A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic

Depicting occupational trauma concepts impacting nurse well-being during the COVID-19 pandemic

PURPOSE

The purpose of this concept delineation was to differentiate similar concepts impacting nurse well-being during the COVID-19 pandemic, including: compassion fatigue, burnout, moral injury, secondary traumatic stress, and second victim.

METHODS

A total of 63 articles were reviewed for concept delineation. Morse's (1995) approach to concept delineation was utilized to analyse the articles.

RESULTS

Concepts were described interchangeably but were found to present themselves in a sequence. A nurse may experience moral injury, leading to a second victim experience, synonymous with secondary traumatic stress, then compassion fatigue and/or burnout that can be acute or chronic in nature. An Occupational Trauma Conceptual Model was created to depict how these concepts interact based on concept delineation findings.

CONCLUSION

Nurses are experiencing long-lasting occupational trauma and future intervention research should centre on optimizing nurse well-being to ensure the sustainability of nursing profession.

Our New Normal: Pediatric Nurse Residents' Experiences with Transition to Practice during the COVID-19 Pandemic

This phenomenological qualitative study examined the lived experience of pediatric nurse residents' transition to practice during the COVID-19 pandemic. The purposive sample included nine pediatric nurses, participating in a nurse residency program, who entered the nursing profession during the first year of the pandemic. The setting was a free-standing, Magnet-recognized, pediatric academic medical center in the Northeastern U.S. Individual interviews were audio recorded and transcribed. Narratives were analyzed using a hermeneutic phenomenological approach. Five themes emerged from the data: Our New Normal; The Rules Keep Changing; I'm Not Ready for This (transition to practice); The Toll of COVID; and Shattered Family-Centered Care. Sub-themes emerged in The Toll of COVID theme: COVID and the Nursing Care Environment, Emotional Toll of COVID, Burnout: A Universal Truth, and The Pandemic within the Pandemic. The nurse residents' narratives uncovered the essence of their uncertainty, sorrow, growth, and resilience. Through the eyes of pediatric nurse residents, this study illuminated the experiences of these novices as they entered the nursing profession amid a pandemic.

The prevalence and risk factors of PTSD symptoms among nurses during the COVID-19 pandemic-A systematic review and meta-analysis

Since the first reported outbreak in China, the Coronavirus disease 2019 (COVID-19) has raised serious concerns globally. The COVID-19 pandemic has caused a severe psychological impact on healthcare workers (HCWs), and especially nurses, who are the most numerous and exposed frontline group. This systematic review and meta-analysis aims to summarise extant literature on the effects of the COVID-19 pandemic on the psychological health of nurses, particularly concerning the prevalence and risk factors for post-traumatic stress disorder (PTSD). A systematic search was conducted on PubMed, Embase and PsycInfo from March 2020 to July 2023. Articles were included/excluded on predetermined eligibility criteria. A random-effect meta-analysis was performed using proportions to determine the pooled prevalence for PTSD among nurses. Subgroup analyses were also performed, and heterogeneity across studies was analysed using meta-regression. Relatively high prevalence rates of PTSD were reported among nurse populations during the COVID-19 pandemic in twenty-six different countries, globally. Risk factors associated with PTSD include having prior mental health co-morbidities, being a female, having high exposure/contact with COVID-19 patients, having insufficient protective conditions and having intensive workloads. The overall pooled prevalence was 29.1% (95% C.I. = 23.5%, 35.5%) using a random-effects model in 55 studies. The regression test of funnel plot asymmetry indicated a significant level of publication bias among studies. The COVID-19 pandemic is associated with significant levels of PTSD among frontline nurses globally. A high level of heterogeneity was observed across studies. Psychological, social and administrative interventions should be implemented to mitigate heavy psychological distress in nurses.

Mediating role of loneliness and emotional disturbance in the association between childhood trauma and occupational burnout among nurses: a cross-sectional study

Background

The occupational burnout status of nurses in China warrants attention. Childhood trauma, loneliness, and emotional disturbance are significant predictors of this burnout, yet few studies have delved into the underlying mechanisms. This study seeks to explore the mediating pathway from childhood trauma to loneliness, emotional disturbance, and ultimately occupational burnout among nurses through a cross-sectional analysis.

Method

Data for the study were collected from Yunnan province, China, from 11 July to 26 July 2022. Key variables were measured using standardized scales: the Childhood Trauma Questionnaire Short Form for childhood trauma, the three-item loneliness scale for loneliness, the Patient Health Questionnaire and the Generalized Anxiety Disorder questionnaire for emotional disturbance, and the Maslach Burnout Inventory-Human Service Survey for occupational burnout. Mediation modeling analysis was employed for data analysis to test the effect of loneliness and emotional disturbance on the association between childhood trauma and occupational burnout. Data analysis was conducted using AMOS and SPSS software.

Results

Loneliness and emotional disturbance fully mediated the association between childhood trauma and emotional exhaustion [indirect effect (95% CI) = 0.228 (0.196, 0.270)]. Loneliness and emotional disturbance partially mediated the association between childhood trauma [indirect effect (95% CI) = -0.020 (-0.039, 0.002)] and personal accomplishment or depersonalization [indirect effect (95% CI) = 0.221 (0.186, 0.255)].

Conclusion

Childhood trauma could affect occupational burnout through loneliness and emotional disturbance among nurses. Preventive strategies could include protective interventions like treatment of loneliness and emotional disturbance, especially in nurses who experienced childhood trauma.

A study on post-traumatic stress disorder and post-traumatic growth among patients infected with COVID-19 in Wuhan

Objective

The purpose of this study is to assess the physical and psychological conditions of hospitalized patients who were infected with COVID-19 in Wuhan, China, including post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG) scores and predictors.

Methods

The test group consisted of 102 hospitalized patients diagnosed with COVID-19 in Wuhan between March 4, 2020 and April 5, 2020, whereas the control group comprised 168 healthy study participants. Relevant information of the study participants was obtained using online questionnaires, covering five aspects-general information, physical state, emotional state, PTSD, and PTG.

Results

In Wuhan, 37.3% of COVID-19-diagnosed hospitalized patients exhibited hyper-arousal symptoms of PTSD. This percentage is significantly higher than the 13.1% observed in the healthy population. Furthermore, the prevalence of PTG among the same group of hospitalized patients stood at 77.5%, surpassing the 66.1% rate found within the healthy population. It was determined that inconsistent sleep patterns during the hospitalization phase could be indicative of heightened vulnerability to hyperarousal symptoms of PTSD in COVID-19-diagnosed hospitalized patients. The study determined that inconsistent sleep patterns during hospitalization may be a predisposition factor that makes hospitalized patients diagnosed with covid-19 more susceptible to high arousal symptoms of post-traumatic stress disorder. Conversely, COVID-19-diagnosed hospitalized patients who maintained a tranquil demeanor and exhibited positive emotional perceptions during their hospitalization displayed reduced susceptibility to these PTSD symptoms. Factors such as possession of a bachelor's degree, history of severe acute respiratory syndrome (SARS) infection, and poor sleep patterns were identified as predictors elevating the risk of PTG. Whereas, a sentiment of happiness and consistent positive emotional perception during hospitalization were predictors of PTG. Intriguingly, a direct correlation was established between hyper-arousal symptoms of PTSD and PTG.

Conclusion

Although the outbreak of COVID-19 has badly affected the physical and psychological well-being of patients, it has greatly enhanced their PTG.

The prevalence of post traumatic and associated factors among nurses during COVID_19 pandemics: a systematic review and meta-analysis

BACKGROUND

Despite the negative outcomes, exposure to a crisis may cause people to experience positive changes. This study aims to analyze the prevalence of post-traumatic growth (PTG) and its relevant factors among nurses during the COVID-19 pandemic.

METHOD

The research protocol was registered with PROSPERO (CRD42022329671), and PRISMA steps were taken in this study. PubMed, Scopus and ProQuest were explored on 1/9/2022 to create the research database. According to the inclusion criterion, all studies analyzing the prevalence of post-traumatic growth through the PTG Inventory were considered eligible. They were all qualitatively assessed through the modified version of the Quality Assessment Checklist for prevalence studies.

RESULTS

A total of 15 papers met the inclusion criterion (n = 22756). According to the research results, the prevalence of PTG was randomly calculated ES [95% Conf. Interval = 0.15 [0.12-0.17]), and heterogeneity was reported I2 = 98.52% (P = 0.000). The results also indicated that the mean score of PTGI decreased in nurses as their work experience and mean age increased. However, the effect was not statistically significant for the mean age (P = 0.06). According to the results, the PTGI score decreased in nurses with more work experience, a finding which was statistically significant (P = 0.04).

CONCLUSION

This meta-analysis determined a 15% prevalence rate of PTG in nurses. Psychological interventions should be developed and applied to older nurses with more work experience in order to mitigate the harm caused by the pandemic and its consequent crises.

Students who witness critical events in the clinical setting: Recommendations for prevention of psychological trauma

BACKGROUND

Student nurses often do not receive adequate preparation, support, and debriefing related to witnessing or experiencing critical events in the clinical setting.

PURPOSE

The purpose of this analysis was to describe the experiences of student nurses who have witnessed critical events in the clinical setting, the support and preparation they received, and staff and faculty actions they perceived as facilitating or hindering their processing of the event.

METHODS

This is a sub-analysis of a Straussian Grounded Theory qualitative study.

RESULTS

Staff and faculty actions that helped and hindered the processing of the critical event were identified at four time points: pre-event, during the critical event, immediately post-event, and in the days and weeks following.

CONCLUSIONS

Students exposed to critical events during their clinical rotations can experience psychological trauma. If unresolved, this can result in new nurses entering the profession already in distress. Preparation and support for witnessing critical patient events should start at the beginning of nursing school. During critical patient events, students need faculty or staff to be actively present to explain the event and support the student throughout the event. Immediate debrief and follow-up is recommended and should continue weeks or months after the event.

A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study

Background

Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives.

Objective(s)

Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety.

Design

Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation.

Setting and methods

Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool.

Participants

A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews.

Interventions

Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions.

Results

Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere.

Limitations

Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results.

Conclusions

WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review.

Future work

The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context.

Study registration

This study is registered as ISRCTN14470430.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

[Post-traumatic growth of critical care nursing teams after the Covid-19 pandemic]

As the negative psychological impact of Covid-19 is no longer in doubt, the aim of the study presented here was to quantify the post-traumatic growth (PTC) of caregivers working in critical care. To this end, a paper questionnaire was distributed in the critical care department of the Lyon-Sud hospital. Among the care team, 67% had developed PTC, showing that despite the difficulties experienced during the trauma, the team had managed to grow from this crisis.

Six-month psychopathological symptom trajectories following the COVID-19 outbreak: Contrasting mental health outcomes between nurses and the general population

The COVID-19 pandemic prompted a social, economic and health crisis that had a major impact on the mental health of the global community, particularly nurses. The objective of the current study is to conduct a longitudinal evaluation of the trajectory of depressive, anxiety, trauma, and fear of COVID-19 symptoms, comparing self-reports of nurses and the general population over a six-month period. Self-report questionnaires were administered online to a sample of 180 nurses and 158 individuals from the general population for the baseline assessment (T1) and follow-up at 6 months (T2). Levels of symptoms reported by nurses were generally greater and tended to worsen over time, as opposed to the levels of symptoms reported by the general population that tended to improve. Levels of depressive, anxiety, and trauma symptoms were significantly different between nurses and the general population over time. Levels of fear of COVID-19 declined significantly from T1 to T2 in both groups. These results suggest that it is crucial to monitor the longer-term effects of COVID-19 and to develop resilience-promoting interventions tailored to the unique needs of this vulnerable group.

"COVID-19 - A Perfect Storm": A Qualitative Exploration of Residential Care Facility Managers Perspectives on the Psychosocial Impacts of COVID-19

Growing evidence highlights the negative impact of managing the COVID-19 pandemic on the wellbeing of the healthcare workforce, including in the aged care sector. We undertook a qualitative study during the pandemic's third year to explore the psychosocial impacts on nine managers of residential care facilities (RCFs) across metropolitan and rural New South Wales, the largest state in Australia. Four themes were identified: (1) Increased pressure on maintaining aged care services, (2) Increased responsibility on RCF managers, (3) Psychosocial impacts due to accumulating pressures, and (4) Experience of beneficial supports. COVID-19 compounded pre-pandemic sector challenges and added new stressors. While resilient and resourceful, RCF managers experienced workplace stress and burnout, which may affect quality of resident care and impact on staff retention. There is a need for more investment to effectively support staff, and research to identify optimal psychosocial and management supports.

The levels and related factors of posttraumatic growth among nurses: A systematic review and meta-analysis

WHAT IS KNOWN ON THE SUBJECT?: Nurses often encounter traumatic events in their clinical practice. Trauma can have both negative effects, such as post-traumatic stress disorder and positive effects, such as growth and positive emotions. Posttraumatic growth is beneficial for nurses, as it contributes to positive mental health outcomes and increases life satisfaction. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Our study confirms that nurses commonly experience posttraumatic growth after being exposed to traumatic events, and the level of growth is moderate. We have identified individual, work-related, and social and organizational factors that may influence the occurrence of posttraumatic growth among nurses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our findings provide valuable insights for interventions aimed at promoting posttraumatic growth among nurses. It is crucial to consider individual factors, work-related factors, and social and organizational factors when designing these interventions. By addressing these factors, healthcare professionals can support nurses in coping with trauma and facilitate their posttraumatic growth.

ABSTRACT

INTRODUCTION: While the negative effects of trauma on nurses have been well-documented, it is equally important to focus on ways to promote posttraumatic growth (PTG) among nurses.

AIM

This study aims to explore the levels and related factors of PTG among nurses.

METHOD

A comprehensive search was conducted across nine databases up to 26 December 2022. The pooled mean score for PTG was calculated and presented with a 95% confidence interval. Subgroup and meta-regression analyses were performed to identify potential moderators of PTG among nurses.

RESULTS

A total of 55 studies, involving 35,621 nurses from 11 countries and regions, were included in this review. The pooled scores of the PTG indicated that nurses experienced a moderate level of PTG (55.69, 95% CI: 50.67-60.72).

DISCUSSION

Nurses commonly experience PTG following exposure to traumatic events, with a moderate level of PTG. Our systematic review highlights the potential determinants of PTG among nurses, including individual, work-related, and social and organizational factors.

IMPLICATIONS FOR PRACTICE

Targeting these factors in interventions can provide nurses with the necessary resources and support to effectively cope with stress and trauma, and potentially facilitate PTG.

Understanding the mental health impacts of biological disasters: Lessons from Taiwan's experience with COVID-19

Biological disasters pose a growing challenge in the 21st century, significantly impacting global society. Taiwan has experienced such disasters, resulting in long-term consequences like loss of life, trauma, economic decline, and societal disruptions. Post-disaster, mental health issues such as fear, anxiety, depression, post-traumatic stress disorder (PTSD), and stress surge, accompanied by increased suicide rates. The Coronavirus disease 2019 (COVID-19) (also called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) pandemic, recognized as a biological disaster, triggered lockdowns and quarantines in Taiwan, causing lifestyle changes, economic recession, and so on. These shifts may elevate uncertainty about the future, intensifying mental stress and leading to a rise in various mental illnesses. This article reviews mental health studies conducted in Taiwan during the pandemic, emphasizing the need to integrate this research for future preparedness and interventions regarding the mental health impacts of biological disasters, including COVID-19. Further research is essential to explore long-term effects, interventions, and generalizability.

Exploring Social Work Practitioners' Perspectives on the Contributors to Burnout since the COVID-19 Pandemic

Burnout has a historic and disproportionate impact on social workers and is one important contributor to the ongoing health and behavioral health workforce crisis in the United States. Little is known, however, about social workers' experiences of burnout and their perceptions of factors that contribute to burnout since the COVID-19 pandemic. This study sought to explore this by answering the following research questions: (a) To what extent are social workers in South Carolina experiencing burnout? and (b) What do South Carolina social workers view as the top reasons for burnout in their professional role? Seventy social work practitioners and leaders from South Carolina completed an online survey during Fall 2022 that included the Copenhagen Burnout Inventory and an open-ended question focused on identifying their perceptions of the top three reasons for burnout in the profession. Findings suggest that social workers in this study are experiencing moderate levels of burnout since the COVID-19 pandemic and report primarily organizational (83 percent) contributors to burnout. They also identified individual (36 percent), systemic (29 percent), and interpersonal (27 percent) contributors to burnout. Implications are discussed related to policy and practice responses to prevent and address burnout among social workers.

Covid-19 pandemic? Mental health implications among nurses and Proposed interventions

Background

With its abrupt and huge health and socio-economic consequences, the coronavirus disease (COVID-19) pandemic has led to a uniquely demanding, intensely stressful, and even traumatic period. Healthcare workers (HCW), especially nurses, were exposed to mental health challenges during those challenging times.

Objectives

Review the current literature on mental health problems among nurses caring for COVID-19 patients.

Methods

This is a narrative review and critical evaluation of relevant publications.

Results

Nurses experienced higher levels of stress, burnout, anxiety, depression, frustration, stigma, and depersonalization compared to other HCW. Factors that increased this symptomatology included concerns about infection or infection of family members, inadequate staff protective equipment, extended working hours, insufficient information, a reduced sense of security, and post-traumatic stress disorder. The factors that improved the psychopathology included a general positive attitude, job satisfaction, adequate information and education, harmonious group relationships, post-traumatic development, emotional intelligence, psychological counseling, mindfulness-based stress reduction, stable leadership, guidance, and moral and practical administrative support.

Conclusions

Recent studies clearly show that nurses, especially women, are the most vulnerable subgroup among HCW and are particularly prone to mental health impacts during the COVID-19 pandemic. The documented mental health vulnerability of frontline nursing staff during the COVID-19 pandemic requires preventive nursing management actions to increase resilience and to develop relevant defense mechanisms.

Structural Factors Contributing to Compassion Fatigue, Burnout, and Secondary Traumatic Stress Among Hospital-Based Healthcare Professionals During the COVID-19 Pandemic

High levels of burnout among healthcare providers (HCPs) have been a widely documented phenomenon, which have been exacerbated during the COVID-19 pandemic. In the United States, qualitative studies that are inclusive of HCPs in diverse professional roles have been limited. Therefore, we utilized a qualitative-quantitative design to examine professional quality of life in terms of compassion fatigue, burnout, and secondary traumatic stress among hospital-based HCPs, including social workers, hospitalists, residents, and palliative care team members during COVID-19. HCPs (n = 26) participated in virtual semi-structured focus groups or individual interviews and online surveys (n = 30) including the Professional Quality of Life (ProQOL) Scale. While ProQOL scores indicated low levels of compassion fatigue, burnout, and secondary traumatic stress, thematic analysis of our qualitative data included rich descriptions of compassion fatigue, burnout, and secondary traumatic stress. Safety concerns and value misalignment characterized structural stressors perceived to contribute to HCP compassion fatigue, burnout, and secondary traumatic stress. The discrepancy between our qualitative and quantitative findings may be indication that modifications to current screenings are warranted. These findings also suggest a need to identify and implement structural and policy changes that increase HCPs' physical and emotional safety and promote better alignment of institutional interests with HCP values.

Impact of the Work Environment on Nurse Outcomes: A Mediation Analysis

BACKGROUND

The nursing workforce remains in a vulnerable state post pandemic as working conditions are difficult and exacerbated by a global nursing shortage. Identifying factors leading to turnover intentions are thus critical for health care system recovery.

PURPOSE

The purpose of this study was to examine the impact of nurses' work environment and the pandemic on missed nursing care, scope of practice, emotional exhaustion, and intent to leave.

METHODS

This study was a cross-sectional, self-reporting online survey, sent to hospital-based nurses in a Canadian province (n = 419). Mediation analysis was used to examine both direct and indirect effects of work environment and COVID-19 impact on nurse outcomes (emotional exhaustion and intent to leave) through missed care and scope of practice.

RESULTS

The results showed that 73% of nurses were considering leaving the profession. Several direct and indirect pathways predicted emotional exhaustion and intent to leave. A better work environment was related to both decreased emotional exhaustion and intent to leave. Nurses' scope of practice partially mediated the relationship between work environment and intent to leave. On the other hand, missed care did not mediate emotional exhaustion or intent to leave.

CONCLUSIONS

While considering the global nursing shortage, it is imperative to implement strategies to promote nurses' well-being and their retention within the health care system.

Prevalence and influencing factors of PTSD symptoms among healthcare workers: A multicenter cross-sectional study during the surge period of the COVID-19 pandemic since December 2022 in the Chinese mainland

BACKGROUND

China has experienced a surge period of COVID-19 pandemic since December 2022. Healthcare workers (HCWs) were exposed to huge workload under high risk of being infected, and significant levels of trauma, which might cause Post-traumatic Stress Disorders (PTSD) symptoms in HCWs.

OBJECTIVES

To identify the prevalence of PTSD symptoms among HCWs in the Chinese mainland during the surge period of the COVID-19 pandemic; to explore their psycho-social factors of PTSD symptoms.

METHODS

A multicenter cross-sectional study was conducted among HCWs in Chinese mainland from January 5 to February 9, 2023, covering seven geographical regions. 6552 participants were recruited by convenience sampling. Data were collected on demographic characteristics, work-related factors, and psychological factors by online questionnaires. Univariate analysis and binary logistic regression were used to determine the influencing factors of PTSD symptoms.

RESULTS

The prevalence of PTSD symptoms among HCWs was 37.49 %. A higher level of mindfulness, resilience, and perceived social support were protective factors. Female gender, nurses, higher educational attainment, married status, more working years, higher perceived risk of contracting COVID-19 due to work, and higher perceived work intensity were risk factors.

CONCLUSION

High prevalence of PTSD symptoms among HCWs necessitates psychological interventions. Tailored interventions, designed by professional psychiatrists, should be tailored to address the stressors. A comprehensive approach, incorporating mindfulness, resilience-building, and perceived social support enhancement, is vital to bolster the mental well-being of HCWs exposed to traumatic events, thus mitigating the impact of PTSD effectively. Additionally, it is essential to provide support to HCWs with other potential risk factors.

Reliability and validity of the revised Rushton Moral Resilience Scale for healthcare workers

AIM

To refine the Rushton Moral Resilience Scale (RMRS) by creating a more concise scale, improving the reliability, particularly of the personal integrity subscale and providing further evidence of validity.

BACKGROUND

Healthcare workers are exposed to moral adversity in practice. When unable to preserve/restore their integrity, moral suffering ensues. Moral resilience is a resource that may mitigate negative consequences. To better understand mechanisms for doing so, a valid and reliable measurement tool is necessary.

DESIGN

Cross-sectional survey.

METHODS

Participants (N = 1297) had completed ≥1 items on the RMRS as part of the baseline survey of a larger longitudinal study. Item analysis, confirmatory factor analyses, reliability analyses (Cronbach's alpha), and correlations were used to establish reliability and validity of the revised RMRS.

RESULTS

Item and confirmatory factor analysis were used to refine the RMRS from 21 to 16 items. The four-factor structure (responses to moral adversity, personal integrity, relational integrity and moral efficacy) demonstrated adequate fit in follow-up confirmatory analyses in the initial and hold-out sub-samples. All subscales and the total scale had adequate reliabilities (α ≥ 0.70). A higher-order factor analysis supports the computation of either subscale scores or a total scale score. Correlations of scores with stress, anxiety, depression and moral distress provide evidence of the scale's validity. Reliability of the personal integrity subscale improved.

CONCLUSION AND IMPLICATIONS

The RMRS-16 demonstrates adequate reliability and validity, particularly the personal integrity subscale. Moral resilience is an important lever for reducing consequences when confronted with ethical challenges in practice. Improved reliability of the four subscales and having a shorter overall scale allow for targeted application and will facilitate further research and intervention development.

PATIENT/PUBLIC CONTRIBUTION

Data came from a larger study of Canadian healthcare workers from multiple healthcare organizations who completed a survey about their experiences during COVID-19.

Changes in harm reduction service providers professional quality of life during dual public health emergencies in Canada

BACKGROUND

Harm reduction (HR) is a critical response to the pronounced toxicity deaths being experienced in Canada. HR providers report many benefits of their jobs, but also encounter chronic stress from structural inequities and exposure to trauma and death. This research study sought to quantify the emotional toll the toxicity emergency placed on HR providers (Cycle One; 2019). Study objectives were later expanded to determine the impact of the ongoing toxicity as well as the pandemic's impact on well-being (Cycle Two; 2021).

METHODS

Standardized measures of job satisfaction, burnout, secondary traumatic stress, and vulnerability to grief were used in an online national survey. Open-ended questions addressed resources and supports. HR partners across Canada validated the findings and contributed to alternative interpretations and implications.

RESULTS

651 respondents in Cycle One and 1,360 in Cycle Two reported moderately high levels of job satisfaction; they reported finding great meaning in their work. Yet, mean levels of burnout and secondary traumatic stress were moderate, with the latter significantly increasing in Cycle Two. Reported vulnerability to grief was moderate but increased significantly during COVID. When available, supports lacked the quality necessary to respond to the complexities of HR workers' experiences, or an insufficient number of sessions were covered through benefits. Respondents shared that their professional quality of life was affected more by policy failures and gaps in the healthcare system than it was by the demands of their jobs.

CONCLUSION

Both the benefits and the strain of providing harm reduction services cannot be underestimated. For HR providers, these impacts are compounded by the drug toxicity emergency, making the service gaps experienced by them all the more critical to address. Implications highlight the need for integration of HR into the healthcare system, sustainable and reliable funding, sufficient counselling supports, and equitable staffing models. Support for this essential workforce is critical to ensuring the well-being of themselves, the individuals they serve, and the health of the broader healthcare system.

Posttraumatic growth of medical staff during COVID-19 pandemic: A scoping review

BACKGROUND

The COVID-19 pandemic has imposed unprecedented stress and challenges upon medical staff, potentially resulting in posttraumatic growth (PTG). This scoping review aims to synthesize the existing knowledge on PTG among medical staff during the pandemic by identifying its current status and potential influencing factors. The findings may provide a foundation for future research and interventions to enhance the medical staff's psychological resilience and well-being.

METHODS

Literature was systematically searched on PTG among medical staff during the COVID-19 pandemic from 01 January 2020 to 31 December 2022. The following databases were searched: PubMed, Web of Science, Embase, CINAHL, PsycINFO, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), and Wanfang Data. Eligibility criteria included: (1) medical staff as research subjects; (2) a focus on "posttraumatic growth" or "alternative posttraumatic growth" related to the COVID-19 outbreak and pandemic; (3) discussion of the situation and influencing factors of PTG; and (4) study types, such as qualitative, quantitative, and mixed methods. Two researchers independently selected and extracted study characteristics (study design, study population, region, measurement instruments, and primary outcomes) from the included literature. The data were synthesized qualitatively and descriptively.

RESULTS

Thirty-six papers from 12 countries met the inclusion criteria. Moderate PTG levels were observed among healthcare workers during the COVID-19 pandemic, with emphasis on "interpersonal relationships," "changes in life philosophy," and "growth in personal competence." Influencing factors included trauma exposure, sociodemographics, psychological characteristics (resilience and positive qualities), coping, and social support.

CONCLUSIONS

This review discovered moderate PTG levels among medical staff during the COVID-19 pandemic, with critical areas in interpersonal relationships, life philosophy, and personal competence. The identified influencing factors can inform future research and interventions to enhance healthcare workers' psychological resilience and well-being.

Turkish nurses' psychological resilience and burnout levels during the COVID-19 pandemic: A correlational study

AIMS

To investigate the relationship between the psychological resilience and burnout of nurses caring for COVID-19 patients and to determine the factors that affect their psychological resilience and burnout.

BACKGROUND

In pandemic diseases such as COVID-19, nurses experience burnout due to long working hours, decreased quality of life and anxiety/fear about their own/families' health. Psychological resilience helps to control burnout in nurses and prevent the development of a global nurse shortage.

DESIGN

This was a descriptive, correlational study.

METHODS

The sample of this study included 201 nurses in a Training and Research Hospital. The study used the Brief Resilience Scale and the Burnout Measure Short Version. Data were collected between 4 May and 1 June 2020. Statistical analysis was made with Pearson/Spearman, independent sample t test, one-way analysis of variance (ANOVA) test.

RESULTS

Nurses reported moderate burnout and psychological resilience, with a negative and highly significant correlation between psychological resilience and burnout levels.

CONCLUSIONS

In order to increase the quality of patient care/treatment, nurse managers need to reduce nurses' burnout and increase their psychological resilience. Nurses are recommended to adopt a healthy lifestyle, organize training programmes and implement psychological resilience interventions to prevent sleep disorders. Giving nurses the tools to understand what they need to manage within their locus of control will allow them to find a new sense of resilience, preventing potential burnout.

A Two-Phased Telehealth Model to Treat Post-Traumatic Stress Disorder in a Health Care Worker due to the COVID-19 Pandemic: A Case Report

Background: We report a case describing the use of a two-step telehealth intervention to treat symptoms of post-traumatic stress disorder (PTSD) that developed in a frontline health care worker (HCW) during the COVID-19 pandemic. HCWs are at increased risk of adverse psychological outcomes, including PTSD, due to the nature of their work, which has been exacerbated by the global pandemic. Methods: This case represents the first successfully completed participant in a larger ongoing trial to address psychological distress, PTSD, and comorbidities in HCWs consequent to the COVID-19 pandemic. Following a two-step intervention of self-directed narrative writing delivered entirely online followed by prolonged exposure therapy using videoconferencing, the HCW displayed significant improvement in symptoms of PTSD, depression, anxiety, and substance use. Results: The treatment model described here offers preliminary support for a two-step remote delivery approach to meet the need for scalable self-directed distance technology-based mental health interventions for HCWs. This study is registered on clinicaltrials.gov (NCT04626050).

A theoretical framework for Acute Care Nurse Stress Appraisal: Application of the transactional model of stress and coping

AIM

To develop a framework for understanding the stress appraisal process among acute care nurses during the COVID-19 pandemic.

DESIGN

A secondary analysis of open-ended responses from a cross-sectional survey of 3030 frontline, acute care nurses in New Jersey and the effect of burnout during the COVID-19 pandemic.

METHODS

Lazarus and Folkman's transactional model of stress and coping guided the study. Thematic analysis was used to analyse 1607 open-ended responses.

RESULTS

Nine themes emerged during the secondary appraisal of stress. Five themes contributed to distress and burnout including (1) high patient acuity with scarce resources, (2) constantly changing policies with inconsistent messaging, (3) insufficient PPE, (4) unprepared pandemic planning and (5) feeling undervalued. Four themes led to eustress and contributed to post-traumatic growth including (1) team nursing to ensure sufficient resource allocation, (2) open channels of communication, (3) sense- of-duty and (4) personal strength from new possibilities.

CONCLUSION

The COVID-19 pandemic was a traumatic event for patients and the nursing workforce. Internal and external demands placed on acute care nurses increased burnout, however, a subset of nurses with adequate support experienced personal growth.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Beyond mental health interventions for acute care nurses, organizational interventions such as reevaluation of emergency action plans to optimize resource allocation, and work environment strategies such as improved communication and decision-making transparency are necessary.

IMPACT

To better understand how frontline acute care nurses experienced stress during COVID-19, a data-informed framework was developed that included a primary and secondary appraisal of stress. Themes contributing to distress and burnout were identified, and themes leading to eustress and post-traumatic growth were also identified. These findings can assist nurse leaders in optimizing strategies to reduce burnout and promote post-traumatic growth in the post-COVID years.

REPORTING METHOD

No patient or public contribution.

Non-linear association of years of experience and burnout among nursing staff: a restricted cubic spline analysis

Background

Occupational burnout is intricately linked to a spectrum of physical disorders encompassing respiratory, cardiovascular, and gastrointestinal conditions, as well as manifestations such as headaches, type 2 diabetes, elevated cholesterol levels, chronic fatigue, and muscle pain. Despite this association, there remains a paucity of research on the specific risk factors contributing to burnout among nurses in China.

Methods

This cross-sectional study utilized convenience sampling to recruit participants, with data analyzed from 1,774 nurse staffs. Psychosocial traits were assessed using the Three-Item Loneliness Scale for loneliness, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety symptoms, the 9-item Patient Health Questionnaire (PHQ-9) for depressive symptoms, the Connor Davidson Resilience Scale-10 item (CDRISC-10) for resilience, and the Maslach Burnout Inventory-Human Service Survey (MBI-HSS) for burn out. Restrictive cubic spline analysis to investigate the dose-response relationship between years of experience and burn out. Multivariate linear regression was employed to investigate the relationship between burnout and various risk factors.

Results

After controlling for basic demographic variables, good sleep quality was associated with a reduction in emotional exhaustion (β = -0.307, p < 0.001), while loneliness (β = 1.334, p < 0.001), depressive symptoms (β = 0.896, p < 0.001), and anxiety symptoms (β = 0.504, p < 0.001) were significantly associated with increased emotional exhaustion. Moreover, higher levels of resilience were positively associated with personal accomplishment (β = 0.635, p < 0.001). Regarding depersonalization, loneliness (β = 0.577, p < 0.001), depressive symptoms (β = 0.429, p < 0.001), and anxiety symptoms (β = 0.152, p < 0.01) were found to increase its level. Conversely, good resilience was associated with a decrease in depersonalization (β = -0.069, p < 0.001). The non-liner association between year of experience and emotional exhaustion was significantly (p < 0.05).

Conclusion

Our findings revealed that significant risk factors contributing to burnout among nursing staff including bad sleep quality, loneliness, lower level of resilience, anxiety symptoms, depressive symptoms. Moreover, a nonlinear correlation between years of experience and the likelihood of experiencing emotional exhaustion was exist.

Is primary care ready for a potential new public health emergency in the wake of the COVID-19 pandemic, now subsided?

INTRODUCTION

The lingering burden of the COVID-19 pandemic on primary care clinicians and practices poses a public health emergency for the United States. This study uses clinician-reported data to examine changes in primary care demand and capacity.

METHODS

From March 2020 to March 2022, 36 electronic surveys were fielded among primary care clinicians responding to survey invitations as posted on listservs and identified through social media and crowd sourcing. Quantitative and qualitative analyses were performed on both closed- and open-ended survey questions.

RESULTS

An average of 937 respondents per survey represented family medicine, pediatrics, internal medicine, geriatrics, and other specialties. Responses reported increases in patient health burden, including worsening chronic care management and increasing volume and complexity. A higher frequency of dental- and eyesight-related issues was noted by respondents, as was a substantial increase in mental or emotional health needs. Respondents also noted increased demand, "record high" wait times, and struggles to keep up with patient needs and the higher volume of patient questions. Frequent qualitative statements highlighted the mismatch of patient needs with practice capacity. Staffing shortages and the inability to fill open clinical positions impaired clinicians' ability to meet patient needs and a substantial proportion of respondents indicated an intention to leave the profession or knew someone who had.

CONCLUSION

These data signal an urgent need to take action to support the ability of primary care to meet ongoing patient and population health care needs.

From Anxiety to Hardiness: The Role of Self-Efficacy in Spanish CCU Nurses in the COVID-19 Pandemic

Background and Objectives: Evidence shows that throughout the COVID-19 pandemic, nurses suffered from emotional symptoms, yet in spite of this, few studies within "positive psychology" have analyzed the emergence/promotion of positive traits, such as hardiness. In this context, the present study aimed to test a model regarding the mediating role of self-efficacy between anxiety experienced at the beginning of the COVID-19 pandemic and hardiness assessed six months later among nurses in critical care units (CCU) in Spain. Materials and Methods: An observational, descriptive, prospective longitudinal study with two data collection periods: (1) from the 1 to the 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March) in which socio-demographic and occupational variables, anxiety (Depression, Anxiety and Stress Scale, DASS-21), self-efficacy (General Self-Efficacy Scale, GSES) and basal resilience (Resilience Scale-14, RS-14) were assessed, and (2) a follow-up 6 months later (January-March 2021) in which hardiness (Occupational Hardiness Questionnaire, OHQ) was evaluated. To analyze the data, multivariate regressions were performed using the PROCESS macro (simple mediation, model 4). Results: A total of 131 Spanish nurses from CCUs, with a mean age of 40.54 years (88.5% women) participated in the study. Moderate and severe levels of anxiety were observed in 19.1% of the sample. Significant and positive correlations were observed between self-efficacy, hardiness and resilience (all p < 0.001). Significant negative correlations were observed between anxiety and self-efficacy (p < 0.001), hardiness (p = 0.027) and resilience (p = 0.005). The indirect effect of anxiety on hardiness through self-efficacy was significant (Effect (SE) = -0.275 (0.100); LLCI = -0.487, ULCI = -0.097), contributing to 28% of the variance, including resilience (p = 0.015), age (p = 0.784), gender (p = 0.294) and years of experience (p = 0.652) as covariates. A total mediation was observed (non-significant anxiety-hardiness direct effect; Effect (SE) = -0.053 (0.215), t = 0.248, p = 0.804, LLCI = -0.372, ULCI = 0.479). Conclusions: The results suggest that in Spanish CCU nurses, anxiety experienced at the beginning of the COVID-19 pandemic may contribute to the development of hardiness through positive resources such as self-efficacy.

Impacts for health and care workers of Covid-19 and other public health emergencies of international concern: living systematic review, meta-analysis and policy recommendations

BACKGROUND

Health and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR).

METHODS

We reviewed literature retrieved from MEDLINE-PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes.

RESULTS

The 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted.

DISCUSSION

PHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.

The relationship of social support to posttraumatic growth in COVID-19 among college students after experiencing campus lockdown: the effects of belief in a just world and meaning in life

Background

Campus lockdown orders were issued for the purpose of preventing and controlling COVID-19, which resulted in psychological problems among college students. However, the experiences they have during the pandemic may also lead to positive personal changes, including posttraumatic growth (PTG). The current study examined the mediating role of belief in a just world and meaning in life in social support and PTG during the COVID-19 campus lockdown.

Method

An online survey was conducted on 1711 college students in Hebei Province, China. Based on the survey results, a structural equation model was established.

Results

Social support positively predicted PTG. Furthermore, belief in a just world and meaning in life played a mediating role between social support and PTG respectively. Besides, social support could also predict PTG through the multiple serial mediating effect of belief in a just world and meaning in life.

Conclusion

These results indicated mechanisms by which social support influenced PTG, and this provided insights into how to promote post-traumatic growth among university students in the post-pandemic period.

Status and influencing factors of work stress among nurse managers in western China: a cross-sectional survey study

AIMS

Due to the nature of their work, nurses are more prone to experiencing psychological consequences than other healthcare workers. However, evidence on the emotional burden of nurse managers in China is limited. Furthermore, perceived organizational support has been approved that can affect mental health outcomes. Therefore, this study aimed to investigate the status quo and influencing factors of nurse managers' work stress, and their possible relationship with perceived organizational support, which could further provide more countermeasures to safeguard their health.

METHODS

A cross-sectional online survey of 21 secondary and tertiary hospitals was conducted in a city in Sichuan province, Southwest China, using a convenience sampling method between October and November 2022. Data were collected using the general information questionnaire, the Chinese version of the Stress Overload Scale (SOS) and the perceived Organizational Support Scale (POSS). SPSS 23.0 was applied to analyze the data.

RESULTS

In total, 380 participants completed the survey. The median scores (interquartile range [IQR]) for SOS and POSS were 60.50 (50.00, 70.75) and 51.00 (44.00, 55.00), respectively. The work stress of the nurse managers was negatively correlated with perceived organizational support (P < 0.01). Multiple linear regression analysis showed that age older than 40 years, from secondary hospitals, working in emergency or pediatric wards, and professional qualification of supervisor nurse or deputy supervisor nurse, and the scores of POSS less than 51 significantly influenced the work stress of the nurse managers.

CONCLUSIONS

Our study shows that nurse managers are more prone to work stress, and organizational support can effectively reduce this stress. Governments and hospital administrators should pay more attention to providing comprehensive strategies based on various risk factors to protect and promote psychological health.

Control beliefs about stress and post-traumatic growth in nurses during the COVID-19 pandemic: The mediating roles of basic psychological needs satisfaction and optimism

The purpose of this study was to examine the relationship between control beliefs about stress and post-traumatic growth among Chinese nurses during the COVID-19 pandemic and to examine the mediating role of basic psychological needs satisfaction and optimism in this relationship. A total of 692 Chinese nurses participated in this online study, who completed the Beliefs about Stress Scale, Post-Traumatic Growth Inventory, Positive Psychological Capital Questionnaire, Basic Psychological Needs Satisfaction Scale and demographic variables between September and October 2020. Results indicate that 48.8% (N = 388) of nurses reported significant post-traumatic growth related to the COVID-19 pandemic. Moreover, control beliefs about stress were positively related to post-traumatic growth (r = 0.38, p < 0.001), basic psychological needs satisfaction (r = 0.44, p < 0.001) and optimism (r = 0.47, p < 0.001). In addition, basic psychological needs satisfaction and optimism were both independent and serial mediators of the relationship between control beliefs about stress and post-traumatic growth. Nurses and hospital administrators should focus on increasing nurses' control beliefs about stress and thereby enhancing their post-traumatic growth after experiencing events such as the COVID-19 pandemic. To support this process, programs should be designed to meet nurses' basic psychological needs and increase their optimism.

Coping profiles and their association with vicarious post-traumatic growth among nurses during the three waves of the COVID-19 pandemic

AIMS

This study aimed to examine (a) changes in coping strategies and vicarious post-traumatic growth (VPTG) across three timepoints of the COVID-19 pandemic among nurses; (b) discrete groups of nurses with unique coping profiles and (c) the association of these coping profiles with VPTG across the timepoints.

BACKGROUND

Although literature abounds with the negative mental health consequences of the pandemic among healthcare professionals, much less is known about the positive consequences on nurses, the coping strategies that they use, and how these change over time.

DESIGN

This was a cross-sectional web-based survey at three timepoints during the pandemic.

METHODS

A sample of 429 nurses completed online the Post-Traumatic Growth Inventory (PTGI) and the Brief Coping Orientation to Problems Experienced Inventory (COPE) to measure vicarious post-traumatic growth (VPTG) and coping strategies, respectively. The STROBE checklist was used to report the present study.

RESULTS

Significantly higher VPTG scores were observed during the third timepoint. Different coping strategies were employed across the three timepoints. Nurses responded to the pandemic either with an active, an avoidant or a passive coping profile. Significantly higher VPTG levels were reported by the nurses of the active profile compared to those of the passive profile, whereas the difference between active and avoidant profiles was not significant.

CONCLUSIONS

Notwithstanding the preponderance of the nurses with the active coping profile in achieving high VPTG, the avoidant copers had more gains (VPTG) than the passive copers, suggesting that doing something to cope with the stressor-let it be trying to avoid it-was better than doing nothing.

RELEVANCE TO CLINICAL PRACTICE

The identification of distinct coping profiles among nurses and their association with VPTG is of particular use to policymakers and practitioners in developing tailored prevention and intervention efforts to help the nurses effectively manage the demands of the pandemic.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution since the study was exclusively conducted by the authors.

Positive effect of Balint group on burnout and self-efficacy of head nurses in China: a randomized controlled trial

Background

Burnout is common among nurses and can lead to negative outcomes of medical care. This study aimed to explore the effectiveness of Balint groups to reduce burnout in head nurses in a Chinese hospital.

Methods

This was a randomized controlled trial with a pre- and post-test. A total of 80 head nurses were randomly assigned to either a Balint group (n = 40) or a control group (n = 40). Participants participated in Balint group for a period of 3 months. Participants in both groups completed the Maslach Burnout Inventory-Human Services Survey and the General Self-Efficacy Scale at the beginning and end of the study. Balint group members also completed the Group Climate Questionnaire-Short Form.

Results

In the Balint group, 33 participants attended all Balint groups, while the 40 participants in the control group had no intervention. Analysis of variance with repeated measures demonstrated a statistically significant difference on the Maslach Burnout Inventory subscale of sense of personal achievement (F = 9.598, p = 0.003) between the Balint and control groups. However, there were no significant differences between the groups on the subscales of emotional exhaustion (F = 0.110, p = 0.740) and depersonalization (F = 0.75, p = 0.387), and the General Self-Efficacy Scale (F = 0.709, p = 0.403).

Conclusions

Balint groups helped reduce burnout among head nurses in terms of personal achievement.

The relationship between the strength of religious faith and spirituality in relation to post-traumatic growth among nurses caring for COVID-19 patients in eastern Poland: a cross-sectional study

Introduction

The COVID-19 pandemic had forced intensive care unit (ICU) nurses to adapt to extreme conditions in a short period of time. This resulted in them experiencing extremely stressful situations. The aim of this study was to assess the relationship between post-traumatic growth (PTG) and religiosity and spirituality (R/S) among nurses caring for COVID-19 patients in intensive care during the pandemic.

Materials and methods

120 nurses working in Lublin, eastern Poland, participated in the cross-sectional study. The questionnaire was made up of three standardised tools: The Post-Traumatic Growth Inventory, The Santa Clara Strength of Religious Faith Questionnaire, The Spiritual Attitude and Involvement List.

Results

In terms of spirituality, the study group of nurses achieved the highest score in the Connectedness with Nature subscale (4.37 ± 1.07), while the strength of religious beliefs had a positive correlation with post-traumatic growth only in the Spiritual changes subscale (r = 0.422, p < 0.001). The following dimensions of spirituality were significantly correlated with post-traumatic growth in the multi-factor model that included religiosity and spirituality: Transcendent experiences, Spiritual activities, Meaningfulness, Acceptance, and Trust. We saw that increase in the assessment of the Transcendent experiences, Meaningfulness and Trust subscales significantly mirrors increase in post-traumatic growth, while increase in the assessment of the Spiritual activities and Acceptance subscales significantly mirrors decrease in post-traumatic growth. The above variables explained up to 44% of the dependent variable.

Conclusion

Both religiosity and spirituality were significantly associated with post-traumatic growth in the group of ICU nurses, but spirituality appears to have played a larger role. Our findings support the value and significance of the development of spiritual and religious identity as a means of enhancing positive psychological changes in the face of traumatic events.

Examination of Burnout Levels and Social Support Resources of Healthcare Workers in Filiation Teams During COVID-19 Pandemic in Turkey

This study aims to examine the level of burnout and social support of healthcare workers in filiation teams during the period of COVID-19 in Turkey. A total of 1028 healthcare workers have been reached. The sociodemographic questionnaire, Maslach Burnout Inventory (MBI), and Multidimensional Scale of Perceived Social Support (MSPSS) have been used. SPSS was used to analyze the data. Descriptive statistics were created, and independent t-tests and Pearson correlation tests were performed. 69.5% of the participants were females. The participants consisted of midwives (21.2%), nurses (15.5%), doctors (14.1%), psychologists (10.8%), and dentists (10.7%). The MSPSS scale scores of the participants were 62.66 ± 16.96; family 22.87 ± 5.85, friends 21.14 ± 6.30, and significant other person 18.65 ± 7.95. MBI scale scores are 54.05 ± 10.77, emotional exhaustion 18.12 ± 8.36, depersonalization 4.53 ± 3.45, and personal achievement 31.40 ± 7.04. The study showed that females have higher levels of emotional exhaustion and, as education levels, the population of the region, daily working hours, patient burden, and death of coronavirus-infected colleagues increase, and burnout levels increase.

Providing Trauma-Informed Care During a Pandemic: How Health Care Workers at Ryan White-Funded Clinics in the Southeastern United States Responded to COVID-19 and Its Effects on Their Well-Being

As HIV/AIDS health care workers (HCWs) deliver services during COVID-19 under difficult conditions, practicing trauma-informed care (TIC) may mitigate negative effects on mental health and well-being. This secondary qualitative analysis of a larger mixed methods study sought to understand the pandemic's impact on HCWs at Ryan White-funded clinics (RWCs) across the southeastern US and assess changes in prioritization of TIC. RWC administrators, providers, and staff were asked about impacts on clinic operations/culture, HCW well-being, institutional support for well-being, and prioritization of TIC. HCWs described strenuous work environments and decreased well-being (eg, increased stress, burnout, fear, and social isolation) due to COVID-19. RWCs initiated novel responses to disruptions of clinic operations and culture to encourage continuity in care and promote HCW well-being. Despite increased awareness of the need for TIC, prioritization remained variable. Implementing and institutionalizing trauma-informed practices could strengthen continuity in care and safeguard HCW well-being during public health emergencies.

Factors associated with burnout among hospital-based healthcare workers during the COVID-19 pandemic: A cross-sectional CRACoV-HHS study

AIMS

To assess the prevalence of burnout and associated factors among healthcare workers (HCWs) working in a hospital admitting patients with COVID-19.

BACKGROUND

Burnout among HCWs is related to age, gender and occupation. However, little is known about organisational factors associated with burnout during the COVID-19 pandemic.

DESIGN

A cross-sectional study of 1412 hospital HCWs (748 nurses) was carried out via online survey during the COVID-19 pandemic between 4 and 19 January 2021.

METHODS

The Maslach Burnout Inventory-Human Services Survey, the Checklist Individual Strength questionnaire, the interRAI items covering mental health, the WHO questionnaire items assessing HCWs' preparedness and exposure to SARS-CoV-2 were used. Univariable and multivariable linear regression analyses were conducted to clarify factors associated with emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). This study adheres to the STROBE guidelines.

RESULTS

Burnout prevalence varied from 10.0% to 22.0%. Most respondents (83.6%) reported low PA, 22.9% high EE and 18.7% high DP. Nurses and physicians had the highest levels of EE and DP. Staff exposed or uncertain if exposed to contaminated patients' body fluids and materials had higher levels of burnout. Preparedness (training) (b = 1.15; 95%CI 0.26 to 2.05) and adherence to infection prevention and control procedures (b = 1.57; 95%CI 0.67 to 2.47) were associated with higher PA, and accessibility of personal protective equipment (PPE) (b = -1.37; 95%CI -2.17 to -0.47) was related to lower EE. HCWs working in wards for patients with COVID-19 reported lower EE (b = -1.39; 95%CI -2.45 to -0.32). HCWs who contracted COVID-19 reported lower DP (b = -0.71, 95%CI -1.30 to -0.12).

CONCLUSIONS

Organisational factors such as better access to PPE, training, and adherence to infection prevention and control procedures were associated with a lower level of burnout.

RELEVANCE TO CLINICAL PRACTICE

Healthcare managers should promote strategies to reduce burnout among HCWs with regard to preparedness of all staff.

Risk perception predicts post-traumatic growth during the COVID-19 pandemic in China: the mediation effect of engaging in health-protective behaviors

The COVID-19 pandemic exposed the public to enormous health risks and induced wide-ranging impacts on people's mental health. Post-traumatic growth is a possible psychological benefits that may occur during struggling with the COVID-19 pandemic. This research explored 1) demographics differences on risk perception of COVID-19 pandemic, engagement in health-protective behavior and post-traumatic growth during the COVID-19 pandemic; and 2) the mediation effect of engaging in health-protective behaviors between risk perception and post-traumatic growth during the COVID-19 pandemic. Females showed a significant higher level of engagement in health-protective behaviors. People who were married reported a significantly higher level of risk perception, engagement in health-protective behavior and post-traumatic growth than those who were in other marital status (i.e. single, divorced, widowed). People who had acquaintances being infected with COVID-19 reported significant higher level of risk perception and engagement in health-protective behaviors. Engagement in health-protective behaviors mediated the relationship between risk perception and post-traumatic growth. Implications of the results for public health interventions are discussed.

Feasibility of a 3-Minute Mindful Breathing Intervention for Enhancing Psychiatric Mental Health Nurses' Resilience During COVID: Findings From a 4-Week Pilot Study

COVID created a perfect storm of conditions leading to excessive and prolonged stress on already vulnerable nurses. This study examines the feasibility of enhancing psychiatric mental health nurses' (PMHNs') resilience by practicing a 3-minute mindfulness-based intervention. In this pilot study, we explored if PMHNs could be recruited and retained for intervention implementation, intervention acceptability, and measurement of any notable changes over the prescribed period. Study feasibility is reflected in high participant retention and increased postintervention resilience scores. Given the positive outcomes, a larger-scale study is warranted. Additional areas of opportunity include strategies for increasing participant uptake, and, due to limited acceptability feedback, the introduction of a usefulness scale.

COVID-19 Experiences and Mental Health Among Graduate and Undergraduate Nursing Students in Los Angeles

BACKGROUND

Nurses and nursing students are at risk for negative mental health as a result of significant work stressors from the COVID-19 pandemic.

AIMS

The purpose of this study was to (1) describe the mental health of nursing students during the COVID-19 pandemic, (2) investigate relationships between stressful COVID-19 experiences and mental health, and (3) examine correlates of mental health service use.

METHOD

This observational study used a web-based survey to assess COVID-19 experiences, self-reported mental health, and mental health service utilization among nursing students in Los Angeles in spring 2021 (N = 174, 30.1% response rate). The survey used measures of stressful COVID-19 experiences (personal COVID-19 illness, hospitalization of close friends or family, and death of close friends or family), loneliness, resilience, depression, anxiety, COVID-19-related traumatic stress, and utilization of campus and noncampus mental health services.

RESULTS

Students had high levels of depression (30%), anxiety (38%), and traumatic stress (30%). There was no relationship between stressful COVID-19 experiences and mental health, but loneliness was associated with higher odds of mental health problems and resilience with lower odds. Mental health problems were not associated with use of campus or noncampus mental health services. Students with primary caregiving responsibilities (OR = 0.22, 95% CI [0.05, 0.87]) and students who identified as Asian/Pacific Islander (OR = 0.24, 95% CI [0.09, 0.70]) had lower odds of mental health service utilization.

CONCLUSIONS

Resilience and loneliness affect nursing student risk for negative mental health as a result of the COVID-19 pandemic. Targeted, accessible mental health support within nursing education programs may be warranted.

Development and External Validation of Clinical Features-based Machine Learning Models for Predicting COVID-19 in the Emergency Department

Introduction

Timely diagnosis of patients affected by an emerging infectious disease plays a crucial role in treating patients and avoiding disease spread. In prior research, we developed an approach by using machine learning (ML) algorithms to predict serious acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on clinical features of patients visiting an emergency department (ED) during the early coronavirus 2019 (COVID-19) pandemic. In this study, we aimed to externally validate this approach within a distinct ED population.

Methods

To create our training/validation cohort (model development) we collected data retrospectively from suspected COVID-19 patients at a US ED from February 23-May 12, 2020. Another dataset was collected as an external validation (testing) cohort from an ED in another country from May 12-June 15, 2021. Clinical features including patient demographics and triage information were used to train and test the models. The primary outcome was the confirmed diagnosis of COVID-19, defined as a positive reverse transcription polymerase chain reaction test result for SARS-CoV-2. We employed three different ML algorithms, including gradient boosting, random forest, and extra trees classifiers, to construct the predictive model. The predictive performances were evaluated with the area under the receiver operating characteristic curve (AUC) in the testing cohort.

Results

In total, 580 and 946 ED patients were included in the training and testing cohorts, respectively. Of them, 98 (16.9%) and 180 (19.0%) were diagnosed with COVID-19. All the constructed ML models showed acceptable discrimination, as indicated by the AUC. Among them, random forest (0.785, 95% confidence interval [CI] 0.747-0.822) performed better than gradient boosting (0.774, 95% CI 0.739-0.811) and extra trees classifier (0.72, 95% CI 0.677-0.762). There was no significant difference between the constructed models.

Conclusion

Our study validates the use of ML for predicting COVID-19 in the ED and demonstrates its potential for predicting emerging infectious diseases based on models built by clinical features with temporal and spatial heterogeneity. This approach holds promise for scenarios where effective diagnostic tools for an emerging infectious disease may be lacking in the future.

Prevalence and factors of posttraumatic growth among Hubei residents during the COVID-19 pandemic: A cross-sectional study

The adverse impact of the COVID-19 pandemic on mental health has been widely concerned, but the research on positive psychological factors is insufficient, this study aims to investigate the prevalence and factors of posttraumatic growth (PTG) among residents in the worst-hit areas of China (Hubei Province). We were conducted in three disaster areas with different severity in Hubei Province three months after the outbreak, and the data were from 575 respondents. Instruments included the simplified Chinese version of the Posttraumatic Growth Inventory (C-PTGI) and the public health emergency psychological questionnaire. Nonparametric tests, Spearman correlation analyses, and multiple linear regression equations were used to analyze the data. The results showed that three months after the outbreak of COVID-19, the PTG of Hubei residents was at a low level, and their sense of fear was the most prominent, with a positive detection rate of 82.09%. According to the results of this study, high PTG levels were associated with high levels of fear, married and healthcare providers, while low levels of PTG were associated with serious chronic diseases, males, good economic status, and poor prevention and control measures. Government departments should strengthen social support for residents, carry out necessary stress management training to help them correctly deal with negative emotions and promote their personal growth.

Burnout, emotional distress and sleep quality among Chinese psychiatric healthcare workers during the COVID-19 pandemic: a follow-up study

Background

Different from the very early stages of the COVID-19 pandemic, burnout and chronic mental health problems among health care workers (HCWs) has become a challenge. Research is lacking on the relationship between burnout, stress, emotional distress and sleep quality.

Methods

The Chinese center has been involved in the Cope-Corona project since the second survey (T2). Named after the project, a total of three cross-sectional surveys were distributed: T2 (February 16-20, 2021), T3 (May 10-14, 2022), and T4 (December 20-24, 2022). Burnout, depression, anxiety, sleep quality, workplace factors and individual resources were measured. Using the T4 data, we conducted structural equation model (SEM) to examine the mediating role of burnout in predicting emotional distress and sleep quality.

Results

96, 124, and 270 HCWs were enrolled at T2, T3, and T4, respectively. In line with the epidemic trends, the level of perceived COVID-19 related risks was significantly higher at T4, while the feeling of health and safety decreased significantly. At T4, the percentages of participants with clinically significant levels of depression and anxiety symptoms were 18.9% (51/270) and 9.3% (25/270), respectively, while 30.4% (82/270) of them reported poor or very poor sleep quality. According to the SEM, individual resources and workplace factors mainly had an indirect effect in predicting depression and anxiety via burnout. However, neither burnout nor stress was a mediator or predictor of sleep quality. Instead, individual resources, positive workplace factors, and younger age had a direct effect in predicting good sleep quality.

Conclusion

Measures designed to enhance workplace factors and individual resources should be implemented to improve psychosomatic wellbeing of HCWs.

Symptoms of post traumatic stress disorder and their relationship with the fear of COVID-19 and COVID-19 burden among health care workers after the full liberalization of COVID-19 prevention and control policy in China: a cross-sectional study

BACKGROUND

Over the past three years, the COVID-19 pandemic has brought an overwhelming impact on China's hospital system and health care workers, which can lead to post traumatic stress disorder (PTSD) symptoms. Previous research has shown that the COVID-19 pandemic had long-term adverse effects on the mental health of health care workers. Indeed, PTSD symptoms have emerged as one of the significant mental health issues for health care workers arising from the COVID-19 pandemic. Therefore, we conducted this cross-sectional survey to investigate the prevalence of PTSD symptoms in health care workers and its relationship with the fear of COVID-19 and the COVID-19 burden after the full liberalization of COVID-19 prevention and control policy in China.

METHODS

This study was conducted three years after the global COVID-19 pandemic (January 15 to January 16, 2023). This study was conducted via the Wenjuanxing platform and used the Chinese versions of the scales PC-PTSD-5, COVID-19 Anxiety Scale (FCV-19S), Social Support Scale, COVID-19 Stress Scale, GAD-2, and PHQ-2.

RESULTS

The prevalence of PTSD symptoms in health care workers was 24.3% (232/955). depression(P < 0.001), anxiety(P < 0.05), the fear of COVID-19(P < 0.001), and COVID-19 burden(P < 0.001) were highly correlated with PTSD symptoms in health care workers. Social support(P < 0.05) was a protective factor of PTSD symptoms.

CONCLUSIONS

This survey shows that PTSD symptoms were highly prevalent among Chinese health care workers after the COVID-19 pandemic. Governments and leaders of medical institutions should, through psychological interventions, address the current situation of PTSD symptoms among health care workers and develop targeted programs and strategies to reduce their psychological problems.

Leveraging twitter data to understand nurses' emotion dynamics during the COVID-19 pandemic

The nursing workforce is the largest discipline in healthcare and has been at the forefront of the COVID-19 pandemic response since the outbreak of COVID-19. However, the impact of COVID-19 on the nursing workforce is largely unknown as is the emotional burden experienced by nurses throughout the different waves of the pandemic. Conventional approaches often use survey question-based instruments to learn nurses' emotions, and may not reflect actual everyday emotions but the beliefs specific to survey questions. Social media has been increasingly used to express people's thoughts and feelings. This paper uses Twitter data to describe the emotional dynamics of registered nurse and student nurse groups residing in New South Wales in Australia during the COVID-19 pandemic. A novel analysis framework that considered emotions, talking topics, the unfolding development of COVID-19, as well as government public health actions and significant events was utilised to detect the emotion dynamics of nurses and student nurses. The results found that the emotional dynamics of registered and student nurses were significantly correlated with the development of COVID-19 at different waves. Both groups also showed various emotional changes parallel to the scale of pandemic waves and corresponding public health responses. The results have potential applications such as to adjust the psychological and/or physical support extended to the nursing workforce. However, this study has several limitations that will be considered in the future study such as not validated in a healthcare professional group, small sample size, and possible bias in tweets.

Mental health and work-related factors in healthcare workers in a pandemic - meta-analysis

Due to the SARS-CoV-2 pandemic, healthcare workers worldwide faced major challenges in the form of psychological stress. The aim of this systematic literature review and meta-analysis is to identify mental health consequences and associated work-related factors in healthcare workers during a pandemic and to quantify the influence of associated work-related factors on mental health consequences. A systematic literature search according to PRISMA was conducted on 5 August 2021 using the databases PubMed Central and APA PsychInfo. The included studies investigated the mental health consequences and associated work-related factors in healthcare workers in a pandemic. In addition, we performed a risk of bias analysis to assess the study quality of the included studies using the JBI checklists. Random-effect models and pooled effect estimators were used for the meta-analysis. The Chi2 and I2 statistics were used to identify the statistical heterogeneity. Additional sensitivity analysis was performed. From a total of 3,910 publications, 43 studies met the inclusion criteria. These studies provided 15 stress consequences and 20 stress factors. The most frequently reported stress factors were 'contact with COVID-19 patients', 'no education or training in handling infectious diseases' and 'insufficient protective equipment'. Anxiety, stress, and depression were the most common outcomes identified. Analyses showed an increase in anxiety scores among HCWs who cared for COVID-19 patients, as well as a rise in depressive symptoms due to inadequate or no personal protective equipment. In this review, various pandemic-associated stress factors and stress consequences of healthcare workers were observed. With the results, criteria for effective measures and interventions can be developed to minimize the risk of stress consequences.

Finding Silver Linings in the Covid-19 Pandemic: A 2-Wave Study in the UK

The Covid-19 pandemic has resulted in widespread anxiety, fear and depression, yet focussing only on these negative issues may obscure the opportunity to promote positivity and resilience. Traumatic events can often result in positive life changes (adversarial growth) though there is little evidence in the context of pandemics, and no previous studies in Covid-19 with the general public. The present research investigated whether adversarial growth was perceived in Covid-19 and whether this could account for variance in wellbeing, over and above effects of personality traits. Participants recruited from the UK public (N = 183) completed the Big Five Personality Inventory, the WHO-5 Wellbeing Scale and the Silver Lining Questionnaire (SLQ) measure of adversarial growth. Questionnaires were completed online, at two timepoints, nine months apart. At Time 1, wellbeing was negatively associated with trait Neuroticism and positively associated with Openness to experience. Both associations were positively mediated by SLQ score. At Time 2, SLQ score again mediated the effects of Openness on wellbeing, and also the influence of wellbeing at Time 1 on that at Time 2. Reported Silver Linings included strengthened personal relationships at Time 1, and improved ability to handle life events at Time 2. This suggests a shift from an appreciation of relationships to an awareness of personal development once life returned to some semblance of normality. Overall, results suggest that perceived adversarial growth supported wellbeing during the pandemic and highlight a focus for therapeutic intervention.

Effects of compassion satisfaction and compassion fatigue on posttraumatic growth of psychiatric nurses: A cross-sectional study

AIMS

This study aimed to explore the effects of compassion satisfaction and compassion fatigue on the posttraumatic growth of psychiatric nurses.

BACKGROUND

Psychiatric nurses' prolonged and repeated exposure to trauma and complex situations in the work environment can lead to negative emotions such as compassion fatigue, but they also experience positive consequences such as posttraumatic growth, and the relationship between compassion fatigue and posttraumatic growth is not unclear.

METHODS

A total of 336 nurses from psychiatry departments of seven tertiary hospitals in Sichuan Province, China, were administered an online questionnaire. Participants were recruited through convenience sampling. The posttraumatic growth level was measured with the Simplified Chinese version of the Posttraumatic Growth Inventory. The Professional Quality of Life Scale-Chinese version was used to assess compassion satisfaction, burnout and secondary traumatic stress. T-test and one-way variance analysis, Pearson correlation analysis and hierarchical linear regression were used for data analysis. A STROBE checklist was used to guide the reporting of the research.

RESULTS

Psychiatric nurses' posttraumatic growth is at a low level, influenced by demographic and occupational factors, whereas compassion satisfaction, burnout and secondary traumatic stress are at a moderate level. Hierarchical regression analysis suggested that compassion satisfaction and secondary traumatic stress had a positive impact on posttraumatic growth, whereas burnout had a negative impact on posttraumatic growth.

CONCLUSIONS

Findings suggest that nursing managers should attach importance to the mental health of psychiatric nurses, improve compassion satisfaction, alleviate burnout and promote posttraumatic growth.

Motivations and expectations of generation Z nursing students: A post-pandemic career choice qualitative analysis

BACKGROUND

The global nursing shortage is a growing concern so recruiting and retaining Generation Z (Gen Z) students is vital to the sustainability of the profession.

PURPOSE

To explore the perceptions and expectations of first-year nursing students regarding the nursing profession, its working conditions, and how these factors influenced their career choices.

METHOD

Descriptive qualitative research design, employing an interpretive research approach and content analysis conducted following Graneheim & Lundman's method. Our study involved 105 Generation Z nursing degree students enrolled in first year at the Mar Nursing School in Barcelona, Spain in 2021. Data collection included voluntary written narratives about their career choice and questionnaires of demographic information and their healthcare experiences.

RESULTS

It became evident that Generation Z students' perceptions and expectations of nursing don't align with the actual professional experience. This mismatch could lead to disillusionment and attrition among these students.

CONCLUSIONS

Several factors (economic, aspirational, perception of nursing during the COVID-19, or gender) influence new students' career choice. These factors shape their expectations and often do not match actual working conditions in nursing. Educational institutions must prepare students by transferring cross-cutting competencies to effectively meet these challenges and avoid potential dropout from the profession.