Mental health of nurses after the Fukushima complex disaster: a narrative review

Perceived stress, burnout, and resilience among healthcare workers in a multiple disaster-impacted setting during the COVID-19 pandemic

OBJECTIVE

Current literature on coronavirus disease 2019 (COVID-19) research presents gaps and opportunities to investigate the psychological experiences of healthcare workers (HCWs) serving in mass trauma situations. We aimed to measure perceived stress, burnout, and resilience in Kashmiri HCWs and explore the relationship of burnout with sociodemographic, work-related, and pandemic-related factors.

DESIGN, SETTING, AND PARTICIPANTS

This was a cross-sectional descriptive study. Data were collected by circulating a web-based questionnaire among HCWs across primary, secondary, and tertiary healthcare levels in Kashmir, India. The questionnaire consisted of sections on personal, work-related, and pandemic-related variables as well as validated instruments to measure perceived stress, burnout, and resilience.

RESULTS

A total of 514 valid responses were received. More than 80 percent of HCWs had moderate to high perceived stress. The prevalence of personal, work-related, and client-related burnouts was 68, 48.6, and 46 percent, respectively. Resilience was negatively correlated with stress and burnout. Younger (18-28 years), unmarried HCWs, especially junior residents and nurses, had higher burnout levels. Redeployment to deliver COVID-19 duties, unpredictability in work schedule, tested positive for COVID-19, and spending time in isolation/quarantine were also found to be significant risk factors for developing burnout.

CONCLUSIONS

Nearly half of the HCWs suffered from burnout, and more than half had moderate to high perceived stress. In addition to pre-existing risk factors of burnout, the pandemic seems to have introduced more occupational risk factors in this disaster-affected area. Lessons learnt from COVID-19 pandemic may help guide need-based intervention strategies designed for specific target population rather than a one size fits all approach.

Qualitative interview study of strategies to support healthcare personnel mental health through an occupational health lens

BACKGROUND

Employee Occupational Health ('occupational health') clinicians have expansive perspectives of the experience of healthcare personnel. Integrating mental health into the purview of occupational health is a newer approach that could combat historical limitations of healthcare personnel mental health programmes, which have been isolated and underused.

OBJECTIVE

We aimed to document innovation and opportunities for supporting healthcare personnel mental health through occupational health clinicians. This work was part of a national qualitative needs assessment of employee occupational health clinicians during COVID-19 who were very much at the centre of organisational responses.

DESIGN

This qualitative needs assessment included key informant interviews obtained using snowball sampling methods.

PARTICIPANTS

We interviewed 43 US Veterans Health Administration occupational health clinicians from 29 facilities.

APPROACH

This analysis focused on personnel mental health needs and opportunities, using consensus coding of interview transcripts and modified member checking.

KEY RESULTS

Three major opportunities to support mental health through occupational health involved: (1) expanded mental health needs of healthcare personnel, including opportunities to support work-related concerns (eg, traumatic deployments), home-based concerns and bereavement (eg, working with chaplains); (2) leveraging expanded roles and protocols to address healthcare personnel mental health concerns, including opportunities in expanding occupational health roles, cross-disciplinary partnerships (eg, with employee assistance programmes (EAP)) and process/protocol (eg, acute suicidal ideation pathways) and (3) need for supporting occupational health clinicians' own mental health, including opportunities to address overwork/burn-out with adequate staffing/resources.

CONCLUSIONS

Occupational health can enact strategies to support personnel mental health: to structurally sustain attention, use social cognition tools (eg, suicidality protocols or expanded job descriptions); to leverage distributed attention, enhance interdisciplinary collaboration (eg, chaplains for bereavement support or EAP) and to equip systems with resources and allow for flexibility during crises, including increased staffing.

Work accidents, climate change and COVID-19

The effects brought by climate change and the pandemic upon worker health and wellbeing are varied and necessitate the identification and implementation of improved strategic interventions. This review aims, firstly, to assess how climate change affects occupational accidents, focusing on the impacts of extreme air temperatures and natural disasters; and, secondly, to analyze the role of the pandemic in this context. Our results show that the manifestations of climate change affect workers physically while on the job, psychologically, and by modifying the work environment and conditions; all these factors can cause stress, in turn increasing the risk of suffering a work accident. There is no consensus on the impact of the COVID-19 pandemic on work accidents; however, an increase in adverse mental effects on workers in contact with the public (specifically in healthcare) has been described. It has also been shown that this strain affects the risk of suffering an accident. During the pandemic, many people began to work remotely, and what initially appeared to be a provisional situation has been made permanent or semi-permanent in some positions and companies. However, we found no studies evaluating the working conditions of those who telework. In relation to the combined impact of climate change and the pandemic on occupational health, only publications focusing on the synergistic effect of heat due to the obligation to wear COVID-19-specific PPE, either outdoors or in poorly acclimatized indoor environments, were found. It is essential that preventive services establish new measures, train workers, and determine new priorities for adapting working conditions to these altered circumstances.

Home-Based Care and Mental Health during a Disaster: A Qualitative Analysis

Disasters adversely affect individuals' mental health; yet, research is scant on the mental health needs of frontline workers during and immediately after disasters. Our study explored this gap through the perspectives of home-based care providers (HBCP) who provided care during and after Hurricanes Irma and Harvey. In this qualitative study, five in-person focus groups were held between January and November 2019 with 25 HBCP drawn from home health care agencies in southern Florida and the Greater Houston Area. Four themes were identified using an abductive analytic approach: HBCPs' disaster-related mental health needs; HBCP resilience in the context of disaster; psychological tensions associated with simultaneously caring for self, family, and patients; and supporting patients' mental health needs during and after disaster. Our data suggest that HBCP may benefit from formal training and interventions to support their own mental health as well as that of their patients in the context of disasters.

Objective stress values during radiation emergency medicine for future human resources: Findings from a survey of nurses

Introduction

Shortages of human resources in radiation emergency medicine (REM) caused by the anxiety and stress of due to working in REM, are a major concern. The present study aimed to quantify stress and identify which tasks involved in REM response are most stressful to help educate (human resource development) and effectively reduce stress in workers. Furthermore, the final goal was to reduce the anxiety and stress of medical personnel in the future, which will lead to sufficient human resources in the field of REM.

Methods

In total, 74 nurses who attended an REM seminar were asked to answer a questionnaire (subjective) survey and wear a shirt-type electrocardiogram (objective survey). Then, informed consent was obtained from 39 patients included in the analysis. In the objective survey, average stress values of participants for each activity during the seminar were calculated based on heart rate variability (HRV). The average stress value was output as stress on a relative scale of 0–100, based on the model which is the percentile of the low-frequency/high-frequency ratio derived from HRV at any point in time obtained over time.

Results

A total of 35 (89.7%) participants answered that they had little or no knowledge of nuclear disaster and 33 (84.6%) had more than moderate anxiety. Stress values observed during the decontamination process were significantly higher than those observed when wearing and removing protective gear and during the general medical treatment process (P = 0.001, 0.004, and 0.023, respectively). Stress values did not increase during general medical treatment performed in protective clothing, but increased during the decontamination process, which is the task characteristic of REM.

Discussion

Stress felt by medical personnel throughout the entire REM response may be effectively reduced by providing careful education/training to reduce stress during the decontamination process. Reducing stress during REM response effectively could contribute to resolving the shortage of human resources in this field.

Pregnant women's migration patterns before childbirth after large-scale earthquakes and the added impact of concerns regarding radiation exposure in Fukushima and five prefectures

The 2011 Great East Japan Earthquake (within Fukushima, Iwate, and Miyagi prefectures) was a complex disaster; it caused a tsunami and the Fukushima Daiichi Nuclear Power Plant accident, resulting in radiation exposure. This study investigated the earthquake's effects on the migration patterns of pregnant women and their concerns regarding radiation exposure. We also considered the following large-scale earthquakes without radiation exposure: Great Hanshin-Awaji (Hyogo prefecture), Niigata-Chuetsu, and Kumamoto. Pregnant women were categorized as outflow and inflow pregnant women. Data on the annual number of births three years before and after the earthquake were used as a denominator to calculate the outflow and inflow rates per 100 births. The odds ratios of annual outflow and inflow rates after the earthquake, using three years before the earthquake as the baseline, were calculated. The odds-ratio for outflow significantly increased for Hyogo, Fukushima, Miyagi, and Kumamoto prefectures after the earthquake, particularly for Fukushima, showing a significant increase until three years post the Great East Japan Earthquake (disaster year: odds-ratio: 2.66 [95% confidence interval: 2.44-2.90], 1 year post: 1.37 [1.23-1.52], 2 years post: 1.13 [1.00-1.26], 3 years post: 1.18 [1.05-1.31]), while the remaining three prefectures reported limited increases post one year. The inflow decreased after the earthquake, particularly in Fukushima, showing a significant decrease until 2 years post the Great East Japan Earthquake (disaster year: 0.58 [0.53-0.63], 1 year post: 0.76 [0.71-0.82], 2 years post: 0.83 [0.77-0.89]). Thus, pregnant women's migration patterns changed after large-scale earthquakes, suggesting radiation exposure concerns possibly have a significant effects. These results suggested that plans for receiving assistance and support that considers the peculiarities of disaster related damage and pregnant women's migration patterns are needed in both the affected and non-affected areas.

Mental health and psychosocial consequences linked to radiation emergencies-increasingly recognised concerns

A major radiological or nuclear emergency may, apart from causing a substantial loss of life and physical damage, also put a substantial strain on affected societies with social, economic and political consequences. Although such emergencies are relatively uncommon, it is now being increasingly recognised that their subsequent psychosocial impact can be widespread and long lasting. Mental health effects, such as depression, anxiety and post-traumatic stress disorder, are highly represented in a population affected by a radiation disaster. In order to reach the majority of the people affected by radiation accidents, we need to be aware of how to distribute relevant and accurate information related to both short- and long-term medical effects. Effective risk communication is associated with improved compliance with any given recommendations. It is important to protect the public from physical radiation damage, but it is also essential to take into account the social and mental health effects that radiation disasters may induce. This article provides a brief review of recent reporting on the psychological consequences after a major radiation emergency.

Thoughts of suicide or self-harm among healthcare workers during the COVID-19 pandemic: qualitative analysis of open-ended survey responses

BACKGROUND

Healthcare workers are at higher risk of suicide than other occupations, and suicidal thoughts appear to have increased during the COVID-19 pandemic.

AIMS

To understand the experiences of healthcare workers with frequent thoughts of suicide or self-harm during the pandemic, including factors that contributed to their distress, and the supports that they found helpful.

METHOD

We used content analysis to analyse free-text responses to the Australian COVID-19 Frontline Healthcare Workers Study, from healthcare workers who reported frequent thoughts that they would be better off dead or of hurting themselves, on the Patient Health Questionnaire-9.

RESULTS

A total of 262 out of 7795 healthcare workers (3.4%) reported frequent thoughts of suicide or self-harm in the preceding 2 weeks. They described how the pandemic exacerbated pre-existing challenges in their lives, such as living with a mental illness, working in an unsupportive environment and facing personal stressors like relationship violence or unwell family members. Further deterioration in their mental health was triggered by heavier obligations at home and work, amid painful feelings of loneliness. They reported that workplace demands rose without additional resources, social and emotional isolation increased and many healthful activities became inaccessible. Tokenistic offers of support fell flat in the face of multiple barriers to taking leave or accessing professional help. Validation of distress, improved access to healthcare and a stronger sense of belonging were identified as helpful supports.

CONCLUSIONS

These findings highlight the need for better recognition of predisposing, precipitating, perpetuating and protective factors for thoughts of suicide and self-harm among healthcare workers.

Depression and Psychological Stress Among Health Workers in Remote Areas in Indonesia

Background

The Indonesian government launched the Nusantara Sehat program in 2015, under which teams of health workers were assigned to community health care centers in remote, border, and island areas for 2 years. The deployment to remote areas is likely to affect their psychological condition if they are not equipped with facilities and strong motivation. This study aimed to describe the psychological condition of health workers in remote areas in Indonesia, focusing on the proportion of the prevalence of depression and psychological stress.

Materials and Methods

This cross-sectional study was conducted between April and December of 2018. Participants were 140 health workers placed in 26 community healthcare centers in 13 provinces. Interviews were conducted by enumerators using a questionnaire that included questions from the Mini International Neuropsychiatric Interview (MINI) and Self-Reporting Questionnaire-20 (SRQ-20).

Results

Of the participants, 7.1% experienced depression and 10.0% experienced psychological stress. Motivation was related to psychological stress in participants with an odds ratio of 0,218 (95% confidence interval = 0.065–0.729, p = 0.013). Health workers with high motivation tend not to experience psychological stress compared to individuals with lower motivation.

Conclusion

Health workers with high motivation experience relatively low levels of psychological stress. To overcome stress, high motivation is needed to control psychological risk factors before and during placement.

Concerns and desires of healthcare workers caring for patients with COVID-19 in April and July 2020 in Japan: a qualitative study of open-ended survey comments

OBJECTIVES

The prolonged effects of the COVID-19 pandemic continue to have a serious impact on healthcare workers. We described and compared the experiences of healthcare workers in Japan during the first wave of the COVID-19 pandemic from March to May 2020, and during the lull from June to July 2020.

DESIGN

In this qualitative study, we used a web-based survey to obtain comments from healthcare workers about their experiences during the pandemic, and explored these using inductive content analysis.

SETTING

A tertiary emergency hospital in Tokyo, in April and July 2020.

PARTICIPANTS

Participants were staff in the hospital, including physicians, nurses, pharmacists, radiological technicians and laboratory medical technicians. Many, but not all, had directly cared for patients with COVID-19.

RESULTS

In total, 102 participants in the first survey and 154 in the second survey provided open-ended comments. Three themes were extracted: concerns, requests and gratitude. There were four subthemes under concerns: the hospital infection control system, fear of spreading infection to others, uncertainty about when the pandemic would end and being treated as a source of infection. There were 53 requests in the first survey and 106 in the second survey. These requests were divided into seven subthemes: compensation, staffing, information, facilities, leave time, PCR tests and equitable treatment. The theme on gratitude had two subthemes: information and emotional support, and material support. The fears and desires of healthcare workers included two types of uncertainty-related concerns, and requests were very different across the two surveys.

CONCLUSIONS

It is important to apply a balance of information to help staff adjust to their new work environment, as well as support to minimise the burden of infection and impact on their families.

Mental Health and Related Factors of Adolescent Students During Coronavirus Disease 2019 (COVID-19) Pandemic

OBJECTIVE

Adolescents are at a special stage of physical and mental development, which is a susceptible period for mental disorders. Since the outbreak of coronavirus pneumonia in December 2019, long term stress may have negative effects on the mental health of the adolescents. In the context of the coronavirus disease 2019 (COVID-19), the study was designed to investigate the mental and psychological health of adolescents in China and its possible related factors.

METHODS

A cross-sectional study design was adopted using a structured questionnaire which were distributed through the Internet to measure depression, anxiety, life events and stress related factors. Descriptive statistics and multiple regression analyses were conducted to process the data.

RESULTS

The final sample comprised 795 adolescents. The total detection rate of depression was 76.48% and the total detection rate of anxiety was 33.08%. ANOVA showed that there were significant differences in depression scores in terms of gender, anxiety scores, history of mental disorders, COVID-19 knowledge reserve, family and social contradictions (p<0.05). And there were significant differences in anxiety scores in terms of gender, depression scores, mental health knowledge reserves, family and social contradictions (p<0.05). Multiple regression analysis showed that anxiety score, health status and COVID-19 knowledge reserve were positively associated with depression score (p<0.01), and history of psychosocial disorders was negatively associated with depression score (p<0.05); depression score, family and social contradictions were significantly positively correlated with anxiety score (p<0.01), and history of mental disorders was significantly negatively correlated with SDS score (p<0.01).

CONCLUSION

During the outbreak of COVID-19, adolescent students with better understanding of the pandemic, more complete knowledge of mental health, and better family and social relationship had less impact on their mental health. Therefore, to ensure a sound social support system, elaborate health instruction, and family communication and mutual understanding are conducive to alleviating the psychological stress caused by the epidemic, and it is positive for adolescent students to maintain a good mental health.

The Correlation between Nurses' COVID-19 Infections and Their Emotional State and Work Conditions during the SARS-CoV-2 Pandemic

The COVID-19 pandemic caused by the SARS-CoV-2 virus has significantly influenced the functioning of Polish hospitals, and thus, the working conditions of nurses. Research on the presence of specific negative emotions in nurses may help identify deficits in the future, as well as directing preventive actions. The present research was performed among nurses (n = 158) working in Polish healthcare facilities during the third wave of the COVID-19 pandemic caused by the SARS-CoV-2 virus, where Group A (n = 79) consisted of nurses diagnosed with COVID-19, and Group B (n = 79) nurses who have never been infected with COVID-19. To perform the research, the Courtauld Emotional Control Scale (CECS), Trait Anxiety Scale (Polish: SL-C) and the authors' survey questionnaire were used. A positive test result was generally determined more often among nurses who indicated a noninfectious ward as their main workplace, compared to nurses employed in infectious wards (64.55% positive vs 33.45% negative). Over a half of the subjects identified moderate levels of emotion suppression as the method to regulate strong emotions, while one-quarter cited high levels of suppression. Anxiety was suppressed at high and moderate levels by 97% of the subjects, depression by 86.71%, and anger by 79.48%. Infection with COVID-19 results in a higher level of anxiety and depression, as well as a feeling of increased work load.

Anxiety, depression and quality of life (QOL) related to COVID-19 among frontline health care professionals: A multicentric cross-sectional survey

Background

During this pandemic everyone is facing the wrath of this novel coronavirus but nurses who are meticulously working in closed contact with diseased are at more risk for developing anxiety, depression and compromised quality of life. This study was conducted with an intent to identify anxiety, depression and quality of life and its predictors among nurses who are actively involved in caring of COVID-19 patients.

Methods

A cross-sectional online survey was carried out among nurses who were actively involved in COVID-19 duties at government tertiary health care institutes of India and data was collection through convenience sampling. Standardized tools (HADS, WHOQOL-BREF) were preferred for the assessment of participants' anxiety, depression and quality of life. Multivariate regression analysis was used to identify predictors for anxiety and depression.

Results

Of 354 nurses, 12.1% were suffering from anxiety while 14.7% had depression. Mean score for physical, psychological, social and environmental domains were 14.75 ± 1.86, 14.92 ± 2.46, 15.21 ± 3.01, and 14.48 ± 2.38 respectively. Nurses' education was a significant predictor for anxiety (odds ratio [OR] = -0.262, 95% CI: -0.510- -0.014, and P value = 0.038). Similarly for depression, designation of nurses acts as a contributing factor (odds ratio [OR] = 0.287, 95% CI: 0.016- 0.557, and P value = 0.038).

Conclusion

Nurses are providing their services beyond boundaries so that we can overcome with hard time of COVID-19 pandemic. Although less but still nurses are suffering from anxiety and depression which need to be addressed to protect and enhance their mental well-being.

Anxiety and Depression in Health Workers and General Population During COVID-19 in IRAN: A Cross-Sectional Study

BACKGROUND

The COVID-19 outbreak has exerted a great deal of psychological pressure on Iranian health workers and the general population. The aim of this study was to determine the effect of pandemic on anxiety and depression in Iranian population.

METHODS

An online cross-sectional study was conducted for the general public and healthcare workers in Iran using a questionnaire comprised of demographic questions and Hospital Anxiety and Depression Scale. Chi-square test and univariate and multivariate logistic regression models were conducted.

RESULTS

Of the 2045 participants, 1136 (65.6%) were considered to have moderate and severe anxiety symptoms, and 865 (42.3%) had moderate and severe depression symptoms. The prevalence of anxiety was higher in the females than in the males (OR = 1.4, 95% CI: 1.123-1.643, P = .002); the prevalence of anxiety was significantly higher in those aged 30-39 years than in other age-groups (OR = 1.6, 95% CI: 1.123-2.320, P = .001); furthermore, the prevalence of anxiety and depression was significantly higher in doctors and nurses compared with other occupations ((OR = 1.9, 95% CI: 1.367-2.491, P < .001) and (OR = 1.5, 95% CI: 1.154-2.021, P = .003)). In addition, the prevalence of anxiety symptoms in the likely infected COVID-19 group was higher than in the noninfected COVID-19 group (OR = 1.35, 95% CI: 1.093-1.654, P = .005).

CONCLUSIONS

Regarding the high prevalence of anxiety and depression symptoms, especially among healthcare workers, appropriate psychological/psychiatric intervention necessitates.

Anxiety, depression and cognitive emotion regulation strategies in Chinese nurses during the COVID-19 outbreak

AIMS

To explore the association between cognitive emotion regulation strategies and anxiety and depression among nurses during the COVID-19 outbreak.

BACKGROUND

Nurses play a vital role in responding to the COVID-19 outbreak, but many of them suffer from psychological problems due to the excessive workload and stress. Understanding the correlation between cognitive emotion regulation strategies and anxiety and depression will promote targeted psychosocial interventions for these affected nurses.

METHODS

This cross-sectional study of 586 nurses was conducted in Eastern China. Participants completed online questionnaires that investigated anxiety, depression and cognitive emotion regulation strategies.

RESULTS

The prevalence of nurses' anxiety and depression was 27.6% and 32.8%, respectively. Lower self-blame, rumination and catastrophizing, as well as greater acceptance and positive refocusing, were related to fewer symptoms of anxiety or depression.

CONCLUSION

The cognitive emotion regulation strategies of acceptance and positive refocusing contribute to reducing anxiety or depression. These strategies should be considered when implementing psychotherapeutic interventions to improve nurses' adverse emotional symptoms.

IMPLICATIONS FOR NURSING MANAGEMENT

This study highlights the need to assess cognitive emotion regulation strategies use in screening for anxiety and depression. Nurse managers should develop psychosocial interventions including appropriate strategies to help nurses with adverse emotions during a pandemic.

What Factors Are Most Closely Associated With Mood Disorders in Adolescents During the COVID-19 Pandemic? A Cross-Sectional Study Based on 1,771 Adolescents in Shandong Province, China

Background and Aims: COVID-19 has been proven to harm adolescents' mental health, and several psychological influence factors have been proposed. However, the importance of these factors in the development of mood disorders in adolescents during the pandemic still eludes researchers, and practical strategies for mental health education are limited. Methods: We constructed a sample of 1,771 adolescents from three junior high middle schools, three senior high middle schools, and three independent universities in Shandong province, China. The sample stratification was set as 5:4:3 for adolescent aged from 12 - 15, 15 - 18, 18 - 19. We examined the subjects' anxiety, depression, psychological resilience, perceived social support, coping strategies, subjective social/school status, screen time, and sleep quality with suitable psychological scales. We chose four widely used classification models-k-nearest neighbors, logistic regression, gradient-boosted decision tree (GBDT), and a combination of the GBDT and LR (GBDT + LR)-to construct machine learning models, and we utilized the Shapley additive explanations value (SHAP) to measure how the features affected the dependent variables. The area under the curve (AUC) of the receiver operating characteristic (ROC) curves was used to evaluate the performance of the models. Results: The current rates of occurrence of symptoms of anxiety and depression were 28.3 and 30.8% among the participants. The descriptive and univariate analyses showed that all of the factors included were statistically related to mood disorders. Among the four machine learning algorithms, the GBDT+LR algorithm achieved the best performance for anxiety and depression with average AUC values of 0.819 and 0.857. We found that the poor sleep quality was the most significant risk factor for mood disorders among Chinese adolescents. In addition, according to the feature importance (SHAP) of the psychological factors, we proposed a five-step mental health education strategy to be used during the COVID-19 pandemic (sleep quality-resilience-coping strategy-social support-perceived social status). Conclusion: In this study, we performed a cross-sectional investigation to examine the psychological impact of COVID-19 on adolescents. We applied machine learning algorithms to quantify the importance of each factor. In addition, we proposed a five-step mental health education strategy for school psychologists.

Does Self-Efficacy and Emotional Control Protect Hospital Staff From COVID-19 Anxiety and PTSD Symptoms? Psychological Functioning of Hospital Staff After the Announcement of COVID-19 Coronavirus Pandemic

OBJECTIVES

The aim of this study was to assess coronavirus disease 2019 (COVID-19) anxiety and posttraumatic stress disorder (PTSD) symptoms in the hospital staff, as well as to identify protective factors of COVID-19 anxiety once the coronavirus pandemic was announced in Poland.

METHODS

90 healthcare workers from the hospital in Poland completed validated self-report questionnaires assessing self-efficacy, emotional control, and PTSD symptoms; a questionnaire assessing COVID-19 anxiety; and a socio-demographic questionnaire. A multiple linear regression was conducted to assess the effects of gender, being directly vs indirectly exposed to patients, and general self-efficacy on COVID-19 anxiety.

RESULTS

The analysis showed that female (β = -0.271, p < 0.01) healthcare professionals indirectly exposed to patients (β = -0.336, p < 0.01) and those who reported lower levels of general self-efficacy (β = -0.295, p < 0.01) have a stronger tendency to experience COVID-19 anxiety [R 2 = 0.301, F(3,89) = 12.34, p < 0.01].

CONCLUSION

The findings show the importance of self-efficacy for dealing with COVID-19 anxiety. The internal coping strategies should be introduced to healthcare workers.

Communication between Health Professionals and Community Residents in Fukushima: A Focus on the Feedback Loop

Interactive communication and the ability to consider feedback are critical for linking health professionals and the community. Goto and colleagues developed and conducted health literacy training workshops for public health nurses after the 2011 nuclear accident in Fukushima to improve their communication skills. The present study aimed to examine the association between past workshop attendance and nurses' attitudes toward feedback from community residents. We conducted a questionnaire survey with 723 public health nurses in Fukushima and analyzed differences in feedback acceptance, work environment, basic characteristics, and health literacy levels between health literacy workshop attendees and non-attendees. Among 582 respondents, 19.4% were past attendees and showed a higher likelihood of accepting feedback from community residents (amount: adjusted odds ratio [aOR] = 1.87, 95% confidence interval [CI]: 1.21-2.88; specificity: aOR = 1.69, 95%CI: 1.09-2.61; satisfaction: aOR = 2.34, 95%CI: 1.50-3.65) than did non-attendees after adjusting for other variables. Furthermore, work engagement was associated with positive feedback acceptance (amount: aOR = 1.43, 95%CI: 1.03-1.98; specificity: aOR = 1.57, 95%CI: 1.12-2.20; satisfaction: aOR = 1.97, 95%CI: 1.38-2.81). We note the importance of creating a better work environment as well as a training system at the organizational level that encourages public health nurses to learn about health literacy and to improve their communication skills. This could improve professional/community relationships, increase the accessibility of health information for the public, and ultimately improve community health.

An experiential approach to developing radiological content for public health nursing: Lessons from a nuclear disaster

OBJECTIVE

This study identified the radiological content required for PHNs and public health nursing students based on PHNs' experiences caring for people affected by the 2011 Fukushima Daiichi nuclear power plant accident.

DESIGN

We used qualitative research, interviews, and content analysis.

SAMPLE

Participants were eight PHNs employed by local governments in Fukushima and neighboring prefectures.

RESULTS

Six content themes regarding the nuclear disaster were identified: (a) basic knowledge about radiation, (b) public health nursing activities in emergency exposure situations, (c) management in emergency exposure situations, (d) consultation to support residents affected by the nuclear disaster, (e) activities in the existing exposure situations, and (f) disaster preparedness in the planned exposure situations. Necessary content shifted depending on the phase of the nuclear disaster recovery.

CONCLUSIONS

The use of the experiences of PHNs after the nuclear power plant accident to inform PHNs and public health nursing students will enable PHNs to respond appropriately and support people without difficulties. Comprehensive radiation content is needed to address the range of situations caused by nuclear disaster.

Association of Anxiety over Radiation Exposure and Acquisition of Knowledge Regarding Occupational Health Management in Operation Leader Candidates of Radioactivity Decontamination Workers in Fukushima, Japan: A Cross-Sectional Study

An operation leader (OL) of radioactivity decontamination workers is required by law to have accurate knowledge of occupational health management (OHM) such as working environment management, control of operations, and health management as a field supervisor in Japan. The purpose of the current study is to examine the association between anxiety over radiation exposure and the possession/acquisition of the OHM knowledge required for OLs. In this cross-sectional study, data were collected before and after training sessions held by Fukushima Prefecture Labor Standard Associations in Fukushima, Japan, in 2017. Eighty-seven males who completed the questionnaires were enrolled to this study. As a result, acquisition of knowledge of working environment management was significantly associated with an increase of anxiety over radiation exposure after the session comparing the situation before and after the session (knowledge possession; odds ratio = 4.489; 95% confidence interval = 1.216, 16.571). In conclusion, acquisition of accurate knowledge of how to manage working environment management was associated with anxiety over radiation exposure. Although acquisition of said knowledge may contribute to the reduction of physical health risks, it may increase mental health risks. Both mental health support for OLs with accurate knowledge and educational support for those without accurate knowledge are required.

Determinants and supporting factors for rebuilding nursing workforce in a post-disaster setting

BACKGROUND

The workforce shortage is one of the major issues associated with the recovery of Minamisoma City in Fukushima Prefecture, after the Great East Japan Earthquake and the subsequent accidents at the Fukushima Daiichi Nuclear Power Plants in March 2011. While the radiation risks are often discussed as a major factor of evacuation, little is known about the actual reasons why the residents chose to evacuate, and what enables them to return. This study aims to find the essential factors for rebuilding the workforce in a post-disaster setting by analysing the residents' decisions about evacuation and the return to Minamisoma. In particular, we focus on the experiences of nurses as an example of healthcare workers, who play an important role in the disaster recovery.

METHODS

The data were obtained through qualitative interviews in a semi-structured form with 25 nurses from four hospitals in Minamisoma City. The interview questions focused on the reasons of their decisions on evacuation and return. The data were analysed by a thematic approach to investigate the major factors which led them to evacuate and enabled them to return afterwards, as well as the support they needed to resettle.

RESULTS

Nearly two-thirds of the interviewees chose to evacuate from Minamisoma with their family. Family conditions seem to be the predominant factor that influenced their decisions. In particular, having small children was a strong cause for evacuation. After a certain period of time, the nurses that evacuated were then faced with another decision about returning to the area; once again, having children, as well as other life factors, such as livelihoods, job opportunities and emotional attachment to the work, influenced this decision. On the other hand, radiation risk was a minor factor. Therefore, we analyse that improved support considering their life situations would contribute to the better retention of the nurses.

CONCLUSIONS

We suggest measures such as parenting supports, ensuring job opportunities after return, and psychological support in the workplace as possible solutions for higher job retention.

Psychological Care Augmented by Telemedicine after a Polar Bear Encounter at an Arctic Research Station: A Case Report

Background: Psychologically stressful events can be particularly challenging in the wilderness or extreme environments due to a lack of immediate medical or psychological support. Telemedicine consultations may provide a means to supply medical providers in austere environments with expertise when confronted with these situations. Methods: In this study, we detail a case of psychological care imparted to residents at a remote, arctic research station after they encountered a polar bear. The health care provider at the camp was not a dedicated mental health professional but was able to deliver psychological care with assistance from a trained provider through use of telemedicine. We provide a brief overview of the evidence behind psychological first aid and incident support sessions for the treatment of stress injuries. We also review the evidence for telemedicine for psychological care in wilderness situations and describe its use in this scenario. Results: All station residents were able to resume regular arctic activities. Resident feedback was that the sessions were advantageous. Conclusions: We anticipate the need for psychological care in austere situations to increase in the future, and further training in this field and the advancement of telemedicine consultation will be of benefit to wilderness providers.