Burnout and peritraumatic distress of healthcare workers in the COVID-19 pandemic

Depicting occupational trauma concepts impacting nurse well-being during the COVID-19 pandemic

PURPOSE

The purpose of this concept delineation was to differentiate similar concepts impacting nurse well-being during the COVID-19 pandemic, including: compassion fatigue, burnout, moral injury, secondary traumatic stress, and second victim.

METHODS

A total of 63 articles were reviewed for concept delineation. Morse's (1995) approach to concept delineation was utilized to analyse the articles.

RESULTS

Concepts were described interchangeably but were found to present themselves in a sequence. A nurse may experience moral injury, leading to a second victim experience, synonymous with secondary traumatic stress, then compassion fatigue and/or burnout that can be acute or chronic in nature. An Occupational Trauma Conceptual Model was created to depict how these concepts interact based on concept delineation findings.

CONCLUSION

Nurses are experiencing long-lasting occupational trauma and future intervention research should centre on optimizing nurse well-being to ensure the sustainability of nursing profession.

Professional, educational and psychosocial impacts of the COVID-19 pandemic on pediatricians

OBJECTIVES

COVID-19 infection is not limited to medical aspects, but may have significant negative impacts on education, tourism, the economy as well as sociocultural, ethical, and legal aspects. We aimed to assess the multidimensional impact of the COVID-19 pandemic on pediatricians by examining their COVID-19 infection, domestic life and quarantine, as well as work patterns, educational activities, and psychosocial impact.

METHODS

An online survey consisted of seven sections and 68 questions was prepared through 'Google Forms.' The survey was sent via e-mail to physicians who are members of the National Pediatric Association of Turkey.

RESULTS

The pandemic has affected pediatricians working in our country in a multifaceted aspect. They experienced significant anxiety/depression/stress, 8% of them felt it at a pathological level and were receiving treatment, and women and young pediatricians were more vulnerable to the pandemic. The more adequately informed about the disease, the more prepared for COVID-19 and lower levels of psychological distress, which emphasizes the importance of education and institutional continuing support. Our study showed that academic education was seriously disrupted and the satisfaction rate with virtual education was low.

CONCLUSION

Although COVID-19 has less impact today, it has taught us that it is necessary to be ready for new pandemics in the future. The required measures should be taken urgently and effectively healthcare professionals should follow a rational and applicable disaster plan.

The relationship between peritraumatic distress, mental health symptoms, and functioning impairment in healthcare workers during the COVID-19 emergency

OBJECTIVE

Healthcare workers (HCWs) were considered a population at risk for developing psychiatric symptoms during the COVID-19 pandemic, such as anxiety, depression, and post-traumatic stress disorder (PTSD). Peritraumatic distress is associated with post-traumatic psychopathological symptoms; however, little is known about how it may affect functioning. The study aimed at evaluating the level of peritraumatic distress in a sample of HCWs during the first wave of the COVID-19 pandemic and at examining the relationship between peritraumatic distress, mental health symptoms, and functioning impairment.

METHODS

A sample of 554 frontline HCWs were consecutively enrolled in major university hospitals and community services in Italy. The PDI, IES-R, PHQ-9, and GAD-7 were used to assess peritraumatic distress, symptoms of PTSD, depression, and anxiety, respectively, and the WSAS to investigate functioning impairment. PDI scores were higher among females, community services, physicians, and nurses. Furthermore, the PDI correlated significantly with the GAD-7, PHQ-9, IES-R, and WSAS.

RESULTS

In a mediation analysis, the direct effect of PDI on WSAS and the indirect effects through the PHQ-9 and IES-R were statistically significant (P < .001).

CONCLUSION

Peritraumatic distress reported by HCWs was associated with symptoms of PTSD, depression, and anxiety, but the association with reduced functioning may be only partially mediated through symptoms of depression and PTSD.

Global estimate of burnout among the public health workforce: a systematic review and meta-analysis

INTRODUCTION

Burnout is an occupational phenomenon resulting from chronic workplace stress. We conducted this review to estimate the pooled global prevalence of burnout among the public health workforce.

METHODS

We conducted this review as per the PRISMA 2020 guidelines. We included only cross-sectional studies reporting outcome estimates among the study population. We included articles published before December 2023. We used a search strategy to systematically select the articles from PubMed, Embase, and Google Scholar. We assessed the quality of the studies using an adapted version of NIH's study tool assessment for cross-sectional and observational cohort studies. We estimated the pooled proportion using the random-effects model.

RESULTS

We included eight studies in our review, covering a sample size of 215,787. The pooled proportion of burnout was 39% (95% CI: 25-53%; p-value: < 0.001). We also identified high heterogeneity among the included studies in our review (I2: 99.67%; p-value: < 0.001). Seven out of the eight studies were of good quality. The pooled proportion of the studies conducted during the COVID-19 pandemic was 42% (95% CI: 17-66%), whereas for the studies conducted during the non-pandemic period, it was 35% (95% CI: 10-60%).

CONCLUSION

In our review, more than one-third of public health workers suffer from burnout, which adversely affects individuals' mental and physical health. Burnout among the public health workforce requires attention to improve the well-being of this group. Multisite studies using standardized definitions are needed for appropriate comparisons and a better understanding of variations in burnout in various subgroups based on sociodemographic characteristics and type of work responsibilities. We must design and implement workplace interventions to cope with burnout and increase well-being.

LIMITATIONS

Due to the limited research on burnout among public health workers, we could not perform a subgroup analysis on various factors that could have contributed to burnout.

Risk and prediction of job burnout in responding nurses to public health emergencies

BACKGROUND

In public health emergencies, nurses are vulnerable to adverse reactions, especially job burnout. It is critical to identify nurses at risk of burnout early and implement interventions as early as possible.

METHODS

A cross-sectional survey of the hospitals in Xiangyang City was conducted in January, 2023 using stratified cluster sampling. Anonymized data were collected from 1584 working nurses. The Impact of Events Scale-Revised (IES-R) and the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS) were used to evaluate the post-traumatic stress disorder (PTSD) and burnout of nurses in public health emergencies. Logistic regression analysis was established to screen for risk factors of burnout, and a nomogram was developed to predict the risk of burnout. A calibration curve and the area under the receiver operating characteristic (ROC) curve were used to validate the nomogram internally.

RESULTS

This study showed that only 3.7% of nurses were completely free of PTSD during a public health emergency. We found that PTSD varied by age, marital status, procreation status, length of service, employee status, and whether working in the ICU. The nurses aged 30 ~ 40 years old, single, married without children, non-regular employees, worked for less than three years or worked in the ICU had higher levels of PTSD. Regarding the prevalence of burnout, 27.4%, 48.5%, and 18.6% of nurses had a high level of emotional exhaustion (EE), depersonalization (DP), and diminished personal accomplishment (PA), respectively. There, 31.1% of nurses had more than two types of job burnout. The number of night shifts, the type of hospital, marital status, and the severity of PTSD were all associated with higher rates of exhaustion among nurses. As a graphical representation of the model, a nomogram was created and demonstrated excellent calibration and discrimination in both sets (AUC = 0.787).

CONCLUSIONS

This study confirmed the PTSD and burnout are common problems for in-service nurses during public health emergencies and screened out the high-risk groups of job burnout. It is necessary to pay more attention nurses who are single and working in general hospitals with many night shifts, especially nurses with severe PTSD. Hospitals can set up nurses' personal health records to give timely warnings to nurses with health problems, and carry out support interventions to relieve occupational stress.

Predictors of professional burnout and fulfilment in a longitudinal analysis on nurses and healthcare workers in the COVID-19 pandemic

AIMS AND OBJECTIVES

(1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID-19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects.

BACKGROUND

Nurses were at increased risk for burnout and low fulfilment prior to the COVID-19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety.

METHODS

Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non-clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self-report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study.

RESULTS

Both at baseline and across the 5 months, nurses working during the COVID-19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses.

CONCLUSIONS

Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention.

RELEVANCE TO CLINICAL PRACTICE

Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.

Evaluation of burnout and stress perception levels of Turkish dental laboratory technicians according to affecting factors during the COVID-19 pandemic

BACKGROUND

The coronavirus disease-2019 (COVID-19) pandemic has caused healthcare professionals to face unequal acute workplace stress and burnout. This study aimed to analyze the potential impact of COVID-19 on the burnout and associated emotional stress conditions of Turkish dental technicians.

METHODS

A 20-question demographic scale, Maslach Burnout Inventory (MBI), Sense of Coherence-13 (SoC-13), and Perceived Stress Scale-10 (PSS-10) were used to obtain data. A total of 152 participants answered these surveys directly and reported their stress burnout levels during the COVID-19 pandemic.

RESULTS

Of all participants who agreed to participate in the survey, 39.5% were females and 60.5% were males. Regardless of demographic variables, the MBI-total (37.2 ± 11.71), SoC-13 total (53.81 ± 10.29), and PSS-10 total (21.25 ± 5.5) scores indicated moderate burnout, SoC, and perceived stress levels. According to sub-scores of the MBI; mean emotional exhaustion and depersonalization indicate low-level burnout, and mean personal accomplishment indicates moderate burnout. Long working hours increase burnout. No significant differences were observed according to demographic variables, except for work experience. A positive correlation was found between perceived stress and burnout.

CONCLUSIONS

The findings showed that dental technicians working during the COVID-19 pandemic are influenced by emotional stress due to the outcomes of the pandemic. One reason for this situation might be the long working hours. Working arrangements, under-controlled disease risk factors, and lifestyle changes may improve stress levels.Key MessagesCOVID-19 outbreak exposed psychological returns to the general population, and especially to healthcare workers.Questionnaire method was applied to evaluate the burnout and stress levels among dental laboratory technicians during COVID-19 outbreak.Moderate levels of burnout and stress perception were detected. Long working time was one of the effective factors.

Motivations and expectations of generation Z nursing students: A post-pandemic career choice qualitative analysis

BACKGROUND

The global nursing shortage is a growing concern so recruiting and retaining Generation Z (Gen Z) students is vital to the sustainability of the profession.

PURPOSE

To explore the perceptions and expectations of first-year nursing students regarding the nursing profession, its working conditions, and how these factors influenced their career choices.

METHOD

Descriptive qualitative research design, employing an interpretive research approach and content analysis conducted following Graneheim & Lundman's method. Our study involved 105 Generation Z nursing degree students enrolled in first year at the Mar Nursing School in Barcelona, Spain in 2021. Data collection included voluntary written narratives about their career choice and questionnaires of demographic information and their healthcare experiences.

RESULTS

It became evident that Generation Z students' perceptions and expectations of nursing don't align with the actual professional experience. This mismatch could lead to disillusionment and attrition among these students.

CONCLUSIONS

Several factors (economic, aspirational, perception of nursing during the COVID-19, or gender) influence new students' career choice. These factors shape their expectations and often do not match actual working conditions in nursing. Educational institutions must prepare students by transferring cross-cutting competencies to effectively meet these challenges and avoid potential dropout from the profession.

Effects of COVID-19 stress, proximity, and adverse childhood experiences on healthcare workers' mental health

Past research has shown that healthcare workers (HCWs) experience high levels of psychological distress during epidemics and pandemics, resulting in cascading effects that have led to chronically understaffed hospitals and healthcare centers. Due to the nature of their responsibilities and workplace stress, HCWs are among vulnerable groups especially during global health crises. During COVID-19 many healthcare workers reported greater symptoms of anxiety, depression, and COVID-19 related worries. Furthermore, adverse childhood experiences increase vulnerability for psychological conditions, especially during pandemics. This study sets out to (1) investigate the moderating effects of adverse childhood experiences on healthcare workers' COVID-19 related stressors and depression/anxiety symptoms, and (2) investigate the moderating effects of adverse childhood experiences on proximity to the COVID-19 virus and depression/anxiety symptoms. Participants included 438 employed HCWs recruited from academic medical centers and smaller healthcare agencies in northcentral Florida between October to December 2020. Mean age of participants was 38.23 (SD = 11.5) with most of the HCWs being white (72.1%), non-Hispanic (86.8%) and female (82%). Healthcare workers completed several online questionnaires, including the Adverse Childhood Experiences scale, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, a COVID-19 specific worries scale, and a Social Proximity to COVID-19 scale. Healthcare workers experiencing specific COVID-19 worries reported experiencing anxiety and depressive symptoms. A significant positive interaction was seen between childhood adverse experiences globally and COVID-19 worries on anxiety symptoms. A significant positive interaction was observed between childhood maltreatment specifically and COVID-19 worries on depressive symptoms. Additionally, a positive interaction effect was seen between childhood adverse experiences and COVID-19 social proximity for both depression symptoms and anxiety symptoms. Findings from the present study indicate that adverse childhood experiences strengthen the relationship between COVID-19 worry/proximity and negative psychological symptoms. Vulnerable populations such as individuals who have experienced ACEs could benefit from targeted and specific interventions to cope with the collective trauma experienced globally due to COVID-19. As COVID-19 becomes endemic, hospital leadership and authorities should continue addressing COVID-19 worries and HCWs' psychological symptoms through mental health support and organizational interventions.

Association Between Nursing Discussions, Resilience, Workplace Social Support and Burnout: A Quantitative Study in Japan

Background

Although it is known that resilience is negatively associated with burnout, and that certain interventions can effectively increase resilience, little is known about online resilience-enhancing interventions during the COVID-19 crisis. The aim of this study was to identify the association between an online resilience-enhancing intervention and workplace social support, and burnout among nurses working in the mainland and remote islands of Japan during the COVID-19 crisis.

Methods

Pretest-posttest was conducted between April 2020 and February 2021, and the questionnaire survey included the bidimensional resilience scale, the Japanese version of Pine's Burnout Measure, and the workplace social support scale. Changes in burnout, resilience, and social support and the associations with nursing discussions as intervention were analyzed. Participants were 98 Nurses with 1 to 10 years of experience from Japan's mainland and remote island hospitals of Kagoshima Prefecture participated in a baseline survey in April 2020. Of these, 76 participated in a secondary survey in September 2020, and 69 participated in the intervention program and a third survey in February 2021. The online intervention over Zoom consisted of small-group nursing discussions based on the broaden-and-build theory.

Results

Changes in burnout showed a significant negative association with change in workplace social support (Coef. = -0.019, 95% CI -0.035- -0.003), as did the interaction between change in acquired resilience and intervention (Coef. = -0.088, 95% CI -0.164- -0.011).

Conclusion

Change in workplace social support was significantly negatively associated with changes in burnout, as was the interaction of intervention and acquired resilience. Promotion of this intervention and making workplace social support more accessible may contribute to reduce burnout in nurses.

Comparison of methylprednisolone pulse vs conventional dexamethasone for adult cases of COVID-19 requiring oxygen; a Japanese retrospective cohort study

BACKGROUND

Although dexamethasone is an effective treatment in cases of coronavirus disease 2019 (COVID-19) requiring oxygen, the efficacy of methylprednisolone pulse is unclear. We compared the characteristics and outcomes of methylprednisolone pulse to those of dexamethasone.

METHODS

We conducted a retrospective cohort study on adult COVID-19 cases requiring oxygen and no invasive mechanical ventilation treated with methylprednisolone pulse (1 g/day for 3 days) or dexamethasone (6 mg/day orally or 6.6 mg/day intravenously for ≥5 days). The primary outcome was intensive care unit (ICU) admission. The secondary outcomes were hospital mortality, length of hospital stay (LoS), duration of oxygen requirement, and requirement for hospital transfer, vasopressor(s), intubation, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT).

RESULTS

Twenty two cases of methylprednisolone pulse and 77 cases of dexamethasone were included. Mask ventilation was more common in the methylprednisolone pulse group (P < 0.001). The proportion of ICU admissions was similar between both groups (P = 0.635). The secondary outcomes of hospital mortality and the requirement for hospital transfer, vasopressor(s), intubation, and CRRT were similar between groups. No cases received ECMO. Median LoS (P = 0.006) and duration of oxygen requirement (P = 0.004) were longer in the methylprednisolone pulse group.

CONCLUSIONS

The proportion of ICU admissions was similar between the methylprednisolone pulse and the dexamethasone group. However, more cases in the methylprednisolone pulse group required mask ventilation than in the dexamethasone group, suggesting that some cases benefited from methylprednisolone pulse.

The Burnout of Nurses in Intensive Care Units and the Impact of the SARS-CoV-2 Pandemic: A Scoping Review

BACKGROUND

The world's population changed with the emergence of the SARS-CoV-2 pandemic. Burnout arises due to overwork, prolonged work periods, a lack of human and material resources, etc. Several studies have reported the incidence of burnout syndrome in nurses that work in intensive care units (ICUs). The aim was to map the scientific evidence related to nurses' burnout in the ICU, namely the repercussions of SARS-CoV-2 in terms of burnout among nurses.

METHODS

A scoping review followed the Joanna Briggs Institute methodology guidelines to search for and synthesise studies published between 2019 and 2022. The databases searched were MEDLINE, CINAHL, LILACS, SCOPUS, PsycINFO and OPEN GREY. A total of fourteen articles were eligible to be included.

RESULTS

A content analysis of the selected articles was carried out, and three categories emerged that corresponded to the dimensions of burnout according to Maslach and Leiter: emotional exhaustion, depersonalisation dimension and a lack of personal accomplishment. It was evident that nurses who worked in the ICU during the pandemic showed high levels of burnout.

CONCLUSIONS

It is recommended that hospital administrations hire health professionals, namely nurses, as a strategic and operational management strategy to reduce the risk of increased burnout during pandemic outbreaks.

The impact of COVID-19 pandemic on well-being of Italian physicians: a report from the Italian Society of Internal Medicine (SIMI) national survey

Over the past few years, COVID-19 pandemic has imposed a high toll worldwide, with a high burden of morbidity and mortality. Healthcare practitioners (HCPs) have been in the frontline since the beginning of the outbreak, and the high level of stress have affected their physical and mental status, as well as their relationships. We aimed at exploring the self-reported changes in comprehensive well-being in a cohort of Italian physicians. An online-based survey was administered to the members of the Italian Society of Internal Medicine (SIMI) between March and June 2021. The survey was based on 32 multiple-choice questions exploring self-reported physical and mental well-being, as well as changes in workloads, work-related feelings and physicians' relationship with patients, colleagues and families. 228 physicians (mean age: 35.7 ± 9.8 years) participated in the survey; 120 (52.6%) were residents, 196 (86.0%) worked in COVID-19 units and 65 (28.5%) had COVID-19 during the pandemic. A significant proportion of respondents reported to have experience onset or worsening of physical and mental symptoms, with insomnia/sleep disorders (58.3%) and mood swings (47.8%) being the most common, respectively. The burden of physical and mental consequences was broadly higher among residents compared to specialists, with the former reporting more frequently an increase in the number of worked hours (p = 0.020) and being more frequently infected with COVID-19 (35.0% vs. 21.3, p = 0.032). Moreover, familiar and doctor-patient relationships were also considerably affected. Physicians have been suffering a wide spectrum of physical, mental and relational consequences during COVID-19 pandemic, with youngest doctors being more likely to present several physical and mental health symptoms. Further studies are needed to evaluate long-term consequences of COVID-19 pandemic on the well-being of HCPs, and potential preventive strategies.

The clinical characteristics and the risk factors for mortality in Non-COVID-19 critical patients in a pandemic hospital in Turkey: a retrospective cross-sectional study

Background

Coronavirus disease 2019 (COVID-19) disrupted standard health policies and routine medical care, and thus, the management and treatment pathways of many clinical conditions have changed as never before. The negative impact of the pandemic rendered the systemic disease more complicated and accelerated mortality. For the last two years, clinicians have primarily focused on COVID-19 patients; however, the non-COVID-19 critically ill patients needed to be addressed from multiple perspectives. This study investigated the demographic and clinical characteristics of non-COVID-19 critical care patients admitted concurrently with a COVID-19 wave. The objective of this study was to identify the risk factors for mortality in critically ill non-COVID-19 patients.

Methods

All consecutive cases admitted to the intensive care unit (ICU) were included in the study between January 1, 2021 and July 14, 2021. All data, including age, gender, admission characteristics, patient dependency, pre-existing systemic diseases, the severity of illness (Acute Physiology and Chronic Health Evaluation -APACHE-II), predicted death rate in ICU, life-sustaining medical procedures on admission or during ICU stay, length of stay, and admission time to the ICU, were obtained from the hospital's electronic database. The Charlson Comorbidity Index (CCI) was assessed for all patients.

Results

A total of 192 patients were screened during the study period. Mortality was significantly increased in non-surgical patients, previously dependent patients, patients requiring mechanical ventilation, continuous renal replacement therapy, and patients requiring the infusion of vasoactive medications. The number of pre-existing diseases and the admission time had no impact on mortality. The mean CCI was significantly higher in non-survivors but was not a strong predictor of mortality as APACHE II.

Conclusions

In this retrospective study, the severity of illness and the need for vasoactive agent infusion were significantly higher in non-survivors confirmed by multivariate analysis as predictive factors for mortality in critical non-COVID-19 patients.

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.

The moderating effect of burnout on professionalism, values, and competence of nurses in Saudi Arabia amidst the COVID-19 pandemic: A structural equation modeling approach

Aim

To examine the moderating effect of burnout on the relationship between nurses' competence, professional competence and professional values.

Background

There is a preponderance of burnout studies of nurses before and during the COVID‐19 pandemic. However, little is known about burnout's moderating influence on nurses' professionalism, competence and values during the ongoing pandemic.

Methods

This study used a correlational, cross‐sectional design and convenience sampling to recruit 809 Saudi nurses employed in four government hospitals. Four self‐report instruments were used to collect data from August 2021 to March 2022. Spearman Rho, structural equation modelling and multi‐group moderation analysis were used to analyse the data.

Results

Most of the participants had high burnout. There was a moderate to high correlation between the dimensions of professional competence, nurse professional values, burnout and nurse competence. Both professional competence and nurse professional values significantly affected nurse competence. Nurse professional values also had a direct effect on professional competence. Professional competence and nurse professional values on nurse competence may vary among those with low, moderate and high levels of burnout, suggesting the moderating effect of burnout.

Conclusions

The positive impacts of nurse professional values and professional competence on nursing competence were validated in this study, as was the evidence of burnout's moderating effect on the studied connections. To avoid burnout, it is necessary to increase organizational knowledge and support for nurses, their working conditions and the environment through strategies that promote well‐being and empowerment.

Implications for nursing management

Nurse managers can implement policies to help nurses minimize burnout and improve their professional values and competence. Management policies may be considered include increased staffing, opportunities to improve technical abilities through education and vocational training programs, and increased diversity of job assignments.

Burnout, psychopathology and purpose in life in healthcare workers during COVID-19 pandemic

Background

The COVID-19 pandemic has led to a significant increase in the workload of healthcare workers that, together with the risks associated with exposure to this new virus, has affected their mental health.

Objectives

The objective of the current study was to determine the prevalence of psychopathology and burnout syndrome in healthcare workers and the predictive role of purpose in life and moral courage in this relationship.

Methods

A cross-sectional study was carried out in 115 Spanish healthcare workers.

Results

Participants with burnout had higher anxiety (p = 0.001), depression (p < 0.001), post-traumatic stress (p = 0.01) and alcohol consumption (p = 0.03) levels. The different components of burnout (emotional fatigue and despersonalization) were associated with the occurrence of anxiety (OR = 0.31) and depression (OR = 0.26), respectively. A strong purpose in life decreased emotional fatigue (OR = -0.39) depersonalization (OR = -0.23) scores, increased personal accomplishment (OR = 0.52), subsequently reducing burnout levels (OR = -0.45).

Conclusions

Purpose in life was most strongly related to decreased levels of burnout. Furthermore, an association between anxiety, depression and the components of burnout was found.

Exhaustion in Healthcare Workers after the First Three Waves of the COVID-19 Pandemic

This study aims to identify the determinants of exhaustion of frontline and second-line healthcare workers (HCW) during the third wave of the COVID-19 pandemic. A case−control study was conducted based on an anonymously distributed questionnaire, which was completed by 1872 HCW. Exhaustion was assessed with a validated Romanian questionnaire. The Siegrist questionnaire was used to determine workload, reward and overcommitment. Frontline HCW reported significantly more frequent longer working hours (p = 0.0009) and a better perception of the management of the risk for infection (p = 0.0002) than second-line HCW. The effort and overcommitment scores were higher in frontline HCW (9.51 + 1.98 vs. 8.45 + 21, p < 0.001 and 16.34 ± 2.80 vs. 15.24 ± 2.94, p < 0.001, respectively) and the reward scores were lower (5.21 ± 1.522 vs. 5.99 ± 1.44, p < 0.001). In the fully adjusted regression model, age, imbalance between effort and reward, overcommitment and management of the risk of infection in the workplace were associated with the exhaustion score in each category of HCW. The number of working hours was correlated with exhaustion in frontline HCW and occupation in second-line HCW. There were more similarities than differences between frontline and second-line HCW. Even if frontline HCW had a higher risk of exhaustion, the risk was not negligible for all HCW.

Burnout Among Medical Staff 1 Year After the Beginning of the Major Public Health Emergency in Wuhan, China

Objectives

Wuhan is the city where coronavirus disease (COVID-19) was first reported and developed into a pandemic. However, the impact of the prolonged COVID-19 pandemic on medical staff burnout remains limited. We aimed to identify the prevalence and major determinants of burnout among medical staff 1 year after the beginning of the COVID-19 pandemic in Wuhan, China.

Materials and Methods

A total of 1,602 medical staff from three hospitals in Wuhan, China, were included from November 1–28, 2021. Chi-square tests were conducted to compare the prevalence of burnout across groups based on sociodemographic and professional characteristics. A multivariate analysis was performed using a forward stepwise logistic regression model.

Results

Approximately 37.39% of the medical staff experienced burnout 1 year after COVID-19 pandemic. Emotional exhaustion (EE) was the most common symptom of burnout, with 1,422 (88.76%) participants reporting a severe EE. Burnout was associated with insufficient social support and “neutral” or “dissatisfied” patient-physician relationships. Respondents who participated in the care of COVID-19 patients had a higher risk of burnout symptoms than those who did not participate. In particular, mental resilience was negatively associated with burnout among the medical staff.

Conclusion

Nearly two-fifths of the participants had symptoms of burnout, with reduced personal accomplishment being the predominant symptom 1 year after COVID-19. Healthcare organizations should regularly measure and monitor burnout among the medical staff. In addition, creating positive work environments and improving the mental resilience of medical staff may be effective ways to reduce burnout.

Mental Health, Burnout, and Job Stressors Among Healthcare Workers During the COVID-19 Pandemic in Iran: A Cross-Sectional Survey

Introduction

The COVID-19 pandemic has caused increasing levels of mental health problems such as anxiety and depression among doctors, nurses and other healthcare workers in hospitals or health centers. The main objective of this study was to assess the mental health, job stressors, and burnout among healthcare workers in Iran.

Materials and Methods

A cross-sectional study was performed in the primary healthcare centers and hospitals affiliated with six of the medical universities in Iran. The selection of participants was done using multi-center convenient sampling. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Copenhagen Burnout Inventory were used for gathering data through an online platform. Data related to job stressors were obtained using a validated checklist. Data analysis was performed using Chi-square and multiple regression tests and the phi coefficient.

Results

The results of our study showed that 53% of the healthcare workers of the hospitals and primary healthcare centers enrolled in our study either had generalized anxiety disorder or major depressive disorder or both disorders. Moderate and high levels of burnout were seen among 48.9% of the study participants. The prevalence of mental disorders and burnout were significantly higher among the female healthcare workers compared to the male (p = 0.0001) and a higher rate of mental disorder and burnout was also seen among healthcare workers of hospitals compared to those working in primary healthcare centers (p = 0.024). "Worry about children and old members of family," "family worries for my health condition" and "lack of specific effective treatment for COVID-19" were found to be predictive of mental disorder and burnout. The most prevalent job stressor among the total sample was "low payment or income during the COVID-19 period".

Conclusion

The results of our study revealed high psychological distress and burnout among healthcare workers of the hospitals during the fourth peak of the COVID-19 pandemic in Iran. This study highlights the need for health officials to pay attention to the job stressors of healthcare workers and obliges them to perform effective interventions to address their needs and concerns.

The impact of the COVID-19 pandemic on pediatric developmental services: a cross-sectional study on overall burden and mental health status

BACKGROUND

The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers, even those who have not been directly involved in the care of acutely ill patients. The aims of this study were to identify the overall burden and mental health status of healthcare workers in pediatric developmental services under the influence of the COVID-19 pandemic, and to identify the risk and protective factors associated with mental health.

METHODS

This cross-sectional web-based study was part of a large multicenter VOICE study conducted among employees ((neuro-)pediatricians, psychologists, speech therapists, occupational therapists, etc.) from various pediatric developmental services between June and July 2020. A total of 1291 questionnaires regarding overall burden, mental health status (depression, generalized anxiety disorder and emotional exhaustion) and risk and protective factors for mental health (working conditions, potential problems during the COVID-19 pandemic and psychological resources) were analyzed. Descriptive statistics and multiple linear regression were used for data analysis.

RESULTS

A total of 44.5% (574/1291) participants felt a high or very high overall burden during the COVID-19 pandemic. Of all the participants, 14.6% (171/1173) reported clinically significant levels of depressive symptoms, 17.0% (199/1173) reported generalized anxiety disorder symptoms and 44.6% (532/1192) reported emotional exhaustion. Multiple linear regression analyses identified several common risk and protective factors for mental health status variables. The burden of an increase in the quantity of work, fear of work and fear of becoming infected showed the strongest negative associations, whereas psychological resources and sufficient relaxation in leisure time exhibited the strongest positive associations.

CONCLUSION

Employees who were not directly involved in the care of acutely ill patients were also exposed to considerable stress, some of which was not different from that experienced by professionals who were directly affected. These employees should not be lost sight of and must be offered appropriate support.

Using behavioural science in public health settings during the COVID-19 pandemic: The experience of public health practitioners and behavioural scientists

INTRODUCTION

The emergence of COVID-19 and the importance of behaviour change to limit its spread created an urgent need to apply behavioural science to public health. Knowledge mobilisation, the processes whereby research leads to useful findings that are implemented to affect positive outcomes, is a goal for researchers, policy makers and practitioners alike. This study aimed to explores the experience of using behavioural science in public health during COVID-19, to discover barriers and facilitators and whether the rapidly changing context of COVID-19 influenced knowledge mobilisation.

METHODS

We conducted a semi-structured interview study, with ten behavioural scientists and seven public health professionals in England, Scotland, Wales, The Netherlands and Canada. We conducted an inductive thematic analysis.

RESULTS

We report three key themes and 10 sub-themes: 1.Challenges and facilitators of translation of behavioural science into public health (Methods and frameworks supported translation, Lack of supportive infrastructure, Conviction and sourcing of evidence and Embracing behavioural science) 2. The unique context of translation (Rapid change in context, the multi-disciplinary team and the emotional toll). 3. Recommendations to support future behavioural science translation (Embedding experts into teams, Importance of a collaborative network and showcasing the role of behavioural science).

DISCUSSION

Barriers and facilitators included factors related to relationships between people, such as networks and teams; the expertise of individual people; and those related to materials, such as the use of frameworks and an overwhelming amount of evidence and literature.

CONCLUSION

People and frameworks were seen as important in facilitating behavioural science in practice. Future research could explore how different frameworks are used. We recommend a stepped competency framework for behavioural science in public health and more focus on nurturing networks to facilitate knowledge mobilisation in future emergencies.

Degraded Psychophysiological Status in Caregivers and Human Resources Staff during a COVID-19 Peak Unveiled by Psychological and HRV Testing at Workplace

During COVID-19 pandemic peaks, healthcare professionals are a frontline workforce that deals with death on an almost daily basis and experiences a marked increase in workload. Returning home is also associated with fear of contaminating or be contaminated. An obvious consequence is stress accumulation and associated risks, especially in caregivers in mobility and possibly in human resource teams managing mobility. Here, during the second pandemic peak, we designed a 15-min testing procedure at the workplace, combining HADS and Brief COPE questionnaires with heart rate variability (HRV) recordings to evaluate psychophysiological status in four groups: caregivers in mobility (MOB); human resources teams managing mobility (ADM); caregivers without mobility (N-MOB); and university researchers teaching online (RES). Anxiety, depression, coping strategies, vagally-mediated heart rate regulation, and nonlinear dynamics (entropy) in cardiac autonomic control were quantified. Anxiety reached remarkably high levels in both MOB and ADM, which was reflected in vagal and nonlinear HRV markers. ADM maintained a better problem-solving capacity. MOB and N-MOB exhibited degraded problem-solving capacity. Multivariate approaches show how combining psychological and physiological markers helps draw highly group-specific psychophysiological profiles. Entropy in HRV and problem-solving capacity were highly relevant for that. Combining HADS and Brief COPE questionnaires with HRV testing at the workplace may provide highly relevant cues to manage mobility during crises as well as prevent health risks, absenteeism, and more generally malfunction incidents at hospitals.