnaires and medical records. The Depression Anxiety Stress Scale-21 was used to assess depression and anxiety status. Ordinal logistic regression analysis was performed to identify factors independently associated with depression and anxiety symptoms.

RESULTS

The detection rates of mild-to-moderate depression and anxiety are 40.7% and 27.8%, and severe-to-extremely severe levels are 23.1% and 25.9%, respectively. Regression results show that factors independently associated with depression include elbow flexion (odds ratio [OR]_{per 1° loss} = 1.021, 95% confidence interval [CI]: 1.001-1.041, P = .035), elbow pain on movement (OR_{per 1 point increase} = 1.236, 95% CI: 1.029-1.484, P = .023), family relationship (OR_{less close/very close} = 10.059, 95% CI: 2.170-46.633, P = .003), and self-care ability (OR_unable/able = 3.858, 95% CI: 1.244-11.961, P = .019). Factors independently associated with anxiety are elbow flexion (OR_{per 1° loss} = 1.031, 95% CI: 1.009-1.052, P = .005), elbow pain on movement (OR_{per 1 point increase} = 1.212, 95% CI: 1.003-1.465, P = .047), and clinically significant heterotopic ossification around elbow (OR_yes/no = 2.344, 95% CI: 1.048-5.243, P = .038).

CONCLUSION

Patients with PTES exhibit significant depression and anxiety symptoms. Several sociodemographic and clinical characteristics are independently associated with depression and anxiety levels. Identifying and addressing these factors may be of particular benefit during PTES management. Future research might address whether depression and anxiety affect the outcome after stiff elbow surgery.

The influence of workplace stress and coping on depressive symptoms among registered nurses in Bangladesh

Background

Nurses report high levels of workplace stress, which has been linked to an increased risk for experiencing depressive symptoms. Nurses' workplace stress is also linked to increased absenteeism and decreased job satisfaction.

Objectives

The objectives of this study were to examine: (1) the incidence of depressive symptoms among hospital-based registered nurses in Bangladesh; (2) common sources of workplace stress and their relationships to individual characteristics and depressive symptom scores; and (3) the potential mediating roles of coping strategies in the relationship between workplace stress and depressive symptoms.

Methods

A cross-sectional study design involved three hundred and fifty-two registered nurses. Data were collected using a demographic questionnaire and three standardized tools measuring sources of nurses' workplace stress, coping strategies, and depressive symptoms.

Results

More than half of the participants scored ≥ 16 on the CES-D, which was associated with a major depression episode. Total NSS scores had a small but significant influence on scores on the depression scale. Coping strategies had no mediated effect on the relationship between workplace stress and scores on the depression scale. Low-reliability coefficients for subscales of two of the standardized tools highlight the challenge for researchers in developing countries to address contextual differences that may influence the meanings attached to individual items.

Conclusion

Findings suggest that the mental health of registered nurses in Bangladesh requires immediate attention in part by attending to workplace stressors. Further research should focus on a deeper understanding of Bangladeshi registered nurses' work experiences and the unique contribution that workplace stressors have on their physical and mental health.

Factors Influencing Mindfulness Among Clinical Nurses in China: An Observational Cross-Sectional Study

AIM

To evaluate factors influencing mindfulness among clinical nurses in China.

BACKGROUND

Mindfulness has positive effects on nurses' negative emotions and job burnout. However, few studies have explored the antecedent variables of mindfulness.

METHODS

A total of 358 clinical nurses in Beijing Aerospace Center Hospital completed a cross-sectional survey between July and September 2020. The study employed self-report questionnaires covering social demographics, mindfulness, anxiety, job burnout, emotion regulation, stress perception, resilience, well-being, and loneliness.

RESULTS

The mean Mindful Attention Awareness Scale score was 66.82±11.53, which is near the cut-off score between the high and medium mindfulness categories. Anxiety, stress perception, emotional exhaustion, and expressive suppression negatively affected the level of mindfulness, while mental resilience and cognitive reappraisal positively influenced the level of mindfulness (all P<0.05).

CONCLUSION

Hospital nurses have higher-than-normal levels of mindfulness. The mindfulness level of clinical nurses is related to anxiety, stress perception, resilience, cognitive reappraisal, emotional exhaustion, and expressive suppression.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers should consider the role and mechanism of positive psychology and develop targeted intervention measures to improve nurses' mindfulness, in order to further reduce their negative emotions, improve their sense of professional benefit, and thus ensure the quality and safety of nursing.

Influence of Sleep Characteristic Changes on Nurses' Quality of Life during Their Transition to Practice: A Prospective Cohort Study

Aim: To explore the effect of changes in sleep characteristics on changes in quality of life during the transition period of new graduate nurses. Background: Sleep problems among nurses are associated with negative physical and psychological consequences. Methods: This prospective cohort study was conducted at a tertiary hospital in South Korea. Participants included 88 newly graduated nurses. Data were collected twice, prior to shift work and after 4 months of working as a nurse, via online structured self-report questionnaires created using Survey Monkey from March 2018 to February 2020. A generalized linear mixed model was used to analyze the influence of changes in sleep characteristics on quality of life. Results: A generalized linear mixed model showed that changes in the subjective quality of sleep, subjective health perception, and daytime dysfunction influenced quality of life changes during the transition. This implies that deterioration already existed. From their undergraduate period to four months after they began working as nurses, a significant decrease was observed in the quality of sleep. Participants’ quality of life significantly decreased. Conclusions: Changes in the quality of life of new graduate nurses may show deterioration with a significant drop in subjective sleep quality. Institutions should improve existing work adaptation programs provided during new graduate nurses’ transition to practice by including information on changes in nurses’ health caused by changes in sleep characteristics and sleep quality.

Factors influencing hospital anxiety and depression among emergency department nurses during the COVID-19 pandemic: A multi-center cross-sectional study

INTRODUCTION

The emergency department (ED) is a highly stressful environment, which exposes nurses to infection. ED nurses handle life-threatening conditions, endure long working hours, and deal with anxious patients and their families.

AIM

This study aimed to examine factors, which may influence anxiety and depression levels among ED nurses during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A cross-sectional design was used with 251 participants from six hospitals in Saudi Arabia (mean age = 32.7 ± 6.59, range = 21-54 years, 70.5% females). Data were collected using the Hospital Anxiety and Depression Scale (HADS), and the analysis was conducted using structural equation modeling (SEM).

RESULTS

Based on the HADS scores, 29.1 and 25.5% of ED nurses were identified as doubtful cases for depression and anxiety, respectively. Additionally, 34.7 and 43.3% of ED nurses were identified as definite cases for depression and anxiety, respectively. Higher anxiety levels were observed among female nurses, nurses with lower physical activity levels, and nurses who worked in urban areas. Low physical activity levels and more than 6 years of work experience correlated with a higher level of depression. None of the hypothesized paths in the anxiety and depression models were significant, except for two observed variables-namely, work location and physical exercise in the anxiety model and physical exercise in the depression model.

CONCLUSION

Emergency department nurses expressed high levels of anxiety and depression during the COVID-19 pandemic, which may negatively affect their performance and reduce care quality. Therefore, health care leaders should implement specialized mental health education programs focused on nursing occupational safety and support to improve ED nurses' psychological well-being. Specific attention should be paid to ED female nurses who work in urban areas, especially those with more than 6 years of experience.

Lifestyle and Social Factors Exacerbated on the Prevalence of Mood Disorders and Functional Dyspepsia Among Neonatal Nurses in China

BACKGROUND

Nursing is a high-stress occupation that can have an impact on mental health, particularly for neonatal nurses. Job-related stress factors and work-related behaviors have played a critical role in nurses' mental health. This study aimed to explore the prevalence of mood disorders and the impact of social factors, lifestyle on mood disorders among neonatal nurses.

METHODS

A total of 260 participants comprising neonatal nurses and nurses who work in neonatal intensive care units (NICU) were recruited. Data were collected using a validated generalized anxiety disorder questionnaire, patient health questionnaire-9, Pittsburgh sleep quality index, and social factors and lifestyle assessments.

RESULTS

In total, 49.23% of neonatal nurses exhibited mood disorders, particularly a combination of depression and anxiety. Female, poor interpersonal relationships and unhappy marital status, preference for smoking, alcohol, irregular diet, and poor sleep were common in neonatology nurses who exhibited mood disorders; preference for coffee and tea were lower in neonatology nurses without mood disorders (all P < 0.05). Interpersonal relationships, marital status, irregular diet, and poor sleep were independent factors associated with mood disorders among neonatal nurses (all P < 0.05). Mood disorders presented as functional dyspepsia (FD) among 50.78% of the participants (P < 0.05). Poor sleep and preference for smoking were common among neonatal nurses who had FD with mood disorders (all P < 0.05). Furthermore, the preference for sugary beverages was lower in participants with FD and mood disorders (P < 0.05). Poor sleep was independently associated with FD with mood disorders in neonatology nurses (P < 0.05).

CONCLUSION

Prevalence of anxiety and depression was higher among neonatal nurses. Furthermore, most cases of mood disorders presented as FD. Thus, social factors and lifestyle have an impact on mood disorders which can manifest through somatic symptoms.

Mindful self-compassion for nurses: a systematic review

This article details a systematic review that aimed to synthesise and analyse the published research on the effects of mindful self-compassion interventions on stress in nurses. Five studies were identified that met the inclusion criteria and were analysed in terms of sample characteristics, intervention, measurement of self-compassion, additional psychosocial outcome measures, intervention duration and adherence, intervention outcomes and effect size and follow-up. The review found that mindful self-compassion interventions had medium-to-large effect sizes for self-compassion, traumatic stress, burnout, stress and compassion satisfaction. There was also high intervention adherence (mean=86%) in the included studies. Since these interventions can improve self-compassion and compassion in nurses, they have the potential to enhance the quality of compassionate care provided by nurses who undergo training in mindful self-compassion.

The association between moral distress and mental health among nurses working at selected hospitals in Iran during the COVID-19 pandemic

BACKGROUND

In the event of an epidemic outbreak, the mental health of medical staff, including nurses who serve on the frontlines of hospitals, can be affected; thus, the identification of factors affecting nurses' mental health is of importance.

OBJECTIVE

This study aimed to examine the association between moral distress and the mental health of nurses working at four selected hospitals in Iran during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A cross-sectional questionnaire survey was conducted on 296 nurses working at the selected hospitals in Bushehr and Shiraz (south of Iran) at the time of the COVID-19 outbreak. The collected data were analyzed via logistic regression analysis.

RESULTS

The mean scores for nurses' moral distress were low (54.31±24.84). The results of this study indicated more symptoms of mental issues among nurses (73.60%). Moreover, a significant association was observed between mental health and moral distress. Among the examined demographic variables, only gender had a significant association with mental health (p-value = 0.014).

CONCLUSION

The results of this study indicated that an increase in moral distress would lead to a significant increase in mental health issues of the examined nurses. Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of mental health, as well as providing adequate emotional and family support for nurses. Considering the intensifying role of gender in this association, timely interventions are necessary to reduce the negative effects of workplace pressure/stress on female nurses.

Influence of Irritable Bowel Syndrome on Stress and Depressive Symptoms in Nurses: The Korea Nurses' Health Study

Despite the high risk of irritable bowel syndrome (IBS) and stress/depressive symptoms in nurses, limited research has examined the relationship between these conditions in female nurses. The purpose of this study was to determine the prevalence of IBS and the influence of IBS on stress and depressive symptoms in female nurses. We analyzed the data from the Korea Nurses’ Health Study. Among 7667 participants from the 7th survey conducted from December 2018 to September 2019, 178 nurses were identified as having IBS based on the Rome IV criteria. Using the propensity score matching, 712 were selected as a comparison group. Multivariate ordinal logistic regression analyses were conducted to examine the influence of IBS on stress and depressive symptoms. The prevalence of IBS was 2.3% and the prevalence of depressive symptoms among nurses with IBS was 13.5%. Female nurses with IBS were 2.214 times more likely to experience increased stress levels. However, when demographics, dietary habits, sleep quality, and depressive symptoms were considered, having IBS was no longer an influential factor for increased stress levels. When all the variables were considered, female nurses with IBS were still 2.205 times more likely to experience depressive symptoms. Adequate support is needed to relieve depressive symptoms in nurses with IBS.

General mental state and quality of working life of call center employees

Working conditions of call centers lead to serious mental problems in employees as well as affecting their working life quality due to factors such as excessive workload, complex and uncertain work environment, repetitive tasks, type of tasks that ignore notions of employees, benefiting from only a part of their skills, and poor labor inspection. This study aims to determine the general mental state and quality of working life of call center employees. The sample of this descriptive study consisted of 200 employees working at Sivas 'ALONET' call center between December 01, 2018, and December 31, 2018. We used the Personal Information Form, General Health Questionnaire-28 (GHQ-28), and Professional Quality of Life Scale (ProQOL) as data collection tools. We collected the data from the employees through face-to-face interviews during working hours. During the analysis, we used Pearson's Product Moments Correlation Analysis, t-test, Mann Whitney U test, Kruskal Wallis H test, and Dunnet T3 Post Hoc test. We found that the mean score of the employees in GHQ-28 was 5.34 ± 5.60, and the compassion satisfaction, burnout, and compassion fatigue subscales of the ProQOL were 36.07 ± 9.88, 14.40 ± 7.74, and 13.89 ± 9.31, respectively. While the score of the employees from the overall GHQ-28 was significantly negatively correlated with the score from the compassion satisfaction subscales of the ProQOL, we found a significantly positive correlation between the scores of burnout and compassion fatigue subscales of the ProQOL. The findings of this study revealed that approximately 45.8% of the call center employees were mentally in the at-risk group, that their compassion satisfaction level was moderate, and that their burnout and compassion fatigue levels were low. Therefore, stress factors that employees facing in their working life should be determined, and training, counseling, and support programs should be carried out to prevent them from suffering from burnout and compassion fatigue.

COVID-19 pandemic and death anxiety among intensive care nurses working at the Hospitals Affiliated to Tehran University of Medical Science

Introduction

The unpredictable challenges and conditions of COVID-19 can cause mental health problems. In such a situation, one of the most important psychological problems is the fear and anxiety of death. Death anxiety can affect the quality of patient care services and the job satisfaction and mental health of nurses.

Methods

This is a descriptive cross-sectional study in which 110 nurses working in the intensive care units of hospitals affiliated to the Tehran University of Medical Sciences were selected by the convenience sampling method from April to September 2016. The data collection tools used in the study include a demographic questionnaire and a Templer death-anxiety questionnaire.

Findings

The results showed that the level of death anxiety in nurses working at COVID-19 intensive care units is associated with age, working hours per week, childbearing, several patients needing end-of-life care, cases of direct participation in resuscitation operations, cases of patient death observations, and satisfaction with personal protective equipment (P < o.o5).

Conclusion

Increasing the nurses' awareness of the critical situations of COVID-19, management measures, improving the working environment, social support, and increasing personal protective equipment seem to be the effective factors in protecting the intensive care unit nurses against COVID-19 and reducing death anxiety.

Prevalence and associated factors of stress among primary health care nurses in Saudi Arabia, a multi-center study

Background:

Nursing practice has been identified as one of the most stressful professions within the healthcare systems. The current study aimed to determine the prevalence of stress and its associated factors among primary healthcare nurses.

Materials and Methods:

This analytical cross-sectional study was conducted among 200 Saudi nurses in the government primary health care centers in Medina city, Saudi Arabia. Stress was measured by the stress subscale of the 21-Item Depression, Anxiety and Stress Scale. Sources of stress were assessed by 15 items.

Results:

The majority were females (68.0%) and aged less than 40 years (72.5%). Thirty percent had severe or very severe stress. Stress was associated significantly with the presence of chronic diseases (P = 0.037) and with working in night shifts (P = 0.042). All sources of stress in the workplace were associated significantly and positively with stress (P < 0.01).

Conclusion:

About one-third of the participants had stress. Improving work conditions and minimizing stress in the workplace should be a priority in the primary health care setting.

Associations Between Sleep Quality and 10-Year Cardiovascular Disease Risk Among Female Nurses in Hong Kong: A Cross-sectional Study

BACKGROUND

Sleep problems are common among nurses compared with the general population. Poor sleep quality increases the risk of developing cardiovascular disease (CVD). The relationship between sleep quality and CVD risk has not been previously investigated among Hong Kong female nurses.

OBJECTIVE

The authors of this study explored the association between sleep quality and CVD risk among Hong Kong female nurses.

METHODS

Data were collected from the Hong Kong Women's Health Study cross-sectional survey between 2019 and 2020. Questionnaires were sent to female nurses (≥aged 30 years). Ten-year CVD risk was measured using the Framingham 10-year risk score, and the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Relationships were evaluated using adjusted multiple linear regression and binary logistic regression.

RESULTS

In 1344 respondents, the mean age was 46.12 ± 10.47 years, average PSQI score was 6.02 (3.35), and 52.4% reported poor sleeping quality (global PSQI score > 5). The mean 10-year CVD risk was 3.6% (3.3%). The 10-year CVD risk was significantly associated with sleep disturbance (β = 0.006) and daytime dysfunction (β = -0.002) (both Ps < .01). Participants who reported sleep disturbance had a higher CVD risk (odds ratio, 1.82; 95% confidence interval, 1.04-3.18). High daytime dysfunction decreased CVD risk (odds ratio, 0.63; 95% confidence interval, 0.46-0.85). Subgroup analysis showed stronger associations between sleep quality and Framingham 10-year risk score among those unemployed, undergoing postmenopause, or with a family history of CVDs.

CONCLUSIONS

Sleep disturbance and daytime dysfunction were associated with the 10-year CVD risk among Hong Kong female nurses. Nurses who were unemployed, were undergoing postmenopause, or with a family history of CVD were those with the highest risk.

Sociodemographic Factors and Depressive Symptoms Among Cardiac Nurses: A Cross-Sectional Study

Background: The nursing profession is predisposed toward depressed mood and depressive symptoms. The multidirectionality and intensity of stressors in the nurses' occupational environment are of great significance in this respect. The study aimed to evaluate the impact of selected sociodemographic factors on depressive symptoms among cardiac nurses.

Methods: This cross-sectional study included 336 cardiac nurses (302 women and 34 men) and was conducted between December 2019 and September 2020 in four hospital cardiac units in Wroclaw, Poland. Sociodemographic data were collected using a self-developed survey. The following standardized instruments were used for the study outcomes: Patient Health Questionnaire-9 (PHQ-9) and Beck Depression Inventory (BDI).

Results: The study among cardiac nurses showed mild depression in 11.61%, moderate depression in 5.06%, and severe depression in 2.68%. Linear regression models showed that significant (p < 0.05) predictors of the PHQ-9 score included (1) higher occupational education (bachelor's degree), graduation “only” from medical high school or “other” education; (2) work experience of 16–20 years; (3) living in a relationship; (4) living in a rural area. Linear regression models showed that significant (p < 0.05) predictors of the BDI score included (1) higher occupational education (bachelor's degree); (2) graduation “only” from medical high school or “other” education; (3) living in a relationship.

Conclusions: Depressive symptoms are a significant problem among Polish cardiac nurses. The prevalence of depressive symptoms is affected by the education level, employment form, marital status, and place of residence.

Association of salivary alpha-amylase with anxiety and stress in nursing professionals

Objective:

to assess if changes in salivary alpha-amylase activity are associated with anxiety and stress among hospital nursing professionals and whether anxiety and stress are associated with sociodemographic, epidemiological, and occupational factors.

Method:

cross-sectional, quantitative study, carried out with 210 nursing professionals from a hospital. For data collection, we used a questionnaire to characterize workers, Beck’s Anxiety Inventory, Lipp’s Stress Symptoms Inventory for Adults and samples and saliva samples collected in work shifts. The data were analyzed descriptively and inferentially using the software Statistical Package for the Social Science and GraphPad Prism.

Results:

most professionals experienced stress and anxiety. The variables age group, number of children, use of medication and workload were associated with anxiety; age group, smoking and medication use were associated with stress. An increase in the salivary alpha-amylase activity was observed in the middle of the work shift. Professionals who had stress and anxiety had significant changes in alpha-amylase in the night shift.

Conclusion:

changes in salivary alpha-amylase were associated with anxiety and stress among nursing professionals, indicating that this enzyme can be a possible biomarker of anxiety and stress in workers.

Evaluating online learning engagement of nursing students

BACKGROUND

Previous studies suggest that increased learning satisfaction may encourage learning engagement in an online learning environment.

OBJECTIVES

To evaluate the level of learning engagement and its relationship with students' perceived learning satisfaction in an online clinical nursing elective course.

DESIGN

A prospective interventional study.

SETTINGS

A nursing course was converted to an online format because of the coronavirus disease COVID pandemic.

PARTICIPANTS

Part-time post-registration nursing undergraduates enrolled in an elective online clinical course.

METHODS

Related teaching and learning strategies were deployed in the course using the Community of Inquiry framework. All students who completed the course were invited to complete an online survey that included a validated Online Student Engagement questionnaire (OSE). Pearson's correlations were used to determine the association between perceived learning satisfaction and learning engagement. A logistic regression model was used to explore the associations of gender, age, working experience and perceived learning satisfaction with higher learning engagement.

RESULTS

The questionnaires were completed by 56 of 68 students (82%). The Pearson's correlation coefficient between the mean perceived learning satisfaction and OSE scores was 0.75 (p < .001). Twenty-five students (45%) were identified as highly engaged, using a cut-off of ≥3.5 for the mean OSE score. The mean perceived learning satisfaction (SD) score differed significantly between highly engaged and not highly engaged students [4.02 (0.49) vs. 3.27 (0.62), p < .001]. The logistic regression model showed that a greater perceived learning satisfaction [adjusted odds ratio (OR): 17.2, 95% C.I.: 3.46-86.0, p = .001] was associated with an increased likelihood of higher learning engagement, and >1 year of working experience (adjusted OR: 0.11, 95% C.I.: 0.01-0.89, p = .0039) was associated with a decreased likelihood of higher learning engagement.

CONCLUSIONS

The study findings suggest that perceived learning satisfaction predicts learning engagement among nursing students in this online learning course.

Gender Gap in Mindfulness Assessment Among Italian Nurses: A Pilot Descriptive Study

"Purpose: The present study aimed to explore gender differences in the mindfulness tendency, specifically in the awareness and attention dimensions and also in the observing, describing, acting with awareness and accepting without judgement in Italian nurses. Methods: In June 2020 an on-line questionnaire was administered to nurses in order to analyze any differences both in the Mindfulness Attention Awareness Scale (MAAS) and the Kentucky Inventory of Mindfulness Skills (KIMS) according to gender variable. Findings: 200 questionnaires were collected. Findings showed significant higher MAAS total score in males than females (p=.004). Additionally, by considering the four sub dimensions in the Mindfulness tendency, females reported significant higher levels in some items of “Observe” (p=.004) and “Act with awareness” (p=.001) than males, while males reported significant higher scores in the “Accept without judgement” than females (p<.001). Conclusions: The present study was a pilot research on exploring gender differences in mindfulness in Italian nurses in order to hope that it will be only the beginning of empirical research on this topic and to better address future mindfulness training courses addressed to nurses by emphasizing certain aspects of mindfulness for females compared to males and vice versa."

Effects of Holy Name Meditation on the Quality of Life of Hospital Middle Manager Nurses in Korea: A 6-Month Follow-Up

BACKGROUND

Nurses experience poor quality of life due to workload and role stress. In this study, a spirituality-based intervention was administered to nurse managers.

METHOD

A total of 45 nurse managers participated in the study; 24 were assigned to the experimental group, and 21 were assigned to a control group. The Holy Name Meditation Program was provided solely to the experimental group. Pretest, posttest 1 (5 weeks after the intervention), posttest 2 (12 weeks after the intervention), and posttest 3 (24 weeks after the intervention) data were gathered on seven variables, including spiritual well-being, spiritual needs, job satisfaction, leadership, burnout, depression, and self-efficacy.

RESULTS

The experimental group showed significant improvement in spiritual well-being (p < .001), spiritual needs (p = .029), and job satisfaction (p = .005) until the 24-week follow-up. Burnout (p < .001), depression and anxiety (p = .034), and self-efficacy (p = .024) showed significant improvement until the 12-week follow-up. Depression and anxiety (p = .053) showed decreasing tendency until the 24-week follow-up.

CONCLUSION

Evidence suggests this program promotes spiritual and psychosocial well-being of nurse managers. [J Contin Educ Nurs. 2020;51(5):215-224.].

Socioeconomic Status, Mental Health, and Workplace Determinants among Working Adults in Hong Kong: A Latent Class Analysis

This study provides insights on mental health correlates and work stress patterns in a representative sample of working adults in Hong Kong using an intersectional perspective. Using data from a cross-sectional, population-based telephone survey of 1007 working adults in Hong Kong, latent class analysis was conducted to identify socioeconomic classes within the sample. Three latent classes were identified, and they differed significantly in all the SES variables. Results suggested mental health to be the lowest in Class 1, the lowest income group. The three classes did not differ from their perceived level of job demand and control in work-related stress. Predictably, the highest income group perceived the lowest level of effort-reward imbalance. The lowest paid class was also reported perceiving the lowest level of relational justice. Different barriers to mental health services were also identified. Finally, cultural implications associated with work stress patterns, research, and practice implications are discussed. This study provides an empirical foundation for future studies to investigate patterns of job stress and mental health needs in a diverse population of working adults, with a particular focus on addressing the intersectional profiles of working adults and their needs in mental health services.

The effects of auricular acupressure on stress, anxiety, and depression of outpatient nurses in South Korea

BACKGROUND AND PURPOSE

Outpatient nursing is an occupation with high emotional labor and job stress. The purpose of this study was to examine the effects of auricular acupressure on stress, anxiety, and depression of outpatient nurses.

MATERIALS AND METHODS

The study design was a randomized controlled trial. Participants were 54 outpatient nurses, divided into an experimental (n = 28) and a control group (n = 26). Auricular acupressure using vaccaria seeds was administered to the experimental group, while placebo auricular acupressure using vaccaria seeds was administered to the placebo group. Sessions continued for 5 weeks. Outcome measurements included blood tests such as cortisol and serotonin.

RESULTS

There was a statistically significant difference in depression scores (t = 3.111, p = 0.002) and serotonin levels (t = 6.304, p < 0.001) between the experimental and placebo groups. Auricular acupressure decreased depression scores, and the depression-related physiological index, serotonin, also changed significantly.

CONCLUSION

Auricular acupressure using vaccaria seeds was effective in decreasing depression in outpatient nurses.

The linkage "Body Mass Index-Insomnia Levels-Eating Disorder Flexibility" in Italian nurses during the Covid-19 outbreak: a psychoendocrinological employment disease

AIM

To evaluate differences between insomnia condition and flexibility attitude to eating in Italian nurses directly involved in the care of patients affected by Covid-19 according to sex, Body Mass Index, shift working condition and incidence of new Covid-19 cases in the region of participants. Moreover, any correlations between the insomnia condition and the flexible attitude to eat have been investigated.

METHODS

An online questionnaire was administered in October 2020, including the socio-demographic section, the insomnia condition assessment, and the behavioral flexibility evaluation to develop an eating disorder.

RESULTS

341 Italian nurses answered the questionnaire. Regarding the insomnia condition levels, nurses belonging to regions with a higher incidence rate of the Covid-19 pandemic recorded higher levels of insomnia than others (p=.004). Females and nurses belonging to areas with lower Covid-19 incidence rate recorded a significantly higher total eating flexibility attitude (p=.003; p<.001), also, in the Food and Exercise flexibility (p=.007; p<.001). As regards the flexible attitude for weight and shape, significant differences were recorded among nurses according to their BMI values (p<.001) and to their incidence rate of the belonging region (p<.001). The insomnia condition levels significantly correlated with the eat flexibility attitude both in its total score (p=.010), in the general score (p=.010), and the weight and shape score (p<.001). All correlations between the insomnia conditions and the flexibility to eat were significantly inverse except for the food and exercise dimension. All the eat flexibility sub-dimensions significantly correlated among them (p<.001).

CONCLUSION

There was a direct correlation among socio-demographic factors, BMI values, insomnia, and behavioral flexibility scores in Italian nurses. So, it could be assumed that the nursing profession is at risk of developing a metabolic syndrome condition. Therefore, it could be considered a psychoendocrinological employment disease during the Covid-19 outbreak.

Psychological stress and associated factors among municipal solid waste collectors in Hanoi, Vietnam: A cross-sectional study

INTRODUCTION

In low and middle-income countries, the manually operated municipal waste collection system prominently depended on the performance of waste collectors (WC). Most of the literature has focused on the impact of waste collection tasks on WCs' physical health, while little was known about the psychological effects of work-related stress. This study aimed to examine the prevalence of psychological stress and related factors among waste collectors in Hanoi, Vietnam.

METHODS

A cross-sectional survey was conducted among 802 WCs in 2017. The questionnaire included the 7-item Stress component of the 21-item Depression, Anxiety and Stress Scale, and questions on demographics and work conditions. Descriptive and multivariate logistics regression analyses were conducted to examine the factors related to psychological stress among WCs.

RESULTS

Results showed that 13.4% of WCs reported stress symptoms; among them, 3.3% of WCs experienced severe stress. Factors related to lower odds of self-reported psychological stress included self-perceived frequent exposure to high and low temperatures in the working environment (OR = 0.51 and 0.52, respectively). Factors associated with the increased likelihood of symptoms included frequent exposure to hot/flammable objects (OR = 2.41), working a night shift in the last three months (OR = 1.82), education lever lower than high school (OR = 1.82), and having an insufficient monthly income (OR = 1.99).

CONCLUSION

The high percentage of workers with severe stress implies the need for mental health prevention and treatment for WCs who participated in this study.

Assessing the effect of nursing stress factors on turnover intention among newly recruited nurses in hospitals in China

Aim

This study sought to investigate some possible job stress factors that could influence newly recruited nurses’ behaviour to either continue or discontinue their job with their organization.

Design

A cross‐sectional study design was adopted for this study.

Method

Using 654 responses from novice nurses working in 20 county Chinese hospitals, we estimated the effects of six job stressors from the perceived stress scale on the turnover intention with a structural equation model in AMOS version 21 software.

Results

The results showed that four stressors, stress from taking care of patients (β = 0.111, p < .01), stress from roles and workload (β = 0.129, p < .001), stress from co‐workers and daily life (β = 0.323, p < .001) and stress from lack of professional knowledge and skills (β = 0.137, p < .001), from the perceived stress scale had a significant impact on turnover intention among nurses.

Depression and Anxiety Predict Healthcare Workers' Understanding of and Willingness to Help Suicide Attempt Patients

We examined whether burnout, depression, anxiety, stress, lifetime suicidal ideation, self-efficacy in preventing suicide and demographic factors predicted the understanding of and willingness to help suicidal patients among hospital healthcare workers. A total of 368 healthcare workers from the major surgical and medical departments in a general hospital setting were recruited. Participants responded to the Depression Anxiety and Stress Scale-21, Self-efficacy in Suicide Prevention, and Understanding Suicide Attempt Patient Scale. Those from the psychiatric department, with higher suicide prevention self-efficacy, and lower personal accomplishment indicated more understanding and helpful attitudes; doctors, depressed and anxious healthcare workers reported less understanding and helpful attitudes. Suicide prevention efforts must be conducted in tandem with equipping and supporting the healthcare workers who manage suicidal patients.

Predictors and prevalence of lower quadrant work-related musculoskeletal disorders among hospital-based nurses: A cross-sectional study

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) represent a significant problem for nurses. It is thus important to investigate nurses' WMSDs prevalence and comprehensive predictors including motor, mental, and lifestyle factors.

OBJECTIVES

To investigate the prevalence and predictors of lower quadrant WMSDs among Jordanian nurses.

METHODS

A cross-sectional design, using self-administered questionnaires, was utilized. Outcome measures included Nordic Musculoskeletal Questionnaire (NMQ), Depression Anxiety Stress Scale (DASS21), Pittsburgh Sleep Quality Index (PSQI), sociodemographic data, and self-reported work ergonomics. Descriptive analyses were used to determine lower quadrant WMSDs prevalence and regression analyses were used to assess their predictors.

RESULTS

A total of 597 nurses participated in the study. Twelve-month prevalence of lower quadrant WMSDs were 77.4% in lower back, 22.3% in hips, 37.5% in knees, and 28.5% in ankles and feet. Older age, longer years of experience, high workload, poor work habits and ergonomics, high physical activity level, availability of patient handling equipment, handling policies, stress, and anxiety were significant predictors (p< 0.05) of lower quadrant WMSDs.

CONCLUSIONS

Jordanian nurses have a high prevalence of lower quadrant WMSDs. Many modifiable risk factors of WMSDs were identified. Future studies need to design effective treatment and preventive strategies for nurses' WMSDs to improve their work efficiency and wellbeing.

Internet Addiction, Sleep Quality and Depressive Symptoms Amongst Medical Students in Delhi, India

Today, the internet has become an important element in people's lives, and owing to internet access becoming widespread, it has resulted in internet addiction. It is a major concern amongst medical students aiming to develop into health professionals. The implications of this addiction as well as its association with sleep and depression affects their studies, impacts their career goals and has detrimental consequences for society as a whole. The objectives of this study were to assess the proportion of medical undergraduate students and interns with internet addiction (IA), depressive symptoms and poor sleep quality and to study the association of IA with sleep quality and depressive symptoms. A cross-sectional questionnaire-based study was carried out in a medical college in Delhi. Universal sample consisting of all the medical students from first to final year (n = 185) and interns (n = 37) enrolled during the time of the study were included. Sleep quality, internet addiction and depressive symptoms in these students was assessed using Pittsburgh Sleep Quality Index (PSQI) Young's Internet Addiction Test (YIAT) and Patient Health Questionnaire-9 (PHQ) respectively. The average YIAT score was 33.16 ± 15.68. Overall 18%, 59.9%, 46.8% of students scored above validated cutoff scores for internet addiction, poor sleep quality and depression respectively. Prevalence of IA among males and females were 20.4% and 12.9% respectively. Significant correlations were found between potential IA, sleep quality and depression (p < 0.001). The study concluded a strong correlation between IA, disturbed sleep quality and depression. Identifying medical students with potential IA is important because this addiction often coexists with other psychological problems. Thus timely remedial actions and tailored interventions are required to combat IA among medical students.

Depression, Anxiety, Stress and Workplace Stressors among Nurses in Tertiary Health Care Settings

Background:

Chronic job stress adversely impacts both mental health of nurses and patient care. There is paucity of data regarding workplace stressors and negative emotions among nurses.

Aims:

To assess depression, anxiety and stress among nurses and analyse their association with workplace stressors.

Settings and Design:

A hospital based cross-sectional study was conducted in two tertiary care hospitals.

Methods and Material:

Four hundred and thirty one nurses completed nurses rated depression, Anxiety and Stress instrument (DASS-21) and a questionnaire probing perceived workplace stressors on a 4 point Likert scale . The stressors across subgroups of workareas were compared.

Satistical Analysis:

Association between stress, anxiety or depression and workplace stressors were analysed using binary logistic regression.

Results:

50.8% of nurses had stress; 74% had anxiety; 70.8% had depression. 79.1% had at least one of them. Stressed, anxious or depressed nurses were more concerned about lack of job satisfaction and conflicts with supervisors. Work-place stressors varied with work areas: private hospital, no job satisfaction, conflicts with doctors and patients; government hospital, acquiring infectious diseases; ICUs, inadequate salary; non-ICUs, odour and sounds in workplace and conflicts with patients.

Conclusions:

Prevalence of depression, anxiety and stress was high. Workplace stressors varied across different working areas. Interventions need are to be tailored accordingly.

Strength use and nurses' depressive symptoms: The mediating role of basic psychological needs satisfaction

AIMS

This study aimed to reveal the role of satisfying basic psychological needs in the relationship between strength use and depressive symptoms in nurses.

BACKGROUND

There is a high prevalence of depressive symptoms among nurses. Previous studies on different groups have reported that strength use is beneficial for alleviating individuals' depressive symptoms.

METHOD

A total of 475 participating Chinese nurses completed questionnaires. Hypotheses were tested using the PROCESS macro.

RESULTS

Strength use was positively correlated with basic psychological needs satisfaction overall and negatively correlated with depressive symptoms. Furthermore, autonomy and relatedness satisfaction acted as mediating mechanisms through which strength use influenced depressive symptoms.

CONCLUSIONS

Autonomy and relatedness satisfaction can mediate the influence of strength use on depressive symptoms in nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Focus should be placed on improving nurses' strength use level to reduce their depressive symptoms. Hospital managers should create an organisational environment conducive to meeting nurses' basic psychological needs and thereby reduce their depressive symptoms.

Portuguese Nurses' Stress, Anxiety, and Depression Reduction Strategies during the COVID-19 Outbreak

The COVID-19 pandemic has contributed to mental health problems worldwide. Nurses are particularly prone to stress because they directly care for individuals with suspected or confirmed cases of COVID-19. The aims of this study were (a) to explore the association between the mental health promotion strategies used by nurses during the COVID-19 outbreak and their symptoms of depression, anxiety, and stress; (b) to compare the symptoms of depression, anxiety, and stress of mental health nurses to those of non-mental health nurses; and (c) to compare the frequency of use of mental health strategies of mental health nurses to those of non-mental health nurses. A cross-sectional study was conducted with a sample of 821 nurses. Univariate and multivariate regression models were developed to identify potential protective factors of depression, anxiety, and stress. The chi-square test was also used to compare the use of strategies among mental health and non-mental health nurses. Portuguese nurses demonstrated high symptoms of depressive symptoms, stress, and anxiety. Healthy eating, physical activity, rest between shifts, maintaining social contacts, verbalizing feelings/emotions, and spending less time searching for information about COVID-19 were associated with better mental health. Mental health nurses had less depression, anxiety, and stress, and used more strategies to promote mental health than other nurses. We consider it important to promote nurses’ mental health literacy by encouraging them to develop skills and strategies aimed at improving their resilience and ability to deal with difficult situations while caring for the population.

Turnover among foreign nurses in Saudi Arabia

Background: Globally, nursing turnover has become a contemporary concern that significantly influences the financial proficiency of healthcare systems. Not only costs, but healthcare accessibility and quality also reverberate the consequence of the phenomenon.

Design and methods: The study explores the factors that attribute to turnover among foreign registered nurses working in Saudi Arabia. A quantitative-based cross-sectional descriptive study design that uses survey data to make statistical inferences about foreign nurse turnover in Saudi Arabia, was conducted to ascertain factors influencing the termination of foreign nurses working with the Ministry of Health (MOH) hospitals.

Results: Factors influencing turnover were categorized into 9 dimensions, professional growth and development, leadership style, management, wage and benefits, workload, interpersonal relationship, housing facilities and services, hospital facilities and intent to stay and turn-over intention, of which the professional growth (4.1±0.7) and development had the highest mean agreement scores (4.0±1.1), whereas housing (2.3±1.3) and hospital facilities (2.1±1.0) showed the lowest mean scores.

Conclusions: Wage benefits and workload factors were found to be the most significant causes of expatriate nursing turnover, closely followed by inadequate housing and hospital facilities. Recommendations from nursing staff on how to improve retention were also noted.

"Oh, My God! My Season Is Over!" COVID-19 and Regulation of the Psychological Response in Spanish High-Performance Athletes

Background: In an unprecedented situation of interruption of the sporting dynamics, the world of sport is going through a series of adaptations necessary to continue functioning despite coronavirus disease 2019 (COVID-19). More than ever, athletes are facing a different challenge, a source of discomfort and uncertainty, and one that absolutely alters not only sports calendars, but also trajectories, progressions, and approaches to sports life. Therefore, it is necessary to identify the levels of psychological vulnerability that may have been generated in the athletes, because of the coexistence with dysfunctional responses during the COVID-19 experience, and which directly influence the decrease of their mental health. Methods: With a descriptive and transversal design, the study aims to identify the state of the dysfunctional psychological response of a sample of Spanish athletes (N = 284). The DASS-21 (Depression, Anxiety, and Stress Scale), Toronto-20 (alexithymia), and Distress Tolerance Scale questionnaires were administered to a sample of high-level Spanish athletes in Olympic programs. Results: The results suggest that the analyzed athletes indicate high levels of dysfunctional response (e.g., anxiety, stress, depression, and alexithymia) when their tolerance is low. In addition, the variables show less relational strength, when the capacity of tolerance to distress is worse and age is lower. At the same time, the greater the anxiety and uncertainty are, leading to more catastrophic and negative thoughts, the younger the athletes are. Conclusions: It is clear that both age and tolerance to distress are considered adequate protective factors for psychological vulnerability in general and for associated dysfunctional responses in particular. Moreover, the psychological resources offered by more experienced athletes are also a guarantee of protection against negativity and catastrophism.

Healthcare Professional Experiences of Clinical Incident in Hong Kong: A Qualitative Study

BACKGROUND

Studies showed that adverse events within health care settings can lead to two victims. The first victim is the patient and family and the second victim is the involved healthcare professionals. However, there is a lack of research studying the experiences of healthcare professionals encountering clinical incidents in Hong Kong. This paper reports a qualitative study in exploring the healthcare professional experiences of clinical incident, their impacts and needs.

METHODS

This study is the second part of the mixed research method with two studies conducted in a cluster of hospitals in Hong Kong. Study 1 was a quantitative questionnaire survey and Study 2 was a qualitative In-Depth Interview. In study 2, a semi-interview guide was used.

RESULTS

Results showed that symptoms experienced after the clinical incident were mostly from psychological, physical, then social and lastly spiritual aspects which were consistent with those found in study 1 and other studies. Using content analysis for analyzing the impacts, four themes were identified. Concerning the impacts immediately from the clinical incident, two themes emerged were 1) facing emotion distress and 2) maintaining rationality. Regarding the impacts after the clinical incident, another two themes were 3) managing further emotional distress 4) restoring personal wellness. With regard to the needs after clinical incidents, three themes emerged were 1) self-recovery; 2) senior good mentoring and 3) positive organization climate with emphasis on enhancement of training and development of a positive practice culture.

CONCLUSION

Great impacts are found with healthcare professionals encountering clinical incidents from a holistic perspective. They need time for self-recovery with support from good supervisors, peers and a caring environment. Some recommendations based on the findings of the study are made.

Predictors of poor mental health among nurses during COVID-19 pandemic

AIMS

To examine the impact of various factors affecting nurses' mental health during the COVID-19 pandemic.

DESIGN

An online cross-sectional study.

METHODS

Registered nurses who graduated from a nursing school in Southern California, USA, participated in the study from 20 April-10 May 2020 (N = 320). Kendall's tau correlations and multivariate logistic regression procedures were performed with stress, anxiety and depression as outcome variables.

RESULTS

Most nurses reported moderate/high stress (80.1%), while 43% and 26% reported moderate/severe anxiety and depression, respectively. COVID-19 patient care was positively associated with moderate/severe high stress (OR = 2.25; p = .012) and moderate/severe anxiety (OR = 3.04; p < .001), whereas quarantine was associated with moderate/severe depression (OR = 2.68; p < .001). High levels of family functioning, resilience and spirituality predicted two- to sixfold lower odds of moderate/severe stress, anxiety or depression. High resilience, spirituality and family functioning appear to be good coping mechanisms for nurses against stress, anxiety and depression during the pandemic.

Sleep quality and its predictors among hospital-based nurses: a cross-sectional study

PURPOSE

Sleep disorders are common among nurses and may have negative effects on their performance and well-being. This study aimed to investigate the level of sleep quality and its possible associated factors among hospital-based nurses in Jordan.

METHODS

A cross-sectional design targeting Jordanian hospital-based nurses. In addition to demographics and work habits, the outcome measures included Pittsburgh Sleep Quality Index (PSQI), Nordic Musculoskeletal Questionnaire (NMQ), and Depression Anxiety Stress Scale (DASS). Data were analyzed descriptively and by a multiple variable linear regression analysis to identify predictors of sleep quality.

RESULTS

In total, 597 nurses with a mean age of 32.1 (± 5.7) years participated in this study and 47% were men. PSQI mean score was 7.8 (± 3.7) and 68% of the participants showed sleep quality deficits. Stress (β = 0.15 [95%CI 0.13 to 0.19, P < 0.001), depression (β = 0.05 [95%CI 0.009 to 0.08], P = 0.015), the number of joints with 12 months musculoskeletal pain (β = 0.25 [95%CI 0.15 to 0.36], P < 0.001) positively predicted decreased sleep quality. Manual handling training (β = - 0.48 [95%CI -0.96 to 0.003], P = 0.048) and years of experience (β = - 0.05 [95%CI -0.09 to 0.002], P = 0.039) negatively predicted decreased sleep quality.

CONCLUSIONS

Nurses reported poor levels of sleep quality, high levels of mental health symptoms, and musculoskeletal pain complaints. Sleep quality among nurses and its predictors should be carefully considered by administrations of healthcare services.

Risky Behaviour among Nurses in Poland: An Analysis of Nurses' Physical Condition, Mental Health, and Resilience

Background: Nursing is a profession where staff are exposed to chronic stress. Mental resilience plays a significant role in the process of coping with these challenges. The aim of this study was to assess nurses' mental and physical wellbeing, as well as resilience, by taking into account the occurrence of risky behaviour among nurses in Poland. Methods: A descriptive study was carried out between June 2017 and May 2018 among nurses (n = 1080) employed in primary healthcare or in training centres in Silesia, Poland. Data were obtained from a number of questionnaires. Results: Over half of the nurses (n = 735; 68%) had an average psychophysical mood level resulting from stress, and 179 (16.6%) nurses had a low psychophysical mood. Those with a lower psychophysical mood showed a greater tendency towards developing improper eating habits (r = -0.23; p < 0.001). Most nurses had an average (n = 649; 60.1%) or low (n = 255; 23.6%) level of resilience. Higher resilience levels were observed in nurses aged over 30 years (p = 0.004) and in those with additional employment (p = 0.008). High resilience was associated with a lower intensity of risky behaviour. Conclusion: Most nurses in Poland display average and low levels of resilience, which can have unfavourable consequences for their health.