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

A narrative review of research on healthcare staff’s burnout during the COVID-19 pandemic

Background

During the 2019 coronavirus disease (COVID-19) pandemic, burnout emerges as a critical health problem that might involve workers in many occupations, particularly healthcare personnel. Although burnout syndrome is not necessarily proved to be nosologic, it yields serious physical, mental, and social outcomes. However, it is essential to provide practical strategies and effective instruments for people so that they can adapt to such highly stressful conditions.

Objectives

The present review was conducted to explore preliminary evidence for nature, treatment, and prevention of burnout among healthcare workers during the COVID-19 pandemic.

Methods

Related English literatures published from the beginning of January 2020 to the end of September 2020 were searched in PubMed, Web of Science, Scopus, and Google scholar databases. “Burnout,” “COVID-19,” “healthcare workers,” “medical staff,” and “pandemic” constituted the search terms. A narrative technique was implemented for material synthesis and creating a compelling and cohesive story.

Results

Final results provided the burnout history and its major effects, causes, and prevalence among healthcare workers. Also, some strategies were listed to be employed by hospital medical staff and organizations to deal with the COVID-19 pandemic.

Conclusions

Recent evidence demonstrated that healthcare staff could gain significant benefits from interventions to modify burnout syndrome, especially from organization-directed interventions. So, health policymakers and practitioners should adopt such interventions and develop context-specific approaches promoting a healthy workplace and averting burnout during the COVID-19 crisis.

'Young saplings on fire' newly graduated nurses in the COVID-19 pandemic: A qualitative study

Aim

To explore the experiences of newly graduated nurses during the pandemic.

Background

Newly graduated nurses were employed during the pandemic by several countries to meet the increasing demand for healthcare services.

Methods

A descriptive qualitative study with thematic analysis. The study was conducted with 14 newly graduated nurses.

Results

Themes were systematized into four variables of the system research organization model, and a total of 12 themes were identified. Nurses, who started to work in the beginning months of the pandemic, faced several difficulties in their transition period, including the difficulties of starting employment and the effects of the pandemic on both society and health systems.

Conclusions

During the pandemic, newly graduated nurses faced various difficulties in transition processes, difficulties in starting the employment process and the effects of the pandemic on both society and health systems. In order to reduce these effects, regulations are needed at all stages of the health system.

Implications for Nursing Management

It is the responsibility of health system policymakers, hospital managers, nurse managers and senior nurses to ensure that newly graduated nurses endure these pandemic conditions, which are quite challenging even for senior nurses, without any damage, and continue in the profession.

Nurses' burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis

AIMS

To examine the nurses' burnout and associated risk factors during the COVID-19 pandemic.

DESIGN

We followed the Cochrane criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for this systematic review and meta-analysis.

DATA SOURCES

PubMed, Scopus, ProQuest, Cochrane COVID-19 registry, CINAHL and pre-print services (medRχiv and PsyArXiv) were searched from January 1 to November 15, 2020 and we removed duplicates.

REVIEW METHODS

We applied a random effect model to estimate pooled effects since the heterogeneity between results was very high.

RESULTS

Sixteen studies, including 18,935 nurses met the inclusion criteria. The overall prevalence of emotional exhaustion was 34.1%, of depersonalization was 12.6% and of lack of personal accomplishment was 15.2%. The main risk factors that increased nurses' burnout were the following: younger age, decreased social support, low family and colleagues readiness to cope with COVID-19 outbreak, increased perceived threat of Covid-19, longer working time in quarantine areas, working in a high-risk environment, working in hospitals with inadequate and insufficient material and human resources, increased workload and lower level of specialized training regarding COVID-19.

CONCLUSION

Nurses experience high levels of burnout during the COVID-19 pandemic, while several sociodemographic, social and occupational factors affect this burnout.

IMPACT

We found that burnout among nurses is a crucial issue during the COVID-19 pandemic. There is an urgent need to prepare nurses to cope better with COVID-19 pandemic. Identification of risk factors for burnout could be a significant weapon giving nurses and health care systems the ability to response in a better way against the following COVID-19 waves in the near future.

On the Relationship Between Authentic Leadership, Flourishing, and Performance in Healthcare Teams: A Job Demands-Resources Perspective

This study integrates the job demands-resources model and authentic leadership theory to test the general hypothesis that authentic leadership is a job resource that enables flourishing and performance in healthcare teams. Furthermore, this article tests the hypothesis that the daily bed occupancy is a job demand that weakens this relationship. Participants were 106 nurses that were distributed across 33 teams from two hospitals. The results suggest that the authentic leadership of team leaders is positively related with subjective and objective team performance, but only when daily bed occupancy is low. Authentic leadership had no relationship with team flourishing, regardless of the daily bed occupancy. Our findings suggest that the extent to which authentic leadership is adequate to promote the performance of teams working in a hospital setting is sensitive to contextual boundary conditions. Leading authentically might only be effective under specific circumstances.

COVID-19 and mental well-being of nurses in a tertiary facility in Kenya

BACKGROUND

The 2019 coronavirus disease (COVID-19) epidemic is a global health emergency which has been shown to pose a great challenge to mental health, well-being and resilience of healthcare workers, especially nurses. Little is known on the impact of COVID-19 among nurses in sub-Saharan Africa.

METHODS

A cross sectional study was carried out between August and November 2020 among nurses recruited from the Aga Khan University Hospital, Nairobi. The survey questionnaire consisted of six components- demographic and work title characteristics, information regarding care of COVID-19 patients, symptoms of depression, anxiety, insomnia, distress and burnout, measured using standardized questionnaires. Multivariable logistic regression analysis was performed to identify factors associated with mental health disorders.

RESULTS

Of 255 nurses, 171 (67.1%) consented to complete the survey. The median age of the participants was 33.47 years, 70.2% were females and 60.8% were married. More than half, 64.9% were frontline workers directly engaged in COVID-19 care. Only 1.8% reported a prior history or diagnosis of any mental health disorder. Depression, anxiety, insomnia, distress, and burnout were reported in 45.9%, 48.2%, 37.0%, 28.8% and 47.9% of all nurses. Frontline nurses reported experiencing more moderate to severe symptoms of depression, distress and burnout. Furthermore, females reported more burnout as compared to males. Multivariate logistic regression analysis showed that after adjustment, working in the frontlines was an independent risk variable for depression and burnout.

CONCLUSION

This is one of the few studies looking at mental health outcomes among nurses during the COVID-19 pandemic in Kenya. Similar to other studies from around the world, nurses directly involved with COVID-19 patients reported higher rates of mental health symptoms. Burnout threatens to exacerbate the pre-existing severe nursing workforce shortage in low-resource settings. Cost-effective and feasible mitigating strategies, geared to low-middle income countries, are urgently needed to help cope with mental health symptoms during such a pandemic.

The Effects of COVID-19 Pandemic on Stress Vulnerability of Nursing Students According to Labour Market Status

Nursing has always been a stressful job affecting the physical and mental health of the nurses, but the new medical context of the COVID-19 pandemic has enhanced this issue. The objective of this paper is to study differences between non-employed and employed nursing students in the medical system of Romania before and during the epidemic using matching methods and a sample of 526 nursing students. Stressors and strategies for coping with stress were also identified during the pandemic. The results indicated that employed students were more vulnerable to stress compared to non-employed ones before and during the pandemic. Females registered significantly higher stress scores compared to males in the period of the epidemic. The analysis of the overall sample suggested that gender and environment were significant stress factors during the pandemic, but living conditions were not relevant. The most effective coping strategies against stress for nurses during the COVID-19 crisis were based on self-control and the spiritual dimension, unlike the previous period when other colleagues’ support helped most nurses to overcome difficult working conditions. The implications of this study might help medical management in ensuring a less stressful environment for nurses during the epidemic.

Protective Factors against Emergency Stress and Burnout in Healthcare and Emergency Workers during Second Wave of COVID-19

Working as healthcare workers (HCWs) and emergency workers (EWs) during the first wave of COVID-19 has been associated with high levels of stress and burnout, while hardiness, coping strategies and resilience have emerged as protective factors. No studies have so far investigated these psychological factors during the second wave. We aimed to verify the trend of stress levels, burnout, coping strategies and resilience during the pandemic in Italian healthcare and emergency workers by comparing a first sample recruited from the first COVID-19 wave (N = 240) with a second sample relating to the second wave (N = 260). Through an online platform we administered questionnaires to measure stress, burnout, resilience, hardiness and coping strategies. The results showed that in the two waves the total stress levels of HCWs and EWs did not differ, while the physical stress and hardiness scores in the second wave were greater. No differences were found in the coping strategies used. An analysis of burnout levels in the second wave sample found that stress showed a high predictive power in the emotional exhaustion and depersonalization scales. Hardiness and resilience emerged as protective factors in reducing stress. The implications for the need to provide support and to improve hardiness for HCWs and EWs are discussed.

Burnout Determinants among Nurses Working in Palliative Care during the Coronavirus Disease 2019 Pandemic

Nurses working in palliative care are at risk of burnout. The Copenhagen Burnout Inventory was used to determine burnout levels of nurses working in the Portuguese national network of palliative care. We evaluated the contribution of personal, work, and COVID-19 variables in three burnout subclasses: personal, work, and patient-related. A cross-sectional, exploratory, and quantitative design was employed and participants were sampled using convenience and snowball technique. An online survey was conducted and 153 nurses participated in our study. Socio-demographic characterization was conducted, levels of burnout and determinants were explored through multiple linear regression models for its three dimensions. High levels of personal, working, and patient burnout were present in 71 (46%), 68 (44%), and 33 nurses (22%), respectively. Most of them agreed that COVID-19 had an impact on their activities. Significant personal and work related burnout factors found were specialization in palliative care, self-perceived health status, unit type, weekly hours of work, and allocation to COVID-19 units. Gender was found to be a significant factor in patient-related burnout. There is a high level of burnout among nurses working in the Portuguese national network of palliative care. Measures for identification and mitigation of burnout are necessary to protect health care professionals.

Burnout and Its Relationship With Depressive Symptoms in Medical Staff During the COVID-19 Epidemic in China

Objective

The large-scale epidemic of Coronavirus Disease 2019 (COVID-19) has triggered unprecedented physical and psychological stress on health professionals. This study aimed to investigate the prevalence and risk factors of burnout syndrome, and the relationship between burnout and depressive symptoms among frontline medical staff during the COVID-19 epidemic in China.

Methods

A total of 606 frontline medical staff were recruited from 133 cities in China using a cross-sectional survey. The Maslach Burnout Inventory (MBI) was used to assess the level of burnout. Depressive symptoms were assessed by the Patient Health Questionnaire Depression (PHQ-9).

Results

During the COVID-19 pandemic, 36.5% of the medical staff experienced burnout. Personal and work-related factors were independently associated with burnout, including age (OR = 0.68, 95% CI: 0.52–0.89, p = 0.004), family income (OR = 0.72, 95% CI: 0.53–0.99, p = 0.045), having physical diseases (OR = 2.16, 95% CI: 1.42–3.28, p < 0.001), daily working hours (OR = 1.35, 95% CI: 1.03–1.77, p = 0.033), and profession of nurse (OR = 2.14, 95% CI: 1.12–4.10, p = 0.022). The correlation coefficients between the scores of each burnout subscale and the scores of depressive symptoms were 0.57 for emotional exhaustion, 0.37 for cynicism, and −0.41 for professional efficacy (all p < 0.001).

Conclusions

Our findings suggest that the prevalence rate of burnout is extremely high among medical staff during the COVID-19 pandemic, which is associated with other psychological disorders, such as depression. Psychological intervention for medical staff is urgently needed. Young and less experienced medical staff, especially nurses, should receive more attention when providing psychological assistance.

Occupational Burnout Among Frontline Health Professionals in a High-Risk Area During the COVID-19 Outbreak: A Structural Equation Model

Background: The outbreak of coronavirus disease 2019 (COVID-19) resulted in a substantial workload and stress for frontline health professionals in high-risk areas. Little research has investigated the mechanism of occupational burnout among the frontline health professionals located in the center of the epidemic in Wuhan, China. Methods: A total of 199 frontline health professionals from Wuhan Jinyintan Hospital completed the cross-sectional survey. Mechanisms of occupational burnout (according to the Maslach Burnout Inventory-General Survey, MBI-GS) among the health professionals in Jinyintan Hospital during the COVID-19 outbreak were examined using a structural equation model (SEM). Results: The levels of the three burnout dimensions (emotional exhaustion, cynicism, and professional efficacy) were high at 34.2, 50.8, and 35.2%, respectively. Frontline health professionals in this stressful period reported significantly greater emotional exhaustion (p < 0.001) and job-related cynicism (p < 0.001), but no significant difference in professional efficacy (p = 0.449), when compared to employees in a large multinational company. The SEM results revealed that both acute stress symptoms and psychosomatic symptoms significantly predicted the emotional exhaustion and occupation cynicism dimensions of burnout. Conclusion: The study reveals the occupational burnout mechanism of frontline health professionals during the COVID-19 peak at the time of the outbreak. This study provides an important contribution to understanding the future psychological interventions necessary for frontline health professionals during an epidemic crisis.

Post-traumatic Growth Level and Its Influencing Factors Among Frontline Nurses During the COVID-19 Pandemic

Objective: To assess post-traumatic growth (PTG) level and explore its influence factors among frontline nurses during the COVID-19 pandemic. Methods: From April 11th to 12th, 2020, a cross sectional study was conducted on 116 frontline nurses who had participated in fight against the COVID-19 in Wuhan city, China. General information and psychological discomfort were collected. Chinese version post-traumatic growth inventory with 20 items was applied to assess PTG level. Univariable analyses and multiple linear regression were performed to explore potential influencing factors of PTGI score. Results: The average score of PTGI in frontline nurses was 65.65 ± 11.50. In univariable analyses, gender, age, education level, marital status, living with parents, professional title, working years and professional psychological support was not statistically associated with the PTGI score. In both univariable and multivariable analyses, having support from family members and friends, being psychological comfort and having children and increased the PTGI score significantly. The three factors only explained 3.8% variance. Conclusion: Moderate PGT was observed in the frontline nurses who had battled against COVID-19. Social support and professional psychological intervention should be applied to further improve PTG level. Further studies with large sample size are required to explore more potential influencing factors.

A Systematic Review and Meta-Analysis of Burnout Among Healthcare Workers During COVID-19

Burnout among healthcare personnel has been exacerbated by the COVID-19 pandemic's unique features. During the COVID-19 pandemic, this systematic review and meta-analysis aims to provide a complete assessment of the prevalence of burnout across various healthcare personnel. Until January 2021, systematic searches for English language papers were conducted using PubMed, Scopus, EMBASE, Web of Science, Cochrane Library, and ProQuest. Thirty observational studies were found after conducting systematic searches. The pooled overall prevalence of burnout was 52% [95% confidence interval (CI) 40-63%]. Pooled emotional exhaustion (EE), depersonalization (DP), and lack of personal accomplishment (PA) were 51% (95% CI 42-61%), 52% (95% CI 39-65%), and 28% (95% CI 25-31%), respectively. This study demonstrated that nearly half of the healthcare workers experienced burnout during the COVID-19 pandemic. In the studies that were included, non-frontline COVID-19 exposed healthcare personnel also experienced burnout. From high to lower middle-income countries, there was a gradient in the prevalence of total burnout, EE, and lack of PA. Further studies on burnout in low and lower-middle-income countries are suggested. A uniform diagnostic tool for the assessment of burnout is warranted.

COVID-19 Pandemic and Overall Mental Health of Healthcare Professionals Globally: A Meta-Review of Systematic Reviews

OBJECTIVE

This meta-review aimed to provide a comprehensive overview of overall mental health of healthcare professionals during the COVID-19 pandemic.

METHOD

We conducted a comprehensive literature search on Academic Search Premier, CINAHL, Cochrane Library, and MEDLINE. A predefined eligibility criterion was used to screen the articles. The methodology quality of eligible studies was assessed using Joanna Briggs Institute checklist for systematic reviews. The data were narratively synthesised in line with the meta-review aim.

RESULT

Forty systematic reviews (represented as K = 40), which reported data from 1,828 primary studies (N) and 3,245,768 participants, met the inclusion criteria. The findings from a pooled prevalence indicate that anxiety (16-41%, K = 30, N = 701), depression (14-37%, K = 28, N = 584), and stress/post-traumatic stress disorder (18.6-56.5%, K = 24, N = 327) were the most prevailing COVID-19 pandemic-related mental health conditions affecting healthcare workers. Other reported concerns included insomnia, burnout, fear, obsessive-compulsive disorder, somatization symptoms, phobia, substance abuse, and suicidal thoughts. Considering regions/countries, the highest anxiety was reported in the United-Kingdom [22.3, 95% Confidence Interval (CI):7-38, N = 4] compared to other countries, while the highest depression was in the Middle-East, (41, 95% CI:16-60, N = 5) and stress in the Eastern Mediterranean region (61.6, 95% CI:56.4-66.8, N = 2) compared to other regions. The most significant risk factors include female gender, younger age, being a nurse, and frontline professional. The most-reported coping strategies include individual/group psychological support, family/relative support, training/orientation, and the adequacy of personal protective equipment.

CONCLUSION

It was concluded that healthcare professionals (nurses, doctors, allied health) have experienced various mental health issues during COVID-19 pandemic. The meta-review, therefore, recommends targeted interventions and health policies that address specific mental health issues to support health professionals worldwide during the duration of the COVID-19 pandemic and similar future health crises.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202126200, identifier: CRD42021262001.