Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic

Knowledge, Attitudes, and Practices of Hand Hygiene, Mask Use, and Social Distancing among Public Hospital and Polyclinic Nurses in Barbados during the Coronavirus 2019 Pandemic

BACKGROUND

Nurses are essential members of the healthcare workforce and were among the first-line carers for patients in community and hospital settings during the COVID-19 pandemic. As a result, they were at a heightened risk of infection, resulting in several reported deaths among nursing staff. Several preventive measures were adopted to contain the spread of the COVID-19 virus. This study aims to explore the knowledge, attitudes, and practices (KAP) of nurses regarding hand hygiene, mask wearing, and social distancing measures in healthcare settings in Barbados during the COVID-19 pandemic.

METHOD

An online survey of nurses working in public hospitals and polyclinics (public primary care clinics) in Barbados from March 2021 to December 2021 was conducted. A nonsystematic convenience sampling method was employed to recruit nurses who were readily available and willing to participate. A questionnaire captured the sociodemographic information and knowledge and practices related to hand hygiene, the use of face masks, and social distancing. Each correct response received one mark. Overall knowledge scores were categorized as poor (<60%), average (60-80%), or good (>80-100%).

RESULTS

Of the 192 participants, the majority were female (82.8%) and had >5 years of experience (82%). The findings revealed that 45.8% had poor knowledge of hand hygiene, and that the knowledge of 43.8% of respondents was average. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 2.1 times increased odds (95% confidence interval 1.0, 4.2) of having good knowledge compared to other nursing categories. Regarding mask wearing, 53.6% of nurses had average knowledge, and 27.1% had good knowledge. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 3.3 times increased odds (95% confidence interval 1.5, 7.4) of having good knowledge compared to nursing assistants. A total of 68.6% of respondents followed the correct steps of handwashing every time, and 98.3% wore a mask in public places. More than half of the nurses (51.2%) kept a safe distance from others to avoid spreading SARS-CoV-2; one-third were in a crowded place(s) in the past three months, and 55.8% usually followed guidelines for social isolation as recommended by the WHO.

CONCLUSIONS

The study identified knowledge deficiencies related to hand hygiene and wearing masks among nurses. It is imperative to provide additional training on infection control measures.

Australian emergency nurses' experiences of working with personal protective equipment during the COVID-19 pandemic. A qualitative study

INTRODUCTION

The COVID-19 pandemic has exposed a need to understand the challenges associated with wearing Personal protective Equipment (PPE). The aim in this study was to explore emergency nurses' experiences early in the COVID-19 pandemic in Australia and the impact of PPE use on their practice.

METHODS

An explorative descriptive qualitative study was conducted between January 2022 and April 2022. Eighteen emergency nurses and six leaders participated. Semi-structured interviews (n = 21) and one focus group were conducted. Interview transcripts were analysed using Braun and Clarke's framework.

RESULTS

Two major themes were identified. The first theme was: (1) The shifting ground of the COVID-19 pandemic response. Associated sub-themes were: i) What's the go with PPE today? ii) In the beginning we were scrambling for masks; iii) Emergency is the true frontline. The second theme was: (2) Physical and emotional impacts of emergency nursing work. Sub-themes were: (i) Facing the fear of exposure; (ii) By the end of the shift I am just absolutely spent; iii) Discomfort of wearing PPE impacts on compliance.

CONCLUSIONS

Healthcare leaders need to secure PPE supply chains and evaluate the effectiveness and side-effects of different PPE designs to minimise occupational harms associated with prolonged PPE use.

Nurses' experiences of the phenomenon 'isolation communication'

BACKGROUND

Communication with patients and relatives can be a challenge in the intensive care unit (ICU) setting because of the acute and critical situation. However, when caring for patients with infectious diseases like COVID-19, nurses' communication is challenged further due to the required use of personal protective equipment (PPE) and mandatory isolation regimes.

AIM

To explore nurses' experiences of communicating while wearing PPE during COVID-19 isolation precautions in the ICU.

STUDY DESIGN

A qualitative study within the phenomenological-hermeneutic tradition. Data were collected via 12 interviews with nurses working in a Danish ICU from September to November 2020. Data were analysed using a Ricoeur-inspired text interpretation method.

FINDINGS

Three themes emerged during the analysis: (1) communication was limited and distanced and nurses had to compromise; (2) the nurses' senses were reduced, and verbal and nonverbal communication practises changed; and (3) patients' and relatives' communicative vulnerability were exposed in an extraordinary situation.

CONCLUSION

The analysis revealed a phenomenon that can be described as 'isolation communication'. The isolation precautions and use of PPE had a profound impact on the nurses' caring and communicative practices, which were limited in this situation. The nurses found themselves physically, emotionally and socially distanced from the patients, relatives and their colleagues. However, to prevent the spread of the virus, isolation communication is something that the nurses have to endure.

RELEVANCE TO CLINICAL PRACTICE

As our findings show that the nurses' communicative practises had to change during isolation communication, it is important for clinical practise and education to focus on implementing communication methods that optimise message transmission between ICU clinicians, patients and relatives in conditions requiring PPE and isolation. We should also focus on how to optimise interdisciplinary health communication in this situation.

Stress among nursing staff and interventions in Austrian nursing homes: Results of a survey in the first and the second waves of COVID-19

Background

Most of the limited number of studies that have been carried out on COVID-19 in nursing homes have not included primarily nursing staff. Nevertheless, knowledge about staff experiences will help to provide recommendations for the future.

Aim

The aim of this study was to describe stress experienced and interventions performed by nursing staff and to identify factors that are associated to the perceived stress among Austrian nursing home staff during the first and the second waves of COVID-19.

Methods

A secondary data analysis of two cross-sectional surveys performed in 2020 and 2021 among nursing home staff was performed. We did descriptive analysis as well as univariate and multivariate logistic regression analyses.

Results

A total of 449 nurses participated in the first survey and 300 in the second survey. 12.7% experienced high stress levels in the first wave, while 26.0% experienced high stress levels in the second wave (p < 0.001). The analysis showed that nursing staff in the second wave had a 2.195-fold higher relative chance of experiencing a high stress level compared to nursing staff in the first wave (p < 0.001). Caring for COVID-19 residents (odds ratio [OR] 1.827; p = 0.007) and being female (OR 1.992; p = 0.018) also significantly increased the relative chance of experiencing a high stress level. Some protective interventions, such as the use of FFP masks, increased between the two waves, while others decreased, such as the practice of airing the residents' rooms.

Conclusion

Austrian nursing staff in nursing homes experienced more stress during the second wave, illustrating the heavy burden of the long pandemic on staff. Nursing management should plan appropriate supportive interventions such as psychological help, stress relief measures and financial incentives for nursing staff, especially for the identified high-risk groups.

Supplementary Information

The online version of this article (10.1007/s16024-022-00395-x) contains supplementary material, which is available to authorized users.

Physical Burden and Perceived Stress of Personal Protective Equipment During COVID-19 Pandemic: A Retrospective Study in the United Arab Emirates

Introduction

Over the course of the COVID-19 pandemic, personal protective equipment (PPE) has become necessary. According to published research, PPE-related physical impacts were probably underreported during the pandemic.

Objective

To examine the physical burden and perceived stress associated with prolonged PPE wearing among nurses during the COVID-19 pandemic in the United Arab Emirates (UAE).

Methods

This was a cross-sectional retrospective study of 209 nurses working in two hospitals in the UAE. A convenience sampling technique was applied, and the data were collected using an online questionnaire. Data collection was completed within three months (April 2022 to June 2022). The completed questionnaires were analyzed using SPSS version 21. Chi-square statistics was used to test the association of categorical variables at a 5% level of significance.

Results

A total of 209 nurses had a mean age of 38.4 ± 8.7 years. More than 65.1% wore PPE continuously for 4 hrs per day. The most common physical burdens reported were difficulty in breathing (62.2%), excessive thirst (41.6%), and facial itchiness (39.2%). Most participants (95.2%) reported high-stress levels. There was no significant association between the level of stress and the duration of wearing PPE (p = .43 > .05). However, the authors found a statistically significant association between breathing difficulty with face masks and the duration of wearing them (p < .05). In addition, itchiness/rash related to gloves was significantly associated with wearing duration (p < .05).

Conclusion

Findings show that nurses experienced adverse effects from PPE use, which increased with the number of hours of wearing. Further studies with a larger sample size will allow for generalization of the study results.

A Cross-Sectional Study of the Perceived Stress, Well-Being and Their Relations with Work-Related Behaviours among Hong Kong School Leaders during the COVID-19 Pandemic

The health and well-being of school leaders during the COVID-19 pandemic have been largely neglected compared to the health and well-being of students and teachers. This study assessed the magnitude of perceived stress and well-being and the associated factors, including number of working hours, work-related sense of coherence (work-SoC), perceived stress, self-endangering work behaviour, secondary burnout symptoms, and satisfaction with work, among school leaders in Hong Kong, China during the COVID-19 pandemic. This cross-sectional, survey-based study collected demographic data and mental health measurements from 259 eligible school leaders in Hong Kong from April 2021 to February 2022. Pearson's correlation analyses, multilinear regression models, and independent-samples Student's t-tests were performed. The findings revealed that school leaders' perceived stress was negatively correlated with their well-being (r = -0.544, p < 0.01) and work-related SoC (r = -0.327, p < 0.01) but positively correlated with their extensification of work (r = 0.473, p < 0.01), exhaustion related to work situations (r = 0.559, p < 0.01), and psychosomatic complaints (r = 0.439, p < 0.01). In a model that adjusted for gender and age, student leaders with higher subjective well-being scores had a lower level of perceived stress (B = -0.031; 95% confidence interval [CI], -0.59, -0.02; p = 0.034), whereas leaders in schools with a larger student population had a higher level of perceived stress (B = 0.002; 95% CI, 0.000, 0.003; p = 0.030). School leaders with a higher likelihood of performing the self-endangering work behaviour of 'intensification of work' had higher perceived stress levels (B = 1.497; 95% CI, 0.717, 2.278; p < 0.001). School leaders with a higher work-related SoC (B = 4.20; 95% CI, 1.290, 7.106; p = 0.005) had a higher level of well-being. School leaders with higher levels of perceived stress (B = -0.734; 95% CI, -1.423, -0.044; p = 0.037), a higher likelihood of performing the self-endangering work behaviour of 'extensification of work' (B = -4.846; 95% CI, -8.543, -1.149; p = 0.010), and a higher score for exhaustion related to work (B = -10.449; 95% CI, -13.864, -7.033; p = 0.000) showed lower levels of well-being. The finding of a high incidence of stress among school leadership justifies the need for more societal attention to the well-being of school leaders in Hong Kong. It is important that policies and initiatives are designed to enhance the well-being of school leaders and that they are supported in leading the management of schools and coping with stress in school settings.

Stress among healthcare workers during the COVID-19 pandemic and the determinant factors: a cross-sectional study

BACKGROUND During the COVID-19 pandemic, there has been an increase in workload, as well as greater vigilance and compliance at work. Healthcare workers must perform their duties while facing the fear of COVID-19, which can trigger and/or aggravate stress. This study aimed to obtain the determinant factors of stress among healthcare workers during the pandemic by emphasizing the change in the psychosocial situation at the hospital. METHODS This cross-sectional study was conducted from January to March 2021 using an online questionnaire consisting of personal and occupational questionnaires, as well as the validated stressor and stress questionnaires using validity and reliability tests (Cronbach’s alpha 0.8 and 0.9). For the multivariate analysis, multiple logistic regression was used to identify the determinant factors (p<0.05). Data were analyzed using SPSS software version 20 (IBM Corp., USA). RESULTS Determinant factors of the occurrence of moderate–severe stress were the alteration of stressors including age (aOR = 1.9), working hours (aOR = 1.9), work zone (aOR = 2.7), limited facilities and resources (aOR = 6.2), risk of disease transmission (aOR = 0.3), and personal work demands (aOR = 2.1). CONCLUSIONS In addition to the younger age, the determinant factors of the incidence of moderate–severe stress in healthcare workers during the COVID-19 pandemic at the hospitals were work-related conditions. However, they remained controllable to prevent stress among healthcare workers in the peak load work situations such as a pandemic.

The effect of work stress, workload and social support on nurses' self-perceptions of parenting roles during the Covid-19 pandemic

AIMS

This study aims to investigate the effects of workload, work stress and social support on nurses' self-perceptions regarding their parenting roles in the Covid-19 pandemic and to examine the effect of nurse parents' sociodemographic characteristics on work stress and workload during the Covid-19 pandemic.

BACKGROUND

The Covid-19 pandemic has brought many challenges in the lives of nurses who are fighting at the forefront of the pandemic.

METHODS

One hundred ninety-eight nurse parents participated in the study conducted with a relational study design using an online questionnaire spread through social networks. 'The Nurse Parents Descriptive Information Form', 'The Swedish Demand-Control-Support Questionnaire (DCSQ)' and 'The Self-Perception of Parental Role Scale (SPPR)' were used for the study data.

RESULTS

A total of 90.9% of the participants are women. A significant difference was found between the spouse's job and the work stress and the work stress and workload (p < .05).

CONCLUSIONS

Participants working during the day experienced less work stress and workload than those working at night. Working in the pandemic unit has increased work stress and workload.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers need to plan supportive approach activities so that nurses can use effective methods to manage work stress and heavy workload. In addition, nurse managers should pay attention to developing qualified care and treatment skills in crises such as pandemics, where the workload increases tremendously.

Impact of Non-Face-to-Face Teaching with Passive Training on Personal Protective Equipment Use in Health Science Students: A Randomized Controlled Trial

BACKGROUND

In the COVID-19 era, there was a call for the transformation of higher education. Universities had to combine non-face-to-face teaching with traditional procedures. This study analyzed the effectiveness and perceived satisfaction in a cohort of health sciences students of non-face-to-face teaching with passive training versus face-to-face teaching with active training in the proper donning and doffing of personal protective equipment (PPE) in a clinical simulation scenario.

METHODS

A total of 142 participants were randomized into two groups: (a) non-face-to-face teaching with passive training; (b) face-to-face teaching with active training. The proper protocol for donning and doffing PPE was assessed. Students evaluated their skills before and after training and satisfaction with training received.

RESULTS

Significant differences were observed for the statements "I felt more confident in donning after receiving this training" (p = 0.029) and "I felt more confident in doffing after receiving this training" (p = 0.042) in the face-to-face teaching with active training group compared to the non-face-to-face teaching with passive training group, whose number of tasks violated was significantly higher (p = 0.020). Satisfaction was significantly higher in the face-to-face and active training group (p = 0.004).

CONCLUSIONS

Face-to-face teaching with active training improves effectiveness and satisfaction more than non-face-to-face teaching with passive training for acquiring skills in donning and doffing PPE properly.

Fostering Nursing Staff Competence in Personal Protective Equipment Education during COVID-19: A Mobile-Video Online Learning Approach

Nursing staff who are competent to use personal protective equipment (PPE) correctly can protect themselves while providing safe, high-quality care to patients. Under pandemic conditions, the ability to wear PPE correctly is essential in clinical practice, but the acquisition of correct PPE-wearing procedures is difficult for most staff in the absence of live practice drills. This study aimed to test the mobile video online learning approach by integrating PPE contexts into a digital learning system. We conducted an experiment to verify whether the mobile video online learning approach could effectively improve nursing staff’s learning achievement, learning anxiety, critical thinking skills, and learning self-efficacy. The study used a quasi-experimental design and was conducted with 47 nursing staff, divided into one group using a mobile video online learning approach and one group with a conventional learning approach. We used pre-and post-test examinations of learning achievements, learning anxiety, critical thinking, and learning self-efficacy. Results showed a significant effect of using the mobile video online learning method in helping nursing staff to decrease learning anxiety and improve knowledge about COVID-19 protection, increase learning achievement, critical thinking skills, and learning self-efficacy. These benefits are of interest to nursing workplace managers wishing to maintain professional standards during epidemics by improving the nursing staff’s PPE knowledge and self-efficacy concerning PPE.

Perceived Occupational Stressors and the General Health of Critical Care Nurses During COVID-19 Pandemic

INTRODUCTION

The COVID-19 situation is placing nurses under great stress which may negatively influence their health.

OBJECTIVE

The purpose of this study was to examine the association between occupational stress and general health of critical care nurses during COVID-19 pandemic.

METHODS

A descriptive, cross-sectional design was used. A convenience sample of 150 Jordanian critical care nurses completed the study.

RESULTS

Occupational stress was a significant predictor of nurses' general health. Female gender, young, living with elderly or persons having chronic diseases, and little nursing experience were associated with worse general health, while living with elderly or persons having chronic diseases were associated with more occupational stress.

CONCLUSION

Providing psychological support services for critical care nurses is required to reduce the impact of occupational stress on nurses' poor general health.

Hot days and Covid-19: Online survey of nurses and nursing assistants to assess occupational heat stress in Germany during summer 2020

OBJECTIVES

Our aim was to identify if working during hot days while wearing Covid-19 related personal protective equipment causes occupational heat stress for nurses and nursing assistants in Germany.

DESIGN

Using an online survey, we assessed the impact of hot weather on nurses and nursing assistants working with personal protective equipment. Respondents were recruited by distributing the link to the survey via personal communication, email and various social media channels to nursing staff from hospitals, nursing homes and outpatient care.

RESULTS

There were in total 428 participants (18.2% male, 82.5% female), mostly (30.5%) aged between 45 and 55 years. Half of respondents (48.3%) had more than 20 years of experience in nursing. Cardiac, pulmonary, or other pre-existing conditions were reported by 46.2%.Nurses and nursing assistants working in personal protective equipment during hot days were exposed to occupational heat stress. Work was found exhaustive by 96.5% of the participants during those days. 93.0% reported breathing problems and 85.8% reported difficulties with focusing on their work. Many workplaces did not provide adequate heat protection, with distinct differences concerning the amount of prophylactic and heat mitigating measures across institutions. There were significant differences across institutions when it comes to the number of drinks served (p < 0.001), the availability of room thermometers (p < 0.001), the use of mobile cooling devices (p < 0.001) and fans (p < 0.05).

CONCLUSIONS

Results suggest employers must make more of an effort to provide adequate heat protection for their nursing staff. In order to ensure patient care, there is a need for action; in particular, attention must be paid to the pre-existing health conditions of the nursing staff.

[Make nursing practice visible through nursing science in times of COVID-19]

Die Pflegepraxis steht durch die COVID-19-Pandemie vor enormen Herausforderungen. Dennoch war die Pflegewissenschaft als Sprachrohr für die Praxis im öffentlichen Diskurs rund um die COVID-19-Pandemie kaum aktiv vertreten. Dementsprechend stellt sich die Frage, welche Projekte mit Fokus auf Pflege und COVID-19 an österreichischen Hochschulen durchgeführt wurden. Insgesamt wurden 6 Projekte mittels Schneeballverfahren identifiziert. Eine Studie zeigte, dass eine erhöhte Tragedauer von Masken mit einem erhöhten Stresslevel der Pflegepersonen zusammenhängt. Ein weiteres Studienergebnis zeigte, dass 50 % der Laien, Masken fehlerhaft benutzten. Individuelle Erfahrungen, getroffene Maßnahmen und Lösungsansätze aus der Sicht der Pflegepersonen hinsichtlich ethischer Herausforderungen in Pflegeheimen wurden in einem weiteren Projekt erhoben. Durch diese und andere Projekte ergreift die Pflegewissenschaft mit ihren Erkenntnissen als Sprachrohr für Pflegekräfte die Initiative und bringt sich in den COVID-19-Diskurs ein. Die Erkenntnisse aus den Projekten können zukünftig als Basis für politische Entscheidungen genutzt werden.

Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic

Aim

This study gives insights into the association between the use of personal protective equipment (PPE), wearing time of masks and stress among frontline nursing staff during the COVID‐19 pandemic.

Background

PPE can have physical consequences like headache and pain, which could result in increased nurse stress levels.

Methods

A total of 2600 nurses participated in this online survey. The questionnaire is based on literature and includes the perceived level of stress scale.

Results

We found no significant association between the use of PPE and stress. Nurses who wore masks for more than 8 h had significant higher stress levels than those who used the masks for a shorter period.

Conclusions

The duration of wearing masks is associated with nurse's stress level. Our findings can help nurses to argue a higher frequency of breaks and a maximum duration of mask usage in their organisations.

Implications for Nursing Management

We recommend that nursing managers implement practical strategies such as a mask break task force. This task force could promote awareness for mask breaks and recommend and allocate rooms or locations such as balconies for mask breaks.