The Impact of COVID-19 on nurses working in a University Health System in Singapore: A qualitative descriptive study

Under pressure - Nursing staff's perspectives on working hours and recovery during the COVID-19 pandemic: A qualitative study

Background

The COVID-19 pandemic contributed to increased pressure on healthcare systems. During periods when the demands exceed the capacity of healthcare organizations, adaptive strategies are used to meet these demands. During the COVID-19 pandemic, working hours for nursing staff were reorganized and extended. This has posed challenges for recovery, which may be a key factor for maintaining health and safety under such conditions.

Objectives

The aim of the study was to bring insights into how nursing staff perceived their working hours and recovery during the COVID-19 pandemic, and if they experienced any changes in their sleep and well-being.

Design

A qualitative descriptive design was chosen, as it is suitable for gaining insight into perceptions and experiences.

Methods

Qualitative semi-structured interviews were conducted using an interview guide. The interviews were analyzed using thematic analysis. Sixteen registered nurses and six certified nursing assistants from four Swedish hospitals participated in the study.

Results

The organization of working hours during the COVID-19 pandemic was considered suboptimal and resulted in more demanding working hours and poor recovery. Nursing staff experienced loss of control as they lost influence over working hours, working hours became more unpredictable and the boundaries between work and leisure became blurred. Nursing staff also experienced a decline in their health and well-being, including extreme fatigue, impaired sleep and physical/mental changes.

Conclusion

The strategies used by healthcare organizations to meet increasing demands during the COVID-19 pandemic contributed to impaired recovery and well-being of nursing staff, which could generate negative feedback loops contributing to depletion of resources at the organizational level.

A Bibliometric Analysis of the 36-Year History of Cancer Nursing (1987-2023)

BACKGROUND

Bibliometric analysis is an effective method for evaluating the publication characteristics and development of a journal. To our knowledge, this study is the first such analysis of the publications in Cancer Nursing .

OBJECTIVE

This study aimed to analyze the publication characteristics and evolution of Cancer Nursing over a period of 36 years since its inception.

METHODS

Bibliometric analysis was carried out on 3095 publications. Data were collected from the Web of Science Core Collection database on September 15, 2023. Data analysis was conducted with Web of Science Core Collection, VOSviewer, and Bibliometrix package in R software.

RESULTS

The results showed a steady increase in the citation and publication structure of Cancer Nursing . "Quality of life" was at the center of the studies, and "quality of life," "women," and "breast cancer" were identified as trend topics. The United States was both at the center of the cooperation network and was the country that contributed the most publications to the journal.

CONCLUSION

Cancer Nursing has had an increasing contribution to and impact on cancer nursing in terms of the quality and citations of published articles. It was noted that the journal's network of collaboration has expanded globally and that its thematic diversity is high. Although quality of life, women, and breast cancer have been reported extensively, more studies addressing the concepts of "children," "support," and "needs" are needed in the journal.

IMPLICATIONS FOR PRACTICE

This study not only enriches global readers in the field of cancer nursing but may also be beneficial in providing input to guide future research.

Healthcare team resilience during COVID-19: a qualitative study

BACKGROUND

Resilience, in the field of Resilience Engineering, has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the resilience potentials of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a cognizant, singular source of knowledge and defined by its collective identity, purpose, competence, and actions, versus the resilience of an individual or an organization.

METHODS

We developed a descriptive model which considered the healthcare team as a unified cognizant entity within a system designed for safe patient care. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework.

RESULTS

Five themes were identified from the interviews with acute care professionals across the US (N = 22): teamwork in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants' described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance.

CONCLUSION

Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. Our research contributes to a growing understanding of the importance of resilience in the healthcare team. And provides a bridge between individual and organizational resilience.

Stress and burnout in the context of workplace psychosocial factors among mental health professionals during the later waves of the COVID-19 pandemic in Hungary

Background

While literature is abundant on the negative mental health impact of the COVID-19 outbreak, few studies focus on the Central and Eastern European region.

Objectives

We examined stress, burnout, and sleeping troubles among mental health professionals in the context of psychosocial risk factors related to participation in COVID care during the fourth and fifth waves.

Materials and methods

Mental health professionals (N=268) completed an online cross-sectional survey in Hungary, between November 2021 and April 2022. Of the respondents, 58.2% directly participated in COVID care. The main data collection instrument was the Copenhagen Psychosocial Questionnaire (COPSOQ II), including 20 subscales on work-related psychosocial factors and 3 outcome scales (stress, burnout, and sleeping troubles). We added a question on competence transgression, and items on sociodemographic and professional background.

Results

Participation in COVID care was associated with higher work pace (59.08 versus 49.78), more role conflicts (55.21 versus 45.93), lower scores on the influence at work (38.18 versus 51.79), predictability (44.71 versus 57.03), reward (55.82 versus 65.03), role clarity (70.19 versus 75.37), social support from supervisor (59.24 versus 65.55), job satisfaction (54.36 versus 62.84), trust regarding management (55.89 versus 67.86), justice and respect (44.51 versus 54.35) scales. Among those involved in COVID care, only the stress score was higher (47.96 vs. 42.35) in the total sample; however, among psychiatrists, both stress (52.16 vs. 38.60) and burnout scores (58.30 vs. 47.06) were higher. Stepwise multiple regression revealed that work-family conflict, emotional demands and workplace commitment were independent predictors of higher stress and burnout scores; furthermore, competence transgression had a significant effect on stress, and being a psychiatric specialist had a significant effect on burnout. These models explained 40.5% of the variance for stress and 39.8% for burnout.

Conclusion

During the fourth and fifth waves, although COVID care was more well-organized, psychiatrists, as specialist physicians responsible for the quality of the care, were still experiencing challenges regarding their competence and influence at work, which may explain their increased levels of stress and burnout.

Surviving Covid-19 Diagnosis Among Registered Nurses: Reactions, Consequences, and Coping Mechanisms

Background

To mitigate the spread of Covid-19, nurses infected with the virus were required to isolate themselves from their families and community. Isolated patients were reported to have experienced mental distress, posttraumatic stress disorder symptoms, and suicide. Though studies have reported the psychological impact of the Covid-19 pandemic, less is known about the lived experiences of nurses who survived Covid-19 infection in sub-Saharan Africa.

Methods

A descriptive phenomenological approach was used to study the lived experiences of registered nurses who survived Covid-19 disease. In-depth interviews were conducted among nurses diagnosed with Covid-19 from two hospitals in Kenya between March and May, 2021. Purposive and snowball sampling were used to recruit registered nurses. Data were analyzed using Giorgi's steps of analysis.

Results

The study included ten nurses between 29 and 45 years of age. Nurses' experiences encompassed three themes: diagnosis reaction, consequences, and coping. Reactions to the diagnosis included fear, anxiety, and sadness. The consequence of the diagnosis and isolation was stigma, isolation, and loneliness. Nurses coping mechanisms included acceptance, creating routines, support, and spirituality.

Conclusion

Our findings aid in understanding how nurses experienced Covid-19 infection as patients and will provide evidence-based content for supporting nurses in future pandemics. Moreover, as we acknowledge the heroic contribution of frontline healthcare workers during the Covid-19 pandemic, it is prudent to recognize the considerable occupational risk as they balance their duty to care, and the risk of infection to themselves and their families.

Caring for COVID-19 patients: Nurses' perceptions of the most critical issues and their impact on their well-being and performance

AIMS

(1) Exploring nurses' perceptions of issues that impacted the quality of patient care and their own performance on COVID-19 wards; (2) examining nurses' perceptions of how these issues impacted their psychological state and level of performance; and (3) presenting recommendations for improving healthcare policies.

BACKGROUND

Nurses played a critical role in caring for hospitalized COVID-19 patients and managing the disease.

METHODS

Semistructured interviews were conducted with 50 nurses (32 females), aged 31-58 years, 6-37 years' tenure, from eight hospitals across Israel. Prior to working in COVID-19 wards, they worked in internal medicine, emergency rooms, or intensive care units. Based on the COREQ checklist, these interviews were recorded and transcribed, and categorized into themes and subthemes.

FINDINGS

The findings indicate that the unpreparedness of healthcare systems for the pandemic outbreak rendered nurses paying a high price at the personal and professional levels, which in turn may have impacted the levels of care that they provided.

CONCLUSION

The rich, qualitative data source revealed important interactions between clinical, personal, social, and familial factors in determining distress levels and performance impairment. A nuanced understanding of the link between these stressors is key to developing and implementing policies that could mitigate deficiencies in the management of epidemics and pandemics in the future.

IMPLICATIONS FOR NURSING AND HEALTH POLICIES

Changes should be made to government directives and healthcare policies, with an emphasis on increasing the nursing workforce, providing emotional support, ensuring availability of equipment and beds, optimizing work practices, developing transparent means of communication within teams, and clearly defining the areas of responsibility of nurses-in times of routine and crises.

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.

In-between duty and hope for recognition, the experience of physiotherapists working in a university hospital during the COVID-19 first wave in Switzerland: a qualitative study based on focus groups

BACKGROUND

Learning more about the physiotherapists' experience, perceived role and perception of events during the COVID-19 crisis, as well as their recovery and projection into the post-crisis future, may be useful to inform stakeholders about the impact of the crisis. The objective of this study was to investigate the experience of physiotherapists working in a university hospital in Switzerland during the 1st wave of the COVID-19 crisis, more specifically their subjective experience, professional involvement, perception of management and perceived implications for the future.

METHODS

This interpretative qualitative study investigated the subjective experience of a purposeful sample of 12 physiotherapists using two 2 h semi-directive focus group interviews conducted by a physiotherapist in June 2020. Data were recorded, transcribed, and analysed using a thematic analysis approach. The report was approved by participants and the study was audited by a health anthropologist.

RESULTS

The most impressive points were the unprecedented nature of the crisis, the health threat, the hospital's capacity to reorganise on a large scale and the solidarity between colleagues. Participants expressed a high level of commitment to their role despite the potentially serious repercussions at an individual level. Pride and stress coexisted for those directly involved in the crisis, while those working in a reduced activity department felt anxious and idle. The need for immediacy in decision-making and action led to a flattening of hierarchies and an increase of uncertainties. Communication management was seen as the main area for improvement. Physiotherapists hoped that their involvement would improve recognition of the profession but feared that working conditions would deteriorate after the crisis.

CONCLUSIONS

The physiotherapists expressed high dedication to their profession and pride to be part of the "war effort" during the crisis. The stress level was partly tempered by the solidarity amongst health professionals and distraction by engaging in action. Despite the mental load, this situation was also seen as an opportunity to grow at a personal and professional level. The healthcare system capacity having not been exceeded in Switzerland, less distress related to death and powerlessness were expressed than in other studies investigating healthcare professionals' experience of the COVID-19 crisis.

Anxiety, depression, and insomnia among nurses during the full liberalization of COVID-19: a multicenter cross-sectional analysis of the high-income region in China

Introduction

Frontline nurses fighting against the epidemic were under great psychological stress. However, there is a lack of studies assessing the prevalence rates of anxiety, depression, and insomnia among frontline nurses after the full liberalization of COVID-19 in China. This study demonstrates the impact of the full liberalization of COVID-19 on the psychological issues and the prevalence rate and associated factors of depressive symptoms, anxiety, and insomnia among frontline nurses.

Methods

A total of 1766 frontline nurses completed a self-reported online questionnaire by convenience sampling. The survey included six main sections: the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7), the 7-item Insomnia Severity Index (ISI), the 10-item Perceived Stress Scale (PSS-10), sociodemographic information, and work information. Multiple logistic regression analyses were applied to identify the potential significantly associated factors for psychological issues. The study methods were compliant with the STROBE checklist.

Results

90.83% of frontline nurses were infected with COVID-19, and 33.64% had to work while infected COVID-19. The overall prevalence of depressive symptoms, anxiety and insomnia among frontline nurses was 69.20%, 62.51%, and 76.78%, respectively. Multiple logistic analyses revealed that job satisfaction, attitude toward the current pandemic management, and perceived stress were associated with depressive symptoms, anxiety, and insomnia.

Conclusions

This study highlighted that frontline nurses were suffering from varying degrees of depressive symptoms, anxiety, and insomnia during full liberalization of COVID-19. Early detection of mental health issues and preventive and promotive interventions should be implemented according to the associated factors to prevent a more serious psychological impact on frontline nurses.

Experiences of environmental services workers in a tertiary hospital in Asia during the COVID-19 pandemic: a qualitative study

Background

The Coronavirus Disease 2019 (COVID-19) pandemic has had a significant impact on all walks of life, in particular, environmental services workers in healthcare settings had higher workload, increased stress and greater susceptibility to COVID-19 infections during the pandemic. Despite extensive literature describing the impact of the pandemic on healthcare workers such as doctors and nurses, studies on the lived experiences of environmental services workers in healthcare settings are sparse and none has been conducted in the Asian context. This qualitative study thus aimed to examine the experiences of those who worked for a year of the COVID-19 pandemic.

Methods

A purposive sample of environmental services workers was recruited from a major tertiary hospital in Singapore. Semi-structured interviews were conducted in-person, lasting around 30min, and included open-ended questions pertaining to five main domains: work experiences during COVID-19, training and education needs, resource and supplies availability, communication with management and other healthcare staff, and perceived stressors and support. These domains were identified based on team discussions and literature review. The interviews were recorded and transcribed for thematic analysis, as guided by Braun and Clarke.

Results

A total of 12 environmental services workers were interviewed. After the first seven interviews, no new themes emerged but an additional five interviews were done to ensure data saturation. The analysis yielded three main themes and nine subthemes, including (1) practical and health concerns, (2) coping and resilience, and (3) occupational adaptations during the pandemic. Many expressed confidence in the preventive efficacy of proper PPE, infection control practice and COVID-19 vaccination in protecting them against COVID-19 and severe illness. Having prior experience with infectious disease outbreaks and previous training in infection control and prevention appeared to be useful as well for these workers. Despite the various challenges presented by the pandemic, they could still find meaning in their everyday work by positively impacting the wellbeing of patients and other healthcare workers in the hospital.

Conclusion

Besides uncovering the concerns shared by these workers, we identified helpful coping strategies, resilience factors and certain occupational adaptations, which have implications for future pandemic planning and readiness.

Experiences of nurses providing care for patients with COVID-19 in acute care settings in the early stages of the pandemic: A thematic meta-synthesis study

AIM

The aim of this work is to synthesize and interpret qualitative research examining the experiences of nurses providing care for patients with COVID-19 in acute care settings in the early stages of the pandemic in different countries.

BACKGROUND

The prevalence of disasters, including the pandemic, is increasing globally. It is important to understand nurses' experiences in depth to effectively manage extraordinary events that may occur in the future.

DESIGN

This is a thematic meta-synthesis study.

METHODS

Electronic databases, including CINAHL, MEDLINE, PubMed, Web of Science, OVID, and Scopus, were searched for publications from December 2019 to October 2020. The search was updated for publications to 30 May 2022. The thematic synthesis method was used to analyse and interpret the data.

FINDINGS

The experiences of the nurses giving care to patients with COVID-19 were grouped under four themes: (1) Difficulties encountered in the care of patients with COVID-19; (2) mixed emotions experienced in the care of patients with COVID-19; (3) coping strategies that nurses used in the management of the pandemic; (4) the benefits of the COVID-19 to nurses.

CONCLUSION

Nurses faced many difficulties and experienced mixed emotions while providing care for patients with coronavirus disease. Perceived social support was seen as the most important strategy for coping with these difficult situations. It is important to be aware of the difficulties and emotions experienced by nurses and support them during the COVID-19 pandemic for the management of future pandemics.

The Psychological and Professional Burden Experienced by Nurses Who Worked in COVID-19 Clinics during the Pandemic: A Content Analysis

INTRODUCTION

Since the beginning of the pandemic, nurses have played a key role in providing care for COVID-19 patients. Infection risk and fear, use of personal protective equipment, and social isolation were related to high levels of stress and extreme psychological drain among front-line healthcare providers.

AIM

The aim of this study was to explore how front-line nurses experienced psychological and professional burdens during the coronavirus outbreak.

MATERIAL AND METHODS

The study used a qualitative research design. Semi-structured interviews were applied as the method of data collection. Ten nurses from COVID-19 wards and units of two general public hospitals participated in the study. A content analysis approach was employed to analyze the data.

RESULTS

Data analysis revealed two main categories, namely: (A) front-line experience "From fear to empowerment", and (B) caring and management "From powerlessness to adaptation". Eight sub-categories were developed and included within the corresponding main categories. The study's findings demonstrated that the pandemic caused significant psychological and professional strain on front-line nurses, with feelings of fear, anxiety, and uncertainty predominating. Nonetheless, the process of adaptation and adjustment brought about sentiments of self-actualization and empowerment.

CONCLUSIONS

A thorough understanding of the psychological and professional burden experienced by the front-line nurses is crucial to ensure that nurses receive appropriate support and that quality care is sustained under highly demanding healthcare conditions.

Learning from COVID-19: Cross-sectional e-survey of critical care nurses' satisfaction and experiences of their role in the pandemic response across the United Kingdom

BACKGROUND

Since the start of the global COVID-19 pandemic in 2019, critical care nurses across the world have been working under extreme levels of pressure.

AIM

To understand critical care nurses' experiences of and satisfaction with their role in the pandemic response across the United Kingdom (UK).

STUDY DESIGN

A cross-sectional electronic survey of critical care nurses (n = 339) registered as members of the British Association of Critical Care Nurses. Anonymous quantitative and open-ended question data were collected in March and April 2021 during the height of the second surge of COVID-19 in the UK via an online questionnaire. Quantitative data were analysed using descriptive statistics and free text responses were collated and analysed thematically.

RESULTS

There was a response rate of 17.5%. Critical care nurses derived great satisfaction from making a difference during this global crisis and greatly valued teamwork and support from senior nurses. However, nurses consistently expressed concern over the quality of safe patient care, which they perceived to be suboptimal due to staff shortages and a dilution of the specialist skill mix. Together with the high volume of patient deaths, critical care nurses reported that these stressors influenced their personalwell-being.

CONCLUSIONS

This study provides insights into the key lessons health care leaders must consider when managing the response to the demands and challenges of the ongoing COVID-19 pandemic. COVID-19 is unpredictable in its course, and what future variants might mean in terms of transmissibility, severity and resultant pressures to critical care remains unknown.

RELEVANCE TO CLINICAL PRACTICE

Future responses to the challenges that critical care faces must consider nurses' experiences and create an environment that engenders supportive teamwork, facilitates excellent nursing practice and effective safe patient care where critical care nursing may thrive.

Nurses' adaptations to changes on a COVID-19 ward in South Korea: A qualitative study

Background

Elucidating nurses' adaptation to changes in the early stage of an infectious disease epidemic is necessary to promote nurses' coping with and adapting to situations in which new infectious diseases are predicted periodically.

Aim

To explore nurses' adaptation to changes in COVID-19 wards in South Korea.

Methods

In-depth interviews were conducted with 20 nurses through purposive sampling from May to August 2020. The collected data were transcribed verbatim, and analysis was performed using conventional content analysis.

Findings

Three categories emerged from the interviews: (a) Disruption caused by an unforeseen pandemic outbreak, (b) perseverance through the turmoil of changes as a nurse, and (c) transition from feelings of fearfulness to those of accomplishment. While the nurses initially struggled to care for patients with COVID-19, they made conscious efforts to provide emotional nursing and maintain their professionalism.

Discussion

Nurses caring for patients with COVID-19 have faced a number of challenges but have adapted to new scenarios by endeavoring to fulfil their professional roles.

Conclusion

To overcome a national disaster situation such as COVID-19, the government and healthcare organizations should prepare strategies to support the efforts of nurses to strengthen their own professionalism.

Analysis of Factors Affecting Psychological Resilience of Emergency Room Nurses Under Public Health Emergencies

Resilience is essential for frontline health workers to cope with the unfavorable situations, especially under public health emergencies. Emergency room (ER) nurses are a special cohort of health professionals that may present moderate level of resilience. This study aimed to identify factors that are correlated with resilience in this special cohort to provide directions for intervention and management. ER nurses that have encountered a public health emergency within 3 months were recruited using purposive sampling and snowball technique for the study. Questionnaires, including Connor-Davidson Resilience Scale (CD-RISC), Zung Self-Rating Depression Scale (SDS), and Maslach Burnout Inventory-Human Services Survey (MBI-HSS) were established, followed by an in-depth interview to identify different clusters of themes. Thirteen ER nurses were recruited, and the average CD-RISC score was 66 ± 21. Resilience was negatively correlated with SDS index, and positively correlated with personal accomplishment. Five clusters of themes were identified from in-depth interviews, including physical tolerability, psychological tolerability, tenacity of internal drive, institutional implementation, and external adjustment. This study identified factors associated with resilience in ER nurses under public health emergencies, providing useful information for future directions for intervention.

Burn-out, emotional labour and psychological resilience among gastroenterology nurses during COVID-19: a cross-sectional study

OBJECTIVES

To investigate the relationship between burn-out, emotional labour and psychological resilience of gastroenterology nurses during the COVID-19 pandemic and explore the factors associated with these specific variables.

DESIGN

A multicentre cross-sectional study with anonymous self-reporting was conducted from 24 November 2021 to 26 December 2021.

SETTING

The study was conducted in Fujian Province, China.

PARTICIPANTS

The participants were 345 gastroenterology nurses from 7 tertiary hospitals.

PRIMARY AND SECONDARY OUTCOME MEASURES

Burn-out, emotional labour and psychological resilience were the primary outcome measures. Using a convenience sampling method, the data were collected using Questionnaire Star (a tool for questionnaire surveys) via WeChat. The Chinese version of the Maslach Burnout Inventory, the Chinese version of the Emotional Labour Scale and the Chinese version of the Psychological Resilience Scale were used to evaluate burn-out, emotional labour and psychological resilience, respectively.

RESULTS

The total scores for burn-out, emotional labour and psychological resilience in gastroenterology nurses were 53.07±19.63, 38.79±12.22 and 69.97±22.38, respectively, with less use of deep acting and more use of surface acting. Pearson correlation analysis showed that burn-out was positively correlated with two dimensions of emotional labour; surface acting and emotional expression, and negatively correlated with deep acting. There was a negative correlation between emotional labour and all three dimensions of psychological resilience.

CONCLUSIONS

Greater adoption of deep acting by nurses can be promoted by improving their psychological resilience during events such as the COVID-19 pandemic, which can help improve emotional labour, thereby reducing burn-out and decreasing turnover rates. Senior management in hospitals must pay attention to nurses' psychological status. Further interventional studies could be conducted in the future to explore relevant measures.

Nurse managers' challenges and opportunities in the COVID-19 pandemic crisis: A qualitative descriptive study

AIM

The study was conducted to understand the experiences of nurse managers with regard to the difficulties and opportunities they encountered during the pandemic.

BACKGROUND

Although many studies have been carried out to understand how nurses were affected in the COVID-19 pandemic, there are few studies that treat the experiences of nurse managers.

METHODS

In this qualitative descriptive study with 19 nurse managers working in pandemic management at a university hospital in Turkey during the first three waves of the pandemic, data were collected between April and July 2021 using the semi-structured interview method. Content analysis was performed to analyse the data.

RESULTS

Six themes were identified with respect to the experiences of nurse managers during the pandemic. These themes were initial reactions to the crisis, ineffective crisis management, excessive workload, the moral burden in decision-making, support of colleagues and other multidisciplinary team and nurse manager empowerment.

CONCLUSIONS

The nurse managers had difficulties in their managerial roles during the pandemic. However, they also viewed the crisis as an opportunity because they were able to note the deficiencies in management at all levels of the hospital and their leadership and decision-making roles took on more importance.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers may use the results of this study to be prepared for the continuing COVID-19 pandemic and any other emergency circumstances that they may have to face in the future.

The impact of COVID-19 on nurses (ICON) survey: Nurses' accounts of what would have helped to improve their working lives

AIMS

To use nurses' descriptions of what would have improved their working lives during the first peak of the COVID-19 pandemic in the UK.

DESIGN

Analysis of free-text responses from a cross-sectional survey of the UK nursing and midwifery workforce.

METHODS

Between 2 and 14 April 2020, 3299 nurses and midwives completed an online survey, as part of the 'Impact of COVID-19 on Nurses' (ICON) study. 2205 (67%) gave answers to a question asking for the top three things that the government or their employer could do to improve their working lives. Each participants' response was coded using thematic and content analysis. Multiple response analysis quantified the frequency of different issues and themes and examined variation by employer.

RESULTS

Most (77%) were employed by the National Health Service (77%) and worked at staff or senior staff nurse levels (55%). 5938 codable responses were generated. Personal protective equipment/staff safety (60.0%), support to workforce (28.6%) and better communication (21.9%) were the most cited themes. Within 'personal protective equipment', responses focussed most on available supply. Only 2.8% stated that nothing further could be done. Patterns were similar in both NHS and non-NHS settings.

CONCLUSIONS

The analysis provided valuable insight into key changes required to improve the work lives of nurses during a pandemic. Urgent improvements in provision and quality of personal protective equipment were needed for the safety of both workforce and patients.

IMPACT

Failure to meet nurses needs to be safe at work appears to have damaged morale in this vital workforce. We identified key strategies that, if implemented by the Government and employers, could have improved the working lives of the nursing and midwifery workforce during the early stages of the COVID-19 pandemic and could prevent the pandemic from having a longer-term negative impact on the retention of this vital workforce.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution, due to the COVID-19 Pandemic, urgency of the work and the target population being health and social care staff.

Cognitive appraisals and coping strategies of registered nurses in the emergency department combating COVID-19: A scoping review

OBJECTIVE

Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic.

METHODS

This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings.

FINDINGS

Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively.

CONCLUSION

The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics.

CLINICAL RELEVANCE

EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.

Exploring the experiences of frontline nurses caring for COVID-19 patients

AIM

This study seeks to gain a comprehensive understanding of the experiences of frontline nurses who provided direct care for COVID-19 patients.

BACKGROUND

Due to the COVID-19 pandemic, the demands on healthcare systems have been higher than before. Although previous studies have explored the experiences of frontline nurses, these experiences could vary depending on each country's social, cultural, and historical contexts.

INTRODUCTION

In the midst of the global pandemic, sharing the experiences of COVID-19 frontline nurses could have implications for both nursing and nursing policies that could be applied to future pandemics.

METHODS

This descriptive qualitative study comprised 14 South Korean nurses with a minimum of one month of experience working within a COVID-19 department. Individual interviews were conducted on a virtual platform, and a thematic analysis was employed. The consolidated criteria for reporting qualitative studies were used to ensure a detailed reporting of the study.

RESULTS

Four themes and 12 subthemes were developed. The themes included: (1) feeling forced into a world of uncertainty; (2) providing unique care for COVID-19 patients; (3) perceiving barriers to providing quality care; and (4) seeking meaning in caring for COVID-19 patients.

DISCUSSION

Nurses recognized their unique roles in caring for COVID-19 patients and sought new meanings within their profession. However, the poor work environment exacerbated the physical and emotional burden among the nurses and compromised the provision of quality care.

CONCLUSION

This study highlighted the nursing policy issues that need to be improved to ensure better quality care and a stronger healthcare system.

IMPLICATIONS FOR NURSING POLICY

Governmental action is essential to ensure that nurses can maintain the quality of care they have provided during COVID-19 and any future pandemics.

The Effect of Perceived Organizational Support of Nurses on Their Resilience: A Cross-Sectional Study From Turkey

Background

Throughout and following the ongoing Coronavirus outbreak, there is an urgent need to focus on organizational support strategies aimed at improving the resilience of nurses.

Purpose

This research aims to examine the relationship between the nurses’ perceived organizational support and their resilience levels, and to reveal the characteristics that make a significant difference.

Methods

The data of this descriptive and cross-sectional study were collected from 722 nurses in February 2021 using the web-based survey method. The study followed the STROBE guideline. The data collection tools included the Introductory Information Form, the Survey of Perceived Organizational Support, and the Psychological Resilience Scale.

Results

Nurses were concluded to have perceived a moderate level of organizational support and their psychological resilience were found to be higher than average. A positive relationship was determined between the organizational support perceived by nurses and their psychological resilience. The gender, position/title of nurses, their work experience in COVID-19 treatment services, and having been infected with the COVID-19 virus were found to affect their perception of organizational support and resilience.

Conclusion

Organizational support perceived by nurses significantly affects their resilience. Resilience programs should, in particular, prioritize permanent clinical nurses who are in the risk group in terms of resilience, female nurses, nurses who had been infected with the COVID 19 virus, and nurses who have been assigned to COVID-19 treatment wards.

Exploring Nurses’ Working Experiences during the First Wave of COVID-19 Outbreak

During the COVID-19 outbreak, nurses employed in the clinical sector faced a number of difficulties associated with excessive workload, increased stress, and role ambiguity, which impacted nurses themselves and patient care. The aim of the present study was to investigate how Greek hospital nurses working in non-COVID units experienced the virus outbreak during the first wave of the pandemic. A descriptive qualitative research design was applied using a content analysis approach. To recruit the study participants a purposive sampling strategy was used. Ten nurses participated in the study. Data collection was conducted through semi-structured interviews. Content analysis revealed three themes namely, (a) emotional burden, (b) professional commitment, and (c) abrupt changes. Six subthemes were formulated and assimilated under each main theme respectively. Organizational changes, emotional burdens and feelings of fear and uncertainty, appeared to have a crucial effect on nurses and patient care. However, the professional commitment and the nurses’ effort to provide excellent nursing care remained high. Nurses demonstrated that despite the burdens caused by the COVID-19 outbreak, the pandemic era created opportunities for thoroughness and accuracy in nursing care.

Predictors burden in mental health workers during the COVID-19 pandemic

OBJECTIVES

to analyze burden predictors in mental health workers during the COVID-19 pandemic.

METHODS

a quantitative study, collected between October and December 2020 through a sociodemographic questionnaire and Mental Health Service Burden Assessment Scale, in four services in a municipality in the state of São Paulo, Brazil, with 108 workers. Descriptive analysis and multiple linear regression of ordinary least squares were performed, in search of predictors for variation in the scale score.

RESULTS

it showed median work burden (2.03). Predictors: psychological or psychiatric follow-up; normal performance of activities during the pandemic; direct action with suspected or confirmed cases of COVID-19; and belonging to the risk group (people over 60 years of age, diabetics, hypertensive, cardiac, respiratory problems) (p<0.05).

CONCLUSIONS

working conditions observed during the pandemic, simultaneously with workers' mental health care needs predict burden at work in health.

Resilience among health care workers while working during a pandemic: A systematic review and meta synthesis of qualitative studies

Background

Aim

Method

Results

Conclusion

Experiences, Challenges, and Coping Strategies of Frontline Healthcare Providers in Response to the COVID-19 Pandemic in Kelantan, Malaysia

Introduction

In the fight against the COVID-19 pandemic, frontline healthcare providers who are engaged in the direct diagnosis, treatment, and care of patients face a high risk of infection and inadequate protection from contamination, overwork, frustration, and exhaustion. These impose significant psychological and mental health concerns for frontline healthcare providers.

Objectives

This study aimed to explore the experiences and challenges faced and coping strategies adopted by frontline healthcare providers in response to the COVID-19 pandemic in Kelantan, Malaysia.

Methodology

This phenomenological approach to qualitative study used a telephone-based in-depth interview that followed a semistructured interview guide. The number of frontline healthcare providers was based on saturation theory. All the participants recruited fulfilled the inclusion and exclusion criteria from May to July 2020 in Raja Perempuan Zainab II Hospital. All interviews were audio recorded and transcribed verbatim. Thematic data analysis using NVIVO version 10 was performed.

Result

The 10 respondents involved in this study consisted of doctors, medical assistants, and nurses. The findings were divided into four main themes: invaluable experiences during the pandemic, challenges, coping strategies, and future expectations. The providers responded well in facing the disease even though they felt psychologically disturbed at the initial phase of the COVID-19 pandemic.

Conclusion

Healthcare providers perceived themselves as being more resilient and less vulnerable to psychological impacts than they were before the pandemic.

The Helicopter Transports of Patients Critically ill with COVID-19

Objective

The aim of our study was to describe specialist nurses’ experiences with the helicopter transport of patients critically ill with COVID-19.

Method

Our study followed a descriptive qualitative design anchored in the naturalistic paradigm and was based on qualitative content analysis. The study followed the consolidated criteria for reporting qualitative research.

Results

Six semi-structured interviews were conducted with specialist nurses who have cared for patients critically ill with COVID-19 during helicopter transport. The analysis of the interviews resulted in three themes—designing new routines before transport, working under new conditions and post-transport and reflections—with 11 categories. The goal of the intensive care transport of patients with COVID-19 was twofold: to prevent the spread of infection by using personal protective equipment and to prevent the contamination of the helicopter.

Conclusion

For the nurses, working in personal protective equipment created a feeling of distance from patients that compromised patient–nurse intimacy. Our results suggest that ensuring the sufficiency of equipment required in the event of major accidents and pandemics is critical.

Health care workers' experiences during the COVID-19 pandemic: a scoping review

BACKGROUND

COVID-19 has challenged health systems worldwide, especially the health workforce, a pillar crucial for health systems resilience. Therefore, strengthening health system resilience can be informed by analyzing health care workers' (HCWs) experiences and needs during pandemics. This review synthesizes qualitative studies published during the first year of the COVID-19 pandemic to identify factors affecting HCWs' experiences and their support needs during the pandemic. This review was conducted using the Joanna Briggs Institute methodology for scoping reviews. A systematic search on PubMed was applied using controlled vocabularies. Only original studies presenting primary qualitative data were included.

RESULTS

161 papers that were published from the beginning of COVID-19 pandemic up until 28th March 2021 were included in the review. Findings were presented using the socio-ecological model as an analytical framework. At the individual level, the impact of the pandemic manifested on HCWs' well-being, daily routine, professional and personal identity. At the interpersonal level, HCWs' personal and professional relationships were identified as crucial. At the institutional level, decision-making processes, organizational aspects and availability of support emerged as important factors affecting HCWs' experiences. At community level, community morale, norms, and public knowledge were of importance. Finally, at policy level, governmental support and response measures shaped HCWs' experiences. The review identified a lack of studies which investigate other HCWs than doctors and nurses, HCWs in non-hospital settings, and HCWs in low- and lower middle income countries.

DISCUSSION

This review shows that the COVID-19 pandemic has challenged HCWs, with multiple contextual factors impacting their experiences and needs. To better understand HCWs' experiences, comparative investigations are needed which analyze differences across as well as within countries, including differences at institutional, community, interpersonal and individual levels. Similarly, interventions aimed at supporting HCWs prior to, during and after pandemics need to consider HCWs' circumstances.

CONCLUSIONS

Following a context-sensitive approach to empowering HCWs that accounts for the multitude of aspects which influence their experiences could contribute to building a sustainable health workforce and strengthening health systems for future pandemics.

Exploration of the occupational and personal dimensions impacted by the COVID-19 pandemic for nurses: A qualitative analysis of survey responses

Aim

To explore the occupational and personal life dimensions that have been impacted by the COVID‐19 pandemic for registered nurses (RN) and licensed practical nurses (LPN).

Design

Qualitative interpretive description approach.

Methods

Between July and September 2020, a web‐based cross‐sectional study was conducted among RNs and LPNs in Quebec, Canada. Included in this survey was an open‐ended question allowing nurses to describe the occupational and personal life dimensions that were impacted by the COVID‐19 pandemic. Thematic analysis was used to interpret the qualitative data from this open‐ended question. Reporting followed the Standards For Reporting Qualitative Research (SRQR).

Results

Of the 1860 survey respondents, 774 RNs and 43 LPNs responded to the open‐ended question (total n = 819). For the occupational dimension, six themes were identified: impacts of infection control on work, change in daily work tasks, offloading and reorganization of care, deterioration of working conditions, increased stress at work and issues related to the profession. For the personal dimension, four themes were found: impacts on the family, dealing with changes about leisure and personal life, impacts on physical and psychological health.

Conclusion

Knowing the dimensions affected by the COVID‐19 pandemic could help to identifying appropriate interventions to support RNs and LPNs.

Impact

The COVID‐19 pandemic has significantly impacted the occupational and personal lives RNs and LPNs working in the Quebec healthcare system. More specifically, Quebec's nurses experienced a major reorganization of care generated by important government decisions. Knowing how the pandemic affected different life dimensions will help in the development of support adapted to nurses' realities. Even in a pandemic context, improvements in the work environment or appropriate support could lead to an improved psychological health for nurses.

TURNOVER INTENTION AND CORONAPHOBIA AMONG FRONTLINE NURSES DURING THE SECOND SURGE OF COVID-19: THE MEDIATING ROLE OF SOCIAL SUPPORT AND COPING SKILLS

BACKGROUND

Turnover among frontline healthcare workers, particularly nurses, reached an alarming rate during the COVID-19 pandemic. This turnover has been attributed, in part, to excessive fear of the virus (a condition called coronaphobia). Studies have not yet been conducted examining whether social support and coping skills could act as buffers between coronaphobia and the intention to leave.

AIM

To examine the relationship between coronaphobia and frontline nurses' organizational and professional turnover intention and to assess whether social support and coping skills can buffer this relationship.

METHODS

A correlational research design was used to collect responses through an online questionnaire from a convenience sample of 687 frontline nurses from the Central Philippines. Data was analysed using descriptive (mean, standard deviation, percentages) and inferential statistics (t - test, Pearson r correlation coefficient, ANOVA, and multiple linear regression).

RESULTS

More than half of the frontline nurses experienced coronaphobia, while 25.8% reported a desire to leave their job and 20.7% reported a desire to leave their profession. Coronaphobia had direct significant effects on nurses' organizational (β=.424, p<.001) and professional turnover intention (β=.316, p<.001). Social support and coping skills partially mediated the relationship between organizational (β=.365, p<.001; β=.362, p<.001) and professional turnover intention (β=.279, p<.001; β=.289, p<.001).

CONCLUSION

Frontline nurses who experienced coronaphobia were more likely to quit their job and the nursing profession. Increasing nurses' social support and enhancing their coping skills reduced the negative effects of coronaphobia, resulting in improved nurse retention.

IMPLICATIONS FOR NURSING MANAGEMENT

Institutional approaches to reduce coronaphobia and turnover intention during the pandemic can be facilitated by improving social support through innovative approaches (e.g., use of technology, social media) and equipping nurses with positive coping skills through coping skills training and other empirically based coping skill-building interventions.

Preditores de sobrecarga dos trabalhadores de saúde mental durante a pandemia de COVID-19

RESUMO Objetivos: analisar os preditores de sobrecarga dos trabalhadores de saúde mental durante a pandemia de COVID-19. Métodos: estudo quantitativo, coletado entre outubro e dezembro de 2020 por meio de questionário sociodemográfico e Escala de Avaliação da Sobrecarga de Profissionais em Serviços de Saúde Mental, em quatro serviços de um município do estado de São Paulo, Brasil, com 108 trabalhadores. Realizou-se análise descritiva e regressão linear múltipla de mínimos quadrados ordinários, em busca de preditores para a variação no escore da escala. Resultados: evidenciou-se mediana sobrecarga de trabalho (2,03). Preditores: acompanhamento psicológico ou psiquiátrico; desempenho normal das atividades durante a pandemia; atuação direta com casos suspeitos ou confirmados de COVID-19; e pertencer ao grupo de risco (pessoas acima de 60 anos, diabéticos, hipertensos, cardiopatas, problemas respiratórios) (p<0,05). Conclusões: condições de trabalho observadas durante a pandemia, simultaneamente com necessidades de cuidado à saúde mental dos trabalhadores, predizem sobrecarga no trabalho em saúde.

Professional and psychological perceptions of emergency nurses during the COVID-19 pandemic: A qualitative study

AIM

To explore the changing roles and responsibilities, difficulties, feelings, and coping strategies of emergency nurses during the COVID-19 pandemic.

METHODS

This study was conducted as a qualitative study using a phenomenological approach. A total of 12 emergency nurses were recruited using purposive sampling from a COVID-19-designated hospital in Konya, Turkey for qualitative study. Data were collected through semi-structured individual interviews in January 2021. The data were analyzed using the content analysis method with the MAXQDA 2020 software program. The study conforms to the consolidated criteria for reporting qualitative research checklist.

RESULTS

Four theme categories emerged from the data analysis: (a) "Increasing roles and responsibilities as an emergency nurse"; (b) "Difficulties of working in pandemic conditions"; (c) "Emotional responses in the pandemic"; and (d) "Strategies for coping with the effects of the pandemic". In this study, it was determined that emergency nurses had increased roles and responsibilities due to physicians being in the background, fulfilled their roles and responsibilities in a chaotic working environment, experienced many positive and negative feelings together or gradually, and applied individual coping strategies.

CONCLUSIONS

This study indicated that emergency nurses fulfilled their increasing roles and responsibilities on the frontlines in a chaotic working environment during the pandemic. Despite many negative feelings, it was determined that they tried to show psychological adjustment and resilience with a strong professional commitment and social support.

Experiences of first-line nurse managers during COVID-19: A Jordanian qualitative study

AIM

The aim of this study is to explore the experiences of Jordanian first-line nurse managers during COVID-19.

BACKGROUND

Nurses are exposed to life-threatening occupational risks during COVID-19. Exploring the first-line nurse managers' experiences will help in designing health policies to better deal with such emerging crises.

METHODS

A descriptive phenomenological study was conducted. A purposive sample was used to recruit 16 first-line nurse managers from Jordanian hospitals. Semistructured interviews were conducted. Phenomenological data analysis method was used to analyse the data.

RESULTS

Four major themes emerged: (a) unprecedented pressure (first-line nurse managers revealed their suffering with the unprecedented demanding situations during COVID-19 pandemic); (b) strengthening system and resilience (nurse managers employed several strategies to strengthen the health system and enhance resilience); (c) building a supportive team (the presence of a robust supportive system is vital to deal with the pandemic); and (d) maturity during the crisis (exposure to a new experience developed nurse managers management skills and self-awareness).

CONCLUSIONS

The unprecedented pressure associated with COVID-19 drained first-line nurse managers physically and psychosocially. Providing adequately trained staff and medical equipment is important to better deal with crises.

IMPLICATIONS FOR NURSING MANAGEMENT

Strengthening emergency training and improving emergency response plans of hospitals are essential.

The Psychological Impact of COVID-19 on Front Line Nurses: A Synthesis of Qualitative Evidence

Caring for people with COVID-19 on the front line has psychological impacts for healthcare professionals. Despite the important psychological impacts of the pandemic on nurses, the qualitative evidence on this topic has not been synthesized. Our objective: To analyze and synthesize qualitative studies that investigate the perceptions of nurses about the psychological impacts of treating hospitalized people with COVID-19 on the front line. A systematic review of qualitative studies published in English or Spanish up to March 2021 was carried out in the following databases: The Cochrane Library, Medline (Pubmed), PsycINFO, Web of Science (WOS), Scopus, and CINHAL. The PRISMA statement and the Cochrane recommendations for qualitative evidence synthesis were followed. Results: The main psychological impacts of caring for people with COVID-19 perceived by nurses working on the front line were fear, anxiety, stress, social isolation, depressive symptoms, uncertainty, and frustration. The fear of infecting family members or being infected was the main repercussion perceived by the nurses. Other negative impacts that this review added and that nurses suffer as the COVID-19 pandemic progress were anger, obsessive thoughts, compulsivity, introversion, apprehension, impotence, alteration of space-time perception, somatization, and feeling of betrayal. Resilience was a coping tool used by nurses. Conclusions: Front line care for people with COVID-19 causes fear, anxiety, stress, social isolation, depressive symptoms, uncertainty, frustration, anger, obsessive thoughts, compulsivity, introversion, apprehension, impotence, alteration of space-time perception, somatization, and feeling of betrayal in nurses. It is necessary to provide front line nurses with the necessary support to reduce the psychological impact derived from caring for people with COVID-19, improve training programs for future pandemics, and analyze the long-term impacts.

The role of spiritual intelligence in predicting the empathy levels of nurses with COVID-19 patients

AIM

Given the prolongation of the newly emerging COVID-19 pandemic and the significance of caring for the patients by nursing staff, investigating and planning for the different psychological dimensions of this group is of paramount importance. Hence, this study investigated the role of spiritual intelligence in predicting nurses' empathizing with COVID-19 patients.

METHODS

This descriptive-correlation study was conducted in 2021 on nurses caring for COVID-19 patients in three public hospitals. The researchers used two standard questionnaires, including the Jefferson Scale of Empathy (JSE) and Spiritual Intelligence (SI), for data collection. The collected data were analyzed in SPSS16 using descriptive statistics and the following: The Mann-Whitney U test, Kruskal-Wallis test, Regression, chi-square test, and Pearson and Spearman correlations.

RESULTS

The statistical population consisted of 338 nurses with an average age of 34 and ten years of work experience. There was a significant positive relationship between the empathy scores and spiritual intelligence scores of the nurses caring for COVID-19 patients (P < 0.05). It was also concluded from the regression analysis that, spiritual intelligence affect empathy. Mean score of empathy was higher in hospitals where more nursing staff had MSc degrees. There was a significant difference between the empathy scores of the three hospitals (P < 0.05).

CONCLUSION

The results indicated that there is a positive relationship between empathy and spiritual intelligence. Therefor improving spiritual intelligence is the appropriate strategy to ameliorate empathy during the COVID19 pandemic. At the same time, study indicated attention to the issue of nurses' mental health. Hence, it was suggested to incorporate these issues in the training programs and national/international decisions.

Perceived COVID-19-associated discrimination, mental health and professional-turnover intention among frontline clinical nurses: The mediating role of resilience

COVID-19-associated discrimination (CAD) is an important issue that may adversely affect frontline nurses' work effectiveness and well-being. This study examined the relationships between frontline nurses' perceptions of COVID-19-associated discrimination and their resilience, mental health, and professional-turnover intention. This cross-sectional descriptive study involved 259 frontline nurses in the Central Philippines and used four online self-report measures. The results revealed that frontline nurses perceived a moderate level of COVID-19-associated discrimination. Frontline nurses who perceived a higher level of discrimination during the coronavirus pandemic reported poorer mental health and higher professional-turnover intention. Resilience acted as a mediator and reduced the effects of COVID-19-associated discrimination on nurses' mental health and their professional-turnover intention. Proactive measures to reduce the negative consequences of discrimination during the pandemic, and efforts to foster resilience in nurses who are in the forefront of the fight against the highly transmissible virus, should be given high priority by hospital and nursing administrators to better support nurses' mental health and foster retention.

Fear of Nurses During COVID-19 Pandemic in Saudi Arabia: A Cross-Sectional Assessment

Objective: We aimed to assess the level of fear among nurses in Saudi Arabia during the COVID-19 outbreak.

Methods: A cross-sectional survey-based study was conducted from June to August 2020. All nurses currently working in public and private hospitals in Saudi Arabia during the COVID-19 pandemic were invited to complete an online survey. We used the 7-item unidimensional Fear of COVID-19 Scale (FCV-19S) to assess the level of fear of COVID-19. Multiple regression analysis was used to identify predictors associated with fear of COVID-19.

Results: A total of 969 nurses participated in this study. The participants were relatively young with a mean age of 35.5 ± 10.46 years. About two-thirds of the participants were women (65.9%), married (57.2%), and were non-Saudi nationals (67%). The total mean score for the FCV-19S was 19.7 SD 7.03 (range 7–35), which is near the mid-point, indicating a moderate level of fear of COVID-19. Out of the eight variables measured in the analysis, three variables emerged as a significant predictor (i.e., gender, marital status, and age). A higher level of fear (FCV-19S) was associated with being a woman, married, and older age (p ≤ 0.05).

Conclusion: This study demonstrated the level of fear of COVID-19 among nurses in Saudi Arabia. Overall, nurses in Saudi reported moderate levels of fear of COVID-19. Assessing the level of fear of nurses who work during the COVID-19 pandemic should be a priority to health care administrators to prevent mental health difficulties or psychological injury.

Psychosocial experiences of frontline nurses working in hospital-based settings during the COVID-19 pandemic - A qualitative systematic review

BACKGROUND

Frontline nurses have been directly exposed to the SARS-CoV-2 virus and come in close contact with patients during the COVID-19 pandemic. Nurses execute tasks related to disease control and face multiple psychosocial challenges in their frontline work, potentially affecting their mental well-being and ability to satisfyingly perform their tasks.

OBJECTIVES

To explore the psychosocial experiences of frontline nurses working in hospital-based settings during the COVID-19 pandemic.

DESIGN

The qualitative systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Registered in PROSPERO (CRD42021259111).

DATA SOURCES

Literature searches were performed through PubMed, CINAHL, and the WHO COVID-19 database. Inclusion criteria were: All types of nurses having direct contact with or taking care of patients; Primary, secondary, and tertiary health-care services admitting and treating COVID-19 patients; Experiences, perceptions, feelings, views in psychosocial aspects from the identified population group; Qualitative studies; Mixed methods studies; Language in English; Published date 2019-2021. Exclusion criteria were: Commentaries; Reviews; Discussion papers; Quantitative studies; Language other than English; Published in 2018 or earlier; Studies without an ethical approval and ethical statement.

REVIEW METHODS

The studies were screened and selected based on the inclusion and exclusion criteria. Quality appraisal was conducted according to the Critical Appraisal Skills Program qualitative study checklist. Data was extracted from included studies and a thematic synthesis was made.

RESULTS

A total of 28 studies were included in the review. The experiences of 1141 nurses from 12 countries were synthesised. Three themes were constructed: 'Nurses' emotional, mental and physical reactions to COVID-19', 'Internally and externally supported coping strategies', and 'A call for future help and support'.

CONCLUSION

Nurses working frontline during the COVID-19 pandemic have experienced psychological, social, and emotional distress in coping with work demands, social relationships, and their personal life. The results pointed to a need for increased psychological and social support for frontline nurses to cope with stress and maintain mental well-being, which may subsequently affect nursing care outcomes.

The experiences of frontline nurses in Wuhan: A qualitative analysis of nurse online diaries during the COVID-19 pandemic

Aims and objective

To explore the experiences of frontline nurses through analyzing nurse online diaries during the pandemic.

Background

Over 42,600 healthcare professionals took care of patients with COVID‐19 in Wuhan in the initial months between 23 January 2020 and 8 April 2020. Many used to write online diaries on Sina Microblog and still wrote about their experiences in the front line on this site. However, there has been little research on frontline nurses' experiences in the initial months of the pandemic through analyzing their narratives.

Design

A qualitative descriptive design.

Methods

A qualitative content analysis was used to analyze online diaries written by frontline nurses in Wuhan. A total of 205 entries in online diaries were collected from 12 frontline nurses, as accessible to those who subscribed to Sina Microblog social media site, between 23 January 2020 and 8 April 2020. NVivo12 was used to help analyze the data, and COREQ reporting guidelines were also used in this study.

Results

Two themes were identified: constructing a better self and constructing a strong support network. A better self was constructed in describing positive emotions, commitment to care, pride and achievements, and whole‐person growth. A strong support network was constructed through social support via different sources and gaining self‐support via narrating their personal experiences in diaries.

Conclusions

Frontline nurses demonstrated personal growth, psychological well‐being, and professionalism in the process of constructing a better self and a strong support network.

Relevance to clinical practice

The findings indicate that frontline nurses can use narratives as debriefing opportunities and a way of gaining self‐support. We suggest that online communities of professional support be used as an essential platform for sharing narratives and gaining a more comprehensive understanding of frontline nurses in the COVID‐19 pandemic and other global public health events.

One Year on: An Overview of Singapore's Response to COVID-19-What We Did, How We Fared, How We Can Move Forward

Background—One year has passed since the first COVID-19 case in Singapore. This scoping review commemorates Singaporean researchers that have expanded the knowledge on this novel virus. We aim to provide an overview of healthcare-related articles published in peer-reviewed journals, authored by the Singapore research community about COVID-19 during the first year of the pandemic. Methods—This was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) protocol. It included healthcare-related articles about COVID-19 published between 23 January 2020 and 22 January 2021 with a Singapore-affiliated author. MEDLINE, Embase, Scopus, Web of Science, CINAHL, PsycINFO, Google Scholar, and local journals were searched. The articles were screened independently by two reviewers. Results—The review included 504 articles. Most of the articles narrated the changes to hospital practice (210), while articles on COVID-19 pathology (94) formed most of the non-narrative papers. Publications on public health (61) and the indirect impacts to clinical outcomes (45) were other major themes explored by the research community. The remaining articles detailed the psychological impact of the pandemic (35), adaptations of medical education (30), and narratives of events (14). Conclusion—Amidst a resurgence of community cases involving variant COVID-19 strains, the resources from the research community will provide valuable guidance to navigate these uncertain times.

Association between resilience and burnout of front-line nurses at the peak of the COVID-19 pandemic: Positive and negative affect as mediators in Wuhan

The outbreak of coronavirus disease 2019 (COVID-19) is having a dramatic effect on the mental health of healthcare workers (HCWs). Upon the emergence of the COVID-19 pandemic, the Chinese government dispatched about 42 000 HCWs to Wuhan City and Hubei Province to fight this pandemic. This study briefly examines front-line nurses who experienced burnout, with the main objective of investigating the mediating roles of positive and negative affect in the relationship between resilience and burnout in Wuhan hospitals at the peak of the COVID-19 pandemic. A total of 180 front-line nurses voluntarily participated via a social media group. They completed the online questionnaires, including the Maslach Burnout Inventory-General Survey (MBI-GS), the Positive and Negative Affect Schedule (PANAS), the Connor-Davidson Resilience Scale (CD-RISC), demographics, and work-related characteristics. Structural equation modelling (SEM) analysis was used to examine the mediating effect of positive and negative affect on the relationship between resilience and burnout. The total prevalence of burnout was 51.7%, of which 15.0% were severe burnout. These preliminary results revealed that positive and negative affect fully mediated the effects of resilience on burnout, emotional exhaustion, depersonalization, and reduced personal accomplishment of front-line nurses. It is necessary to know the impact of resilience on HCWs with burnout through the positive and negative affect of individual backgrounds and situations, and how policymakers can deploy resilience interventions to support front-line HCWs.

Mental wellness among psychiatric-mental health nurses during the COVID-19 pandemic

Psychiatric nursing providers and their unique challenges in the face of the COVID-19 pandemic are not well-represented in the literature. Therefore, this study sought to describe mental well-being of psychiatric nurses, and sought to elucidate factors related to mental wellness during the COVID-19 pandemic. This study utilized cross-sectional survey methodology to evaluate burnout, mental wellness, COVID-related anxiety, professional fulfillment, depressive symptoms, and anxiety symptoms among psychiatric nurses. There was a total of 151 respondents. A linear regression model was employed to identify predictors of mental wellness. The final regression model included the following predictors: depressive symptoms, burnout, professional fulfillment, and educational status. These predictors together accounted for 73% of the variance for the outcome variable of mental well-being.

Healthcare worker resilience during the COVID-19 pandemic: An integrative review

AIM

The purpose of this review was to examine resilience among healthcare workers during the coronavirus-disease-2019 (COVID-19) pandemic.

BACKGROUND

The COVID-19 pandemic has caused an unprecedented strain on healthcare workers internationally. Rising infection rates, inadequate personal protective equipment, and the lack of availability of hospital beds has resulted in further deterioration of the already-fragile mental health of healthcare workers. Resilient workers have lower rates of burnout and improved patient outcomes.

EVALUATION

PubMed and the Cumulative Index to Nursing and Allied Health Literature databases were searched using the terms resilience, nurse and COVID-19 to identify studies on resilience during the COVID-19 pandemic. Results were organized by outcome measures for comparison.

KEY ISSUES

Resilience scores among frontline healthcare workers worldwide during the COVID-19 pandemic in the studies reviewed were overall found to be in the moderate range. Data from the United States showed a decrease in nurse resilience, whereas participants from China had increased resilience compared with pre-pandemic levels.

CONCLUSIONS

Building resilience in nurses and other healthcare workers can serve as a protective factor against negative outcomes related to the job, including burnout, anxiety and depression, and can improve patient outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

Strategies for building resilience in healthcare workers are discussed.

Associations between the working experiences at frontline of COVID-19 pandemic and mental health of Korean public health doctors

BACKGROUND

Demographic, work environmental, and psychosocial features are associated with mental health of healthcare professionals at pandemic frontline. The current study aimed to find predictors of mental health for public health doctors from working experiences at frontline of COVID-19 pandemic.

METHODS

With first-come and first-served manner, 350 public health doctors with experiences of work at COVID-19 frontline participated online survey on August 2020. Mental health was defined using the total scores of the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Perceived Stress Scale, and the Stanford Presenteeism Scale-6. Multivariate logistic regression models of mental health with lowest Akaike Information Criterion were determined among all combinations of working environments, perceived threats and satisfaction at frontline, and demographics that were significant (P < 0.05) in the univariate logistic regression.

RESULTS

Perceived distress, lowered self-efficacy at work, anxiety, and depressive mood were reported by 45.7, 34.6, 11.4, and 15.1% of respondents, respectively. Predictors of poor mental health found in the multivariate logistic regression analyses were environmental (insufficient personal protective equipment, workplace of screening center, prolonged workhours) and psychosocial (fear of infection and death, social stigma and rejection) aspects of working experiences at frontline. Satisfaction of monetary compensation and proactive coping (acceptance and willingness to volunteer at frontline) were predictive of better mental health.

CONCLUSIONS

Sufficient supply of personal protective equipment and training on infection prevention at frontline, proper workhours and satisfactory monetary compensation, and psychological supports are required for better mental health of public health doctors at frontline of COVID-19 pandemic.

Factors affecting frontline Korean nurses' mental health during the COVID-19 pandemic

AIM

To identify the factors affecting fear, anxiety and depressive symptoms among frontline nurses working with COVID-19 patients or are in charge of COVID-19 screening in Korea.

BACKGROUND

Nurses are at a higher risk of COVID-19 infection because they are in closer, longer-duration contact with patients. These situations can negatively affect the mental health of nurses.

METHODS

This study analysed data from COVID-19 module in the Korean Nurses' Health Study. Data from 906 participants were analysed. To identify the factors influencing mental health, descriptive statistics, Pearson's correlation and hierarchical multiple regression analyses were performed.

RESULTS

Caring for patients who are COVID-19-positive increased levels of fear, anxiety and depressive symptoms of nurses. The hospital safety climate influenced mental well-being among nurses.

CONCLUSION

Caring for patients with COVID-19 had a negative impact on fear, anxiety and depressive symptoms. However, the higher was the perceived hospital safety climate, the lower were the nurses' psychological symptoms. Further research on the mental health of nurses is warranted.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Institutions should manage human resources to enable periodic rotation of nurses' work and working periods related to COVID-19. In addition, hospital managers should provide sufficient personal protective equipment, related education, and safety climate.

Factors affecting frontline Korean nurses' mental health during the COVID-19 pandemic

AIM

To identify the factors affecting fear, anxiety and depressive symptoms among frontline nurses working with COVID-19 patients or are in charge of COVID-19 screening in Korea.

BACKGROUND

Nurses are at a higher risk of COVID-19 infection because they are in closer, longer-duration contact with patients. These situations can negatively affect the mental health of nurses.

METHODS

This study analysed data from COVID-19 module in the Korean Nurses' Health Study. Data from 906 participants were analysed. To identify the factors influencing mental health, descriptive statistics, Pearson's correlation and hierarchical multiple regression analyses were performed.

RESULTS

Caring for patients who are COVID-19-positive increased levels of fear, anxiety and depressive symptoms of nurses. The hospital safety climate influenced mental well-being among nurses.

CONCLUSION

Caring for patients with COVID-19 had a negative impact on fear, anxiety and depressive symptoms. However, the higher was the perceived hospital safety climate, the lower were the nurses' psychological symptoms. Further research on the mental health of nurses is warranted.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Institutions should manage human resources to enable periodic rotation of nurses' work and working periods related to COVID-19. In addition, hospital managers should provide sufficient personal protective equipment, related education, and safety climate.

Pandemic fatigue and clinical nurses' mental health, sleep quality and job contentment during the covid-19 pandemic: The mediating role of resilience

Aim

This study examined the influence of pandemic fatigue on clinical nurses’ mental health, sleep quality and job contentment, with resilience as a mediator.

Background

Pandemic fatigue is an emerging health concern among frontline clinical nurses as a consequence of the ongoing coronavirus pandemic and the various measures implemented to slow the spread of infection. As yet, no studies have investigated the link between pandemic fatigue and resilience, mental health, sleep quality and job contentment in frontline clinical nurses.

Methods

This was a descriptive, cross‐sectional study involving 255 frontline clinical nurses in the Philippines. The Pandemic Fatigue Questionnaire, Brief Resilience Scale, Job Contentment Scale and the Sleep Quality Scale were used to collect data through an online survey.

Results

The mean pandemic fatigue score was 3.086 (out of 5). Being vaccinated (β = 0.231, p < .001) and increased staffing levels (β = −0.488, p < .01) were associated with decreased pandemic fatigue in clinical nurses. Resilience partially mediated the relationships between (a) pandemic fatigue and mental health (β = −0.488, p < .001), (b) pandemic fatigue and sleep quality (β = −0.326, p < .001) and (c) pandemic fatigue and job contentment (β = −0.395, p < .001).

Conclusion

Clinical nurses who received a COVID‐19 vaccine and those who perceived sufficient staffing in their units reported lower levels of pandemic fatigue. Resilience reduces the effects of pandemic fatigue on clinical nurses’ mental health, sleep quality and job contentment.

Implications for Nursing Management

By providing frontline nurses with access to COVID‐19 vaccines and ensuring sufficient staffing levels, nurse managers could effectively reduce or prevent pandemic fatigue and improve their mental health. Implementing resilience‐promoting measures are essential to support nurses’ mental health, promote their sleep quality and foster job satisfaction.

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

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

The Difficulties and Mental Health Intervention Need of Doctors and Nurses in Biological Emergencies: A Qualitative Study

When a biological public health event breaks out, due to the characteristics of their work, doctors and nurses must face risks directly when the situation is unknown. Their difficulties and psychological pressure are unimaginable. However, few studies have investigated the difficulties encountered by those doctors and nurses and their requirements for psychological interventions. This study aimed to explore the difficulties and psychological intervention needs of doctors and nurses during the new biological public health events in China in 2019. We carried out a qualitative study using a phenomenological approach. We used convenience sampling to identify participants who provided direct care and treatment for patients with biological events such as coronavirus disease 2019 (COVID-19). They participated in semi-structured, in-depth face-to-face interviews. The interviews were transcribed and analyzed using Colaizzi's seven-step method. Analysis of this study was divided into the difficulties encountered by doctors and nurses and their mental health need. The difficulties encountered by doctors and nurses included four themes: being worried about the impact on others, lack of knowledge and skills, difficult patients, being socially isolated, and the feeling of uncertainty. The mental health need was summarized into two parts, needs expressed by doctors and nurses and needs observed by researchers. Doctors and nurses mostly did not feel that they needed any psychological support, but the researchers noticed several signs of stress or potential mental health problems among interviewees. Doctors and nurses faced significant complex and multidimensional difficulties. Many denied needing psychological support, even though the researchers noted signs that it might be helpful. Interventions and support strategies that involve mental health promotion activities should consider individual needs related to doctors and nurses' situation.