Factors associated with motivation and hesitation to work among health professionals during a public crisis: a cross sectional study of hospital workers in Japan during the pandemic (H1N1) 2009

Navigating a Pandemic: Leadership Dynamics and Challenges within Infection Prevention and Control Units in Israel

This study investigates the impact of the coronavirus disease 2019 (COVID-19) pandemic on leadership within infection prevention and control (IPC) units across public hospitals in Israel. Through qualitative interviews with ten IPC managers from nine hospitals, equivalent to 30% of the country's acute care facilities, the research uncovers significant changes in managerial approaches due to the health crisis. The results reveal four main themes: (1) Enhanced managerial autonomy and leadership skills, with a noted rise in self-efficacy against the pandemic's backdrop; (2) Shifted perceptions of IPC units by upper management, recognizing their strategic value while identifying the need for a more profound understanding of IPC operations; (3) The increased emphasis on adaptability and rapid decision-making for effective crisis management; (4) The dual effect on job satisfaction and well-being, where greater commitment coincides with risks of burnout. The study underscores the essential nature of effective IPC leadership during emergencies, highlighting the need for clear communication, prompt action, and empathetic leadership. The conclusions point to the necessity for continuous research into IPC leadership, promoting strategic advancements in management to bolster IPC units against future health threats.

The impact of the COVID-19 pandemic on professional life and well-being in German physicians: A cross-sectional study

This study assessed perceptions of German physicians' regarding the impact of the COVID-19 pandemic on work-related issues as well as mental and physical health. Almost three quarters of the physicians felt stressed by the increased quantity (69%) and quality (73%) of the work and felt physically (68%) or mentally exhausted (71%). Also about three-quarters of physicians reported the pandemic having a strong impact on family life. A higher proportion feared to infect their family more than being infected themselves (66% vs 50%). Mental health scores were significantly lower in physicians compared to the general population. In female physicians, these findings were even more pronounced. Stressful work conditions and feelings of isolation were the most important predictors for mental health scores (R2 = 0.37), and also for motivation to work (R2 = 0.20). Preventive measures to strengthen resilience and optimize work organization are warranted to alleviate the toll of the pandemic on physicians.

Physicians' Trust in Relevant Institutions during the COVID-19 Pandemic: A Binary Logistic Model

Little research has been done on professionals' perceptions of institutions and governments during epidemics. We aim to create a profile of physicians who feel they can raise public health issues with relevant institutions during a pandemic. A total of 1285 Romanian physicians completed an online survey as part of a larger study. We used binary logistic regression to profile physicians who felt they were able to raise public health issues with relevant institutions. Five predictors could differentiate between respondents who tended to agree with the trust statement and those who tended to disagree: feeling safe at work during the pandemic, considering the financial incentive worth the risk, receiving training on the use of protective equipment, having the same values as colleagues, and enjoying work as much as before the pandemic. Physicians who trusted the system to raise public health issues with the appropriate institutions were more likely to feel that they shared the same values as their colleagues, to say they were trained to use protective equipment during the pandemic, to feel that they were safe at work during the pandemic, to enjoy their work as much as before the pandemic, and to feel that the financial bonus justified the risk.

Motivation and hesitation of healthcare workers to work during the H1N1 influenza and COVID-19 pandemics: An exploratory single-centered repeated cross-sectional study

Aim

Pandemics of life-threatening viruses have detrimental impacts on the motivation of healthcare workers to work. However, no study has examined this impact during different pandemics with the same setting and design. This study aimed to reveal similarities and differences in factors associated with willingness and hesitation to work between two recent pandemics, H1N1 influenza and COVID-19, in the same hospital, using the same questionnaire.

Methods

Healthcare workers in one hospital in Japan completed a questionnaire on basic characteristics and stress-related questions during the H1N1 influenza (n = 1061) and the COVID-19 (n = 1111) pandemics. Logistic regressions were performed to ascertain the effect of personal characteristics and stress-related questions on the likelihood that employees showed strong or weak motivation or hesitation to work.

Results

The feeling of being protected by the hospital was the only factor that significantly decreased hesitation and increased motivation to work, and females felt significantly more hesitation to work than males did in both pandemics.

Conclusions

Hospital managers and government officers should focus on increasing organizational support and caring for female workers to maintain healthcare workers' motivation to work during future pandemics.

The sustained psychological impact of coronavirus disease 2019 pandemic on hospital workers 2 years after the outbreak: a repeated cross-sectional study in Kobe

BACKGROUND

Healthcare workers who are exposed to coronavirus disease 2019 are psychologically distressed. This study aimed to evaluate the mental health outcomes of hospital workers 2 years after the outbreak of coronavirus disease 2019 and to identify changes in the stress of hospital workers and predicted risk factors.

METHODS

This survey was conducted 2 years after the initial evaluation performed under the first emergency declaration of the coronavirus disease 2019 pandemic among hospital workers at the same hospital in an ordinance-designated city in Japan from June to July 2022. Sociodemographic data, 19 stress-related question responses, the Impact of Event Scale-Revised, and the Maslach burnout inventory-general survey were collected. Multiple regression models were used to identify factors associated with each of the mental health outcomes 2 years after the coronavirus disease 2019 outbreak.

RESULTS

We received 719 valid responses. Between 2020 and 2022, hospital workers' anxiety about infection decreased, whereas their exhaustion and workload increased. Multiple regression analysis revealed that 2 years after the coronavirus disease 2019 outbreak, nurses and young people were at a higher risk of experiencing stress and burnout due to emotional exhaustion, respectively.

CONCLUSIONS

This is the first study to examine the long-term stress of hospital workers measured in Japan. Exhaustion and workload were worsened 2 years into the pandemic. Therefore, health and medical institutions should continuously monitor the physical and psychological health of staff members.

Longitudinal depression screening of frontline critical care nurses during the COVID-19 pandemic: A mixed-methods study

PURPOSE

To evaluate the severity and longitudinal trends of depression in critical care nurses caring for patients with COVID-19 in the US during a global pandemic.

METHODS

The study employed longitudinal mixed methods. Using the Patient Health Questionnaire (PHQ-9), nurses were sent electronic surveys at baseline, 1 month, and between 3 and 6 months to measure the severity and trends of depression during the prevaccination stage of the COVID-19 pandemic. One-on-one interviews were conducted with critical care nurses to evaluate their depressive symptoms.

RESULTS

Forty-eight nurses completed the questionnaire at baseline, 40 completed 1-month surveys, and 20 completed the 3 to 6 month surveys. The mean PHQ-9 score was 5.85, 6.20, and 8.30 at baseline, at 1 month, and at 3 to 6 months, respectively. PHQ-9 scores increased significantly over time (estimate = 1.120, P = .037). The probability of participants being moderately to severely depressed was 0.980 (P = .049) at baseline, 0.990 (P = .013) at 1 month, and 1.0 (P = .002) at 3 to 6 months. Fourteen nurses were included in a single, one-on-one interview. Eight major themes were found in qualitative analyses. For example, nurses expressed fear of spreading COVID-19 to their loved one and community. Common themes identified within the interviews included uncertainty, limited human interaction, fluctuations in mood, life is in my hands, a threat to others, positive and negative coping, nurses as scapegoats, and emerging vulnerability to COVID-19 exposure. All 14 nurses who were interviewed denied accessing any mental health services.

CONCLUSIONS

More research is needed to evaluate critical care nurses who care for patients with COVID-19 and their levels of depression to improve practice at the bedside further and develop policies to promote their well-being.

A 16-month longitudinal investigation of risk and protective factors for mental health outcomes throughout three national lockdowns and a mass vaccination campaign: Evidence from a weighted Israeli sample during COVID-19

BACKGROUND

COVID-19 is an ongoing global crisis, with a multitude of factors that affect mental health worldwide. We explored potential predictors for the emergence and maintenance of depression, anxiety, and posttraumatic stress symptoms (PTSS) in the general population in Israel.

METHODS

Across the span of 16 months, 2478 people completed a repeated self-report survey which inquired psychiatric symptoms and pandemic related stress factors (PRSF). We applied mixed-effects models to assess how each stressor contributes to depression, anxiety and PTSS at each time point, and longitudinally assessed participants who completed at least two consecutive surveys (n = 400). We weighted our sample to increase representativeness of the population.

RESULTS

Fatigue was the strongest predictor for depression, anxiety and PTSS at all time points, and predicted deterioration overtime. Financial concerns associated with depression and anxiety at all time points, and with their deterioration overtime. Health related concerns were uniquely associated with anxiety and PTSS at all time points and their deterioration, but not with depression. Improvement in sense of protection overtime associated with decrease in depression and anxiety. Hesitancy towards vaccination was associated to higher financial concerns and lower sense of protection by the authorities.

CONCLUSIONS

Our findings accentuate the multitude of risk factors for psychiatric morbidity during COVID-19, and the centrality of fatigue in determining mental health outcomes.

Emergency Medicine Residents' Perceptions of Working and Training in a Pandemic Epicenter: A Qualitative Analysis

INTRODUCTION

We sought to describe the range of emergency medicine (EM) resident physicians' perceptions and experiences of working and training during the initial coronavirus 2019 (COVID-19) pandemic surge at two, large-volume, urban training hospitals in Brooklyn, New York.

METHODS

A total of 25 EM resident physicians who worked at either of two large emergency departments (ED) from March 15-April 11, 2020 participated in semi-structured interviews conducted in July and August 2020. Interviews were conducted by the authors who were also emergency medicine resident physicians working in the ED during this time. We asked open-ended questions to residents about their experiences and emotions at work and outside of work, including their relationship with co-workers, patients, and their community. The interviews were audio-recorded and transcribed. We then conducted a thematic analysis to identify, classify, and define themes from interview transcripts. Iterative commonalities and differences between interview response themes were grouped to create a broadly applicable narrative of the residents' perceptions and experiences of working and training during this initial wave of a novel pandemic. Interviewees also responded to a demographics survey.

RESULTS

Study participants described four major aspects of their perceptions and experiences of working and training during the stated time, including emotional challenges such as anxiety and feeling underappreciated; protective thoughts, including camaraderie, and sense of duty; workplace challenges such as limited knowledge surrounding COVID-19 and a higher volume of acute patients; and adaptive strategies including increased communication with ED administrators.

CONCLUSION

Emergency medicine residents have a unique perspective and were key frontline hospital responders during a prolonged disaster and mass triage event within a local health system. Considering the chronic case and mortality fluctuations and new variants of COVID-19, as well as the anticipation of future infectious disease pandemics, we believe it is important for key decision-makers in resident education, hospital administration, and all levels of public health management to inform themselves about residents' emotional and workplace challenges when establishing hospital and residency program disaster protocols.

Quality of therapy and mental health among occupational therapists during the COVID-19 pandemic

Introduction

The coronavirus disease of 2019 (COVID-19) has had a severe psychological impact on occupational therapists. Clarifying the mental health status of occupational therapists and its relationship with therapy quality is essential for maintaining the quality of care and patients' quality of life. Therefore, the present study aimed to investigate whether and how mental health problems are related to the quality of occupational therapy.

Methods

A nationwide cross-sectional online survey was conducted during Japan's second national state of emergency (January 2021). A total of 4,418 registered occupational therapists who were members of the Japanese Association of Occupational Therapists participated in this study. After screening for the exclusion criteria, data from 1,966 participants were analyzed.

Results

Path analysis showed that insufficient information provision by the workplace and increased workload were associated with depression, anxiety, and insomnia. Specifically, depression was associated with decreased therapy quality. Furthermore, one's therapy quality showed a strong positive correlation with colleagues' therapy quality.

Discussion

These results demonstrated a direct link between therapists' mental health conditions and therapy quality and suggested that decreased therapy quality might occur at the institutional rather than individual level. A reassessment of the support system and prompt detection and support for professionals with psychological symptoms may be the key to enhancing therapy quality and patients' quality of life. The present results contribute to the understanding of these relationships, considering the current pandemic context for occupational therapists.

Willingness and motivations towards volunteering during the COVID-19 pandemic: A cross-sectional survey among final year medical students in Lagos, Nigeria

Introduction

Increasing manpower capacity to meet the demands in the healthcare system is important during health emergencies. Medical students have roles to play during a pandemic but their involvement in these duties should be voluntary. The objective of this study was to assess the willingness and motivations of final year medical students in Lagos, Nigeria towards volunteering during the COVID-19 pandemic.

Methods

A descriptive cross-sectional study was conducted among medical students in their sixth (final) year of study at the two public Universities in Lagos, Nigeria using total population sampling technique. A web-based questionnaire was used for data collection and data were analysed using SPSS. Logistic regression analysis was used to predict the willingness to volunteer.

Results

The mean age of the respondents was 23.4 years ± 2.6SD and 62.6% were female. About 65.9% of the medical students were willing to volunteer. Motivational factors which include self-rated good health status [OR: 2.1(95%CI: 1.16-3.6)], self-rated competence to work as a COVID-19 volunteer [OR: 6.5(95%CI: 3.61-11.54)] and availability of adequate protection and personal protective equipment [OR: 3.3(95%CI: 1.74-6.33)] significantly increased the odds of willingness to volunteer after controlling for other variables. Respondents' opinions on settings where medical students can serve as volunteers during the COVID-19 pandemic include case management (21.7%) and telemedicine (85.8%).

Conclusion

Medical students are willing to volunteer during the COVID-19 pandemic. There is a need to prepare and motivate the final year medical students by developing their skills to improve their competence and by providing adequate protection for the willing students to function as volunteers.

Mental health outcomes and workplace quality of life among South African pharmacists during the COVID-19 pandemic: a cross-sectional study

Background

The effect of the COVID-19 pandemic on the mental health of healthcare workers is gaining attention globally. This study assessed the quality-of-working life (QoWL) and prevalence of, and risk factors for anxiety, depression and stress among South African pharmacists.

Methods

An online survey, after stratification by province, was sent to 3435 (target = 2454) randomly selected pharmacists between 14 April to 18 May 2021. Sociodemographic data were collected and mental health was assessed using the 7-item Generalized Anxiety Disorder scale, the 9-item Patient Health Questionnaire, Perceived Stress Scale and a modified Work-Related Quality-of-Life tool. Prevalence of anxiety, depression, stress and QoWL was estimated. A multivariate logistic regression analysis identified factors associated with mental health outcomes.

Results

A total of 953/2454 pharmacists (38.8%) responded. Of these, 56.5% were 40 years or younger, 78.5% were female, 45.4% were White race and 44.5% were practicing in a community pharmacy setting. Pharmacists demonstrated symptoms of anxiety (n = 605, 66.1%), depression (n = 561, 62.9%), stress (n = 642, 73.8%) and low QoWL (n = 409, 51.3%). Significant risk factors (aOR; 95%CI) for anxiety, depression and stress were female gender (1.96;1.36–2.83,1.84;1.27–2.67,1.58;1.05–2.38, history of mental health conditions (2.50; 1.52–4.13, 3.68; 2.19–6.19, 3.34;1.85–6.03) and significant COVID-19 mitigation changes to pharmacy practice (2.70; 1.36–5.38, 4.23; 2.06–8.70, 3.14;1.44–6.82), respectively. Practice changes were also associated with a low QoWL (5.19; 2.40–11.8). Compared to their Black/African colleagues, Indian pharmacists were at higher risk for anxiety (1.82; 1.03–3.23) and stress symptoms (2.28; 1.21–4.32), while risk for depression was significant amongst White pharmacists (1.86; 1.05–3.32). Pharmacists living apart from family were at significant risk for anxiety (1.66; 1.15–2.41), depression (1.52; 1.06–2.18) and low QoWL (1.60; 1.10–2.34).

Conclusions

COVID-19 pandemic has had a significant negative impact on the mental health of South African pharmacists. Interventions to support the psychological well-being and improve QoWL of pharmacists are needed.

Factors associated with loss of motivation and hesitation to work amongst frontline health care providers during the COVID-19 pandemic: A cross-sectional survey from a developing country

Background

The COVID-19 took over the world in 2020 and a lockdown has been imposed seeing its fast spread. Frontline health care workers (HCWs) were reported frequently with a lack of motivation, hesitancy and unwillingness to perform their duties during this pandemic. This cross-sectional survey aims to evaluate the factors associated with lack of motivation and increased hesitancy among the frontline HCWs to perform their duties during COVID-19 pandemic.

Materials and methods

A total of 239 HCWs were included in this web-based cross-sectional study, who have worked during the COVID-19 pandemic. The anonymous online questionnaire was sent to all faculty, trainees and staff of Aga Khan University Hospital in Karachi, Pakistan. The survey was conducted from September 2020 to January 2021 during the COVID-19 pandemic. All data was exported into Statistical Package for Social Sciences Version 19 for multivariate analysis.

Results

The risk of getting infected was strongly reported by 180 participants, and it was associated with higher hesitation to work (aOR = 6.09 [2.55–14.59]). Fifty-one participants felt that lack of knowledge about prevention and protection was associated with lower motivation to work (aOR = 0.66 [0.35–1.25]). Participants reported higher hesitation due to the burden of changed quality of work, physical exhaustion, mental exhaustion and altered sleep patterns. Sense of feeling protected by their hospitals was a motivating factor, and participants receiving adequate support reported higher motivation to work (aOR = 2.60 [1.32–5.14]).

Conclusion

Fear of infection, increased working hours, and inadequate support of the workplace played a key role in escalating the hesitancy among HCWs to perform their duties. Lack of disease knowledge and paucity of personal protective equipment further lowered the motivation levels of HCWs to work effectively during the COVID-19 pandemic.

•

The COVID-19 took over the world in 2020 and a lockdown has been imposed seeing its fast spread. Frontline health care workers (HCWs) were reported frequently with a lack of motivation, hesitancy and unwillingness to perform their duties during this pandemic.

•

This cross-sectional survey aims to evaluate the factors associated with lack of motivation and increased hesitancy among the frontline HCWs to perform their duties during COVID-19 pandemic.

•

Fear of infection, increased working hours, and inadequate support of the workplace played a key role in escalating the hesitancy among HCWs to perform their duties.

Willingness to Work during Public Health Emergencies: A Systematic Literature Review

The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies.

Psychological impact of the COVID-19 pandemic on hospital workers in Kobe: A cross-sectional survey

Aim

Many health-care workers exposed to coronavirus disease 2019 (COVID-19) are psychologically distressed. This study aimed to investigate the psychological impact of the COVID-19 pandemic on hospital workers under the emergency declaration in Japan.

Methods

This cross-sectional, survey-based study collected sociodemographic data and responses to 19 stress-related questions and the Impact of Event Scale-Revised (IES-R), which measures post-traumatic stress disorder (PTSD) symptoms, from all 3217 staff members at Kobe City Medical Center General Hospital from April 16, 2020 to June 8, 2020. Exploratory factor analysis was applied to the 19 stress-related questions. Multiple regression models were used to evaluate the association of personal characteristics with each score of the four factors and the IES-R.

Results

We received 951 valid responses; 640 of these were by females, and 311 were by respondents aged in their 20s. Nurses accounted for the largest percentage of the job category. Women, those aged in their 30s-50s, nurses, and frontline workers had a high risk of experiencing stress. The prevalence of stress (IES-R ≥ 25) was 16.7%. The psychological impact was significantly greater for those aged in their 30s-50s and those who were not medical doctors.

Conclusions

This is the first study to examine the stress of hospital workers, as measured by the IES-R, under the emergency declaration in Japan. It showed that women, those aged in their 30s-50s, nurses, and frontline workers have a high risk of experiencing stress. Health and medical institutions should pay particular attention to the physical and psychological health of these staff members.

Psychological Impacts of the COVID-19 Pandemic on Rural Physicians in Ontario: A Qualitative Study

Frontline rural physicians in Canada are vulnerable to the psychological impacts of the COVID-19 pandemic considering their high pre-pandemic burnout rates as compared to their urban counterparts. This study aims to understand the psychological impacts of the COVID-19 pandemic on rural family physicians engaged in full-time primary care practice in Ontario and the stressors behind any identified challenges. Recruitment combined purposive, convenience, and snowball sampling. Twenty-five rural physicians participated in this study. Participants completed a questionnaire containing Patient Health Questionnaire-2 (depression), General Anxiety Disorder-2 (anxiety), and Perceived Stress Scale-4 (stress) screening as well as questions exploring self-reported perceptions of change in their mental health, followed by a semi-structured virtual interview. Quantitative data showed an overall increase in self-reported depression, anxiety, and stress levels. Thematic analysis revealed seven qualitative themes including the positive and negative psychological impacts on rural physicians, as well as the effects of increased workload, infection risk, limited resources, and strained personal relationships on the mental health of rural physicians. Coping techniques and experiences with physician wellness resources were also discussed. Recommendations include establishing a rapid locum supply system, ensuring rural representation at decision-making tables, and taking an organizational approach to support the mental health of rural physicians.

Left alone outside: A prospective observational cohort study on mental health outcomes among relatives of COVID-19 hospitalized patients

Hospitalization due to COVID-19 bears many psychological challenges. While focusing on infected patients, their relatives are being largely neglected. Here, we investigated the mental health implications of hospitalization among relatives, over a one-month course. A single center study was conducted to assess relatives of COVID-19 patients during the first month from their admission to the hospital, and elucidate risk and protective factors for mental health deterioration. Ninety-one relatives of the first patients to be hospitalized in Israel were contacted by phone and screened for anxiety, depression, and posttraumatic stress symptoms (PTSS) at three time points (25-72 hours, 7-18 days, and one month). We found that anxiety and depression decreased significantly during the first month from their admission. Risk factors for deteriorated mental health at one month included feelings of mental exhaustion, financial concerns, and social disconnection. Being an ultra-orthodox was a protective factor for anxiety and depression but not for PTSS. Our findings emphasize the importance of addressing the mental health status of close relatives and adjust support for the unique setting of COVID-19.

Sleep Difficulties Among COVID-19 Frontline Healthcare Workers

OBJECTIVE

To identify COVID-19 work-related stressors and experiences associated with sleep difficulties in HCW, and to assess the role of depression and traumatic stress in this association.

METHODS

A cross-sectional study of HCW using self-report questionnaires, during the first peak of the pandemic in Israel (April 2020), conducted in a large tertiary medical center in Israel. Study population included 189 physicians and nurses working in designated COVID-19 wards and a comparison group of 643 HCW. Mean age of the total sample was 41.7 ± 11.1, 67% were female, 42.1% physicians, with overall mean number of years of professional experience 14.2 ± 20. The exposure was working in COVID-19 wards and related specific stressors and negative experiences. Primary outcome measurement was the Insomnia Severity Index (ISI). Secondary outcomes included the Primary Care-Post Traumatic Stress Disorder Screen (PC-PTSD-5); the Patient Health Questionnaire-9 (PHQ-9) for depression; the anxiety module of the Patient-Reported Outcomes Measurement Information System (PROMIS); Pandemic-Related Stress Factors (PRSF) and witnessing patient suffering and death.

RESULTS

Compared with non-COVID-19 HCW, COVID-19 HCW were more likely to be male (41.3% vs. 30.7%) and younger (36.91 ± 8.81 vs. 43.14 ± 11.35 years). COVID-19 HCW reported higher prevalence of sleep difficulties: 63% vs. 50.7% in the non-COVID group (OR 1.62, 95% CI 1.15-2.29, p = 0.006), mostly difficulty maintaining sleep: 26.5% vs. 18.5% (OR 1.65, 95% CI 1.11-2.44, p = 0.012). Negative COVID-19 work-related experiences, specifically witnessing patient physical suffering and death, partially explained the association. Although past psychological problems and current depression and PTSD were associated with difficulty maintaining sleep, the main association remained robust also after controlling for those conditions in the full model.

CONCLUSION AND RELEVANCE

COVID-19 frontline HCW were more likely to report sleep difficulties, mainly difficulty maintaining sleep, as compared with non-COVID-19 HCW working at the same hospital. Negative patient-care related experiences likely mediated the increased probability for those difficulties. Future research is needed to elucidate the long-term trajectories of sleep difficulties among HCW during large scale outbreaks, and to identify risk factors for their persistence.

Factors Associated With Prolonged Psychological Distress Among Nurses and Physicians Engaged in COVID-19 Patient Care in Singapore and Japan

This study explores the factors contributing to the prolonged psychological distress of frontline nurses and physicians caring for COVID-19 patients in hospitals in Singapore and Japan. A cross-sectional survey between September and December 2020 yielded 1,644 responses (23.8%), from 62 nurses and 64 physicians in Singapore and 1,280 nurses and 238 physicians in Japan. Multivariate logistic regression analysis revealed that significant risk factors for prolonged psychological distress included being a frontline nurse [adjusted odds ratio (aOR) = 2.40, 95% confidence interval (CI): 1.24-4.66], having an underlying medical condition (aOR = 1.74, 95% CI: 1.22-2.46), experiencing prejudice because they undertook COVID-19 patient care (aOR = 3.05, 95% CI: 2.23-4.18), having trouble dealing with panicked or uncooperative patients (aOR = 2.36, 95% CI: 1.71-3.25), and experiencing an outbreak of COVID-19 in the hospital (aOR = 2.05, 95% CI: 1.38-3.04). Factors inversely associated with psychological distress included age (OR = 0.98, 95% CI: 0.97-1.00), number of beds in the hospital (aOR = 0.73, 95% CI: 0.57-0.94), clinical practice of carefully putting on and taking off personal protective equipment in daily COVID-19 patient care (aOR = 0.52, 95% CI: 0.37-0.73), and knowledge on COVID-19 (aOR = 0.82, 95% CI: 0.72-0.94). These results could help us identify vulnerable healthcare providers who need urgent mental care during the COVID-19 pandemic. Measures that may reduce psychological strain include adequate supply of medical resources, education on precautionary measures, and communication strategies to combat discrimination against frontline healthcare providers.

Individual and working experiences of healthcare workers infected with COVID-19: A qualitative study

INTRODUCTION

The major burden of the COVID-19 pandemic has been mainly on healthcare workers (HCWs) and as a result many of them have been afflicted with the disease thus far.

PURPOSE

The present study was an effort to investigate Tehran University of Medical Sciences HCWs' experiences of COVID-19 during the pandemic in Tehran, Iran.

METHODS

This study is essentially a conventional qualitative content analysis. Twenty-six HCWs (including 7 physicians, 16 nurses, and 3 physiotherapists) were purposefully selected to participate in the study. The data were collected from April 2020 to January 2021 through semi-structured face-to-face interviews. The interviews were transcribed and then analyzed based on the Graneheim and Lundman method using MAXQDA 12.

RESULTS

Based on the qualitative content analysis which resulted in 364 initial codes, three themes and eight subthemes were extracted. The extracted themes were "support," "control," and "improvement."

CONCLUSIONS

HCWs are in close contact with COVID-19 patients as part of their professional careers and the provision of quality patient care in times of crises is unattainable unless HCWs enjoy support and their own health is maintained. Making institutional, national, and international preparations for their protection is an obligation.

Positive impact of the COVID-19 pandemic? A longitudinal study on the impact of the COVID-19 pandemic on physicians' work experiences and employability

OBJECTIVE

The COVID-19 pandemic places an enormous demand on physicians around the world. The aim of this study was to examine the impact of the COVID-19 pandemic on physicians' work experiences and their ability and willingness to continue working in their profession until retirement (ie, their employability).

DESIGN

A longitudinal comparative design was used. Survey data were collected on three moments: before (May 2019), in the early phase (May 2020) and in a later phase (November 2020) of the COVID-19 pandemic. Time effects were tested using repeated-measures analyses of variance and one-way analyses of variance.

SETTING

This study took place among physicians of two hospitals in a large city in the Netherlands.

PARTICIPANTS

165 hospital physicians with surgical, medical and other specialties participated in this study.

RESULTS

Physicians' employability significantly increased from the time prior to the COVID-19 pandemic, compared with the period during this pandemic. Employability differs among physicians with surgical, medical and other specialties. Furthermore, physicians experienced a lower emotional, physical and quantitative workload during the first peak of the COVID-19 pandemic, compared with before the pandemic. Moreover, physicians experienced the most stress from the impact of COVID-19 on their work in general and from combining work and private life.

CONCLUSIONS

This study shows that physicians' employability and work experiences are affected by the COVID-19 pandemic. Work experiences vary for physicians with different specialties. These varieties stress the importance of attention for physicians' individual needs and challenges regarding working during the COVID-19 pandemic and the possibility of continuing work in the aftermath of this crisis. Based on this, physicians can be offered tailor-made solutions. This is important to maintain a healthy and employable workforce, which is essential for a sustainable healthcare system.

Levels and predictors of anxiety, depression, and stress during COVID-19 pandemic among frontline healthcare providers in Gurage zonal public hospitals, Southwest Ethiopia, 2020: A multicenter cross-sectional study

INTRODUCTION

The provision of quality health care during the COVID-19 pandemic depends largely on the health of health care providers. However, healthcare providers as the frontline caregivers dealing with infected patients, are more vulnerable to mental health problems. Despite this fact, there is scarce information regarding the mental health impact of COVID-19 among frontline health care providers in South-West Ethiopia.

OBJECTIVE

This study aimed to determine the levels and predictors of anxiety, depression, and stress during the COVID-19 pandemic among frontline healthcare providers in Gurage zonal public hospitals, Southwest Ethiopia, 2020.

METHODS

An institutional-based cross-sectional study was conducted among 322 health care providers from November 10-25, 2020 in Gurage zonal health institutions. A simple random sampling technique was used to select the study participants. A pretested self -administered structured questionnaire was used as a data collection technique. The data were entered into the Epi-data version 3.01 and exported to SPSS version 25.0 for analysis. Both descriptive statistics and inferential statistics (chi-square tests) were presented Bivariable and Multivariable logistic regression analyses were made to identify variables having a significant association with the dependent variables.

RESULTS

The results of this study had shown that the overall prevalence of anxiety, depression and stress among health care providers during the COVID-19 pandemic was 36%, [95% CI = (30.7%- 41.3%)], 25.8% [95% CI = (21.1%- 30.4%)] and 31.4% [95% CI = (26.4%- 36.0%)] respectively. Age, Adjusted Odds Ratio [AOR = 7.9], Educational status, [AOR = 3.2], low monthly income [AOR = 1.87], and presence of infected family members [AOR = 3.3] were statistically associated with anxiety. Besides this, gender, [AOR = 1.9], masters [AOR = 10.8], and degree holder [AOR = 2.2], living with spouse [AOR = 5.8], and family [AOR = 3.9], being pharmacists [AOR = 4.5], and physician [AOR = (0.19)], were found to be statistically significant predictors of depression among health care providers. Our study finding also showed that working at general [AOR = 4.8], and referral hospitals [AOR = 3.2], and low monthly income [AOR = 2.3] were found to be statistically significant predictors of stress among health care providers.

CONCLUSION

Based on our finding significant numbers of healthcare providers were suffered from anxiety, depression, and stress during the COVID-19 outbreak. So, the Government and other stakeholders should be involved and closely work and monitor the mental wellbeing of health care providers.

A qualitative study to explore primary health care practitioners' perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa

BACKGROUND

The coronavirus disease 2019 (COVID-19) is a novel virus that has rapidly spread across countries globally, and has been declared a pandemic by the World Health Organization (WHO). In South Africa, more that 1 million cases have been confirmed since case zero was detected in March 2020. South Africa is currently leading in the sub-Saharan African region in terms of COVID-19-related mortality and morbidity rates.

AIM

The aim of this study was to explore primary health care practitioners' perceptions and understanding regarding the COVID-19 pandemic in KwaZulu-Natal, South Africa.

SETTING

The study was conducted at two selected primary health care facilities (a community health centre and satellite clinic) within a low-income rural context in KwaZulu-Natal, South Africa.

METHODS

A qualitative study was conducted to explore and describe perceptions and understanding of primary health care practitioners regarding the COVID-19 pandemic in KwaZulu-Natal (KZN), South Africa. Data were collected from a purposive sample of 15 participants at two different clinics situated in rural KZN, South Africa. Participants comprised of nurses, physiotherapists, pharmacists, community care givers, social workers and clinical associates. The participants were both men and women who were all above the age of 20. Data were collected through individual, in-depth face-to-face interviews using a semi-structured interview guide. An audiotape was used to collect data, which were transcribed verbatim. Data were analysed manually by thematic analysis following Tech's steps of data analysis.

RESULTS

Participants reported pre-pandemic and pandemic perceptions of fear, denial, expectancy and a perceived poor preparation for the COVID-19 outbreak. The findings also revealed participants' misperceptions regarding the nature of the COVID-19 pandemic and unrealistic expectations of occupational compensations for working during the outbreak.

CONCLUSION

The findings of this study suggest that primary health care practitioners generally have negative perceptions and understanding regarding the pandemic because of misinformation obtained from social media. Interventions to support health care practitioners are necessary to mitigate the potentially negative implications of health practitioners' misconceptions on service delivery and their mental health.

Mental Health Concerns, Insomnia, and Loneliness Among Intern Doctors Amidst the COVID-19 Pandemic: Evidence from a Large Tertiary Care Hospital in Bangladesh

Precisely how intern doctors (or trainee physicians) have been impacted during the COVID-19 pandemic is currently poorly understood. The present study aimed to investigate the mental health consequences (i.e., depression, anxiety, and stress), insomnia, and loneliness among intern doctors in Bangladesh amidst the pandemic. A cross-sectional offline survey of 108 intern doctors (53.7 % female; mean age = 24.80 ± 1.08; age range = 23-29 years) in a large tertiary care hospital in Bangladesh was conducted. The participants were surveyed randomly from respective wards during their duties with an anonymous and self-reported questionnaire assessing socio-demographics, COVID-19-related consideration, mental health, insomnia, loneliness, and other measures. Hierarchical regression analyses were conducted to examine relationships. The prevalence estimates of mild to extremely severe depression, anxiety, and stress were 53.7 %, 63.9 %, and 38.9 %, respectively. Sub-threshold to severe insomnia was acknowledged by 53.7 % and loneliness by 43.5 %. Depression was associated with not receiving mental health counseling during the pandemic, anxiety, stress, and loneliness; anxiety was associated with depression and stress; stress was associated with depression, anxiety, and loneliness; insomnia was associated with being married; and loneliness was associated with poorer quality of life, depression, and stress. Depression, but not anxiety and insomnia, fully mediated the relationship between loneliness and regret regarding choice of profession because of the pandemic and its many unexpected experiences. The findings showed considerable mental health concerns, insomnia, and loneliness among intern doctors in Bangladesh during the COVID-19 pandemic. Future studies should further explore the role of mental health concerns in healthcare providers and perceptions of their profession during the pandemic, and examine interventions to help this vulnerable population.

Predictors of nurses' reporting for work at the time of epidemics and natural disasters; solutions for hospital surge capacity

PURPOSE

To identify the predictors of nurses' presence at hospitals at the time of three types of disasters.

DESIGN

This cross-sectional study was performed using a researcher-generated questionnaire.

METHODS

This study was performed on 350 nurses of five public hospitals. Data was collected using a questionnaire in which the respondents were asked about their decisions on reporting for work in the event of three scenarios: epidemic of an unknown contagious respiratory disease, earthquake, and flood. Multiple logistic regression was used to analyze the data.

FINDINGS

The four predictors of nurses reporting for work include receiving trainings on disasters, and concerns on the non-compensation for providing services following the disaster, concerns about family safety and workplace safety.

CONCLUSION

Although slightly different factors affect the willingness of participants to report for work in each scenario, they can be put in two main categories; namely as personal and impersonal. Devising a family disaster plan and providing educational programs on self-care are two main strategies to increase the chances of presence at work following disasters.

CLINICAL RELEVANCE

The presence of more nurses in the hospital at the time of disasters can significantly improve the quality of care, and clinical outcomes of patients and disaster victims.

Determinant of Stress and Burnout among Nurses at the Second Wave of the Indonesian COVID-19 Pandemic: A National Web-based Survey

BACKGROUND: COVID-19 pandemic has developed into a major public health threat. Nurses who work to combat COVID-19 are frequently under pressure. The high stresses caused by the consequences of transmission of the COVID-19 put nurses at risk of developing burnout syndrome. AIM: The purpose of this study was to evaluate the level of anxiety and burnout experienced by nurses during the COVID-19 pandemic. METHODS: This study was conducted using a cross-sectional design. An online web-based survey was used to collected data in the national sample of nurses (n = 243, response rate = 78.6%). This study used a convenience sampling technique. The Hamilton Anxiety Rating Scale and the Maslach Burnout Inventory were also employed. Multiple linear regressions were used to determine characteristics associated with burnout. RESULTS: The participants’ average age was 34.62 years (SD = 7.91). The mean anxiety score was 7.89 (SD = 2.94). The mean score of emotional exhaustion was 14.35 (SD = 7.72), the depersonalization means score was 8.81 (SD = 5.11), and the professional accomplishment mean score was 13.51 (SD = 7.51). Education and job experience had a substantial effect on emotional exhaustion and depersonalization, with R2 values of 10.8% and 18.5%, respectively. When anxiety was included in the model, the R2 for emotional exhaustion increased to 20.4% and the R2 for depersonalization increased to 22.2%, respectively. Work experience had a little effect on professional accomplishment (R2 = 10.3%) but had a much larger effect when the variable of anxiety was included in the model (R2 = 18.3%). CONCLUSION: This study revealed that during the COVID-19 epidemic, nurses experienced many emotional states, including exhaustion, depersonalization, and anxiety. Efforts should be made by governments and policymakers in this regard in better preparing health-care systems, persons, and nursing to respond to the COVID-19 pandemic in the future.

Re-ordering connections: UK healthcare workers' experiences of emotion management during the COVID-19 pandemic

This paper examines the impact of disruptions to the organisation and delivery of healthcare services and efforts to re-order care through emotion management during the COVID-19 pandemic in the UK. Framing care as an affective practice, studying healthcare workers' (HCWs) experiences enables better understanding of how interactions between staff, patients and families changed as a result of the pandemic. Using a rapid qualitative research methodology, we conducted interviews with frontline HCWs in two London hospitals during the peak of the first wave of the pandemic and sourced public accounts of HCWs' experiences of the pandemic from social media (YouTube and Twitter). We conducted framework analysis to identify key factors disrupting caring interactions. Fear of infection and the barriers of physical distancing acted to separate staff from patients and families, requiring new affective practices to repair connections. Witnessing suffering was distressing for staff, and providing a 'good death' for patients and communicating care to families was harder. In addition to caring for patients and families, HCWs cared for each other. Infection control measures were important for limiting the spread of COVID-19 but disrupted connections that were integral to care, generating new work to re-order interactions.

Resilience and stress in frontline social workers during the COVID-19 pandemic in Singapore

As social work under normal circumstances is already a stress-laden helping profession, this study intended to examine the level of psychological distress among the frontline social workers during the COVID-19 pandemic and whether resilience and organizational support played a part in mitigating their psychological distress. Frontline social workers from various social service sectors across Singapore were surveyed using two standardized measurements to assess resilience (Connor-Davidson Resilience Scale 25) and psychological distress (Depression Anxiety and Stress Scale 21). A self-designed questionnaire comprising 10 items measured "personal" and "work-related" support at the organization. Sociodemographic data were captured using a structured questionnaire. The results showed that the frontline social workers, although resilient, were psychologically distressed in all the three areas of depression, anxiety and stress. The results indicated that those working in the Family Service Centers (FSC) were the most affected. Significant correlations were observed between psychological distress, resilience, and organizational support. Organizations must be mindful that support can help frontline staff who are usually younger and less experienced during challenging times such as the pandemic. Building the resilience of social workers will prepare them for their daily challenges and those that accompany unexpected situations.

Frontline healthcare workers' mental distress, top concerns, and assessment on hierarchy of controls in response to COVID-19: a cross-sectional survey study

BACKGROUND

The existing studies showed that frontline healthcare workers during an epidemic experienced unusual stressors and mental distress which even lasted for years after the crisis. It is important to learn about their concerns early to mitigate the negative impact as well as to evaluate disease control from experiences on the front lines for improving responses to the outbreak. The study aimed to provide insights on how to strengthen public health responses to protect healthcare workers both physically and mentally, and effectively control the disease in light of hierarchy of controls.

METHODS

A cross-sectional survey was distributed online via Qualtrics to frontline healthcare workers during the COVID-19 through a university's nursing program and received 267 valid responses from 103 certificated nursing assistants, 125 nurses, and 39 other health professionals. A descriptive data analysis with a Chi-square test at a two-sided 0.05 level of significance was performed on factors that potentially affected mental health of healthcare workers and effectiveness of disease control at workplace in five domains. The themes were summarized on open-ended questions.

RESULTS

About 30% of the respondents showed the symptom of depression and needed a further investigation. The influencing factors in five domains were examined. Engineering and administrative controls, as well as PPE were widely used in response to COVID-19. The respondents assessed the state and workplace responses to COVID-19 better than the federal government responses. The workplace responses were considered most effective. Multiple factors with a statistically significant correlation with effectiveness of the disease control at workplace were identified.

CONCLUSIONS

The study suggested that timely responses at policy level will be more effective than other measures in early prevention and control of the pandemic, mental distress should be addressed in addition to PPE, and nursing programs should consider providing a situation-specific career coaching or counseling for students. A longitudinal study at a larger scale is warranted to capture the variation of time change with the disease control evolvement and across geographic regions.

Psychological Effects on Healthcare Workers during the COVID-19 Outbreak: A Single-center Study at a Tertiary Hospital in Tokyo, Japan

Objective The present study analyzed the psychological status of healthcare workers in Japan and the influencing factors during the 2019 coronavirus disease pandemic. Methods An online survey was conducted from July 22 to August 21, 2020. A total of 328 of the 1,029 medical staff members in our university hospital participated in the study. Their mental health was assessed using the 12-item General Health Questionnaire. A multivariate regression analysis was performed to identify the factors associated with the mental health outcomes. Results Of the respondents, 78.0% reported psychological distress. Overall, we found that women, non-physicians, those who lived alone, and younger respondents had significantly greater psychological distress than their counterparts. The multivariate regression analysis showed that four factors were extracted as independent 12-item General Health Questionnaire-related factors: the lack of a sense of mission as a medical professional, the burden of the change in the quality of work, the lack of understanding about virus infectivity, and a strong sense of duty. Conclusion In summary, we found a high prevalence of psychological distress among healthcare workers during the 2019 coronavirus disease outbreak in Japan. Independent risk factors for psychological distress were the burden of the change in the quality of work, the lack of understanding about virus infectivity, a sense of responsibility, and the lack of a strong motivation and drive to help.

Association among income loss, financial strain and depressive symptoms during COVID-19: Evidence from two longitudinal studies

BACKGROUND

COVID-19 pandemic has major ramifications for global health and economy, with growing concerns about economic recession and implications for mental health. Here we investigated the associations between pandemic-related income loss with financial strain and mental health trajectories over a 1-month course, in two independent cohorts.

METHODS

Two independent studies were conducted in the U.S and in Israel at the beginning of the outbreak (March-April 2020, T1; study I: N = 2904, study II: N = 1267) and at a 1-month follow-up (T2; study I: N = 1318, study II: N = 241). Mixed-effects models were applied to assess associations among COVID-19-related income loss, financial strain, and pandemic-related worries about health, with anxiety and depression, controlling for multiple covariates including pre-COVID-19 income.

RESULTS

In both studies, income loss and financial strain were associated with greater depressive symptoms at T1, above and beyond T1 anxiety, worries about health, and pre-COVID-19 income. Worsening of income loss was associated with exacerbation of depression at T2 in both studies. Worsening of subjective financial strain was associated with exacerbation of depression at T2 in one study (US).

CONCLUSIONS

Income loss and financial strain were uniquely associated with depressive symptoms and their exacerbation over time, above and beyond pandemic-related anxiety. In times when a myriad of stressors are affecting mental health worldwide, our findings reveal specific links between the economic impact of COVID-19 and psychiatric outcomes.

Fear of COVID-19 and its Impact on Job Satisfaction and Turnover Intention among Egyptian Physicians

Introduction

The risk of experiencing psychiatric symptoms related to the COVID-19 pandemic is high among healthcare workers whose occupations are in public health, emergency medicine, and intensive or critical care.

Materials and methods

A cross-sectional study aimed to assess the prevalence of fear of COVID-19 among 411 frontline Egyptian physicians during the COVID-19 pandemic; identify determinants and predictors for fear of COVID-19; determine the impact of fear of COVID-19 on job satisfaction; and detect the impact of fear of COVID-19 on turnover intention. Three standardized scales (fear of COVID-19, job satisfaction, and turnover intention scores) were used for data collection via online Google Form.

Results

Regarding fear relating to the COVID-19 pandemic, 16.5% of the study subjects were classified as experiencing a severe fear level, while 78.1% experienced a moderate degree. A significant association between the level of fear relating to COVID-19 and the work department. The highest degree of fear is in a general-educational-university facility. Regarding job satisfaction, 42% of those having a severe level of fear are dissatisfied. Fear of COVID-19 is negatively associated with job satisfaction while positively significant correlated with turnover scores, a positive significant predictor of turnover intention. Job satisfaction is negatively associated with turnover intention; a negative significant predictor of turnover intention.

Conclusions

Frontline Egyptian physicians reported higher levels of fear relating to the COVID-19 pandemic (moderate to severe). Increased fear levels relating to COVID-19 have a relationship with lower levels of job satisfaction and higher levels of job turnover.

A survey of Canadian emergency physicians' experiences and perspectives during the COVID-19 pandemic

BACKGROUND

The objective of this study was to explore Canadian emergency physicians' experiences, concerns, and perspectives during the first wave of the coronavirus disease (COVID-19) pandemic.

METHODS

This cross-sectional survey of physician members of Pediatric Emergency Research Canada and the Canadian Association of Emergency Physicians explored: personal safety/responsibility to care; patient interactions; ethical issues in pandemic care; institutional dynamics and communication practices. Data analysis was descriptive: categorical data were summarised with frequency distributions, continuous data [100 mm visual analog scales (VAS)] were analysed using measures of central tendency. Short open-ended items were coded to identify frequencies of responses.

RESULTS

From June 29 to July 29, 2020, 187 respondents (13% response rate) completed the survey: 39% were from Ontario and 20% from Quebec, trained in general (50%) or pediatric (37%) emergency medicine. Respondents reported a high moral obligation to care for patients (97/100, IQR: 85-100, on 100 mm VAS). Fear of contracting COVID-19 changed how 82% of respondents reported interacting with patients, while 97% reported PPE negatively impacted patient care. Despite reporting a high proportion of negative emotions (84%), respondents (59%) were not/slightly concerned about their mental health. Top concerns included a potential second wave, Canada's financial situation, worldwide solidarity, and youth mental health. Facilitators to provide emergency care included: teamwork, leadership, clear communications strategies.

CONCLUSION

Canadian emergency physicians felt a strong sense of responsibility to care, while dealing with several ethical dilemmas. Clear communication strategies, measures to ensure safety, and appropriate emergency department setups facilitate pandemic care. Emergency physicians were not concerned about their own mental health, requiring further exploration.

A systematic mapping review of factors associated with willingness to work under emergency condition

INTRODUCTION

An effective response to an emergency situation relies on health care workers' preparedness. The main purpose of this study was to provide a comprehensive overview of relevant studies regarding the willingness to work in emergency and disaster situations, describe and classify the most important challenges and solutions, identifying knowledge gaps in the literature which could inform future research.

METHODS

In this Systematic Mapping Review required information was searched from PubMed, Scopus, the web of science, Embase databases, and Google scholar search engine in the period 2000-2020. Data were analyzed using a content framework analysis.

RESULTS

From 2902 article search results, 26 articles met the inclusion criteria. The studies varied in terms of aim, study design, and detail of reporting. The results showed that nearly three-quarters of studies were conducted in high and middle-income countries. Most of the studies were published in 2020 due to the COVID-19 pandemic. Also, the most common types of crises reported in the included studies were emerging and re-emerging infectious diseases. The results show that most of the problems were in the dimension of mental and psychological issues, personnel health concerns, and management relationship with personnel.

CONCLUSION

This mapping review illustrated a big picture of health workers' resilience in disaster conditions. This review presents an overview of different kinds of strategies that address the challenges. One of the most important challenges in health workforce retention is poor communication between managers and staff. Being away from family, which leads to mental fatigue, puts staff in moral dilemmas. Attracting adequate health professionals, especially volunteers and regulating the shifts of health personnel in crisis time will largely prevent burnout.

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

Given Singapore's high population density and extensive geographical interconnections, it is unsurprising that the country reported one of the highest numbers of COVID-19 cases in Asia. Past pandemic studies have suggested that nurses working in such crises might experience a deterioration of mental health, which could persist for years beyond the initial outbreak. This study used a qualitative descriptive design to explore nurses' experiences of working in tertiary hospitals during the COVID-19 pandemic. A total of 17 registered nurses who had worked for at least one year prior to the start of the COVID-19 pandemic were recruited from a University Health System in Singapore from March to June 2020. Data were collected through semi-structured interviews lasting at least an hour conducted over an online platform by the principal investigator. The data were analysed through Braun and Clarke's six-step thematic analysis independently by two researchers. Three main themes emerged: (i) challenging moments of COVID-19, during which the participants reported physical and psychological challenges relating to working conditions of the hospital in the initial months of the pandemic; (ii) the professional role as nurses, in where the participants dispelled their worries and demonstrated commitment to their role as nurses; and (iii) support for nurses, which originated from their family, friends and leaders from their organizations for them to persevere and overcome the unprecedented challenges of COVID-19. The nurses in this study demonstrated resilience and professionalism despite the challenges of COVID-19. The findings highlighted the importance of a robust support system for healthcare professionals.

Factors affecting mental illness and social stress in hospital workers treating COVID-19: Paradoxical distress during pandemic era

BACKGROUND

The coronavirus disease 2019 (COVID-19) has affected all countries in the world. Hospital workers are at high risk of mental illness, such as anxiety and depression. Furthermore, they also face many social stresses, such as deterioration of human relations and income reduction. Apart from mental illness, these social stresses can reduce motivation and lead to voluntary absenteeism, which contribute to a collapse of medical systems. Thus, for maintaining medical systems, it is crucial to clarify risk factors for both mental illness and increased social stress among hospital workers. However, little attention has been paid to factors affecting social stress, and thus, we aimed to address this gap.

METHODS

In this cross-sectional survey of 588 hospital workers, the levels of anxiety, depression, and social stress were assessed using the 7-item Generalized Anxiety Disorder scale (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), and Tokyo Metropolitan Distress Scale for Pandemic (TMDP). Multiple regression analyses were conducted to identify the demographic variables affecting these problems.

RESULTS

Older age and female sex were common risk factors for anxiety, depression, and social stress. Moreover, occupational exposure to COVID-19 and hospital staff other than doctors/fewer non-work days were risk factors for increased anxiety and depression, respectively. Furthermore, living with families/others was a risk factor for increased social stress during this pandemic.

CONCLUSION

Our findings could be useful for developing policies and practices to minimize the risk of mental illness and increased social stress among hospital workers, highlighting that attention should be paid to social factors, such as an individual's household situation.

Nurses’ Intention to Work during the COVID-19 Outbreak in West Sumatra, Indonesia

Background: Nurses who work on the front-line and are involved in caring for COVID-19 patients have a high risk of transmission. The increase in the number of confirmed and suspected cases, followed by an increase in workload, a limitation of personal protection equipment, a lack of effective treatment, and inadequate emotional support may contribute to the work intention during a pandemic.Purpose: This study aimed to describe nurses’ intention to work and provide care when people may be at risk of the COVID-19 and examine its relating factors. Methods: This was a cross-sectional and survey-based study that collected the respondents' characteristics and the intention to work measurements from 238 nurses in 36 hospitals in West Sumatera, Indonesia. Data analysis was performed using descriptive statistics, T-tests, and ANOVA.Results: The mean and standard deviation scores of nurses’ intention to work during the COVID-19 outbreak were 42.49±5.92. The isolation experience, the presence of authorized beds for COVID-19, and sufficient protection equipment supply, were correlated to the intention to work (p=0.016, p=0.035, p=0.000). Nurse respondents expected that hospital managers should provide more attention to nurses who agreed to attend to work during the COVID-19 outbreak. Conclusion: Nurses showed preserved intention to work during the COVID-19 outbreak. The factors correlated with intention to work were isolation experience, the presence of authorized beds for COVID-19, and protection equipment supply. The government and hospital management should ensure strategies and regulations to provide adequate hospital protective equipment supplies. They should also support compensations to nurses who actively care for patients during the COVID-19 outbreak.

The association between witnessing patient death and mental health outcomes in frontline COVID-19 healthcare workers

BACKGROUND

Healthcare workers (HCW) treating coronavirus disease 2019 (COVID-19) patients face high levels of psychological stress. We aimed to compare mental health outcomes, risk and protective factors for posttraumatic stress symptoms (PTSS), probable depression, and anxiety between HCW working in COVID-19 and non-COVID-19 wards.

METHODS

A self-report survey, administered in a large tertiary hospital in Israel during the peak of the COVID-19 outbreak was completed by 828 HCW (42.2% physicians, 57.8% nurses. Patient-Reported Outcomes Measurement Information System; the Patient Health Questionnaire-9; the Primary Care-Post Traumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) were used for assessing anxiety, depression, and PTSS, respectively. Pandemic-related stress factors, negative experiences, and potential protective factors were also assessed.

RESULTS

Median PC-PTSD scores differed significantly between study teams (χ² [5] = 17.24; p = .004). Prevalence of probable depression and anxiety were similar in both groups. Risk factors for mental health outcomes included mental exhaustion, anxiety about being infected and infecting family. Overall, higher proportion of the COVID-19 team witnessed patient deaths as compared to the non-COVID-19 team (50.2% vs. 24.7%). Witnessing patient death at the COVID-19 wards was associated with a four-fold increased likelihood of PTSS (odds ratio [OR] = 3.97; 95% confidence interval [CI], 1.58-9.99; p = .0007), compared with the non-COVID-19 wards (OR 0.91; 95% CI, 0.51-1.61; p = .43).

CONCLUSIONS

Witnessing patient death appears to be a risk factor for PTSS unique to HCW directly engaged in treating patients with COVID-19. Our findings suggest that helping HCW cope with COVID-19 related deaths might reduce their risk of posttraumatic stress.

The mental health of doctors during the COVID-19 pandemic

Doctors experience high levels of work stress even under normal circumstances, but many would be reluctant to disclose mental health difficulties or seek help for them, with stigma an often-cited reason. The coronavirus disease 2019 (COVID-19) crisis places additional pressure on doctors and on the healthcare system in general and research shows that such pressure brings a greater risk of psychological distress for doctors. For this reason, we argue that the authorities and healthcare executives must show strong leadership and support for doctors and their families during the COVID-19 outbreak and call for efforts to reduce mental health stigma in clinical workplaces. This can be facilitated by deliberately adding 'healthcare staff mental health support process' as an ongoing agenda item to high-level management planning meetings.

Nurses' burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis

AIMS

To examine the nurses' burnout and associated risk factors during the COVID-19 pandemic.

DESIGN

We followed the Cochrane criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for this systematic review and meta-analysis.

DATA SOURCES

PubMed, Scopus, ProQuest, Cochrane COVID-19 registry, CINAHL and pre-print services (medRχiv and PsyArXiv) were searched from January 1 to November 15, 2020 and we removed duplicates.

REVIEW METHODS

We applied a random effect model to estimate pooled effects since the heterogeneity between results was very high.

RESULTS

Sixteen studies, including 18,935 nurses met the inclusion criteria. The overall prevalence of emotional exhaustion was 34.1%, of depersonalization was 12.6% and of lack of personal accomplishment was 15.2%. The main risk factors that increased nurses' burnout were the following: younger age, decreased social support, low family and colleagues readiness to cope with COVID-19 outbreak, increased perceived threat of Covid-19, longer working time in quarantine areas, working in a high-risk environment, working in hospitals with inadequate and insufficient material and human resources, increased workload and lower level of specialized training regarding COVID-19.

CONCLUSION

Nurses experience high levels of burnout during the COVID-19 pandemic, while several sociodemographic, social and occupational factors affect this burnout.

IMPACT

We found that burnout among nurses is a crucial issue during the COVID-19 pandemic. There is an urgent need to prepare nurses to cope better with COVID-19 pandemic. Identification of risk factors for burnout could be a significant weapon giving nurses and health care systems the ability to response in a better way against the following COVID-19 waves in the near future.

Concerns, Perceived Impact, Preparedness in Coronavirus Disease (COVID-19) Pandemic and Health Outcomes among Italian Physicians: A Cross-Sectional Study

BACKGROUND

Health care workers (HCWs) are among the professionals at serious risk for the impact of the COVID-19 pandemic on their mental health. In this sense, the next public health challenge globally will be to preserving healthy HCWs during this pandemic.

AIM

The present study has the aim of investigating the relationship among concerns, perceived impact, preparedness for the COVID-19 pandemic and the mental health of Italian physicians.

METHODS

From March 29th to April 15th 2020, we conducted an online survey using snowball sampling techniques through Limesurvey platform. Data were analyzed using descriptive statistics and multiple binary logistic regressions.

RESULTS

Multivariate analysis showed that the risk factors for perceived job stress were concerns about catching COVID-19 (OR = 3.18 [95% CI = 2.00-5.05] P < .001), perceived impact on job demands (OR = 1.63 [95% CI = 1.05-2.52] P < .05), perceived impact on job role (OR = 2.50 [95% CI = 1.60-3.90] P < .001), and non-working concerns (OR = 1.86 [95% CI = 1.15-3.03] P < .05). With respect to the risk factors for rumination about the pandemic emerged concerns about catching COVID-19 (OR 1.74, [95% CI = 1.12-2.71] P < .05), perceived impact on job role (OR = 1.68 [95% CI = 1.12-2.52] P < .05), and impact on personal life (OR = 2.04 [95% CI = 1.08-3.86] P < .05). Finally, the risk factors for crying at work were perceived impact on job role (OR = 2.47, [95% CI = 1.20-5.09] P < .05), rumination about the pandemic (OR = 3.027 [95% CI = 1.27-7.19] P < .01), watching colleagues crying at work (OR = 3.82 [95% CI = 1.88-7.77] P < .01), and perceived job stress (OR = 3.53 [95% CI = 1.24-10.07] P < .05).

CONCLUSION

In general, our results highlighted that being concerned about being infected/infecting other people, carrying out new and unusual tasks, and witnessing colleagues crying at work were important risk factors for physicians' well-being. Additional data are necessary to advance understanding of these risk factors in a long-term perspective.

Willingness to work during initial lockdown due to COVID-19 pandemic: Study based on an online survey among physicians of Bangladesh

BACKGROUND

During the catastrophic situation of the COVID-19 pandemic, the role of the health care workers (HCWs) is the most crucial, and their absenteeism, whether due to inability or unwillingness, becomes a major concern for the national health system. Hence, the present study aimed to determine the willingness and its associated factors to work during the COVID-19 pandemic among the physicians of Bangladesh.

METHODS

This was a cross-sectional study conducted from April 21 to May 10, 2020, using an online survey among the Bangladeshi physicians living in the country. Both univariate and multivariable binary logistic regression models were used to determine the predictors of the willingness of the physicians to work during the COVID-19 pandemic.

RESULTS

More than 69% physicians reported that they were willing to work during the COVID-19 pandemic, 8.9% reported that they were not willing, while 21.4% of participants were not sure about their willingness. Younger age, having experience of treating patients during previous pandemics, working in the emergency departments and high self-reported compliance to the recommended PPE were important predictors of being willing to work during COVID-19 pandemic. Concern for family and risk of transmitting the infection to family members were most commonly reported as major barriers of working during the pandemic (30%) followed by having comorbidities (25%), lack of adequate safety measures (25%), fear of being infected (12.2%), not involved in clinical practice (12.5%) etc.

CONCLUSIONS

Though the majority of the physicians were willing to work during the COVID-19 pandemic, sufficient supply of PPE, support to maintain recommended quarantine and isolation policy after risky hospital duty along with adequate and effective training can increase their willingness to continue their sacred duty during this crucial pandemic.

Healthcare Professionals' Willingness and Preparedness to Work During COVID-19 in Selected Hospitals of Southwest Ethiopia

BACKGROUND

Many healthcare professionals are dying of COVID-19 while trying to save others. The loss in the healthcare workforce due to sickness and absence will double the risk of a crisis. Identifying barriers of willingness to work during epidemics outbreak and preparedness of healthcare professionals is important to minimize the shortage of human power.

METHODS

Facility-based cross-sectional study was conducted among healthcare professionals working in the selected hospitals of Southwest Ethiopia from June 1-30/2020. The data entry was done by Epi-Data Manager version 4.4.1.0 and exported to SPSS version 23 for analysis. Multivariable logistic regression analysis with a backward stepwise approach was done to identify independent predictors of poor preparedness and willingness of the healthcare professionals to work during COVID-19 and Variables with P-value <0.05 were considered as a statistically significant determinant.

RESULTS

Of 407 healthcare professionals who participated in the study, 246 (60.4%) were male. The mean age of the respondents was 28.47±5.60 years. Forty-seven (11.55%) Physicians, 59 (14.50%) pharmacy personnel, 52 (12.78%) Laboratory personnel, 31 (7.62%) Midwives, and 195 (47.91%) Nurses were included in the study. The healthcare professionals who were not prepared for the provision of services during COVID-19 and not willing to work during COVID-19 were 165 (40.5%) and 86 (21.1%) respectively. Having 6 to10 years' experience (AOR=4.046, CI: 1.05-15.58), and divorced marital status (AOR=7.855, CI: 1.781-34.65) were independent predictors of not willing to work during COVID-19. Similarly, lack of personal protective equipment (AOR=28.089, CI: 13.9-56.67) and shortage of infrastructure at the work place (AOR=28.1, CI: 13.9-56.67) were independent predictors of poor preparedness.

CONCLUSION AND RECOMMENDATIONS

Healthcare professionals' willingness and preparedness to work during COVID-19 was low. Use of Telemedicine, provision of personal protective equipment, increasing hospital's safety with adequate infection control policy, and assigning staff who have experience of more than ten years in the risky wards of the hospitals may decrease staffs absentee and increase in the provision of continuous service.

The psychological effects of COVID-19 on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship

The aim of the present study was to investigate the psychological effects of the COVID-19 outbreak and associated factors on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. This cross-sectional, survey-based study collected demographic data, mental health measurements, and stress-related questionnaires from workers in 2 hospitals in Yokohama, Japan, from March 23, 2020, to April 6, 2020. The prevalence rates of general psychological distress and event-related distress were assessed using the 12-item General Health Questionnaire (GHQ-12) and the 22-item Impact of Event Scale-Revised (IES-R), respectively. Exploratory factor analysis was conducted on the 26-item stress-related questionnaires. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes for workers both at high- and low-risk for infection of COVID-19. A questionnaire was distributed to 4133 hospital workers, and 2697 (65.3%) valid questionnaires were used for analyses. Overall, 536 (20.0%) were high-risk workers, 944 (35.0%) of all hospital workers showed general distress, and 189 (7.0%) demonstrated event-related distress. Multivariable logistic regression analyses revealed that 'Feeling of being isolated and discriminated' was associated with both the general and event-related distress for both the high- and low-risk workers. In this survey, not only high-risk workers but also low-risk workers in the hospitals admitting COVID-19 patients reported experiencing psychological distress at the beginning of the outbreak.

Anxiety amongst physicians during COVID-19: cross-sectional study in Pakistan

BACKGROUND

Ensuring safety and wellbeing of healthcare providers is crucial, particularly during times of a pandemic. In this study, we aim to identify the determinants of anxiety in physicians on duty in coronavirus wards or quarantine centers.

METHODS

We conducted a cross-sectional quantitative survey with an additional qualitative item. Five constructs of workload, exhaustion, family strain, feeling of protection, and anxiety were measured using items from two validated tools. Modifications were made for regional relevance. Factor analysis was performed showing satisfactory Cronbach alpha results. Overall, 103 physicians completed the questionnaire.

RESULTS

T-test results revealed significant associations between gender and anxiety. Structural equation modeling identified that high workload contributed to greater exhaustion (β = 0.41, R² = 0.17, p < 0.001) and greater family strain (β = 0.47, R² = 0.22, p < 0.001). Exhaustion (β = 0.17, p < 0.005), family strain (β = 0.34, p < 0.001), and feelings of protection (β = - 0.30, p < 0.001) significantly explained anxiety (R² = 0.28). Qualitative findings further identified specific needs of physicians with regard to protective equipment, compensation, quarantine management, resource allocation, security and public support, governance improvement, and health sector development.

CONCLUSIONS

It is imperative to improve governmental and social support for physicians and other healthcare providers during the corona pandemic. Immediate attention is needed to reduce anxiety, workload, and family strain in frontline practitioners treating coronavirus patients, and to improve their (perceptions of) protection. This is a precondition for patient safety.

Interventions to Improve the Willingness to Work Among Health care Professionals in Times of Disaster: A Scoping Review

The critical role of the health workforce in the function of the health care system is undeniable. In times of disaster and public health emergency, the importance of this valuable resource for the organization multiplies. This scoping review was conducted to identify, analyze, and categorize interventions to improve willingness to work in times of disaster as well as the existing knowledge gaps in the topic. For this purpose, four databases were searched. These included Scopus, PubMed, WOS, and World Health Organization observatory, and they were searched for papers published from July 2000 to September 2020. Studies of the English language that described strategies to improve human resources for health willingness to work during times of disaster/public health emergency were included. Full-text papers were screened by authors and data extraction was done according to self-designed form. Framework analysis identified key interventions based on human resources for health action framework. From 6246 search results, 52 articles were included, a great portion of which was published in 2020 probably due to the COVID-19 pandemic. Northern America was the region with most studies. From 52 included studies, 21 papers have reported the interventions to improve willingness to work and 31 papers have explored factors that affected a willingness to work. The interventions used in the studies were categorized into five themes as Leadership, Partnership, Financing, Education, and Organizational policies. The most and least interventions were financial and partnership respectively. The review identified a wide range of feasible strategies and interventions to improve human resources for health's willingness to work at times of disaster that are expected to be effective. Organizations should let the staff know these decisions and as a necessary step in every organizational intervention remember to evaluate the impacts.

Prevalence of anxiety towards COVID-19 and its associated factors among healthcare workers in a Hospital of Ethiopia

Background

The World Health Organization declared the outbreak of COVID-19 as a pandemic on 11 March 2020. Healthcare workers are directly involved in the prevention, diagnosis, treatment, and care of patients with COVID-19.This study aims to assess the prevalence of anxiety and its associated factors towards the COVID-19 outbreak among healthcare workers in a Hospital of Ethiopia.

Methods

A Hospital-based survey study was conducted on a total of 305 Healthcare workers in a Hospital of Ethiopia. Bivariable and multivariable logistic regression were used to analyze data between independent variables with anxiety. Variables with a p-value of <0.2 were transformed into multivariate analysis. Crude and adjusted odds ratios with 95% CI, p-values of <0.05 were used to show the strength of association and level of significance.

Results

The prevalence of CVID-19 anxiety was 63%. In multivariate logistic regression, age of 30–39 (AOR, 3.05; 95% CI, (1.70, 5.47) and age of ≥40 (AOR, 11.32; 95% CI (3.37, 37.98), being married (AOR, 3.56; 95% CI, (2.30, 6.38), having chronic illness (AOR, 3.43; 95% CI, (1.59,7.43), having suspected COVID-19 family members (AOR, 5.20; 95% CI, (2.11, 12.78), and not having an access to PPEs (AOR, 2.55; 95% CI, (1.43, 4.56) were statistically significantly associated with anxiety.

Conclusion

Being married, having a chronic illness, having suspected COVID-19 family members, not having access to PPEs, and age greater than or equal to 30 years were identified as risk factors for anxiety of Healthcare Workers towards COVID-19.

Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK

OBJECTIVE

The COVID-19 pandemic has set unprecedented demand on the healthcare workforce around the world. The UK has been one of the most affected countries in Europe. The aim of this study was to explore the perceptions and experiences of healthcare workers (HCWs) in relation to COVID-19 and care delivery models implemented to deal with the pandemic in the UK.

METHODS

The study was designed as a rapid appraisal combining: (1) a review of UK healthcare policies (n=35 policies), (2) mass media and social media analysis of front-line staff experiences and perceptions (n=101 newspaper articles, n=1 46 000 posts) and (3) in-depth (telephone) interviews with front-line staff (n=30 interviews). The findings from all streams were analysed using framework analysis.

RESULTS

Limited personal protective equipment (PPE) and lack of routine testing created anxiety and distress and had a tangible impact on the workforce. When PPE was available, incorrect size and overheating complicated routine work. Lack of training for redeployed staff and the failure to consider the skills of redeployed staff for new areas were identified as problems. Positive aspects of daily work reported by HCWs included solidarity between colleagues, the establishment of well-being support structures and feeling valued by society.

CONCLUSION

Our study highlighted the importance of taking into consideration the experiences and concerns of front-line staff during a pandemic. Staff working in the UK during the COVID-19 pandemic advocated clear and consistent guidelines, streamlined testing of HCWs, administration of PPE and acknowledgement of the effects of PPE on routine practice.

Anxiety and Depression Symptoms in COVID-19 Isolated Patients and in Their Relatives

Background: While focusing on the management and care of COVID-19 patients, the mental health of these patients and their relatives is being overlooked. The aim of the current study was to measure anxiety and depression, and to assess their association with socio-demographic and pandemic-related stress factors in COVID-19 patients and their relatives during the initial stage of hospitalization. Methods: We assessed isolated hospitalized patients (N = 90) and their relatives (adults and children, N = 125) by phone, 25-72 h following patients' admission. The quantitative measures included the Anxiety and Depression modules of the Patient-Reported Outcomes Measurement Information System (PROMIS) and pandemic-related stress factors. Qualitative measures included questions exploring worries, sadness, and coping modes. Results: Both patients and relatives suffer from high levels of anxiety and related pandemic worries, with lower levels of depressive symptoms. Compared to adult relatives, child relatives reported significantly lower anxiety. The multivariable logistic regression analysis revealed an increased risk for anxiety among females and a decreased risk among ultra-orthodox participants. While increased anxiety among patients was associated with feelings of isolation, increased anxiety among relatives was associated with a feeling of not being protected by the hospital. Conclusions: Patients and relatives experience similar high anxiety levels which are more robust in women and lower in ultra-orthodox participants. Our findings indicate that anxiety symptoms of both patients and adult relatives should be addressed.