Insomnia, fatigue and psychosocial well-being during COVID-19 pandemic: A cross-sectional survey of hospital nursing staff in the United States

Characteristics of sleep disturbance across two waves of the COVID-19 pandemic among nursing staffs

Objectives

COVID-19 has impacted human lifestyles, including sleep quality. For nursing staff, sleep disorders not only impact their health and daily lives but also have implications for patient safety. The objective of this study is to explore the impact of the COVID-19 pandemic on the psychological and social aspects of nursing staff and the factors influencing their sleep quality through a two-wave survey.

Methods

Nursing staff from a psychiatric hospital in southern Taiwan were recruited in two waves during the COVID-19 epidemic. The level of sleep disturbance and related variables, such as Lo's Healthy and Happy Lifestyle Scale (LHHLS) and Societal Influences Survey Questionnaire (SISQ), were collected through self-report questionnaires. Factors related to the level of sleep disturbance were examined using univariate linear regression and multilevel linear regression.

Results

508 nursing staff members were included in the study, with 254 members in each wave. A significant difference was found between the two waves in the positive thinking of LHHLS and all subscales of SISQ. During the second wave, sleep disturbances were mainly related to self-efficacy, positive thinking, social anxiety, and social desirability. At the fourth wave, sleep disturbances were mainly related to self-efficacy, positive thinking, and social anxiety. However, these effects change when the trend of the epidemic shifts, and other factors are taken into account.

Conclusions

This study analyzed the factors related to the sleep quality of nursing staff during the COVID-19 pandemic. We preliminarily explored the impact of the COVID-19 pandemic on the sleep quality of nursing staff. However, determining whether the end of the epidemic has reduced the impact on nursing staff requires further research.

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.

"We didn't even have time to worry about our mental health." Long-term impact of the pandemic on nursing professionals' experiences

Explore the experiences of nursing professionals during the COVID-19 pandemic and the impact these experiences continue to have on their personal and professional lives. This qualitative study utilized interpretative phenomenological analysis with nine nursing professionals from southern Brazil. Two main themes and five subthemes were developed. The first theme, "Ongoing trauma response," had three subthemes: (a) Fear of dying and family dying, (b) Loneliness and isolation, and (c) My emotions don't matter. The second theme highlights the "Continued problems with the larger healthcare system" and is made up of two subthemes: (a) We are humans, not superheroes, and (b) We are still invisible. Symptoms of trauma response continued to be a significant challenge among nursing professionals even after the end of the pandemic. Recommendations for improving working conditions and making mental health services more readily available are discussed.

A Cross-Sectional Study of the Social Work Environment and Black Registered Nurses' Sleep

INTRODUCTION

Workplace experiences may place Black nurses at higher risk for poor sleep and adverse health outcomes. This study aimed to identify poor sleep prevalence and associations of workplace discrimination and workplace social capital with sleep.

METHODOLOGY

Descriptive statistics and multiple linear regression with exploratory analyses were conducted of cross sectional survey data from US Black nurses.

RESULTS

On average, 63 respondents reported sleeping 6.15 h, 45 min less daily than 6.9 h reported nationally for nurses. Ninety-percent of respondents reported poor sleep quality. While no direct significance was found, respondents reporting sleep quality changes had lower workplace social capital and higher workplace discrimination.

CONCLUSION

Black nurses may have higher prevalence of poor sleep than the larger nursing workforce. A potential relationship between decreased sleep quality and negative perceptions of the work environment may exist. Organizations should examine sleep and potential occupational health inequities among Black nurses when considering worker health.

Psychological detachment from work during nonwork time as a moderator and mediator of the relationship of workload with fatigue and sleep in hospital nurses

OBJECTIVES

To examine differences in psychological detachment from work during nonwork time by nurses' personal and work-related characteristics, and to examine the moderating and mediating effects of psychological detachment on the relationships between nursing workload and fatigue and sleep.

METHODS

This study employed a cross-sectional design with a self-administered online survey. Survey data from 827 hospital nurses providing direct patient care in the United States were used. Moderating and mediating effects of psychological detachment between workload and fatigue/sleep relationships were assessed using Hayes' PROCESS macro in SPSS.

RESULTS

There were significant differences in psychological detachment from work based on age, highest nursing degree, work experience, shift length, weekly work hours, and frequency of providing care to patients with COVID-19. The associations of workload with physical fatigue, mental fatigue, and sleep quality were weakened when psychological detachment was high. Psychological detachment statistically mediated the associations between workload and fatigue and sleep problems.

CONCLUSION

Healthcare organizations are encouraged to facilitate nurses' psychological detachment during time-off to protect them from fatigue and sleep problems.

Psychometric Evaluation of the Insomnia Severity Index in Nurses

OBJECTIVES

Examine psychometric properties of the Insomnia Severity Index (ISI) in a sample of nurses.

METHOD

In a sample of day shift nurses (N = 289), a confirmatory factor analysis (CFA), convergent and discriminant validity analyses, and a test-retest reliability analysis were performed.

RESULTS

CFA showed that a two-factor model provided the best fit. The ISI had moderate to poor convergent validity with sleep diary parameters, and moderate convergent validity with the Sleep Condition Indicator (r = -.66), Pittsburgh Sleep Quality Index (r = .66), and PROMIS Sleep-Related Impairment measure (r = .67). The ISI demonstrated good discriminant validity with the measures Composite Scale of Morningness (r = -.27), Nightmares Disorder Index (r = .25), PTSD Checklist for DSM-5 (sleep items removed; r = .32), and Perceived Stress Scale (r = .43). The ISI had weaker discriminant validity with the PHQ-9 (r = .69) and Generalized Anxiety Disorder Screener (r = .51). The ISI demonstrated a good test-retest reliability (ICCs = .74-.88).

CONCLUSIONS

The ISI is a psychometrically strong measure for the assessment of insomnia severity in day shift nurses. Overlap with psychological symptoms, primarily anxiety and depression, suggests caution while interpreting these constructs.

The mediating effect of resilience between work fatigue and psychological distress among healthcare workers in Brazil, Lebanon, Nigeria, Pakistan, Poland, Qatar, Serbia, and Tunisia

OBJECTIVES

To test the hypothesis that resilience has a mediating effect on the association between work fatigue and psychological distress.

METHODS

A cross-sectional survey was conducted online in eight countries in 2021: Brazil, Lebanon, Nigeria, Pakistan, Poland, Qatar, Serbia, and Tunisia. A total of 1094 healthcare professionals specialized in medicine, pharmacy, and nurse practitioners that were exposed to/worked with COVID-19 patients were included (age: 33.89 ± 10.79 years; 59.6% females).

RESULTS

After adjusting for potential confounders (i.e., country, gender, primary work in emergency department, primary work in infectious disease, primary work in intensive care unit, working in a COVID-19 ward, and working voluntary hours), the results of the mediation analysis showed that resilience fully mediated the association between physical work fatigue and psychological distress and partially mediated the associations between mental and emotional work fatigue and psychological distress. Higher work fatigue was significantly associated with less resilience; higher resilience was significantly associated with less psychological distress. Finally, higher mental and emotional, but not physical, work fatigue, were directly and significantly associated with more psychological distress.

CONCLUSION

Identifying resilience as an important mediator in the path from fatigue to distress helps elucidate underlying mechanisms and pathways leading to the mental health-alteration process among healthcare workers during COVID-19. New strategies targeting resilience may be developed to further improve mental health outcomes among healthcare workers.

Caregiving in long-term care before and during the COVID-19 pandemic: a scoping review

PURPOSE

The COVID-19 pandemic magnified pre-existing socioeconomic, operational, and structural challenges in long-term care across the world. In Canada, the long-term care sector's dependence on caregivers as a supplement to care workers became apparent once restrictive visitation policies were employed. We conducted a scoping review to better understand the associations between caregiving and resident, formal and informal caregiver health in long-term care before and during the COVID-19 pandemic.

METHODS

A literature search was performed using MEDLINE, AgeLine, Google Advanced, ArXiv, PROSPERO, and OSF. Pairs of independent reviewers screened titles and abstracts followed by a review of full texts. Studies were included if they reported biological, psychological, or social health outcomes associated with caregiving (or lack thereof).

RESULTS

After screening and reviewing 252 records identified by the search strategy, a total of 20 full-text records were eligible and included in this review. According to our results, research on caregiving increased during the pandemic, and researchers noted restrictive visitation policies had an adverse impact on health outcomes for residents and formal and informal caregivers. In comparison, caregiving in long-term care prior to the pandemic, and once visitation policies became less restrictive, led to mostly beneficial health outcomes.

CONCLUSION

Caregiver interventions, for the most part, appear to promote better health outcomes for long-term care residents and formal and informal caregivers. Suggestions to better support caregiving in long-term care settings are offered.

Prevalence and factors associated with poor sleep quality among nurses in COVID-19 wards

The COVID-19 pandemic has significantly impacted the working conditions of nurses, leading to a detrimental effect on their sleep quality. This cross-sectional study aimed to investigate the prevalence of poor sleep quality and its associated factors among nurses working in COVID-19 wards in Kermanshah, Iran. A total of 97 nurses were selected through simple random sampling from COVID-19 wards. Data was collected using a demographic information sheet and the Pittsburgh Sleep Quality Index. Descriptive and inferential statistical methods, including chi-square and multiple logistic regression, were used for data analysis. The results showed that 74.2% (n = 72) of the nurses experienced poor sleep quality. Significant associations were found between poor sleep quality and work experience (p = 0.045) as well as the type of work shift (p = 0.001). However, no significant relationships were observed between poor sleep quality and factors such as age, sex, body mass index, overtime hours per month, physical activity, or underlying diseases. The high prevalence of poor sleep quality among nurses working in COVID-19 wards underscores the necessity of implementing targeted interventions to address this issue. In this regard, in addition to periodic shift schedule changes and reductions in working hours, it is necessary to adopt purposeful measures to improve working conditions and enhance the physical and mental health of nurses. These measures may include providing sufficient human resources to reduce the workload and fatigue of nurses, appropriate scheduling of working hours, and the implementation of stress management programs.

Effect of occupational stress and resilience on insomnia among nurses during COVID-19 in China: a structural equation modelling analysis

OBJECTIVES

To explore the effects of occupational stress and resilience on insomnia among Chinese nurses during the COVID-19 pandemic.

DESIGN, SETTINGS AND PARTICIPANTS

A quantitative description study. The data were collected via a cross-sectional survey. A total of 725 front-line nurses at three tertiary hospitals in western China were included from December 2022 to January 2023. The Connor-Davidson Resilience Scale, Job Content Questionnaire, and Athens Insomnia Scale were used to collect data from a self-reported online questionnaire.

OUTCOME MEASURES

The outcome variable was insomnia, and structural equation modelling was used to assess the associations among resilience, occupational stress and insomnia.

RESULTS

The prevalence of insomnia among the participants was 58.76%. The structural equation model showed that resilience had a negative direct effect on insomnia and occupational stress, and occupational stress had a positive direct effect on insomnia. Involvement in COVID-19-related work has a positive effect on insomnia through occupational stress. In contrast, higher education levels improved insomnia through increased resilience.

CONCLUSION

A significantly higher prevalence of insomnia has been observed among Chinese nurses during the COVID-19 pandemic. Our study suggests that better resilience may improve insomnia by relieving occupational stress, and implementing measures to promote resilience is essential to reduce occupational stress in nurses and improve their sleep quality.

The relationship between sleep quality and occupational fatigue in endoscopy nurses: mediating role of positive coping style

Background

Nursing occupational fatigue has emerged as a critical issue affecting the safety and health of nurses. This phenomenon not only impairs nurses' performance and mental well-being but also poses risks to patient safety and the quality of care provided. This study focuses on endoscopic nurses to explore the mediating role of positive coping styles between sleep quality and occupational fatigue, aiming to identify effective strategies to alleviate fatigue, thereby improving the work environment and enhancing healthcare quality.

Methods

From July to August 2023, a cross-sectional design was used to select 258 endoscopy nurses from 25 top-three hospitals in 14 cities across 5 provinces in China. Data was collected through general information questionnaires, Fatigue assessment instrument, Pittsburgh sleep quality index, and Simple Coping Style Questionnaire. A structural equation model of sleep quality - positive coping style - occupational fatigue was constructed using Amos 26.0, and Bootstrap was employed to test the mediating effect.

Results

The results showed that the mean scores of sleep quality, occupational fatigue, and positive coping style for endoscopy nurses were 8.89 ± 4.13, 17.73 ± 5.64, and 18.32 ± 10.46, respectively. Positive coping style were negatively correlated with sleep quality and occupational fatigue (p < 0.001). Positive coping style partially mediated the relationship between sleep quality and occupational fatigue, with a mediating effect value of 0.253, accounting for 42.10% of the total effect.

Conclusion

Sleep quality can indirectly affect the level of occupational fatigue through positive coping style. Nursing managers should enhance nurses' positive coping skills, improve nurses' sleep quality, and reduce occupational fatigue among nurses.

Optimizing Nurse Workflow Efficiency: An Examination of Nurse Walking Behavior and Space Accessibility in Medical Surgical Units

OBJECTIVE

This study aimed to investigate the effect of spatial adjacencies on nurses' walking patterns and the subsequent impact on staff satisfaction with perceived accessibility and adjacency-related issues.

BACKGROUND

Recognizing the crucial importance of spatial adjacencies in healthcare facilities is essential, as they significantly affect staff morale, fatigue management, operational efficiency, error reduction, and overall patient care excellence, highlighting the need for objective assessments to evaluate the impact of facility layout and space configuration on workflow patterns and staff satisfaction in patient care units.

METHODS

Integrating on-site observations with survey data, we explored how spatial adjacencies affect staff walking behavior and satisfaction in two med-surgical unit floors.

RESULTS

The findings highlighted a significant frequency of movements between nurse stations, patient rooms, and medication areas. Regression analysis identified several contributing factors to staff satisfaction, including the proximity of supplies, team visibility, ease of access across departments, and the location of equipment rooms. Specifically, satisfaction with the proximity of supplies was positively associated with increased provider satisfaction with workflow, quality of care, and workplace. Additionally, valuable feedback from staff revealed concerns regarding break room placement, medication area functionality, and disparities in the availability of supplies.

CONCLUSION

This study highlighted the critical need for carefully planned spatial adjacency strategies to enhance workflow efficiency and raise clinical staff satisfaction within healthcare facilities. The actionable insights gleaned from this research offer valuable direction to architects, healthcare administrators, and design professionals, enabling the creation of environments that positively resonate with healthcare providers and improve healthcare operations.

Quiet quitting: Obedience a minima as a form of nursing resistance

In this article, we provide a philosophical and ethical reflection about quiet quitting as a tool of political resistance for nurses. Quiet quitting is a trend that gained traction on TikTok in July 2022 and emerged as a method of resistance among employees facing increasing demands from their workplaces at the detriment of their personal lives. It is characterised by employees refraining from exceeding the basic requirements outlined in their job descriptions. To understand why quiet quitting can be a tool of resistance useful for nurses, we first draw on Frédéric Gros' concept of 'surplus obedience' and Michael Lipsky's notion of 'routines and simplification strategies' to highlight the ethical implications associated with nurses engaging in and sustaining harmful systems, such as the neoliberal healthcare system. Leaning again on Gros, we then propose that 'obedience a minima', a concept akin to quiet quitting, can serve as a method of ethical nursing resistance. After describing what the concept entails, we provide a discussion emphasising the potential of obedience a minima as a one method, among many, that can be leveraged by nurses to challenge and resist a system that prioritises financial considerations over patient wellbeing. The article concludes by reflecting on the ethical nature of resistance in the context of nursing, that is the act of obeying oneself and refraining from participating in systems that are detrimental to the lives of Others.

Psychosocial consequences of the COVID-19 pandemic and its effects on professional resilience and self-care on nurses: an example of Ankara

The COVID-19 pandemic has significantly impacted nurses, who are frontline care providers, with high infection risk, disease transmission to relatives, and adverse psychosocial effects. This descriptive and correlational study examines the psychosocial impact of COVID-19 on 224 nurses, focusing on their professional resilience and self-care during active care of COVID-19 patients from December 2022 to August 2023. Data was collected through demographic information forms, questionnaires, and scales. Structural equation modeling was used for the relational dimension of the study. The mean score of the nurses' COVID-19 Pandemic Psychosocial Impact Scale was 85.43 (SD = 22.08), while the Skovholt Practitioner Professional Resiliency and Self-Care Inventory had a mean score of 135.64 (SD = 19.73). A statistically significant low-level negative relationship between the scale scores (r = -0.220). The COVID-19 pandemic's psychosocial impact scores significantly impact personal vitality and stress, indicating a direct negative effect on these factors, according to structural equation modeling results.

A study protocol for the modified interactive screening program plus MINDBODYSTRONG© RCT: A mental health resiliency intervention for nurses

BACKGROUND

Nurses, the largest workforce in healthcare, are at high risk of depression, anxiety, burnout, and suicidal ideation. Suicide among nurses is higher than the general population. This randomized controlled trial pairs the MINDBODYSTRONG© cognitive-behavioral skills building program with the American Foundation for Suicide Prevention's (AFSP) Modified Interactive Screening Program (mISP) to reduce depression, suicidal ideation, post-traumatic stress, anxiety, and burnout, and improve healthy lifestyle beliefs, healthy lifestyle behaviors, and job satisfaction in nurses with moderate to high risk of suicide.

AIMS

This study aims to determine the effects of the mISP combined with the digitized MINDBODYSTRONG© program versus the mISP alone on depression, suicidal ideation, burnout, anxiety, post-traumatic stress, healthy lifestyle beliefs, healthy lifestyle behaviors, and job satisfaction in 364 U.S. nurses.

METHODS

A digitized version of MINDBODYSTRONG© combined with the mISP screening and referral platform will be compared to the AFSP mISP alone through a two-arm randomized controlled trial. Follow-up post-intervention data will be collected at week eight and months three, six, and 12.

DISCUSSION

If successful, this study's findings could assist nurses who are hesitant to use conventional mental health resources by providing them with confidential aid and learning opportunities to reduce suicidality, depression, anxiety, post-traumatic stress, and burnout and improve healthy lifestyle beliefs, healthy lifestyle behaviors, and job satisfaction.

TRIAL/STUDY REGISTRATION

The Ohio State University Protocol Record 2021B0417, Modified Interactive Screening Program Plus MINDBODYSTRONG: A Mental Health Resiliency Intervention for Nurses, is registered and posted at ClinicalTrials.gov Identifier: NCT05582343. First posted date is October 17, 2022.

Prevalence of psychological and mental health symptoms among nursing professionals during the COVID-19 pandemic in the Americas: Systematic review and meta-analysis

To assess the prevalence of mental health symptoms in nursing professionals during the COVID-19 pandemic on the American continent. A systematic review and meta-analysis of observational studies that estimated the prevalence of mental health symptoms in nursing professionals during the COVID-19 pandemic was performed through bibliographic database searches. A three-level meta-analysis model was used with the inverse variance method, tau was estimated via restricted maximum likelihood and logistic transformation, and heterogeneity was presented as tau2 and I2. Of the 7467 studies obtained, 62 were included in the meta-analysis, which involved 52 270 nursing professionals. The overall prevalence for at least one mental health symptom was 56.3% (50.4%, 62.1%; I2 = 98.6%, p < 0.001). Eight mental health symptoms were found; among them, the most prevalent were burnout (52.1%, 37.1%, 88.8%; I2 = 98.5%, p < 0.001) and fear (52.1%, 30.1%, 73.3%; I2 = 98.1%, p < 0.001). The prevalence of mental health symptoms in nursing professionals during the COVID-19 pandemic on the American continent was high, and strategies should be developed and implemented by managers and government agencies to promote the well-being, physical and mental health of nursing professionals. Studies like this one are necessary to highlight the need for efforts in the implementation of promotion and prevention actions to be developed by health organisations, managers and leaders with a view to improving the quality of life of nursing workers.

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.

Workplace violence, work-related exhaustion, and workplace cognitive failure among nurses: A cross-sectional study

AIM

To examine the relationships between nurses' exposure to workplace violence and self-reports of workplace cognitive failure.

DESIGN

A cross-sectional study.

METHODS

An online questionnaire was administered in April 2023 to nurses in Michigan, US. Structural equation modelling was used to examine effects of physical and non-physical workplace violence (occupational stressors) and work efficiency and competence development (occupational protective factors) on workplace cognitive failure.

RESULTS

Physical violence was a significant predictor of the action subscale of cognitive failure. There were no direct effects of non-physical violence, workplace efficiency, or competence development on any of the workplace cognitive failure dimensions. Both types of violence and efficiency had significant indirect effects on workplace cognitive failure via work-related exhaustion. Work-related exhaustion predicted significantly higher scores for workplace cognitive failure.

CONCLUSION

Workplace violence and work efficiency exhibited primarily indirect effects on workplace cognitive failure among nurses via work-related exhaustion.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses experiencing workplace violence may be at increased risk for workplace cognitive failure, especially if they are also experiencing work-related exhaustion. Workplaces that nurses perceive as more efficient can help to mitigate the effects of violence on nurses' cognitive failure.

IMPACT

This study addressed the possible effects of workplace violence as well as work efficiency and competence development on nurses' cognitive failure at work. Analyses revealed primarily indirect effects of workplace violence, and indirect protective effects of work efficiency, on nurses' cognitive failure via work-related exhaustion. This research has implications for healthcare organizations and suggests that efforts made by healthcare workplaces to prevent violence and work-related exhaustion, and to enhance work efficiency, may help to mitigate workplace cognitive failure among nurses.

REPORTING METHOD

We have followed the STROBE checklist in reporting this study.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or public contribution.

Nursing Home Workers' Experience During the COVID-19 Pandemic

PURPOSE

To understand nursing home workers' experience during the coronavirus disease 2019 (COVID-19) pandemic and investigate the prevalence of health-related quality of life, emotional distress, job satisfaction, and the impact of the pandemic.

METHOD

The Healthcare Worker Exposure Response and Outcomes (HERO) Registry served as the data source for this descriptive cross-sectional analysis. Recruitment was conducted nationally. Eligible nursing home workers (N = 1,409) enrolled in the study online, self-reported demographic and employment characteristics, and completed electronic surveys.

RESULTS

Nursing home workers reported overall good physical health, frequent depressive symptoms, burnout, and a high prevalence of feeling tired, stressed, having trouble sleeping, and feeling worried. Age and race were found to be positively associated with the impact of the pandemic.

CONCLUSION

Findings demonstrate the difficulties and challenges nursing home workers faced during the COVID-19 pandemic. Future research needs to evaluate the relationships among nursing home workers' roles, mental health, depressive symptoms, and prevalence of burnout with a larger, more diverse sample. [Research in Gerontological Nursing, 17(3), 131-140.].

Implementation of a Continuous Patient Monitoring System in the Hospital Setting: A Qualitative Study

BACKGROUND

Technology can improve care delivery, patient outcomes, and staff satisfaction, but integration into the clinical workflow remains challenging. To contribute to this knowledge area, this study examined the implementation continuum of a contact-free, continuous monitoring system (CFCM) in an inpatient setting. CFCM monitors vital signs and uses the information to alert clinicians of important changes, enabling early detection of patient deterioration.

METHODS

Data were collected throughout the entire implementation continuum at a community teaching hospital. Throughout the study, 3 group and 24 individual interviews and five process observations were conducted. Postimplementation alarm response data were collected. Analysis was conducted using triangulation of information sources and two-coder consensus.

RESULTS

Preimplementation perceived barriers were alarm fatigue, questions about accuracy and trust, impact on patient experience, and challenges to the status quo. Stakeholders identified the value of CFCM as preventing deterioration and benefitting patients who are not good candidates for telemetry. Educational materials addressed each barrier and emphasized the shared CFCM values. Mean alarm response times were below the desired target of two minutes. Postimplementation interview analysis themes revealed lessened concerns of alarm fatigue and improved trust in CFCM than anticipated. Postimplementation challenges included insufficient training for secondary users and impact on patient experience.

CONCLUSION

In addition to understanding the preimplementation anticipated barriers to implementation and establishing shared value before implementation, future recommendations include studying strategies for optimal tailoring of education to each user group, identifying and reinforcing positive process changes after implementation, and including patient experience as the overarching element in frameworks for digital tool implementation.

Investigating the role of organizational stress in nurses' psychosomatic complaints: Evidence from a study in northeastern Italy

Background

Nursing is pivotal to healthcare delivery but is often associated with high levels of organizational stress. In this cross-sectional study, we aimed to investigate the associations between exposure to organizational stressors, measured using the Health and Safety Executive Management Standards Indicator Tool, and psychosomatic complaints among nurses in a medium-sized city hospital in northeastern Italy.

Methods

A total of 215 nurses participated in the study, completing self-report questionnaires assessing organizational stressors and the prevalence of psychosomatic complaints experienced over the preceding six months.

Results

Significant associations were observed between various organizational stressors and psychosomatic complaints among nurses. Specifically, the Relationships factor emerged as a significant predictor of palpitations, irritability, anxiety, physical and mental tiredness, and headache. Additionally, Demands and Managers' support were identified as significant predictors of specific psychosomatic complaints.

Conclusion

This study highlights the critical role of addressing organizational stressors, particularly those related to interpersonal relationships, in promoting nurse well-being and optimizing patient care delivery. Despite its strengths, including the use of a well-established measurement tool and a comprehensive assessment of psychosomatic complaints, limitations such as the cross-sectional design and self-report measures warrant consideration. By prioritizing supportive work environments and implementing targeted interventions, healthcare organizations can cultivate a culture of well-being among nurses, ultimately enhancing the quality and safety of healthcare delivery.

PTSD prevalence and factors in intern nursing students after COVID-19 full liberalization in China: a cross-sectional study

Objective

This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) and its influencing factors among intern nursing students after the full liberalization of the COVID-19 prevention and control policy in China.

Methods

Participants completed the online survey from January 14 to January 19, 2023. A demographic questionnaire, COVID-19 and internship-related questionnaire, the Fear of COVID-19 scale, the Primary Care PTSD Screen, and the Connor-Davidson Resilience Scale were used to conduct the online survey.

Results

Of 438 participants, 88.4% tested positive for COVID-19 in the last 6 months. The prevalence of fear, resilience, and PTSD was 16.9, 15.5, and 11.2%, respectively. Direct care of COVID patients in hospital (OR = 2.084, 95%CI 1.034 ~ 4.202), the experience of occupational exposure (OR = 2.856, 95%CI 1.436 ~ 5.681), working with an experienced team (OR = 2.120, 95%CI 1.070 ~ 4.198), and fear COVID-19 (OR = 8.269, 95%CI 4.150 ~ 16.479) were significantly and positively associated with PTSD in nursing internship students.

Conclusion

After COVID-19 full liberalization in China, intern nursing students still experienced pandemic-related mental distress, which can bring PTSD. Adequate support and counseling should be provided, as needed, to intern nursing students who are about to enter the workforce and have experienced severe PTSD symptoms related to COVID-19. Our findings indicated that should understand the importance of screening, formulate intervention strategies and preventive measures to address psychosocial problems, and provide coping skills training to intern nursing students.

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.

The Effect of Distant Reiki on the Stress and Fatigue Levels of Nurses Working in COVID-19 Clinics: A Randomized-Controlled, Single-Blind Study

The study was conducted using a pre/posttest, randomized-controlled, single-blind trial method. After the pretest, a survey was administered and, distant Reiki was applied to nurses in the intervention group (n = 30) for 20 minutes a day for 4 consecutive days at a usual time. No intervention was made in the control group (n = 32). On the second day after the fourth Reiki session, a posttest survey was administered to nurses in the intervention group. The control group, on the other hand, was administered the posttest survey together with the last intervention group. As a result, in the intervention group, there was a decrease in the mean scores of the Helpless Approach subdimension on the Coping Style Scale and an increase in the mean scores of the Optimistic Approach and Social Support subdimensions ( P < .05). In the Visual Analog Scale for Fatigue, the mean Fatigue score in the intervention group decreased and there was an increase in the Energy subdimension mean score ( P < .05).

Did the prevalence of depressive symptoms change during the COVID-19 pandemic? A multilevel analysis on longitudinal data from healthcare workers

BACKGROUND

Healthcare workers (HCW) are at high risk to develop mental health problems during the COVID-19 pandemic because of additional work load, perceived stress, and exposure to patients with COVID-19. Currently, there are few studies on change over time in the prevalence of depressive symptoms during pandemic start among HCW. Thus, the aims of the current study were to examine whether depressive symptoms increased during the pandemic and were associated with perceived stress and own COVID-19 infection and workplace exposure to virus-infected patients.

METHODS

The cohort study used longitudinal data from HCW collected monthly (July 2020 till December 2020) during the first year of the pandemic before vaccination became available. The sample of n = 166 was drawn from a German hospital and included medical (e.g. nurses, therapists, and physicians) and administrative staff. Using multilevel models, we analyzed the change in depressive symptoms [assessed with General Depression Scale (GDS), a validated German version of the Center for Epidemiological Studies Depression Scale (CES-D)] and its association with perceived stress across the study period. Laboratory-confirmed own infection was tested as a potential moderator in this context. Subscales of the GDS were used to examine change over time of depressive symptom modalities (e.g. emotional, somatic, and social interactions (β, 95% confidence interval).

RESULTS

Depression scores increased significantly during the study period (β = .03, 95% CI [0.02, 0.05]). Perceived stress was associated with depressive symptoms (β = .12, 95% CI [0.10, 0.14]) but did not change over time. Exposure to COVID-19 infection was associated with a higher increase of depressive symptoms (β = .12, 95% CI [0.10, .14]). Somatic symptoms of depression increased among medical HCW with workplace exposure to COVID-19 (β = .25, 95% CI [0.13, 0.38]), but not in administrators (β = .03, 95% CI [-0.04, 0.11]).

CONCLUSION

Research is needed to identify factors that promote the reduction of depressive symptoms in medical HCW with exposition to COVID-19 patients. Awareness of infection protection measures should be increased.

A systematic review of studies on stress during the COVID-19 pandemic by visualizing their structure through COOC, VOS viewer, and Cite Space software

Background

The COVID-19 epidemic generated different forms of stress. From this period, there has been a remarkable increase in the quantity of studies on stress conducted by scholars. However, few used bibliometric analyses to focus on overall trends in the field.

Purpose

This study sought to understand the current status and trends in stress development during COVID-19, as well as the main research drives and themes in this field.

Methods

2719 publications from the Web of Science(WOS) core repository on stress during COVID-19 were analyzed by utilizing Co-Occurrence (COOC), VOS viewer, and Cite Space bibliometric software. The overall features of research on stress during COVID-19 were concluded by analyzing the quantity of publications, keywords, countries, and institutions.

Results

The results indicated that the United States had the largest number of publications and collaborated closely with other countries with each other. University of Toronto was the most prolific institution worldwide. Visualization and analysis demonstrated that the influence of stress during COVID-19 on the work, life, mental and spiritual dimensions is a hot research topic. Among other things, the frequency of each keyword in research on stress during COVID-19 increased from 2021 to 2022, and the researchers expanded their scope and study population; the range of subjects included children, nurses, and college students, as well as studies focusing on different types of stress, and emphasizing the handling of stress.

Conclusion

Our findings reveal that the heat of stress research during COVID-19 has declined, and the main research forces come from the United States and China. Additionally, subsequent research should concern more on coping methods with stress, while using more quantitative and qualitative studies in the future.

Just as Essential: The Mental Health of Educators During the COVID-19 Pandemic

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic deleteriously impacted physical and mental health. In the summer of 2020, return-to-learn plans were enacted, including virtual, hybrid, and in-person plans, impacting educators and students. We examined (1) how return-to-learn plan was related to depressive and social anxiety symptoms among educators and (2) how psychological flexibility related to symptoms.

METHODS

Educators (N = 853) completed a survey via Qualtrics that assessed internalizing symptoms, psychological flexibility, and occupational characteristics. Two one-way analyses of variance (ANOVAs) examined between-group differences in return-to-learn plans across depression and social anxiety. Two hierarchical linear regressions examined the relation between psychological flexibility components and depressive and social anxiety symptoms.

RESULTS

Median T-scores were well above the national normative means for General Depression (median T-score: 81) and Social Anxiety (median T-score: 67). There were no significant differences between reopening plans in general depression nor social anxiety T-scores. Psychological flexibility accounted for 33% of the variance in depressive symptoms and 24% of the variance in social anxiety symptoms.

CONCLUSIONS

Results indicated high levels of psychiatric symptoms among educators during COVID-19, and psychological flexibility was associated with lower symptoms. Addressing educator mental health is of utmost importance in future research.

Nurses' coping strategies caring for patients during severe viral pandemics: A mixed-methods systematic review

BACKGROUND

Nurses play an essential role in responding to severe viral disease which bring considerable challenges to their personal and professional well-being. This subsequently can affect the delivery of care and healthcare systems' organisational capacity to respond. Understanding nurses' experiences of these challenges will help inform healthcare policies.

AIM

To explore the experiences and coping strategies of nurses caring for patients during severe viral disease pandemics.

DESIGN

A mixed-methods systematic review informed by the Joanna Briggs Institute (JBI) methodology.

METHODS

A mixed-methods systematic review. Five electronic databases Medline, CINAHL, PsychInfo, ASSIA and Scopus were searched on 4th April 2021. Results were reported in accordance with PRISMA. The findings were analysed and reported in the context of the Self-Regulatory Common-Sense Model.

RESULTS

In total, 71 peer-review primary research articles describing nurses' experiences of caring for patients during SARS, MERS, Swine flu H1N1, Avian influenza or SARS-CoV-2 / COVID-19 published in English from 2003 to 2021 were included. We found links between nurses' perception of the health threats, their emotional reactions, and coping strategies. Perceived health threats were influenced by organisational factors including frequent changes in clinical guidelines and workplace protocols, onerous workloads and working hours, unavailability of PPE, and lack of knowledge and training in pandemic management. These impacted nurses' physical, psychological and social well-being. Nurses also reported helpful and unhelpful coping strategies to manage the health threats.

CONCLUSIONS

It is vital for stakeholders, policymakers, government and healthcare institutions to recognise and monitor the wider impact on healthcare workers from health emergencies. In addition, support to develop and implement effective systems and individual mechanisms to offset the anticipated impact pre and post pandemics/epidemics is needed. Our findings can inform those strategies for similar future health emergencies.

RELEVANCE TO CLINICAL PRACTICE

Nurses are often the first point of contact in providing direct care to patients, hence they are at high risk of being infected. The findings from this review can help managers and policymakers in developing programmes to enhance resilience in the nursing workforce.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a literature review study.

The insomnia, fatigue, and psychological well-being of hospital nurses 18 months after the COVID-19 pandemic began: A cross-sectional study

BACKGROUND

Research has shown sleep problems, elevated fatigue, and high cases of burnout, as well as signs of post-traumatic stress and psychological distress among nurses during the COVID-19 pandemic. Many US hospitals attempted to minimise its impact on staff by providing basic resources, mental health services, and wellness programs. Therefore, it is critical to re-evaluate these well-being indices and guide future administrative efforts.

PURPOSE

To determine the long-term impact of the COVID-19 pandemic after 18 months on hospital nurses' insomnia, fatigue, burnout, post-traumatic stress, and psychological distress.

DESIGN

Cross-sectional.

METHODS

Data were collected online mainly through state board and nursing association listservs between July-September 2021 (N = 2488). The survey had psychometrically tested instruments (Insomnia Severity Index, Occupational Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short Post-Traumatic Stress Disorder, and Patient Health Questionnaire-4) and sections on demographics, health, and work. The STrengthening the Reporting of Observational studies in Epidemiology checklist was followed for reporting.

RESULTS

Nurses had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue, and low-to-moderate intershift recovery. Regarding burnout, they experienced increased emotional exhaustion and personal accomplishment, and some depersonalisation. Nurses had mild psychological distress but scored high on post-traumatic stress. Nurses who frequently cared for patients with COVID-19 in the past months scored significantly worse in all measures than their co-workers. Factors such as nursing experience, shift length, and frequency of rest breaks were significantly related to all well-being indices.

CONCLUSION

Nurses' experiences were similar to findings from the early pandemic but with minor improvements in psychological distress. Nurses who frequently provided COVID-19 patient care, worked ≥12 h per shift, and skipped rest breaks scored worse on almost all well-being indices.

RELEVANCE TO CLINICAL PRACTICE

Administration can help nurses' recovery by providing psychological support, mental health services, and treatment options for insomnia, as well as re-structure current work schedules and ensure that rest breaks are taken.

Prevalence and predictors of burnout among nurses during the COVID-19 pandemic: A survey in teaching hospitals

BACKGROUND

Occupational burnout is one of the most important consequences of the coronavirus disease pandemic, associated with psychological well-being, quality of care, and intention to leave the nursing profession. This is a major health problem with serious adverse consequences not only for nurses but also for patients and healthcare systems.

OBJECTIVE

To assess burnout and its associated factors in nurses who worked in teaching hospitals during the COVID-19 pandemic in Iran.

METHODS

A cross-sectional study was conducted on nurses of two COVID-19 referral hospitals in Tehran, Iran. Data were collected using the sociodemographic form and Maslach burnout inventory-human service survey (MBI-HSS) questionnaire. Data were evaluated using SPSS software version 26.

RESULTS

A total of 264 participants, 52.7% (n = 139) were males and the mean of them age was 34.41±9.71 years. Almost 50% of nurses experienced burnout, in each dimension. Emotional exhaustion was associated significantly with job retention intention (P = 0.01) and depersonalization was significantly associated with gender (P = 0.02), age (P = 0.01), educational level (P = 0.004), work shifts (P = 0.006), and job retention intention (P = 0.02). In addition, personal accomplishment score was significantly associated with age (P = 0.002), marital status (P = 0.03), educational level (P = 0.03), work shift (P = 0.04) and job retention intention (P = 0.01).

CONCLUSION

The burnout rate in the COVID-19 era is high among nurses associated with improper care. Psychosocial support is needed to improve mental well-being among health care workers during unpredictable conditions like pandemics.

Fatigue during the COVID-19 pandemic - prevalence and predictors: findings from a prospective cohort study

The COVID-19 pandemic and consequent lockdowns had a substantial impact on mental health. Distress and fatigue are highly correlated. However, little is known about the determinants of fatigue in the general population during the pandemic. This study aimed to examine the prevalence and predictors of fatigue during the COVID-19 pandemic in the UK population. Online surveys were completed by a UK community cohort in April 2020 (wave 1), July-September 2020 (wave 2) and November-December 2020 (wave 3). In total, 3097 participants completed the wave 1 survey, and 1385 and 1087 participants (85.4% women) completed wave 2 and 3 surveys respectively. Fatigue was assessed using the Chalder Fatigue Scale at waves 2 and 3. Hair samples were provided by 827 participants (90.6% women) at wave 1 and wave 2, which were analyzed to indicate HairE (stress hormone). The mean total fatigue score during wave 2 was 14.7 (SD = 4.7), significantly higher than pre-pandemic levels observed in the community (mean difference 0.50, p = .003). At wave 2, 614 (44.3%) participants met the case definition for fatigue, only 15.6% of whom indicated that fatigue lasted for more than 6 months (suggesting it had started prior to the pandemic). Predictors of fatigue at wave 3 included being in a risk group, depression and belief in having COVID-19, which explained 23.8% of the variability in fatigue scores. Depression at wave 1 was the only significant predictor of remaining a fatigue case at wave 3. Fatigue was highly prevalent in the UK community during the COVID-19 pandemic and limited people's daily function. Depression and sociodemographic variables were significant predictors of fatigue.

Pandemic fatigue and clinical front-line medical staff health, job status during the COVID-19 pandemic: A cross-sectional survey after the lifting of epidemic restrictions

AIM

This study aimed to measure pandemic fatigue, physical and mental health, and job status of front-line medical staff in Ningbo. And to identify factors associated with pandemic fatigue.

BACKGROUND

There was an acute increase in fatigue symptoms at the COVID-19 pandemic onset. The front-line medical staff is particularly vulnerable to fatigue due to their high-intensity work.

DESIGN

This was a descriptive, cross-sectional study conducted using an online survey that included demographic data, investigation of COVID-19 history and job status. The Fatigue Assessment Scale, GAD-7 score and Sleep Quality Scale were used to collect data from 479 front-line medical staff.

METHODS

The study involved 479 front-line medical staff in Ningbo, China. The survey was conducted using an online questionnaire that included demographic data, investigation of COVID-19 history and job status. The Fatigue Assessment Scale, GAD-7 score and Sleep Quality Scale were used to collect data.

RESULTS

The results showed that of the 479 participants, 393 (82%) reported pandemic fatigue, 393 (82%) reported job satisfaction and 433 (90.4%) identified with their sense of job value. Sleep quality, work with a fever, economic subsidies for fighting COVID-19 and recognizing professional value were significantly correlated with pandemic fatigue.

CONCLUSIONS

As the COVID-19 pandemic challenges front-line medical workers, implementing measures is essential. Health policy implementers could provide sufficient front-line medical staff to ensure rest in case of infection, promote sleep quality and foster professional value and financial subsidies in units.

RELEVANCE TO CLINICAL PRACTICE

The study shows how pandemic fatigue affects front-line medical staff during the COVID-19 pandemic and suggests measures to support them, including promoting sleep quality, providing rest for infected staff, fostering professional value and financial subsidies. The recommendations are relevant to clinical practice as they help support medical staff and ensure high-quality care for patients during the pandemic.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. Not applicable.

The measurement of fatigue in clinicians within hospital settings: A systematic review of measurement properties

Medical staff fatigue leads to accidents and mistakes and puts patient safety at risk. A measure of fatigue in the workplace may help to quantify, predict, and manage fatigue. This review aimed to evaluate instruments used to measure fatigue in medical staff within hospitals. A systematic review following the JBI methodology was undertaken. A search for articles was conducted in 2021. Included articles (all validation studies) were assessed for methodological quality using the COSMIN checklist. Measurement property data was evaluated for Quality of Evidence using GRADE methodology. Ten studies representing five instruments were reviewed: Occupational Fatigue Exertion and Recovery scale (now superseded); Occupational Fatigue Exertion and Recovery scale (15-item); Multidimensional Fatigue Inventory; Need for Recovery Scale; and the Swedish Occupational Fatigue Inventory. Four instruments show promise for measuring fatigue in hospital medical staff, however, there is limited certainty in the measure property estimates. The Quality of Evidence for measurement properties for all instruments is insufficient. Further validation studies following the COSMIN standards are needed before recommendations for use can be made.

[Concern about Covid-19 Infection and the Risk of Burnout Symptoms: a Study of Caregiver Stress in Brandenburg Nursing Homes During the Covid-19 Pandemic]

OBJECTIVE

Investigation of the association of concern about own infection or infection of friends, family and care recipients with Covid-19 and burnout symptoms of caregivers in Brandenburg full inpatient geriatric care facilities.

METHODS

Cross-sectional survey of nursing staff (n=195) in Brandenburg nursing homes between August and December 2020 regarding their psychosocial stress at work.

RESULTS

Concern about having infected oneself, family and/or friends, or care recipients with Covid-19 is associated with increased expression of burnout symptoms (b=0,200, t(155)=2,777, p=0,006).

CONCLUSION

Increased experience of burnout symptoms due to concerns of risk of infection with Covid-19 in the workplace indicates a need for comprehensive support measures as well as sustainable approaches to managing psychosocial stress for geriatric caregivers.

Nurses' Rest Breaks and Fatigue: The Roles of Psychological Detachment and Workload

BACKGROUND

Rest breaks have been shown to reduce acute fatigue, yet not all nurses who take rest breaks report lower fatigue. Psychological detachment-letting go of work-related thoughts-during rest breaks and workload may be key factors in explaining this phenomenon.

OBJECTIVE

To examine the mediating role of psychological detachment during rest breaks and determine how workload moderated that pathway to lower acute fatigue among hospital nurses.

METHODS

In this cross-sectional study, data were collected from 1861 12-hour shift nurses who answered an online survey between July and September 2021. The survey included measures of occupational fatigue, psychological detachment from work, workload, and questions on breaks, work, health, and demographics. Structural equation modeling was used in Mplus 8.9 software to estimate the direct and indirect effects of rest breaks on acute fatigue at 3 levels of workload.

RESULTS

Nurses, on average, reported high acute fatigue, rarely experienced psychological detachment during rest breaks, and reported heavy workloads. Around 60% were able to sit down for a break on their last shift but with patient-care responsibilities. The relationship between taking a rest break and acute fatigue was fully mediated by psychological detachment from work. However, this relationship only held in the context of manageable workloads.

CONCLUSION

Our findings showed that within-shift recovery is possible when nurses can psychologically detach from work during rest breaks. However, this within-shift recovery mechanism was disrupted for nurses with heavy workloads.

Sociotechnical Work System Approach to Occupational Fatigue

INTRODUCTION TO THE PROBLEM

Occupational fatigue is a characteristic of excessive workload and depicts the limited capacity to complete demands. The impact of occupational fatigue has been studied outside of health care in fields such as transportation and heavy industry. Research in health care professionals such as physicians, medical residents, and nurses has demonstrated the potential for occupational fatigue to affect patient, employee, and organizational outcomes. A conceptual framework of occupational fatigue that is informed by a sociotechnical systems approach is needed to (1) describe the multidimensional facets of occupational fatigue, (2) explore individual and work system factors that may affect occupational fatigue, and (3) anticipate downstream implications of occupational fatigue on employee well-being, patient safety, and organizational outcomes.

CONCEPTUAL FRAMEWORK OF OCCUPATIONAL FATIGUE

The health care professional occupational fatigue conceptual framework is outlined following the Systems Engineering Initiative for Patient Safety (SEIPS) model and adapted from the Conceptual Model of Occupational Fatigue in Nursing. Future research may apply this conceptual framework to health care professionals as a tool to describe occupational fatigue, identify the causes, and generate solutions. Interventions to mitigate and resolve occupational fatigue must address the entire sociotechnical system, not just individual or employee changes.

Frontline Health Care Workers' Mental Health and Well-Being During the First Year of the COVID-19 Pandemic: Analysis of Interviews and Social Media Data

BACKGROUND

The COVID-19 pandemic has shed light on fractures in health care systems worldwide and continues to have a significant impact, particularly in relation to the health care workforce. Frontline staff have been exposed to unprecedented strain, and delivering care during the pandemic has affected their safety, mental health, and well-being.

OBJECTIVE

This study aimed to explore the experiences of health care workers (HCWs) delivering care in the United Kingdom during the COVID-19 pandemic to understand their well-being needs, experiences, and strategies used to maintain well-being (at individual and organizational levels).

METHODS

We analyzed 94 telephone interviews with HCWs and 2000 tweets about HCWs' mental health during the first year of the COVID-19 pandemic.

RESULTS

The results were grouped under 6 themes: redeployment, clinical work, and sense of duty; well-being support and HCW's coping strategies; negative mental health effects; organizational support; social network and support; and public and government support.

CONCLUSIONS

These findings demonstrate the need for open conversations, where staff's well-being needs and the strategies they adopted can be shared and encouraged, rather than implementing top-down psychological interventions alone. At the macro level, the findings also highlighted the impact on HCW's well-being of public and government support as well as the need to ensure protection through personal protective equipment, testing, and vaccines for frontline workers.

Up all night: the effect of the COVID-19 pandemic on insomnia among college students

Objective: To investigate COVID-19's impact on sleep, specifically insomnia, in college students. Participants: Students from a private university were eligible if they registered for Refresh, an online sleep-health program. Methods: A pre-intervention survey was distributed and assessed insomnia and COVID-19 factors using the Insomnia Severity Index (ISI) and a COVID-19 questionnaire. Baseline ISI scores from students enrolled in 2020-2021 were compared to scores from students enrolled in 2018-2019 using a two-sample t-test. Associations between insomnia and the COVID-19 factors were determined using chi-square tests. Results: There was no significant difference in baseline ISI scores when comparing 2018-2019 scores to those collected during the pandemic, p = 0.274. There was a statistically significant association between having insomnia and a student's learning location, p = 0.006, as well as disturbances in sleep caused by the pandemic, p = 0.026. Conclusion: Our results indicate that the COVID-19 pandemic did not worsen baseline insomnia.

Burnout Levels in Nurses and Associated Factors during the COVID-19 Pandemic-A Cross-Sectional Study

Previous studies have shown that sudden changes in the nature of nursing work and their work environment related to the COVID-19 pandemic have affected the professional experience of nurses, and consequently led to an increase in professional burnout in this professional group. Thus, the aim of the study was to measure occupational burnout among nurses working during the COVID-19 pandemic in Poland. A cross-sectional study was conducted with pediatric and surgery female nurses (N = 110, mean age 51 ± 6.92) from the Provincial Specialist Hospital in Włocławek, Poland. The participants completed the Link Burnout Questionnaire (LBQ) and the Socio-Demographic Questionnaire (SDQ). The data were analyzed using Spearman's rank correlation and Mann-Whitney U test. The study showed that high burnout affected 6.4% of nurses. The level of professional burnout for the subscales of psychophysical exhaustion, relationship deterioration, professional inefficacy and disappointment was 28.2%, 26.4%, 11.8% and 13%, respectively (mean score: 19.85 ± 6.51, 18.03 ± 5.15, 13.74 ± 4.07 and 17.61 ± 5.85, respectively). The results show that surgical nurses were statistically more likely to experience professional burnout. In sum, burnout among nurses has become a serious problem, especially considering the COVID-19 pandemic, which is why it is so important to continue research in this area. Hospital management needs to take urgent action to address the systemic and professional issues that contribute to the suboptimal mental health of nurses.

Work-related psychosocial challenges and coping strategies among nursing workforce during the COVID-19 pandemic: a scoping review

BACKGROUND

Nurses and midwives have been stretched by the COVID-19 pandemic amidst the heroic roles they have played during the peak of the COVID-19 pandemic. Nurses stood tall among their peers in the healthcare industry saving lives. The pandemic has had a toll on nurses physically, psychologically, and socio-economically. The numerous deaths have traumatized nurses coupled with the fear of possible infection. Nurses have seen their colleagues and loved ones lose their lives to the pandemic, nevertheless, they still render care to patients no matter the circumstances. Due to that, it is imperative to ascertain the extent to which nurses who are much needed in healthcare delivery have been affected by this pandemic. This scoping review used Arksey and O'Malley's review methodology to investigate the nature of work-related psychosocial challenges nurses encountered during the peak of the pandemic, noting the major contributors to the challenges and the coping strategies used to address them.

METHODS

We performed a scoping review and searched for articles from five databases including PUBMED, CINAHL, SCOPUS, Google Scholar, and Grey literature from December 2019 to December 2021. A total of 7,334 articles were retrieved for the study but 45 met the inclusion criteria.

RESULTS

Work-related psychosocial challenges identified included stress, burnout (emotional exhaustion and depersonalization), Post-Traumatic Stress Disorder, depression, sleeplessness, and anxiety. Factors that accounted for the challenges were inadequate personal protective equipment (PPEs), discomfort using the PPEs, extreme workload, and fatigue. Nurses experienced job insecurity, business closure, and separation from family and loved ones, and these contributed to their challenges. Strategies used to deal with the challenges centred on emotion-focused and problem-focused coping.

CONCLUSIONS

The study recommends regular counselling and support for all nurses working at the frontline to help them better cope with the devastating effects of the pandemic so that they could build resilience towards future pandemics.

Resilience, job satisfaction, intentions to leave nursing and quality of care among nurses during the COVID-19 pandemic - a questionnaire study

BACKGROUND

The COVID-19 pandemic has challenged nurses and healthcare systems globally and raised major concerns for nurses' wellbeing and working conditions. This cross-sectional and correlational study design aims to describe nurses' resilience, job satisfaction, intentions to leave and quality of care, and explain their relationships during the COVID-19 pandemic.

METHODS

Data were collected from Registered Nurses (N = 437) in Finland through an electronic survey between February 2021 and June 2021. The questionnaire covered background characteristics (seven questions), resilience (four questions), job satisfaction (one question), intention to leave nursing (two questions), quality of care (one question), and requiring factors of the work (eight questions). The background variables and dependent variables were analyzed and presented using descriptive statistics. Structural equation modeling was used to explain dependent variables relationships. The study followed procedures recommended in the STROBE Statement for cross-sectional studies in efforts to maximize the quality of reporting results.

RESULTS

The surveyed nurses evaluated their resilience by mean score 3.92, more nurses had considered leaving nursing during the pandemic (16%) than before (2%). Nurses´ mean score of requiring factors of the work was 2.56 and overall job satisfaction 5.8. Structural equation modeling revealed that resilience affected their job satisfaction, which also influenced the quality of care, that was rated moderate (7.46 out of 10). Structural equation modeling indices of goodness of fit were NFI = 0.988, RFI = 0.954, IFI = 0.992, TLI = 0.97, CFI = 0.992, and RMSEA = 0.064. No direct relationship was found between resilience and intention to leave nursing.

CONCLUSIONS

Good resilience promoted delivery of high-quality care by nurses during the pandemic and enhanced their job satisfaction, which reduced their intention to leave nursing. The results indicate that it is important to develop interventions that support nurses' resilience.

IMPACT

The study highlights the importance of nurses' resilience during the pandemic, while job satisfaction may decrease and requiring factors of the work increase. Given the number of nurses who consider leaving nursing, there are clear needs to develop effective strategies to maintain quality healthcare with resilient, committed nursing staff.

Physical and stressful psychological impacts of prolonged personal protective equipment use during the COVID-19 pandemic: A cross-sectional survey study

BACKGROUND

Healthcare workers (HCWs) caring for COVID-19 infected patients are exposed to stressful and traumatic events with potential for severe and sustained adverse mental and physical health consequences. Our aim was to assess the magnitude of physical and mental health outcomes of HCWs due to the prolonged use of personal protective equipment (PPE) treating COVID-19 patients.

METHODS

This cross-sectional study assessed the symptoms of stress, anxiety, insomnia, and psychological resilience using the Stress and Anxiety to Viral Epidemics (SAVE) scale, Insomnia Severity Index (ISI), and Resilience Scale (RS), respectively, in Italy between 1st February and 31st March 2022. The physical outcomes reported included vertigo, dyspnea, nausea, micturition desire, retroauricular pain, thirst, discomfort at work, physical fatigue, and thermal stress. The relationships between prolonged PPE use and psychological outcomes and physical discomforts were analyzed using Generalized Linear Models (GLMs). We calculated the factor mean scores and a binary outcome to measure study outcomes.

FINDINGS

We found that 23% of the respondents reported stress related symptoms, 33% anxiety, 43% moderate to severe insomnia, and 67% reported moderate to very low resilience. The GLMs suggested that older people (>55 years old) are less likely to suffer from stress compared to younger people (<35 y.o); conversely, HCW aged more than 35 years are more inclined to suffer from insomnia than younger people (<35 y.o). Female HCW reported a lower probability of resilience than males. University employed HCWs were less likely to report anxiety than those who worked in a community hospital. The odds of suffering from insomnia for social workers was significantly higher than for other HCWs. Female HCW>3 years old, enrolled in training programs for nursing, social work, technical training and other healthcare professionals increased the probability of reported physical discomforts. HCW that worked on non COVID-19 wards and used PPE for low-medium exposure level, were at lower risks for lasting physical side effects as compared to the HCW who worked in high-risk PPE intense, COVID-19 environments.

INTERPRETATION

The study suggests that frontline HCWs who had extensive PPE exposure while directly engaged in the diagnosis, treatment, and care for patients with COVID-19 are at significant risks for lasting physical and psychological harm and distress.

Impact of COVID-19 on Referral Patterns and Service Delivery for an Integrated Behavioral Health Program

The emergence and rapid spread of COVID-19 led to unprecedented changes for families and systems of care. This study sought to understand the needs of families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) before and during the pandemic and considers the impact remote service delivery has on access to an integrated behavioral health intervention to support the psychosocial needs of children and caregivers. Needs for referral varied significantly pre- and post-pandemic onset. Analyses revealed that significantly more referrals were made regarding social determinants of health after the onset of COVID-19 (13.8%) compared with prior to the COVID-19 pandemic (4.1%, p < .05). Providers' transition to telehealth services sufficiently served WIC families.

Factors Associated with Job Stress and Their Effects on Mental Health among Nurses in COVID-19 Wards in Four Hospitals in Korea

Increased workload during the COVID-19 pandemic has threatened nurses' mental health. This study aimed to identify factors associated with job stress in COVID-19 nurses compared to other nurses. Nurses were recruited from four hospitals in Republic of Korea in November 2020. The general sociodemographic questionnaire, job stress, anxiety (GAD-7), and depression (PHQ-9) were used to conduct an online survey. Stepwise multiple regression analysis was used to identify the factors associated with job stress. A total of 290 participants were analyzed: 122 in the dedicated ward and 168 in the nondedicated ward nurse groups. Job stress, anxiety, and depression were higher in nurses dedicated to COVID-19 (4.19 ± 0.59, 5.98 ± 3.92, and 6.97 ± 4.47, respectively) than in the nondedicated group (3.92 ± 0.72 (p = 0.001), 4.98 ± 4.20 (p = 0.042), and 5.92 ± 4.36 (p = 0.047), respectively). Among COVID-19 nurses, job stress levels were higher in 30-39 year olds than in 20-29 year olds (3.71 ± 0.43 vs. 4.04 ± 0.54, p = 0.006) and in non-smokers compared with smokers (3.85 ± 0.49 vs. 3.38 ± 0.53, p = 0.24). Anxiety (β = 0.34, standard error (SE) = 0.01, p < 0.001) and clinical experience of 5-10 years (β = 0.23, SE = 0.10, p = 0.004) were associated with job stress. These findings can be applied when devising response strategies for infectious diseases and developing psychological and organizational intervention programs for alleviating job stress in nurses.

Understanding the Impact of Span of Control on Nurse Managers and Hospital Outcomes

GOAL

Span of control is a multidimensional concept requiring a comprehensive definition that captures the complexities of the nurse manager's role in acute care settings. This concept analysis aimed to identify factors associated with span of control and provide a comprehensive definition outlining the breadth of this concept.

METHODS

ProQuest, PubMed, and Scopus databases were used to search peer-reviewed literature addressing the span of control in acute care nurse management. The search produced 185 articles; 177 titles and abstracts were screened for eligibility. Data from 22 articles were included in this analysis.

PRINCIPAL FINDINGS

This analysis includes antecedents, attributes, and consequences of expanded nurse manager spans of control. Work-related factors such as staff and manager experience levels, work complexity, and patient acuity are attributes of a nurse manager's span of control. Our findings suggest that expanded spans of control can have negative consequences on nurse managers such as role overload and burnout. Low satisfaction among staff and patients can result from excessive spans of control.

PRACTICAL IMPLICATIONS

An awareness of span of control can promote sustainable nursing practices by improving workplace conditions, staff satisfaction, and patient care quality. Our findings may translate across other health disciplines and thus contribute to scientific knowledge that can support changes in job designs and encourage more manageable workloads.

Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes

GOAL

The purpose of this study was to examine nurse staffing while describing the relationships that exist in staffing and quality associated with nursing care during the COVID-19 pandemic, a significantly challenging time for nurse staffing. We examined the relationship between permanent registered nurse (RN) and travel RN staffing during the pandemic and the nursing-sensitive outcomes of catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), falls, and hospital-acquired pressure injuries (HAPIs) and length of stay and compared the cost of CAUTIs, CLABSIs, falls, and HAPIs in fiscal years 2021 and 2022.

METHODS

We used a descriptive, observational design to retrospectively examine permanent nurse staffing volume and CAUTI, CLABSI, HAPI, and fall counts from October 1, 2019, to February 28, 2022, and travel nurse volume for the most current 12 months, April 1, 2021, to March 31, 2022. Descriptive statistics, Pearson correlation, and statistical process control analyses were completed.

PRINCIPAL FINDINGS

Pearson correlation showed a statistically significant, moderately strong negative correlation (r = -0.568, p = .001) between the active registered nurse full-time equivalents (RN FTEs) and average length of stay (ALOS), and a moderately strong positive correlation (r = 0.688, p = .013) between the travel RN FTEs and ALOS. Pearson correlations were not statistically significant, with low to moderate negative correlations for CAUTIs (r = -0.052, p = .786), CLABSIs (r = -0.207, p = .273), and falls (r = -0.056, p = .769). Pearson correlation for active RN and HAPI showed a moderately strong, statistically significant positive correlation (r = 0.499, p = .003). We observed common cause variation in CAUTIs and CLABSIs, with HAPIs and falls showing special cause variation via statistical process control.

PRACTICAL APPLICATIONS

Despite the challenges associated with the lack of available nurse staffing accompanied by increasing responsibilities including unlicensed tasks, positive clinical outcomes can be maintained by staff adherence to evidence-based quality improvement.

Lessons Learned from the COVID-19 Outbreak as Experienced by ICU Nurses: Manifest Qualitative Content Analysis

From the moment the World Health Organization (WHO) declared the coronavirus (COVID-19) a global pandemic, intensive care unit (ICU) nurses struggled to care for the COVID-19 patients. As the pandemic became increasingly critical, the task of daily care for critically ill patients fell upon the shoulders of ICU nurses. Understanding the lived experience of ICU nurses, as well as their perception of the experience, is important to identify key lessons to further improve ICU nurses' psychological well-being and resilience. This study explored the lived experiences of ICU nurses who cared for COVID-19 patients using exploratory manifest qualitative content analysis. The findings of this study revealed that these ICU nurses offer important information concerning the crucial role of nurses' family support and religious-spiritual practices in helping them to maintain well-being and cope with the intense situations caused by the pandemic. The lessons emerging from the study findings show that family support and religious-spiritual practices are resources for coping and resilience in times of future pandemics. This implies that ICU nurses who provide care during stressful emergency surges require relief by nurses working in other areas to provide them the opportunity to rest, reconnect with family and become emotionally re-energized.

Aging and Burnout for Nurses in an Acute Care Setting: The First Wave of COVID-19

We examined the relationship between age, coping, and burnout during the peak of the COVID-19 pandemic with nurses in Texas (N = 376). Nurses were recruited through a professional association and snowball sampling methodology for the cross-sectional survey study. Framed in lifespan development theories, we expected that nurse age and experience would be positively correlated with positive coping strategies (e.g., getting emotional support from others) and negatively correlated with negative coping strategies (e.g., drinking and drug use). We also expected age to be negatively related to the emotional exhaustion and depersonalization facets of burnout and positively related to the personal accomplishment facet of burnout. Findings were largely supported in that age was positively associated with positive coping and personal accomplishment and age and experience were negatively correlated with negative coping and depersonalization. Age was not, however, associated with emotional exhaustion. Mediation models further suggest that coping explains some of the effect of age on burnout. A theoretical extension of lifespan development models into an extreme environment and practical implications for coping in these environments are discussed.

Determining the effect of selected mental factors on turnover intention through two modulators - stress and resilience over COVID-19 period

INTRODUCTION

Turnover intention among nurses has risen in an alarming rate since the onset of the pandemic. There are various underlying factors to turnover intention. The present study aims to determine the effect of a number of mental factors on nurses' professional-turnover intention through two modulators of stress and resilience over COVID-19 period.

METHODS

The current cross-sectional study was conducted at three hospitals in Khuzestan Province, southern Iran, during the winter of 2021. To collect the data, given the restrictions in place during COVID-19 period, the web link of electronic self-reported questionnaires (including general health, mental workload, work-family conflict, resilience, job stress, corona fear, and turnover intention) were sent to 350 nurses through e-mail and other social media (WhatsApp and Telegram). Accordingly, they were asked to complete the questionnaire during rest periods within two weeks. Totally, 300 people (85% participation) filled out the questionnaires. Finally, a model was constructed in the Amos software.

RESULTS

The results showed that the four independent parameters of decreasing general health, increasing mental workload, increasing WFCs and fear of COVID-19 can indirectly increase nurses' turnover intention by increasing job stress. Among these variables, the highest indirect effect coefficient on turnover intention was related to the general health parameter (-0.141). The results also demonstrated a negative correlation between job stress and resilience, with lower resilience raising job stress and, consequently, increasing intention to quit the job.

CONCLUSION

Mental factors affecting turnover intension were identified in this study through path analysis. Therefore, it is recommended that the required resilience-enhancing measures to be taken by hospitals and nursing administrations to reduce psychological pressures caused by mentioned variables with the aim of minimizing job-related stress and fostering nurse retention.

Hospital staff nurse perceptions of resources and resource needs during the COVID-19 pandemic

BACKGROUND

There is a knowledge gap related to the resource needs of hospital nurses working during the Coronavirus disease 2019 (COVID-19) pandemic.

PURPOSE

To investigate nurses' perceptions of organizational resources and support needs approximately 18 months after the COVID-19 pandemic began.

METHOD

Cross-sectional survey of a convenience sample of 2,124 U.S. hospital nurses from July to September 2021 FINDINGS: There were some misalignments between what resources were provided to nurses and what was perceived as helpful to them. Nurses reported increased staffing, compensation, and management and leadership support most frequently as resources that could help them continue to provide safe and quality care during and after the pandemic. These were also the resources nurses most frequently reported that they wanted to be provided by their hospitals during the pandemic but were not.

DISCUSSION

The findings offer valuable insights into how organizations can prepare to ensure workforce resilience during future crises.