COVID-19 under the SARS Cloud: Mental Health Nursing during the Pandemic in Hong Kong

Sleep Disturbances in Health Professional Students During the COVID-19 Pandemic: A Concept Analysis

AIM

The aim is to delineate the concept of sleep disturbances in health professional students during the COVID-19 pandemic.

DESIGN

A concept analysis was conducted.

METHODS

A systematic search was conducted for relevant articles published and performed from inception to July 5, 2024. Electronic databases searched included PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Web of Science. Rodgers' method of evolutionary concept analysis was used.

RESULTS

A total of 50 pertinent articles were included in our analysis. Utilising inductive thematic analysis, this study identified attributes, antecedents and consequences of sleep disturbances. Important attributes included insomnia, disrupted sleep patterns, altered sleep duration/nocturnal sleep duration and poor sleep quality. Antecedents encompassed factors such as gender, age/grade levels, physical activity, screen time of digital production, mental health issues, COVID-19-related stressors, financial strain and academic stress. Consequences included both mental and physical health implications. By addressing sleep disturbances and promoting better sleep health among students, we can enhance their learning and performance, which could translate to improved patient care outcomes. Additionally, understanding and mitigating sleep disturbances can contribute to the development of a more resilient and effective health care workforce, capable of providing high-quality care even during crises like the COVID-19 pandemic.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The effect of dispositional resilience on the relationship between professional quality of life and psychological distress factors of nurses during the pandemic: A three-wave longitudinal study

BACKGROUND

COVID-19 overwhelmed all healthcare workers, especially nurses, who worked tirelessly in patient care in extremely stressful situations. Italy, with its hospital overcrowding and staff shortages, exacerbated these negative consequences.

DESIGN

A three-wave prospective longitudinal-design was adopted to use validated scales to examine the trend of stress, anxiety, depression and resilience on the professional quality of life of nurses who worked during the pandemic. During an 8-month period, a sample of 411 individuals was recruited and surveyed three times.

RESULTS

Resilience showed an increasing positive trend from the first to the third wave, increasing its effects on the outcomes and demonstrating its important protective role. The compassion fatigue showed progressively higher scores in the three waves, indicating greater workload perception and greater difficulty in managing the patients' perceived stress. Burnout increased in the first compared to second waves but decreased significantly in the third wave, due to the effect of resilience on burnout that was significantly stronger in the third wave.

CONCLUSION

Our findings align with the literature about the role of resilience and emphasize the importance of investing in strategies aimed at developing resilience in healthcare workers and providing prevention and assistance to them in terms of job demands and unsustainable stressors.

A Pilot Randomized Controlled Trial Among People Recovering from Mental Illness: A Tailored Mindfulness-Based Intervention versus Relaxation Training

BACKGROUND

This study assessed the potential effectiveness, acceptability and feasibility of a tailored mindfulness-based intervention (MBI, REMIND 2.0) for personal recovery among people with mental illness during the COVID-19 pandemic.

METHODS

In this pilot mixed methods randomized controlled trial, participants were assigned to either the MBI (n = 14) or the relaxation training (RT) (n = 14). Quantitative measures were used to assess primary outcomes, including personal recovery, mindfulness, self-compassion, resilience, and secondary outcomes, including depression, stress, anxiety, positive and negative moods, quality of life and general health at baseline (T0), post-intervention (T1) and one-month follow-up (T2). Quantitative interviews were conducted to explore the experiences and perceptions toward the MBI.

RESULTS

Results indicated significant group and time interactions for all outcomes except anxiety and stress. MBI participants showed significant improvements in all outcomes at T1, which were maintained at T2, except for positive mood. RT participants showed a significant decline in resilience but significant improvements in all secondary outcomes at T1, but all outcomes significantly declined at T2, except for anxiety and stress. MBI participants were receptive toward the programme in all aspects of personal recovery.

CONCLUSIONS

The tailored MBI is a potentially effective, feasible and acceptable approach to facilitate personal recovery among people with mental illness. Differences between MBI and RT are discussed.

Impact of Severe Acute Respiratory Syndrome, Coronavirus Disease 2019, and Social Unrest on Adult Psychiatric Admissions in Hong Kong: A Comparative Population-Based Study

ABSTRACT

In Hong Kong, two infectious disease outbreaks occurred in 2003 (SARS) and 2020 (COVID-19), and a large-scale social unrest happened in 2019. These were stressful societal events that influenced the mental well-being of the public. We aimed to explore the impact of these events on psychiatric admissions in Hong Kong. Socioeconomic and population-based psychiatric hospital admission data were retrieved from the government and Hospital Authority. Negative binomial time-series regression analysis was applied and we found overall significant reductions of psychiatric admissions during both the SARS and COVID-19 periods (-7.4% to -16.8%). Particularly, the admissions for unipolar disorders (-16.2% to -39.7%) and neuroses (-20.9% to -31.9%) were greatly reduced during the infection outbreaks. But an increase of admissions for schizophrenia (12.0%) was seen during the social unrest period. These findings support introducing early and targeted community mental health care strategies to the vulnerable people during the stressful societal events.

Exploring factors influencing depression among Polish nurses during the COVID-19 pandemic

Objectives

The COVID-19 pandemic has been recognized as an international public health emergency. The aim of our study was to identify contributors to nurses' depression.

Methods

This survey-based study was conducted in the Pomeranian Medical University Hospital no. 1 in Szczecin and involved 207 nurses. The following standardized research instruments were applied: the World Assumptions Scale, the Athens Insomnia Scale, the Impact of Event Scale - Revised, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder, the Perceived Stress Scale, and a questionnaire of our own authorship.

Results

The study showed that 72.95% of the subjects experienced severe stress, and 40.58% suffered from insomnia. In addition, 65.7% of the respondents had anxiety symptoms of varying degrees of severity, and 62.8% had depressive symptoms of mild to severe severity. The mean score on the IES-R scale, reflecting a psychological impact of the COVID-19 pandemic, was 34.25. The COVID-19 pandemic affected the psychological health of medical staff, particularly through increased stress and anxiety symptoms. Anxiety levels and insomnia significantly affect the prevalence of depression among nurses.

Conclusion

The COVID-19 pandemic has been recognized as an international public health emergency. The COVID-19 pandemic affected the psychological health of medical staff, particularly through increased stress and anxiety symptoms. It is important to conduct further research after the COVID-19 pandemic has ended.

Thinking beyond the virus: perspective of patients on the quality of hospital care before and during the COVID-19 pandemic

Objectives

The COVID-19 pandemic has a huge impact on the healthcare system and affects the normal delivery of routine healthcare services to hospitalized patients. This study aimed to examine the differences in patient experience of hospital service before and during COVID-19 among the discharged adult population.

Methods

A territory-wide patient experience survey was conducted before and during COVID-19 (between October 2019 and April 2020) among patients discharged from the main acute and rehabilitation public hospitals in Hong Kong. A hierarchical ordinal logistic model was employed to examine the difference in multiple dimensions of patient experience, with adjustments of covariates.

Results

In total, 9,800 participants were recruited. During the pandemic, there was a marginally significant increase in overall care rating (AOR: 1.12, 95% CI: 0.99-1.27), and an improvement in the timeliness of admission. However, significant reductions in patients' confidence in nurses were observed. Communication of information regarding medication side effects reduced significantly (AOR: 0.72, 95% CI: 0.64-0.82).

Conclusion

The patients hospitalized during the pandemic reported worse responsiveness in communication in their patient journey than those admitted before the pandemic. These findings will help develop appropriate strategies to address patients' concerns in the new normal.

The experiences of nurses during the COVID-19 crisis in India and the role of the state: A qualitative analysis

OBJECTIVES

The study documents the lived experience of nurses coping with the double burden of external demands and internal stressors while providing care during the COVID-19 pandemic in India.

METHODS

This qualitative study interviewed 18 female nurses who worked in the COVID wards of a major hospital in India. The one-on-one telephonic interviews were conducted with respondents based on three broad open-ended questions. Thematic analysis was conducted.

RESULTS

Three themes were identified: (i) external demands such as availability, utilization, and management of resources; (ii) internal psychological stressors, such as emotional exhaustion, moral anguish, and social isolation; and (iii) promotive factors such as the roles of the state and society, and of patients and attendants CONCLUSIONS: Findings suggest that despite limited resources and facilities, nurses ploughed through the pandemic with their resilience and the state's and society's promotive factors. To improve health care delivery in this crisis, the role of the state and healthcare system has become important to prevent the workforce from crumbling. The sustained attention of the state and society is required to reinstate motivation among nurses by raising the collective value of their contribution and capability.

Health-related quality of life and radiological and functional lung changes of patients with COVID-19 Pneumonia 3 and 10 months after discharge

BACKGROUND

Few studies have evaluated the long-term impact on health-related quality of life (HRQoL) in patients who have been hospitalized for COVID-19 pneumonia. Specific follow-up should be carried out to detect and treat possible pulmonary abnormalities, and the worsening of HRQoL should be estimated to target necessary resources for care of these patients after acute phase. The objective was to know the impact on HRQoL of patients who have been admitted for COVID-19 pneumonia, and to evaluate the clinical-radiological and functional changes of patients who have overcome COVID-19 pneumonia at 3 and 10 months of follow-up.

METHODS

Prospective observational study of patients who required hospitalization for COVID-19 pneumonia between April and December 2020. All patients filled out the EuroQol five-dimension (EQ-5D) questionnaire with the EuroQol Visual Analogue Scale (E-VAS) for self-assessment of health status. Respiratory function tests and chest X-ray were carried out at 3 and 10 months of follow-up.

RESULTS

61 patients were included in the study. The need for ventilatory support was associated with anxiety/depression on the EQ-5D scale, as well as patients admitted to the intensive care unit (ICU). The mean EQ-5D and E-VAS index scores decreased with hospitalization time, the number of days spent in intermediate respiratory care unit (IRCU) and the level of dyspnoea at the beginning of the hospitalization period. Pulmonary sequelae were observed in 25 patients (41%) at 3 months and 17 (27.9%) at 10 months. Patients improve their forced vital capacity (FVC) by 196 ml (p = 0.001) at 10 months as well as 9% in diffusing capacity of lung for carbon monoxide (DLCO) (p = 0.001) at 10 months. DLCO was found to be correlated to lymphopenia and time spent in IRCU. Low FVC values were detected 10 months after discharge for subjects exhibiting high levels of dyspnoea at 3 months after discharge.

CONCLUSIONS

Hospitalization for COVID-19 pneumonia affects the HRQoL of patients, with greater anxiety/depression in those who were more serious affected and are younger. A significant percentage of patients present fibrotic abnormalities and lung function impairment at the first and second follow-up after discharge.

Anxiety and Depression in the Initial Stage of the COVID-19 Outbreak in a Portuguese Sample: Exploratory Study

BACKGROUND

In previous studies, it was found that the confinement to which the population was subjected during the quarantine of the COVID-19 pandemic increased the risk of anxiety and depression.

OBJECTIVE

to analyze the levels of anxiety and depression symptoms in Portugal residents during the quarantine of the COVID-19 pandemic.

METHODS

This is a descriptive, transversal, and exploratory study of non-probabilistic sampling. Data collection was carried out between 6th and 31st of May 2020. Sociodemographic and health questionnaires PHQ-9 and GAD-7 were used.

RESULTS

The sample consisted of 920 individuals. The prevalence for depressive symptoms (PHQ-9 ≥ 5) was 68.2% and (PHQ-9 ≥ 10) was 34.8%, and for anxiety symptoms (GAD-7 ≥ 5) was 60.4% and (GAD-7 ≥ 10) was 20%. Depressive symptoms were moderately severe for 8.9% of the individuals, and 4.8% presented severe depression. Regarding the generalized anxiety disorder, we found that 11.6% of individuals present moderate symptoms, and 8.4% severe anxiety symptoms.

CONCLUSIONS

The prevalence of depressive and anxiety symptoms were substantially higher than those previously found for the Portuguese population and when compared with other countries during the pandemic. Younger individuals, female, with chronic illness and medicated, were more vulnerable to depressive and anxious symptoms. In contrast, participants who maintained frequent levels of physical activity during confinement had their mental health protected.

'Caring for the helpers': factors associated with professional quality of life among Hong Kong nurses during the fifth wave of the COVID-19 pandemic

BACKGROUND

Western studies have found that nurses are likely to experience both positive and negative emotions in their job, as a helping profession [professional quality of life (ProQoL)] during the coronavirus disease 2019 (COVID-19) pandemic, and that psychosocial and work-related variables (e.g. pandemic-related stressors, interpersonal and organizational support, coping strategies) are associated with such outcomes. However, relevant studies on nurses in the Asian context are limited.

OBJECTIVE

This study examined the psychosocial correlates of three indicators of ProQoL, i.e. compassion satisfaction, secondary traumatic stress (STS), and burnout, among nurses during the fifth wave of the COVID-19 pandemic in Hong Kong.

METHOD

Nurses in Hong Kong (N = 220) working in hospitals and community settings during the COVID-19 pandemic were recruited between 24 May and 27 June 2022 through nursing associations to complete an online survey measuring the aforementioned psychosocial variables.

RESULTS

Hierarchical regression results found that stressors from clinical work environments, insufficient emotional support, and less positive reframing were associated with poorer ProQoL (i.e. lower compassion satisfaction; higher STS and burnout) (β from 0.16, p > .05, to 0.44, p > .001). In addition, COVID-19-related worries/uncertainties and emotional processing were associated with higher STS (β from 0.21 to 0.23, p < .01), whereas insufficient organizational support for communication with the healthcare system was associated with higher burnout (β = 0.12, p < .05).

CONCLUSIONS

Our findings identified the important psychosocial determinants in ProQoL among nurses in Hong Kong and provide recommendations for services supporting the mental health of these nurses. Providing workshops for nurses to train their skills in coping with COVID-19-related uncertainties, worries, and stressors from the clinical work environment, in using adaptive coping strategies (e.g. positive reframing), and in soliciting emotional support from important others could facilitate their ProQoL. Moreover, the provision of organizational support through timely and transparent communication with the healthcare system could reduce STS in nurses.

The effect of COVID-19 uncertainty on internet addiction, happiness and life satisfaction in adolescents

This study aimed to determine the effects of the events during the COVID-19 epidemic on adolescents' levels of intolerance of uncertainty, internet addiction, happiness, and life satisfaction. Structural Equation Modeling was used in the analysis of the data. Adolescents' internet use increased during the epidemic process. It was found that COVID-19 events increased intolerance of uncertainty, and negatively affected internet addiction and happiness (p < 0.001). In this process, internet addiction and happiness is a mediator (p < 0.001). It is recommended to monitor adolescents' internet use during the COVID-19 process and to provide information about COVID-19.

Initial Psychometric Development of the Fear and Anxiety to COVID-19 Scale in Nursing Professionals: An Occupational Health Assessment Tool

Objective

The effects caused by COVID-19 on the physical and mental health show the need to renew and create tools that specifically measure the fear and anxiety caused by the pandemic in healthcare professionals. The aim of the study was to measure fear and anxiety of COVID-19 in the nursing population group using a specific assessment scale.

Methods

A descriptive, cross-sectional study was carried out in Spain based on questionnaires. The sample was selected by non-probabilistic snowball sampling. Univariate and bivariate descriptive analyses were performed. For qualitative variables, a categorical regression analysis was performed.

Results

The sample consisted of 1012 nurses residing in Spain, 86.6% of whom were women, with a mean age of 40.84 years (SD = 11.51). The bivariate analysis revealed statistically significant differences in the mean score of the scale and the variables sex, level of education, m2 of the dwelling, and work area.

Conclusion

The validation of this scale provides a new management tool that should enable managers to assess anxiety and fear among their nurses, whether in the current COVID-19 pandemic or in other possible epidemiological situations to come.

Analysis of Factors Related to Mental Health, Suppression of Emotions, and Personality Influencing Coping with Stress among Nurses

(1) The specificity of a nurse's work, apart from performing medical procedures, is characterized by intensive contacts with other people. Stress is an inevitable part of a nurse's job and can affect their physical and mental health. Thus, strategies for coping with stress play an important role in improving health or well-being by reducing the level of stress. (2) The aim of the study was to evaluate the impact of coping strategies in predicting the overall health of nurses. The study also assessed the impact of personality traits and emotional control (anger, depression, anxiety) on the choice of coping with stress among nurses. (3) The study included 811 nurses from the West Pomeranian Voivodeship, with an average age of 40 (SD = 9.8), working mainly in hospitals (82%). The research was carried out with a diagnostic survey method, using the Coping Inventory for Stressful Situations questionnaire, NEO-Five Factor Inventor, Courtland Emotional Control Care Scale, General Health Questionnaire 30, and a demographic questionnaire. (4) Among the surveyed nurses, the dominant style of coping with stress was the style focused on emotions (MT 0.43), followed by the style focused on avoidance (MT 0.42). There were mental problems among 46.1% of the respondents. Nurses with mental problems according to GHQ-30 were characterized by a high intensity of coping styles focused on emotions (30.2%), avoiding (18.7%), and engaging in alternative activities (32.3%) (p = 0.000). (5) Most of the surveyed nurses have a tendency to cope with stress through an emotional-focused style, which may be associated with a higher level of occupational stress.

Determinants of the risk of burnout among nurses during the first wave of the COVID-19 pandemic in Belgium: A cross-sectional study

AIMS

To estimate the prevalence of burnout risk among nurses during the peak of the first wave of the COVID-19 pandemic in Belgium and to identify risk groups and protective and risk factors.

BACKGROUND

Nurses are at high risk of burnout, and this can have negative consequences for them, patients and health care systems. The pandemic may have changed their working conditions and increased their risk of burnout.

METHODS

The risk of burnout was assessed through the Maslach Burnout Inventory Scale. Information on socio-demographic and working conditions during the pandemic was also collected. We obtained 4552 respondents through convenience sampling.

RESULTS

A high risk of burnout was found in 70% of respondents. The main risk factors of burnout were the lack of personal protective equipment, changes in perceived workload and working with COVID-19 patients.

CONCLUSIONS

An uneven workload for nurses is an underlying problem during the COVID-19 pandemic and a significant risk factor for their burnout. The decreased workload is a risk factor for burnout as important as increased workload and repeated exposure to COVID-19.

IMPLICATIONS FOR NURSING MANAGEMENT

Burnout prevention and treatment interventions must target the correct risk factors and identify nurses at risk to be cost-effective.

Out of the shadows: Impact of SARS experience on Chinese netizens' willingness to donate for COVID-19 pandemic prevention and control

While charitable donations help to raise funds and contribute to pandemic prevention and control, there are many unanswered questions about how people make such donation decisions, especially in countries like China where charitable donations have played an increasing role in recent years. This study contributes to the literature by assessing the potential impacts of Chinese netizens' experience with the 2002 severe acute respiratory syndrome (SARS) epidemic on their willingness to donate for COVID-19 pandemic prevention and control. Specifically, this study applies a difference-in-differences (DID) model to a dataset collected from a nationwide survey to examine how individuals' exposure to the SARS epidemic affects their willingness to donate to alleviate the COVID-19 pandemic. The results suggest that individuals' SARS epidemic experiences in their early lives, especially during the "childhood-adolescence" period, had a lasting and far-reaching impact on their willingness to donate toward COVID-19 pandemic prevention and control. Also, the impacts were likely heterogeneous by such sociodemographic factors as educational background, health status, and income level. The empirical findings highlight the importance of considering early-life experiences in developing and implementing epidemic prevention and control policies. While the SARS experience likely affected Chinese netizens' willingness to donate toward COVID-19 pandemic prevention and control, lessons learned from both the SARS epidemic and COVID-19 pandemic could be used to develop more effective public health education and prevention programs as well as to increase public donations for future pandemic prevention and control.

[COVID-19: Professional practices in closed institutional settings]

INTRODUCTION

While governments have focused efforts on implementing health measures such as physical distancing and confinement to protect communities from the spread of COVID-19, some researchers focused on the significant impact of these measures on mental health and well-being. Persons with mental disorders who are both institutionalized and justice-involved in psychiatric and forensic hospitals find themselves more vulnerable to these measures and more limited in their movements and activities.

AIMS

The purpose of this paper is to examine the changes in practice in response to the pandemic and their potential impact on individuals in institutional settings.

RESULTS

A rapid review including 69 publications identified nine major themes in the literature, which will serve as a framework to analyze the experience of one forensic psychiatry institution in Canada. These themes are: 1) population-specific vulnerability factors; 2) staff management and training; 3) early discharge, parole, and community integration; 4) management of contagion in closed spaces; 5) sanitary measures and personal protective equipment; 6) care and service continuity; 7) use of technology to maintain social ties and services; 8) legal mechanisms and individual rights; and 9) post-pandemic realities.

CONCLUSION

Although this is the first pandemic of such international magnitude, experts point to an increase in epidemics over the past decade and continued growth in the coming decades. It is thus essential to learn from this health crisis in order to be prepared and minimize their potential impact on vulnerable populations in the future. The reflections presented here could be contrasted with the lived-experiences of people in institutions in order to nuance the data and propose new strategies.

Work-based concerns of Australian frontline healthcare workers during the first wave of the COVID-19 pandemic

OBJECTIVE

This research sought to gauge the extent to which doctors, nurses and paramedics in Australia were concerned about contracting SARS-CoV-2 during the country's first wave of the virus in April 2020.

METHODS

Australian registered doctors, nurses and paramedics (n=580) completed an online questionnaire during April 16-30, 2020 (period immediately following the highest four-week period (first wave) of SARS-CoV-2 confirmed cases in Australia).

RESULTS

During April 2020, two-thirds of participants felt it was likely they would contract SARS-CoV-2 at work. Half the participants suggested Personal Protective Equipment (PPE) supplies were inadequate for them to safely perform their job, with two-thirds suggesting management advised them to alter normal PPE use. One-third of participants suggested they were dissatisfied with their employer's communication of COVID-19 related information. Conclusions and implications for public health: After reports of PPE shortages during Australia's first SARS-CoV-2 wave, and suggestions access to PPE was still limited during Australia's second wave five months later, we must forecast for this and future pandemics ensuring adequate access to PPE for frontline healthcare workers. Further, ensuring consistent and standardised pathways for communication to staff (acknowledging the reality that information may rapidly change) will help alleviate frustration and anxiety.

The Effect of Nurses' Death Anxiety on Life Satisfaction During the COVID-19 Pandemic in Turkey

The purpose of the study is to determine the effect of nurses' death anxiety on life satisfaction during the COVID-19 pandemic. This cross-sectional and correlational study was conducted with 411 nurses in Turkey. Data were collected online through Google Forms using a sociodemographic form, the Revised Death Anxiety Scale (RDAS), and the Satisfaction with Life Scale (SWLS). Percentages, means, Pearson's correlation analysis, and hierarchical linear regression models were used to analyze the data. The nurses' mean age was 28.11 (SD = 6.27) years. More than half of the nurses stated that there were COVID-19 patients in the clinic where they worked (56.0%) and that they were afraid to provide care to patients diagnosed with COVID-19 (54.5%). Their mean RDAS total score was 57.33 (SD = 16.20), indicating moderate death anxiety, and their mean SWLS total score was 2.58 (SD = 0.82), indicating a low level of life satisfaction. Sociodemographic variables accounted for 8.8% of the variance. Death anxiety was associated with life satisfaction (β =  - 0.118, p < 0.05). Model 3, which included all of the analyzed independent variables, explained 17% of the variance in life satisfaction (R² = 0.171, p < 0.001). This study showed that death anxiety adversely affects life satisfaction. Higher death anxiety among nurses was associated with lower satisfaction with life. Based on the findings, we recommend providing more psychological and communication support to nurses and implementing systematic physical and psychological evaluations of nurses to facilitate early intervention.

Assessment of Psychosocial Functioning of Polish Nurses during COVID-19 Pandemic

(1) The COVID-19 pandemic has significantly affected the psychological well-being of people around the world. The aim of this study was to assess the levels of psychological distress of nurses (anxiety, depression, stress, insomnia) in relation to sociodemographic variables and psychosocial variables: self-assessment of health, quarantine, psychological support, presence of chronic diseases and the Impact of Events Scale (IES-R). (2) A total of 207 nurses working with COVID-19 patients at the Independent Public Clinical Hospital No. 1 of the Pomeranian Medical University in Szczecin participated in the study. The study was conducted with the diagnostic survey method, using the Athens Insomnia Scale, the Generalized Anxiety Disorder questionnaire, the Impact of Event Scale-Revised, the Patient Health Questionnaire-9, The Perceived Stress Scale and a questionnaire of our authorship. (3) Among the respondents, 40.58% suffered sleep disturbance, 36.71% had mild anxiety, 71.95% had high stress according to the PSS-10 and 31.88% had depression according to the PHQ-9. The study observed that the chances of insomnia decreased with the age of the respondents. Moreover, the form of employment of nurses significantly affected the levels of depression, anxiety and stress. (4) Education, gender and age were variables that significantly affected the severity of anxiety, depression and insomnia in the surveyed nurses working with patients with COVID-19.

The impact of COVID-19 perceived threat and restrictive measures on mental health in Italy, Spain, New York, and Hong Kong: An international multisite study

In the early stages of the COVID-19 pandemic, Italy, Spain, New York, and Hong Kong stood out for the ir high rates of infections. Given this scenario, a web-based international multisite and cross-sectional study was conducted between April and May 2020 to investigate the psychological impact of the pandemic and the restrictions imposed by the governments in these countries. We expected similar patterns in European countries, and no significant differences in terms of psychological impairment between Hong Kong (with a previous experience related to SARS, but subjected to restrictions for a longer time) and the other areas. Participants were 1955 adults from the above-mentioned areas. We assessed anxiety (GAD-7), depression (PHQ-9), COVID-19-related threats, and perceived burden of restrictive measures. Two-explorative factor analyses (EFAs) with Promax rotation identified COVID-19-related factors: personal physical threat, personal economic threat, global economic threat, and restriction-related burden. ANOVAs studied locations' differences and two-separate hierarchical multiple regression analyses by location determined whether and how COVID-19-related variables were associated with anxiety and depression, adjusting for age and sex. Italy and Hong Kong showed higher anxiety than Spain (p < 0.05); Hong Kong scored higher on depression than Italy and Spain (p < 0.001), which highlighted the lowest mean-score. New York participants showed the poorest mental health conditions. Anxiety was predicted by restriction-related burden (β_NY = 0.242; β_HK = 0.116) and personal economic threat (β_NY = 0.246; β_HK = 0.145) in New York (Adj.R ² = 0.125) and Hong Kong (Adj.R ² = 0.079); by global economic threat (β = 0.199) and restriction-related burden (β = 0.124) in Italy (Adj.R ² = 0.108); and by personal physical threat (β = 0.144) in Spain (Adj.R ² = 0.049). Depression was predicted by restriction-related burden (β_NY = 0.313; β_HK = 0.120) and personal economic threat (β_NY = 0.229; β_HK = 0.204) in New York (Adj.R ² = 0.161) and Hong Kong (Adj.R ² = 0.089); by global economic threat (β = 0.209) in Italy (Adj.R ² = 0.149); and no predictors emerged in Spain. Findings could contribute to understanding the specific impact of the pandemic on people's psychological health in each area, along with the factors that impacted mental health. This information may be useful to implementing prevention interventions in case of restrictions.

Finding the positives from the COVID-19 pandemic: factors associated with posttraumatic growth among nurses in Hong Kong

BACKGROUND

Due to active involvement with patients for COVID-19 treatments, nurses are susceptible to adverse psychological outcomes amid the COVID-19 pandemic. Despite the distress, studies have suggested that nurses are able to experience positive changes (i.e. posttraumatic growth; PTG) during the pandemic. Research on other populations has also indicated that COVID-19-specific worries and work-related coping resources are associated with people's positive changes during the pandemic.

OBJECTIVE

This study examined how socio-demographic characteristics, COVID-19-related worries, and work-related variables (satisfaction with work and workplace pandemic guidelines) were associated with PTG among nurses in Hong Kong.

METHODS

Nurses (N = 1510) working in hospitals and community settings were recruited through nursing associations in Hong Kong between 8 August 2020 and 22 September 2020. They were invited to complete a cross-sectional survey measuring their sociodemographic characteristics, COVID-19 worries, and satisfaction with work and workplace pandemic-control measures.

RESULTS

Results from hierarchical regressions found that those working non-full-time (β = -0.06), affiliating with a religion (β = 0.24), having higher COVID-19-related worries and psychological distress (βs ranging from 0.12-0.15), and having higher work satisfaction (β = 0.14) were associated with higher PTG (ps < .05). Moreover, a significant interaction between psychological distress and satisfaction with workplace pandemic control guidelines emerged in explaining PTG (β = 0.08, p < .05), such that guideline satisfaction was only associated with higher PTG among those with higher distress (β = 0.09, p = .03), but not those with lower distress (β = -0.05, p > .05).

CONCLUSIONS

Nurses in Hong Kong did report positive changes amid the COVID-19 pandemic. Future studies could focus on the contributing factors of PTG to design for effective strategies to enhance resources for nurses to promote positive psychosocial outcomes.

Impact of COVID-19 in nursing professionals: systematic review and meta-analysis

Abstract Nursing work is in increasing demand, becoming strenuous especially during the COVID-19 pandemic. Thus, the objective of the study was to assess the impacts of the COVID-19 pandemic on the health of nursing professionals through a systematic review of the literature with meta-analysis, including studies published in 2020 in Web of Science, PubMed and SciELO. Regarding the systematic review, we included 25 studies with a cross-sectional design, from 12 countries. The participants were mostly nurses or nursing teams. Mental impacts such as anxiety, depression, discouragement and a feeling of obligation to work were frequently reported by study participants. The meta-analyses included psychological distress variables, and no association was found between psychological distress and being a frontline healthcare professional (OR 0.94; 95% CI 0.33-2.67). The mental health of nursing professionals has been negatively impacted by the Covid-19 pandemic. The main symptoms presented were anxiety, depression and discouragement, and many nurses felt obliged to work on the front lines of the fight against the pandemic; although they suffer emotional impacts and work overload in health services.

Mental Health and Resilience among Nurses in the COVID-19 Pandemic: A Web-Based Cross-Sectional Study

Objective: Nurses exposed to COVID-19 could be psychologically stressed. The present study investigated the mental health and the resilience level in the nurses' population. Method: This cross-sectional study was performed on 432 nurses in 27 hospitals working in Guilan province, north of Iran, between April 29, to May 14, 2020. Mental health and resilience were measured using the 12-item General Health Questionnaire-12 (GHQ-12) and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). Hierarchical multiple linear regression model was used to identify factors associated with mental health. Results: The mean GHQ-12 and CD-RISC-10 scores were 15.72 (SD, 5.67) and 25.97 (SD, 6.88), respectively. Probable psychological distress (GHQ-12 score ≥ 15) was present in 57.2% of nurses. Among demographic and COVID-19-related variables, only educational level was significantly and negatively correlated with mental health. After controlling the variables, hierarchical regression analyses results showed that lower resilience was associated with poor mental health (β = -0.49; P < 0.001). Conclusion: Regarding the nurses' mental health, appropriate psychological/psychiatric intervention is necessary, and resilience can play a role as a mental health promoter.

Creating Effective Post-Pandemic Psychiatric Nursing Clinical Experiences Using the Roy Adaptation Model

Introduction

The COVID-19 pandemic significantly impacted students in psychiatric clinical rotations. Clinicals were frequently limited or canceled, restricting exposure of student nurses to this experience. Many modifications led to permanent changes in the psychiatric clinical setting.

Objectives

The purpose of this manuscript is to provide a cohesive approach to serving student nurses in the post-pandemic psychiatric clinical setting.

Methods

A theoretical exploration of the literature framed by the Roy Adaptation Model (RAM) was conducted.

Discussion

Results are presented using the four modes of the theory: Physiological, Self-Concept, Role Function, and Interdependence.

Conclusions

Findings include strategies to enhance student learning while supporting students' health and wellness. Educators and practitioners should provide high-quality, safe learning environments for student nurses.

Depression, Anxiety and Stress on Caregivers of Persons with Dementia (CGPWD) in Hong Kong amid COVID-19 Pandemic

Background: Coronavirus disease 2019 (COVID-19) contributed to increasing prevalence of depressive symptoms and other psychological repercussions, particularly in the disease population in Hong Kong. Nonetheless, the caregiver burden of caregivers of persons with dementia (CGPWD), has been under-investigated. Aims: This study examined the psychological impact and its correlates on the CGPWD in Hong Kong amid the COVID-19 outbreak. Methods: CGPWD referred from rehabilitation clinics and online seminar were used to recruit participants to complete an online questionnaire by the end of the second-wave of the COVID-19 outbreak (June 2021). To be eligible, either full-time or part-time CGPWD, aged 18 or above, can understand Cantonese, currently reside in Hong Kong and offering care to PWD for at least one year, were recruited. Those CGPWD diagnosed with any type of psychiatric disorder were excluded from this study. The Chinese Center for Epidemiologic Studies Depression Scale (CES-D), Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder (GAD-7), Zarit Burden Interview (ZBI-22), and Nonattachment Scale (NAS-7) were used to measure participants’ depression, perceived stress, anxiety symptoms, caregiver burden and wisdom in subjective feelings of internal stress. The modified Medical Outcomes Study Social Support Survey (mMOS-SS) and the SARS Appraisal Inventory (SAI) were also administered to measure participants’ perceived support and coping efficacy. Follow-up responses were gathered by the end of third-wave outbreak (October 2021). Results: A total of 51 CGPWD participated, of which, 33 (64.7%) suffered from probable depression (CES-D score ≥ 16). Participants also showed a significant increase in depression symptom scores at the three-month follow-up period (t = 2.25, p = 0.03). CGPWD with probable depression had less non-attachment awareness and higher scores in anxiety, stress, caregiving burden, and coronavirus impact (all p < 0.05) than those without. Conclusions: High prevalence of depressive symptoms was noted among our CGPWD sample and these symptoms seemed to worsen substantially. Contingent online mental health support should be prioritized to those CGPWD to reduce psychiatric morbidity and the global disease burden.

Risk perception, mental health impacts and coping strategies during COVID-19 pandemic among Filipino healthcare workers

Background

COVID-19 pandemic has caused an extraordinary situation, especially for the healthcare workers (HCWs), leading to increased psychological stress. The aim of the study was to estimate the prevalence of different grades of anxiety and depression across different centers in the Philippines and identify demographic factors associated with them.

Design and Method

A cross-sectional, web-based, multi-center study was conducted among HCWs of Philippines from April 20- May 20, 2020. The study instruments used were the Generalized Anxiety Disorder (GAD-7) scale and Patient Health Questionnaire (PHQ-9). Risk perception scores were analyzed using Mann-Whitney and Kruskal-Wallis test. Logistic regression was done to identify factors significantly associated with symptoms of anxiety and depression determined.

Results

A total of 516 HCWs were included in the study. Most of them have anxiety symptoms (70.74%), but only half of them have symptoms of depression (50.97%). In addition, gender, age, marital status, living status, occupation, work premises, and availability of mental health services were significantly associated with the participants' anxiety symptoms. In contrast, gender, marital status, occupation, and work premises were significantly associated with depression symptoms.

Conclusion

This study reiterates the fact and demonstrates that COVID-19 has disrupted the mental well-being of HCWs in the Philippines. Majority of HCW was psychologically affected by COVID-19. Therefore, there is a dire need to address mental illness amongst HCWs and frame guidelines based on proven algorithms to overcome these mental illnesses.

Quality of Life, Insomnia and Coping Strategies during COVID-19 Pandemic in Hospital Workers. A Cross-Sectional Study

COVID-19 became a pandemic in a few months, leading to adverse health outcomes, reducing the quality of life, affecting the sleep/wake cycle, and altering coping strategies, especially among hospital personnel. Life quality, insomnia, and coping strategies were thus assessed among hospital personnel during the first wave of the COVID-19 pandemic in Italy. This cross-sectional study was conducted from May to November 2020 through an online survey. There were 558 participants (28.5% males and 71.5% females) enrolled in two different metropolitan areas (in North and South of Italy, respectively). Three standardized questionnaires were administered: European Quality of life-5 Dimensions (EQ-5D), Athens Insomnia Scale (AIS), and Brief COPE. Differences in sociodemographic characteristics and work-related factors were also investigated in order to identify possible predictors through a generalized linear model and logistic regression analysis. Results showed good perceived life quality and high insomnia prevalence. After sample stratification, the statistical analysis highlighted that personal (gender, age, educational level) and work-related factors (employment in COVID wards, remote working) played different roles in predicting quality of life, insomnia, and coping attitude. Active, Planning, and Acceptance were the most frequently adopted coping strategies. Despite women confirming their attitude in reacting to the difficulties, adopting emotion-focused coping strategies, they showed a higher probability to develop insomnia, so a gender perspective should be considered in the health protection of this working category. An integrated approach should be implemented at individual, interpersonal and organizational levels aiming to monitor psychological distress, favor regular sharing and communication between peers, and also allow conciliation of work with family life. At the organizational level, preventive and protective measures adequate to work-related risk to COVID-19 should be adopted.

The effectiveness of motivational messages to intensive care unit nurses during the COVID-19 pandemic

Objectives

To examine the effect of motivational messages on optimism, hopelessness, and life satisfaction of intensive care nurses during the COVID-19 pandemic.

Study Design

This is a multicenter, randomized controlled, open-label study.

Research Methodology/Design

The study was conducted with a total of 87 nurses working in the COVID-19 intensive care units of three hospitals in Istanbul. Motivational messages were sent via SMS to the participants in the motivational group (n=41) for 21 days. The data were obtained using a Personal Information Form, the Life Orientation Test, Beck Hopelessness Scale, and the Satisfaction with Life Scale.

Results

The nurses’ mean age in the motivational and control groups was 28.4±7.6 and 26.9±3.7 years, respectively. Before the messages, no statistically significant difference was found between the two groups in terms of life orientation (p=0.059), hopelessness (p=0.214), and satisfaction with life (p=0.898) scores. After the messages, life orientation (p=0.042) and life satisfaction (p=0.040) scores were significantly higher in the motivational group compared with the control group, and the hopelessness score was significantly lower (p=0.005).

Conclusion

According to our study, motivational messages sent to intensive care nurses during the pandemic increased their level of optimism and life satisfaction and decreased their level of hopelessness.

Trial registration: blinded for review

Feeling Anxious Amid the COVID-19 Pandemic: Factors Associated With Anxiety Symptoms Among Nurses in Hong Kong

Background: The coronavirus (COVID-19) pandemic has increased the burden for the medical systems around the world. In Hong Kong, the pandemic not only affects the local populations, but also the healthcare workers. Healthcare workers, especially nurses, involving in COVID-19 treatments are highly susceptible to adverse psychological outcomes (e.g., anxiety symptoms). Studies have shown that socio-demographic characteristics, COVID-19-specific worries, and work settings-related variables are associated with healthcare workers' well-being during the COVID-19 pandemic. However, relevant studies for nurses in Hong Kong are limited. This study examined the psychosocial correlates of anxiety symptoms among nurses in Hong Kong.

Methods: Nurses (N = 1,510) working in hospitals and community settings were recruited through nursing associations in Hong Kong between August 8, 2020 and September 22, 2020. They were invited to complete a cross-sectional survey measuring their anxiety symptoms, sociodemographic characteristics, COVID-19-specific worries, and satisfaction with work and workplace pandemic-control guidelines.

Results: 17.2% of nurses reported moderate to severe levels of anxiety symptoms. Results from hierarchical regressions found that higher COVID-19-specific worries (contracting COVID-19, family members contracting COVID-19 due to their nursing work, insufficient protective equipment at workplace) (βs ranged from 0.07 to 0.20, ps < 0.01), higher perceived stigma of being a healthcare worker (β = 0.18, p < 0.001), and lower work satisfaction (β = −0.21, p < 0.001) were associated with higher anxiety symptoms.

Conclusion: A moderate proportion of nurses in Hong Kong did report levels of anxiety symptoms amid the COVID-19 pandemic. Futures studies could focus on the contributing factors of anxiety symptoms to design for effective strategies to promote nurses' well-being during pandemic situations.

Analysis of Burnout Syndrome and Resilience in Nurses throughout the COVID-19 Pandemic: A Cross-Sectional Study

Background: The COVID-19 pandemic has contributed to the occurrence of work-related stress on nursing staff. Being resilience an essential element to countering adversity. The aim of the study was to assess burnout syndrome as well as resilience in hospital-care nurses during the first outbreak of the COVID-19 pandemic. Methods: A cross-sectional descriptive study of burnout syndrome and resilience of 101 nurses during the first COVID-19 outbreak. The Maslach Burnout Inventory and the Scale of Resilience of Connor-Davidson were used. Results: The burnout average score was 74.35 ± 12.78 points, and resilience was 27.94 ± 5.84. Temporary nurses reached a lower average score for the emotional fatigue dimension (23.80 ± 10.39 points) p < 0.05. The emotional fatigue dimension correlated adversely with the average score of resilience (r = −0.271; p < 0.001). Conclusions: The level of burnout in nurses was high, being higher on those who took care of COVID-19 patients. Resilient nurses were able to better cope with stressful situations.

Willingness to Work amongst Australian Frontline Healthcare Workers during Australia's First Wave of Covid-19 Community Transmission: Results of an Online Survey

OBJECTIVES

The majority of research investigating healthcare workers' (HCWs) willingness to work during public health emergencies, asks participants to forecast their perceptions based on hypothetical emergencies, rather than in response to the actual public health emergencies they have experienced. This research explored frontline HCWs willingness to work during Australia's first wave of the COVID-19 pandemic among frontline HCWs.

METHODS

Participants (n = 580) completed an online questionnaire regarding their willingness to work during the pandemic.

RESULTS

A total of 42% of participants reported being less willing to work during the pandemic compared to before. Availability of personal protective equipment (PPE), concern expressed by family members, and viral exposure were significant barriers. A third of participants disagreed that some level of occupational risk for exposure to infectious disease was acceptable while a quarter of participants had received communications from their workplace concerning obligations to work during COVID-19.

CONCLUSIONS

The COVID-19 pandemic has impacted Australian frontline HCWs' willingness to work. Scarcity of PPE and exposure to the virus were the most cited reasons impacting on willingness to work. Appropriate policies and practices should be implemented and communicated efficiently to frontline HCW's. This research provides insight into the lived experiences of Australian healthcare professionals' willingness to work during a pandemic.

Network analysis of depressive symptoms in Hong Kong residents during the COVID-19 pandemic

In network theory depression is conceptualized as a complex network of individual symptoms that influence each other, and central symptoms in the network have the greatest impact on other symptoms. Clinical features of depression are largely determined by sociocultural context. No previous study examined the network structure of depressive symptoms in Hong Kong residents. The aim of this study was to characterize the depressive symptom network structure in a community adult sample in Hong Kong during the COVID-19 pandemic. A total of 11,072 participants were recruited between 24 March and 20 April 2020. Depressive symptoms were measured using the Patient Health Questionnaire-9. The network structure of depressive symptoms was characterized, and indices of "strength", "betweenness", and "closeness" were used to identify symptoms central to the network. Network stability was examined using a case-dropping bootstrap procedure. Guilt, Sad Mood, and Energy symptoms had the highest centrality values. In contrast, Concentration, Suicide, and Sleep had lower centrality values. There were no significant differences in network global strength (p = 0.259), distribution of edge weights (p = 0.73) and individual edge weights (all p values > 0.05 after Holm-Bonferroni corrections) between males and females. Guilt, Sad Mood, and Energy symptoms were central in the depressive symptom network. These central symptoms may be targets for focused treatments and future psychological and neurobiological research to gain novel insight into depression.

Analyzing the Impact of COVID-19 Trauma on Developing Post-Traumatic Stress Disorder among Emergency Medical Workers in Spain

The early stages of the COVID-19 pandemic presented the characteristics of a traumatic event that could trigger post-traumatic stress disorder. Emergency Medical Services workers are already a high-risk group due to their professional development. The research project aimed to analyse the impact of the COVID-19 pandemic on EMS professionals in terms of their mental health. For this purpose, we present a descriptive crosssectional study with survey methodology. A total of 317 EMS workers (doctors, nurses, and emergency medical technicians) were recruited voluntarily. Psychological distress, post-traumatic stress disorder, and insomnia were assessed. The instruments were the General Health Questionnaire-12 (GHQ-12), the Davidson Trauma Scale (DTS-8), and the Athens Insomnia Scale (AIS-8). We found that 36% of respondents had psychological distress, 30.9% potentially had PTSD, and 60.9% experienced insomnia. Years of work experience were found to be positively correlated, albeit with low effect, with the PTSD score (r = 0.133). Finally, it can be stated that the COVID-19 pandemic has been a traumatic event for EMS workers. The number of professionals presenting psychological distress, possible PTSD, or insomnia increased dramatically during the early phases of the pandemic. This study highlights the need for mental health disorder prevention programmes for EMS workers in the face of a pandemic.

Psychological Impact of the COVID-19 Pandemic on Licensed Full-Time Practicing Nurses Undertaking Part-Time Studies in Higher Education: A Cross-Sectional Study

Frontline nurses face an unpreceded situation with the coronavirus disease (COVID-19) pandemic, and many report suffering from physical and psychological stress. This online, cross-sectional survey used questionnaires, such as the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire (PHQ-2), the Connor-Davidson Resilience Scale, stress-related questions, and Brief Coping Orientation to Problems Experienced (Brief-COPE), to determine the psychological impact of COVID-19 on licensed full-time practicing nurses undertaking part-time studies in higher education. Recruitment commenced from August to September 2020; 385 students were approached, and 124 completed the survey (response rate: 32%). Most of the respondents were frontline nurses working in public sectors (89.5%), 29% of whom reported symptoms of depression, and 61.3% reported mild to severe levels of anxiety. The GAD-7 was significantly associated with the resilience score (β = -0.188; p = 0.008) and exhaustion (β = 0.612; p < 0.001). The PHQ-2 was significantly associated with 'anxiety about infection' (β = 0.071; p = 0.048). A lower anxiety level was significantly associated with a higher resilience level and a lower level of exhaustion, and a lower depression level was significantly associated with a lower anxiety about infection. Nursing programs incorporating resilience building may mitigate psychological distress of the study population.

A Mixed-Methods Study of Nurse Managers' Managerial and Clinical Challenges in Mental Health Centers During the COVID-19 Pandemic

Purpose

The worldwide outbreak of the COVID‐19 pandemic has posed challenges for nurses. The aim of this study was to examine the managerial and clinical challenges of nurse managers in mental health centers during the current COVID‐19 pandemic.

Design

A mixed‐methods study based on an analysis of data obtained in focus groups with 25 nurse managers from two mental health centers in Israel.

Methods

The quantitative phase was conducted prior to the group sessions using a structured self‐administered questionnaire that examined the nurse managers’ (a) background data, (b) communication with the staff nurses, (c) perceptions of nurses’ functioning, (d) perceptions of their own functioning, and (e) management as impacted by the pandemic. The qualitative phase included three sessions of focus groups in which the nurse managers discussed both their challenging and positive issues during the pandemic.

Findings

The most important challenges were related to the need to protect patients from infection and communicating with families and primary caregivers. Work policies and procedures were less well adapted to pandemic conditions; nevertheless, nurse managers felt a sense of purpose, duty, and pride in their work. Three themes emerged: (a) "management complexity" included the change from a familiar routine to a new reality, working in capsules, protecting against infection, functional confusion, and insights into future epidemics; (b) "challenging communication" included communication with patients through glass walls and communication with staff through screens and (c) "bright spots" referred to staff cohesion and the provision of respectful care.

Conclusions

Mental health nurse managers have experienced during the pandemic a change in their roles from being less managerial to focusing more on clinical work. Communication between nurse managers and staff nurses and between mental health patients and staff were the main challenges. Nurse managers favorably noted the uniformity and humanity of the staff, sense of cohesion, and shared responsibility.

Clinical Relevance

In the first wave of the pandemic, there was confusion as to the functional role of ward nurse managers, as the focus of their activities became more clinical and less managerial. During and after the pandemic, preventive interventions should be carried out in order to assist patients, staff nurses, and nurse managers in mental health centers.

Moderating Roles of Resilience and Social Support on Psychiatric and Practice Outcomes in Nurses Working During the COVID-19 Pandemic

Introduction

Staff and equipment shortages and an easily transmissible virus make working in the COVID-19 pandemic demanding physically and psychologically. Nurses on the frontlines are particularly vulnerable to the adversity of working under these conditions, particularly with regard to mental health. Thus, understanding risk and protective factors for this vulnerable and essential group is critical for identifying potential targets of interventions. We had two aims for the current study: (a) to examine work functioning and symptoms of depression, anxiety, and posttraumatic stress (PTSD) among nurses who did and did not care for patients with COVID-19; and (b) to determine if resilience and social support moderate these relationships.

Methods

For three weeks in July 2020, nurses across the United States were invited to participate in an online survey collecting data on demographics, resilience, social support, and screening measures of depression, PTSD, anxiety, and distracted practice. Data were analyzed using descriptive statistics and hierarchical regression for each outcome measure.

Conclusions

Our findings support a growing body of research reporting that nurses are experiencing mental health sequelae during the COVID-19 pandemic, especially those providing direct care to patients with the virus. We found that compared to nurses who did not care for patients with COVID-19, those who did reported increased symptoms of PTSD, depression, and anxiety. A novel contribution is our finding that nurses providing direct COVID-19 care also experienced increased levels of distracted practice, a behavioral measure of distraction linking to a potential impact on patient care. We also found that resilience and social support acted as moderators of some of these relationships. Fostering resilience and social support may help buffer the effects of providing care to patients with COVID-19 and could potentially decrease nurse vulnerability to developing psychological symptoms and impairment on the job.

The psychological impact of the COVID-19 pandemic on otolaryngologists: Should we be concerned?

OBJECTIVE

Physicians on the frontline of the COVID-19 pandemic are at increased risk of contracting the disease. Otolaryngologists are amongst the high-risk practitioners, as they are in close proximity to patient's upper airway, which may induce their psychological stress.

METHODS

A cross-sectional survey study, conducted among otolaryngologists in Saudi Arabia from June 11 to June 22. Survey consisted of sociodemographic questionnaire, Coronavirus Anxiety Scale (CAS), Obsession with COVID-19 Scale (OCS) and Patient Health Questionnaire-9 (PHQ-9). Available otolaryngologists with no history of mental health problems were included. A P-value lower than .05 was considered statistically significant.

RESULTS

The study included 129 participants; 63.6% men and 36.4% women. 81.4% of participants were living with family, 57.4% living with either a child or an elderly family member. Nearly 7.8% of participants had dysfunctional COVID-19 anxiety and 75.2% had COVID-19-related depression symptoms ranging from minimal to severe. Obsession and dysfunctional thinking regarding COVID-19 were found in 26.4% of participants. Single otolaryngologists had significantly higher CAS (P = .025), OCS (P = .048), and PHQ-9 (P < .001) scores. Participants who lived with children or elderly individuals had significantly higher OCS scores (P = .005). When comparing job ranks, residents had significantly higher scores for the CAS (P = .016) and PHQ-9 (P < .001).

CONCLUSION

COVID-19 has a considerable psychological impact on otolaryngologists. Specifically, the young and single who have less social support. This indicates the importance of psychological support to this group. Additional thorough studies should explore the psychological impact of COVID-19 in this field as it may carry devastating long-term consequences if left unattended.

LEVEL OF EVIDENCE

Level 4.

Prevalence and factors associated with depression, anxiety and stress among healthcare workers of Trinidad and Tobago during COVID-19 pandemic: a cross-sectional study

OBJECTIVES

To determine the prevalence and factors associated with depression, anxiety and stress among healthcare workers (HCWs) during COVID-19 pandemic.

DESIGN

Cross-sectional online survey.

SETTING

HCWs from four major hospitals within the Regional Health Authorities of Trinidad and Tobago.

PARTICIPANTS

395 HCWs aged ≥18 years.

MAIN OUTCOME MEASURES

Depression, anxiety and stress scores.

RESULTS

Among the 395 HCWs, 42.28%, 56.2% and 17.97% were found to have depression, anxiety and stress, respectively. In the final stepwise regression model, contact with patients with confirmed COVID-19, p<0.001 (95% CI 3.072 to 6.781) was reported as significant predictors of depression. Further, gender, p<0.001 (95% CI 2.152 to 5.427) and marital status, p<0.001 (95% CI 1.322 to 4.270) of the HCWs were considered to be correlated with anxiety. HCWs who had contact with patients with suspected COVID-19 had lower depression, p<0.001 (95% CI -5.233 to -1.692) and stress, p<0.001 (95% CI -5.364 to -1.591).

CONCLUSIONS

This study has depicted the prevalence and evidence of depression, anxiety and stress among HCWs during the COVID-19 pandemic. The findings of the study will serve as supportive evidence for the timely implementation of further planning of preventative mental health services by the Ministry of Health, for frontline workers within the public and private health sectors.

How has COVID-19 affected mental health nurses and the delivery of mental health nursing care in the UK? Results of a mixed-methods study

WHAT IS KNOWN ON THE SUBJECT?: During the COVID-19 pandemic, there has been research considering the impact on medical healthcare professionals and the mental health needs of the general population. However, limited focus has been placed on mental health services or mental health staff providing care in the community and in hospitals. While nurses make up the largest section of the mental health workforce in the UK, the impact that this pandemic has had on their work has been largely ignored. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides a unique insight into the experiences and impact that the COVID-19 pandemic has had on mental health nurses across a range of community and inpatient settings to understand what has changed in their work and the care they can and do provide during this crisis. This includes exploring how services have changed, the move to remote working, the impact of the protective equipment crisis on nurses and the difficult working conditions facing those in inpatient settings where there is minimal guidance provided. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: By understanding the impact the pandemic has had on mental health nursing care, we can understand the gaps in guidance that exist, the challenges being faced and the impact the crisis has had on care for mental health service users. By doing so, we can plan for the ongoing nature of this pandemic and the aftermath that the crisis may leave for our service users and workforce alike. ABSTRACT: Introduction While evidence has emerged concerning the impact of COVID-19 on the general population and the challenges facing health services, much less is known regarding how the pandemic has directly affected the delivery of mental health nursing care. Aim This paper aimed to explore how COVID-19 has affected the ability of mental health nurses to deliver care in community and inpatient mental health services in the UK. Method We investigated staff reports regarding the impact of the COVID-19 pandemic on mental healthcare and mental health service users in the UK, using a mixed-methods online survey. A total of 897 nurses across a range of inpatient and community settings participated. Discussion Key themes within the data explore the following: new ways of working; remote working; risks of infection/infection control challenges; and the impact on service users. Targeted guidelines are required to support mental health nurses providing care and support during a pandemic to people in severe mental distress, often in unsuitable environments. Implications for Practice Service developments need to occur alongside tailored guidance and support for staff welfare supported by clear leadership. These findings identify areas requiring attention and investment to prepare for future crises and the consequences of the pandemic.

Anxiety, Burnout and Depression Levels According to Sex and Years of Work Experience in Italian Nurses Engaged in the Care of Covid-19 Patients

"Aim: To evaluate burnout, anxiety and depression levels in nurses directly involved in the care of Covid-19 patients. Furthermore, particular attention was paid to the existence of any differences between male and female nurses to evaluate whether the variables considered can be influenced by the gender variable. Design: A cohort case-report study was carry out. Sample: All Italian nurses who were at front line in the care of the Covid-19 patients were involved. Measurement: The on line questionnaire collected data as regards: gender and years of work experience; the Maslach Burnout Inventory questionnaire (MBI) and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Results: Certainly the experience of the pandemic was very emotional for nurses engaged in the front line in the care of Covid-19 patients. However, anxiety and depression levels turned out to be normal, while some nurses experienced them in the dimensions of emotional exhaustion and depersonalization of the burnout rating scale. Conclusion: The practical implication was the implementation of support policies for nurses in tackling the problem of burnout more than that of anxiety or depression."

Depressive Symptoms, Anxiety Disorder, and Suicide Risk During the COVID-19 Pandemic

This study reviews the existing literature on psychiatric interventions for individuals affected by the COVID-19 epidemic. My article cumulates previous research on how extreme stressors associated with COVID-19 may aggravate or cause psychiatric problems. The unpredictability of the COVID-19 epidemic progression may result in significant psychological pressure on vulnerable populations. Persons with psychiatric illnesses may experience worsening symptoms or may develop an altered mental state related to an increased suicide risk. The inspected findings prove that psychological intervention measures for patients affected by the epidemic should be designed and personalized adequately. Preventive measures seek to decrease infection rates and cut down the risk of the public healthcare system to eventually be overburdened. Throughout the COVID-19 crisis, people with psychiatric illnesses may confront a decrease in mental health services. As limitations in the current review, by focusing only on articles published in journals indexed in Web of Science, Scopus, and ProQuest, I inevitably disregarded other valuable sources. Subsequent research directions should clarify the effectiveness of online mental health services in providing remote psychiatric interventions to individuals affected by the COVID-19 epidemic.

Predictive factors affecting stress among nurses providing care at COVID-19 isolation hospitals at Egypt

AIMS

To examine predictive factors affecting stress among nurses providing care at COVID-19 Isolation Hospitals at Egypt.

METHODS

A cross-sectional study conducted in five Isolation governmental hospitals for COVID-19. 374 nurses included at the study. Characteristic forms, factors affecting nurses' stress and Nursing Stress Scale (NSS) were used to collect data.

RESULTS

(52.1%) of studied nurses had moderate level of total nursing stress scale. Also, (26.2%) of them had severe level, while (13.4% & 8.3%) of them had mild and normal level, respectively. Mean SD score of studied nurses regarding to total nursing stress scale was 99.47 ± 10.671.

CONCLUSIONS

Training for COVID-19, availability of PPE, educational level and attention of hospital administration were negative predictor factors for nurses' stress, while having children, people showed that COVID-19 is stigma, fears of infection, workplace, fear of transmission infection for family and nurse to patient ratio were positive predictors.

The Mental Health of Female Physicians and Nurses in Oman during the COVID-19 Pandemic

Objectives

We sought to assess the impact of the COVID-19 pandemic on female doctors and nurses’ mental health in Oman.

Methods

We conducted a cross-sectional, web-based survey of 402 female doctors and nurses recruited from several health facilities in Oman. We used the Generalized Anxiety Disorder (GAD-7) scale, the Perceived Stress Scale (PSS-10), the WHO-5 Well-Being Index (WHO-5), and the Sleep Quality Scale to determine the prevalence rates of anxiety, stress, well-being, and sleep quality.

Results

A total of 231 (57.5%) Omanis and 171 (42.5%) non-Omanis participated in this study. Of the total 402 participants, 28.4% were physicians and 71.6% were nurses. One in four (27.9%) participants reported caring for COVID-19 patients. One in four (27.9%) had moderate to severe anxiety. A higher proportion of Omanis (32.0%) had moderate to severe anxiety than non-Omanis (22.2%). Six in 10 (60.7%) scored at or above the mean on the PSS-10. Doctors and nurses who cared for COVID-19 patients reported higher levels of stress than those who did not. Almost half (45.3%) of the participants scored 50% or less on the well-being scale. A higher proportion of Omanis and those who cared for COVID-19 cases scored ≤ 50. Four in 10 (39.3%) had poor sleep quality; this was particularly prevalent among Omanis. A multiple regression analysis revealed that anxiety, stress, and well-being were significant predictors of poor sleep quality.

Conclusions

The COVID-19 pandemic is having a significant effect on the mental health of health care workers in Oman. In this study, nurses, Omanis, and frontline health care workers were the most impacted by the global health crisis. Urgent psychological, social, and administrative interventions and support should be implemented to mitigate mental health risks in these groups.

Experiences of geriatric nurses in nursing home settings across four countries in the face of the COVID-19 pandemic

AIM

To explore the emotional impact and experiences of geriatric nurses working in nursing homes and caring for patients with coronavirus 2019 disease (COVID-19).

DESIGN

This is a qualitative study with phenomenological method and data were gathered through in-depth interview.

METHODS

The experiences and expectations that nurses are facing during their care duties were explored via video conference, using a semi-structured interview guide. We have followed the Consolidated criteria for reporting qualitative research COREQ.

RESULTS

Interviews (N=24) were conducted with nurses from four countries (Spain, Italy, Peru, and Mexico) during April 2020. Three main categories were extracted: fear of the pandemic situation, the sense of duty and professional commitment, and emotional exhaustion.

CONCLUSIONS

Regardless of the country and situation, in the face of the pandemic, dramatic situations have been experienced in nursing homes worldwide, with nursing staff feeling exhausted and overwhelmed, and reflection is urged on a global level to consider the most appropriate model of care in nursing homes.

Expert Consensus on Nurses' Human Caring for COVID-19 Patients in Different Sites

This study aims to develop the expert consensus on nurse’s human caring for Corona Virus Disease 2019 (COVID-19) patients in different sites, and thus provide a guideline on providing whole process and systematic caring for COVID-19 patients. Based on the frontline experiences of human caring for COVID-19 patients and the review of literature, the initial draft of consensus was made and finalized after online meeting and revisions. The experts reached consensus on the following parts: terms and definitions, principles of human caring for COVID-19 patients, and human caring measures for COVID-19 patients in different sites. The expert consensus is practical, concise, and reasonable for guiding the nurses providing human caring for COVID-19 patients, as well as other similar infectious diseases.